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Covid-19 Live Updates: The Midwest Sees a Spike as Cases Decline Elsewhere

India now has the world’s third-highest death toll, and New Jersey will allow movie theaters to reopen starting on Friday.


Health care workers infected with Covid-19 may be going undiagnosed, according to a C.D.C. report.

As U.S. cases decline elsewhere, the Midwest sees a worrying spike.

Reports of new cases have fallen significantly around the country since July; they are now flat in 26 states and falling in 15 others. But in nine states, cases are still growing, and in some setting new records — especially in the Midwest.

Iowa, Kansas, Minnesota, North Dakota and South Dakota all added more cases in a recent seven-day stretch than in any previous week of the pandemic. Together, they reported 19,133 new cases in the week ended Sunday, according to a New York Times database — 6.4 percent of the national total, though the five states are home to only 4 percent of the population. In each, some of the biggest surges in new case numbers have come in college towns.

The Dakotas, which had made it through the summer without suffering the big increases seen in some other parts of the country, have both recently set single-day case records. On Saturday, South Dakota added 425 new cases and North Dakota added 374, their worst days yet. Grand Forks, home of the University of North Dakota, has one of the highest per capita growth rates in the country.

Iowa’s recent outbreak, so serious that it prompted Gov. Kim Reynolds to shut down bars and nightclubs in six counties, has been most pronounced in college towns like Ames and Iowa City, which reported greater numbers of new cases per capita over the past two weeks than any other metro area in the country.

The situation is similar in Kansas: Lawrence, the home of the University of Kansas, has seen one of the steepest recent surges. Local officials in Lawrence-Douglas County announced last week that nine fraternity and sorority houses at the university were under quarantine, and adjusted those orders as test results came back.

The rise in cases in Minnesota is not as severe as in neighboring Iowa or the Dakotas, but a growing number of counties in the state have more than 10 percent of their tests coming back positive. In a visit to St. Paul on Sunday, Dr. Deborah L. Birx, the White House coronavirus response coordinator, called that a “worrisome” trend and warned that the state may have to increase precautions against the virus as the fall and winter approached, particularly in rural communities.

If Italy was the harbinger of the first wave of Europe’s coronavirus pandemic in February, Spain is the portent of its second.

France is also surging, as are parts of Eastern Europe, and cases are ticking up in Germany, Greece, Italy and Belgium, too, but in the past week, Spain has recorded the most new cases on the continent by far — more than 53,000. With 114 new infections per 100,000 people in that time, the virus is spreading faster in Spain than in the United States, more than twice as fast as in France, about eight times the rate in Italy and Britain, and 10 times the pace in Germany.

Spain was already one of the hardest-hit countries in Europe, and now has about 440,000 cases and more than 29,000 deaths. But after one of the world’s most stringent lockdowns, which did check the virus’s spread, it then enjoyed one of the most rapid reopenings. The return of nightlife and group activities — far faster than most of its European neighbors — has contributed to the epidemic’s resurgence.

Now, as other Europeans mull how to restart their economies while still protecting human life, the Spanish have become an early bellwether for how a second wave might happen, how hard it might hit and how it could be contained.

“Perhaps Spain is the canary in the coal mine,” said Prof. Antoni Trilla, an epidemiologist at the Barcelona Institute for Global Health, a research group. “Many countries may follow us — but hopefully not at the same speed or with the same number of cases that we are facing.”

The median age of sufferers has dropped to around 37 from 60. Asymptomatic cases account for more than 50 percent of positive results, which is partly because of a fourfold rise in testing. And the health institutions feel much better prepared.

Epidemiologists aren’t certain why it arrived so soon.

Explanations include a rise in large family gatherings; the return of tourism in cities like Málaga; the decision to return responsibility for combating the virus to local authorities at the end of the nationwide lockdown; and a lack of adequate housing and health care for migrants. The surge has also been blamed on the revival of nightlife, which was reinstated earlier and with looser restrictions than in many other parts of Europe.

Greece, which has experienced a spike itself in cases, issued on Friday a new directive temporary suspending all passenger flights to the Catalonia region in Spain.

Despite being at high risk for developing Covid-19, a large number of doctors, nurses and other health care workers may be going undiagnosed after they become infected, according to a new report released on Monday by researchers from the Centers for Disease Control and Prevention. The findings raise concern that these health care workers could unknowingly spread the infection within the hospital.

The report also found that workers who said they always wore a face covering, like a surgical mask or N95 respirator, when caring for patients had significantly lower rates of infection. However, many of these frontline workers reported shortages of personal protective equipment, and those workers also had higher rates of infection, according to the report.

Health care workers, particularly nurses, have raised concerns for months about not being protected adequately. The findings underscore the importance of regularly testing hospital employees for the virus and ensuring they are protected when they come into contact with patients. “Universal use of face coverings and lowering clinical thresholds for testing could be important strategies for reducing hospital transmission,” the researchers said.

The researchers looked at the results of antibody tests for 3,248 workers. Serum specimens were collected from early April to mid-June from frontline workers at 13 medical centers across the United States, including in California, Ohio, Maryland, New York and Tennessee.

About 6 percent of the workers had antibody evidence of a previous coronavirus infection, the report said, and more than two-thirds of these individuals had not been previously diagnosed. Almost 30 percent were asymptomatic.

The findings suggest that some infections “are undetected and unrecognized,” possibly because some workers are asymptomatic or those with symptoms are not reporting them or being tested, the researchers said.

Workers who reported that they did not always wear a face covering had a 50 percent greater infection rate, according to the analysis. Some 6 percent of those who were masked had antibodies, compared with 9 percent of those who were not.

Trump retweeted a fringe theory downplaying virus deaths. But more than 183,000 have died in the U.S.

More than 183,000 deaths in the United States are attributed to Covid-19. Yet in only 6 percent of these deaths is the illness listed on death certificates as the sole cause of death, according to the Centers for Disease Control and Prevention.

The vast majority of these patients had other serious conditions — an average of 2.6 for each patient. The statistics do not mean that they did not die because of the virus, but they help explain who is most vulnerable to it: those with underlying conditions like diabetes, hypertension, heart disease and obesity.

The stark reality is that the coronavirus preys on people with such underlying “co-morbidities,” most of them more common in older patients. Death certificates may also list kidney failure or sepsis as an immediate cause of death in these patients, but those dire conditions only came as a result of the viral infection.

President Trump, however, retweeted a conspiracy theory this weekend that distorts this significant aspect of the data to suggest that only 9,000 people in the United States have died of the coronavirus. It rejected the data of his own administration — and attacked the very people he has put in charge of trying to stop the pandemic, among them Dr. Anthony S. Fauci and Dr. Deborah L. Birx.

“So get this straight — based on the recommendation of doctors Fauci and Birx the US shut down the entire economy based on 9,000 American deaths to the China coronavirus,” said the summary of an article by the hard-line conservative website Gateway Pundit that was retweeted by the president.

Twitter deleted one of the tweets that Mr. Trump reposted advancing this claim, replacing it with a message: “This Tweet is no longer available because it violated the Twitter Rules.”

By then it was too late in some quarters. Others on Twitter have been recirculating the 6 percent figure. Independent analyses show that the actual death toll is likely higher than 183,000 — around 200,000 — in part because some deaths have not been recognized as connected to infection from the virus.

George Rutherford, an epidemiologist at the University of California at Berkeley, said the message in the tweet is “clearly a huge disconnect” from the scientific reality.

“If anything,” Dr. Rutherford said, “the number of deaths has been underestimated.”

The inaccurate retweet came as part of a concentrated predawn burst in which the president posted or reposted 89 messages between 5:49 a.m. and 8:04 a.m. on Sunday on top of 18 the night before, many of them inflammatory comments or assertions about violent clashes in Portland, Ore., where a man wearing the hat of a far-right, pro-Trump group was shot and killed Saturday after a large group of Mr. Trump’s supporters traveled through the streets. Mr. Trump resumed on Sunday night.

In the blast of social media messages, Mr. Trump also embraced a call to imprison Gov. Andrew M. Cuomo of New York; threatened to send federal forces against demonstrators outside the White House; attacked CNN and NPR; embraced a supporter charged with murder; mocked his challenger, former Vice President Joseph R. Biden Jr.; and repeatedly assailed the mayor of Portland, even posting the mayor’s office telephone number so that supporters could call to demand his resignation.

Mr. Cuomo responded on his own Twitter feed a few hours later, pointing to the Trump administration’s failure to contain the pandemic. “The White House has learned nothing from COVID,” Mr. Cuomo wrote. “National threats require national leadership. It’s been 6 months without a national strategy on testing or mask mandate. Only the federal government has the power to go to war with COVID. They are failing and the nation suffers.”

One of the most incendiary messages was a retweet of a program from the One America News Network, a pro-Trump channel that advances extreme theories and that the president has turned to when he feels that Fox News has not been supportive enough. The message he retweeted Saturday night promoted a segment accusing demonstrators of secretly plotting Mr. Trump’s downfall.

Kayleigh McEnany, the White House press secretary, brushed the death-related tweets off at her briefing on Monday, offering a benign explanation of Mr. Trump’s interest. “He was highlighting new C.D.C. information that was worth noting,” she said, ignoring the fact that the tweets reposted by the president misstated the data to argue that the threat of the virus was exaggerated and did not justify the measures urged by public health experts like Dr. Fauci and Dr. Birx.

With testing disrupted, storm-hit Louisiana watches other measures of the virus and sees trouble.

Many dangers linger in Louisiana since Hurricane Laura, Gov. John Bel Edwards has warned: Downed power lines. Falling debris. Carbon monoxide poisoning from generators, the cause of more than half of storm-related deaths.

And the coronavirus. It has killed 400 times as many Louisianans as the storm, the governor noted, “just to put things in perspective, for whatever this may be worth.”

The storm interrupted virus testing across the state, so the new-case data “is not going to be robust over the next several days,” Mr. Edwards said at a news conference Sunday evening. It will take time to ramp the testing back up, he said, so officials must depend on other markers, like hospitalizations, to track the virus — and there are signs of trouble, the governor said, including increases in hospitalizations on Friday and Saturday.

Calcasieu Parish, which includes Lake Charles, one of the cities most affected by the storm, has reported 7,439 confirmed cases of the virus and 182 deaths since the pandemic began, according to a New York Times database. As of Sunday afternoon, Louisiana as a whole had reported 148,030 cases and 4,931 deaths.

“The public health emergency is real,” Mr. Edwards said.

Experts warned that the storm stood to worsen the coronavirus’s spread. Residents face more exposure while staying with relatives and friends or cleaning their property, or in other circumstances where it is difficult to maintain social distance. That may be especially true in the southwest, where hundreds of thousands of people lack power and may not see it return for days.

“If we think of Laura on top of Covid or Covid on top of Laura, it’s new and overwhelming,” Susanne Straif-Bourgeois, a professor at the L.S.U. Health Sciences School of Public Health who studies pandemics, told The New Orleans Advocate and Times-Picayune, which reported that the storm recovery provided fertile ground for new infections. “We’ve never had to deal with this before.”

New Jersey will allow movie theaters to reopen and indoor dining to resume on Friday.

With the Labor Day weekend approaching, Gov. Philip D. Murphy announced new guidelines on Monday for residents going out.

On Friday, New Jersey movie theaters and other indoor performance venues can reopen with limits for the first time since the middle of March, and restaurants can open for indoor dining at 25 percent of capacity.

All occupants must wear masks at theaters, “unless you’re pulling it down to put away a handful of popcorn,” Mr. Murphy said Monday afternoon. The occupancy of each room in the theater will be capped at either 25 percent of the capacity limit, or 150 people — whichever is less.

The governor also announced that he was lifting the limit on indoor gatherings to 150 people for certain events, including weddings, funerals and political rallies. The relaxed rules, he said, “does not mean by any stretch that we can let up our vigilance even one bit.”

“We know that this is a virus of opportunity, so let’s not give it any unforced opportunities,” he added.

The reopening of indoor dining comes about two months after Mr. Murphy canceled a scheduled restart as virus cases spiked in parts of the country that had relaxed rules on restaurants. Outdoor dining in New Jersey resumed on June 15.

The slow easing of restrictions has been a growing source of tension in New Jersey, a densely populated state that has had more than 15,900 virus-related deaths, the nation’s highest rate per 100,000 residents.

Last week, the governor said all health clubs could fully reopen for workouts starting Tuesday.

Indoor dining remains forbidden in New York City. Gov. Andrew M. Cuomo of New York on Monday acknowledged that New Jersey’s allowing indoor dining could further put restaurants in the city at an economic disadvantage and said that state officials were considering whether to allow indoor dining there.

But Mr. Cuomo said that he was still apprehensive, especially with city schools set to reopen soon. “I want as much economic activity as quickly as possible,” he said. But, he added, the state was trying to find a balance between that and public health concerns.

Elsewhere in the United States:

  • As some schools begin in-person classes, data compiled by the American Academy of Pediatrics from the summer show that cases, hospitalizations and deaths from the virus have increased at a faster rate in children and teenagers than among the general public. The data, which spans from May 21 to Aug. 20, varies from state to state, possibly obscuring differences in how the virus affects infants, young children and adolescents.
  • Colleges and universities continue to change their plans for the fall semester. Nearly half of the top 20 metropolitan areas where new cases per capita rose the most over the past two weeks are college towns.
  • In 35 states, voters can request ballots so close to Election Day that it may not be feasible for them to be received and sent back in time. Deadlines and other rules may change, but this interactive has the current breakdown of how much time voters will have in each state.
  • The United States Open that began in New York on Monday will be far from full strength, but will it really be the Asterisk Open?

New flu-shot requirement for Massachusetts students draws a protest.

Hundreds of protesters gathered outside the Massachusetts State House on Sunday to protest the state’s new requirement that nearly all students in the state receive a flu shot by the end of the year.

The measure, hailed by public health experts, is believed to be the first such mandate in the nation for influenza vaccination. It is intended to help prevent a combined wave of virus and flu infections that could overwhelm the health care system.

But protesters complained that the mandate infringed on parents’ rights to make medical decisions for their children, and called on Gov. Charlie Baker to rescind the order.

“Momma bears and poppa bears come out strong when their kids are threatened,” said Sean Courtney, who said he drove 90 miles from his home in West Springfield, Mass., to join the protest, and waved a flag that read “Don’t Tread on Me.”

He said the order was particularly unwelcome in Massachusetts because the state has such a high rate of voluntary vaccination. “We don’t understand the necessity of a mandate,” he said. “It’s not smallpox. It’s not freaking diphtheria.”

Near him stood three university students from Young Americans for Liberty.

“I don’t think the government should have the right to tell people what they can and cannot do,” said William Crowley, 21, an undergraduate at Boston University. “We were a country set up to protect the rights of individuals and hold back the government.”

India now has the third-highest death toll from the virus.

India is breaking its own global records for daily cases, and now it has edged ahead of Mexico in a race no country wants to win: the number of deaths caused by the coronavirus.

India, a nation of 1.3 billion people, has the world’s third-highest death toll at 64,469, according to a New York Times database, behind only the United States and Brazil. (Mexico is just over 300 behind at 64,158.) And with India’s new cases exceeding 75,000 for the past five days, the virus doesn’t seem to be loosening its grip.

The steep rise in cases, which officials say is partly explained by an increase in testing, comes as India continues to ease restrictions after one of the world’s most severe lockdowns this spring. Decisions on reopening are being driven in part by economic concerns: The Indian economy shrank by nearly 24 percent in the second quarter, the government reported on Monday, a much bigger contraction than in any other major country, including the United States.

In New Delhi, the capital, the subway will start reopening on Sept. 7, officials said Saturday.

“This is good news,” said Anuradha Raman, a college student in New Delhi. “But people are also scared, because we don’t follow social distance guidelines here.”

Arvind Kejriwal, New Delhi’s chief minister, said he was glad the subway, which is used by 2.6 million commuters a day, was resuming service. But the capital also recorded more than 2,000 new cases on Sunday, its largest daily tally in 51 days.

It was not clear whether subways in other cities would also resume service.

While sports events and religious festivals have been allowed with restrictions on attendance, the country’s schools will remain closed until the end of September. The suspension of scheduled international flights has also been extended until then, the Indian civil aviation authorities said on Monday.

Also in India on Monday, Prime Minister Narendra Modi confirmed the death of Pranab Mukherjee, a politician who rose to high office alongside one of the country’s longest-serving prime ministers, Indira Gandhi. He was 84. Before undergoing brain surgery in recent weeks, Mr. Mukherjee announced on Twitter that he had also tested positive for the coronavirus. He was later put on a ventilator and fell into a coma, according to doctors who were treating him at a military hospital.

Other developments around the world:

  • Global confirmed cases have surpassed 25 million according to a Times database, and at least 845,000 people have died. The 10 countries reporting the highest per capita infections in the last week are largely clustered in the Caribbean (Aruba, Turks and Caicos, Sint Maarten) and in Central and South America (Peru, Argentina, Colombia, Panama). The Maldives, Bahrain and Israel are also in that category.
  • Prime Minister Justin Trudeau of Canada said on Monday that his government had arranged to buy 76 million doses of a vaccine now under development by Novavax, a biotechnology company based in Gaithersburg, Md., and 38 million doses of a different proposed vaccine from Johnson & Johnson. The Novavax vaccine is currently undergoing trials in the United States, Australia and South Africa. Canada, a country of 37 million people, announced earlier in the month that it would also buy 20 million doses of a Pfizer vaccine and 56 million doses of a Moderna vaccine.
  • New Zealand reported nine new cases on Monday, including four imported cases and five community cases linked to a cluster in Auckland, New Zealand’s largest city, which came out of lockdown late Sunday after more than two weeks. Monday is also the first day when it is mandatory to wear masks on public transportation nationwide.
  • Australia reported its highest daily death toll on Monday, most of them deaths from the past month that had not been recorded earlier. Of the 41 deaths — all of them in the state of Victoria, the center of Australia’s worst outbreak — eight were in the previous 24 hours, officials said. The rest occurred in nursing homes as early as late July but are being counted now because of a change in the way they are required to report coronavirus deaths.
  • Schools in Hong Kong will resume in-person classes on Sept. 23, the education minister said Monday. Students in the semiautonomous Chinese territory have been taking classes online since early February, except for about a month at the end of the school year when infections were almost zero. Hong Kong reported nine new cases on Monday as it continues to tamp down what is being called a third wave of infections. Officials also said that as of Monday afternoon, more than 526,000 residents in the city of 7.5 million had signed up for a mass testing program, set to begin on Tuesday.
  • The international airport in Ghana will reopen on Tuesday after being shut down since March, President Nana Akufo-Addo said in a nationwide broadcast late Sunday. Passengers must provide proof of a negative PCR test — the most widely used diagnostic test for the new coronavirus — within 72 hours of departure, in addition to paying for a second test upon arrival. Land and sea borders remain closed in Ghana, which has had more than 44,000 cases and 276 deaths, according to a Times database.

Waivers allowing free school meals in the U.S. get a partial reprieve.

The Department of Agriculture, in a partial reversal, said on Monday that it would once again allow schools and community organizations to provide free breakfasts and lunches to all children, and not just to enrolled students who qualify under the usual regulations.

The policy, meant to allow wider nutritional support during the pandemic, will now apply through the end of 2020, as long as funds remains available.

When schools shut down in the spring because of the pandemic, the department authorized districts across the country to distribute subsidized to-go meals to any child or adolescent under 19, without parents having to apply or show financial need. The change was intended to make it easier to get meals to low-income children while they were stuck at home.

In recent months, though, the department had said that districts would have to go back to the usual rules governing the school meal program when instruction began this fall — whether in-person or remote. That meant providing meals only to students enrolled in that school district, and students who didn’t qualify for free meals would have to pay. (Children living in households with incomes at or below 130 percent of the federal poverty level qualify for free meals. Those in households up to 185 percent of the poverty level qualify for reduced-price meals.)

Officials in districts where schools have already started remotely this month said the change had led to huge drops in the number of meals they were distributing.

Members of Congress from both parties urged the Agriculture Department to extend the special pandemic rules through the end of the 2020-21 school year. But Sonny Perdue, the secretary of agriculture, had said that his department had neither the money nor the authority to do that.

On Monday morning, Mr. Perdue partly reversed course. In an appearance at an elementary school in Georgia, he said that, after getting the latest figures, his department had calculated that it could extend the special rules into the fall, and possibly through December.

Democrats had challenged Mr. Perdue’s explanation for not extending the special rules, saying that providing free meals to all comers had not actually cost more than the regular school lunch and breakfast program, and that Congress had given the department extra money.

Mr. Perdue did not shed any new light on that issue at his appearance on Monday. Asked by a reporter how much extending the special rules through December would cost, he said only, “It’s expensive.”

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