In April, the coronavirus killed more than 10,000 people in New York City. By early May, nearly 50,000 nursing home residents and their caregivers across the United States had died.
But as the virus continued its rampage over the summer and fall, infecting nearly 8.5 million Americans, survival rates, even for seriously ill patients, appeared to be improving. At a New York hospital system where 30 percent of coronavirus patients died in March, the death rate had dropped to 3 percent by the end of June.
Doctors in England observed a similar trend. “In late March, four in 10 people in intensive care were dying.” said John M. Dennis, a University of Exeter Medical School researcher. “By the end of June, survival was over 80 percent.”
Though the virus has been changing slowly as it spreads, most scientists say there is no solid evidence that it has become either less virulent or more virulent.
As older people took greater precautions to avoid infection, however, more of the hospitalized patients were younger adults, who are generally healthier and more resilient. By the end of August, the average patient was under 40.
Were the lower death rates simply a function of the demographic changes, or a reflection of advances in treatment that blunted the impact of the new pathogen?
Researchers at NYU Langone Health zeroed in on this question, analyzing the outcomes of more than 5,000 patients hospitalized at the system’s three hospitals from March through August. They concluded the improvement was real, not just the result of a younger patient pool.
Even when they controlled for differences in the patients’ age, sex, race, underlying health problems and severity of Covid symptoms — like blood-oxygen levels at admission — they found that death rates had dropped significantly, to 7.6 percent in August from 25.6 percent in March.
A combination of factors contributed to the improved outcomes of hospital patients, experts said. As clinicians gained more experience with the disease, they became better able to manage it, incorporating the use of steroid drugs and non-drug interventions.
Researchers have also credited heightened community awareness. Patients are seeking care earlier in the course of their illness. And outcomes may also have improved as the load on hospitals lightened and there was less pressure on the medical staff.
“We don’t have a magic bullet cure, but we have a lot, a lot of little things, that add up,” said Dr. Leora Horwitz, director of NYU Langone’s Center for Healthcare Innovation & Delivery Science. “We understand better when people need to be on ventilators and when they don’t, and what complications to watch for, like blood clots and kidney failure.”
Once doctors became aware of the clotting risk, they began to quickly put patients on blood thinners when necessary.
Another problem in the spring was that as hospitals in hard-hit areas like New York City became overwhelmed, doctors who hadn’t worked in critical care for many years were being drafted to care for seriously ill patients. Nursing departments, meanwhile, were short-staffed, and equipment was in short supply.
Medical experts worry that the surges in cases around the country could roll back the improvements in mortality rates. The number of hospitalized Covid patients has increased by 40 percent over the last month, and more than 41,000 patients are now hospitalized in the United States.
Like millions of young people across Europe, Rebecca Lee, 25, has suddenly found herself shut out of the labor market as the economic toll of the pandemic intensifies.
Her job as a personal assistant at a London architecture firm, where she had worked for two years, was eliminated in September.
After sending out nearly 100 job applications and receiving scores of rejections, Ms. Lee finally landed a two-month contract at a family-aid charity that pays 10 pounds (about $13) an hour.
“At the moment, I will take anything I can get,” she said. “It’s been desperate.”
The coronavirus pandemic has rapidly fueled a new youth unemployment crisis in Europe, and it may be about to get worse.
Britain’s prime minister, Boris Johnson, is facing calls for another national lockdown. On Wednesday, France’s president, Emmanuel Macron, said officials there had no choice but to impose another shutdown in the face of limited hospital capacity and rising cases across the country, while German officials imposed an array of restrictions.
Much of Europe, Mr. Macron said, is facing a similar situation, “overwhelmed by a second wave that we now know will probably be harder and more deadly than the first.”
In Germany, Chancellor Angela Merkel sounded a similar note.
“It is completely clear that we must act, and act now, to prevent a national health crisis,” she said.
But young people are being disproportionately hit, economically and socially, by lockdown restrictions. Many are resorting to internships, living with parents or returning to school to ride out the storm.
Years of job growth has eroded in a matter of months, leaving more than twice as many young people as other adults out of work. The jobless rate for people 25 and under jumped from 14.7 percent in January to 17.6 percent in August, its highest level since 2017.
Europe is not the only place where younger workers face a jobs crunch. Young Americans are especially vulnerable to the downturn. In China, young adults are struggling for jobs in the post-outbreak era. But in Europe, the pandemic’s economic impact puts an entire generation at risk of being left behind for years, according to the Organization for Economic Cooperation and Development.
Young people are overrepresented in sectors where jobs are disappearing, including travel, retail and hospitality. Graduates are facing unprecedented competition for even entry-level positions from a tsunami of newly laid-off workers.
The European Union is trying to cushion the blow by encouraging businesses to recruit young people. But such programs may have little impact as Europe confronts its worst recession since World War II.
In many American cities, where economies have been ravaged by the coronavirus pandemic, there been a surge in gun violence, including six killings of juveniles in Oakland, Calif., since June and a 40 percent increase in homicides over all. To the south, in Los Angeles, the picture is equally bloody, with the city on pace to have more than 300 homicides for the first time since 2009.
A study published this month by researchers at the University of California, Davis, estimated that 110,000 people in California bought guns this year because they were worried about the destabilizing effects of the pandemic. The number, based on a survey conducted over the summer, appears to be corroborated by the surge of firearm background checks this year, about 95,000 more than last year.
Beyond California, major cities including Minneapolis, Milwaukee and New York, as well as smaller communities like Lubbock, Texas, and Lexington, Ky., are all confronting the same grim pattern. Some places, like Kansas City, Mo., and Indianapolis, have set records for the number of killings in a single year. Philadelphia, which was gripped by unrest this week after the police shooting of a Black man, is among the cities with the highest increase in homicides — its 404 killings this year are a more than 40 percent increase compared with the same period last year.
Criminologists studying the rise in the murder rate point to the effects the pandemic has had on everything from mental health to policing in a time of social distancing, with fewer officers able to perform the up-close-and-personal community outreach work that in normal times has helped mitigate violence.
The epidemic of murder in America looms over the final days of a polarizing election campaign that President Trump has sought to frame as a referendum on law and order. His refrain has been constant: that cities run by Democrats have let crime get out of control.
But the data shows that the waves of killings have afflicted Democratic- and Republican-run cities alike.
“The increase has had nothing to do with the political affiliation of your mayor,” said Richard Rosenfeld, a professor of criminology and criminal justice at the University of Missouri-St. Louis.
Dr. Rosenfeld has studied crime trends during the pandemic for the Council on Criminal Justice, a nonpartisan research organization, and found that homicides increased an average of 53 percent across 20 major American cities during the summer.
As an immense new surge in coronavirus cases sweeps the United States, President Trump is closing his re-election campaign by continuing to declare before large and largely maskless crowds that the virus is vanishing.
Hopping from one state to the next, he has made a personal mantra out of declaring that the country is “rounding the corner,” even as case counts soar, fatalities climb, the stock market dips and a fresh outbreak grips the staff of Vice President Mike Pence.
Mr. Trump has attacked Democratic governors and other local officials for keeping public-health restrictions in place, denouncing them as needless restraints on the economy. And the president has been describing the pandemic as a political hindrance inflicted on him by a familiar adversary.
“With the fake news, everything is Covid, Covid, Covid, Covid,” Mr. Trump complained at a rally in Omaha on Tuesday, chiding the news media and pointing to his own recovery from the illness to downplay its gravity: “I had it. Here I am, right?”
Earlier the same day, Mr. Trump ridiculed the notion that the virus was spreading rapidly again, falsely telling a crowd in Lansing, Mich., that the reported “spike in cases” was merely a reflection of increased testing. The 74-year-old president pointed to his teenage son, who tested positive for the virus this month, to suggest that many of those cases were of only trivial concern.
“Do you ever notice, they don’t use the word ‘death,’ they use the word ‘cases’?” Mr. Trump said. “Like, Barron Trump is a case. He has sniffles, he was sniffling. One Kleenex, that’s all he needed, and he was better. But he’s a case.”
Then in Bullhead City, Ariz., on Wednesday, Mr. Trump promised voters that a vaccine would be available “momentarily,” though scientists and pharmaceutical companies say no such breakthrough is assured.
He also took aim at his Democratic opponent, Joseph R. Biden Jr., claiming without evidence that if the former vice president were to be elected, “there would be no graduations, no weddings, no Thanksgiving.” And Mr. Trump mocked a California mask mandate, saying, “You have to eat through the mask.”
Mr. Biden struck a very different note.
“I’m not running on the false promise of being able to end this pandemic by flipping a switch,” Mr. Biden, who received a briefing from public health experts about the coronavirus pandemic, said in remarks at a theater in Wilmington, Del. “But what I can promise you is this: We will start on Day 1 doing the right things. We’ll let science drive our decisions. We will deal honestly with the American people.”
As coronavirus cases and deaths were rising in the United States last spring, Jared Kushner, President Trump’s senior adviser and son-in-law, told an interviewer that the president had taken the “country back from the doctors.”
The comment was made on April 18 in a discussion with the journalist Bob Woodward as he was reporting for his book, “Rage,” his second about the Trump presidency. CNN obtained an audio recording of the interview.
Even as the country was falling into the grip of a pandemic that to date has claimed more than 220,000 American lives, Mr. Kushner told Mr. Woodward that his father-in-law had won a battle for control with the doctors struggling to understand how to combat the little-known virus.
Mr. Kushner sounded decidedly optimistic — even triumphant.
“There were three phases,” he said. “There’s the panic phase, the pain phase and then the comeback phase. I do believe that last night symbolized kind of the beginning of the comeback phase. That doesn’t mean there’s not still a lot of pain and there won’t be pain for a while, but that basically was: We’ve now put out rules to get back to work. Trump’s now back in charge. It’s not the doctors. They’ve kind of — we have, like, a negotiated settlement.”
At the time, Mr. Trump was laser-focused on what the pandemic would mean for his presidency, and his re-election prospects, and was trying to convince the public that restrictions several states had imposed were excessive.
Mr. Kushner had several conversations with Mr. Woodward that White House officials have said he believed were on background, and not for quoting.
A White House spokeswoman, Sarah Matthews, defended Mr. Trump’s approach.
“As he has said numerous times, the cure cannot be worse than the disease,” she said. “When it was in the best interest of the country to shut down, he did so at the advice of top health officials. However, as president, he must take a holistic approach to the virus and consider the devastating effects of lockdowns and the consequences of keeping our economy shut down for an extended period of time. ”
Credit...Ilvy Njiokiktjien for The New York TimesThe Netherlands, one of Europe’s wealthiest countries, is renowned for its efficient and organized government in most circumstances — but not, apparently, in the pandemic.
As a second wave of the coronavirus surfaces across Europe, the Netherlands stands out with Belgium and the Czech Republic as among the hardest hit. It currently ranks sixth among European Union countries when it comes to the rate of new infections, with 56 cases per 100,000 inhabitants — its highest total ever.
The infection numbers keep rising, to a record 10,346 new cases on Monday in a country of 17 million people — one-19th the size of the United States, which is reporting in the neighborhood of 75,000 new cases a day. And it is hard to keep track of the true toll, with the country’s official data incomplete because of technical errors.
Last week, new coronavirus patients had to be transferred by helicopter to Germany to relieve Dutch intensive-care units.
After weeks of taking incremental steps to curb the spread of the virus, the government announced on Oct. 14 that, in addition to the new rules on face masks, all bars and restaurants would close for at least four weeks. With infections still rising, the authorities are considering establishing an evening curfew to keep people indoors, or even a two-week “circuit breaker” lockdown.
For the Dutch, who generally regard their country as one of the best run in the world — with at times an undertone of superiority — the level of institutional chaos has been a hard reckoning.
“It’s shocking really. I always thought we were one of the best countries in the world, best organized,” said Rob Elgersma, 18, an agriculture student. “But now, they have the ability to fix things but can’t get their act together. What happened to us?”
That’s a question a lot of Dutch people are asking right now.
GLOBAL ROUNDUP
Singapore is easing restrictions on hundreds of thousands of migrant workers who have largely been confined to their dormitories since last spring.
Under the new policy, which has been in trials for the past two months, workers who test negative for the coronavirus will be allowed to visit designated recreation centers on their days off starting Saturday. There must also be no active cases in their dorms.
The eight recreation centers across Singapore are central to the lives of the workers, who go there to buy groceries, get haircuts, wire money to their families back home and socialize with friends.
By means of a government smartphone app, workers who wish to leave their dorms will have to apply for permission and choose one of five three-hour slots between 8 a.m. and 11 p.m. There are a limited number of exit passes for each time slot.
The economy of Singapore, a country of almost six million people, is heavily dependent on more than 300,000 migrant workers, who hail largely from South Asian countries, including India and Bangladesh. They work in construction, shipbuilding, manufacturing and other sectors, earning about $400 or $500 a month. The pandemic has renewed longstanding questions in Singapore about inequality and how foreign workers are treated.
Early in the year, Singapore appeared to have largely brought the virus under control, thanks to extensive contact tracing and a partial national lockdown. But in April, after a surge in cases in the crowded dorms, the government imposed a much stricter lockdown that lasted until June 1. New infections began to be reported as separate tallies, one for foreign workers and one for “the local community.”
But even as stay-at-home orders were eased for Singapore’s other residents, migrant workers were barred from leaving their dorms and sometimes even their rooms except for work and essential errands. The confinement and the financial stress of job uncertainty have taken a heavy mental toll on the workers, with reports of suicides and attempted suicides. Government officials said keeping the dorms sealed off was necessary to reopen the economy.
All dorms were declared clear of the virus on Aug. 11, but new clusters emerged within weeks, delaying the easing of restrictions until now. Migrant workers account for about 95 percent of Singapore’s 58,000 total cases.
Kirsten Han, a Singaporean journalist and activist, said on Twitter in April that the country’s experience showed “that even if you do most things right, if you’re not considering or proactively looking out for the most vulnerable and marginalized in your society, you’re not going to effectively fight Covid-19.”
In other global developments:
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Officials in India confirmed that the country had surpassed eight million cases of the coronavirus. The Ministry of Health reported 49,881 infections and 517 fatalities in the past 24 hours, raising the death toll to 120,527. India is the second country to break the eight-million mark after the United States.
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The Marshall Islands reported its first coronavirus cases after two people who flew to a U.S. military base from Hawaii tested positive. The Pacific nation was among the last places in the world to have no reported cases.
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Taiwan has gone 200 days without a locally transmitted case of the coronavirus, far longer than anywhere else in the world. The self-governing island of 23 million people last recorded a local case on April 12, with experts crediting tight border control, extensive contact tracing, strict quarantines and the widespread use of masks. Taiwan has had a total of 550 cases, the vast majority of them detected among people in quarantine after arriving from overseas, and seven deaths. A handful of countries, including New Zealand, Thailand and Vietnam, have come close to or surpassed 100 days without any local cases, only to experience new outbreaks.
In today’s edition of the Morning newsletter, David Leonhardt writes:
With coronavirus cases surging across most of Europe and the Americas, it can be easy to give into nihilism and wonder whether there is any good way for a country to fight the virus.
But the scale of the recent outbreaks really is different, depending on the country. Two countries are worth some attention: Canada and Germany.
Neither Germany nor Canada has escaped the fall wave of the virus, as you can see. But they are also both doing a lot less bad than their neighbors. How?
For one thing, both countries have done a better job of avoiding wishful thinking than either the Trump administration or some European governments.
Germany announced yesterday that it would close restaurants, bars, gyms, theaters and more for several weeks. “We must act, and act now, to prevent a national health crisis,” Chancellor Angela Merkel said. Compare that with the U.S., where the rate of confirmed new cases has been higher than Germany’s current rate for almost all of the past five months — yet almost nobody is talking about closing restaurants.
Yesterday’s move isn’t the first aggressive one from Germany. It was also far ahead of the U.S. in developing widely available tests this spring and offers them to residents free.
But Canada may be an even better example, given that its current rate of new cases is well below Germany’s. Consider this map:
Some of Canada’s success is probably cultural and would have been hard to replicate in the U.S., as Ian Austen, a Canadian who has covered the country for The Times for more than a decade, told me. “There is generally a lot of deference to authority in Canada,” Ian said.
But specific actions have also mattered. Unlike in the U.S., conservative politicians in Canada are not doubting the wisdom of mask-wearing, Ian said. This spring, Doug Ford, the conservative premier of Ontario, described people protesting social-distancing measures as “a bunch of yahoos.”
And some top public-health officials in Canadian provinces have become semi-celebrities, as they have repeatedly urged social distancing, mask-wearing and other forms of caution. Imagine versions of Anthony Fauci, but ones who are praised across the political spectrum, rather than being called “a disaster,” as President Trump did with Fauci.
Among the most successful Canadian regions have been the four small provinces along the Atlantic Ocean, all of which have almost extinguished the virus. They have done so by largely closing their borders — a strategy that has also worked in several other countries, including Australia, Ghana, Taiwan and Vietnam, despite skepticism from some political liberals around the world.
The four Canadian provinces — Nova Scotia, New Brunswick, Prince Edward Island and the combined Newfoundland and Labrador — were successful enough this spring that they were able to form a joint “bubble” this summer. Residents can travel among the four, even as they remain closed to the outside.
“We don’t have any cases here,” Sharon Stewart, a restaurant owner in Pictou, Nova Scotia, recently told The Globe and Mail, “and we want to keep it that way.”
Global markets showed signs of stabilizing on Thursday, one day after a Wall Street swoon was prompted by worries about the relentless spread of the coronavirus.
European markets opened modestly higher on Thursday and seesawed between gains and losses during early trading. Most Asian stocks ended lower, but moderately, and mainland Chinese shares ended higher.
Futures markets were betting on further improvement later in the day. They were forecasting Wall Street would open less than 1 percent higher.
Other markets pointed to calm after Wednesday’s sell-down. Prices for U.S. Treasury bonds, long considered by investors as a safe place to park money in troubled times, fell in overnight trading, sending yields higher. Oil prices, which usually fall during times of economic doubt, were mixed.
Investors on Wednesday had been spooked by growing infections in Europe and the return of tighter containment efforts. The coronavirus also continues to spread in the United States. The S&P 500 index fell 3.5 percent on Wednesday, its worst decline since mid-June.
A police officer in the Philippines was killed this week after a fighting rooster slashed him during a raid on an illegal cockfighting den to stop the spread of the coronavirus.
The officer, Lt. Christian Bolok, 38, was part of a team that descended on an arena in the province of Northern Samar on Monday, after it was suspecting of violating lockdown rules against mass gatherings.
“There was a commotion, the spectators scampered away, and when the dust cleared, Officer Bolok tried to pick up one of the birds, but he didn’t notice that it still had bladed spurs on,” the provincial police chief, Col. Arnel Apud, said in an interview.
Fighting roosters typically have a razor-sharp steel blade called a gaff attached to their legs, and the bird Lieutenant Bolok grabbed slashed him with one.
“He was wounded in his femoral artery on the left leg and lost a lot of blood,” Colonel Apud continued. “Within minutes, he died. It was a freak accident.”
In the Philippines, which has confirmed 375,180 cases of the virus and 7,114 deaths, security forces help maintain lockdown orders.
While cockfighting has been legalized in many areas and matches are sometimes sanctioned and televised, the government banned it and other such events in March to prevent the spread of the coronavirus among large crowds.
Health officials on Long Island were scrambling on Wednesday to respond to two coronavirus superspreader events that left 56 people with the virus and nearly 300 in quarantine after attending a wedding and a birthday party.
The birthday party complied with health rules, but the wedding exceeded New York State’s 50-person limit for social gatherings, officials said.
“This kind of blatant disregard for the well-being of others is not only extremely disappointing, it will not be tolerated,” Steven Bellone, the Suffolk County executive, said at a news conference. “If you violate the rules, you’ll be caught and held responsible.”
Ninety-one people attended the wedding, on Oct. 17, officials said. Thirty people — 27 guests, two employees and an outside vendor — later tested positive for the virus, and 156 people wound up in quarantine, officials said.
Mr. Bellone said the venue where the wedding was held, the North Fork Country Club in Cutchogue, would be fined $17,000. And a spokesman for the State Liquor Authority said it had opened an investigation into the matter “upon learning of this allegedly illegal and dangerous event.”
Raluca Pintea, the country club’s general manager, did not respond to requests for comment.
Although the birthday party, which took place in Bellport on Oct. 17, adhered to state restrictions on attendance, inadequate social distancing resulted in 26 guests testing positive and 132 people having to quarantine, officials said.
Mr. Bellone said it was important for county residents to consider the potential harm that even seemingly modest family gatherings could do. “These kinds of superspreader events are a threat to our public health and to our continued economic recovery,” he said.
These were not the first superspreader events in Suffolk County this fall. In September, dozens of people tested positive after a Sweet 16 party that the authorities said violated state restrictions.
The pandemic has brought national movie theater chains like AMC to the brink of bankruptcy. It has been just as unsparing with the 602 independently owned theaters in the United States, which are often in smaller communities, providing movies to communities sometimes ignored by the major chains.
Park Plaza Cinema in Hilton Head Island, S.C., is one such theater, and it has been decimated by the pandemic.
“We are an industry that is part of the fabric of America, and it’s going away,” said Lucie Mann, who owns and runs the theater with her husband, Larry.
The theater has established social-distancing protocols and installed new air filtration systems. It has tried initiatives like curbside popcorn sales. But the efforts have not been enough to offset the larger trends upending moviegoing, namely that many people still don’t seem inclined to return to theaters in large numbers and that Hollywood, with no audience to speak of, has pushed off most major releases until next year.
These days, Ms. Mann has been running private events, charging $250 to rent out a theater. On Saturday night, the local Italian-American Club hosted a private party where 10 people stopped in for a screening of “Moonstruck.” But last weekend when she booked Pixar’s “Coco” in an attempt to attract families, the seats remained empty.
Mr. Mann spends his days on the phone trying to resurrect a disaster loan from the Small Business Administration that keeps being denied. And he’s applying for a grant from the state. If aid doesn’t materialize — either in the form of federal funding, which looks unlikely given the political climate in Washington, or a decision from Hollywood studios to move some big movies back into 2020, which they said they would consider only if theaters reopened in New York and Los Angeles — the Manns figure they have about three weeks before they’ll be forced to close for good.
The Los Angeles Dodgers’ joy over winning the World Series on Tuesday night was overshadowed when Justin Turner, the team’s veteran third baseman, joined his teammates in celebration on the field shortly after learning he had tested positive for the coronavirus.
The Dodgers had pulled Turner, 35, from the game when they learned of his positive test before the eighth inning, but later he was seen on the field, kissing his wife, holding the World Series trophy, and hugging and talking to teammates — sometimes with a mask, sometimes without. And he took his place at the center of a team photograph, sitting between Manager Dave Roberts and Andrew Friedman, the Dodgers’ president of baseball operations — none of whom wore a face covering.
Turner’s return to the field, which occurred right in front of Rob Manfred, Major League Baseball’s commissioner, at Globe Life Field in Arlington, Texas, raised questions about how the league had allowed such a public lapse in its coronavirus protocols and drew widespread criticism from experts in epidemiology.
M.L.B. said on Wednesday afternoon that it would investigate the incident, but placed the blame squarely on Turner, saying he had refused the orders of league security to remain in isolation.
“Turner was placed into isolation for the safety of those around him,” M.L.B. said in a statement.
“However, following the Dodgers’ victory, it is clear that Turner chose to disregard the agreed-upon joint protocols and the instructions he was given regarding the safety and protection of others. While a desire to celebrate is understandable, Turner’s decision to leave isolation and enter the field was wrong and put everyone he came in contact with at risk. When M.L.B. Security raised the matter of being on the field with Turner, he emphatically refused to comply.”
According to Dr. John Swartzberg, an infectious disease expert and professor emeritus at the University of California, Berkeley, the fact that the team knew to pull Turner from the game should have been sufficient reason to keep him off the field for celebrations, especially as he could have exposed more people to the virus than he had before.
Multiple news media reports said that Turner’s test from Monday had come back “inconclusive” during the second inning of Tuesday’s game. That led the league to expedite processing Turner’s test from Tuesday morning, which came back positive.
“The test result should be back before they started playing,” said Dr. Abraar Karan, a global health researcher at Harvard Medical School. “That’s the whole point of testing to begin with.”
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