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The Four Percent

Texas pauses its reopening and moves to free up room in hospitals as cases rise.

Texas paused its reopening process and moved to free up hospital space for coronavirus patients on Thursday amid growing concern over its rising tally of cases, Gov. Greg Abbott announced Thursday.

The state has recorded more than 130,000 cases and nearly 3,000 deaths. More than 4,300 people with the virus are hospitalized across the state, more than double the number at the beginning of June. To ensure that hospitals have enough capacity to care for virus patients, Mr. Abbott issued an executive order suspending elective procedures in hospitals in four counties: Bexar, Dallas, Travis and Harris, which includes hard-hit Houston.

Mayor Sylvester Turner of Houston told local lawmakers on Wednesday that the city’s intensive-care units were filled to 97 percent capacity, and that more than a quarter of those patients had tested positive for the virus.

Even as Texas health officials grappled with the surge, the state’s attorney general, Ken Paxton, asked the Supreme Court on Thursday to overturn the Affordable Care Act, which has extended subsidized health insurance to thousands of Texans while protecting state residents who have pre-existing medical conditions.

In legal briefs filed with the court on behalf of Texas and 19 other states, Mr. Paxton argued that when Congress rescinded the tax penalty that the law imposed on Americans who did not purchase insurance — known as the “individual mandate” — the entire law became invalid, a legal argument that has not changed with the pandemic.

“Congress deliberately designed the ACA and its goal of expanding health care coverage around the individual mandate,” Thursday’s brief said. Absent the mandate, it added, other provisions of the law “not only malfunction, but result in the opposite of what Congress intended.”

Although critics have blamed the reopening for contributing to the expanding pandemic, Mr. Abbott has said repeatedly that rolling it back would be a last resort, a stance he repeated on Thursday. Businesses that have already reopened can continue to operate, but any further reopening is halted, he said in a statement. (Bars now operate at 50 percent capacity, while restaurants operate at 75 percent capacity.)

“The last thing we want to do as a state is go backwards and close down businesses,” Mr. Abbott said. “This temporary pause will help our state corral the spread until we can safely enter the next phase of opening our state for business.”

Texas is one of 29 states where case numbers have been rising. The United States reported its largest one-day total since the start of the pandemic on Wednesday: 36,880 new cases, more than two months after the previous high. The resurgence is concentrated largely in the South and West; New York has imposed a quarantine on travelers from many hard-hit states that meet certain health metrics. Florida, Oklahoma, South Carolina and Texas reported their highest single-day totals on Wednesday.

The Trump administration delivered more than a million stimulus payments worth about $1.4 billion to dead people in a rush to pump money into the economy this year, the Government Accountability Office said on Thursday.

The Treasury Department, working with the Internal Revenue Service, raced to deliver nearly $270 billion in economic impact payments to Americans this spring. But a chunk of the money ended up in the wrong places.

The improper payments reflect some of the wasteful government spending that occurred in the wake of the rapid economic stabilization effort that was undertaken after Congress passed a $2.6 trillion bailout package in March.

“The agencies faced difficulties delivering payments to some individuals, and faced additional risks related to making improper payments to ineligible individuals, such as decedents, and fraud,” the report said.

The report noted that while the I.R.S. typically uses death records maintained by the Social Security Administration to prevent improper payments, that did not happen with the first three batches of stimulus payments. The Treasury and the I.R.S. “did not use the death records to stop payments to deceased individuals for the first three batches of payments” because of a legal interpretation of the legislation authorizing the payments. I.R.S. lawyers “determined that I.R.S. did not have the legal authority to deny payments to those who filed a return for 2019, even if they were deceased at the time of payment,” the report found.

The G.A.O. recommended that the I.R.S. find ways to notify ineligible recipients of the payments how to return them, though it did not explain how that would work with regard to those who are deceased. It also suggested that Congress ensure that the Treasury and its Bureau of the Fiscal Service, which distributed the payments, gain full access to the Social Security Administration’s full set of death records to help prevent money from being paid to the deceased.

Treasury Secretary Steven Mnuchin said in April that the heirs of the deceased who received stimulus money should give the funds back.

In its report, the G.A.O. also warned that the $660 billion Paycheck Protection Program was vulnerable to fraud because the Small Business Administration is relying on borrower certifications to determine if the loans are needed and how they are being used.

The G.A.O. called on the S.B.A. to develop a system for identifying fraud associated with the program. It also expressed concern about potential overlap of people who were being paid unemployment insurance while also receiving proceeds from P.P.P. loans.

The report also criticized the C.D.C.’s counting of coronavirus tests, which combines tests for an active infection and those that detect antibodies. This practice inflates the percentage of Americans that appear to have been tested and gives an unreliable picture of the way the virus is spreading around the country, according to the new report.

After the C.D.C. was criticized last month for combining the two types of tests in its reports, the agency promised to separate them. But as of June 9, it had still not resolved the issue, the office reported.

Israel on Thursday announced a new partnership with the United Arab Emirates to battle the pandemic, a deal could open a door to closer ties with its Arab neighbors.

By mid-February, there were only 15 known cases in the United States, all with direct links to China.

The patients were isolated. Their contacts were monitored. Travel from China was restricted.

But none of that worked, as some 2,000 hidden infections were already spreading through major cities.

At every crucial moment, American officials were weeks or months behind the reality of the outbreak. Those delays likely cost tens of thousands of lives.

The Times has analyzed travel patterns, hidden infections and genetic data to show how the epidemic spun out of control in the United States.

In other news from around the country:

  • U.S. testing capacity has begun to strain as the pandemic spreads, with more than a dozen public laboratories saying they are “challenged” to meet the demand. The problem has become especially acute in Arizona.

  • North Carolina’s lieutenant governor, Dan Forest, announced on Thursday that he planned to sue Gov. Roy Cooper over his decision a day earlier to extend the state’s emergency orders and his mandate that state residents wear masks. Mr. Forest — a Republican who will face Mr. Cooper, a Democrat, in the November gubernatorial election — accused his opponent of overstepping his authority.

  • The cliffhanger elections on Tuesday in Kentucky and New York were what election officials called a preview of what could happen after the polls close in November: no clear and immediate winner in the presidential race. The record number of mailed-in ballots during the pandemic has made vote-counting more unwieldy, and election administrators are straining to deliver timely results.

  • The Democratic National Convention will move out of Milwaukee’s professional basketball arena, and state delegations are being urged not to travel to the city because of concerns about the pandemic, party officials said Wednesday.

  • With no major outbreaks among its workers, the U.S. auto industry is nearly back to pre-pandemic production levels, and vehicle sales have perked up more than many industry executives had expected.

  • The Walt Disney Company on Wednesday abandoned a plan to reopen its California theme parks on July 17, citing a slower-than-anticipated approval process by state regulators. The announcement came after some employees had criticized the reopening timetable as too fast.

  • Starting in August, travelers to Hawaii can avoid the state’s 14-day quarantine by showing a negative result from a valid test, the governor announced.

Europe sees a ‘significant resurgence’ of cases, a W.H.O. official warns.

He noted that a record 183,020 new cases had been reported to the W.H.O. over the previous 24 hours. More than nine million cases and 400,000 deaths have been reported worldwide, he added.

The center of the pandemic has shifted from Europe to other continents, such as the Americas. But Europe continues to report 20,000 new cases and 700 deaths a day, Dr. Kluge said.

Hinting at a long struggle ahead, Dr. Kluge applauded Germany, Israel, Poland and Spain for “targeted interventions” that had controlled local outbreaks. He also commended the citizens of Europe for adopting behaviors like physical distancing and wearing face masks.

And with the United States threatening to end financial support to the W.H.O., Germany and France have pledged more than a half-billion dollars for the organization, while calling for reforms and accountability. The W.H.O.’s director-general said the organization is getting all the political and financial support it needs.

A C.D.C. study overlooks an important factor as it measures the effects of pregnancy on Covid-19 patients.

The increased risk for intensive care and mechanical ventilation worried experts. But the new study, by C.D.C. researchers, did not include one pivotal detail: whether pregnant women were hospitalized because of labor and delivery. That may have significantly inflated the numbers, so it is unclear whether the analysis reflects a true increase in the risk of hospitalization.

Admission for delivery represents 25 percent of all hospitalizations in the United States, said Dr. Neel Shah, an assistant professor of obstetrics and gynecology at Harvard University. Even at earlier stages of pregnancy, doctors err on the side of being overly cautious when treating pregnant women — whether they have the virus or not.

The analysis, the largest of its type so far, is based on data from women with confirmed infections as reported to the C.D.C. by 50 states, as well as New York City and Washington, from Jan. 22 to June 7.

Despite the ambiguities, some experts said that the new data suggested at the very least that pregnant women with the virus should be carefully monitored.

“I think the bottom line is this: These findings suggest that compared to nonpregnant women, pregnant women are more likely to have severe Covid,” said Dr. Denise Jamieson, a member of the Covid-19 task force for the American College of Obstetricians and Gynecologists. (An earlier version of this article misstated Dr. Jamieson’s title in the task force.)

When the pandemic first hit Egypt, the words “Stay Home” were projected in neon light across the Giza pyramids every night, a grand gesture fusing urgent health messaging with one of the world’s most famous monument.

But no more.

Starting Saturday, restaurants, cafes and mosques will gradually reopen after three months of lockdown that exacted a punishing economic toll on Egypt’s 100 million citizens. Restaurants will operate at 25 percent capacity and close by 10 p.m., and mosques and churches will stay shut for weekly prayers, the busiest time of the week.

In July, the Giza pyramids and ancient sites along the Nile will reopen, the tourism minister said on Wednesday, in an effort to tempt tourists.

But experts have questioned the wisdom of easing restrictions as the virus continues a steep upward trajectory in Egypt. Some desperate patients, unable to find treatment in overburdened hospitals, have resorted to social media to appeal for medical assistance. Medical unions say that chronic shortages of equipment and training has caused nearly 100 doctors to die and over 3,000 to become infected.

On Friday, Egypt reported 1,774 new cases, the highest number yet, for a total of nearly 60,000 cases and 2,450 deaths — the highest death toll of any Arab country.

The national carrier, EgyptAir, said Thursday it would resume flights to 24 destinations in early July when airports reopen.

President Abdel Fattah el-Sisi has been keen to show he is in control, even as several of his top generals died from the virus in March. But he has been hit with unusually strong criticism from the country’s main doctors’ union.

Although public protest and most strikes are outlawed in Egypt, doctors in several hospitals have walked out in protest over their working conditions. Prime Minister Mostafa Madbouly this week accused the doctors of fueling a rise in infections.

Elsewhere in the world:

  • The top U.N. relief official warned of a drastic worsening in the outbreak in war-ravaged Yemen, the Arab world’s poorest country, where he said that 25 percent of those infected die — about five times the global average.

  • In Honduras, the condition of President Juan Orlando Hernández, who was hospitalized last week after testing positive, was improving, his office said Wednesday.

  • In Guatemala, the number of members of the presidential staff who have tested positive has climbed to 158, President Alejandro Giammattei said Wednesday. He said he had been tested three times; the results were negative.

  • Portugal’s government announced a renewed lockdown in 19 districts on the outskirts of Lisbon starting July 1. Portugal had been hailed for early successes and began to lift restrictions in early May, but cases have risen significantly this month.

More than 1 million people in the U.S. seek state jobless benefits for the 14th week in a row.

China has warned its citizens to stop falsifying virus test results to board flights home from Russia.

The Chinese Embassy in Russia issued a statement this week in response to recent discoveries that Chinese travelers from Russia had fabricated negative results for the nucleic acid tests that are required before passengers can board their flights. The embassy announced that the counterfeiters had been placed under investigation and would be made to “bear the corresponding legal responsibilities.” It was the second time in three weeks that the embassy had issued such a warning.

Some passengers had “deliberately concealed their illnesses, caused adverse effects and consequences, caused great harm to the health and safety of other passengers and crew members on the same flight, and undermined China’s domestic epidemic prevention work,” the embassy said in a statement.

China requires passengers to produce a negative test that must be taken within the five days preceding their flight from Russia to China.

The Chinese government, fearful that incoming travelers would bring in the virus, has restricted international flights and banned foreigners, including those with resident permits.

Several Chinese cities along the China-Russia border have struggled with hundreds of infections. Russia on Wednesday reported 7,176 new cases over the previous 24 hours.

These are some of the challenges of maintaining distance.

With eased lockdowns in many places, keeping the recommended distance from others this summer has become more complicated. Here are ideas for handling conflicts over differing ideas of what is safe.

Reporting was contributed by Brooks Barnes, Ronen Bergman, Aurelien Breeden, Weiyi Cai, Benedict Carey, Choe Sang-Hun, Abdi Latif Dahir, Reid J. Epstein, Thomas Erdbrink, Jacey Fortin, Rick Gladstone, James Glanz, Michael Gold, Shane Goldmacher, Josh Holder, Ben Hubbard, David D. Kirkpatrick, Apoorva Mandavilli, Salman Masood, Raphael Minder, Dave Montgomery, Jack Nicas, Richard C. Paddock, Elian Peltier, Alan Rappeport, Dana Rubinstein, Christopher F. Schuetze, Nelson D. Schwartz, Kirk Semple, Dera Menra Sijabat, Mitch Smith, Chris Stanford, Sheryl Gay Stolberg, Carlos Tejada, Daniel Victor, Neil Vigdor, David Waldstein, Declan Walsh, Derek Watkins, Sui-Lee Wee, Jeremy White, Nic Wirtz, Katherine J. Wu and Karen Zraick.

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