Spike in U.S. Cases Far Outpaces Testing Expansion

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The rise in testing is not driving the rise in U.S. virus cases. Here’s why.

As coronavirus cases have surged in recent weeks, President Trump has repeatedly said the growing case count is a result of increased testing, not a worsening outbreak. An analysis by The New York Times, however, shows the rise in cases far outpaces the growth in testing.

About 21,000 cases were reported per day in early June, when the positive test rate was 4.8 percent. As testing expanded, the positive test rate should have fallen. Even if it had stayed the same, there would have been about 38,000 cases reported each day. Instead, the positive test rate has nearly doubled, and more than 66,000 cases are now reported each day.

The average number of tests conducted nationwide has grown by 80 percent since early June, to 780,000 per day. Daily case counts have grown by 215 percent in the same period.

Florida, the state with the largest discrepancy, is reporting more than 11,000 new cases per day, on average, while only about 2,400 cases each day would be expected because of increased testing. California and Texas numbers are also far above what would be expected.

In some states with smaller outbreaks, case growth outpaces testing growth by large percentages. In Idaho, there are more than five times as many cases as would be expected with expanded testing. In Nevada, there are six times as many.

In 14 states and Washington, D.C., however, testing has increased faster than cases have, meaning positive test rates are falling. Many of those states are in the Northeast. In New York — the epicenter of the outbreak early on — cases have continued to decline, even with more than 60,000 tests performed daily.

In an interview on Fox News on Wednesday evening, Dr. Deborah L. Birx, the White House coronavirus response coordinator, said that the Trump administration was encouraging states with lower positive test rates to use more pool testing, a method in which samples from many people are tested at once in an effort to quickly find and isolate the infected.

That form of screening, she said, would free up more tests for states in the South and West, where surges in cases have led to long waits for test results. She added that large commercial labs such as Roche, LabCorp and Quest should “really look at pooling in the Midwest and the Northeast.”

“The turnaround times, particularly across the South, are too long,” she said.

California surpasses New York for the most reported cases of any state.

California, where the virus is surging, has now reported more cases than New York, the early center of the pandemic in the U.S., where the spread of the virus has slowed.

There have now been more than 422,000 cases announced in California over the course of the pandemic, the most of any state, according to a New York Times database. New York, with more than 413,000 known cases, had the most until Wednesday.

On Wednesday evening, California announced more than 12,100 cases, its single-day record.

While California has overtaken New York in reported cases, it is difficult to know which state has actually had more total infections. Both states had significant outbreaks very early on, when testing was severely limited, and the C.D.C. has said that huge numbers of infections went undetected, dwarfing the number of known cases.

For example, in a recent study of antibody prevalence, the C.D.C. found evidence that as many as 2.8 million people in the New York City area had been infected by May 6 — 10 times the number of cases reported by then. The figure for San Francisco in late April was 9 times.

Gov. Gavin Newsom of California said on Wednesday that as the state greatly expanded testing, it expected to find many more cases. The challenge for the state, he said, was to sustain its virus response.

“We are not going to let off in our day-to-day monitoring and our technical assistance,” he said. “We’ll see those numbers increase and as a consequence, we need to be more vigilant and more aware of our personal behaviors and our collective behaviors.”

Mr. Newsom said the state’s stay-at-home order and its efforts to increase hospital capacity bought California some time. Now, as the partly reopened state contends with climbing case numbers, he said, it is in a better position than before to distribute protective equipment and tailor restrictions to allow some businesses to reopen outside.

New York remains by far the hardest-hit state by another measure: It has recorded 32,228 deaths related to Covid-19, according to a Times database — more than the next three states (New Jersey, Massachusetts and California) combined.

As hospitals fill, the U.S. nears another peak.

Seriously ill Covid-19 patients may be less geographically concentrated than they once were, but there are as many of them as ever, with more people are on track to be hospitalized in the United States than at any point in the pandemic.

Across the country, 59,628 people were being treated in hospitals on Wednesday, according to the Covid Tracking Project. That is near the peak of 59,940 on April 15, when the center of the outbreak was New York.

The country is averaging more than 66,000 new virus cases per day, more than twice as many as a month ago, and deaths have also started trending upward, with an average of more than 800 daily. But hospitalizations may be the clearest measure of how widely the virus is causing the most serious illnesses, and could offer a glimpse of what is ahead.

“Once you get to the point of being hospitalized or in the I.C.U., some notable portion of those people will die,” said Natalie E. Dean, an infectious-disease expert at the University of Florida.

Even when patients walk out of the hospital, their ordeal may not be over. “Surviving doesn’t mean thriving,” Dr. Dean said.

Not long ago, things seemed to be improving. Fewer than 28,000 patients were hospitalized as of mid-June, when a new surge of cases was appearing throughout the Sun Belt.

The uptick in hospitalized patients around the country reflects a different phase of the pandemic — a widening geographic area, especially across the South, for the most serious illnesses compared with what had been a relatively concentrated crisis in the spring.

More mask orders are issued, a day after Trump, in a shift, urged Americans to cover up.

For months, public health officials have urged the public to wear masks to curb the spread of the virus. And for months the issue has been politicized. But as the virus has surged across the U.S. in recent days, major retailers, state and local officials and even Mr. Trump have all shifted course and urged, and in some cases ordered, people to wear masks.

New statewide mask orders were issued on Wednesday by the Republican governors of Ohio and Indiana and by Minnesota’s governor, a Democrat. And city officials in Washington, D.C., and Baltimore issued new, tougher new mask orders as well.

The latest mask mandates came a day after Mr. Trump, who has long resisted wearing masks and at times even disparaged them, made his most robust call for wearing them yet, urging: “When you can, use a mask.” Some of the nation’s largest retail chains, including Walmart, Winn-Dixie and Whole Foods, have also moved to require customers to wear them.

Asked if he favored such mandates, Mr. Trump said Wednesday evening that it should be up to the governors — “I think all are suggesting if you want to wear a mask, you wear it,” he said — and that he would decide “over the next 24 hours” whether to require masks be worn on federal properties in Washington and at the White House.

But several more governors decided the time for masks had come.

“We’ve got to get this virus under control,” Gov. Mike DeWine of Ohio said Wednesday as he issued a statewide mask order that will take effect Thursday evening. “Wearing a mask is going to make a difference.”

“We all want kids to go back to school, we want to see sports, we want to see a lot of different things, we want to have more opportunities in the fall,” said Mr. DeWine, who had previously ordered people only in the state’s hardest-hit counties to wear masks. “And to do that, it’s very important that all Ohioans wear a mask.”

Gov. Eric Holcomb of Indiana, a Republican, said Wednesday that he would sign an order mandating masks in most public settings beginning Monday. “As we continue to monitor the data, we’ve seen a concerning change in some of our key health indicators,” he said on Twitter. “Hoosiers have worked hard to help re-open our state & we want to remain open.”

In Minnesota, Gov. Tim Walz signed an executive order Wednesday requiring residents to wear masks in indoor stores and other public indoor spaces beginning Saturday. Mr. Walz said that the state would distribute masks to people and businesses in underserved communities.

Minnesota’s lieutenant governor, Peggy Flanagan, whose brother died of Covid-19, acknowledged that masks had turned into “a political football,” but said the mandate could prevent the virus from spreading. “I just simply don’t want anyone else to endure what my family has endured,” she said.

On Wednesday, Southwest Airlines became the first major airline in the United States to broaden its mask requirement to include passengers with a medical condition or disability that would prevent them from wearing one. Southwest announced its change, which goes into effect on Monday, hours after United said it would extend its requirement for masks on planes to any area it operated in an airport. Southwest and Delta already had such policies in place, and American Airlines added one Wednesday night.

Science Roundup

Can you get Covid-19 more than once? It’s very unlikely, experts say.

The anecdotes are alarming.

A woman in Los Angeles seemed to recover from Covid-19, but weeks later took a turn for the worse and tested positive again. A New Jersey doctor claimed several patients healed from one bout only to become reinfected. Another doctor said a second round of illness was a reality for some people, and was much more severe.

These recent accounts tap into people’s deepest anxieties. They suggest that we are destined to succumb to the coronavirus over and over, and fuel fears that we won’t be able to reach herd immunity, when the virus can no longer find enough victims to pose a major threat.

But the anecdotes are just that — stories without real evidence of reinfection, according to nearly a dozen experts who study viruses, Apoorva Mandavilli of The Times reported.

“I haven’t heard of a case where it’s been truly unambiguously demonstrated,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health.

Other experts were even more reassuring.While little is definitively known about the new virus just seven months into the pandemic, it is behaving like most others, they said.

In other science news:

• The Trump administration on Wednesday announced a nearly $2 billion contract with the pharmaceutical giant Pfizer and a smaller German biotechnology company for up to 600 million doses of a potential coronavirus vaccine. If the vaccine proves to be safe and effective in clinical trials, the companies say, they could manufacture the first 100 million doses by December. The administration’s decision to strike a deal for millions of doses of a not-yet-finished vaccine is unusual in two ways. The private sector purchases most vaccines in the United States, not the government. And when the government does buy vaccines — typically on behalf of low-income children — it almost always pursues contracts with drugmakers who have already gotten safety and efficacy approval from the Food and Drug Administration.

• On Wednesday federal health officials said that most Americans recovering from Covid-19 can come out of isolation without further testing. Instead, patients may be judged to have recovered if 10 days have passed since they first felt ill and they no longer have any symptoms, Donald G. McNeil Jr. of The Times reported. Those who test positive but never experience symptoms may leave isolation 10 days after their first positive test, the new Centers for Disease Control and Prevention guidelines suggest. The recommendations come in response both to high demand for tests and emerging science.

Two cafeterias in the White House complex close after an employee tests positive.

Two cafeterias used by White House staff members were closed and contact tracing was conducted after an employee tested positive for the coronavirus, a Trump administration official said on Wednesday night.

The cafeterias are in the Eisenhower Executive Office Building and the New Executive Office Building, which are part of the White House complex and are next to the West Wing.

It was not immediately clear whether the employee was a cafeteria worker, and the White House did not say what kind of symptoms the person showed.

The White House notified employees about measures in an email and said that there was no need for them to self-quarantine, according to the official, who spoke on condition of anonymity because the person was not authorized to speak publicly about the situation.

In May, a military aide who had contact with Mr. Trump tested positive for the virus, as did Katie Miller, the press secretary for Vice President Mike Pence.

Republicans weigh short-term jobless aid extension as they struggle to find consensus on a relief bill.

Senate Republicans and White House officials are discussing proposing a short-term extension of enhanced unemployment benefits beyond their expiration at the end of the month, an indication that the party is still divided over a broader relief package.

With Republicans at odds over the cost and contents of their opening offer for the next round of virus aid — expected to be around $1 trillion — and bracing for an intense negotiation with Democrats who are demanding three times as much spending, the discussions reflected a growing awareness that a quick resolution is unlikely.

A weekly $600 supplement to unemployment benefits provided as part of the stimulus law is set to expire at the end of July, providing a deadline for Congress to act on another round of economic relief before tens of millions of laid-off workers lose their aid.

It was not clear on Wednesday how long the extension that Republicans are weighing would last, or whether it could gain broad enough support in the party to materialize. Nor was it known whether Democrats would embrace such a temporary fix, which would alleviate much of the political pressure on Congress to quickly produce another economic stabilization measure.

But such a bare-bones proposal might be all that Republicans can coalesce around. Several of them told administration officials on Tuesday during a private policy lunch that they had concerns about a steep price tag for another round of relief, as well as objections to several policy provisions pushed by the White House, including a payroll tax cut. Payroll taxes fund Social Security and Medicare, and critics argue cuts would mostly benefit people with jobs, and not the unemployed.

Senator Mitch McConnell of Kentucky, the majority leader, has said he hopes to unveil a relief package in the coming days that would include $105 billion for schools to reopen, another round of stimulus checks and additional funds for a popular federal loan program for small businesses. Negotiations continued on Wednesday on the details.

The White House will have to reconcile its differences not only with Republicans, but also with Democrats, led by Speaker Nancy Pelosi, who responded to President Trump’s briefing on Tuesday by calling the crisis the “Trump virus.”

Top Democrats on Capitol Hill said they would be willing to negotiate with their Republican counterparts once they put forward an opening piece of legislation. For now, they are standing by the $3 trillion stimulus law Democrats pushed through the House in May, which also included aid to help cash-strapped state and local governments avoid layoffs.

Global Roundup

At Niagara Falls, Canadian boats are limited to six passengers while U.S. boats carry hundreds.

The different approaches by Canada and the United States to the pandemic have been on display this month in the churning waters where their border meets at the foot of Niagara Falls.

On some days in recent weeks, the Maid of the Mist VII tour boat, which sets sail from the American side, could be seen carrying as many as 230 plastic-poncho-covered passengers to the roaring cascade. Across the way, the Niagara Thunder and Niagara Wonder were each limited by the province of Ontario to six passengers.

The contrast has been cited by many Canadians on social media as an example of their country’s superior approach to infection control. “No surprise that the #US #coronavirus death toll climbs,” a woman from Toronto posted with a photo of the passing ships on Twitter on Wednesday.

While there has been a slight upturn in new cases over the past week in some parts of Canada, the rise has not approached the recent surges in several U.S. states.

New York State limits the Maid of the Mist to 50 percent of capacity, or 230 people. The company said that its average load since sailings began again on June 26 had been 165 people. The gap between the two ship lines will narrow on Friday, however. Ontario is further easing restrictions, and Hornblower Niagara Cruises, the Canadian operator, will be able to carry 100 passengers on ships equipped for 700 people.

In other news from around the world:

• The United States ordered China to close its diplomatic consulate in Houston within 72 hours, dealing another blow to the rapidly deteriorating relations between the two countries. China promptly vowed to retaliate, calling the move illegal. Consulates principally process visas for travelers visiting China, but travel between the two countries has been severely limited in any case because of the pandemic.

• As cases hit a record in one Australian state, a top official chastised residents who show symptoms but don’t isolate themselves. “I’m very unhappy and very sad to have to report that nearly nine in 10 of 3,400 cases did not isolate between when they first felt sick and when they went to get a test,” said Victoria’s premier, Daniel Andrews. And more than half of those who did get tested, he said, then went about their normal business before getting the results.

• The average number of new daily cases in Spain has more than tripled in the month since the country ended its state of emergency. Spain now has 224 local outbreaks, the health minister, Salvador Illa, told Parliament on Wednesday. Many of the cases have been traced to young people.

• As schools, shops, cafés and restaurants have continued to reopen in France, the health ministry reported nearly 1,000 new coronavirus cases in the past 24 hours. The country ramped up mask requirements in public spaces earlier this week in response to concerns that cases are once again rising in some parts of the country.

U.S. ROUNDUP

A pair of siblings in Florida who were in their early 20s died of the virus within days of each other.

Mychaela Francis was home with her brother Byron when she saw he was struggling to breathe. Paramedics rushed him to Florida Medical Center on June 27. He died that day of the coronavirus. He was 20.

Three days later, Ms. Francis, 22, began complaining of headaches and a fever, according to her family. Terrified, she insisted that her mother take her to the hospital. She died on July 8, according to the Broward County Medical Examiner’s Office, which confirmed that the cause of death for both siblings was Covid-19.

The deaths of the two young siblings, within 11 days of each other, have devastated their large family in Lauderhill, Fla.

They have also underscored two disturbing developments in the outbreak: the surge of cases in states like Florida that reopened swiftly, and the rising number of people in their 20s, 30s and 40s who are testing positive. In Florida, the median age of residents testing positive has dropped to 40, down from 65 in March.

On Wednesday, the state announced more than 9,780 cases and more than 130 deaths. There have been at least 369,826 cases over all in Florida, according to a New York Times database. As of Wednesday morning, at least 5,205 people had died.

Byron and Mychaela Francis became ill less than two weeks after they got back from a family trip to Orlando, according to Darisha Scott, their cousin, who had joined them with her children.

Because state officials had lifted restrictions, the family felt reasonably secure leaving Broward County, where masks are mandatory and a curfew has since been put in place to deal with the pandemic.

“We said, ‘Let’s go get the kids out of the house,’” Ms. Scott, 31, said. “And then all this happened.”

Here’s what else is going on across the nation:

• New research suggests that the federal Paycheck Protection Program, created by lawmakers in March, saved 1.4 million to 3.2 million jobs in small businesses through the beginning of June — at a high price. That works out to a cost of $162,000 to $381,000 per job, according to research released by economists from the Massachusetts Institute of Technology, the Federal Reserve and the private payroll firm ADP.

• North Dakota reported on Wednesday its single-day record for cases, with 160. And Alabama announced its single-day record for deaths, with more than 60.

• Gov. Ron DeSantis of Florida, who has been sued by a teachers union over his plan to reopen schools next month, insisted on Wednesday that schools should provide instruction in person, as long as parents want to send their children and teachers feel comfortable teaching.

• Officials in Puerto Rico pushed back in-person classes Wednesday and announced that public school students would begin virtual learning on Aug. 17. The earliest that students would return to physical classrooms would be Sept. 17, the secretary of education said in a news conference.

• A third of American museums may not survive the pandemic, their directors said. In a survey of museum directors published on Wednesday by the American Alliance of Museums, 16 percent of respondents said there was a high risk that their museums could close for good in the next 16 months. Another 17 percent said they did not know if they would survive without further financial help from governments and private donors.

• The governor Louisiana is extending virus-related restrictions, including a statewide mask order, through Aug. 7.

Reporting was contributed by Ian Austen, Peter Baker, Graham Bowley, Luke Broadwater, Julia Calderone, Emily Cochrane, Michael Cooper, Matthew Conlen, Jill Cowan, Maria Cramer, Gillian Friedman, Vanessa Friedman, Rick Gladstone, Michael Gold, Maggie Haberman, Anemona Hartocollis, Sarah Kliff, Patrick J. Lyons, Iliana Magra, Sapna Maheshwari, Apoorva Mandavilli, Tiffany May, Raphael Minder, Claire Moses, Heather Murphy, Steven Lee Myers, Derek M. Norman, Bhadra Sharma, Mitch Smith, Eileen Sullivan, Daniel Victor, Neil Vigdor, Noah Weiland and Will Wright.