With infections on the rise across the United States, Alex Azar, the secretary of Health and Human Services, said that Americans were experiencing “mitigation fatigue,” and tried to paint an optimistic picture of how much longer pandemic precautions would be needed.
“Hang in there with us,” he said on Sunday on “Meet the Press” in an interview with Chuck Todd of NBC News. “We’re so close. We’re weeks away from monoclonal antibodies for you, for safe and effective vaccines. We need a bridge to that day.”
“Please, give us a bit more time of your individual, responsible behavior,” he said, listing hand washing, wearing masks, and maintaining social distance.
But any notion that life in America might go back to normal within weeks, or even within a couple of months, would be too hopeful, experts and officials said. The public health strategies that the public is fatigued with will be needed for some time to come, even after new drugs and vaccines can be approved. And compliance with those strategies is already spotty.
“People are not following the mitigations,” Gov. J.B. Pritzker of Illinois said on Sunday, discussing the resurgence of the virus in his state, which reported a record high case count on Friday and has seen hospitalizations and deaths rise recently as well.
Speaking on the CNN program “State of the Union,” Governor Pritzker faulted President Trump for “modeling bad behavior” by not wearing a mask in public and by holding rallies without safety precautions.
“The president has made it nearly impossible for states to open up any more than they are now,” he said.
Monoclonal antibodies, including an experimental cocktail made by Regeneron that President Trump received, may block the coronavirus or shorten the course of the disease. At least four companies are producing them, and clinical trials are underway to see whether they can prevent infections in people who are exposed to the virus, and to see how much they help people already infected.
Both Regeneron and Eli Lilly have asked the Food and Drug Administration to allow them to distribute their antibodies under an emergency use authorization while studies continue. But the applications are for hospitalized patients only, and supplies are limited. One trial of Lilly’s version was paused last week over a safety concern.
But it ultimately is up to Mr. Azar to approve them for emergency use, notes Dr. Matthew Wynia, director of the University of Colorado’s center for bioethics and humanities. There is no explicit standard for approving medications for emergency use, so Mr. Azar could “make his predicted timeline a self-fulfilling prophecy,” Dr. Wynia said.
But monoclonal antibodies are complicated and time-consuming to produce, and even if they are approved, Dr. Wynia said, Mr. Azar “knows very well there are lots of issues to be worked out on who will be able to actually get them.”
A variety of vaccines are also being tested, but none so far is ready even for emergency use. At least three of the 11 Phase 3 trials The Times is tracking have been paused for investigations into possible problems.
Emergency use authorizations for vaccines is more difficult than for drugs, Dr. Wynia said. The drug companies, the F.D.A, and the administration have set out explicit criteria for when a coronavirus vaccine can be approved, including how long people who get the vaccine need to be followed for side effects.
With the first coronavirus vaccines in the final stages of testing, the National Governors Association has some pressing questions for the Trump administration: Who is going to pay for the administration of vaccines? And how will scarce supplies be allocated among the states?
The association, a bipartisan group headed by Gov. Andrew M. Cuomo of New York, posted its questions on Twitter.
“Will there be additional funding allocated to states to assist with distribution of the vaccine and other vaccine efforts?” the group asked.
And what, they asked, is the national plan to deal with vaccine shortages?
There were also questions about the mundane supplies needed to immunize people — needles, syringes, alcohol pads, adhesive bandages, dry ice. How will they be managed, the governors ask.
The need for a vaccine is so large and so urgent that it there will almost certainly not be enough to go around, at least at first. And it is not clear how the vaccine supplies will be doled out. Will they be allocated to each state based on total population, or according to the number of people at the highest risk of infection, or by some other rubric?
The question of who should be vaccinated once the states receive supplies has been studied intensively by several groups, including the National Academies of Science and Medicine, which proposed dividing the population into groups based on risk and need.
The first group to be offered a vaccine would be emergency, public safety and health care workers, including those employed in nursing homes. Next would be people with medical conditions that place them at high risk for severe infections, and older people living in group homes or crowded neighborhoods.
From there the lists move on to less and less vulnerable groups, ending with healthy children and young adults. Lastly, anyone not included in one of the specified groups would then be offered a vaccine.
A federal Centers for Disease Control and Preventions committee said it favored the National Academies’ approach, but would hold an emergency meeting to vote on a final plan once a vaccine was ready and approved by the Food and Drug Administration. From there, it would be up to the C.D.C. to adopt a plan.
Twitter removed a tweet denouncing masks from its service that was posted on Saturday by Dr. Scott Atlas, a neuroradiologist who serves on President Trump’s coronavirus task force.
In the tweet, Dr. Atlas wrote, “masks work? NO” and falsely claimed that the World Health Organization and the Centers for Disease Control did not support their use, and that they cause “many harms.”
Most health authorities are unanimous on the efficacy of wearing masks to curtail the spread of the virus. The C.D.C. recommends wearing masks “in public settings when around people not living in your household and particularly where other social distancing measures are difficult to maintain.” The federal agency adds that masks “may slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.”
The W.H.O. says “masks are a key measure to suppress transmission and save lives.”
Dr. Atlas’s tweet, a Twitter spokeswoman wrote in an email, violated its policy against misleading information about the coronavirus pandemic. That policy, the spokeswoman added, applies to tweets that “could lead to harm,” in particular “statements or assertions that have been confirmed to be false or misleading by subject-matter experts, such as public health authorities.”
Dr. Atlas’s stances on the pandemic have clashed with those of other members of the White House Task Force, including Dr. Deborah L. Birx and Dr. Anthony S. Fauci.
Although President Trump has disdained the wearing of masks, Chris Christie, the former New Jersey governor who helped the president prepare for his presidential debates, said he “was wrong” not to wear one. Mr. Christie was hospitalized with a coronavirus infection around the same time as Mr. Trump.
In a statement last week, Mr. Christie wrote, “I believed when I entered the White House grounds, that I had entered a safe zone, due to the testing that I and many others underwent every day.” But, he said, “I was wrong.”
“I hope that my experience shows my fellow citizens that you should follow C.D.C. guidelines in public no matter where you are and wear a mask to protect yourself and others,” he said.
Congressional Democrats and the White House remain at an impasse over a fresh package of coronavirus economic relief, as time runs out to get a bill passed before the election, Speaker Nancy Pelosi said on Sunday.
Ms. Pelosi said on the ABC program “This Week” that she was still in negotiations with the Treasury secretary, Steven Mnuchin, but that “we don’t have agreement on the language yet.” She said a deal would have to be struck within 48 hours in order for a package to be enacted by Election Day.
One point of contention, she said, is the White House’s attempt to weaken provisions that would require testing and contact tracing for coronavirus infections. Another issue in the talks, a spokesman for Ms. Pelosi said on Saturday, is ensuring that the bill addresses the virus’s “disproportionate impact on communities of color.”
House Democrats, led by Ms. Pelosi, have proposed a $2.4 trillion package that provides aid to families, schools, restaurants, businesses and airline workers. It includes about $500 billion for state and local governments. Mr. Mnuchin, negotiating on behalf of President Trump, has sought a smaller bill, with less state and local aid.
The Senate majority leader, Mitch McConnell, Republican of Kentucky, who has not been negotiating with Ms. Pelosi, is expected to put forward a $500 billion package this week. He has said he did not believe he could sell a package of more than $1 trillion to conservative Senate Republicans.
Mr. McConnell also said on Saturday that he planned to hold votes on a stand-alone bill to revive the Paycheck Protection Program, a federal loan program for small businesses created in the spring. Some of the $500 billion in his relief proposal would be used to finance the loan program.
Mr. McConnell has faced pressure from moderate members of his conference to act on relief legislation. President Trump’s decision to abruptly end talks, and then to reverse course, prompted concerns among Republicans that he had in effect guaranteed that Republicans would be blamed for a failure to provide further federal aid.
Without congressional action and a new round of federal relief, the country’s economic recovery has continued to shudder, and millions of Americans have slipped back into poverty.
Key Data of the Day
In both Europe and the United States, coronavirus cases are mounting sharply for a third time in the pandemic, but reported deaths are not rising proportionately.
Part of the reason may be more widespread testing. Jon Zelner, an epidemiologist at the University of Michigan, said that many of the additional cases are probably being found among younger people who have no symptoms or mild illness — cases that might have gone undetected before. That is what is happening in Michigan, he said in an interview.
But he said that it also may just be a matter of time. “Deaths are a very laggy indicator of transmission,” he said, and the deaths occurring now are largely among people who became ill 30 to 40 days ago. Dr. Zelner said he expected the current surge in cases to be reflected in an increase in deaths in November.
Single-day and weekly records for new cases are growing more common both in European countries and in individual American states.
In the U.S., average daily reported cases have increased by 28 percent over the last 14 days, and hospitalizations are rising, while deaths have increased 1 percent.
Ohio, Indiana, North Dakota, Illinois, New Mexico, Wyoming, Colorado, South Dakota, Kentucky, West Virginia and Idaho each reported more cases this week than in any previous seven-day period. So did Minnesota, even though the state reported no new cases on Saturday because of computer updates.
Only one of those states — North Dakota — was among the eight reporting the highest number of deaths relative to their populations.
In France, which reported 115,897 cases and 619 deaths in the last week, according to a Times database, curfews were imposed in Paris and other cities. Italy reported a record of 10,925 new infections on Saturday, almost three times the number it was averaging 14 days ago, and a slight increase of 47 deaths. The government is expected to announce further restrictions on Sunday.
Poland also reached a new high, with 9,622 new infections on Saturday and 84 coronavirus-related deaths, according to the Health Ministry. And Ukraine, which has extended a lockdown until the end of the year, reported two daily records of 6,410 new infections and 109 deaths on Saturday according to its National Security and Defense Council.
The European region registered its highest weekly incidence of cases since the pandemic’s beginning, the World Health Organization said on Thursday. “Daily numbers of cases are up, hospital admissions are up, Covid-19 is now the fifth leading cause of death and the bar of 1,000 deaths per day has now been reached,” said a statement by Dr. Hans Kluge, the organization’s regional director for Europe. Still, deaths were still five times fewer than the April peak.
New York State continued its incremental path to recovery from the pandemic on Sunday, with Gov. Andrew M. Cuomo announcing that ski resorts would be allowed to open at 50 percent indoor capacity starting on Nov. 6.
Across the United States, the coming winter brings a significant risk of stoking outbreaks of the virus, with the colder weather forcing people to gather indoors. But Mr. Cuomo noted on Sunday that “once we start talking about the winter, skiing comes up,” and encouraged New Yorkers to ski in the state instead of traveling to other parts of the country.
“You don’t have to quarantine when you come back,” he said.
Public health experts have linked skiing to significant coronavirus outbreaks in other countries, underscoring the dangers of travel and tourism while the pandemic still rages. An outbreak at an Austrian ski resort, Ischgl, and its surrounding villages led to the infection of thousands of skiers who traveled to the area from around the world.
The skiers then carried the coronavirus to more than 40 countries on five continents, including some of the first known cases in Iceland.
Many ski resorts in North America shut down earlier this year, fearing the spread of the virus among visitors as well as in surrounding communities that service them, which often have limited medical resources.
Mr. Cuomo said that skiers would still have to socially distance at the resorts, especially in bars, restaurants and aboard shuttles to and from ski mountains. Other restrictions include limiting ski lessons to 10 people or less, requiring masks unless people are eating, drinking or skiing and reducing outdoor capacity on the slopes by 25 percent on peak days.
He said that the state has aggressively attacked new clusters of the virus to keep the overall infection rate in the state relatively stable, even as the northeast has seen the virus’s resurgence in recent days.
A protest in Prague against the Czech Republic’s new coronavirus restrictions turned violent on Sunday, as police used tear gas and water cannons to disperse an unruly crowd about four times larger than currently allowed.
Some 2,000 protesters in the city’s historic center, many of them unmasked, were objecting to measures imposed on Wednesday, including a ban on sporting events. When representatives of the city’s Town Hall tried to end the event after an hour, the crowd became unruly, and when the police began to try to break the protest up, some in the crowd began throwing bottles, trash bins and flares. The police responded with greater force.
The Czech prime minister, Andrej Babis, tweeted: “I am shocked how inconsiderate and selfish some citizens are, they do not follow the government restrictions and put both themselves and others in harm’s way. I am for a strict recourse.”
The Czech Republic is currently seeing the fastest rise in Covid-19 cases per capita in Europe, according to a New York Times database. On Friday, the health ministry reported the country’s highest number of new daily cases, adding 11,105.
Starting on Wednesday, when the government barred all sporting events, it also closed all schools, with the exception of kindergardens. Restaurants, bars and cafes were also closed, and public gatherings of more than six people were banned, though demonstrations of up to 500 masked people were allowed if they broke into groups of 20.
In a televised speech last week, the health minister, Roman Prymula, said that a steep rise of patients with serious illness was expected and that the death toll was almost certain to rise, too.
“We have three truly complicated and joyless weeks ahead of us,” said the minister.
Early results of a few small studies offer a glimmer of hope that, in at least some cases, patients with lung damage caused by Covid-19 showed signs of recovery, especially with intensive aftercare and exercise.
Lingering shortness of breath and diminished stamina have dogged many Covid-19 patients, and doctors have worried that the lung damage might be irreversible.
In one of the studies, a group of doctors at the University Clinic of Internal Medicine in Innsbruck, Austria, observed similar improvements in their 86 patients.
Even after rehabilitation, many were still coughing and short of breath as they went home, equipped with exercise instructions and breathing devices — small, inexpensive plastic tubes that require one to breathe in and out with force.
But as they came back for checkups weeks later, their CT scans showed improvement, doctors said. Fluids were clearing from their lungs, and the white-glass lesions often seen in Covid pneumonia were lessening, sometimes disappearing entirely and sometimes noticeable only as thin white bands.
“There are some signs of reversible damage,” said Dr. Thomas Sonnweber, a co-author of the study. At the time the patients were discharged from the hospital, 88 percent had lung damage, but 12 weeks later, only 56 percent did.
Their symptoms also improved. They coughed less, breathed and walked more easily, in some cases with markedly improved endurance.
Longer range studies still have to be conducted to assess the potential for permanent effects.
In parts of the world where the coronavirus is resurging, the outbreaks and a rising sense of apathy are colliding, making for a dangerous combination.
Health officials say growing impatience is a new challenge as they try to slow the latest outbreaks, and it threatens to exacerbate what they fear is turning into a devastating autumn.
“People are done putting hearts on their windows and teddy bears out for scavenger hunts,” said Katie Rosenberg, the mayor of Wausau, Wis., a city of 38,000 where a hospital has opened an extra unit to treat Covid-19 patients. “They have had enough.”
The issue is particularly stark in the United States, which has more known cases and deaths than any other country. But a similar phenomenon is sending off alarms across Europe, where researchers from the World Health Organization estimate that about half of the population is experiencing “pandemic fatigue.”
In some parts of the world, behavior has changed and containment efforts have been tough and effective. Infections have stayed relatively low for months in places such as Australia, Japan, New Zealand, South Korea and China, where the virus first spread. After a dozen cases were detected in the Chinese city of Qingdao, the authorities sought this past week to test all of its 9.5 million residents.
Siddharth Sridhar, an assistant professor of microbiology at the University of Hong Kong, said, “We have very little backlash here against these types of measures.”
“If anything,” he added, “there’s a lot of pushback against governments for not doing enough to contain the virus.”
The response in the United States and much of Europe has been far different. People who once would not leave their homes are now considering dining indoors for the first time.
Beth Martin, who is working as a contact tracer in Marathon County, Wis., said she had interviewed a family that became sick through what is now a common situation — at a birthday party for a relative in early October.
“Another case said to me, ‘You know what, it’s my adult son’s fault,’” Ms. Martin recalled. “‘He decided to go to a wedding and now we’re all sick.’”
Dr. Michael Landrum, who treats coronavirus patients in Green Bay, Wis., said that mask use was more widespread than in the spring and that treatment of the virus was more sophisticated.
Back then, it was not as hard to figure out where sick patients had contracted the virus. There were outbreaks at meatpacking plants in town, and many cases were tied to them. Now it is more complicated.
“The scary scenario is the number of patients who really just don’t know where they got it,” Dr. Landrum said. “That suggests to me that it’s out there spreading very easily.”
In mid-September, parents of students at Corner Canyon High School, in an affluent suburb of Salt Lake City, received a text urging them to beg the school board to keep classrooms open.
Three weeks into the school year, the number of coronavirus cases at the Corner Canyon was rising, and the district was considering shifting to online instruction.
After parents flooded the board with messages, the school stayed open. Within a week, the number of cases had nearly quadrupled. A teacher was hospitalized and put on a ventilator.
When the board finally decided on Sept. 18 to close the school temporarily, 77 students and staff members had tested positive.
And Corner Canyon was not the only school in the district to have an outbreak. By Sept. 28, Canyons School District had temporarily closed three high schools and a middle school.
The story of Canyons illustrates what can happen when schools open in communities that are failing to contain the virus. In the two weeks before the district opened for the fall, Salt Lake County had roughly 187 new cases per 100,000 people, a level at which some experts have advised against high schools opening in person; that level is two and a half times higher than the standard Washington State uses to recommend distance learning for all students.
Since then, with schools and colleges open, things have only worsened. In the two weeks that ended Thursday, Salt Lake County had nearly 617 cases per 100,000 people. Over the past week, Utah had the sixth-highest rate of new cases per 100,000 people of any state.
Canyons is also an example of how the nation’s 13,000 school districts are struggling to find workable policies in the absence of clear standards from the federal government and many state governments.
“We’ve forced every school district to figure out how to respond to a pandemic on its own, and it’s insane,” said Dr. Ashish Jha, dean of the Brown University School of Public Health.
Saeb Erekat, a senior Palestinian official who tested positive for the coronavirus earlier this month, was transferred from his home in the West Bank to an Israeli hospital on Sunday, following a deterioration in his health.
His wife, Neamh Erekat, is also infected, but her condition is improving, Palestinian officials said.
Mr. Erekat, 65, a veteran negotiator and secretary general of the Palestine Liberation Organization’s Executive Committee, received a lung transplant in 2017 and is considered to be at high risk of suffering severe Covid-19.
An Israeli ambulance transported him from his home in Jericho to the Hadassah Ein Kerem hospital in Jerusalem, Israel’s Magen David Adom emergency medical service said.
In a statement, the hospital said that Mr. Erekat had received supplemental oxygen in a Covid-19 intensive care unit, describing his condition as “serious but stable.”
Mr. Erekat, who has long supported nonviolence and the two-state solution, has been intimately involved in Palestinian politics and Israeli-Palestinian negotiations for decades. He was a central member of the Palestinian delegation to the Madrid peace conference in 1991 and has served as a close aide to Mahmoud Abbas, the president of the Palestinian Authority.
Mr. Erekat has also been one of the loudest Palestinian voices rejecting the Trump administration’s policies on the Israeli-Palestinian conflict.
In other global news:
Officials in Melbourne, Australia, announced some easing of one of the world’s strictest lockdowns, allowing residents to travel up to 25 kilometers from their homes and up to 10 people from two households to socialize outdoors. Dan Andrews, premier of the state of Victoria, drew a contrast between the situation there and in Britain, where there have been fewer restrictions despite a surge in cases. “Back in August and at our peak, we reported 725 daily cases. At the same time, the U.K. recorded 891,” he said in a statement. “Today, as Victoria records two new cases, the U.K. hit 16,171. And as we continue easing our restrictions, they are being forced to increase theirs.”
Prime Minister Jacinda Ardern of New Zealand said on Sunday that her landslide election victory was an endorsement of the government’s efforts to stamp out the coronavirus and reboot the economy. Ms. Ardern’s liberal Labour Party got 49 percent of the vote, crushing the conservative National Party, which got 27 percent, The Associated Press reported. With a population of five million, the country has tallied only 25 coronavirus deaths. However, on Sunday it reported its first community transmission in more than three weeks.
Wallis and Futuna, a French territory in the South Pacific, reported its first coronavirus case on Friday. Officials said the infected individual, who is asymptomatic and in isolation, arrived on Oct. 3 and tested positive while in a compulsory 14-day quarantine. Almost all of the handful of nations believed to still be virus-free are in the Pacific, including Kiribati, the Marshall Islands, Micronesia, Nauru, Palau, Samoa, Tonga, Tuvalu and Vanuatu.
Ireland will reimpose tighter restrictions across the country on Monday, a cabinet minister said in a televised interview. Reuters reported that Simon Harris, who was health minister in the spring and now heads the higher education ministry, said the current level of precaution in most of the country “has not worked” and that varying it by region had been ineffective. Mr. Simon suggested that many nonessential businesses would have to close, but that the new restrictions would be short of a total lockdown. The country has set new daily case records four times in the last week.
Many scientists say the likelihood of catching the virus from packaged frozen food is very low, arguing that when the virus crosses international borders, it is almost certainly transmitted by people, rather than the products they transport.
So what should we make of a finding reported by the Chinese Centers for Disease Control and Prevention that coronavirus that survived on packages of imported frozen cod fueled an outbreak in Qingdao, in eastern China?
In a statement on its website on Saturday, the Chinese C.D.C. said it had isolated live virus samples from frozen-food packaging in Qingdao. It is known that viruses can survive cold and freezing.
But to prove that a dangerous, viable, virus persists on food or packaging, researchers would need to isolate the microbe and show in a lab that it can still replicate and that it is present in sufficient quantities to fuel an outbreak, a complicated process it is not clear the Chinese researchers managed.
And to show the virus that was isolated actually infected people, researchers would need to demonstrate that the genetic signature of the virus on food matched that in patients.
China, which acknowledges that the virus’s main route to infection is through respiratory droplets, is alone in pointing to frozen foods as the potential cause of outbreaks. The U.S. Centers for Disease Control and Prevention maintain that “there is no evidence to suggest that handling food or consuming food is associated with Covid-19.”
In the Qingdao outbreak, Chinese authorities said a dozen people tested positive for the virus last weekend, the country’s first locally transmitted cases in almost two months. Officials said the cases appeared to be linked to the Qingdao Chest Hospital, which had been treating people who tested positive after arriving in China from abroad.
The Chinese C.D.C. said that employees handling the frozen foods were at risk of infection and that it would step up monitoring and disinfection. The agency stressed that it had found no evidence that consumers had been infected by handling frozen foods and that the risk of infection to them was “extremely low.”