Glimmers of hope, and new challenges, as the world struggles to beat back the virus.
The grim, grinding news from the worldwide struggle with the coronavirus has begun to be leavened by scattered indications that the spread of the scourge might be slowing.
While Prime Minister Boris Johnson of Britain remained in intensive care Tuesday morning, New York officials expressed cautious optimism that the state and city might be reaching a turning point, and Italy yet again reported a lower daily death toll. China, where the pandemic began late last year, claimed its first day since January with no coronavirus deaths at all.
But from London to New York, officials warned that lockdowns and social distancing would need to remain in place for some time to ensure that the first signs of success were not swamped by a resurgence of the pathogen.
Investors around the world chose to focus on the upside. Wall Street staged a huge rally on Monday, and the gains were expected to continue on Tuesday as global stocks pushed higher.
In Asia, markets rose on news that Japan would spend some 20 percent of its gross domestic product to stabilize its economy, even as Prime Minister Shinzo Abe prepared to declare a state of emergency after infections surged in Tokyo and Osaka.
But Britain was dealing with a crisis that sent shudders worldwide, as its prime minister, 55, was moved into intensive care so he would be near a ventilator should his lungs fail. The government admitted that Mr. Johnson’s condition had deteriorated significantly.
The crisis that has engulfed nearly every nation on earth came suddenly, but there were warnings in the early days of the outbreak in China that the contagion could do vast damage.
A top White House adviser starkly warned Trump administration officials in late January that the coronavirus crisis could cost the United States trillions of dollars in lost output and put millions of Americans at risk of illness or death.
Since then, the federal government has been criticized for a halting, contradictory and bumbling response that has resulted in delays in testing, sent hospitals scrambling for critical supplies and left the public confused, frightened and looking for definitive answers.
The virus has seemed to outpace governments at many steps along the way, and much about it remains a mystery, despite perhaps the largest concentrated global scientific effort in history.
The fatality rate remains unclear, estimates of the proportion of people contracting the virus who never show symptoms ranges from 25 to 50 percent and there is no clear explanation for why it proves so deadly for some people who are relatively young and previously in good health.
A top White House adviser starkly warned Trump administration officials in late January that the coronavirus crisis could cost the United States trillions of dollars and put millions of Americans at risk of illness or death.
The warning, in a memo by Peter Navarro, President Trump’s trade adviser, is the highest-level alert known to have circulated inside the West Wing as the administration was taking its first substantive steps to confront a crisis that had already consumed China’s leaders and would go on to upend life in Europe and the United States.
“The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,” Mr. Navarro’s memo said. “This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”
Dated Jan. 29, it came during a period when Mr. Trump was playing down the risks to the United States. He later went on to say that no one could have predicted such a devastating outcome.
Mr. Navarro said in the memo that the administration faced a choice about how aggressive to be in containing an outbreak, saying the human and economic costs would be relatively low if it turned out to be a problem along the lines of a seasonal flu.
But he went on to emphasize that the “risk of a worst-case pandemic scenario should not be overlooked” given the information coming from China.
In one worst-case scenario cited in the memo, more than a half-million Americans could die.
Prime Minister Boris Johnson of Britain remained in the intensive care unit of a London hospital on Tuesday morning battling coronavirus symptoms, raising questions not just about the state of his health but about who would lead the country, gripped by a major coronavirus outbreak, in his stead if that became necessary.
Mr. Johnson was transferred to the intensive care unit on Monday after his illness worsened. Aides said he had been moved in case he needed a ventilator to help his recovery. On Tuesday morning, Michael Gove, a senior minister, noted that Mr. Johnson was not on a ventilator but has received “oxygen support.”
As Britain has no written Constitution and no standard line of succession in the case of illness or death of the head of the government, it was for Mr. Johnson to decide who should stand in for him if he became ill. But the man he nominated, Dominic Raab, has been relatively untested, serving as the country’s foreign secretary for less than a year.
While Mr. Johnson remains as the head of the government from his hospital bed, the seriousness of his illness means that could change quickly. At a time of extraordinary challenge, Mr. Raab is already serving as chairman of a key committee on the pandemic as the government battles to control the spread of the coronavirus and stabilize an economy hit hard by the lockdown measures it has imposed.
Previous British prime ministers, including Tony Blair and Margaret Thatcher, have had health issues while in power, but had brief periods of absence for planned procedures.
Mr. Johnson could be hospitalized for some time, and at a moment when the government must make major decisions about its coronavirus response. Though some British prime ministers have nominated deputies, Mr. Johnson chose not to do so when he took the role last year.
The last time Britain experienced such a power vacuum was in 1953, when Winston Churchill suffered a stroke and the truth of his condition was kept from the British public.
Before going into intensive care, Mr. Johnson asked Mr. Raab to stand in for him “where necessary.”
Mr. Gove — who has had a lead role in coordinating the government’s coronavirus response, including giving interviews on Mr. Johnson’s state of health — announced on Twitter on Tuesday that he was self-isolating. He felt well, he said, but a member of his family showed symptoms of the virus.
The authorities in mainland China on Tuesday reported no new coronavirus deaths for the first time since January, just as they planned to further ease a monthslong lockdown in Wuhan, the city where the pandemic began.
Wuhan has been slowly returning to a semblance of normalcy in recent weeks. Its subways began running again in late March, and restrictions on outbound travel were scheduled to lift on Wednesday.
As of Tuesday, China has had 83,654 coronavirus infections since the start of the outbreak, according to official figures collated by The New York Times. At least 3,331 people nationwide have died, with most other patients recovered.
But many believe the true death toll is far higher. American intelligence officers say that because midlevel officials in Wuhan and elsewhere have lied about infection rates, testing and death counts, even Beijing does not know the full extent of China’s outbreak.
Those doubts are rife in Wuhan, the capital of Hubei Province, where officials have suppressed online discussion of fatalities and pushed for quick, quiet burials of coronavirus victims.
Other doubts revolve around how China counts new cases.
The National Health Commission said on Tuesday that the 32 new confirmed infections it had recorded a day earlier were all imported from abroad.
But China, unlike other countries, does not include asymptomatic infections in that count. And on Tuesday it recorded 30 new asymptomatic cases, including 18 in Hubei Province. All but nine had been transmitted locally.
Wisconsin voters will face a choice between protecting their health and exercising their civic duty on Tuesday after state Republican leaders, backed up by a conservative majority on the state’s Supreme Court, rebuffed the Democratic governor’s attempt to postpone in-person voting in their presidential primary and local elections.
The political and legal skirmishing throughout Monday was only the first round of an expected national fight over voting rights during the coronavirus crisis.
The Republicans’ success came at the end of a day that left anxious voters whipsawed between competing claims from Gov. Tony Evers and his opponents in the G.O.P.-controlled State Legislature over how the elections scheduled for Tuesday would proceed. It rattled democracy in a key battleground state already shaken by a fast-growing number of cases of the coronavirus.
The governor had issued an executive order postponing in-person voting and extending to June the deadline for absentee ballots. But Republican leaders succeeded in getting the state’s top court to stay the decree.
And in a decision late Monday, the U.S. Supreme Court’s conservative-leaning majority dealt its own blow to Wisconsin Democrats. In a 5-4 vote, the majority ruled against extending the deadline for absentee voting, saying such a change “fundamentally alters the nature of the election.” The court’s four liberal members dissented, with Justice Ruth Bader Ginsburg writing that “the court’s order, I fear, will result in massive disenfranchisement.”
France’s health minister said on Tuesday that the country had not reached the peak of its epidemic and was “still in a worsening phase.” The country has recorded some 74,390 cases in total and 8,911 deaths, with the toll still steadily rising. Monday marked its highest 24-hour death toll yet, with 613 fatalities reported in hospitals.
Olivier Véran, the health minister, told the broadcaster BFM TV on Tuesday that a slowdown in the number of additional patients in intensive care was encouraging, but added: “We are not out of the woods yet.”
“Confinement is more necessary than ever,” he said.
Meanwhile, Anne Hidalgo, the mayor of Paris, told FranceInfo radio on Tuesday that 2 million reusable cloth masks would be handed out to Parisians in the coming days. The masks will be made by about 30 small local companies, Ms. Hidalgo said.
It was yet another sign of shifting attitudes in France toward wearing masks. Previously, following World Health Organization recommendations, the authorities had said masks were only necessary for health care workers and sick patients, but a growing number of officials have been encouraging people to wear cloth masks or other mouth coverings in public.
Officials in some cities, like Nice, have said that they would make it mandatory for people leaving their homes to wear a mask.
From dorm rooms and apartments, 52 medical students watched video of themselves roll across their screens. Miles away, their proud families followed online. Gazing into webcams, the students pledged the Hippocratic oath in frayed unison, dozens of different starts and voices, all coming to the same point.
They could get on with doctoring.
On Friday, a virtual graduation was held over video chat for nearly half the 2020 class at New York University’s Grossman School of Medicine. They were two months ahead of schedule. That moment will be repeated in some form at other medical schools in the coming days.
The more ragged the ritual, the more soul-stirring its core: Young people were stepping up to join others already serving at an hour of crisis, little different than soldiers being deployed in war.
“The country needs to mobilize people,” said Dr. Steven Abramson, vice dean of the Grossman school. “Last time this happened was in World War II, when medical schools were shortened to three years.”
Celebrate the students today. Remember, too, that they stand as proxies for an entire caste of the essential: doctors, nurses and technicians, of course, but also those who drive buses, pick up garbage, save lives in ambulances, stock grocery shelves, deliver mail, push bins of dirty sheets down corridors, keep the electricity grid humming and the sewer system flowing, and figure out how to make space in hospitals when none is left.
India appeared to be softening its position on blocking the export of hydroxychloroquine, a drug that President Trump has promoted as a possible treatment for the coronavirus.
India is the world’s largest producer of hydroxychloroquine, known as HCQ, and the president threatened Monday night to retaliate against India if it did not lift tough export restrictions imposed last month.
Many scientists question if the drug, usually prescribed to treat malaria and rheumatism, actually helps against the coronavirus. But Mr. Trump and others have called it “a game changer.”
“In view of the humanitarian aspects of the pandemic, it has been decided that India would license paracetamol and HCQ in appropriate quantities to all our neighboring countries who are dependent on our capabilities,” Anurag Srivastava, a spokesman for India’s foreign ministry, said on Tuesday. (Paracetemol is the pain reliever usually called acetaminophen or Tylenol in the United States.)
“We will also be supplying these essential drugs to some nations who have been particularly badly affected by the pandemic,” Mr. Srivastava said.
India’s coronavirus cases have been doubling every four days; the number of detected cases has risen above 4,000, and the country remains under a strict lockdown that has kept much of its 1.3 billion people indoors.
Concerns are rising that the lockdown could send India into a deep recession that will hit hundreds of millions of poor people especially hard. The Indian government is now planning to slash the salaries of all members of Parliament, including Prime Minister Narendra Modi, by 30 percent.
Even as death tolls are rising in France, rebounding in Spain and have yet to peak in cities across Europe, some countries have begun publicly considering plans to lift restrictions on movement and return to some semblance of normalcy.
Sebastian Kurz, the chancellor of Austria, in a Monday news conference introduced a timetable for the country to re-emerge from lockdown that would see some stores reopen after Easter.
Austria has recorded 12,058 confirmed cases and 220 deaths, but with new cases appearing to peak on March 26, the government has begun to plan for a loosening of restrictions. Mr. Kurz pleaded with residents to maintain social distancing rules this week, saying it was crucial.
Denmark will allow its youngest children to return to day care and school starting April 15, Prime Minister Mette Frederiksen announced on Monday, describing the steps as the first phase of the lifting a series of restrictions announced last month.
Other restrictions — like border closures, and the shuttering of restaurants and other nonessential services — will remain in place at least another four weeks. A ban on large gatherings was extended through August. Ms. Fredericksen said the relaxing of restrictions was not an easy decision.
“It’s like walking a tightrope: If we stand still, we may fall,” she said. “If we go too fast it may soon go wrong.”
In Italy, where there is a growing sense that the worst of the epidemic may have passed, officials are weighing the idea of widespread testing for antibodies that would allow workers to return. But elsewhere, officials have stressed that talk of lifting restrictions was premature. Chancellor Angela Merkel of Germany warned on Monday that it would be “irresponsible” to discuss a date for easing measures.
Édouard Philippe, France’s prime minister, said last week that it was too early to say precisely when and how easing would happen, adding it was important not to “ruin the collective effort.”
As Prime Minister Shinzo Abe prepares to declare a state of emergency for Japan’s largest population centers, citizens and businesses in cities like Tokyo, Yokohama, Osaka, Kobe and Fukuoka must now decide how to respond.
Unlike in other countries, Mr. Abe does not have the legal power to issue stay-at-home orders or force businesses to close, and he has promised to keep public transit operational.
Even as experts warn that Japan is on the brink of an explosion of infections that could overwhelm its health care system, the government will largely depend on voluntary compliance.
Those covered by the planned emergency declaration — about 56.1 million people across seven prefectures, or less than half of Japan’s total population — will be strongly urged for the next month to work from home and avoid going out for anything other than essential trips to the market or pharmacy.
Until now, Japan’s health officials have reassured the public that they have prevented the virus from raging out of control, mainly by closing schools, asking organizers of large sports and cultural events to cancel them, and quickly identifying clusters of cases and tracing close contacts to infected people.
But as Mr. Abe, who also announced an economic stimulus package on Monday that he said was worth nearly $1 trillion, prepares to take the nation’s containment measures a step further with an official declaration that is expected Tuesday evening, some experts saw that as a tacit admission that the government’s previous approach was no longer working.
As of Tuesday morning, Japan had confirmed a total of 3,906 cases and 80 deaths from the coronavirus.
Here’s how to help from home.
Sitting at home, it’s easy to feel like there’s nothing you can do to help those on the front lines of the coronavirus pandemic. But there are many things you can do to help medical professionals, the people affected directly by the virus and your local businesses.
As people across the world are under pressure to follow strict lockdown measures, government officials might be having a hard time following their own advice.
Only days after Scotland’s chief medical officer resigned for flouting social distancing rules, New Zealand’s health minister, David Clark, called himself an “idiot” on Tuesday for failing more than once to adhere to the country’s lockdown.
Mr. Clark admitted to driving his family to a park near their house to ride a mountain bike after a photo of his van parked there was published by local outlets on Thursday.
But that wasn’t the first time he bent the lockdown rules that his government announced last month, when New Zealand declared its second ever state of national emergency.
Mr. Clark said in a statement on Tuesday that late last month he had driven his family to a beach about 12 miles away from their house so that they would take a walk.
“This trip was a clear breach of the lockdown principles of staying local and not driving long distances to reach recreation spots,” he said, adding that he disclosed that trip to Jacinda Ardern, the country’s prime minister, and offered his resignation.
“I’ve been an idiot, and I understand why people will be angry with me,” he said.
But Ms. Ardern did not immediately accept Mr. Clark’s resignation, hoping to avoid disrupting the health sector and the government’s response to the coronavirus crisis.
New Zealand has recorded 1,160 cases of infection and one death.
In Afghanistan, thousands of people flooded through the border with Pakistan on Tuesday in chaotic scenes that overwhelmed any screening measures to identify coronavirus cases and slow the spread of the disease.
The country’s weak management of borders has been a major issue. Even as the virus spread in neighboring Iran, hundreds of thousands of people still made it back to Afghanistan through its western borders, before spreading across the country. Now the rush of returnees from Pakistan, where nearly 4,000 cases have been confirmed, has exacerbated fears. By Tuesday morning, Afghanistan had reported 423 cases of coronavirus — but officials warn those numbers could not be an authentic indication of the spread, with testing starting late and remaining limited.
The border with Pakistan, shut for weeks, was temporarily opened on Monday to allow measured return of Afghans stuck on the other side. On the first day, officials even showed pictures of circles drawn on the ground to enforce distancing as returnees were checked to see if they had any symptoms. But early on Tuesday, the scenes were chaotic.
“Between 8,000 and 10,000 people rushed in all at once,” said Rahat Gul Ziarmal, the mayor in the border town of Torkham.
In a state with pockets of deep wariness about both big government and mainstream medicine, the sweeping restrictions aimed at containing the spread of the virus have run into outright rebellion in some parts of Idaho, which is facing its own worrying spike in coronavirus cases.
The opposition is coming not only from people like Ammon Bundy, whose armed takeover of the Oregon refuge with dozens of other men and women in 2016 led to a 41-day standoff, but also from some state lawmakers and a county sheriff who are calling the governor’s statewide stay-at-home order an infringement on individual liberties.
Health care providers and others have been horrified at the public calls to countermand social-distancing requirements, warning that failing to take firm measures could overwhelm Idaho’s small hospitals and put large numbers of people at risk of dying.
Many of the latest claims about the Constitution have come from Idaho’s northern panhandle, where vaccination rates for other diseases have always been low and where wariness of government is high.
At a time when health officials say social-distancing measures are vital to avert catastrophic outbreaks of the kind that could overwhelm hospitals — as happened in Italy — Idaho’s tensions threaten to undermine compliance. While the state was one of the last in the country to identify a coronavirus case, it now has far more cases per capita than California. Blaine County, which includes the popular Sun Valley ski resort, now has the largest per capita concentration of coronavirus cases in the nation.
The director general of the World Health Organization has denounced as “racist” the remarks of two French doctors who suggested a potential vaccine for the coronavirus be tested in Africa.
During the organization’s coronavirus briefing on Monday, Tedros Adhanom Ghebreyesus said he was “appalled” by the comments from the scientists at a time when there was need for global “solidarity” to defeat the march of the coronavirus pandemic. The comments, made during a discussion on French television last week, were centered on the launch of trials in Europe and Australia to see if a tuberculosis vaccine could be used to treat the coronavirus.
“If I can be provocative, shouldn’t we be doing this study in Africa, where there are no masks, no treatments, no intensive care?” Jean-Paul Mira, head of intensive care at Cochin hospital in Paris, said. “A bit like as it is done elsewhere for some studies on Aids. In prostitutes, we try things because we know that they are highly exposed and that they do not protect themselves.”
Camille Locht, research director at France’s national health institute, Inserm, agreed, saying: “You are right. We are in the process of thinking about a study in parallel in Africa.”
On Monday, Mr. Tedros called those comments a “disgrace” and condemned them “in the strongest terms possible.”
“Africa cannot and will not be a testing ground for any vaccine,” he said. “We will follow all the rules to test any vaccine or therapeutics all over the world using exactly the same rule.”
“The hangover from colonial mentality has to stop,” he said.
A health official from the Democratic Republic of Congo last week stirred controversy after saying the country would participate in any future coronavirus vaccine tests.
More than 50 African states have so far reported a total of over 10,000 cases and 487 deaths, according to the Africa Centers for Disease Control and Prevention. As the cases have spread, nations like South Africa have introduced total lockdowns, limited movement within the country like Kenya or imposed night curfews like Egypt. Protesters in Ivory Coast have destroyed a coronavirus treatment center, saying it was too close to their homes.
Turkey has ordered all citizens to wear masks when shopping or visiting crowded public places and announced it will start to deliver masks to every family, free of charge, as coronavirus infections sharply increase in the country of 80 million.
Turkey has over 30,000 confirmed cases of the virus and has registered 649 deaths. More than 1,300 patients are in intensive care units and at least 600 medical workers have been infected, according to figures released by the Health Ministry.
The number of confirmed cases places Turkey among the top 10 currently worst affected countries, a sharp rise since its first confirmed death from the disease on March 17.
Health Minister Fahrettin Koca, however, said on Monday that the increase in confirmed cases was low when compared with the increase in testing, which has been ramped up to more than 20,000 per day.
President Recep Tayyip Erdogan has introduced gradual measures to contain the spread of the coronavirus, asking people to stay at home and imposing a curfew on those over 65 and under 20, but resisting a nationwide lockdown.
Opposition politicians, including the mayors of two of the biggest cities, Ankara and Istanbul, which have been among the hardest hit by the virus, have called for stricter measures, but Mr. Erdogan has allowed industry, construction firms and public transport to continue working.
“Turkey’s situation concerning urgent needs, from health to food and cleaning material, is very good,” Mr. Erdogan said in an address to the nation on Monday. “We not only have the ability to overcome this epidemic, but also the morale and determination.”
Reporting was contributed by Carlotta Gall, Aurelien Breeden, Martin Selsoe Sorensen, Christopher F. Schuetze, Marc Santora, Megan Specia, Iliana Magra, Maggie Haberman, Mike Baker, Declan Walsh, Andrew Higgins, Carlotta Gall, Patrick Kingsley, Stephen Castle, Mark Landler, Adam Liptak, Sheila Kaplan, Katie Thomas, Motoko Rich, Mike Ives, Richard C. Paddock, Hannah Beech, Jason Gutierrez, Muktita Suhartono and Elaine Yu.