In the dispiriting, continuing surge of coronavirus cases across the United States, one region has a reason to be hopeful. Seven states in the Midwest have seen a sustained decrease in case numbers over the past 14 days, something health experts say is not necessarily definitive but undeniably encouraging.
Cases in Illinois, Iowa, Missouri, Kansas, Nebraska, North Dakota and South Dakota all began climbing after Labor Day, as cold weather pushed people in the Midwest indoors, creating incubators for infection.
The worst-hit part of the country still, the Midwest has suffered thousands of deaths and been dealing with overwhelmed hospitals for months. Thanksgiving may be affecting the rising numbers of cases, with a big wave of tests before the holiday.
Nationally, the picture is looking only worse: On Friday, more than 229,000 cases were reported and the seven-day rolling average of new cases passed 183,700, both records. Nine states set single-day case records. More than 101,000 Americans are in hospitals now, double the number from just a month ago.
And the country topped 2,800 deaths for the first time on Wednesday, and then did so again on Thursday. The seven-day average for new deaths rose to more than 2,000 for the first time since April with Tennessee and Oregon setting single-day records; 16 states reported more deaths in the past week than in any previous week.
California, where daily case reports have tripled in the past month, is just one of several states that had appeared to have gained control of the virus, only to see it spread rapidly throughout the fall. More than 23,000 new cases were reported by Friday night, the third consecutive single-day record.
In the Midwest, Illinois, Iowa, Missouri, Kansas, Nebraska and North Dakota have had varied mask mandates and other restrictions, with South Dakota doing very little at all, but all of them have been declining in cases, according to a New York Times database. North Dakota, for example, after leading the nation in daily new cases per person for weeks, has seen its rate fall by more than half since mid-November.
In part, the news media may have had a role in the change, said Carl Bergstrom, a professor of biology at the University of Washington in Seattle. Before the virus slammed into the region, news outlets were not necessarily giving as much coverage to the pandemic there as in other areas, like the Northeast. But once cases became prevalent, he said, news reports heightened public awareness of the danger, and more residents took action to protect themselves.
“One of the big lessons in the pandemic is, no matter how good you are at predicting how a disease spreads through a population, that’s not going to help you that much because the enormous drivers are behavioral changes,” Mr. Bergstrom said.
Holiday paperwork slowdowns may have diminished reporting as well, so there is a chance numbers could tick back up soon. Deaths — which tend to lag behind case counts — were still increasing in a number of Midwestern states over the past two weeks.
Mr. Bergstrom said he believed the apparent improvement might be a Midwestern mirage. He said he was alarmed by rates of positive tests in the seven Midwestern states where cases had been declining.
As an example, he pointed to South Dakota, where nearly half of tests came back positive on average over the past 14 days, according to Johns Hopkins University. Deaths in the state also remain at their peak level, the highest per person rate in the country.
“I think it’s going to be a really rough next few months basically everywhere,” he said.
The United States is winding up a particularly devastating week, one of the very worst since the coronavirus pandemic began nine months ago.
The country set a single-day record for new daily infections on Thursday, with more than 217,000, only to jump to a new high of more than 228,000 on Friday. Many other data points that illustrated the depth and spread of a virus that has killed more than 279,000 people in the United States, more than the entire population of Lubbock, Texas; or Modesto, Calif.; or Jersey City, N.J.
“It’s just an astonishing number,” said Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. “We’re in the middle of this really severe wave and I think as we go through the day to day of this pandemic, it can be easy to lose sight of how massive and deep the tragedy is.”
As the virus has spread, infectious-disease experts have gained a better understanding of who among the nation’s nearly 330 million residents is the most vulnerable.
Nursing home deaths have consistently represented about 40 percent of the country’s Covid-19 deaths since midsummer, even as facilities kept visitors away and took other precautions and as the share of infections related to long-term care facilities fell substantially.
Underlying conditions have played a pivotal role in determining who survives the virus. Americans who have conditions like diabetes, hypertension and obesity — about 45 percent of the population — are more vulnerable.
And new evidence has emerged that people in lower-income neighborhoods experienced higher exposure risk to the virus because of their need to work outside the home.
The poor, in particular, have been more at risk than the rich, according to analyses of those who have been sickened by the virus or succumbed to it.
Studies suggest that the reason the virus has affected Black and Latino communities more than white neighborhoods is tied to social and environmental factors, not any innate vulnerability.
According to one recent study of cellphone data, people in lower-income neighborhoods experienced significantly higher exposure risk to the virus because they were compelled to go to jobs outside their homes.
NEW ROCHELLE, N.Y. — There are lines again at Glen Island Park, the drive-through coronavirus testing center that state officials set up when the coronavirus was discovered in this city in March.
Nurses at the hospital went on a two-day strike this week over fears that their working conditions made them vulnerable to infection as hospitalization rates climb.
And at the synagogue where the first case here was detected nine months ago, a sign on the door now turns away people who live in coronavirus hot zones.
As the virus rages across Westchester County, it has returned to New Rochelle, a city of 80,000 hit so hard during the outbreak’s earliest days that it was, for a time, the epicenter of the pandemic in the region. In early March, when Gov. Andrew M. Cuomo announced the state’s first so-called containment zone in this New York City suburb, New Rochelle’s fate proclaimed that the virus had arrived.
And now it is back.
Westchester County’s caseload is rising by an average of more than 580 a day. New Rochelle contributed 73 new cases on Friday, adding to a profound sense of defeat.
That the coronavirus could re-emerge here, in a city and county scarred by loss and praised as a model of how to stop the spread of the virus, is a testament to the pandemic’s intractability. Local leaders and health experts fear the city is also a bellwether for the rest of the country: If the disease can roar back here, it can happen anywhere.
Britain’s approval of a coronavirus vaccine this week, leaping ahead of every other Western country, would be a political gift for any leader. But perhaps no one needs it as much as Prime Minister Boris Johnson.
A successful vaccine rollout could be the last chance for Mr. Johnson’s government to show competence, after botching virtually every other step of its response to the pandemic, from tardy lockdowns to a costly, ineffective test-and-trace program — all of which contributed to the country having the highest death toll in Europe.
It also comes just as Britain has reached a climactic stage in its long negotiations with the European Union for a post-Brexit trading relationship. Allies of Mr. Johnson were quick to claim that the swift approval of the vaccine vindicated the Brexit project.
That claim was quickly debunked. Nevertheless, the mass vaccination program will be an early test of how well Britain works once it is fully untethered from Europe.
“The British government is looking for ways to claim a victory because they’ve made such a bloody mess of the epidemic,” said David King, a former chief scientific adviser to the government who has become a vocal critic of its performance. “The nationalistic response is brutish and rather distasteful.”
Still, it is difficult to separate politics from public health. As the first vials of the Pfizer-BioNTech vaccine rolled into Britain in refrigerated trucks from Belgium this week, negotiators in London were in the last stages of trying to stitch together a long-term, E.U.-British trade agreement. European officials expressed hope they could come to terms as soon as Sunday, though stumbling blocks remained.
The pandemic has raised the pressure on Mr. Johnson to strike a deal, since a failure could deepen the economic damage caused by multiple lockdowns. Yet the convergence of events could also be fortuitous, allowing the beleaguered prime minister to resolve an issue that has divided Britain for more than four years at the very moment that relief finally begins to arrive for a country ravaged by the virus.
Millions of federal student loan borrowers will continue to have a reprieve on their loans through Jan. 31, Education Secretary Betsy DeVos announced Friday, extending a pandemic relief measure that had been set to expire at the end of the month.
The extension avoids what borrowers — and the loan servicers that handle their accounts — feared would be a messy disruption between the end of President Trump’s administration and the start of President-elect Joseph R. Biden Jr.’s term.
Mr. Biden has not said if he intends to extend the student loan moratorium, but he has called for limited student-debt cancellation and other relief efforts. The announcement means the moratorium, which has been in place since March, can be extended during the Biden administration with no interruption.
As of Sept. 30, 23 million borrowers had taken advantage of the relief option, suspending payments on $927 billion in debt, according to Education Department data.
The moratorium allows borrowers to skip payments on their federal student loans without penalty and without incurring interest. For those who opt to keep making payments, the entire amount goes toward their loan principal.
The measure covers only federal loans that are owned by the Education Department, which holds the vast majority of all student loans. Borrowers with private loans still need to make those payments.
The moratorium on payments extends to those who have defaulted on their federal loans and are having their wages garnished. Employers have been told to stop garnishing paychecks, Ms. DeVos said, and those who have had money garnished are due refunds.
“The coronavirus pandemic has presented challenges for many students and borrowers, and this temporary pause in payments will help those who have been impacted,” Ms. DeVos said in her announcement. “The added time also allows Congress to do its job and determine what measures it believes are necessary and appropriate.”
With the coronavirus pandemic surging and initial vaccine supplies limited, the United States has a tough decision to make: Should the country’s immunization program focus in the early months on the elderly and people with serious medical conditions, who are dying of the virus at the highest rates, or on essential workers, an expansive category encompassing Americans who have borne the greatest risk of infection?
Health care workers and the frailest of the elderly — residents of long-term-care facilities — will almost certainly get the first shots, under guidelines that the Centers for Disease Control and Prevention issued on Thursday. But with vaccinations expected to start this month, the debate among federal and state health officials about who goes next, and lobbying from outside groups to be included, is growing more urgent.
It’s a question increasingly guided by concerns over the inequities laid bare by the pandemic, from disproportionately high rates of infection and death among poor people and people of color to disparate access to testing, child care and technology for remote learning.
Ultimately, the choice comes down to which is the higher priority: preventing death, or curbing the spread of the virus and returning to some semblance of normalcy. “If your goal is to maximize the preservation of human life, then you would bias the vaccine toward older Americans,” Dr. Scott Gottlieb, the former Food and Drug Administration commissioner, said recently. “If your goal is to reduce the rate of infection, then you would prioritize essential workers. So it depends what impact you’re trying to achieve.”
Adding to the complexity of any choice, the definition of “essential workers” used by the C.D.C. covers nearly 70 percent of the American work force, sweeping in not just grocery store clerks and emergency responders, but also weather forecasters, tugboat operators, exterminators, nuclear energy workers, those working in animal shelters and workers in laundry services. Some labor economists and public health officials consider the category overbroad and say it should be narrowed to only those who interact in person with the public.
An independent committee of medical experts that advises the C.D.C. on immunization practices will meet on Thursday to decide which group to recommend for the second phase of vaccination. In a meeting last month, all voting members of the committee indicated support for putting essential workers ahead of people 65 and older and those with high-risk health conditions.
In the ongoing conversation about how to defeat the coronavirus, experts have made reference to the “Swiss cheese model” of pandemic defense.
The metaphor is easy enough to grasp: Multiple layers of protection, imagined as cheese slices, block the spread of the virus that causes Covid-19. No one layer is perfect: Each has holes, and when the holes align, the risk of infection increases. But several layers combined — social distancing, masks, hand-washing, testing and tracing, ventilation, government messaging — significantly reduce the overall risk. Vaccination will add one more protective layer.
“Pretty soon you’ve created an impenetrable barrier, and you really can quench the transmission of the virus,” said Dr. Julie Gerberding, executive vice president and chief patient officer at Merck, who recently referenced the Swiss cheese model.
“But it requires all of those things, not just one of those things,” she added. “I think that’s what our population is having trouble getting their head around. We want to believe that there is going to come this magic day when suddenly 300 million doses of vaccine will be available and we can go back to work and things will return to normal. That is absolutely not going to happen fast.”
In October, Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, retweeted an infographic rendering of the Swiss cheese model, noting that it included “things that are personal *and* collective responsibility — note the ‘misinformation mouse’ busy eating new holes for the virus to pass through.”
The Swiss cheese concept originated with James T. Reason, a cognitive psychologist, now a professor emeritus at the University of Manchester, England, in his 1990 book, “Human Error.” A succession of disasters — including the Challenger shuttle explosion, Bhopal and Chernobyl — motivated the concept, and it became known as the “Swiss cheese model of accidents,” with the holes in the cheese slices representing errors that accumulate and lead to adverse events.
The metaphor now pairs well with the coronavirus pandemic. Ian M. Mackay, a virologist at the University of Queensland, in Brisbane, Australia, saw a version on Twitter, but thought that it could do with more slices, more information. So he created, with collaborators, the “Swiss Cheese Respiratory Pandemic Defense.”
THOSE WE’VE LOST
Irina A. Antonova, a commanding art historian who led the Pushkin State Museum of Fine Arts in Moscow for more than a half century, used it to bring outside culture to isolated Soviet citizens and turned it into a major cultural institution, died on Tuesday in that city. She was 98.
The cause was heart failure complicated by a coronavirus infection, the museum said.
Ms. Antonova steered the museum through the isolationist and rigid cultural policies of the Soviet Union and into the period after the fall of Communism. In recent years, she expanded it to adjacent buildings — sometimes angering their tenants — to accommodate mushrooming exhibitions.
From early on, Ms. Antonova used her inexhaustible energy to build connections with the world’s leading museums. In 1974, she brought Leonardo da Vinci’s Mona Lisa from the Louvre in Paris. Hundreds of thousands of people lined up to see it, the only queues the Soviet government was proud of at the time. Many knew that with the country’s borders shut, it might be the sole opportunity to see that famous work during their lifetimes.
She further opened the world to the Soviet people with exhibitions of 100 paintings from the Metropolitan Museum of Art in New York and of the treasures of Tutankhamen.
On Ms. Antonova’s watch, the Pushkin museum also exhibited abstract and avant-garde works by Russian and international artists. That was generally unimaginable in a country where an unofficial art show was once broken up with the help of a bulldozer, and whose leader at the time, Nikita S. Khrushchev, while visiting an exhibition of new Soviet art in 1962, shouted that some abstract paintings were made with a “donkey’s tail” and that even his grandson could do better.
In 1981, the museum hosted “Moscow-Paris, 1900-1930,” a landmark exhibition that mixed works by French artists like Matisse and Picasso together with highlights of the Russian avant-garde of the time, including works by Chagall, Malevich and Kandinsky. The exhibition showed how Russian artists fit in well with Western European trends and how they had sometimes helped form them.
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