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Death toll discrepancies add to mounting list of uncertainties.
Doctors are scrambling to treat the coronavirus, researchers are racing to find a vaccine, economies are suffering, and now there is a further element of uncertainty to the outbreak that has touched nearly every corner of the globe: Even the death toll is being called into question.
Increasing evidence suggests there is significant gap between the number of confirmed coronavirus deaths and the true number of fatalities: At least 28,000 more people have died during the coronavirus pandemic over the last month than official counts report.
The gap was highlighted in an analysis of mortality data from 11 countries that show far more deaths than the average for the same period in recent years, which include deaths from Covid-19 and those from other causes, potentially including those who could not be treated when hospitals became overwhelmed.
The New York Times found that in Paris alone, more than twice as many people have died than during the same time frame in other years.
The revelations came as parts of Asia took steps on Tuesday to halt renewed outbreaks in places that were once held up as examples of how to effectively combat the virus.
Hong Kong, which has been battling a second wave of infections, on Tuesday extended a range of social distancing measures to May 7, a day after reporting no new coronavirus infections for the first time since early March. In Singapore, Prime Minister Lee Hsien Loong extended a lockdown by four weeks, until June 1, to stem a sharp rise in cases.
In Europe, Italy, one of the countries that has been hit hardest by the virus, became the latest to announce that it would pull back from restrictions and gradually open back up, joining a list that includes Germany, Spain and Denmark.
Prime Minister of Guiseppe Conte announced plans to begin easing the country’s lockdown, likely by May 4, with further details to be released later this week. Italy issued stringent restrictions on the movement of people across the country six weeks ago after its north was ravaged by the first major outbreak in Europe.
In recent days, a number of heartening developments — including the fact that the number of recoveries was outpacing the dwindling number of new cases — have left the Italian authorities hopeful that some restrictions could be lifted.
Still, Mr. Conte made clear in a Facebook post announcing the decision that any loosening would be gradual. “It’s too easy to say, ‘let’s open everything,’” he wrote.
The World Health Organization has emphasized the need for a cautious approach, noting that a rush to ease restrictions was likely to lead to a resurgence of the illness.
“This is not the time to be lax,” said Dr. Takeshi Kasai, the organization’s regional director for the Western Pacific, speaking in Bangkok on Tuesday. “Instead, we need to ready ourselves for a new way of living for the foreseeable future.”
As some countries explored targeted measures for a partial reopening, President Trump, whose efforts to limit immigration to the country predate the outbreak, announced a much broader approach, by saying that he intended to close the United States to people trying to come to the country to live and work.
28,000 missing deaths: Tracking the true toll of the crisis.
At least 28,000 more people have died during the coronavirus pandemic over the last month than official Covid-19 death counts report, a review of mortality data in 11 countries shows — providing a clearer, if still incomplete, picture of the toll of the crisis.
In the last month, far more people died in these countries than in previous years, The New York Times found. The totals include deaths from Covid-19 and those from other causes, potentially including those who could not be treated as hospitals became overwhelmed.
These numbers contradict the notion that many people who have died from the virus might soon have died anyway. In Paris, more than twice the usual number of people have died each day, far more than at the peak of a bad flu season. In New York City, the number is four times the normal amount.
Of course, mortality data in the middle of a pandemic is not perfect. The disparities between the official death counts and the total rise in deaths most likely reflect limited testing for the virus, rather than intentional undercounting. Officially, about 160,000 people have died worldwide of the coronavirus as of Tuesday.
But the total death numbers offer a more complete portrait of the pandemic, experts say, especially because most countries report only those Covid-19 deaths that occur in hospitals.
Italy is likely to begin easing its lockdown on May 4.
Prime Minister Giuseppe Conte of Italy said on Tuesday that the country was likely to begin easing lockdown measures from May 4, but added that the measures would be cautious and calculated.
Italy has been one of the countries hit hardest by the virus, and was the first in Europe to experience an influx in cases that overwhelmed its health care system. Its lockdown has been among the most restrictive in the world.
The announcement comes a day after the Italian authorities reported the country’s first decline in current positive cases. The number of recoveries reported on Monday outpaced the number of new cases; the overall total fell by 20, to 108,237 from Sunday’s 108,257.
Angelo Borrelli, who heads Italy’s Civil Protection Department, called the numbers “a further positive figure” that showed the success of the country’s six-week lockdown.
In a Facebook post on Tuesday morning, Mr. Conte said he would reveal the government’s plans to loosen restrictions and reopen the economy by the weekend, adding that caution must prevail in any decision.
“It’s too easy to say, ‘let’s open everything,’” he wrote.
Mr. Conte promised “a serious, scientific plan,” including measures to check whether the loosening was leading to an uptick in cases.
Social distancing measures would continue in workplaces and changes to public transportation and workday hours are expected. The measures are likely to vary from region to region, he wrote, adding that a “reasonable expectation” for when measures could be loosened would be May 4.
Concerns that loosening the lockdown measures could spark new outbreaks, especially in areas of the country that have remained mostly untouched, have weighed heavily on the government’s decisions. The current lockdown measures are officially in force until May 3, and experts say the restrictions have been key in tamping down the outbreak that ravaged the country’s north.
Hospitalizations and the number of patients in intensive care from the virus continue to decline in Italy, while the number of people being recovering has risen, the authorities said at a news conference on Monday. That said, the number of deaths remained at more than 450 a day.
“The battle has certainly not been won,” said Luca Richeldi, a government adviser. “It’s not time yet to lower our guard.”
Hong Kong extends its social distancing rules, even after local infections slow to zero.
Hong Kong on Tuesday extended a range of social distancing measures to May 7 as a precaution, a day after reporting no new coronavirus infections for the first time since early March.
Those measures, which had been set to expire on Thursday, include a ban on public gatherings of more than four people, along with widespread closures of gyms, bars and playgrounds, among other facilities.
Hong Kong has been praised for the early steps that its government took to contain the virus, including closing schools and ordering civil servants to work from home. For weeks, that helped to keep the semiautonomous Chinese territory’s overall caseload in the low hundreds.
But over the last month, Hong Kong has battled a second wave of infections that were fueled in large part by residents who were returning from Europe and the United States. It now has over 1,000 confirmed cases and four deaths, but has recorded five or fewer new cases each day since April 12.
On Tuesday, hours after announcing the extended restrictions, officials said they identified four new cases, all imported from overseas.
In mainland China, where the global outbreak began, officials on Tuesday reported 11 new cases, four of them imported, but no new deaths. China has recorded 4,632 deaths and more than 88,000 infections.
China said that six of its seven new locally transmitted cases were in Heilongjiang, a border province with Russia that has recently emerged as a hot spot for infections. The other was in Guangdong Province, next to Hong Kong.
Trump plans to halt immigration, and defends testing capacity.
President Trump said on Monday that he intended to close the United States to people trying to immigrate into the country to live and work, his most wide-ranging attempt yet to seal the country off from the rest of the world.
In recent weeks, the Trump administration has said health concerns justified moving swiftly to bar asylum seekers and undocumented immigrants from entering the country, alarming immigration activists who have said that Mr. Trump and his advisers were using a global pandemic to further hard-line immigration policies.
Mr. Trump also defended his administration’s handling of coronavirus testing, saying the nation had excess capacity even as some governors insisted that they lacked crucial materials, including nasal swabs and chemical reagents.
He framed the debates around testing in political terms, saying that Democrats wanted maximum testing “because they want to be able to criticize.” Testing has also emerged as a sticking point in negotiations between Congress and the administration on small-business aid, with Democrats pushing for a national testing strategy and Republicans, wary of placing the onus on the White House to devise and carry out such a strategy, arguing that states should set their own plans.
The Republican governors of Georgia, Tennessee and South Carolina moved to let some businesses reopen, including gyms, restaurants and beaches, though social distancing protocols will remain in effect to varying degrees. In South Carolina, for example, retail stores were told to operate at 20 percent occupancy or at five customers per 1,000 square feet, whichever is less.
The reopening announcements came as the outbreak continued to spread in parts of the nation, and modest crowds gathered to protest stay-at-home orders in several states. A prison in Ohio, the Marion Correctional Institution, is now the largest reported source of virus infections in the nation.
And although the curve is beginning to flatten in New York, the country has added more than 25,000 new cases a day for the past week, with Massachusetts particularly hard hit and clusters emerging in several other states.
As the coronavirus overwhelms the health care system, people with other illnesses are struggling to find treatment. Nearly one in four cancer patients reported delays in their care.
And in Texas, after an appeals court ruling, abortion is effectively banned in the state.
Oil prices plummeted on Monday as the economic crisis set off by the pandemic continued to destroy demand. Storage tanks in the United States that hold all the unused crude are near full capacity.
Shake Shack announced that it was returning a $10 million small-business aid loan from a federal program amid mounting criticism that large chains had been favored over smaller entities.
The Federal Reserve could soon expand its municipal bond-buying plans after announcing earlier this month its first-ever campaign to bolster the market for state and local debt.
Oktoberfest, the iconic German beer festival, is canceled.
Oktoberfest, Munich’s annual festival of beer-drinking, mug-swinging people packed together in massive tents, will not take place in 2020 because of concerns over the spread of the coronavirus, the authorities in the southern state of Bavaria said on Tuesday.
Beer fans from around the world convene in Munich every fall for the event, which has become an iconic symbol of southern German culture, as well as a highly lucrative tourist draw that last year generated $1.33 billion for the city.
But the authorities acknowledged that it would not be possible to enforce safe social distancing or the wearing of face masks among the millions of revelers during the festival, which was scheduled to run from Sept. 19 to Oct. 4.
“We are living in changed times,” Markus Söder, the governor of Bavaria, said as he announced the decision alongside the mayor of Munich. “Living with corona means living cautiously.”
This year will not be the first year in its 210-year history that Oktoberfest has had to be called off. It did not take place during the world wars, or during the epidemics of the 19th century.
For the past month, a tent has been set up on the fairgrounds, not to serve beer, but to test people for the coronavirus.
Indonesia bans travel during Muslims’ most important holiday.
President Joko Widodo of Indonesia announced Tuesday that he will ban millions of from returning to their home villages for the Eid al-Fitr holiday, known in Indonesia as Idul Fitri, an annual pilgrimage in late May to celebrate the Muslim holiday.
Mr. Joko had been under mounting pressure to ban the holiday migration, known as mudik, to slow the spread of the coronavirus. The travel ban will take effect Friday, but there will be no sanctions for violating it until May 7, said a top cabinet minister, Luhut Panjaitan.
Officials said major highways would not be closed but checkpoints would be set up around greater Jakarta to inspect vehicles and turn back those who appear to be violating the ban. Domestic air travel and train, bus and ferry service will be restricted.
Health experts fear that the virus is rapidly spreading in the world’s fourth-largest country and could overwhelm its limited health system. The virus has been found in all 34 provinces even though testing has been minimal.
Indonesia reported 7,135 confirmed cases and 616 deaths as of Tuesday, a fatality rate of nearly 9 percent. At least 42 doctors, nurses and dentists are among those who have died. In addition, many suspected Covid-19 patients have died before tests were conducted or completed.
In previous years, about 20 million people have traveled during mudik to be with their families. Mr. Joko earlier banned government employees and members of the police and military from joining in the migration.
There are many hurdles to developing and widely distributing a vaccine, a W.H.O. official warned.
The head of the World Health Organization’s emergencies program warned on Monday that even if a vaccine against the coronavirus were quickly developed, manufacturing and distributing it could prove extraordinarily difficult.
There is no approved treatment for or vaccine against infection with the coronavirus. More than two dozen companies have announced vaccine programs; at least three candidates already are in human trials.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has warned that a vaccine is at least 18 months away. Other experts say even that timeline is optimistic.
The development process is important, but manufacturers must begin planning to scale up manufacturing capacities to meet global demand when a successful vaccine is discovered, said Dr. Michael Ryan, head of the W.H.O.’s emergencies program.
Billions of people around the globe eventually may need vaccination. Modern vaccines, made with DNA and RNA, require specialized facilities; it is not clear who could make them.
And it will be important that vaccines go where they are most needed, not simply to the countries that can afford them. The W.H.O. is working with government leaders and nonprofits like the Bill and Melinda Gates Foundation and the Coalition for Epidemic Preparedness Innovations to ensure that means for equitable vaccine distribution are in place when the time comes, Dr. Ryan said.
“We’ve worked for over 20 years trying to ensure that products like vaccines are distributed in emergencies on the basis of epidemiological need,” Dr. Ryan said at a news briefing. “We intend to do exactly the same here.”
The agency has a long history of distributing vaccines to countries in need, including the meningitis, yellow fever, cholera and polio vaccines. Yet mass vaccination campaigns are still logistically difficult and often met with resistance in the community.
“As a global health architecture, we’re not very good at delivering vaccines in people other than children — in adults,” Dr. Ryan said.
“If this is to work, it will require one of the greatest scientific, one of the greatest political, one of the greatest financial, one of the greatest public health operations in a generation,” he added.
In Old Cairo, a subdued Ramadan looms as the virus shutters the city.
For over a thousand years, Cairo’s oldest mosques kept their doors open — through the Black Death of the 14th century, the devastating cholera epidemics of the 19th century and the Spanish flu in the winter of 1918 that claimed 140,000 Egyptian lives.
Then the coronavirus hit.
On the first day of the lockdown at Al Azhar, a famed center of scholarship that opened in A.D. 972, tears flowed down the cheeks of the muezzin, Sheikh Mohamed Rashad Zaghloul, as he made the call to prayer in an empty hall.
“It was hard on my heart,” he said after midday prayers one day last week at the mosque, where a stray cat meandered between the ancient pillars. “When I call people, nobody can come. It feels like God is refusing us.”
The shuttered ancient mosques are a harbinger of another event that will be jarringly altered by the pandemic. Ramadan, the holy month of fasting, begins at the end of this week and promises this year to be the strangest experienced by any Cairene, not to mention 1.8 billion Muslims worldwide.
A sacred period that is rooted in gathering — at mosques, homes and on the streets — will be replaced with a month of solitary prayer, stifled celebrations and gnawing anxiety over the silent march of a virus that has closed a city that never, ordinarily, sleeps.
“This Ramadan is going to be flavorless,” said Abdul Rehman, 19, at the deserted lantern store he tends in Khan el Khalili, the city’s most famous bazaar.
Frustrated by a lack of coronavirus tests, Maryland got 500,000 from South Korea.
When President Trump told governors that they needed to step up their efforts to secure medical supplies, Gov. Larry Hogan of Maryland took the entreaty seriously and negotiated with suppliers in South Korea to obtain coronavirus test kits.
“The No. 1 problem facing us is lack of testing,” said Mr. Hogan, a Republican, who has been among the many critics of the Trump administration’s repeated claims that states have adequate testing provided by the federal government. “We can’t open up our states without ramping up testing.”
In recent days, his wife, Yumi Hogan, a Korean immigrant who speaks fluent Korean, had been on the phone in the middle of the night helping to secure the final deal with two labs to sell Maryland the tests.
“Luckily we had a very strong relationship with Korea,” Mr. Hogan said. “But it should not have been this difficult.”
On Saturday, a Korean Air flight arrived at Baltimore-Washington International Airport carrying 5,000 test kits, which officials said would give the state the ability to make 500,000 new tests. The Food and Drug Administration and other agencies gave their seal of approval for the kits as the plane was landing.
Other states, desperate for things like personal protective equipment and other medical gears, have moved to acquire it, often stealthily, from other nations.
The latest in science: Six feet between tables may not be enough distance to safely reopen restaurants.
In January, at a restaurant in Guangzhou, China, one diner infected with the novel coronavirus but not yet feeling sick appeared to have spread the disease to nine other people. One of the restaurant’s air-conditioners apparently blew the virus particles around the dining room.
There were 73 other diners who ate that day on the same floor of the five-story restaurant, and the good news is they did not become sick. Neither did the eight employees who were working on the floor at the time.
Chinese researchers described the incident in a paper that is to be published in the July issue of Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention. The field study has limitations. The researchers, for example, did not perform experiments to simulate the airborne transmission.
That outbreak illustrates some of the challenges that restaurants will face when they try to reopen. Ventilation systems can create complex patterns of air flow and keep viruses aloft, so simply spacing tables six feet apart — the minimum distance that the C.D.C. advises you keep from other people — may not be sufficient to safeguard restaurant patrons.
The social nature of dining out could increase the risk. The longer people linger in a contaminated area, the more virus particles they would likely inhale. Eating is also one activity that cannot be accomplished while wearing a mask. Virus-laden droplets can be expelled into the air through breathing and talking, not just through coughs and sneezes.
On the other hand, all of the people who became sick at the restaurant in China were either at the same table as the infected person or at one of two neighboring tables. The fact that people farther away remained healthy is a hopeful hint that the coronavirus is primarily transmitted through larger respiratory droplets, which fall out of the air more quickly than smaller droplets known as aerosols, which can float for hours.
With Ramadan nearing, Pakistan urges reluctant mosques to obey distancing rules.
A showdown between Pakistan’s Muslim clerics and the government is brewing ahead of Thursday, the start of the holy month of Ramadan, as officials plead with mosques to follow social distancing rules.
Mosques have consistently violated Pakistan’s lockdown, ushering in the faithful every Friday for the last four weeks, as worshipers wash themselves under communal water taps before kneeling almost shoulder to shoulder in supplication. The police have tried to break up Friday Prayer across the country, but have been violently attacked by worshipers.
Pakistan saw its biggest single-day jump in cases on Monday, with 474 testing positive. So far the country has recorded 9,200 cases with nearly 200 deaths. With limited testing, the numbers are likely much higher.
A collection of clerics and the heads of Muslim political parties signed a letter last week demanding the government lift the lockdown rules for mosques during Ramadan. The world’s second-largest Muslim country, Pakistan has struggled to monitor and regulate mosques for decades, and they have become a driver of radicalization.
Government officials met with clerics over the weekend and agreed that mosques would be allowed to open during Ramadan as long as they followed 20 rules, which include forcing worshipers to stand six feet apart and performing ablutions at home. That the government capitulated underscored the tremendous power mosques yield over the state.
But many are skeptical the rules are enforceable after the clashes with police during Friday Prayer. Pakistan’s mosques have long operated as if they are above the law, often without repercussion.
In much of the Muslim world, clerics have followed the lockdown rules and shut their mosques.
Reporting was contributed by Elisabetta Povoledo, Maria Abi-Habib, Jin Wu, Allison McCann, Daniel Victor, Megan Specia, Carlotta Gall, Farnaz Fassihi, Melissa Eddy, Jennifer Steinhauer, Jason Schreier, Mike Ives, Jin Wu, Richard C. Paddock, Dan Levin, Alissa J. Rubin, Declan Walsh and Kenneth Chang.
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