As Hot Spots Shift, Pandemic Enters a New Phase

As new hot spots emerge, the pandemic may be entering another phase.

The simplest way to track the progress of any outbreak is by seeing how many new cases and deaths are reported in a given area each day. And in the United States, falling numbers in some of the hardest-hit places have offered glimmers of hope. Totals for the country have been on a downward curve, and in former hot spots like New York and New Jersey, the counts appear to have peaked.

But infections and deaths are rising in more than a dozen states, as they are in countries around the world, an ominous sign that the pandemic may be entering a new phase.

Wisconsin saw its highest single-day increase in confirmed cases and deaths this week, two weeks after the state’s highest court overturned a stay-at-home order. Cases are also on the rise in Alabama, Arkansas, California and North Carolina, which on Thursday reported some of the state’s highest numbers of hospitalizations and reported deaths since the crisis began.

In metropolitan areas like Fayetteville, Ark.; Yuma, Ariz.; and Roanoke and Charlottesville, Va., data show new highs may be only days or weeks away.

Outbreaks have accelerated especially sharply in Argentina, Brazil, Colombia, Mexico and Peru, leading the World Health Organization to say on Tuesday that it considered the Americas to be the new center of the pandemic.

And although much of the Middle East seemed to avert early catastrophe even as the virus ravaged Iran, case counts have been swelling in Kuwait, Saudi Arabia, Qatar and the United Arab Emirates.

Reported cases are not perfect measures to chart the spread of the virus because they depend on how much testing is done. Death counts are less dependent on testing, though official numbers are typically undercounts. Both counts, though, can indicate how the outbreak is evolving, especially in places where lockdown rules are easing or where governments have been ineffective at slowing the spread, and offer early clues about new hot spots.

That is why Wisconsin is being closely monitored. Two weeks ago, the conservative majority on the State Supreme Court overturned that state’s stay-at-home order, effectively removing the most serious restrictions on residents.

It can take several weeks after changes in behavior — like the increased movement and interactions associated with the end of a stay-at-home order — for the effect on transmissions to be reflected in the data. In Wisconsin, there were indications that the virus was still spreading before the order was lifted. But in the weeks since restrictions were overturned, the case numbers have continued to grow.

“It worries us,” said Dr. Nasia Safdar, the medical director for infection prevention at the University of Wisconsin Hospital in Madison. “We wonder if this is a trend in an unfavorable direction.”

The C.D.C. is suggesting changes that would radically alter how America goes to work.

Upon arriving at work, employees should get a temperature and symptom check.

Inside the office, desks should be six feet apart. If that is not possible, employers should consider erecting plastic shields around them.

If followed, the guidelines would lead to a far-reaching remaking of the corporate work experience. They even upend years of advice on commuting, urging people to drive to work by themselves, instead of taking mass transportation or car-pooling, to avoid potential exposure to the virus.

The recommendations run from technical advice on ventilation systems (more open windows are most desirable) to a suggested abolition of communal perks like latte makers and snack bins. And some border on the impractical, if not near impossible: “Limit use and occupancy of elevators to maintain social distancing of at least 6 feet.”

The G.O.P. is pressuring North Carolina’s governor to approve a safety plan for its convention.

Republicans planning their party’s convention on Thursday gave North Carolina’s governor a deadline of June 3 to approve safety measures to prevent the spread of the coronavirus during the event, planned for Charlotte in August. The move came as President Trump pressures Democratic leaders in the state to allow him to hold the kind of convention he wants, and as they cite public health concerns and say it is too soon to make a determination.

The Republican National Committee chairwoman, Ronna McDaniel, and the president of the convention committee, Marcia Lee Kelly, laid out the deadline in a joint letter to Gov. Roy Cooper.

The president has tried to force Mr. Cooper and Vi Lyles, the mayor of Charlotte, to commit quickly to a Republican plan for a party celebration in the biggest city in a state that Mr. Trump won in 2016.

But the letter also appeared to be an effort to put the onus on Mr. Cooper and Ms. Lyles, both of whom are Democrats, if Republicans end up trying to stage their convention in another state.

“We still do not have solid guidelines from the state and cannot in good faith, ask thousands of visitors to begin paying deposits and making travel plans without knowing the full commitment of the governor, elected officials and other stakeholders in supporting the convention,” Ms. McDaniel and Ms. Kelly wrote.

Relief programs are set to run out, severing an economic lifeline.

For millions of Americans left out of work by the pandemic, government assistance has been a lifeline preventing a plunge into poverty, hunger and financial ruin.

This summer, that lifeline could snap, reports Ben Casselman.

The $1,200 checks sent to most households are long gone, at least for those who needed them most, with little imminent prospect for a second round. The lending program that helped millions of small businesses keep workers on the payroll will wind down if Congress does not extend it. Eviction moratoriums that kept people in their homes are expiring in many cities.

And the $600 per week in extra unemployment benefits that have allowed tens of millions of laid-off workers to pay rent and buy groceries will expire at the end of July.

The latest sign of the economic strain and the government’s role in easing it came Thursday, when the Labor Department reported that 2.1 million more Americans applied for unemployment benefits last week. More than 40 million people have filed for benefits since the crisis began, and some 30 million are receiving them.

The multitrillion-dollar patchwork of federal and state programs has not kept bills from piling up or prevented long lines at food banks, but it has mitigated the damage. Now the expiration of those programs represents a cliff that individuals — and the broader economy — are hurtling toward.

“The CARES Act was massive, but it was a very short-term offset to what is likely to be a long-term problem,” said Aneta Markowska, the chief financial economist for the investment bank Jefferies, referring to the legislative centerpiece of the federal rescue. “This economy is clearly going to need more support.”

Even the possibility that the programs will be allowed to expire could have economic consequences, Ms. Markowska said, as consumers and businesses brace for the loss of federal assistance.

President Trump and other Republicans have played down the need for more spending, saying the solution is for states to reopen businesses and allow companies to bring people back to work. So despite pleas from economists across the political spectrum — including Jerome H. Powell, the Federal Reserve chairman — any federal action is likely to be limited.

Masks become a flash point for businesses, with many requiring them, and a few banning them.

The C.D.C. recommends wearing cloth face coverings in public settings where it is difficult to maintain social distancing, including grocery stores, pharmacies and gas stations. It also continues to emphasize how critical social distancing is.

But masks have unexpectedly crossed over from public health measures to politically charged symbols, with many shops and restaurants banning customers who do not wear them — and a few others moving to ban customers who do.

In Kentucky, a gas station told customers that no one was allowed inside its convenience store if they had their face covered. In California, a flooring store near Los Angeles has encouraged hugs and handshakes but does not permit face masks. And a bar in Texas taped a poster to its front door this week that said “sorry, no masks allowed.”

In New York, the nation’s hardest-hit state, Gov. Andrew M. Cuomo said on Thursday that he would issue an executive order authorizing businesses to deny entry to people who were not wearing face coverings.

“That store owner has a right to protect themselves,” Mr. Cuomo said. “That store owner has a right to protect the other patrons in that store.”

Dennis Townsend, a Republican supervisor in California’s rural Tulare County, said that as his conservative district reopened for business, masks had become a continuing point of contention.

“People tell me, ‘OK, I’ll go to the stores, but they better be wearing masks in there.’ And then other people tell me, ‘OK, I’ll go to the stores, but they better not make me wear a mask,’” he said.

Mr. Townsend said he was “not real big on wearing masks” himself but had done so when shopping.

“What I tell people is that with every freedom we have comes additional responsibility,” he said. “We’ve had one freedom suppressed for a little while, but now it’s back, and that’s going to require additional personal responsibility on our parts.”

Washington State says it has reclaimed $300 million in fraudulent unemployment claims.

Washington State, which has been battling a deluge of fraudulent unemployment claims, has managed to claw back some $300 million in payments that went out to fraudsters, officials said Thursday.

Suzi LeVine, the commissioner of Washington State’s Employment Security Department, said the recovery came from coordination among law enforcement agencies and financial institutions. She did not reveal exact numbers on recoveries or the total number of fraudulent claims and said that the state was continuing to work on additional collections while blocking more false claims.

“The criminals have not gone away because we continue to see significant highly suspicious traffic,” Ms. LeVine said.

The Massachusetts Department of Unemployment Assistance said in a statement that it had also seen fraudsters trying to file large numbers of illegitimate claims, while the cybersecurity firm Agari said it had seen evidence of the fraudulent claims targeting states all over the country.

What is the real risk of catching the virus from a surface or object?

Fears about contracting the virus from contaminated surfaces have prompted many to wipe down groceries, leave packages unopened and stress about elevator buttons.

But what is the real risk? The C.D.C. recently tried to clarify its guidance: “It may be possible that a person can get Covid-19 by touching a surface or object that has the virus on it, and then touching their own mouth, nose or possibly their eyes, but this isn’t thought to be the main way the virus spreads.”

So does this mean we can get the virus from touching a doorknob, catching a Frisbee or sharing a casserole dish? The Times asked the experts, who said the best way we can protect ourselves from the virus — whether it is surface transmission or close human contact — is still social distancing, washing our hands, not touching our faces and wearing masks.

Sports fans can attend games at outdoor venues in Texas.

Gov. Greg Abbott of Texas said that starting Friday, sports fans could attend games at outdoor venues in most counties in Texas, so long as occupancy was limited to 25 percent. Fans cannot attend indoor sporting events.

Gov. Brian Kemp of Georgia said amusement parks, traveling carnivals and water parks could open June 12. And in California, more than a dozen Indian casinos, asserting sovereignty, defied Gov. Gavin Newsom and reopened last week. The Viejas Casino and Resort in Alpine, Calif., vowed to impose strict limits on the number of people gambling at once. A majority of Indian casinos in the state have chosen to stay closed and are coordinating their reopening with the governor’s office, which has proposed a date in early June.

A French study found 1 in 10 diabetic patients with Covid-19 died within a week of being hospitalized.

One in 10 diabetic patients with Covid-19, the illness caused by the virus, died within a week of being hospitalized, according to a study published on Thursday by French researchers in Diabetologia, the journal of the European Association for the Study of Diabetes.

Another 20 percent were put on ventilators to assist with breathing by the end of their first week in the hospital. Only 18 percent were discharged within a week.

“I don’t want to scare people, but what is true is we did not expect to see such high mortality, with 10 percent of people admitted dying in the first seven days,” said Dr. Samy Hadjadj, a professor of endocrinology at the University of Nantes in France and one of the authors of the study.

A majority of patients in the study had Type 2 diabetes. Many people with diabetes also have cardiovascular disease, which raises the risk of death in Covid-19 patients.

But the new study, which included 1,317 patients at 53 French hospitals, found that microvascular injuries — involving tiny blood vessels supplying the eyes, kidneys and peripheral nerves — were also linked to a higher risk of death.

Obstructive sleep apnea also raised the risk of early death in these patients, while obesity and advanced age were linked to a greater likelihood of severe disease, the study found.

“This is serious,” Dr. Hadjadj said. “If you have diabetes and are elderly or have complications, be very careful. Keep away from the virus. Go on with social distancing, wash your hands carefully, keep people away who can bring you the virus.”

Dr. Hadjadj added, “You are not the kind of person who can afford to disregard these rules.”

As more people under 40 test positive in Washington State, researchers fear they will spread the virus.

People under 40 make up an increasing share of those who have tested positive for the virus in Washington State. Researchers in Seattle said that policymakers might need to focus on younger people to limit the spread.

In a new analysis, the researchers said about half of new identified cases were among people under 40, up from one-third of infections earlier in the outbreak.

Younger people may be more likely to work or participate in social activities, especially as restrictions are eased. While they do not face as high a risk of serious complications from infections, they can expose other people they encounter who may be older or who have hazardous underlying conditions, the researchers said.

“Our findings indicate a justifiable concern regarding the phased reopening plan for Washington State in late May in light of the shift in Covid-19 incidence from older to younger age,” the researchers wrote in their report, posted on the preprint server medRvix.

The researchers said government leaders may need to pursue specific advisories for children, teenagers and young adults to warn them of the risks of social interaction.

Democrats hope to turn a small business loan program into a political liability for Trump.

Democrats are mobilizing to turn the $2 trillion effort that President Trump is overseeing into a political liability going into his re-election campaign.

The attention has focused on a small business loan program that has been marred by glitches, changing rules and cases of large, publicly traded companies receiving funds while smaller shops are left waiting.

Top Democrats have seized on examples of rich executives’ getting money through the Paycheck Protection Program as indicative of corporate cronyism.

The Democratic National Committee and Democratic state parties in swing states held conference calls last week with reporters and other events highlighting stories of small business owners who did not get approved for loans.

Pacronym, a progressive super PAC that focuses on digital advertising, began running a $1.5 million ad campaign in five swing states — Arizona, Michigan, North Carolina, Pennsylvania and Wisconsin — that focused on struggling small businesses.

Some Republicans are embracing the program. Senator Susan Collins, a Maine Republican facing a tough re-election battle, has spent nearly $500,000 on ads that promote her role in “co-authoring” the program, according to data from Advertising Analytics, an ad tracking firm. And Senator Mitch McConnell, Republican of Kentucky and the majority leader, spent $175,000 on an ad featuring small business owners and employees describing jobs and businesses that were “rescued” by Mr. McConnell’s efforts on the stimulus package.

The Trump administration has scrambled to rewrite the rules of the program on the fly as public backlash intensified. The Treasury on Thursday carved out $10 billion of money to be used for loans to underserved communities.

Pennsylvania House Democrats say Republicans hid a lawmaker’s positive virus test.

Democrats in Pennsylvania’s House of Representatives on Thursday accused Republicans of keeping a lawmaker’s positive virus test a secret to avoid political embarrassment, even at the risk of exposing fellow legislators.

A Republican House member, Andrew Lewis, confirmed on Wednesday that he received a positive test on May 20 and self-isolated. Mr. Lewis said that every lawmaker or staff member he was in contact with who “met the criteria for exposure” was notified.

But Democrats disputed that, saying none of their own members were alerted even though some were near Mr. Lewis in committee meetings.

The House Democratic campaign arm accused Republicans of hiding Mr. Lewis’s positive test “to protect their public talking points against science and facts.” Another Republican representative, Russ Diamond, who said he was notified of possible exposure through contact with Mr. Lewis, had previously spoken at a shutdown protest outside the Capitol and boasted on social media of not wearing a mask while shopping.

In an emotional Facebook video recorded in his office at the Capitol, Representative Brian K. Sims, a Democrat from Philadelphia, said Mr. Diamond had “apparently been quarantining himself for weeks” but “didn’t explain that to any of us when he was in committee, talking with us or walking up and down the aisles or bumping into us or letting us hold the door open for him.”

Mr. Lewis said he had kept his positive diagnosis private “out of respect for my family and those who I may have exposed.”

Representative Ryan Bizzarro, a Democrat, disputed that Mr. Lewis had quarantined himself after his diagnosis. “We have footage of him being here,” he said.

The White House will not update its economic projections this summer.

The Trump administration will not issue a midyear update to its economic forecasts this summer, breaking decades of tradition during the uncertainty of a pandemic recession, administration officials confirmed on Thursday.

The decision will spare the administration from having to announce its internal projections for how deeply the recession will damage economic growth and how long the pain of high unemployment will persist.

When the administration last published official projections in February, it forecast economic growth of 3.1 percent from the fourth quarter of 2019 to the fourth quarter of 2021, and growth rates at or around 3 percent for the ensuing decade. It forecast an unemployment rate of 3.5 percent for the year.

The virus has rendered those projections obsolete. Unemployment could hit 20 percent in June, the White House economic adviser Kevin Hassett told CNN this week. The Congressional Budget Office said in April that it expects the economy will contract by 5.6 percent this year and end with unemployment above 11 percent.

The White House is required by law to issue both an annual budget and a midyear update to it, called a “mid-session review.” Updating economic projections in the mid-session review is optional, but it is a practice that administrations — including Mr. Trump’s — have widely followed since the review was mandated by Congress in 1970.

The review is required by law to give at least a partial window into how the administration expects the economy to perform this year and in the future.

Global updates: Britain begins a track-and-trace system.

The push for large-scale coronavirus testing and contact tracing has been at the core of the World Health Organization’s guidance for stopping the coronavirus. And as some nations bring in new track-and-trace systems designed to prevent a second major wave of infections, others’ experiences offer case studies — and cautionary tales.

What does it feel like to have Covid-19 and not need hospitalization?

Rest and fluids are essential, but so is knowing when to call a doctor. Give yourself plenty of time to feel better.

Reporting was contributed by Mike Baker, Karen Barrow, Scott Cacciola, Ben Casselman, Emily Cochrane, Patricia Cohen, Michael Cooper, Catie Edmondson, Nicholas Fandos, Thomas Fuller, Trip Gabriel, David Gelles, Erica L. Green, Jenny Gross, Apoorva Mandavilli, Jennifer Medina, Sarah Mervosh, Talya Minsberg, Andy Newman, Nadja Popovich, Roni Caryn Rabin, Alan Rappeport, Dana Rubinstein, Margot Sanger-Katz, Anna Schaverien, Kaly Soto, Sheryl Gay Stolberg, Vanessa Swales, Jim Tankersley and Katie Van Syckle.