When Will the Pandemic End? And How?

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When will the Covid-19 pandemic end? And how?

According to historians, pandemics typically have two types of endings: the medical, which occurs when the incidence and death rates plummet, and the social, when the epidemic of fear about the disease wanes.

Among the diseases to have achieved a medical end is smallpox, which has an effective vaccine that gives lifelong protection. Bubonic plague struck several times in the past 2,000 years, killing millions of people and altering the course of history, but cases are now rare.

An end can also occur not because a disease has been vanquished but because people grow tired of panic mode and learn to live with a disease.

“When people ask, ‘When will this end?’ they are asking about the social ending,” said Dr. Jeremy Greene, a historian of medicine at Johns Hopkins.

The 1918 flu killed 50 million to 100 million people worldwide, preying on young to middle-aged adults — orphaning children, depriving families of breadwinners, killing troops in the midst of World War I.

After sweeping through the world, it evolved into a variant of the more benign seasonal flu. It ended socially, too. People were ready for a fresh start, a new era, and eager to put the nightmare of disease and war behind them.

That virus still circulates as a seasonal flu, but its initial path of destruction is rarely recalled. Until recently, even the 1918 flu was largely forgotten.

One possibility with the Covid-19 pandemic, historians say, is that it could end socially before it ends medically. People may grow so tired of the restrictions that they declare the pandemic over, even as the virus continues to smolder in the population and before a vaccine or effective treatment is found.

“Looking back, we have a weak narrative,” said Dora Vargha, a historian at the University of Exeter. “For whom does the epidemic end, and who gets to say?”

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Delta Air Lines started 2020 celebrating what it said was the most successful year in company history. Not long after, it shared a record $1.6 billion in profits with its 90,000 employees. But with air travel nearly shut down by the coronavirus, the airline is now bleeding money and will drop 10 more airports from its already skeletal network on Wednesday.

Even as Delta and the other major airlines in the United States drastically slash schedules, they are averaging an anemic 23 passengers on each domestic flight and losing $350 million to $400 million a day as expenses like payroll, rent and aircraft maintenance far exceed the money they are bringing in. Passenger traffic is down about 94 percent and half of the industry’s 6,215 planes are parked at major airports and desert airstrips, according to Airlines for America, a trade group.

Yet, devastating as the downturn has been, the future is even more bleak. With much of the world closed for business, and no widely available vaccine in sight, it may be months, if not years, before airlines operate as many flights as they did before the crisis. Even when people start flying again, the industry could be transformed, much as it was after the Sept. 11 terrorist attacks. And airline executives need only look in the not-distant past to see how lesser crises sank carriers that were household names like Pan Am and Trans World Airlines.

The current crisis could push some airlines, especially smaller ones, into bankruptcy or make them takeover targets. Consumer fears about catching the virus on crowded planes could lead to reconfigured seating. Carriers may initially entice wary travelers with discounts, but if they cannot fill up flights, they may resort to raising ticket prices.

Henry Harteveldt, president of Atmosphere Research Group, a travel analysis firm in San Francisco, said that carriers might continue to leave middle seats empty in coach “until they see demand exceed two-thirds of where it was before the pandemic.” Now, he said, “You can be benevolent. It’s easy to give away a product that you don’t have any demand for.”

To get through the next few months, airlines successfully lobbied for a huge federal rescue. But half of that money was intended to cover payroll and that will run out by the end of September. Few in the industry expect Congress or the public to tolerate another bailout. So, for now, airlines are preparing for a long, lonely fight for survival.

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The Trump administration is racing to contain an outbreak of the coronavirus inside the White House, as some senior officials believe that the disease is already spreading rapidly through the warren of cramped offices that make up the three floors of the West Wing.

Three top officials leading the government’s coronavirus response have begun two weeks of self-quarantine after two members of the White House staff — one of President Trump’s personal valets and Katie Miller, the spokeswoman for Vice President Mike Pence — tested positive. But others who came into contact with Ms. Miller and the valet are continuing to report to work at the White House.

“It is scary to go to work,” Kevin Hassett, a top economic adviser to the president, said on CBS’s “Face the Nation” program on Sunday. Mr. Hassett said he wore a mask at times at the White House, but conceded that “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

He added: “It’s a small, crowded place. It’s, you know, it’s a little bit risky. But you have to do it because you have to serve your country.”

The discovery of the two infected employees has prompted the White House to ramp up its procedures to combat the virus, asking more staff members to work from home, increasing usage of masks and more rigorously screening people who enter the complex.

It is not clear how many other White House officials Ms. Miller or the valet might have come into contact with in recent days, but many members of the West Wing staff who were most likely in meetings with Ms. Miller before she tested positive are still coming to work, according to senior administration officials.

Late Sunday, the White House put out a statement saying that Mr. Pence would not alter his routine or self-quarantine. The vice president “has tested negative every single day and plans to be at the White House tomorrow,” said Devin O’Malley, a spokesman for Mr. Pence.

At the White House, all employees are being tested at least weekly, officials said, and a handful of top aides who regularly interact with the president are being tested daily.

“To get in with the president, you have to test negative,” Mr. Hassett said on CNN’s “State of the Union” program.

Mr. Trump continues to reject guidance from the Centers for Disease Control and Prevention to wear a mask when meeting with groups of people. But a senior administration official said the president was spooked that his valet, who is among those who serve him food, had not been wearing a mask. And he was annoyed to learn that Ms. Miller tested positive and has been growing irritated with people who get too close to him, the official said.

Concern about the spread of the virus in the White House has temporarily sidelined three of the most high-profile members of the coronavirus task force — Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention; Dr. Stephen Hahn, the commissioner of the Food and Drug Administration; and Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases.

Dr. Redfield and Dr. Hahn announced over the weekend that they would self-quarantine for two weeks after coming in contact with an infected member of the president’s staff. Both attended a meeting in the Situation Room last week where Ms. Miller was present, and they said they would continue to participate in the response effort from home. Dr. Fauci said he, too, had begun a “modified quarantine” after what he called a “low risk” contact with an infected staff member.

The Navy’s top admiral, Michael M. Gilday, will self-quarantine for one week after coming into contact with a family member who has tested positive for the coronavirus, the Pentagon said in a statement on Sunday night. And Senator Lamar Alexander, Republican of Tennessee, said Sunday that he, too, would self-quarantine after a member of his staff tested positive.

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Before coronavirus cases hit hard a few weeks ago, paramedics would respond to calls for patients whose hearts had stopped by beginning chest compressions, administering epinephrine or using the defibrillator to try to shock the heart back to life.

They would have done this even though studies have found that only about 1 to 3 percent of people found in such a condition can be resuscitated. For that is what emergency workers have been trained to do: make every possible effort to save every life.

But with so many paramedics sickened by the virus, emergency units have changed their practices to limit their exposure. The most unsettling change, according to interviews with paramedics in a half-dozen of the most affected states, is the decision to suspend, or limit, resuscitation in cases when the odds of survival are near zero.

“This is medicine that we have never done before. It’s scary. There are ethical dilemmas that come with it,” said Terry Hoben, the coordinator of emergency medical services at University Hospital in Newark. “To resuscitate and save one life, and risk five?” he asked, saying of these tough decisions, “We do not take this lightly.”

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The coronavirus has preyed on residents of nursing homes in New Jersey with lethal force, claiming more than 4,850 lives. Deaths at long-term care facilities now account for half of the state’s Covid-19 fatalities, well over the national rate.

As of Sunday, 15 nursing homes had reported 30 or more deaths apiece, including four with more than 50 deaths, state records show. But nowhere has the devastation been starker than at the New Jersey Veterans Home at Paramus, a state-run home for former members of the U.S. military.

The home, about 12 miles northwest of New York City, is built on the idea that those who served in the military are entitled to dignified care in their twilight years. Instead, in what some people have called a betrayal of this fundamental pact, the Paramus home is the site of one of the biggest coronavirus outbreaks in the country.

The virus has swept through the facility, which in late March had 314 residents, infecting 60 percent of its patients. As of Sunday, 72 deaths there had been linked to the virus.

The list of the dead is almost certain to grow: Of the remaining 211 veterans and their spouses, 120 had either tested positive for the virus or were awaiting results. About one in five staff members has contracted the virus, and one employee has died.

“The whole place is sick now,” said Mitchell Haber, whose 91-year-old father, Arnold, an Army veteran, died last month at the home.

“What they should really do is raze it and put a park there,” he said. “It’s like a mass shooting.”

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Encompassing tens of millions of acres of snow-peaked mountains, jagged coastlines and geological marvels, the National Park System is facing the quandary of how to keep visitors at more than arm’s length from each other as the summer months approach.

But campgrounds, visitor centers and picnic pavilions remained closed, as the park began undertaking measures to disinfect public buildings and restrooms, install plexiglass barriers at visitor centers, reduce group sizes and require maintenance workers to wear personal protective equipment.

“We recognize this closure has been extremely difficult for our local residents, as well as park visitors from across the country, who seek the park as a special place for healing, exercise, recreation and inspiration,” Cassius Cash, the park’s superintendent, said in a statement. “We are approaching this phased reopening with that in mind, as we balance our responsibility to protect park resources and the health and safety of everyone.”

“The public’s renewed appreciation for our public lands is a bright spot in an otherwise dark time,” Wendy Ross, the park’s superintendent, said in a statement.

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Being first is often a good thing, but the opening this week of what could be the first major concert in the United States since the pandemic prompted the cancellation of live events is turning into a fraught affair.

While the world’s big touring acts remain on hiatus or confined to sporadic online performances, Travis McCready, a country-rock singer, is set to take the stage on Friday for an intimate acoustic live performance at a venue in Fort Smith, Ark.

The performance, though modest, is attracting outsize attention, not only because it is testing whether people are ready to return in numbers to listen to live music but also because it is challenging the restrictions the governor put on such performances.

Gov. Asa Hutchinson has said indoor venues such as theaters, arenas and stadiums can reopen on May 18 as long as they limit their audiences to fewer than 50 people. The venue, Temple Live, a former Masonic Temple, is saying the show will be held three days earlier, with more than four times that number of fans allowed in — 229 in the 1,100-seat theater.

Promoters have emphasized that masks will be mandatory and social distancing enforced, and they have suggested it is discriminatory for the government to have set more lenient restrictions on church gatherings than on concert venues.

“The virus does not know if it’s in a body in church or high school or a music venue,” said Mike Brown, a representative for Temple Live. “Not that I have anything against church, but if you can go to a church and it’s a public assembly, there is no difference. How is it OK for one group to have a public meeting and it’s not OK for a music venue to have the same opportunity?”

The governor, however, is not backing down.

“As advertised, this concert does not comply with our Department of Health directives for indoor entertainment venues,” Governor Hutchinson said in an emailed statement.

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The coronavirus has left many people struggling to make sense of the seemingly random terror it inflicts. But for many black families in America, mourning coronavirus deaths brings an added burden, as they wonder whether racial bias may have played a role.

Decades of research shows that black patients in the United States receive inferior medical care compared with white patients. Many families, social scientists and public health experts now fear that racial bias may be contributing to the disproportionately high rate at which Covid-19 is killing African-Americans.

African-American patients enter the health care system with distinct disadvantages, experts say. There is less access to quality health care in many black communities, research shows. And black people are more likely to have diabetes, hypertension and other underlying conditions that make Covid-19 particularly fatal.

The National Medical Association, the country’s largest professional organization representing black doctors, is calling on federal health agencies to study the role bias may have played in the testing and treatment of African-Americans for Covid-19.

Its president, Dr. Oliver Brooks, said, “I think what we will find is race is a factor.”

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President Trump’s top economic advisers are bracing for the unemployment rate to climb above 20 percent in the coming months, as the coronavirus pandemic continues to stifle economic activity and wipe out jobs.

The unemployment rate leapt to 14.7 percent in April, the Labor Department reported on Friday — the highest level since the Great Depression — as lawmakers debate the next round of stimulus measures to buttress the cratering economy. Congress has already pumped trillions of dollars into the economy in the hope of propping up businesses and stabilizing financial markets, but the job losses show little sign of abating.

Treasury Secretary Steven Mnuchin said on Sunday that the jobs figures would get worse before they got better. He said the real unemployment rate — including people who are underemployed as well as those entirely without work — could soon approach 25 percent.

“There are very, very large numbers,” Mr. Mnuchin said on “Fox News Sunday.”

The White House is encouraging governors to begin reopening their states safely but quickly. Mr. Mnuchin suggested that not reopening could cause “permanent” economic damage, ultimately posing a greater risk to the country than reopening.

“Unlike the Great Depression, where you had economic issues that led to this, we closed down the economy,” he said.

White House officials are considering proposals for another economic relief package, which they hope will include a payroll tax cut and provisions to protect businesses from liability for bringing employees back to work. But Mr. Mnuchin said more legislation was not imminent.

Kevin Hassett, a White House economic adviser, said on the CNN program “State of the Union” that the Trump administration was watching to see what effect the first reopenings have in energizing the economy.

“We think that we have a moment — the luxury of a moment — to learn what’s going on,” Mr. Hassett said, “so that the next step can be prudent.”

Even so, Mr. Hassett predicted that the jobless rate could hit 20 percent next month, and he suggested that restrictions may have to be reimposed if coronavirus cases picked back up.

Despite the White House’s hopes, it appears increasingly likely that the labor market will take a considerable time to recover.

Neel Kashkari, the president of the Federal Reserve Bank of Minneapolis, said Sunday on the ABC program “This Week” that “if this goes on for a long period of time,” outbreaks, lockdowns and returns to work would continue in phases over “a year or two.”

“The worst is yet to come on the job front, unfortunately,” Mr. Kashkari said, adding: “To solve the economy, we must solve the virus. Let’s never lose sight of that fact.”

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Former President Barack Obama thinks that President Trump is doing a poor job of handling the coronavirus pandemic, and that he represents a historic threat to constitutional democracy. But the former president has been so unwilling to call out his successor publicly that his staff has begun referring to Mr. Trump as “He-Who-Must-Not-Be-Named,” a half-joking reference to the arch-villain Voldemort in the “Harry Potter” novels.

Even so, Mr. Obama launched arguably his most scathing attack on Mr. Trump’s White House since he left office, lashing the president’s handling of the pandemic as “a chaotic mess” during a group call with 3,000 of his former White House and campaign aides.

In remarks that were later leaked to the news media, Mr. Obama seemed most infuriated by the Justice Department’s decision to drop charges against Mr. Trump’s former national security adviser, Michael T. Flynn.

“There is no precedent that anybody can find for somebody who has been charged with perjury just getting off scot-free,” Mr. Obama said on the call, according to a participant.

Mr. Obama’s team publicly pointed to his fiery endorsement of Joseph R. Biden Jr., his vice president and the presumptive Democratic nominee, and his sharp attacks on Mr. Trump (sometimes by name), to suggest that his latest remarks were part of a long pattern. Privately, though, the aides acknowledged that they were nothing of the sort.

Mr. Obama is deeply anxious about the election, and is worried about the incumbency advantage that Mr. Trump has. He is seeking to even the playing field a bit by throwing his considerable weight around, four people close to him said, adding that Mr. Obama plans to do so again when opportunities arise.

Mr. Trump has issued a torrent of defensive Twitter messages in the past two days on several sore subjects, including the Flynn matter. On Sunday, he lashed back at Mr. Obama, calling his administration’s handling of the H1N1 flu pandemic in 2009 a “disaster.”

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On April 10, Tony Thompson, the sheriff for Black Hawk County in Iowa, visited the giant Tyson Foods pork plant in Waterloo. What he saw, he said, “shook me to the core.”

Workers, many of them immigrants, were crowded elbow to elbow as they broke down hog carcasses zipping by on a conveyor belt. The few who had face coverings wore a motley assortment of bandannas, painters’ masks or even sleep masks stretched around their mouths. Some had masks hanging around their necks.

Five days later, the plant was closed. Tyson said the reason was “worker absenteeism.” As of last week, the county health department had recorded 1,031 coronavirus infections among Tyson employees — more than a third of the work force. Some are on ventilators. Three have died, according to Tyson.

But the plant — Tyson’s largest pork operation in the United States, responsible for almost 4 percent of the nation’s pork supply — didn’t stay closed for long.

As meat shortages hit U.S. grocery stores and fast-food restaurants, political pressure built to reopen plants that had shut down because of virus outbreaks. An executive order by President Trump declared the meat supply “critical infrastructure” and shielded the companies from certain liability.

New safety precautions have been added at the Tyson plant, and now the question is this: Will America’s appetite for meat be sated without sickening armies of low-wage workers, and their communities, in new waves of infection?

Gov. Mike DeWine of Ohio, who is facing an open revolt among fellow Republicans, said he would veto a bill by state legislators that would limit his administration’s ability to issue a stay-at-home order lasting more than two weeks.

“I’ve made it clear to the legislature that if that reached us, and I don’t think it will, but I would veto that,” he said on “Fox News Sunday.”

Mr. DeWine took aggressive steps in the early days of the virus to reduce transmissions but the state, which has seen its new cases and deaths stabilize, is still not meeting the federal government’s recommendations for reopening.

“We are really at a plateau with hospitalizations, we are at a plateau with deaths, and we are at a plateau in regard to new cases,” he said. “We wish we were going down — we’re not.”

Ohio has more than 23,000 cases and a growing hot spot at a prison in Marion. Still, with more than 1.1 million Ohio workers filing for unemployment over the past two months, Mr. DeWine is under pressure to get the state back to work.

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Elon Musk, the Tesla chief executive, clashed with health officials in California on Saturday over the reopening of the company’s factory in Fremont, with Mr. Musk pushing for an immediate return and the county’s government seeking a delay of about a week.

In a series of tweets, Mr. Musk said he would move the company’s headquarters out of California to Texas or Nevada. Tesla also took its fight to federal court, filing a lawsuit against Alameda County on Saturday. The company said “the county’s position left us no choice but to take legal action to ensure that Tesla and its employees can get back to work.”

The actions came a day after county health officials told Tesla that it was not yet allowed to resume production of electric vehicles in Fremont because of fears that the coronavirus could spread among the company’s workers. Manufacturers have been allowed to restart work in other parts of the state that have had less severe outbreaks.

Tesla, which noted that it was “the last major carmaker remaining in California, and the largest manufacturing employer in the state with more than 10,000 employees at our Fremont factory and 20,000 statewide” — outlined in a blog post its rationale for pushing to reopen, and detailed on how it plans to proceed.

“Frankly, this is the final straw,” Mr. Musk said on Twitter. “Tesla will now move its HQ and future programs to Texas/Nevada immediately. If we even retain Fremont manufacturing activity at all, it will depend on how Tesla is treated in the future.”

Credit…Brittainy Newman/The New York Times

The factors that made New York City the U.S. epicenter of the pandemic — its density, tourism and dependence on mass transit — complicate a return to any semblance of normalcy.

States like Colorado, Georgia and Texas have let stay-at-home orders lapse and businesses like nail salons and retail stores reopen, and New York State is anticipating a partial reopening this month, mostly in rural areas. But the city is far from meeting the public health metrics necessary to reopen, from available critical-care beds to new hospital admissions for the virus.

The virus has killed more than 19,000 people in New York City, a death toll that exceeds those in all but a small number of countries, or in California, Illinois, Massachusetts, Michigan and Texas combined. While the outbreak is receding in the city, more than 1,000 new positive cases were reported on at least three days last week, for a total that now tops 181,000.

The key to reopening is containing the virus, and that will take a vast infrastructure of testing and contact tracing unlike anything the United States has ever seen, public health experts say.

How long might it take to restart New York City’s economy?

Said Gov. Andrew M. Cuomo last week: “Nobody can tell you.”

It’s easy to be stationary when there’s nowhere to go, and children tend not to respond well to formal workouts. Here are some ideas to help the whole family — from the youngest to the oldest — get up and move a bit more, without it feeling like work.

Reporting was contributed by Nicholas Bogel-Burroughs, Neal E. Boudette, Graham Bowley, Audra D. S. Burch, Rukmini Callimachi, Niraj Chokshi, Emily Cochrane, Michael Corkery, Michael Crowley, Melina Delkic, John Eligon, Reid J. Epstein, Tess Felder, Emily Flitter, J. David Goodman, Maggie Haberman, Rebecca Halleck, Shawn Hubler, Gina Kolata, Sharon LaFraniere, Michael Levenson, Ben Protess, Alan Rappeport, Michael Rothfeld, Eric Schmitt, Michael D. Shear, Shreeya Sinha, Jeanna Smialek, Mitch Smith, Sheryl Gay Stolberg, Ana Swanson, Jim Tankersley, Katie Thomas, Glenn Thrush, Tracey Tully, Neil Vigdor and David Yaffe-Bellany.

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