Leaders Re-examine U.S. Reopenings as Coronavirus Cases Soar

MIAMI — As coronavirus cases surge across much of the United States, leaders are urgently rethinking their strategies to curb the spread, which the nation’s top infectious disease expert said on Friday were “not working.”

For the first time, some governors are backtracking on reopening their states, issuing new restrictions for parts of the economy that had resumed.

Leaders in Texas and Florida abruptly set new restrictions on bars, a reversal that appeared unthinkable just days ago. And Gov. Gavin Newsom of California told rural Imperial County, where hospitals have been overwhelmed with patients, that it must reinstate a stay-at-home order, the most restrictive of requirements.

Florida, Utah and South Carolina hit daily highs on Friday for reported new cases, but even leaders outside of the new hot zones in the South and West expressed mounting anxiety.

“This is a very dangerous time,” Gov. Mike DeWine of Ohio said in an interview on Friday, as cases were trending steadily upward in his state after appearing to be under control for more than a month. “I think what is happening in Texas and Florida and several other states should be a warning to everyone.”

“We have to be very careful,” he said.

The stock market responded badly, with the S&P 500 dropping 2.4 percent. Losses accelerated after the Texas announcement, adding to investors’ concerns that the virus continued to be a threat to the economy.

The shifting assessments of the nation’s handling of the virus stretched to the highest levels of the federal government, where Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, made clear that the standard approach to controlling infectious diseases — testing sick people, isolating them and tracing their contacts — was not working. The failure, he said, was in part because some infected Americans are asymptomatic and unknowingly spreading the virus but also because some people exposed to the virus are reluctant to self-quarantine or have no place to do so.

In a brief interview on Friday, he said officials were having “intense discussions” about a possible shift to “pool testing,” in which samples from many people are tested at once in an effort to quickly find and isolate the infected.

Dr. Fauci also issued an urgent warning that while coronavirus infections were spiking mostly in the South, those outbreaks could spread to other regions.

Even in the face of the alarming news, the White House continued to praise its own efforts.

“We have made truly remarkable progress in moving our nation forward,” Vice President Mike Pence said at what has become a rare public briefing by the coronavirus task force in Washington. “We’ve all seen the encouraging news as we open up.”

Mr. Pence did not wear a mask, although the health officials around him did.

The renewed sense of urgency comes as the United States confronts a new, treacherous phase of the pandemic, no longer defined by a crisis concentrated in New York City, but by rising cases in many cities and states. Alabama, Alaska, California, Georgia, Idaho, Missouri, Nevada, Oklahoma and Texas also reported their highest single-day totals of new known cases this week, and the United States set records for daily new cases on both Wednesday and Thursday. By Friday, new daily cases were rising in 29 states.

From Miami to Los Angeles, mayors were contemplating slowing or reversing their plans to return cities to public life. On Friday, San Francisco announced it was delaying plans to reopen zoos, museums, hair salons, tattoo parlors and other businesses on Monday, citing a spike in new cases. “Our numbers are still low but rising rapidly,” Mayor London Breed wrote on Twitter, adding, “I know people are anxious to reopen — I am too. But we can’t jeopardize the progress we’ve made.”

In Miami, officials were considering whether to revert to some of the limits they had set months ago. “We’re in a far more precarious position than we were a month ago,” Mayor Francis Suarez said.

The decisions in Texas and Florida to revert to stronger restrictions on Friday represented the strongest acknowledgment yet that reopening had not gone as planned in two of the nation’s most populous states, where only days ago their Republican governors were adamantly resisting calls to close back down.

On Thursday, Gov. Greg Abbott of Texas placed the state’s reopening on pause, while remaining firm that going “backward” and closing down businesses was “the last thing we want to do.”

But by Friday, he did just that, ordering bars closed and telling restaurants to limit themselves to 50 percent capacity rather than 75 percent.

“It is clear that the rise in cases is largely driven by certain types of activities, including Texans congregating in bars,” Mr. Abbott said in a statement, adding that he hoped the new restrictions would be “as limited in duration as possible.”

Eight weeks ago, Mr. Abbott started a phased-in reopening of Texas, when the state had reported about 29,000 cases and more than 800 deaths. Bars had been allowed to open since late May.

New cases and hospitalizations have increased significantly in recent days in Houston, San Antonio and other large cities. By Friday, Texas had more than 130,000 known coronavirus cases and more than 2,300 deaths, and the leader of the third-largest county in America — Harris County, which is home to Houston — had deemed the region to be on a code-red coronavirus threat level.

“We find ourselves careening toward a catastrophic and unsustainable situation,” the top elected official in Harris County, Lina Hidalgo, said at a news conference. She said the current hospitalization rate was on pace to overwhelm the hospital system “in the near future.”

In Florida, the speed of the virus’s growth was dizzying: State officials reported 8,942 new coronavirus cases on Friday, by far outpacing its earlier single-day record of 5,508 cases, which had been set on Wednesday.

Officials announced limits on bars, immediately banning alcohol consumption on the premises. Bars can still sell food if they are licensed to do so, but their facilities must remain at 50 percent capacity.

The return to stricter limits left local officials worried whether residents would follow the rules, especially now, months into the crisis.

  • 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.

“People are tired of being in a stay-at-home environment, and they’re not going to be compliant,” said Carlos Migoya, president and chief executive of the public Jackson Health System in Miami. “You can’t put the genie back in the bottle. We’ve got to deal with it being in the environment.”

Pete Boland, who co-owns the Galley, a restaurant and bar in St. Petersburg, Fla., was sorting through the details of Florida’s latest order on Friday to determine what the rules will be for establishments that also serve food.

He had just reopened on Wednesday, following a professional deep cleaning after some employees fell ill with the virus.

“I don’t know if we can continue to do this: open, closing, open, closing,” he said. “You have people who desire to socialize and to earn and to live and to have some fun in this crazy world.”

In Arizona, Gov. Doug Ducey has held out on setting new limits in his state, even as cases there surged past 66,000, with an average of 2,750 new cases per day. He warned this week that hospitals were likely to hit surge capacity soon but he has remained opposed to backtracking on reopening.

“This is not another executive order to enforce, and it’s not about closing businesses,” he said this week. “This is about public education and personal responsibility.”

Still, shutting down businesses again in Arizona is not out of the question, Daniel Ruiz, the state’s chief operating officer, said in an interview on Friday.

“We want to treat that like a last resort,” Mr. Ruiz said. “It’s a tool in the toolbox, but it’s something that we’re going to use very judiciously.”

California, which had the first stay-at-home order in the nation this spring, has surpassed 200,000 cases, and on Friday, Mr. Newsom announced new restrictions on Imperial County, which has the state’s highest rate of infection. The county has exceeded its hospital capacity so severely that some 500 patients have had to be moved to beds elsewhere, and hospitals as far away as the Bay Area have been seeing Imperial County patients.

“This disease does not take a summer vacation,” said Mr. Newsom, noting that at least 15 of California’s 58 counties were being monitored closely as the virus surges.

In Los Angeles County, health officials estimate that every 400th person may currently be infected. Mayor Eric Garcetti of Los Angeles said he planned to wait three to five days before deciding whether to pull back on the city’s reopening.

“We’re not in the red zone but we’re in the yellow zone,” the mayor said in an interview on Friday.

From case counts to hospitalizations, he said, the city’s metrics are moving in the wrong direction, in part because of a patchwork of responses in neighboring areas.

Mr. Garcetti said he would like health officials in the state, the county and the surrounding region to come to a consensus strategy.

“If you don’t move together, there’s no point in being the lone holdout,” he said. “If you don’t have an entire region working together, who cares if you keep your gyms closed?”

Patricia Mazzei reported from Miami, Sarah Mervosh from Pittsburgh and Shawn Hubler from Sacramento. Contributing reporting were Nicholas Bogel-Burroughs and Giulia McDonnell Nieto del Rio from New York, Julie Bosman from Chicago, Manny Fernandez from Houston, Frances Robles from Miami, Michael D. Shear and Sheryl Gay Stolberg from Washington, and Dave Montgomery from Austin, Texas.

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