The Global Death Toll Now Tops 500,000

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Credit…Bruno Kelly/Reuters

The global total of deaths passed 500,000 on Sunday, according to a New York Times database, while the number of confirmed cases surpassed 10 million.

The grim markers were hit as countries around the world struggle to keep new infections from reaching runaway levels while simultaneously trying to emerge from painful lockdowns.

In April, roughly a month after the World Health Organization declared the outbreak a pandemic, deaths topped 100,000. In early May, the figure climbed to 250,000. Now it has doubled in less than two months.

More than a quarter of all known deaths have been in the United States.

The number of confirmed infections — which took about 40 days to double — may be substantially underestimated, public health officials say. Data released last week by the Centers for Disease Control and Prevention indicated that the actual figures in many regions are probably 10 times as high as reported.

The Times has also found underestimates in the official death tallies in the United States and in more than a dozen other countries. Limited testing availability has often made it difficult to confirm that the virus was the cause of death.

In the United States, early hot spots emerged in the Northeast, particularly the New York metropolitan area, but the recent surge has occurred primarily in the South and the West, forcing some states to retreat from reopening plans.

Other countries, particularly Brazil and India, are also being hit with a large wave of new infections.

And while dozens of countries that took early steps to contain and track the pandemic have been able to control the virus within their borders, experts fear that fatigue with lockdowns and social distancing has allowed the virus to spread with renewed intensity across many corners of the world.

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Credit…Tony Gutierrez/Associated Press

Vice President Mike Pence urged the public to wear masks during a visit to Texas on Sunday, the first stop on a multistate swing of the most severe virus hot spots that quickly highlighted the contradictory message of the Trump administration on testing and facial coverings.

Mr. Pence wore a mask to a religious service at a Dallas area megachurch, but more than 100 members of the choir sang without any facial coverings.

Later, he and Dr. Deborah Birx, the coordinator of the White House coronavirus task force, joined Gov. Greg Abbott for a briefing on the outbreak at the University of Texas Southwestern Medical Center in Dallas, during which Mr. Abbott said that the virus had taken a “very swift and a very dangerous turn” in the nation’s second-most populous state.

In Texas, the rate of positive Covid-19 tests had risen to more than 13 percent from less than 4 percent in the past month, which Mr. Abbott, a Republican, called an “alarm bell.”

“We encourage everyone to wear a mask in the affected areas,” Mr. Pence said. “We know it will slow the spread.”

Mr. Pence is expected to visit Florida and Arizona, also virus hot spots, in the coming days for similar briefings. Officials in Arizona announced more than 3,800 new cases on Sunday, a single-day record. In Florida, more than 8,500 new cases were announced for a third consecutive day.

On Sunday, Mr. Pence declined to directly answer a question about whether President Trump’s refusal to wear a mask — and his assertion that people who do are making a political statement against him — was responsible for the high numbers of Texans and others who do not wear masks when they are in crowded areas.

Governors in some states have complained that the federal government has failed to provide the resources they needed to test for the virus and treat patients. On Sunday, Mr. Pence pledged that the government would help Texas and other states seeing a new surge in cases.

“We’re going to stay with you to make sure that Texas, and your health care system in Texas, have the resources and supplies and the personnel to meet this moment,” he said

Mr. Pence and the nation’s top health official, Alex M. Azar II, continued to assert on Sunday that reopenings in many states were not causing the sharp rises in coronavirus cases, but rather that increased testing was uncovering more and more infections. Experts says this is not the case.

The vice president also asserted that anyone who wanted a test could get one. “Because of the public-private partnership that President Trump initiated, we are literally able to test anyone in the country that would want a test who comes forward,” Mr. Pence said.

But in some states, residents have been turned away from testing sites that have reached capacity.

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Credit…Adriana Zehbrauskas for The New York Times

It’s not just case counts that are going up. In many places, another statistic is also trending the wrong way: A rising share of coronavirus tests are coming back positive.

In Los Angeles County, officials said Saturday that the positivity rate there had risen to 9 percent; two weeks ago it was averaging 5.8 percent. In Texas, the rate climbed above 13 percent on Friday; it was around 7 percent two weeks ago.

Arizona’s positivity rates have been climbing steadily since early May and have been averaging above 20 percent for a week, according to figures compiled by Johns Hopkins University.

Public health experts watch positivity rates, along with hospitalization rates, deaths and other key indicators, to get a sense of how prevalent the virus is in a particular city or state, and how fast it is spreading.

“The positivity rate is a very important marker for how a state’s testing is going, and for how the state is doing,” said Dr. Thomas Inglesby, the director of the Johns Hopkins Bloomberg Center for Health Security.

The figures, however, can vary greatly from one place to another because of major differences in testing availability and criteria in the way the data is compiled, among other factors. All else being equal, more limited testing would be expected to yield higher positivity rates than widespread testing would.

What’s most significant about positivity rates is if they are moving up, it’s a strong suggestion that the pandemic is gaining strength — and that rapidly rising case counts are not merely the result of having performed more tests, as President Trump and Vice President Pence have argued recently.

The C.D.C. criteria for each stage of reopening from a lockdown include a requirement that positivity rates decline for 14 days. According to Johns Hopkins, only 12 states reported lower average positivity rates last week than the week before.

The criteria also call for widespread availability of testing, but in hot-spot states like Arizona, Florida and Texas, many people have had a hard time getting tested, with long lines and crowding that raises tensions and the risk of infection.

“Pushing, yelling, ZERO social distancing enforced,” one Houston resident wrote on Twitter. Two testing sites at Houston stadiums reached capacity and had to turn people away just a few hours after opening on Saturday, according to the local health department.

In Florida, the first car was on line at 12:30 a.m. Saturday at the Orange County Convention Center in Orlando, according to the Florida Association of Public Information Officers, even though testing did not start there until 9 a.m. At a site in Jacksonville, the testing line was cut off in the early afternoon, before closing time, the association said on Twitter.

Lines of cars at drive-up sites in Phoenix stretched up to three miles, and the state’s largest laboratory received twice as many samples on Friday as it could process.

Coronavirus cases nationwide have risen 65 percent over the past two weeks. More than 37,800 new cases of the coronavirus were announced across the United States on Sunday, the country’s fourth-highest daily total of the pandemic.

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Credit…David J. Phillip/Associated Press

Two days after declaring Houston and its surrounding county to be at a “severe” level of threat from the pandemic, the county’s top official, Lina Hidalgo, said Sunday that she had been exposed to the virus by a staff member and would self-quarantine.

Ms. Hidalgo, the telegenic judge of Harris County, which includes Houston, said in a statement that “there are thousands of residents across Harris County that are increasingly finding themselves in the same position I am in today.”

She was exposed to the virus on June 22 by one of the handful of staff members in her office who were not working from home and still had contact with Ms. Hidalgo as she worked out of the county’s emergency operations center, said Rafael Lemaitre, a spokesman.

All those exposed have been identified, he said, and were being tested for the virus.

Ms. Hidalgo did not have symptoms as of Sunday, Mr. Lemaitre said.

Ms. Hidalgo became a familiar figure on national television as attention focused in recent days to the unfolding crisis in Houston.

Two days ago, Ms. Hidalgo had the county send messages to millions of phones advising residents to stay at home and leave only for essential activities. On Sunday, she reiterated that.

“I continue to call on everyone to stay home except for essential activities,” she said in the statement.

Her 14-day self-quarantine lasts through July 6.

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Credit…Chris Creese for The New York Times

Two governors who have had sometimes testy relationships with the White House during the pandemic expressed harsh reactions to the administration’s insistence on deferring to local governments rather than offering strong national policies to contain the virus at a time when outbreaks are escalating in a number of states.

Vice President Mike Pence strongly defended the approach on the CBS show “Face the Nation,” while attributing the rise in cases to increased testing and irresponsible behavior by young people.

“One of the elements of the genius of America is the principle of federalism, of state and local control,” Mr. Pence said. “We’ve made it clear that we want to defer to governors. We want to defer to local officials and people should listen to them.”

Gov. Andrew M. Cuomo characterized that approach as negligent on the NBC program “Meet the Press.” “They’re basically in denial about the problem,” he said. “They don’t want to tell the American people the truth. And they don’t want to have any federal response, except supporting the states.”

Mr. Cuomo said that New York, once a global epicenter, had reported five deaths on Sunday, the lowest number since the start of the pandemic. But he said that he was afraid that travelers from states with higher infection rates could reverse his state’s hard-won gains.

Gov. Jay Inslee of Washington expressed frustration at the president’s unwillingness to wear masks or to do more to encourage his supporters to wear them. “Instead of tweeting the other day about the importance of masks, he tweeted about monuments,” he said on “Face the Nation.” “We need a president who will care more about living Americans and less about dead confederates.”

Speaker Nancy Pelosi said Sunday that she supported a federal mandate that all Americans must wear masks. “Definitely long overdue for that,” Ms. Pelosi, Democrat of California, said on ABC’s “This Week.” She urged Mr. Trump to start wearing one in public, saying: “Real men wear masks. Be an example to the country.”

The health and human services secretary, Alex M. Azar II, noted on “Meet the Press” that Mr. Pence had donned a mask for a public appearance on Friday, “even though he doesn’t need to in the sense that everybody around him is tested, he’s in a bubble.”

President Trump and those around him “are tested constantly,” he said, reiterating that the government recommends that people wear face coverings if they cannot practice social distancing.

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Credit…Saul Martinez for The New York Times

As more restaurants and bars open for indoor dining, hard-to-trace outbreaks are prompting warnings from public health officials in several states.

In Michigan, more than 70 cases were linked to Harper’s Restaurant and Brewpub in East Lansing. In Alaska, the Seward Alehouse closed and encouraged customers to get tested after an employee contracted the virus.

And in Kansas, cases were linked to the Wild Horse Saloon in Topeka and a bar called the Hawk in Lawrence. Sonia Jordan of Lawrence-Douglas County Public Health said her department released details of the Hawk outbreak because “we are not confident in being able to identify everyone who was there.”

Many times, restaurant outbreaks are contained to a handful of known cases. But in recent weeks, they have also been the sites of more widespread infections. At least 100 cases were tied to the Tigerland nightlife district in Baton Rouge, La.

In Michigan, where dozens of the people infected at Harper’s Restaurant were between the ages of 18 and 23, officials urged others who visited the business to isolate themselves.

“There are likely more people infected with Covid-19 not yet identified,” Linda S. Vail, the Ingham County health officer, said in a statement. “We need help from people who went to Harper’s during the exposure dates so that we can contain the outbreak. We need everyone exposed to stay home.”

In California on Sunday, the state ordered bars to close in some cities, among them Los Angeles and Fresno, and recommended that they close in others, including Sacramento, Contra Costa and Santa Barbara.

The rapid identification of restaurant clusters contrasts with the continuing uncertainty about infections stemming from protests against racially biased policing, which have been held in more than 2,000 U.S. cities since the death of George Floyd in police custody on May 25. The Times has reached out to dozens of cities that have had large protests, finding some small case groupings but no major clusters.

Thus far, the effort has found about 50 infections connected to protests, including members of the National Guard in Nebraska, Minnesota and Washington, D.C.

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Credit…Department of Justice

Cards for sale that claim to exempt people from wearing masks during the coronavirus pandemic are fraudulent, federal officials said.

The cards — featuring a red, white and blue eagle logo and approximately the size of a business card — say the bearer is exempt from ordinances requiring them to wear masks in public.

“Wearing a face mask posses a mental and/or physical risk to me. Under the Americans with Disability Act (ADA), I am not required to disclose my condition to you,” reads the card, which misspells “poses” and incorrectly names the Americans with Disabilities Act.

There’s also a warning that businesses or organizations can be reported to the Freedom to Breathe Agency, the group behind the cards. One version of the cards featured the Justice Department’s logo and listed a legitimate phone number where complaints about violations of the Americans with Disabilities Act can be submitted.

The cards were being sold online in boxes of at least 500 for $49.99.

The cards were created in response to complaints, the group selling them said in an email, and as “an educational tool” to help people “understand their legal and human rights so they can stand up to the unlawful, unscientific and unconstitutional mandates.”

The founder of the Freedom to Breathe Agency, Lenka Koloma, advertised the cards on her Facebook page, and they were sold on a site created through the commerce platform Shopify. The site was unavailable on Sunday afternoon.

The original Facebook group and a website on the Wix platform for the Freedom to Breathe Agency were also taken down.

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Credit…Lawler50, via Reuters

Pictures of hundreds of partygoers crowded in pools, mask-free, caused jaws to drop across the country after Memorial Day weekend.

  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.