Ecuador’s increased deaths during the outbreak are 15 times the official coronavirus toll.
The pandemic death toll in Ecuador is 15 times as high as the official count, an analysis by The New York Times indicates, meaning that it has suffered one of the world’s most devastating outbreaks.
By April 15, the government has said, 503 people had been killed by Covid-19.
But from March 1 to April 15, the overall number of deaths in Ecuador was 7,600 higher than usual for the time of year, in a country of 17 million people, according to the Times analysis, which is based on official death registrations from the past three years.
It was already clear that Ecuador had been hit hard, with bodies abandoned on sidewalks and stacking up in morgues. But the government has acknowledged that with testing scarce and medical resources overwhelmed, its tally was much too low.
“There were people dying at the doors of our clinics and we had no way of helping them,” said Marcelo Castillo, head of an intensive care unit in a private hospital. “Mothers, husbands, asking in tears for a bed, because ‘you are a doctor and you have to help us’.”
The figures give a dire indication of how the pandemic has outstripped both the capacity of health care systems to respond and of governments to keep track, particularly in developing countries.
Raw mortality data gives only a rough measure of the fatal reach of the virus, and unknown factors may contribute to the surge. It includes both people who succumbed to Covid-19 and those who died because they could not receive care for other conditions as hospitals were inundated.
With Ecuador under a national lockdown since mid-March, the overall death rate has fallen sharply in recent days.
Chancellor Angela Merkel of Germany on Thursday warned the governors of the country’s 16 states against loosening restrictions on public life too quickly, saying that it could jeopardize the nation’s ability to keep the spread of coronavirus under control.
“Let us not squander what we have achieved,” she said in an address to Parliament.
Germany has slowed the pandemic’s spread since residents were ordered to largely remain in their homes starting in mid-March. The country, which has reported more than 148,000 infections and over 5,000 fatalities, has had a steady decline in the number of new cases since April.
But virologists have expressed concern that the loosening could result in a surge in the rate of spreading and strain the health system, which has so far been able to cope with the outbreak. Ms. Merkel said that she stood by her decisions to impose restrictions, and to allow them to be slowly eased, but cautioned against creating a false sense of security among the population by rescinding them too swiftly.
“Nobody wants to hear this, but the truth is that we are not living in the final phase of this pandemic, but at the beginning,” she said. “We are going to have to live with it for a long time.”
But the chancellor also noted that the outbreak and subsequent lockdown was proving challenging.
“This pandemic is an imposition on our democracy, because it restricts our existential rights and needs,” she said.
“When people see these pictures of New York City they say, ‘How can this happen? How is this possible?’” said Henrik Enderlein, the president of the Berlin-based Hertie School, a public policy institute. “We are all stunned. Look at the jobless lines: twenty-two million.”
“I feel a desperate sadness,” said Timothy Garton Ash, a professor of European history at Oxford University, and a lifelong and ardent Atlanticist who spends part of the year at Stanford University.
The pandemic has done more than take lives and livelihoods from New Delhi to New York. It is also shaking fundamental assumptions about American exceptionalism — the unique role that the United States played for decades after World War II as the reach of its values and power made it a global leader and example to the world.
As the calamity unfolds, President Trump and state governors are arguing not only over what to do, but also over who has the authority to do it. Mr. Trump has fomented protests against the safety measures urged by scientific advisers, misrepresented facts about the virus and the government response nearly daily, and this week used the virus to cut off the issuing of green cards to people seeking to immigrate to the United States.
“America has not done badly — it has done exceptionally badly,” said Dominique Moïsi, a senior adviser at the Institut Montaigne, a Paris think tank.
The leaders of European Union countries agreed on Thursday to have plans drawn up for a recovery fund to help rebuild their battered economies. Whether they can agree on what those plans should be is another matter.
The 27 leaders offered no consensus on how big the fund should be or how it should distribute money to nations and industries in need — areas of disagreement between the poorer southern countries that have been hit hardest by the coronavirus pandemic, and the wealthier, healthier, north.
Instead, the leaders, meeting by teleconference, directed the bloc’s executive branch, the European Commission, to draft a proposal that balances their competing demands.
European Council president Charles Michel, who convenes the leaders’ meetings, said those measures should be available as of June 1. They include 100 billion euros for unemployment support, 200 billion euros for smaller businesses, and 240 billion euros for health care system investments.
Southern European countries led by Italy and Spain are calling for a recovery fund of more than a trillion euros that will be able to extend grants to nations rather than loans. But the idea of grants does not appeal to northern countries.
“There will be a sound balance of grants and loans and this will be a matter of negotiation with member states, so we find a good mixture” said Ursula von der Leyen, president of the European Commission.
“We already know that the scale, the speed and the impact of the economic crisis is unprecedented in modern times,” she said.
“Unless we act decidedly and collectively,” she warned, “the recovery will not be symmetric.”
Accused of botching its response to the coronavirus, the British government has repeatedly insisted that it was following the advice of its panel of scientific advisers, known as SAGE.
But no one outside government or the panel knows what that advice is, who is giving it, or how faithfully the government is following it.
Meetings of the Scientific Advisory Group for Emergencies are closed. Its list of members is secret. Its recommendations are private.
That has made it impossible for the public to assess how Prime Minister Boris Johnson’s government arrived at its laissez-faire approach to the pandemic through much of March, even as other European countries were limiting travel, public gatherings and personal movement.
Nor is it any clearer what scientific advice had changed when the government did impose a lockdown, on March 23. Mr. Johnson tested positive for the virus three days later and is still recovering.
“You can’t challenge the advice if other experts can’t see what they are looking at,” said Sarah Wollaston, a former chairwoman of the health committee in Parliament.
Critics say the government’s delay may have cost lives and question whether it is getting scientific advice from the right people.
In Europe, only Italy, Spain and France have higher official death tolls, but they were hit earlier than Britain and are closer to getting their outbreaks under control.
In early March, Britain’s government settled on a strategy of urging voluntary measures and keeping the economy running, rather than closing businesses and ordering people to stay at home.
It stuck to that approach until a week after Imperial College London published a frightening study on March 16 that projected up to 500,000 deaths if Britain did not act more aggressively.
Ukraine is struggling to control coronavirus outbreaks in several medieval monasteries that hold the relics of saints, where worshipers have flocked for solace during the pandemic, only to risk being infected.
Police this week sealed the gates of the Pochaiv monastery, a 13th-century fortress and ensemble of churches in western Ukraine that is a traditional pilgrimage site for the sick.
Rumors had swirled for weeks of monks falling ill even as the faithful continued to come and go. Four priests living outside the compound tested positive this week.
Before being forced to close, the monastery had posted on its website assurance that attending services was safe. “There is much evidence that the Sacrament of Holy Communion cannot serve as a source of infection,” it said.
The walled monastery is run by an arm of the Moscow Patriarchate, the Orthodox Christian church that answers to its Russian leaders. The Ukrainian Orthodox church broke away from Moscow last year, reflecting the conflict between the countries.
The Ukrainian Ministry of Health suspects an extensive coronavirus outbreak within the Pochaiv monastery, home to about 600 priests and monks. But it cannot be sure because the abbot has refused to allow doctors in, Oksana Chaychuk, the chief sanitary doctor of the Ternopil region, told Ukrainian media.
Earlier this month, the Ukrainian national guard blocked entrances to one of Orthodox Christianity’s holiest sites, the Monastery of the Caves in Kyiv, Ukraine’s capital, where a labyrinth of catacombs holds the tombs of saints.
By the time it was closed, about 100 monks living there, including the abbot, had become infected. Ambulances carried them out through the police cordon.
Before he was infected, the abbot, Metropolitan Pavlo, urged believers to attend services regardless of the risk of infection, saying in a video posted online, “Whether you are old or young, everybody hurry to the temple and embrace one another.”
If R0 is 2.5, then one person with the disease is expected to infect, on average, 2.5 others. An R0 below 1 suggests that the number of cases is shrinking, possibly allowing societies to open back up. An R0 above 1 indicates that the number of cases is growing, perhaps necessitating renewed lockdowns.
World leaders and health experts are poised to spend the coming months or years obsessed with the figure. But R0 is messier than it might look. It is built on hard science, forensic investigation, complex mathematical models — and often a good deal of guesswork.
China said on Thursday that it would donate an additional $30 million to the World Health Organization after President Trump’s order this month to suspend American funding to the agency as he accused it of promoting “China’s misinformation” and “severely mismanaging” the spread of the coronavirus.
Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, said on Wednesday that he recognized the importance of American funding both for the W.H.O. and in his native Ethiopia, where he had served as health minister.
He said that the money was important not only for global health, but also for the safety of the United States, and that he hoped Mr. Trump would restore the funding.
“I hope the freezing of the funding will be reconsidered and the U.S. will once again support W.H.O.’s work and continue to save lives,” Dr. Tedros said.
The scale of new cases appears modest: The Chinese state news media tallied dozens of new infections, all of which experts said were linked to the return of Chinese from Russia and the United States. Still, it is not clear that the spread has been entirely contained, and local governments put limits on travel and issued bulletins to increase vigilance.
For China, the new rules and the prospect of further spread are a reminder of this past winter, when a vast portion of the country’s cities were locked down. And for the rest of the world, it underscores how challenging it can be to control the contagion — even after the worst seems to be over.
Kenya has vowed to arrest and isolate about 50 people who escaped from a coronavirus quarantine center in Nairobi, highlighting the challenges the authorities are facing in curbing the spread of the disease.
President Uhuru Kenyatta said in an interview with several radio stations that the police were searching for a group that fled the Kenya Medical Training College in the capital, where they were in quarantine.
“We know you and we will find you and we will take you back where you were,” he said.
The announcement came after videos surfaced showing several people scaling a wall and leaving the facility with backpacks. Mr. Kenyatta also lamented that many Kenyans were not taking the disease seriously and were putting their loved ones at risk.
But the president has also reiterated a health ministry directive that those found guilty of flouting social distancing rules and curfews be placed into quarantine centers instead of being detained at police stations.
The authorities in Kenya have faced accusations of mishandling the confinement measures, filling quarantine centers to capacity and charging poor workers to stay in isolation units. Last week, more than two dozen people isolated at a university campus in Nairobi protested, saying that they were being held even after they had tested negative for the coronavirus and finished their quarantine.
The Al Aqsa Mosque compound in Jerusalem, one of the holiest sites in Islam, will be closed to the public throughout the fasting month of Ramadan to stem the spread of the coronavirus, in what scholars believe is the first time in centuries that it has been shut to Muslims during the holiday.
But the Muslim world will still be able to follow prayers from the holy site online.
The Islamic Waqf, the Jordanian-backed body that administers the mosque, plans to run a daily broadcast on Facebook of its employees performing special Ramadan evening prayers at the holy site, as well as traditional Friday Prayer.
“We are deeply pained the people can’t physically be present at the mosque this year because of the contagion, but we hope they can join us in their homes by watching through the live feed,” said Omar Kiswani, the mosque’s director.
Ronnie Ellenblum, a historical geographer at Hebrew University, said he believed that the last time Muslims were unable to access the mosque throughout Ramadan was when the crusaders controlled the site in the 1100s.
Al Aqsa is ordinarily a major point of gathering during Ramadan, which begins Friday, for Palestinians, Arab citizens of Israel and Muslim pilgrims from around the world. Jews also revere the compound as their holiest site and refer to it as the Temple Mount.
Imam Kiswani said he and his colleagues would be praying for the doctors and medical teams treating coronavirus patients. “We hope this period will pass soon and we can reopen the mosque’s gates,” he said.
How long the pandemic lasts, and how governments and activists respond, will determine whether the pause represents a moment of metamorphosis or an unceremonious end for some of the most widespread mass mobilizations in recent history.
The challenges to protesters, in places as different as Hong Kong and Lebanon, are apparent. Millions of demonstrators are hunkered down at home, hemmed in by sweeping quarantines and health concerns. The daily burden of acquiring face masks or food often overshadows debates about corruption and abuse of power.
Also, almost every government has restricted mass gatherings, ostensibly protecting public health but potentially also constraining future mobilization. Some have even used the outbreak to consolidate power or arrest opponents.
But the pandemic’s economic toll, as well as the crises of trust it has inspired in many governments, could fuel fresh outrage. People across the world — from Peru to France to the United States — have defied lockdown measures that they say threaten their jobs, housing and food supplies.
Some protesters are also finding new ways to express their discontent. Chilean activists have projected images of crowds onto empty streets. And in Hong Kong, a union of medical workers, itself born out of the pro-democracy protests, went on strike to criticize the government’s outbreak response.
“It is a rest time,” said Isaac Cheng, a student leader of Demosisto, a prominent Hong Kong pro-democracy group, “but it’s definitely not the end of the movement.”
Some countries have opted for a more hands-off approach to keep their populations at home to limit the spread of the coronavirus. Others have imposed strict measures to enforce lockdowns, fining people who flout the rules, and in this field, Romania is a leader.
Since March 24, Romanian authorities have issued almost 220,000 fines, worth about $95.5 million, according to official figures. Between March 24 and April 19, fines amounted to the equivalent of the country’s corporate profit tax for all of February, according to local news media.
Romanians are allowed out of their homes only for certain reasons, like buying necessities and going to work, and must present signed statements detailing their purpose and destinations to the police or the military when asked, along with their identification cards.
Those found without documentation or a valid reason can be fined up to 20,000 lei ($4,470), in a country where the average monthly salary is around 3,000 lei and the population is less than 20 million.
By comparison, Britain, with more than three times the population of Romania, had issued 3,500 fines as of April 19, with penalties from 30 pounds to 60 pounds ($37 to $74), according to the BBC.
In the Canadian province of Ontario, which has some of the stiffest penalties in the West, people have been fined more than 2,000 Canadian dollars, about $1,420, for lingering too long in parks and then refusing to identify themselves to enforcement officers. People are allowed to walk or run through parks, but dozens have been fined 750 Canadian dollars for taking a break on a bench.
Romania’s fines seem to be working. On Wednesday, President Klaus Iohannis said that the authorities would begin easing restrictions May 15. He added, however, that public events would remain banned and that masks would be required in enclosed public spaces and on public transit, potentially until next year.
Romania declared a state of emergency on March 16, and as of Thursday had 10,096 confirmed cases and 527 deaths.
With the number of reported coronavirus deaths in Italy surpassing 25,000 — the highest death toll in Europe — there is a growing call in the country to hold someone accountable, with some prosecutors considering manslaughter charges against directors of a nursing home where residents died of the coronavirus.
Prosecutors are investigating whether errors by the authorities contributed to or caused some of Italy’s deadliest clusters. Liberal members of Parliament have accused the conservative government in the Lombardy region of exacerbating the outbreak.
About 45,000 relatives of coronavirus victims have joined a Facebook group called “NOI denunceremo” (We Will Denounce You), composed of people who believe that not enough was done to save their family members.
But when another doctor at the Ponte San Pietro Hospital told her that the choice to sedate her father had been motivated by a need to make room for younger patients, Ms. Capelli joined the Facebook group.
“I have the impression they are trying to silence everything,” Ms. Capelli, 48, said on Thursday. “Now it’s a moment of common pain, but for the future, I want justice.”
Prosecutors are investigating what they call an “involuntary epidemic” at the Alzano hospital, near Bergamo, where the virus spread through the medical wards. They are also considering manslaughter charges against the directors of retirement homes where hundreds of residents died and where the full death toll may have been hidden.
Yet many in the country continue to honor health care workers, and not everyone is backing the prosecutorial shift. A 24-year-old nurse wrote a letter in La Repubblica newspaper in response to the criticism heaped on the authorities in Lombardy. She said that in the months she spent in a Covid-19 ward, she had learned the value of sacrifice, of waiting and of forgiving.
A nurse who cared for Prime Minister Boris Johnson of Britain while he was in intensive care for the coronavirus at a London hospital said that she wasn’t fazed by looking after the country’s leader and that he did not get special treatment.
Mr. Johnson was “just another patient,” the nurse, Jenny McGee, told Television New Zealand on Thursday, adding that she had not expected to be singled out by him on national television.
“My first reaction was that it was a joke,” said Ms. McGee, a New Zealand native. “It was totally out of the blue.”
Ms. McGee said the prime minister “absolutely needed to be” in intensive care because of the seriousness of his illness. Mr. Johnson is recuperating at Chequers, the official country house of Britain’s prime ministers.
As the country weighs when and how to ease its lockdown, Prof. Chris Whitty, the senior medical adviser to the government, said on Wednesday that restrictions could be in place for a year. He said social distancing measures would have to remain in place until a vaccine or effective drugs to treat the coronavirus and keep people from dying were available.
“The probability of having those anytime in the next calendar year,” he said, is “incredibly small.”
On Thursday, scientists in Britain began human trials to find a working vaccine. More than 18,700 people have died in the country after testing positive for the coronavirus, according to official figures.
A mentally ill former soldier has been gunned down at a quarantine checkpoint in the Philippines after an altercation with police officers, officials said on Thursday.
The shooting, on Tuesday, came just over three weeks after President Rodrigo Duterte ordered police officers at quarantine checkpoints to shoot dead anyone who resisted. A local human rights group, Karapatan, denounced the shooting as an “alarming and deplorable act of state violence that should be strongly condemned.”
The Army veteran, identified as Winston Ragos, 34, was shot and killed in Quezon City, north of the capital, Manila. A video of the episode that has widely circulated in the country showed five police officers rushing to a store and one of them drawing a gun and shooting Mr. Ragos twice.
In a report on the shooting, the Philippine National Police said that Mr. Ragos had been holding a bag that contained a handgun. That account was disputed by his relatives.
Col. Ramon Zagala, an army spokesman, said in an interview on Thursday that the force was saddened by the incident and had ordered an investigation.
“The victim was mentally troubled, and while he is no longer with the force, people need to realize that he may be battling a lifelong and silent battle with his own demons,” Colonel Zagala said.
He said Mr. Ragos had been discharged from the army in 2017 after being diagnosed with post-traumatic stress disorder.
Most clerics complied with the government’s announcement of a lockdown late last month, keeping people at home to avoid spreading the coronavirus. But some of the most influential imams called on worshipers to attend Friday Prayer in even greater numbers. Devotees attacked police officers who tried to get in their way.
As Ramadan draws closer, dozens of well-known clerics and leaders of religious parties — including some who initially obeyed the lockdown orders — have signed a letter demanding that the government exempt mosques from the shutdown during the holy month or invite the wrath of God and the faithful.
On Saturday, the government gave in, signing an agreement that let mosques stay open for Ramadan as long as they followed 20 rules, including forcing congregants to maintain a six-foot distance, bring their own prayer mats and perform their ablutions at home. Prime Minister Imran Khan met on Monday with the clerics, who vowed to abide by the deal.
“It is very difficult for the state to implement what’s best for the public good,” said Husnul Amin, an Islamabad-based scholar on Islam and politics. “The larger public interest is always up against the clerics. It’s completely undemocratic.”
Even the country’s security forces, which empowered the clerical establishment in the 1980s in an effort to churn out jihadists to fight the Soviet military next door in Afghanistan, seemed unable to counter the imams.
In Karachi, the largest city, scenes emerged of worshipers chasing the police through narrow alleyways, pelting them with rocks and sending several officers to the hospital.
“The military has created a monster they can no longer control,” Mr. Amin said.
While clerics acknowledge that their mosques are perfect vectors for the coronavirus’s spread, some said they had to protect their bottom line.
“We know the coronavirus pandemic is a global health issue, but religious duties cannot be abandoned,” said Maulana Ataullah Hazravi, a Karachi-based cleric. Besides, he added, “mosques depend largely on the donations collected during Ramadan.”
A citizen journalist who disappeared in February after documenting the outbreak in Wuhan, China, said in a YouTube video that he had been released after a period of forced quarantine.
The journalist, Li Zehua, spent weeks interviewing stranded migrant workers and overburdened crematory employees — an attempt to show the toll that the outbreak was taking on the city where it began.
But until his latest video surfaced on Wednesday evening, he had not spoken publicly since Feb. 26, when he streamed footage of men entering his apartment.
In the video, Mr. Li, 25, described being chased by a white S.U.V. that night and hiding in his apartment in the dark. He said that men who identified themselves as security officials eventually took him to a police station for interrogation.
The authorities later said that they had decided not to investigate him, but that he needed to be quarantined because he had visited “sensitive areas,” Mr. Li said in the video.
Mr. Li, who became a citizen journalist after a brief career as a host on state-run television, said he was quarantined from late February until mid-March at a Wuhan hotel. He was given regular meals and allowed to watch state-run television, he said, then driven to his hometown and ordered to quarantine for another two weeks.
In previous videos, Mr. Li had urged other Chinese young people to “stand up” and said he was no longer willing to “shut my eyes.” But in his latest one, he did not criticize the government.
Calmly, and almost without emotion, he said that the police had treated him well.
Mr. Li’s disappearance followed those of two other citizen journalists, Chen Qiushi and Fang Bin, who had also filmed scenes of illness and death in Wuhan. Neither has reappeared.
Reporting was contributed by Anatoly Kurmanaev, Andrew Kramer, Maria Varenikova, Matina Stevis-Gridneff, Mark Landler, Stephen Castle, Ian Austen, Richard Pérez-Peña, Karen Zraick, Adam Rasgon, Kit Gillet, Abdi Latif Dahir, Emma Bubola, Katrin Bennhold, Austin Ramzy, Melissa Eddy, Megan Specia, Iliana Magra, Jason Gutierrez, Paul Mozur, Maria Abi-Habib, Vivian Yee, Raphael Minder, Dan Levin, Vivian Wang, Ron DePasquale, Richard C. Paddock, Max Fisher, Roni Caryn Rabin, Pam Belluck, Gina Kolata and Muktita Suhartono. Albee Zhang and Wang Yiwei contributed research.