Health care workers in some hard-hit states have taken to social media to issue urgent pleas for new restrictions to slow the spread of the virus and for the public to take precautions more seriously.
In Nebraska, Dr. Dan Johnson, a critical care anesthesiologist with Nebraska Medicine, a major health network in the region, posted on Facebook about the crisis last week, saying that current measures were not enough to stop the high rate of transmission.
The state has seen new virus cases reach an average of 2,033 cases per day, an increase of 99 percent from two weeks earlier. In the state, masks are required at indoor businesses where close contact is maintained, and indoor gathering limits are set at 25 percent of capacity. Retail stores, restaurants and bars are still open, as are houses of worship.
“This means that individual citizens and families must take matters into our own hands. Strict adherence to social distancing is essential,” Dr. Johnson wrote. “If things get completely out of control, every family in Nebraska will be affected either by a death or by serious illness.”
On Twitter, Dr. Angela Hewlett, an epidemiologist at the University of Nebraska Medical Center, specifically called on the governor to increase “directed health measures,” noting that the number of hospitalizations in the state was “skyrocketing.”
“Our community and our hospitals are suffering,” she said. “We are not an unlimited resource.”
In another appeal on Facebook, Dr. John McCarley, a doctor in Chattanooga, Tenn., noted that local hospitals were filling up. He posted: “I’m not saying we need a lockdown but I am asking everyone to get back to a May 2020 mind-set and routinely wear the mask when indoors around others besides your household.”
In Amarillo, Texas, an internal medicine doctor said that hospitals in the city were trying to find ways to add additional I.C.U. space, and pleaded with the public to wear a mask and socially distance. “An ounce of prevention is better than a pound of cure,” Dr. Whit Walker wrote on Facebook. “I see some people inside in a public store without a mask. If you give this virus to me I might give the virus to 5 or 20 other people. One or five of those might die from the virus. Even though you feel well, you can carry this virus. Even if you had the infection in the past, you might get this same virus again. This is real. This is deadly.”
In North Dakota, a state with critically understaffed hospitals and the nation’s highest rates of new cases and deaths per person, doctors have for weeks been asking the government to implement stricter restrictions — in particular a mask mandate.
On Friday, Gov. Doug Burgum finally obliged by announcing several measures, including a mask mandate, a limit on indoor dining of 50 percent capacity, or 150 people, and a suspension of high school winter sports and extracurricular activities.
And in Missouri, health care workers asked government officials to enact more restrictions in response to their dire words of caution with a statement released Thursday by the Missouri Hospital Association.
“We urge Gov. Mike Parson to continue to promote the message that Missourians’ help and compliance is necessary to help prevent catastrophic increases in hospital admissions,” the statement said.
Governors and public health officials across the United States are pleading with Americans to change their behavior and prepare for a long winter as the country shatters record after record for coronavirus cases and hospitalizations.
Both records were broken yet again Friday, as more than 181,100 new cases were reported nationwide, and on Saturday at least 121,000 new cases were recorded. The seven-day average of new daily cases is more than 140,000, with upward trends in 49 states. Some 30 states added more cases in the last week than in any other seven-day period.
Gov. Andrew M. Cuomo of New York tweeted on Saturday morning: “One in every 378 Americans tested positive for COVID over the past week. Wear a mask.” Mr. Cuomo’s math is on target: In a population of 330 million, 894,819 people, or 1 in 378, tested positive since last Saturday.
The virus has killed more than 1,000 Americans a day in the past week, a toll that would shock the nation were it not for the fact that twice as many people were dying daily during a stretch in April, when doctors knew less about how to treat Covid-19, the disease caused by the virus.
Wyoming reported 17 new deaths on Saturday; Oklahoma 23; Montana 36; and South Dakota 53, all single-day records.
On Saturday, New Jersey, West Virginia, Maryland, Minnesota, Indiana, Utah, Montana and Alaska all set single-day records for new cases.
North Dakota also hit a single-day record on Saturday, announcing 2,270 new cases. In a reversal, the state’s governor, Doug Burgum, announced several measures late Friday, including a mask mandate; a limit on indoor dining of 50 percent capacity, or 150 people; and a suspension of high school winter sports and extracurricular activities until Dec. 14. The state has critically understaffed hospitals and the highest rates of new cases and deaths per person in the nation.
In the spring, North Dakota was one of a handful of states that never entered a lockdown, and Mr. Burgum had for weeks resisted any new orders, emphasizing personal responsibility instead of requirements such as a mask mandate.
But the state’s situation has rapidly deteriorated: Over the past week, it has averaged 1,334 cases per day, an increase of 54 percent from the average two weeks earlier, and deaths are climbing fast. Hospitals are so overwhelmed that on Monday, Mr. Burgum angered the state nurses’ union by announcing that medical workers who test positive could stay on the job to treat Covid-19 patients as long as the workers show no symptoms.
In New Mexico on Friday, Gov. Michelle Lujan Grisham announced the nation’s most sweeping statewide measure of the fall season, issuing a two-week “stay at home” order to begin Monday. She asked people to shelter in place except for essential trips and said nonessential businesses and nonprofits must cease in-person activities.
Gov. Kate Brown of Oregon issued orders Friday to place the state in a partial lockdown for two weeks, shuttering gyms, halting restaurant dining and mandating that social gatherings have no more than six people. Ms. Brown, along with the governors of California and Washington, also urged residents to avoid all nonessential interstate travel in the days ahead.
Dr. Anthony S. Fauci, the nation’s top infectious disease expert, appeared on “CBS This Morning” on Friday to repeat his pleas to Americans to take the virus seriously.
“If we do the things that are simple public health measures, that soaring will level and start to come down,” he said. “You add that to the help of a vaccine, we can turn this around. It is not futile.”
A Texas appeals court ruled late Friday that El Paso County did not have the authority to impose a sweeping stay-at-home order, dealing a blow to local officials who had restricted business activity in an effort to stop the out-of-control spread of the coronavirus.
The ruling means that restaurants in the border city of 680,000, which now has more people hospitalized with Covid-19 than most states — 1,091 as of Saturday — may serve food indoors and outdoors, and gyms, barbershops and nail salons, which have been closed, may reopen.
The decision was the latest to bring efforts to tamp down the resurging virus into the legal sphere. As governors, mayors and other local officials have begun instituting new restrictions, a new wave of legal fights is also anticipated.
In El Paso, it was the owners of local restaurants, joined by Ken Paxton, the Texas attorney general and a Republican, who sued after the top county executive, Ricardo A. Samaniego, a Democrat, imposed the restrictions in late October.
Hospitals were already filling at the time, and Mr. Samaniego said that the order needed to be extended past Thanksgiving to prevent the virus’s further spread in the hard-hit community.
A lower court upheld the limits, but the Eighth District Court of Appeals ruled that Mr. Samaniego had overstepped his bounds. The appeals court found that the lockdown conflicted with less restrictive statewide orders by Gov. Greg Abbott, a Republican.
“Just as a servant cannot have two masters, the public cannot have two sets of rules to live by, particularly in a pandemic,” wrote Chief Justice Jeff Alley.
The county is not pursuing an appeal, a lawyer involved in the case said.
The mayor of El Paso, Dee Margo, a Republican who had questioned the order from the start, said in a statement that the city and its police force would immediately stop enforcement, and called on El Paso residents to do their own part to limit the spread of the virus. “We must balance the lives and the livelihoods of our community, and this requires all of us to change our social behavior,” he said in a statement.
A state-owned long-term nursing care facility for veterans near Lexington, Ky., is in the grip of a lethal outbreak of the coronavirus.
Eighty-six veterans have tested positive for the virus at the Thomson-Hood Veterans Center since October, and 24 have died, according to Gov. Andy Beshear. Forty-eight of the veterans have recovered, five are in the hospital, and nine are being treated at the center.
Among the staff, 63 have tested positive. Fifty-two of them have recovered, and 11 cases are still active, Mr. Beshear said in a news conference on Friday. He said that the outbreak, the center’s first, was the result of community spread and that it began when three veterans and seven staff members tested positive last month. The U.S. Department of Veterans Affairs provided medical staff to assist at the center.
The governor pleaded with Kentuckians to do what they could to limit the virus’s spread. “This is the toughest spot we’ve been in thus far,” Mr. Beshear said. “You must do your part and folks, this is now to the point where you need to be wearing your mask simply to protect yourself. It will also help others around you, but if you are not wearing a mask, you are putting yourself at personal risk of this virus.”
Over the past week, the state has logged an average of 2,272 cases per day, an increase of 37 percent from the average two weeks earlier. Since the start of the pandemic, Kentucky has had 135,855 coronavirus cases and 1,729 deaths, according to a New York Times database.
The spread of the virus within Thomson-Hood, in Wilmore, Ky., is the latest example of the vulnerabilities at veterans’ homes around the country. Eighty-one have died of the virus at a veterans center in Paramus, N.J., and two former leaders at the Holyoke Soldiers’ Home in Holyoke, Mass., were indicted on charges of criminal neglect in connection to a coronavirus outbreak that contributed to the deaths of at least 76 residents.
“We are still battling,” a post from Monday on Thomson-Hood’s Facebook page said. “Keep praying for our incredible, warrior staff and our precious veterans.”
More than 1,000 Americans are dying of the coronavirus every day on average, a 50 percent increase in the last month. Iowa, Minnesota, New Mexico, Tennessee and Wisconsin have recorded more deaths over the last seven days than in any other week of the pandemic. Twice this past week, the country has suffered more than 1,400 deaths reported in a single day.
“It’s getting bad and it’s potentially going to get a lot worse,” said Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. “The months ahead are looking quite horrifying.”
More than 244,000 people have died from the coronavirus in the United States, more than any other country, and experts say the pace of new deaths is likely to accelerate in the coming weeks.
In towns and cities in Wisconsin and New Mexico, medical examiners are stocking extra body bags, parking mobile morgue units — the size of trucks — outside their doors and ensuring that refrigerated morgue trucks are cooled and ready to be used if needed. And hospitals are filling with patients, threatening the limits of medical systems in some regions.
Deaths lag several weeks behind infections, so the toll being recorded now reflects transmission that happened several weeks ago, before the country began logging more than 140,000 new cases per day and hospitalizations reached their highest levels of the pandemic. On Friday, public health officials reported more than 181,000 new cases across the country, more than ever before.
The rising case numbers — and the threat of mounting deaths — have led some experts to call for a coordinated national shutdown for four to six weeks, but with no announcements from the White House for new measures to respond to the soaring outbreak, most of the country is open for business, even as a few governors began calling for new restrictions on Friday.
President Trump and his motorcade drove by hundreds of supporters who showed up in Washington on Saturday for demonstrations protesting the outcome of the 2020 election, which Mr. Trump has refused to concede.
The president was on his way to his private golf club in Sterling, Va., and was greeted, according to a pool report, by applause and cheers from a crowd in which many were unmasked. People who watched him go by carried signs reading “Best prez ever” and “Stop the steal.” Some people climbed building structures by Freedom Plaza as the motorcade passed to get a better view.
Election results in the last two states were announced on Friday, with President-elect Joseph R. Biden Jr. winning Georgia to finish with a total of 306 electoral votes — the same number that Mr. Trump won in 2016 and called a landslide — and Mr. Trump winning North Carolina, for a total of 232 electoral votes.
Demonstrations of the Trump faithful planned for Saturday in Washington include a “Million MAGA March,” a “Stop the Steal” rally and a “Women for Trump” event, and at least several thousand people turned out.
A 53-year-old truck driver who declined to give his name because he feared losing his job for attending drove from Pennsylvania for the occasion.
Though many in the crowd were not wearing masks, he put one on as the crowd sang “The Star-Spangled Banner,” acknowledging concerns that he might expose himself to the coronavirus and infect his 81-year-old mother.
“I’m hoping maybe I don’t catch it, but you can’t stop everything,” he said.
At a White House briefing on Friday — in his first public remarks since the election was called — the president came close to acknowledging Mr. Biden’s win before catching himself.
“This administration will not be going to a lockdown,” Mr. Trump said in the Rose Garden, adding that “hopefully the — whatever happens in the future, who knows which administration it will be. I guess time will tell. But I can tell you this administration will not go to a lockdown. There won’t be a necessity.”
On Friday, Mr. Biden urged the distracted president to turn his attention to the rapidly worsening pandemic and take stronger action. In a blistering statement, Mr. Biden said that the recent surge, which is killing more than 1,000 Americans every day and is currently hospitalizing about 70,000, required a “robust and immediate federal response.”
“I am the president-elect, but I will not be president until next year,” Mr. Biden said. “The crisis does not respect dates on the calendar, it is accelerating right now.”
New York’s mayor, Bill de Blasio, announced on Saturday morning that the city’s seven-day positivity rate for coronavirus tests remained below 3 percent, the threshold that would trigger the closure of all in-person classes as the city confronts a surge in coronavirus cases. About 300,000 children of the 1.1 million in New York City’s public school system have returned to classrooms so far.
The positivity rate remained at 2.47 percent Saturday, lower than days earlier, Mr. de Blasio said on Twitter, but he warned that the decision to shut down the school system, the nation’s largest, was not off the table yet. “That could change,” he tweeted. “We MUST fight back a second wave to keep our schools open.” It is still possible that the city could reach the 3 percent threshold within the next few days.
Here are this morning’s #COVID19 indicators:
• 97 patients admitted to the hospital
• 926 new cases
• The test positivity 7-day average is 2.47%
We’re still below 3%, but that could change. We MUST fight back a second wave to keep our schools open.
— Mayor Bill de Blasio (@NYCMayor) November 14, 2020
Officials had warned that the positivity rate could surpass 3 percent this week, and many had anticipated that school closures could happen as soon as Monday.
Signs that the pandemic is making a feared resurgence in what was once the epicenter of a global pandemic have become evident. New Yorkers have been standing in long lines for hours for tests, some seeking to determine if they could return to work, and some fearing they may have gotten infected during the election or during the street celebrations after Joseph R. Biden Jr. was declared the winner of the presidential race. Others were hoping for a negative test so they could visit out-of-state relatives over the Thanksgiving holiday.
Mr. de Blasio reported 926 new cases for the preceding 24 hours and added that 97 people had been admitted to area hospitals.
New York City may choose to close its classrooms, where transmission of the virus has been strikingly low, before the halt of indoor dining, which falls under Gov. Andrew M. Cuomo, not the mayor.
During a conference call with reporters on Saturday, Mr. Cuomo said that Mr. de Blasio should focus on the positivity rate of individual schools instead of making that determination based on citywide rates. He suggested that an individual school should close its doors only after 3 percent of its staff and student body had tested positive for the virus to avoid a citywide disruption of in-person classes. He added that thousands of students rely on schools for free breakfast and lunch, and that the economy depends on keeping them open.
“If you close the schools, you make it more difficult for parents to go to work, because now they have to worry about who’s going to take care of their children,” Mr. Cuomo said.
Chancellor Sebastian Kurz of Austria said on Saturday that the country would go into a full lockdown after an existing partial shutdown failed to stem rising infections.
“If we do not react massively, there is a great risk that the numbers will continue to rise or remain at a high level and overstretch the health system,” Mr. Kurz said during a news conference announcing the measures.
Starting on Tuesday and going until at least Dec. 6, schools and most stores will close and people will be required to work from home unless their physical presence at a job site is critical. People will be able to leave their homes only for essential reasons, such as grocery shopping.
“My urgent request: Do not meet anybody,” Mr. Kurz said. “Every social contact is one too many.”
The new measures represent the kind of emergency lockdown Mr. Kurz had hoped to avoid. Similar restrictions in the spring led to a drop in new infections, but they also significantly damaged the national economy.
The recent, lighter shutdown, which went into effect on Nov. 3, allowed stores, schools and other services to stay open, but closed cultural sites, bars and restaurants.
On Friday, Austria recorded 9,586 cases in a single day, a record, and about nine times more than during the country’s peak in March, according to health ministry figures.
In other news from around the world:
The authorities in Greece announced on Saturday the closure of all schools as the country faces a spike in coronavirus infections and deaths. Health officials announced 3,038 new infections on Friday. A nationwide public curfew is now also in effect from 9 p.m. until 5 a.m., with exceptions made for people who need to go out for work, to visit a doctor or to walk a pet. Greece’s total caseload since the start of the pandemic is 69,675.
The five-day average of coronavirus cases in Ireland rose nearly 10 percent this week, despite strict lockdown measures that had led to a sharp decrease in cases since mid-October, the health department said on Saturday. “We have seen higher numbers in recent days than we expected based on the encouraging trends of the last three weeks,” Chief Medical Officer Tony Holohan said in a statement. Ireland has had 67,526 cases and 1,978 deaths in total.
Tuscany and Campania are the latest Italian regions to lock down. Starting on Sunday, residents will be allowed to leave their homes only for essentials and travel outside their own municipalities only for work and health reasons. On Saturday, Italy registered 37,255 new cases and 544 deaths.
Driving will be banned on Sundays throughout Lebanon after the country went into a two-week lockdown that forced nonessential business to close. Vehicles can be driven for three days each week based on even- and odd-numbered license plates, and a sunset to sunrise curfew was extended.
A party in the suburbs of Paris with 300 attendees was dispersed, the police said on Saturday. The gathering was in violation of virus restrictions, and the police said bottles were thrown at them.
The police in Germany used a water cannon on Saturday to break up a group of about 600 protesters that had gathered in Frankfurt to criticize lockdown measures. In Lisbon, hundreds of bar and restaurant workers protested a partial weekend and nighttime lockdown across most of Portugal.
At least 10 people died in Piatra Neamt, a town in northeastern Romania, on Saturday after a fire broke out in an intensive care unit being used for 16 Covid-19 patients, all of them on ventilators, according to The Associated Press. The fire spread rapidly, most likely fed by the oxygen being used to treat the intubated patients, local media reports said. The national health minister, Nelu Tataru, told the local news media that the fire had probably been caused by an electrical short circuit. Ten other people were injured in the incident, seven of them critically, including the doctor on duty, who had rushed to help the patients.
President-elect Joseph R. Biden Jr.’s first economic test is coming months before Inauguration Day, as a slowing recovery and accelerating coronavirus infections give new urgency to talks on government aid to struggling households and businesses.
With a short window for action in the lame-duck congressional session, Mr. Biden must decide whether to push Democratic leaders to cut a quick deal on a package much smaller than they say is needed or to hold out hope for a larger one after he takes office.
A continued standoff over aid could set the stage for sluggish growth that persists long into Mr. Biden’s presidency. Republican and Democratic leaders remain far apart on the size and contents of a rescue package, though both sides say lawmakers should act quickly.
The shifting dynamics of both the pandemic and the recovery are complicating the debate. Even as it has slowed, the economy has proved more resilient than many experts had expected, leading Republicans, in particular, to resist a big new dose of federal aid. But the recent surge in hospitalizations and deaths has increased the risk that the economy could slow further.
Last spring, economists were nearly unanimous in urging Congress to provide as much money as possible, as quickly as it could. Now, many conservative economists say a much smaller follow-up package would suffice. Even as progressives argue for trillions of dollars in aid, a growing number of liberal economists are urging Democrats to compromise and accept a smaller package to get money flowing quickly.
But others with ties to Mr. Biden’s team see the economic and political trade-offs differently. William E. Spriggs, a Labor Department official under former President Barack Obama, agreed that it was vital for Congress to act quickly. But he urged Democrats not to accept too small a deal.
“You will get people saying it didn’t work, so we don’t need to do it again,” said Mr. Spriggs, whom prominent Democrats have pushed for a role in the Biden administration. “You make it harder to go to the well again.”
Just two small hospitals serve mostly rural Elkhart County in northern Indiana, and earlier this week one of them instructed the local ambulance services not to bring any more patients.
With coronavirus cases hitting daily records, Elkhart General Hospital had run out of room.
The hospital’s capacity is 144 beds and more than 200 patients had been admitted, said Dr. Michelle Bache, the hospital’s vice president for medical affairs. On Tuesday, more than 90 were Covid-19 patients, and there were over 20 people with various medical issues in the emergency room needing beds.
“The patients were building up in the waiting room and causing an unsafe situation,” said Dr. Bache, adding that it was only the second time in her 22 years at the hospital that ambulances had been diverted.
Administrators went hunting for more rooms. They reopened 12 beds in a wing that had been closed for five or six years, stopped elective surgeries and moved nurses from other departments to staff the beds.
That, and releasing five coronavirus patients who no longer needed hospitalization, allowed the hospital to start taking ambulances again. It did not really provide a sense of relief, however. Across Indiana, 2,548 Covid-19 patients are hospitalized and infections are rising, with a 39 percent increase in hospitalizations in the state over the past two weeks.
The need for yet more beds is inevitable. Elkhart County hit another record on Thursday with 411 infections out of a population of roughly 200,000, Dr. Bache said. “There still seems to be some people who think that Covid is not real, and the patients we have are not real, so that is frustrating,” she said. “These patients are sick enough to need oxygen.”
Hospital administrators calculated how many more patients they could admit if they put two in each room. They surveyed the hospital auditorium to assess how many beds would fit. They thought about a tent, but temperatures were already dipping below freezing.
The numbers are sapping the medical system of its elasticity. Typically, Memorial Hospital in South Bend, just 15 miles east, takes patients that Elkhart General cannot handle. But Memorial said it could not take any now. Hospitals in Indianapolis, three hours south, have some capacity, but transferring even a few patients dramatically lowers the availability of ambulances, Dr. Bache said.
Elkhart General is not alone in facing this dilemma.
In Mississippi on Thursday, Dr. Thomas Dobbs, the state health officer, said that the main hospitals in Jackson, the capital, had run out of available critical care beds and very few were available elsewhere.
One hospital could not find a transfer bed in Mississippi, so it looked in cities like Birmingham and Mobile in neighboring Alabama, but they were also full, Dr. Dobbs told a news briefing. The closest critical care bed they could find was in Pensacola, Fla., more than 200 miles away.
Hong Kong is making coronavirus tests mandatory for people in high-risk groups as the Chinese territory works to prevent what it said is a potential fourth wave of infections in the cooler months. Those who ignore orders face possible jail sentences.
Those subject to the compulsory tests include people who show symptoms, residents linked to clusters, workers in high-risk occupations and travelers who are completing their mandatory 14-day quarantine upon arriving, Hong Kong’s health officials said Saturday. Those who refuse to comply could face fines of up to $3,220 and six months’ imprisonment.
“The fourth wave of outbreak could be triggered at any moment,” a spokesman with the Food and Health Bureau said Saturday, warning of “fatigue in the community” as people become less vigilant about wearing masks at social gatherings.
In September, Hong Kong rolled out free and voluntary tests for its 7.5 million residents, but less than a quarter of its population took them. Some activists voiced concern that the citywide tests, which were launched with the help of Beijing, could be used to collect people’s DNA. Authorities forcefully denied the charges.
The city will also limit the number of people at each table in restaurants to four, after briefly raising the cap to six people. And at bars and nightclubs, no more than two people may be seated together. Saunas and ball pits were also deemed risky and will remain closed, the government said.
Hong Kong recorded eight new cases on Saturday, five of which were imported.
With the prospect that a coronavirus vaccine will become available for emergency use as soon as next month, states and cities are warning that distributing the shots to an anxious public could be hindered by inadequate technology, severe funding shortfalls and a lack of trained personnel.
While the Trump administration has showered billions of dollars on the companies developing the vaccines, it has left the logistics of inoculating and tracking as many as 25 million people by year’s end — and many tens of millions more next year — largely to local governments without providing enough money, officials in several localities and public health experts involved in the preparations said in interviews.
Public health departments, already strained by a pandemic that has overrun hospitals and drained budgets, are racing to expand online systems to track and share information about who has been vaccinated; to recruit and train hundreds of thousands of doctors, nurses and pharmacists to give people the shot and collect data about everyone who gets it; to find safe locations for mass vaccination events; and to convince the public of the importance of getting immunized.
The federal Centers for Disease Control and Prevention have sent $200 million to the states for the effort, with another $140 million promised in December, but state and local officials said that was billions of dollars short of what would be needed to carry out their complex plans.
“We absolutely do not have enough to pull this off successfully,” said Dr. Thomas E. Dobbs III, the state health officer of Mississippi. “This is going to be a phenomenal logistical feat, to vaccinate everybody in the country. We absolutely have zero margin for failure. We really have to get this right.”
Reporting was contributed by Kit Gillet.