Coronavirus Live Updates: Epidemic Is ‘Extraordinarily Widespread,’ Birx Warns

Live with someone vulnerable? ‘You need to really consider wearing a mask at home,’ Birx says.

As the Trump administration struggles to contain the coronavirus pandemic, and the U.S. economy continues to reel, two of the administration’s top health experts on Sunday encouraged more people to voluntarily wear masks, in some cases at home.

Dr. Deborah L. Birx, the Trump administration’s coronavirus coordinator, said that people living in the growing number of places where cases are increasing should consider wearing a mask if they live with someone who is especially vulnerable.

“If you have an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you’re positive if you have individuals in your household with co-morbidities,” Dr. Birx said on the CNN program “State of the Union.”

Adm. Brett P. Giroir, the assistant secretary for health, speaking on the NBC program “Meet the Press,” said, “Wearing a mask is incredibly important, but we have to have like 85 or 90 percent of individuals wearing a mask and avoiding crowds.” Those percentages, he said, give “you the same outcome as a complete shutdown.”

Asked if he was recommending a national mask mandate, Admiral Giroir said, “The public health message is we’ve got to have mask wearing.” He added: “If we don’t do that, and if we don’t limit the indoor crowded spaces, the virus will continue to run.”

Dr. Birx told CNN that the country is in a “new phase” of the pandemic and said, “What we are seeing today is different from March and April. It is extraordinarily widespread.” She added, “So everybody who lives in a rural area, you are not immune.”

Many states have traced new outbreaks to the loosening of the economically costly restrictions aimed at stopping the spread of the virus.

The United States recorded more than 1.9 million new infections in July, nearly 42 percent of the more than 4.5 million cases reported nationwide since the pandemic began and more than double the number documented in any other month, according to data compiled by The New York Times.

The previous monthly high came in April, when more than 880,000 new cases were recorded.

President Trump on Monday repeated his claim that the spike in cases is a result of increased testing, a position widely rejected by his own health experts.

Late last month the number of coronavirus patients hospitalized throughout the country nearly topped the record set in April, before leveling off in recent days, according to a database compiled by The Atlantic. Deaths linked to the virus, though, remain very high — over 1,000 for six days in a row — according to the Times database.

The country’s limited testing capacity has also hampered efforts to fight the spread of the disease, health officials said.

Dr. Ashish Jha, the director of the Harvard Global Health Institute, said on CNN that “our testing system is under such strain that we just can’t even deliver the test today that we were doing two weeks ago.”

Admiral Giroir defended the nation’s testing program, but noted that testing and contact tracing were not particularly helpful in large, communitywide outbreaks.

Other deadly infectious diseases are making a comeback.

As the coronavirus pandemic spreads around the world, consuming global health resources, tuberculosis — the biggest infectious-disease killer worldwide — as well as H.I.V. and malaria are making a comeback.

Until this year, T.B., which claims 1.5 million lives each year, the toll from each disease over the previous decade was at its nadir in 2018, the last year for which data are available.

“Covid-19 risks derailing all our efforts and taking us back to where we were 20 years ago,” said Dr. Pedro L. Alonso, the director of the World Health Organization’s global malaria program.

It’s not just that the coronavirus has diverted scientific attention from T.B., H.I.V. and malaria. The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.

Fear of the coronavirus and the shuttering of clinics have kept away many patients struggling with H.I.V., T.B. and malaria, while restrictions on air and sea travel have severely limited delivery of medications to the hardest-hit regions.

Scientists are worried about political influence over the U.S. coronavirus vaccine project.

In April, with hospitals overwhelmed and much of the United States in lockdown, the Department of Health and Human Services produced a presentation for the White House arguing that rapid development of a coronavirus vaccine was the best hope to control the pandemic.

“DEADLINE: Enable broad access to the public by October 2020,” the first slide read, with the date in bold.

Given that it typically takes years to develop a vaccine, the timetable for the initiative, called Operation Warp Speed, was incredibly ambitious. With tens of thousands dying and tens of millions out of work, the crisis demanded an all-out public-private response, with the government supplying billions of dollars to pharmaceutical and biotechnology companies, providing logistical support and cutting through red tape.

It escaped no one that the proposed deadline also intersected nicely with President Trump’s need to curb the virus before the election in November.

The ensuing race for a vaccine — in the middle of a campaign in which the president’s handling of the pandemic is the key issue after he has spent his time in office undermining science and the expertise of the federal bureaucracy — is now testing the system set up to ensure safe and effective drugs to a degree never before seen.

Under constant pressure from a White House anxious for good news and a public desperate for a silver bullet to end the crisis, the government’s researchers are fearful of political intervention in the coming months and are struggling to ensure that the government maintains the right balance between speed and rigorous regulation, according to interviews with administration officials, federal scientists and outside experts.

As the world races for a vaccine, the W.H.O cautions that there is ‘no silver bullet’ and ‘might never be.’

The head of the World Health Organization said that while there was great progress in the global search for a vaccine for the coronavirus, people should not expect the crisis to end anytime soon.

“A number of vaccines are now in Phase 3 clinical trials and we all hope to have a number of effective vaccines that can help prevent people from infection,” Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, told reporters on Monday. “However, there’s no silver bullet at the moment and there might never be.”

Dr. Anthony S. Fauci, the top infectious disease expert in the United States, told lawmakers in Congress on Friday that he was “cautiously optimistic that we will have a vaccine by the end of this year and as we go into 2021.”

The comments by Dr. Tedros seemed intended to guard against premature declarations of success that cause people and countries to stop taking prudent interventions to slow the spread of the virus.

“For now, stopping outbreaks comes down to the basics of public health and disease control,” he said. “Testing, isolating and treating patients, and tracing and quarantining their contacts. Do it all.”

“The message to people and governments is clear: do it all,” he said.

At the same time, Dr. Tedros said, scientists and doctors are finding new ways to save lives as they learn more about the virus.

“I’m pleased that the world has made progress in identifying treatments that can help people with the most serious forms of Covid-19 recover,” Dr. Tedros said.

The impact of the virus continued to be felt far beyond just those who are infected, he said. Countries have reported reduced immunization coverage, cancer screening and care, and mental health services.

“A survey of responses from 103 countries between mid May and early July found that 67 percent of countries report disruption in family planning and contraception services,” he said.

Also on Monday, the W.H.O. said that a team of its experts had concluded a visit to China to begin investigating the source of the coronavirus.

The visit, which lasted three weeks, was the first step in what will likely be a monthslong inquiry to examine how the disease spread from animals to humans.

Beijing faces intense pressure from the United States, Australia and other countries to allow an independent investigation of the virus, which appeared in December in the central Chinese city of Wuhan. Experts worry the government may seek to limit the scope of the inquiry to avoid the release of damaging information.

Michael Ryan, head of the W.H.O.’s emergencies program, said that Chinese scientists had provided the agency’s experts with information about their investigations into a seafood market in Wuhan where many of the first reported infections were traced. He said that the two sides had agreed that more in-depth studies would be necessary to determine the source of the outbreak.

“There are gaps in the epidemiological landscape,” Dr. Ryan said. “We must start where the human disease appeared to begin and work from there.”

An outside adviser urges Trump to end aid negotiations with Congress and unilaterally cut payroll taxes.

With the White House and Democrats still far apart on an economic recovery plan, an informal adviser is pressing President Trump to bypass Congress and unilaterally impose a temporary payroll tax cut.

Republicans and Democrats have expressed no interest in Mr. Trump’s push for a payroll tax cut amid the coronavirus recession, a proposal that would do little to help the tens of millions of Americans who lost jobs during the crisis, and which Democrats regard as an effort to undermine the finances of Social Security.

But Stephen Moore, the conservative economist whom Mr. Trump floated — then rescinded — as a nominee for the Federal Reserve board last year, urged the president in a Wall Street Journal op-ed on Sunday to declare that the Treasury Department would temporarily stop collecting the taxes that workers pay to help support Social Security and Medicare. Workers would still be on the hook to pay those taxes next year.

Mr. Moore and a colleague at the Committee to Unleash Prosperity, Phil Kerpen, suggested that Mr. Trump then pledge to sign a bill to permanently absolve workers of that tax liability.

“Mr. Trump can give Americans a tax cut now,” they wrote, “and sign it into law later.”

Such a move would carry steep political and economic risks for Mr. Trump, and he has not yet indicated publicly that he is considering it, though he did post a renewed call for payroll tax cuts this weekend on Twitter, after his lead negotiators dropped it last week from their list of demands for the relief bill.

While White House officials and Democratic leaders reported some progress over the weekend in their talks, they still have substantial differences. Democrats are pushing a $ 3 trillion rescue plan that would include restoring $ 600-per-week jobless aid payments that expired on Friday and extending them through January, while Republicans have proposed a $ 1 trillion package that would slash the unemployment payments considerably.

Speaker Nancy Pelosi is scheduled to host Senator Chuck Schumer of New York, the minority leader; Mark Meadows, the White House chief of staff; and Steven Mnuchin, the Treasury secretary, in her Capitol Hill suite on Monday afternoon to continue negotiations.

Global Roundup

Manila returns to lockdown after reopening leads to a resurgence.

President Rodrigo Duterte of the Philippines on Sunday ordered Manila and its suburbs to re-enter lockdown for two weeks as the health department reported 5,032 new cases of the coronavirus.

Group gatherings were prohibited, and residents were advised to stay at home. Public transportation was halted, domestic flights and inter-island ferries remained suspended, and the government encouraged biking. Schools will remain shut.

Infections spiked after the government eased lockdown rules and gradually opened up in an effort to jump-start the economy. But instead of managing the numbers, it has resulted in grim results, with hospitals overwhelmed and doctors warning they were reaching a breaking point. In an appeal to the government on Saturday, the Philippine College of Physicians, the country’s main organization of doctors, warned that the health system “has been overwhelmed.”

This came shortly after Manila’s city government ordered the temporary closure of its two hospitals, citing the growing number of health care workers who have been infected. It said that the city’s health care workers are burned out “with the seemingly endless number of patients trooping to our hospitals for emergency care and admission.”

Total cases in the country now stand at 103,185, with 2,059 deaths.

Mr. Duterte told officials to “strictly enforce the quarantine, especially the lockdown.”

“I have heard the call of different groups from the medical community for a two-week enhanced community quarantine in mega Manila,” he said. “I fully understand why your health workers would like to ask for such a timeout period. They have been in the front lines for months and are exhausted.”

In other news from around the world:

• Russia plans to launch a nationwide vaccination campaign in October with a coronavirus vaccine that has yet to complete clinical trials, raising international concern about the methods the country is using to compete in the global race to inoculate the public.

• Officials in Melbourne, Australia’s second-largest city, announced stricter measures on Sunday in an effort to stem a coronavirus outbreak that is raging despite a lockdown that began four weeks ago. For six weeks, residents of metropolitan Melbourne will be under curfew from 8 p.m. to 5 a.m. except for purposes of work or giving and receiving care.

• India’s biggest film star, Amitabh Bachchan, was discharged from the hospital on Sunday after recovering from Covid-19, and the country’s powerful home minister, Amit Shah, announced that he had tested positive. Mr. Bachchan, 77, was hospitalized for three weeks.

• Kosovo’s prime minister, Avdullah Hoti, said on Sunday that he had contracted Covid-19 and would self-isolate at home for two weeks, Reuters reports. “I have no signs, except a very easy cough,” he wrote on Facebook.

To better understand the cost of health care during the pandemic, The Times is asking for your medical bills.

Americans have been battling surprise coronavirus bills for nearly as long as they’ve been fighting the disease itself. Tests can cost between $ 199 and $ 6,408 at the same location. A coming wave of treatment bills could be hundreds of multiples higher, especially for those who receive intensive care or have symptoms that linger for months. Services that patients expect to be covered often aren’t.

As part of an effort to understand how the pandemic is reshaping American health care, The New York Times is starting something new today: soliciting your medical bills.

You can read more about the project and submit your medical bills here. One woman’s story is below:

When Debbie Krebs got the bill for a March emergency room visit, she immediately noticed something was missing: her coronavirus test.

Ms. Krebs, a lawyer who focuses on insurance issues, had gone to the Valley Hospital in Ridgewood, N.J., with lung pain and a cough. A doctor ran tests and scans to rule out other diseases before swabbing her nose. A week later, the medical laboratory called, telling her it was negative.

Ms. Krebs had a clear memory of the experience, particularly the doctor saying the coronavirus test would make her feel as if she had to sneeze. She wondered whether the doctor could have lied about performing the test, or if her swab could have gone missing. (But if so, why had the laboratory called her with results?)

The absence of the coronavirus test made a big price difference. Congress, Ms. Krebs had heard, barred insurers from charging patients for visits meant to diagnosis coronavirus. Without the test, Ms. Krebs didn’t qualify for that protection and owed $ 1,980. She called the hospital to explain the situation but immediately ran into roadblocks.

“When I called the hospital, they said, ‘You did not get a coronavirus test,’” she said. “I told them I absolutely did.”

One-third of New York’s small businesses may be gone forever.

Five months into the pandemic, an expanding universe of distinctive small businesses that give New York’s neighborhoods their unique personalities and are key to the city’s economy are starting to topple.

More than 2,800 businesses in New York City have permanently closed since March 1, according to data from Yelp, the business listing and review site, a higher number than in any other large American city.

About half the closings have been in Manhattan, where office buildings have been hollowed out, its wealthier residents have left for second homes and tourists have stayed away.

When the pandemic eventually subsides, roughly one-third of the city’s 240,000 small businesses may never reopen, according to a report by the Partnership for New York City, an influential business group. So far, those businesses have shed 520,000 jobs.

While New York is home to more Fortune 500 headquarters than any city in the country, small businesses are the city’s backbone. They represent roughly 98 percent of the employers in the city and provide jobs to more than three million people, which is about half of its work force, according to the city.

When New York’s economic lockdown started in March the hope was that the closing of businesses would be temporary and many could weather the financial blow.

But the devastation to small businesses has become both widespread and permanent as the economy reopens at a slow pace. Emergency federal aid has failed to provide enough of a cushion, people remain leery of resuming normal lives and the threat of a second wave of the virus looms.

Reporting was contributed by Peter Baker, Benedict Carey, Emily Cochrane, Jason Gutierrez, Matthew Haag, Javier C. Hernández, Annie Karni, Sarah Kliff, Andrew E. Kramer, Sharon LaFraniere, Apoorva Mandavilli, Azi Paybarah, Eileen Sullivan, Jim Tankersley, Katie Thomas, Noah Weiland and Sameer Yasir.