Lockdown Delays Led to at Least 36,000 More Deaths, Models Find

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Lockdown Delays Led to at Least 36,000 More Deaths, Models Find

If the United States had begun imposing social-distancing measures one week earlier in March, about 36,000 fewer people would have died in the pandemic, according to new estimates from Columbia University disease modelers.

And if the country had begun locking down cities and limiting social contact on March 1, two weeks earlier than when most people started staying home, a vast majority of the nation’s deaths — about 83 percent — would have been avoided, the researchers estimated.

The enormous cost of waiting to take action reflects the unforgiving dynamics of the outbreak that swept through American cities in early March. Even small differences in timing would have prevented the worst exponential growth, which by April had subsumed New York City, New Orleans and other major cities, the researchers found.

“It’s a big, big difference,” said Jeffrey Shaman, an epidemiologist at Columbia and the leader of the research team. “That small moment in time, catching it in that growth phase, is incredibly critical in reducing the number of deaths.”

The findings are based on infectious-disease modeling that gauges how reduced contact between people starting in mid-March slowed transmission of the virus.

On March 16, President Trump urged Americans to limit travel, avoid groups and stay home from school. Mayor Bill de Blasio of New York City closed schools on March 15, and Gov. Andrew M. Cuomo of New York issued a stay-at-home order that took effect on March 22.

But in cities like New York, where the virus arrived early and spread quickly, those actions were too late to avoid a calamity. Dr. Shaman’s team modeled what would have happened if those same changes had taken place one or two weeks earlier and estimated the spread of infections and deaths until May 3.

The results show that as states reopen — all 50 states had eased restrictions somewhat as of Wednesday — outbreaks can easily get out of control unless officials closely monitor infections and immediately clamp down on new flare-ups.

And they show that each day that officials waited to impose restrictions in early March came at a great cost.

In Connecticut, flags that had been lowered to half-staff during the somber peak of the pandemic were raised high again to signal the state’s return to business.

In Kentucky, gift shops opened their doors. South Carolina will let mini-golf, water parks, amusement parks and other attractions reopen for Memorial Day weekend, Gov. Henry McMaster said on Wednesday.

And across Alaska, restaurants, bars and gyms, which have already been seeing customers for weeks, were getting ready to rev back up to full capacity. “It will all be open,” Gov. Mike Dunleavy said, “just like it was prior to the virus.”

As of Wednesday, all 50 states had begun to reopen to some degree, two months after the outbreak thrust the country into lockdown. But vast variations remain in how states are deciding to open up, with some forging far ahead of others. Many began to reopen despite not meeting White House guidelines for progress against the virus, and newly reported cases have been increasing in some states, including Minnesota and Texas, that are moving to ease restrictions. Public health officials warn that moving too fast could risk more outbreaks.

The dynamic has left many business owners and customers to decide for themselves what they think is safe.

“It is still a little scary, considering we don’t exactly know what this is,” said Ipakoi Grigoriadis, whose family owns Pop’s Family Restaurant in Milford, Conn., a diner that reopened its outdoor seating on Wednesday morning.

“It is quite exciting to see our customers we haven’t seen in a while,” she said. But it was not business as usual: Servers are gloved and masked, and patrons are expected to wear masks except when they are eating and drinking.

Governors are increasingly facing intense pressure to reopen, as millions of Americans have lost their jobs and the unemployment rate reached a staggering 14.7 percent. But reopening in Texas, where businesses have been allowed to operate at 25 percent capacity for weeks, looks far different than it does in Illinois, where stores are still limited to curbside pickup.

In a medical research project nearly unrivaled in its ambition and scope, volunteers around the world are rolling up their sleeves to receive experimental vaccines against the coronavirus only months after it was discovered.

Companies like Inovio and Pfizer have begun early tests of candidates in people to determine whether the vaccines are safe. Researchers at the University of Oxford in Britain say they could have a vaccine ready for emergency use as soon as September.

Moderna Therapeutics on Monday announced encouraging results of a safety trial of its vaccine in eight volunteers. There were no published data, but the news alone sent hopes — and the company’s stock — soaring.

In labs around the world, there is now cautious optimism that a vaccine, and perhaps more than one, will be ready sometime next year. With many states and nations anxious to ease restrictions and reopen their economies, the urgency is great. Scientists are exploring at least four approaches to creating a vaccine, and they are combining trial phases and shortening a process that usually takes years.

“What people don’t realize is that normally vaccine development takes many years, sometimes decades,” said Dr. Dan Barouch, a virologist at Beth Israel Deaconess Medical Center in Boston. “And so trying to compress the whole vaccine process into 12 to 18 months is really unheard-of.”

Even if scientists develop a vaccine that proves to be safe and effective, hurdles will remain. With nearly all of humanity vulnerable to the virus, officials will have to figure out how to speed the mass production of vaccines.

Gov. Gretchen Whitmer, a Democrat who has clashed with Republicans over the state’s response to the coronavirus, found herself in an ever more complicated position: urging residents to flee their homes while maintaining social distancing to avoid the spreading virus. Midland County has had 76 known cases, a relatively small number in a battered state.

“It’s hard to believe that we’re in the middle of a 100-year crisis, a global pandemic, and we’re also dealing with a flooding event that looks to be the worst in 500 years,” Ms. Whitmer said.

For years, federal regulators had warned that a dam in nearby Edenville Township could rupture and had chided its corporate owner, Boyce Hydro Power, for failing to make required structural changes. On Tuesday night, the dam gave way, sending a torrent of water gushing into streets and threatening Dow Chemical, the producer of plastics that sits along the Tittabawassee River. Ten miles south of the Edenville dam, water was spilling over a second dam, a structure feared to be on the verge of collapse on Wednesday.

By then, floodwaters had crept high enough that red stop signs were barely peeking out in downtown Midland, a city of 42,000 residents about 130 miles northwest of Detroit. Evacuees, wearing face masks, arrived at schools repurposed as emergency shelters. Some slept in their cars because of worries about the coronavirus.

Officials said there were no known injuries or deaths tied to the floods.

As news of the disaster spread, Mr. Trump threatened on Twitter to withhold federal funds to Michigan if the state proceeded to expand vote-by-mail efforts. The president then followed up by saying that the Federal Emergency Management Agency and the military had been deployed to Michigan to assist with disaster response.

Michael D. Cohen, President Trump’s former personal lawyer and fixer, will be released from a federal prison on Thursday on furlough, a Bureau of Prisons spokeswoman said on Wednesday. He had asked to be released over health concerns tied to the coronavirus.

Prisons and jails across the country have been hot spots for the spread of the virus. In April, Attorney General William P. Barr ordered the prisons bureau, which is part of the Justice Department, to determine which federal inmates could be safely released to home confinement. As of May 13, more than 2,500 inmates had been, according to bureau data.

Mr. Cohen’s release came a week after Paul Manafort, Mr. Trump’s onetime campaign chairman, was released into home confinement in Northern Virginia because of underlying health conditions and concerns about the virus. He had been serving a federal prison sentence of seven and a half years.

Some Catholic and Lutheran churches in Minnesota plan to resume in-person worship services this month in defiance of the governor’s orders, becoming the latest groups to apply pressure on political leaders to allow large religious gatherings.

Archbishop Bernard A. Hebda, the top Catholic official in the Minnesota diocese that includes St. Paul and Minneapolis, said in a letter to Gov. Tim Walz that he was concerned that the state had allowed stores and other businesses to reopen, with limitations, but had limited religious gatherings to no more than 10 people.

“We have concluded that many of our parishes are ready to safely resume Mass, albeit in a limited way, next week,” Archbishop Hebda wrote. The presidents of Minnesota’s two districts of the Lutheran Church-Missouri Synod wrote a similar letter to the governor, saying they were allowing Lutheran churches to reopen next Tuesday and to worship on Sunday, May 31.

Becket, a religious liberty group whose lawyers are among those representing the Minnesota churches, said in a statement that residents needed church services.

“If malls, casinos, liquor stores, bars and restaurants are reopening, why can’t Minnesota churches?” Eric Rassbach, a vice president and senior lawyer at Becket.

A spokesman for Mr. Walz, a Democrat, said the governor would be meeting with the Archdiocese this week and that he “understands the toll this pandemic is taking on the spiritual health of Minnesotans.”

“This is a challenging situation for him personally and a challenging situation for him as a public official charged with protecting the health and safety of Minnesotans,” Teddy Tschann, the spokesman, said in a statement.

The Minnesota churches joined opponents to restrictions on religious gatherings in several states, including in North Carolina, where a federal judge last weekend sided with churches who had sued over Gov. Roy Cooper’s efforts to restrict religious gatherings to 10 people. Mr. Cooper, a Democrat, said he would not appeal the ruling.

New York loosened its restrictions on religious gatherings on Wednesday, with Gov. Andrew M. Cuomo, a Democrat, saying that religious gatherings of up to 10 people could resume on Thursday if attendees wear masks and socially distance. The figure is particularly significant for Jewish congregations, where a minyan, defined as 10 people over the age of 13, is required for a worship service.

“I think that even at this time of stress and when people are so anxious and so confused, I think those religious ceremonies can be very comforting,” Mr. Cuomo said. “But we need to find out how to do it, and do it safely and do it smartly.”

And five lawyers with the Justice Department said in a letter to California on Tuesday that the state’s restrictions to combat the virus discriminated against religious institutions. The lawyers, which included all four U.S. attorneys assigned to California, objected to the state’s reopening plan, which seemed to allow restaurants and shopping malls to reopen before religious institutions could hold in-person services. They also objected to the state’s current policy limiting how members of the clergy could be classified as essential workers.

President Trump plans to spend Memorial Day in Baltimore, a city he has repeatedly derided and which remains under a stay-at-home order.

Mr. Trump and Melania Trump, the first lady, are scheduled to attend a ceremony at the Fort McHenry National Monument and Historic Shrine at the Baltimore harbor on Monday, where they are expected to be joined by several top administration officials, including Mark T. Esper, the defense secretary.

A spokesman for Mayor Bernard C. “Jack” Young of Baltimore, who has responded to Mr. Trump’s insults by calling him a “disappointment to the people of Baltimore,” said he would not attend the event.

Although Maryland’s Republican governor, Larry Hogan, has loosened statewide restrictions, Mr. Young last week extended Baltimore’s stay-at-home order indefinitely. The order requires Baltimore residents to stay home except for activities deemed essential, and prohibits gatherings of more than 10 people. Mr. Young also announced on Wednesday that he was canceling all large events in the city through August.

Mr. Trump’s visit would appear to violate the mayor’s stay-at-home order, if not for a provision that allows government employees, as well as journalists and food bank volunteers, to travel in connection with their jobs. A spokeswoman for the Fort McHenry monument, which is managed by the National Park Service and has been closed since March, did not respond to messages seeking more details about the event.

While many roads and highways across the United States have become ghost towns during the pandemic, new data shows that the people still driving on them are dying more frequently.

There was a 14 percent increase in fatality rates per miles driven in March compared with the year before, according to preliminary data reports released by the National Safety Council.

There were 8 percent fewer roadway deaths over all, and the number of miles driven fell 18.6 percent.

It is possible that speeding and reckless driving on emptier roads — as people follow stay-at-home orders — have led to a disproportionate number of deaths.

“Disturbingly, we have open lanes of traffic and an apparent open season on reckless driving,” Lorraine M. Martin, the council’s chief executive, said in a statement on Wednesday. She added that law enforcement and health care workers “are rightly focused on coronavirus patients and should not be overwhelmed by preventable car crashes.”

Closed office buildings that were once in constant use may have been accumulating health risks during the pandemic.

As lockdowns are lifted, bacteria that built up internally in stagnant water, especially in the plumbing, may cause health problems for returning workers if the issue is not properly addressed by facilities managers. Employees and guests at hotels, gyms and other kinds of buildings may also be at risk.

A single small outbreak can sicken many people. The deaths of 12 people from Legionnaires’ disease were linked to the water crisis that started in Flint, Mich., in 2014 after the city changed its water source and officials failed to inform the public of quality problems.

Most worrying, Legionnaires’ disease tends to affect people with compromised immune systems. “Covid patients and survivors could be more vulnerable to this, so when they go back to work we might be concerned about another infection,” said Caitlin Proctor, a postdoctoral fellow at Purdue University.

It was unclear how closely the guidelines would be followed. The C.D.C. said that restaurants “may consider” a number of strategies to maintain healthy environments, including: “Avoid offering any self-serve food or drink options, such as buffets, salad bars and drink stations.”

When Vice President Mike Pence visited Beth’s Burger Bar in Orlando, Fla., on Wednesday with Gov. Ron DeSantis to call attention to restaurants reopening, he was filmed filling his own cup at a self-serve soda fountain. Mr. Pence — who leads the White House’s coronavirus task force and whose press secretary, Katie Miller, tested positive for the virus this month — was not wearing a mask.

The guidance describes the balance of slowing the virus’s spread with the economic threat of shuttering most businesses, and largely mirrors a draft version that was previously shelved by the White House, but with some changes.

The document omits a section on “communities of faith” that had troubled Trump administration officials and also tones down the guidance in several instances. For example, language that initially directed schools to “ensure social distancing” became “promote social distancing,” and the phrase “if possible” was added in several sentences.

Less than a week after lawmakers approved a major rule change, Speaker Nancy Pelosi on Wednesday formally initiated the remote work period for the House, jump-starting a 45-day period when remote voting can be used in the chamber.

With the move, the House will now be able to use proxy voting, which allows lawmakers to give specific instructions on each vote to a colleague authorized to vote on their behalf. Votes are expected in the chamber next week, and several lawmakers had previously expressed frustration with the need to travel to Washington during the pandemic.

The announcement came after the sergeant-at-arms, in consultation with Dr. Brian P. Monahan, the Capitol physician, sent Ms. Pelosi a letter formally notifying her of “an ongoing public health emergency.”

In direct contrast, however, Senator Mitch McConnell of Kentucky on Wednesday highlighted the Senate’s ongoing presence in Washington, outlining how “over here in the United States Senate, the lights are on, the doors are open, and we are working for the American people.”

Mr. McConnell, the majority leader, thanked Dr. Monahan — a Navy doctor whose office is responsible for the care of both chambers and the Supreme Court — for his continued guidance, saying that it had allowed the Senate to operate “smartly and safely” during the pandemic.

“Now that our Country is ‘Transitioning back to Greatness’, I am considering rescheduling the G-7, on the same or similar date, in Washington, D.C., at the legendary Camp David,” Mr. Trump wrote on Twitter. “The other members are also beginning their COMEBACK. It would be a great sign to all – normalization!”

It is unclear whether Mr. Trump has discussed the idea with other Group of 7 leaders and how willing they would be to travel abroad with the large staff and security entourages they require.

The French government said that President Emmanuel Macron was “prepared to go to Camp David, health conditions permitting,” given the importance of the group in the pandemic response.

After the virus struck, the Group of 7 agreed to hold the gathering by video for the first time. It is scheduled for June 10-12. The group is made up of the United States, Britain, Canada, France, Germany, Italy and Japan.

The aircraft carrier Theodore Roosevelt returned to sea after its deployment to the western Pacific was derailed by the outbreak, military officials said late Wednesday.

“Theodore Roosevelt is underway for the first time since arriving in Guam March 27,” the Navy said in a statement, adding that the ship entered the Philippine Sea on Thursday.

The Roosevelt had been docked in Guam for nearly two months, with much of its crew isolated in hotels and on the U.S. naval on the island. About 1,100 sailors from the Roosevelt have been infected since the outbreak began in March.

As the virus swept the country, the College Board announced that it would introduce an online version of its Advanced Placement tests, which students use to show their mastery of subjects like physics and government.

For the first time, college applicants could take the tests at home, the board said, and submit their answers online.

Now a group of students, their parents and FairTest, a nonprofit critical of standardized testing, have sued the College Board and its partner in administering the exams, the Educational Testing Service, saying that technical problems prevented them from submitting answers, and that when they complained, they were told they would have to take makeup exams.

“Students are entitled to the valid and reliable exam they signed up and paid for, absent the severe stress and anxiety associated with the new format,” said the complaint, filed Tuesday in federal court in Los Angeles.

In an email on Wednesday, the College Board said that nearly three million A.P. exams had been given over the last 10 days, and that only a small fraction of the students who took them during the first few days — perhaps 1 percent — had run into problems. It called the lawsuit a “P.R. stunt masquerading as a legal complaint.”

The lawsuit disputes the 1 percent figure, saying that schools have reported that the failure rate for students trying to submit their answers was more like 5 to 20 percent, and as high as 30 percent. It claims breach of contract and negligence, among other accusations, and asks for restitution and damages.

The lawsuit said that after vigorously defending the way the test was being administered for a week, the College Board finally acknowledged that there was a problem. On Monday, the board began providing a backup email option for students who could not submit their answers, but the fix was not retroactive.

Ford Motor, which restarted its North American assembly plants this week, said on Wednesday that it temporarily stopped production at two plants in Chicago and Dearborn, Mich., after employees tested positive for the coronavirus.

In Chicago, two employees were sent home on Tuesday after showing symptoms of the illness; tests later confirmed that they had the virus. Both worked at a parts building about a mile from the main plant. The building they worked in was sanitized and its operations halted, forcing production to stop at the assembly plant.

Production at the Chicago plant was halted a second time on Wednesday after a nearby parts factory stopped deliveries to Ford because of an infection there.

In Dearborn, a single Ford employee tested positive on Wednesday. “We are deep cleaning and disinfecting the work area, equipment, team area and the path that team member took,” Ford said in a statement. The company said it expected the Dearborn plant to resume production Wednesday evening.

In both locations, the affected employees and any others they had contact with were sent home to prevent further spread of illness.

Ford, General Motors and Fiat Chrysler all began restarting their plants on Monday in the United States and Canada after keeping them idled for nearly 60 days. The companies have modified shift schedules, put up barriers between employees, required the use of masks and taken other steps to reduce contact between workers.

The president is scheduled to visit a Ford plant on Thursday in Ypsilanti, Mich., that is manufacturing ventilators.

As he laid out his plans for the fall semester, the president of Purdue University, Mitch Daniels, said in an interview with CNN on Wednesday that young people faced “essentially zero lethal risk” from Covid-19.

The remarks from Mr. Daniels, who served two terms as Indiana’s governor, drew criticism online, as there is still much that is unknown about how the virus affects younger populations and how they might unknowingly spread the virus.

In March, data from the C.D.C. showed that nearly 40 percent of patients sick enough to be hospitalized were between 20 and 54 years old. More recently, neurologists in New York, New Jersey, Detroit and elsewhere have reported a sudden increase in unexplained strokes among younger patients that may be linked to the virus.

Mr. Daniels said that Purdue, in West Lafayette, Ind., would carry out a new hybrid approach to teaching that would protect both its staff members and students during the fall semester.

“We’ve learned over the past two months where the real risk and danger reside. That will be our area of focus with everything we do — from physical facilities to the way we teach,” Mr. Daniels said. “We’re going to have to work as hard on the cultural aspects as the physical.”

New measures include having fewer people in classrooms, requiring masks for all students, building plexiglass barriers for teachers to stand behind and having students take at least one course online.

Students will also be expected to maintain social distancing, practice good hygiene, have their temperature taken daily and self-quarantine if they experience symptoms. The university will also be conducting testing and tracing, he said.

But amid C.D.C. warnings that the United States can expect multiple waves of infections until the development of a vaccine, the nearly 500,000-student California State University system announced last week that it would keep all of its 23 campuses mostly closed in the fall, holding classes primarily online.

Only one in five Americans expects overall business conditions to be “very” or “somewhat” good over the next year, according to a poll conducted this month for The New York Times by the online research platform SurveyMonkey. Sixty percent said they expected the next five years to be characterized by “periods of widespread unemployment or depression.”

Those numbers are slightly different than they were a month earlier and may even reflect a modest decline in outlook, signaling that the reopenings and federal and state political moves to deal with the pandemic have had little impact on confidence.

Other data tells a similar story. A survey from the University of Michigan last week found that consumers’ assessment of current economic conditions had improved modestly in early May, but that their view of the future had continued to darken.

If Americans fear that their jobs are in jeopardy or that business will remain slow, they may be less likely to spend even if their personal finances are stable.

Democrats are more pessimistic than Republicans, as they have been throughout President Trump’s term. But confidence has fallen sharply among members of both parties. Mr. Trump is hoping for an improved economy to help him win re-election in November.

A new survey of nearly 23,000 nurses across the country shows continued concern over inadequate supplies of personal protective equipment like masks and respirators as well as a lack of widespread testing among health care workers.

Even as most states are beginning the process of reopening and hospitals are starting to offer elective procedures like hip replacements and colonoscopies, many nurses remain fearful of becoming ill with Covid-19 because they do not have the equipment they need to remain safe, according to the union that conducted the survey, National Nurses United, which has more than 150,000 members in the United States.

The survey, conducted from April 15 through May 10, includes responses from both union members and nonunion nurses in all 50 states.

“We still can’t get testing,” said Deborah Burger, one of the union’s presidents, in an interview. “We still can’t get the P.P.E. that we need.”

“Almost four months into this, we are still having the same issues,” she said.

The survey found the vast majority of nurses, 87 percent, reported having to re-use personal protective equipment, including respirators, a practice that the nurses say would not have been allowed before the pandemic.

More than 100 nurses have died of the disease, according to the union, and at least 500 of those surveyed said they have already tested positive for the virus. Most nurses, 84 percent of those who participated in the survey, reported they had not yet been tested for a possible infection.

A cyclone was bearing down on India and Bangladesh, disrupting responses to the virus. Taiwan’s president began a new term with high approval ratings for her handling of the pandemic.

If you have been working from home for many weeks now, your body may be feeling the effects of a not-so-ideal setup. The good news: It doesn’t take much to fix your situation. Here are some stretches and simple work-from-home tricks that can help.

Reporting was contributed by Reed Abelson, Mike Baker, Karen Barrow, Katie Benner, Alan Blinder, Nicholas Bogel-Burroughs, Julie Bosman, Ben Casselman, Emily Cochrane, Michael Cooper, Nick Corasaniti, Michael Crowley, Elizabeth Dias, Caitlin Dickerson, Reid J. Epstein, Sheri Fink, Neil Genzlinger, Thomas Gibbons-Neff, James Glanz, Michael Gold, Kathleen Gray, Max Horberry, Anemona Hartocollis, Shawn Hubler, Annie Karni, Dan Levin, Sarah Mervosh, Andy Newman, Sarah Maslin Nir, Jan Ransom, Campbell Robertson, Anna Schaverien, Knvul Sheikh, Kaly Soto, Chris Stanford, Sheryl Gay Stolberg, Eileen Sullivan, Vanessa Swales, Hiroko Tabuchi, Jim Tankersley, Daniel Victor, David Waldstein, Noah Weiland and Carl Zimmer.

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