The outbreak’s collateral damage includes people whose other illnesses go untreated.
The coronavirus may be killing people who are not even infected, by depriving them of desperately needed treatment, said Dr. Bruce Lowell, an internist in Great Neck, N.Y.
“People are still having heart attacks, people are still having strokes,” he said. “I feel as if there is no awareness of anything other than Covid.”
The virus has sickened hundreds of thousands of Americans, killed tens of thousands of them and forced millions into unemployment. But the pandemic has also shaken every aspect of health care, including cancer, organ transplants and even brain surgery.
Beds, blood, doctors, nurses and ventilators are in short supply; operating rooms are being turned into intensive care units; and surgeons have been redeployed to treat people who cannot breathe. Even if there is room for other patients, medical centers hesitate to bring them in unless it is absolutely necessary, for fear of infecting them — or of health workers being infected by them. Patients themselves are afraid to set foot in the hospital even if they are really sick.
Early on, as the epidemic loomed, many hospitals took the common-sense step of halting elective surgery. Knee replacements, face lifts and most hernias could wait. So could checkups and routine mammograms.
But some conditions fall into a gray zone of medical risk. While they may not be emergencies, many of these illnesses could become life threatening, or if not quickly treated, leave the patient with permanent disability. Doctors and patients alike are confronted with a worrisome future: How long is too long to postpone medical care or treatment?
Nearly one in four cancer patients reported delays in their care because of the pandemic, including access to in-person appointments, imaging, surgery and other services, according to a recent survey by the American Cancer Society’s Cancer Action Network.
Patrick Carr, a sociology professor at Rutgers University, died on April 16, after blood rationing prevented him from getting enough transfusions to allow him to receive chemotherapy for a relapse of the blood cancer multiple myeloma. He was 53.
His wife, Maria Kefalas, considers him a forgotten victim of the coronavirus.
“I’m not saying he would have beaten the cancer,” said Ms. Kefalas, a professor of sociology at St. Joseph’s University in Philadelphia. “I’m saying it wouldn’t have been four months, this precipitous decline, fighting for blood, fighting for hospice nurses.”
“People like my husband now are dying not because of Covid, but because the health care system just cracked open and swallowed them up,” she said.
A dispute over President Trump’s handling of coronavirus testing has emerged as one of the final sticking points standing in the way of an otherwise imminent agreement between Congress and the administration to provide $450 billion to replenish a small businesses loan program and provide more funding for hospitals.
Democrats are pushing to include a requirement in the measure, which includes $25 billion for testing, that the government establish a national testing strategy, a move that the Trump administration has so far resisted, according to people familiar with the ongoing negotiations who asked for anonymity to disclose details. Negotiators were also still haggling over the terms of the $300 billion in new aid for small businesses under the Paycheck Protection Program, and a Democratic demand for funds for additional money for state and local governments.
A deal could come as soon as Monday, but the disagreement over a national testing strategy — which Democrats have said is crucial to combating the further spread of the coronavirus and allowing states to contemplate eventual reopening — could delay action.
Steven Mnuchin, the Treasury secretary, on CNN on Sunday gave broad outlines of a final package: $300 billion to replenish the emergency fund, called the Paycheck Protection Program; $50 billion for the Small Business Administration’s disaster relief fund; $75 billion for hospitals and $25 billion for testing.
Mr. Mnuchin and Senator Mitch McConnell of Kentucky, the majority leader, told Republican senators in a conference call Sunday afternoon that they would not include additional aid for state and local governments — one of Democrats’ demands for the interim package — and President Trump told reporters “that will be in our next negotiation.”
In a separate television appearance on Sunday morning, Senator Chuck Schumer, Democrat of New York and the minority leader, suggested negotiations were going well.
“We’ve made very good progress, and I’m very hopeful we could come to an agreement tonight or early tomorrow morning,” Mr. Schumer said, appearing shortly after Mr. Mnuchin on the CNN show “State of the Union.” Mr. Schumer said the White House was “going along with” some of the Democrats’ requests, “so we feel pretty good.”
But while Representative Steny H. Hoyer of Maryland, the majority leader, notified lawmakers that a vote in the House could come as early as Wednesday, it is unclear how quickly the two sides could reach agreement.
Senate leaders are hoping to approve any deal during a procedural session as early as this week in order to avoid having lawmakers back in Washington before their scheduled May 4 return — a maneuver that would require agreement from all 100 senators.
Oil plummets as storage capacity starts to run low.
Oil prices fell sharply on Monday on growing concerns that oil storage tanks in the United States, especially in the crucial site of Cushing, Okla., are not far from their limits.
The price of the main U.S. benchmark, West Texas Intermediate, plummeted by almost 40 percent on Monday to under $11 a barrel.
Under futures contracts, West Texas Intermediate is delivered to Cushing, but investors are worried that there will be no place to put it there.
“Cushing inventories continue to increase at record-high rates and are expected to hit tank tops in May,” said Hillary Stevenson, director of oil markets at Genscape, a market intelligence firm.
Analysts said the price was also being hit because the current futures trading contract, which is used to set the trading price for oil, will expire on Tuesday and so investors have little interest in buying it. The next futures contract for West Texas Intermediate — the June contract — was trading considerably higher.
There are also mounting worries that the deal reached on April 12 among the Organization of the Petroleum Exporting Countries, Russia and other producers will not be sufficient to prevent the oil markets from being overwhelmed with a record surge of surplus oil. With much of the world in lockdown because of the coronavirus pandemic, global demand for oil has collapsed, leading to record surpluses.
David Fyfe, chief economist at Argus Media, a commodities pricing firm, expects tank farms around the globe to fill to the brim by the middle of May.
When Mr. Trump told governors that they needed to step up their efforts to secure medical supplies, Gov. Larry Hogan of Maryland, a Republican, took the entreaty seriously and negotiated with suppliers in South Korea to obtain coronavirus test kits.
“The No. 1 problem facing us is lack of testing,” said Mr. Hogan, who has been among the many critics of the Trump administration’s repeated claims that states have adequate testing provided by the federal government. “We can’t open up our states without ramping up testing.”
He added: “Luckily we had a very strong relationship with Korea. But it should not have been this difficult.”
In recent days, his wife, Yumi Hogan, a Korean immigrant who speaks fluent Korean, had been on the phone in the middle of the night helping to secure the final deal with two labs to sell Maryland the tests.
On Saturday, the first Korean Air flight to touchdown at Baltimore-Washington International Airport arrived carrying 5,000 test kits — for which the Food and Drug Administration and other agencies gave their seal of approval as the plane was landing.
“I was frosted because my team was saying that the F.D.A. approval was going to hold it up,” Mr. Hogan said in a telephone interview. “I didn’t care and was going to get the tests anyway.”
So far, Maryland has conducted 71,577 tests, while 516 people in the state have died from the virus and infections, at nearly 14,000, continue to rise. The new test kits will give the state the capability to make 500,000 new tests, state officials said.
On Saturday, Mr. Hogan, his wife and a group of other state officials greeted the flight to receive the kits. The new tests, once they have passed muster in local labs, will be distributed to the testing centers the state has set up in sporting fields, repurposed vehicle emissions testing centers and other locations.
Cuomo says 478 more people died in New York, the lowest single-day toll in two weeks.
After saying for two days that New York had begun to come down from the plateau where the virus’s spread had slowed, Gov. Andrew M. Cuomo said Monday that officials had begun to ask how long the descent from that extended peak would take.
He said that 478 more people had died in New York, the lowest single-day toll in more than two weeks, bringing the state’s overall death toll from the virus to 14,347. (The state’s tally does not include the more than 3,700 people in New York City who died without being tested and are now presumed to have died of the virus.)
On Monday, the state started an ambitious effort to test for antibodies among a sample of 3,000 people who had been selected randomly. This and more testing, Mr. Cuomo said, is required to give New York a full picture of the extent of the virus, and would help inform decisions about easing restrictions.
Without mentioning the president by name, Mr. Cuomo made another appeal for federal funding to help with the testing needed to guide the gradual lifting of restrictions in certain areas — echoing a plea from Republican and Democratic governors across the country. He expressed frustration that the legislation currently under consideration in Washington did not include a funding pipeline to assist states with tests.
As for easing some of the measures put in place to stem the flow of the virus, Mr. Cuomo said it would not be immediate, though he acknowledged the nice weather luring out New Yorkers who have been staying in their homes for weeks.
He said as more people leave their homes, the infection rate is likely to go up.
“When activity increases, infection rate spreads,” Mr. Cuomo warned on Monday, adding that smart decisions now will lead to good outcomes in two weeks.
Gathering at schools, parades, concerts, Mr. Cuomo said, “will be madness for people.”
As White House defends testing capacity, governors say they lack key supplies.
President Trump said Sunday night that the administration was preparing to use the Defense Production Act to compel an unspecified U.S. facility to increase production of test swabs by over 20 million per month.
The remarks came during his Sunday evening news conference, after he defended his response to the pandemic amid criticism from governors across the country who have said that there had been an insufficient amount of testing — and a shortage of tests themselves — to justify reopening the economy any time soon.
“We are calling in the Defense Production Act,” Mr. Trump said. He added, “You’ll have so many swabs you won’t know what to do with them.”
He provided no details about what company he was referring to, or when the administration would invoke the act. And his aides did not immediately respond when asked to provide more details.
“We already have millions coming in,” he said. “In all fairness, governors could get them themselves. But we are going to do it. We’ll work with the governors and if they can’t do it we’ll do it.”
“We are fighting a biological war,” Gov. Ralph Northam of Virginia said on CNN’s “State of the Union.” “We have been asked as governors to fight that war without the supplies we need.”
Mr. Northam was among the governors who said they needed more swabs and reagents required for the test, and urged federal officials to help them get those supplies.
The governors bristled at claims from the Trump administration that the supply of tests was adequate. On NBC’s “Meet the Press,” Vice President Mike Pence said there was “a sufficient capacity of testing across the country today for any state in America,” a claim Mr. Northam, a Democrat, called “delusional.”
In Michigan, Gov. Gretchen Whitmer, also a Democrat, said the state could perform “double or triple” the number of tests it is doing now “if we had the swabs or reagents.” Gov. Larry Hogan of Maryland, a Republican, said that it was “absolutely false” to claim that governors were not acting aggressively enough to pursue as much testing as possible.
“It’s not accurate to say there’s plenty of testing out there, and the governors should just get it done,” Mr. Hogan said on “State of the Union. ” “That’s just not being straightforward.”
There are currently about 150,000 diagnostic tests conducted each day, according to the Covid Tracking Project. Researchers at Harvard estimated last week that to ease restrictions, the nation needed to at least triple that pace of testing.
Separately, New York will test 3,000 people starting on Monday to see if they have coronavirus antibodies, which would be a signal they have already had the virus.
Gov. Andrew M. Cuomo said on Sunday that antibody testing would be key in guiding the reopening of the state, because finding the number of people who had developed antibodies to the virus would help authorities understand the full extent of its spread.
“That will tell us for the first time what percent of the population actually has had the coronavirus and is now — at least short term — immune to the virus,” Mr. Cuomo said. “This will be the first true snapshot of what we’re really dealing with.”
Shake Shack said on Sunday that it was returning a $10 million loan from a federal program to help small businesses amid mounting criticism that large chains had been favored over smaller operators in the program’s rollout to the restaurant industry.
The $349 billion stimulus effort, which was distributed on a first-come, first-served basis, was exhausted in just two weeks, with many loans favoring larger companies that were better able to navigate the application process. Major chains like Potbelly and Ruth’s Chris Steakhouse were able to secure tens of millions of dollars in loans while other owners were left scrambling to survive the deepening financial crisis.
Shake Shack, with 189 outlets and nearly 8,000 employees in the United States, said that it would return the funds after securing additional capital through an equity transaction on Friday.
The National Restaurant Association on Monday asked congressional leaders to create a recovery fund for the restaurant industry. In a letter, the trade association said that 8 million restaurant employees had been laid off or furloughed and that the industry had lost $30 billion since March, with another $50 billion expected to disappear by the end of April.
“The restaurant industry has been the hardest hit by the coronavirus mandates — suffering more sales and job losses than any other industry in the country,” the letter said. “For an industry with sales that exceed the agriculture, airline, railroad, ground transportation, and spectator sports industries combined, a restaurant relief and recovery program is desperately needed.”
Trump encourages protesters to ‘liberate’ themselves, despite warnings from public health officials.
One month after most Americans were asked to stay in their homes and reorder their lives in an effort to limit the spread of the virus, President Trump defended protesters who were rebelling against the restrictions, threatening to undermine the efforts of his own administration’s public health experts.
“These people love our country,” Mr. Trump said Sunday evening after a day filled with scattered protests around the country. “They want to go back to work.”
Mr. Trump attacked Democratic governors and took up the slogan of protesters who claim to want to “liberate” their states.
At the same time, however, his administration has said that it is up to each state to decide how to safely navigate their way out of lockdown.
The nation’s top public health officials have repeatedly warned that removing restrictions too soon could have devastating consequences — causing a surge of new infections and overwhelming hospitals with critically ill patients.
Gov. Jay Inslee, Democrat of Washington, likened the message coming from the Trump administration to “schizophrenia.”
“To have an American president to encourage people to violate the law, I can’t remember any time during my time in America where we have seen such a thing,” Mr. Inslee said on ABC’s “This Week.”
As the economic pain caused by the sudden collapse of global commerce grows deeper, the United Nations warned that the pandemic could lead to “an increase in social unrest and violence that would greatly undermine our ability to fight the disease.”
More than 2,000 people, many without masks, gathered at the Washington State Capitol, with organizers noting that the gathering was on the anniversary of the “shot heard round the world” that triggered the Revolutionary War.
“We will not tolerate this as the new normal,” said Tyler Miller, who led the gathering.
Several hundred protesters descended on the Colorado State Capitol on Sunday, including drivers honking their horns and flying “don’t tread on me” flags.
But in a moment captured by the photojournalist Alyson McClaran, who posted images on social media, two health care workers blocked protesters’ cars.
As protesters hurled abuse at them, the workers, wearing scrubs and N95 masks, stood silently.
More protests against stay-at-home orders are expected in state capitals across the country this week, including in Maine, Maryland and Pennsylvania on Monday. In Wisconsin, protesters are expected to gather at the Capitol building on Friday, the day that the state’s stay-at-home order was originally scheduled to lift before it was extended. A protest planned in Annapolis, Md., on Monday morning drew only a handful of demonstrators, a departure from more raucous rallies elsewhere.
Police departments across the country have seen infections and quarantines thin their ranks. In New York City, one in six officers was out sick or in quarantine this month. The Miami police chief tested positive for the virus last week, saying his “symptoms are mild.”
But few departments have been hit worse than Detroit’s. Out of about 2,800 uniformed officers and civilians who work for the department, at least 180 had tested positive for the virus by late last week, with more than 1,000 quarantined at some point. Chief James Craig tested positive on March 27 and stayed isolated at home until Thursday.
“Officers were going out left and right,” said a veteran with more than 20 years of experience, who asked that his name be withheld because he was not authorized to speak to reporters. “There were a few days that it became overwhelming.”
The head of the homicide department died. So did a 911 operator and a volunteer police chaplain. As recently as Thursday, nine people from the department remained hospitalized.
Officers patrolling the streets and investigating crimes said that the virus had ratcheted up stress and disrupted all the standard rhythms of police work. Instead of roll call, officers get temperature checks and an envelope with the day’s orders. They give arrested people masks and wipe down patrol cars after every encounter.
“I have to come into work concerned about whether I’m going to be the next victim or not,” said Officer Marc Perez, fresh out of the police academy, after a recent patrol shift through Northwest Detroit. “There’s only so much an officer can do to prevent himself from coming into contact with that actual virus. Every day is stressful for me.”
Activists are focusing on the newest front in the country’s civil rights struggle: the disproportionate impact the coronavirus is having on communities of color.
The racial disparity in infections and deaths is viewed as the latest chapter of historical injustices, generational poverty and a flawed health care system. The epidemic has hit African-Americans and Hispanics especially hard, including in New York, where the virus is twice as deadly for those populations.
But with rallies and marches out in the midst of widespread quarantines, civil rights activists are organizing broad, loosely stitched campaigns at home from their laptops and cellphones, creating online platforms and starting petitions to help shape relief and recovery plans.
Collectively, the goal is targeted legislation, financial investments and government and corporate accountability.
“It’s really hard to overstate the critical moment we are in as a people, given how this virus has ripped through our community,” said Rashad Robinson, president of Color of Change, the nation’s largest online racial justice organization with 1.7 million members. “We know the pain will not be shared equally.”
The New York City subway system rebounded from the 1970s, when the city teetered on the edge of bankruptcy, crumbling cars routinely broke down and rampant crime scared riders away.
It survived the Sept. 11, 2001, terror attacks, and it came through Hurricane Sandy in 2012, which led to years of costly rebuilding and service disruptions. And it turned a corner after a spate of meltdowns and accidents in 2017 — including a derailment injuring dozens of riders — that prompted Gov. Andrew M. Cuomo to declare a state of emergency.
But now, the subway faces its worst financial crisis yet — one that threatens to hobble the system and have a lasting impact on the city and region.
As the coronavirus pandemic has shut down New York, over 90 percent of the city’s subway ridership has disappeared — along with critical fare revenue — leaving behind escalating expenses and an uncertain timeline of when and how the city’s transit lifeline will recover.
It is unclear what the actual fallout could be. But past crises suggest a potentially grim reckoning for riders: subway and bus lines eliminated, unpredictable wait times for trains as service is slashed, more breakdowns as less money is spent on upkeep, and steeper fares.
Boston has a message for would-be marathoners: Stay home.
With the Boston Marathon, once planned for Monday, postponed, local officials have been warning for days that people should not run the 26.2-mile course from the western suburbs to Boylston Street in downtown Boston.
“If you try to run the marathon route Monday, you’re not a champion,” Mayor Martin J. Walsh of Boston said. “You’re actually not helping us. You’re putting people at risk.”
Executives at the Boston Athletic Association, which organizes the marathon, published an open letter with a similar message and said that “groups of runners would divert valuable, urgent resources from the cities and towns along the course.”
The marathon’s postponement was an immense disappointment for the Boston area and for runners worldwide, about 30,000 of whom take on the course on Patriots’ Day each year. The race, rescheduled for Sept. 14, started in 1897 and has been held annually through wars, periods of domestic tension, and in intense weather.
But with the Northeast largely shut down, nonessential businesses closed and Massachusetts under a stay-at-home advisory, Mr. Walsh said that the usual accommodations for the race — road closures, medical personnel, water stations and the like — will be absent on Monday.
“It’s not a great accomplishment,” Mr. Walsh said. “You’re not going to be celebrated for it. No one’s going to be clapping for you, and I would ask you not to do it. There’s no need to do it.”
When Lila A. Fenwick was a student at Harvard Law School in the 1950s, she was doubly invisible. She was a woman and she was black.
Neither of those hurdles meant much to her. “I knew I was going to be a lawyer when I was a little girl,” she told the Harvard Law Bulletin in 2000. “It never occurred to me that there were going to be any obstacles.”
In 1956, she was the first black woman to graduate from Harvard Law, and she went on to become a human rights official at the United Nations, a lawyer in private practice and a benefactor, establishing, with Dr. Doris Wethers and Dr. Yvette Fay Francis-McBarnette, the Foundation for Research and Education in Sickle Cell Disease.
Ms. Fenwick died on April 4 at her home in Manhattan. She was 87. She had been suffering from dementia before contracting the novel coronavirus, said David Colby Reed, a cousin and her guardian.
Ms. Fenwick graduated from law school in 1956, one of a handful of women in a class of hundreds. Ruth Bader Ginsburg started the next school year, when the dean at the time famously challenged the nine women in the class of the future Supreme Court justice to defend why they were occupying a place that could have gone to a man.
Patricia J. Williams, Harvard Law class of 1975 and a professor of law and humanities at Northeastern University, said black women there experienced “a particularly virulent form of racism and sexism.”
In the early 1990s Professor Williams became one of the first black female professors at Columbia Law School. She said she was moved when Ms. Fenwick, whom she had never met, appeared at her office and went on to audit one of her courses.
“She was so elegant, a lady in the lovely, old fashioned, full sense of that word,” Professor Williams said. “We talked about the loneliness, what it took to be in a world where you were always different, always the other and never assumed to be part of the power elite.”
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Reporting was contributed by Marc Santora, Alan Blinder, Eileen Sullivan, Michael Cooper, Denise Grady, Sheryl Gay Stolberg, Alan Rappeport, Winnie Hu, Christina Goldbaum, John Eligon, Emily Cochrane, Sarah Mervosh, Neil MacFarquhar, Vanessa Swales, Stanley Reed, David Yaffe-Bellamy, Rick Rojas, Russell Goldman, Austin Ramzy and Jennifer Steinhauer.