43 percent of U.S. virus deaths are tied to nursing homes and long-term care facilities.
At least 54,000 residents and employees of nursing homes and long-term care facilities have died from the coronavirus, according to a bioreports database, accounting for 43 percent of virus-related deaths in the United States.
Relying on reports from states, counties and individual facilities, as well as some data from the federal government, The Times has tracked 282,000 known coronavirus cases at some 12,000 facilities.
Most of the country’s largest clusters have emerged in nursing homes, prisons and food processing facilities — places where social distancing is difficult or impossible, and in some cases where shutting down because of the pandemic was not an option. While many of the prison and food processing clusters involved more total cases, the country’s deadliest outbreaks have been largely in nursing homes, where older residents with underlying health problems are uniquely vulnerable to the virus.
In nursing homes with large outbreaks, The Times found that about 17 percent of people with the virus died, compared to about 5 percent of all known coronavirus patients. In Minnesota, New Hampshire and Rhode Island, more than three-quarters of all coronavirus deaths have been tied to long-term care facilities. At least six nursing homes, all in the Northeast, have reported 70 or more coronavirus deaths.
In Ohio, outdoor visitation at nursing homes will be allowed starting on July 20, as long as safety protocols are followed, Gov. Mike DeWine said on Monday. Fifty-seven percent of the more than 2,800 virus deaths in the state have been linked to nursing homes, which have barred visitors since March.
“I know that this has been gut wrenching for families not to be able to see in person their loved one,” Mr. DeWine said.
A searchable list of all nursing homes known to have had at least 50 coronavirus cases is available here.
Pence was more vocal about mask wearing over the weekend, despite Trump’s reluctance.
Vice President Mike Pence made a point of wearing a face mask during public events over the weekend as he and top public health officials said face coverings were critical to reversing recent spikes in coronavirus cases.
His actions stood in stark contrast to those of President Trump, who has steadfastly refused to wear a mask as a way of modeling behavior for the public — even as the nation’s top doctors have said they increasingly believe doing so is a critical step in containing the spread of the virus.
In a speech at a Dallas church on Sunday and later at a briefing with the governor of Texas, cameras captured Mr. Pence wearing a black mask as he walked up to the lectern, taking it off only moments before he began speaking.
A few hours later, he wore the same mask as he walked into the briefing room with Gov. Greg Abbott, a Republican, who also wore a mask. Both men kept the masks on — with the cameras rolling — until the briefing began.
One of the central messages of the briefing — from Mr. Pence, Mr. Abbott and Dr. Deborah L. Birx, the coordinator of the White House coronavirus task force — was to encourage everyone in Texas and other states with a high number of new cases to wear masks to stop the disease from accelerating.
“If your local officials, in consultation with the state, are directing you to wear a mask, we encourage everyone to wear a mask in the affected areas. And where you can’t maintain social distancing, wearing a mask is just a good idea,” Mr. Pence said. “And it will, we know, from experience, will slow the spread of the coronavirus.”
The vice president, who was tapped to be the point person on the White House coronavirus task force in February, has worn face masks in public in the past. He wore one in early May at an Indiana manufacturing plant after being criticized for failing to wear one during a tour of the Mayo Clinic.
And on Friday, during a high-profile briefing of the task force, he took his mask off as he was walking up the stage and did not follow the lead of the others on the stage, who put their masks back on when they were not speaking at the lectern.
Senator Mitch McConnell of Kentucky, the majority leader, stressed the need for Americans to wear masks in a speech on the Senate floor.
“We must have no stigma, none, about wearing masks when we leave our homes and come near other people,” said Mr. McConnell, who has been wearing masks as he walks through the Capitol and attends event in Kentucky. “Wearing simple face coverings is not about protecting ourselves, it is about protecting everyone we encounter.”
Gov. Andrew Cuomo of New York called on President Trump on Monday to sign an executive order directing everyone to wear a mask. “We know it works, we’ve proven that it works in the state of New York,” he said.
The W.H.O. will send experts to China to investigate the source of the virus.
The World Health Organization will send a team of experts to China next week to investigate the original source of the coronavirus.
“We can fight the virus better when we know everything about the virus, including how it started,” Dr. Tedros Adhanom Ghebreyesus, the head of the organization, said on Monday.
While the coronavirus likely originated in bats, how it was transmitted to humans remains unknown. The outbreak was first identified late last year at a market in Wuhan, China, and one hypothesis is that other poached wildlife sold there might have spread the virus to people.
Dr. Tedros said it is very important to know the exact zoonotic origin of the virus and understand the science behind it in order to deal with the current pandemic and outbreaks that might occur in the future.
In February, a W.H.O. delegation led by Dr. Bruce Aylward, a specialist with experience fighting polio, Ebola and other health emergencies, spent two weeks in China and said health officials there were seeing success in suppressing the outbreak.
The United States and other countries have criticized China over its initial handling of the outbreak, including delays in reporting the first cases to the W.H.O., and for looking to deflect blame for the epidemic on outsiders. The W.H.O. has been reluctant to publicly criticize China, and at times it has praised health officials for providing genetic information about the virus and taking strong action around Wuhan to contain it. Member countries of the organization agreed to investigate the W.H.O.’s initial response to the virus during a meeting in May, but the Trump administration nonetheless said it would cut off support for the organization.
Tuesday will mark six months since China reported the first cases of the virus to the W.H.O. Dr. Tedros said that “the worst is yet to come.” “I am sorry to say that,” he said, “but with this kind of environment and condition, we fear the worst.”
Gilead will charge up to $3,120 per treatment course of remdesivir, which has shown modest benefits in some patients.
After weeks of donating the antiviral drug remdesivir to hospitals with severely ill patients, the drug’s maker, Gilead Sciences, announced today that it has settled on a price — $390 per vial, which works out to $2,340 per treatment course.
Gilead also said it would charge more to private insurers in the United States: $520 per vial, or $3,120 for a treatment course. Uninsured patients also would be charged that price.
Until recently, remdesivir was the only drug shown to help severely ill Covid-19 patients, but the benefits were modest, and the drug did not improve survival in those patients.
The company said this price, which it will charge in all developed nations, is far below the drug’s value. A large federal study found that remdesivir shortened recovery time in severely ill patients by four days on average. Four days in the hospital would cost about $12,000 per patient, Gilead’s chief executive, Daniel O’Day, said in a statement on Monday.
The Institute for Clinical and Economic Review, a nonprofit group that calculates fair prices for drugs, estimated that Gilead would need to charge $1,600 per regimen to recoup its costs, but that as much as $5,080 per treatment course would be still be cost-effective, given that patients would be able to leave the hospital sooner.
Critics have long accused Gilead of overcharging for groundbreaking drugs, including Harvoni, a hepatitis C treatment that lists for as much as $100,000. In a statement on Monday, I.C.E.R. warned, “Gilead has the power to price remdesivir at will in the U.S., and no governmental or private insurer could even entertain the idea of walking away from the negotiating table.”
But since many Wall Street analysts were expecting the drug to cost about $5,000 for a course of treatment, the lower price “can be viewed as a responsible decision from Gilead,” I.C.E.R. added.
The Department of Health and Human Services said on Monday that the Trump administration had struck “an amazing deal” with Gilead. The company would supply 500,000 vials of the drug through September, enough to treat 232,000 patients. Hospitals would pay the wholesale price of $520 per vial.
Gilead’s last shipment of 120,000 treatment courses of donated drug is going out today.
The new supply will be distributed to hospitals based on need. After September, however, H.H.S. will no longer be involved in remdesivir’s distribution.
Over half of U.S. states see cases of virus-related syndrome in children, a report finds.
Over half of American states have seen young people become seriously ill from a virus-related inflammatory syndrome, most of them previously healthy, according to the first national report on such cases.
Nearly 90 percent of the 186 patients in the report were hospitalized, and most of those needed intensive care, the researchers said. One in five of the patients, who were all under 21, became so sick that they required ventilators, and four children died. The study was conducted by researchers at the Centers for Disease Control and Prevention and several hospitals.
The study, published Monday in The New England Journal of Medicine, along with a separate report by the New York State Health Department, provides the most detailed picture to date of how the recently identified condition has spread and how devastating it can be for some children.
The condition, called Multisystem Inflammatory Syndrome in Children (or MIS-C) appears to arise two to four weeks after children become infected. Most seem to have no or very few of the initial respiratory symptoms that are a hallmark of the virus in adults, suggesting that their bodies were able to fight off the first strike of the infection.
But experts believe that the immune system in some children gets revved up weeks later, causing a surge of inflammatory symptoms like rashes, red eyes, digestive problems and persistent fever. In the most serious cases, the children develop a racing heart rate and very low blood pressure — a form of shock — and can experience inflammation of the heart or cardiac failure that can be deadly.
Half a million people are dead as confirmed virus cases top 10 million.
The global total of deaths from the coronavirus has passed 500,000, according to a bioreports database, while the number of confirmed cases surpassed 10 million.
The grim markers were hit on Sunday as countries around the world struggled to keep new infections from reaching runaway levels while simultaneously trying to emerge from painful lockdowns.
In April, roughly a month after the World Health Organization declared the outbreak a pandemic, deaths topped 100,000. In early May, the figure climbed to 250,000.
More than a quarter of all known deaths have been in the United States.
The number of confirmed infections — which took about 40 days to double — may be substantially underestimated, public health officials say. Data released last week by the Centers for Disease Control and Prevention indicated that the actual figures in many regions are probably 10 times as high as reported.
The Times has also found that the actual death toll in the United States and more than two dozen other countries is higher than has been officially reported. Limited testing availability has often made it difficult to confirm that the virus was the cause of death.
In the United States, early hot spots emerged in the Northeast, particularly the New York metropolitan area, but the recent surge has occurred primarily in the South and the West, forcing some states to retreat from reopening plans.
Other countries, particularly Brazil and India, are also being hit with a large wave of new infections.
And while dozens of countries that took early steps to contain and track the pandemic have been able to control the virus within their borders, experts fear that fatigue with lockdowns and social distancing has allowed the virus to spread with renewed intensity.
At a Houston hospital bracing for a virus peak, new patients are often young.
Coronavirus cases are rising quickly in Houston, as they are in other hot spots across the South and the West. Harris County, which includes most of Houston and is one of the largest counties in the nation, has been averaging more than 1,100 new cases each day, among the most of any American county. Just two weeks ago, Harris County was averaging about 313 new cases daily.
Melissa Estrada, 37, was among those being treated at Houston Methodist Hospital. She probably contracted the virus while attending a dinner with relatives who had also been cautious, she said. Within days, all four adults and several children who had been at the gathering tested positive.
“It was really, really scary,” Ms. Estrada said of her illness. “You hear about it and you think it’s the older people or the people with underlying issues,” she said. “And I’m healthy. I don’t understand how I got this bad.”
Jacksonville moves to require masks as new cases surge in Florida.
As new coronavirus cases surge in Florida, the city of Jacksonville said on Monday that face masks will now be required in any indoor public place where social distancing is not possible. The city is scheduled to host the Republican National Convention in August.
Jacksonville is one of several cities and counties across the state that are moving to reimpose restrictions and closings in response to the surge, which has followed the reopening of beaches, bars, restaurants and other social activities. South Florida counties said they would close their beaches for the Fourth of July holiday weekend, and on Friday, state officials ordered bars to stop selling alcohol for on-premises consumption.
The mask requirement is a reversal of course for Jacksonville, where the Republican mayor, Lenny Curry, had previously resisted issuing such a mandate. He was not at the news conference where it was announced on Monday; a spokeswoman said he had a prior family obligation.
Over the weekend, Florida crushed its previous daily record for new cases, reporting 9,585 infections on Saturday. An additional 8,530 were reported on Sunday, and over 5,200 more on Monday. All told, the state has now had more than 146,000 confirmed cases, and six-hour lines formed in Jacksonville over the weekend as thousands of people flocked to get drive-through tests.
On Monday, the Republican National Committee said it was “committed to holding a safe convention that fully complies with local health regulations in place at the time.”
Elsewhere around the United States:
Hawaii, which has gained a reputation for imposing some of the toughest restrictions for visitors, is seeing a resurgence of infections. On the state’s most populous island, Oahu, an uptick in cases was reported on Sunday by the Honolulu mayor, Kirk Caldwell, who called the spike alarming but said the infections were detected quickly and that the people who tested positive were isolated.
Officials in Montana announced more than 50 new cases of the coronavirus on Monday, a single-day record. Montana and Hawaii are the only states with fewer than 1,000 known cases of the virus.
Black people account for more than 22 percent of the virus cases in Maine, but make up 1.6 percent of the state’s population, Sara Gideon, the speaker of the state House, said in a video posted on Twitter. Ms. Gideon, a Democrat who is running for the U.S. Senate against the Republican incumbent Susan Collins, said it was a reminder of the structural inequities and institutional racism in the health care system.
A Pennsylvania company that sold bottles of hand sanitizer at an extreme markup on Amazon must refund customers nearly $14,000 and pay a $1,900 fine as part of a price gouging action, the state attorney general said. The retailer, Goods And More Inc., which is based in Scranton, charged as much as $109.99 for 24-packs of two-ounce bottles of sanitizer and as much as $39.00 for 12-ounce bottles of Purell, Josh Shapiro, the state attorney general said.
Two friends in Texas were tested for the virus. One bill was $199. The other? $6,408.
Throughout the pandemic, the cost of coronavirus testing across the United States has varied greatly, often by location. In one extreme case, two Texans who were recently administered the same test at the same Austin drive-through location saw a more than $6,000 difference between their bills.
With the virus raging in the state, they wanted to get screened ahead of a camping trip with friends even though they were not experiencing symptoms. The two friends, Jimmy Harvey and Pam LeBlanc, both tested negative.
Mr. Harvey paid $199 out of pocket for his test, and Ms. LeBlanc, who went through her insurance, was charged $6,408. Ms. LeBlanc was able to negotiate that cost down to $1,128, $928 of which she had to pay. (Ultimately, the insurance company dropped all charges).
Researchers say these discrepancies exist because the U.S. government does not regulate health care costs.
Another person tested at the Austin site was told he was only getting a coronavirus test, but when he saw the explanation of costs on his $5,649 bill, it listed tests for other contagious conditions including Legionnaires’ disease, herpes and enterovirus.
The New Jersey-based Genesis Laboratory processed the samples from the Austin location. Another Dallas-based medical laboratory, Gibson Diagnostic Labs, has run some of the most expensive coronavirus tests in America, in one case charging insurers $6,946 for one test.
The virus is battering Africa’s growing middle class.
As the virus spreads in many countries in Africa, it is threatening to push as many as 58 million people in the region into extreme poverty, experts at the World Bank say. But beyond the devastating consequences for the continent’s most vulnerable people, the pandemic is also whittling away at one of Africa’s signature achievements: the growth of its middle class.
For the last decade, Africa’s middle class has been pivotal to the educational, political and economic development across the continent. New business owners and entrepreneurs have created jobs that, in turn, gave others a leg up as well.
Educated, tech-savvy families and young people with money to spare have fed the demand for consumer goods, called for democratic reforms, expanded the talent pool at all levels of society, and pushed for high-quality schools and health care.
About 170 million out of Africa’s 1.3 billion people are now classified as middle class. But about eight million of them could be thrust into poverty because of the coronavirus and its economic fallout, according to World Data Lab, a research organization.
“We have been working hard to build better lives,” James Gichina, a tour van driver, said of his colleagues in the tourist sector. Now, he said, “We have nothing.”
Other world news:
A coronavirus vaccine candidate has received approval from the Chinese government for use by the country’s military, its maker said on Monday. CanSino Biologics, a pharmaceutical company based in Tianjin, says it has seen promising results in early trials.
The Chinese authorities imposed a strict lockdown on nearly half a million people in a county near Beijing, in the latest effort by the government to stamp out a small but stubborn second wave of infections in and around the capital.
Britain is set to lift restrictions on pubs, restaurants, hotels, barbershops and salons and other venues on Saturday, but the city of Leicester, in central England, might not be included after a regional outbreak of the virus, the city’s mayor said.
Polling places open in Texas for a primary runoff in the pandemic’s shadow.
Voters in Texas began casting ballots in person on Monday, the opening day of early voting in the state’s July 14 primary runoff, amid an alarming surge in new coronavirus cases.
Primary runoffs in the state are usually a low-interest affair, with turnout below 10 percent. But with Texas now a U.S. hot spot, this runoff poses special problems.
All the state’s major metropolitan areas have set fresh records for new infections and hospitalizations in recent weeks, prompting Gov. Greg Abbott to abruptly roll back his economic reopening plan last week, ordering bars to close and restaurants to cut back how many patrons they seat.
Familiar pandemic precautions are expected to be in use at polling places across the state. Election administrators and voters will be expected to wear face masks and maintain at least six feet of distance.
The voting will decide more than 30 Democratic and Republican nominating contests for the November general election, including races for Congress, seats in the state legislature and various state and county offices. Top of the list statewide is the choice of a Democratic challenger to run against Senator John Cornyn, a Republican.
The runoff had originally been scheduled for May 26, but Mr. Abbott postponed it to July 14 to give election officials more time to prepare and the coronavirus more time to taper off. Instead, the pandemic has sharply worsened. Early voting continues until July 10.
Texas law limits mail-in balloting to people who are away from home and unable to vote in person, or who are 65 or older. Texas Democrats, citing the dangers caused by the coronavirus, waged an unsuccessful legal effort to allow all voters to cast mail-in ballots in the runoff; they are still trying to do so for the November election.
Cal Jillson, political science professor at Southern Methodist University in Dallas, said concerns about the virus will undoubtedly have an impact on voting. “It can’t help but suppress the early in-person vote, at least marginally.”
CULTURE AND SPORTS ROUNDUP
Broadway will stay dark for the rest of the year.
Broadway will remain closed for at least the rest of this year, and many shows are signaling that they do not expect a return to the stage until late winter or early spring.
The Broadway League said Monday that theater owners and producers are ready to refund or exchange tickets previously purchased for shows through Jan. 3. But, given the unpredictability of the pandemic, the League said it was not yet ready to specify a date when shows will reopen.
Broadway shows went dark on March 12, and already this has been the longest shutdown in history. Thus far three shows, the Disney musical “Frozen,” a new Martin McDonagh play called “Hangmen,” and a revival of Edward Albee’s “Who’s Afraid of Virginia Woolf,” both of which were in previews, have announced that they will not resume performances when Broadway reopens.
Several producers have indicated that they are looking several months into 2021 for a resumption of their productions.
“Birthday Candles,” a new play by Noah Haidle that had been scheduled to open this spring, will not open until the fall of next year.
In other sports and culture news:
Cirque du Soleil announced that it had filed for bankruptcy protection in Canada and would seek to do the same in the United States. With productions shuttered, the famed circus said that it had lost its entire revenue stream. The company, which this year temporarily laid off 5,000 employees, nearly 95 percent of its work force, said that it had entered into a “stalking horse” purchase agreement for existing shareholders to restart the business.
Brazilian soccer players are openly objecting to their return to play. Botafogo, one of the top teams, came out to its first game back carrying a banner protesting the game, and its players laid out their objections on social media. The chairman of another top team has also expressed his reservations.
Tentative plans will expand the 2021 Sundance Film Festival from Park City, Utah to at least 20 other locales in the United States and, possibly, Mexico. The festival said that its “full curated program” would also be made available online.
Wall Street rebounds, shrugging off the continuing rise in virus cases.
Stocks rallied Monday, rebounding from a week of losses, even as a resurgence in coronavirus cases that had alarmed Wall Street last week continued to grow.
The S&P 500 rose more than 1 percent, after having fallen nearly 3 percent last week. A jump in shares of Boeing helped lead the Dow Jones industrial average to a gain of nearly 2 percent. Shares in Europe had also ended higher, after rebounding from a decline earlier in the day.
Companies that have come to reflect investor sentiment toward the return of normal spending by American consumers — retailers and airlines — were among the best performing stocks in the S&P 500. Southwest Airlines rose nearly 9 percent, and Simon Property Group, which operates shopping malls, jumped more than 8 percent.
And oil prices rose, with West Texas intermediate futures approaching the $40 a barrel mark.
Top Democrats resume calls for negotiations on another round of pandemic aid.
Top Democratic leaders renewed calls for negotiations to begin on another pandemic relief package, as coronavirus cases continue to skyrocket across the country and a number of existing relief measures, including a $600 expanded unemployment benefit, near expiration without congressional action.
Speaker Nancy Pelosi of California and Senator Chuck Schumer of New York, the minority leader, slammed Senator Mitch McConnell of Kentucky, the majority leader, for his unwillingness to begin another round of talks, writing in a letter to Mr. McConnell that “now is the time for action, not continued delays and political posturing.”
“As Americans struggle to make rent payments and face evictions and as our health care and child care systems face unprecedented burdens, Senate Republicans have been missing in action at your direction,” the two leaders wrote. “We have overcome larger problems than the Covid-19 pandemic but not without powerful and effective actions by our government.”
Though there is widespread acknowledgment on Capitol Hill that another relief package is needed, Mr. McConnell and top Senate Republicans have pushed to delay any negotiations or legislation until after the chamber returns from a two-week July 4 recess. House Democrats in May already approved what amounts to their opening offer: a sweeping $3 trillion stimulus package that builds on previous legislation.
Republicans, however, have repeatedly stressed that Congress should wait to see the impact and implementation of the $2.2 trillion stimulus package that became law in March, before doling out another round of taxpayer aid. Even as several economists have pleaded with Congress to continue spending and maintain the unemployment extension, the Republican conference remains divided over how to balance the economic need for relief with calls to cut down more spending.
On Monday, Speaker Nancy Pelosi informed colleagues that she would extend into August the period in which members of the House can vote remotely by proxy because of the coronavirus.
In a brief letter, she said that the House sergeant-at-arms and Congress’s attending physician had certified that “a public health emergency is in effect” and that she would allow proxy votes to be cast until at least August 18.
Republicans so far have refused take part in the proxy voting system. Dozens of Democrats unable or unwilling to travel to Washington have done so, casting their votes through designated colleagues present on the House floor.
How to safely return to your exercise routine
Now that stay-at-home restrictions are easing, some are heading to the nearest reopened park or playground for exercise. Here’s how to do so safely.
Reporting was contributed by Ian Austen, Brooks Barnes, Pam Belluck, Emily Cochrane, Abdi Latif Dahir, Sheri Fink, David Leonhardt, Gina Kolata, Iliana Magra, Patricia Mazzei, Dave Montgomery, Christina Morales, Michael Paulson, Daniel Politi, Amy Qin, Austin Ramzy, Frances Robles, Mitch Smith, Hilary Stout, David Streitfeld, Neil Vigdor, David Waldstein, Mihir Zaveri and Karen Zraick.