The outbreak in the United States continued to intensify on Sunday, with federal officials issuing grave warnings about a “shocking” week ahead and state and local officials continuing to plead for needed medical supplies.
But the virus’s impact appears to be staggered across the country, giving state leaders a new strategy against a disease that has stricken 328,000 people and claimed more than 9,300 lives: move limited resources to the areas that need them the most.
Washington State, once the center of the outbreak in the United States, said on Sunday that it had decided to return more than 400 ventilators to the Strategic National Stockpile after determining that the machines could be better used in states facing more dire conditions. The state had 7,498 known cases on Sunday, with 319 deaths.
Referring to the return of the ventilators, to be deployed to states hardest hit, Gov. Jay Inslee said: “I’ve said many times over the last few weeks: We are in this together.”
Washington State officials said mitigation efforts over the past month had helped avert some of the worst potential outcomes of the spreading virus there. The state also bought 750 ventilators, which are expected to arrive in the coming weeks.
Washington had initially requested 1,000 ventilators from the national stockpile. Federal officials shipped 474 ventilators to the state, which is returning 421 of them.
Mr. Inslee said the mitigation strategies, including a statewide stay-at-home order, would have to continue to keep Washington’s outbreak from resurging.
At his daily briefing on Sunday, Gov. Andrew M. Cuomo of New York also said that given the nationwide shortage, resources would have to be shifted around the country. On Saturday, Oregon announced that it would send 140 ventilators to New York to help with that state’s outbreak, by far the country’s largest.
“There’s not enough in the federal stockpile to take care of Louisiana and Illinois and Texas and California,” he said. “It’s not an option. The only option I see is there’s a national deployment.”
Governor Cuomo said that after New York’s outbreak ebbs, the state could help “shift the resources to the next place that is most impacted.”
“Whatever part of the country goes next, we will be there with equipment, personnel and however we can help,” he said.
And two of the Trump administration’s top health officials issued grave warnings to the American public, saying the next week — when the outbreak is expected to reach its peak in places like New York — will be “our Pearl Harbor.”
“The next week is going to be our Pearl Harbor moment,” said the United States surgeon general, Dr. Jerome M. Adams, on “Meet the Press.” “It’s going to be our 9/11 moment. It’s going to be the hardest moment for many Americans in their entire lives.”
His warnings were echoed by Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, who urged Americans to “buckle down” on “Face the Nation.”
“This is going to be a bad week,” he said, adding later: “It is going to be shocking to some, it certainly is really disturbing to see that, but that’s what’s going to happen before it turns around.”
While Dr. Fauci said the mitigation strategies around the country appeared to be having an effect, he pushed back against a suggestion that the outbreak is under control. “I’m not saying we have it under control,” he said. “That would be a false statement. We are struggling to get it under control.”
Some states braced for the outbreak to worsen for weeks. During CNN’s “State of the Union,” Gov. J.B. Pritzker of Illinois projected that his state’s peak was expected toward the end of April. Mr. Pritzker, a Democrat, accused the Trump administration of not reacting quickly enough to the warnings of the seriousness of the virus released by intelligence in January and February.
“If they had started in February building ventilators, getting ready for this pandemic, we would not have the problems we are having today and, frankly, very many fewer people would die,” he said.
The governor has requested 4,000 ventilators from the federal government.
“There’s no way that we can stockpile in anticipation of a pandemic that no one anticipated, and yet the federal government is responsible for doing precisely that,” Mr. Pritzker said.
Hospital officials, public health experts and medical examiners say that official tallies of Americans said to have died in the pandemic do not capture the overall number of virus-related deaths, leaving the public with a limited understanding of the outbreak’s true toll.
Limited resources and a patchwork of decision making from one state or county to the next have contributed to the undercount. With no uniform system for reporting coronavirus-related deaths in the United States, and a continuing shortage of tests, some states and counties have improvised, obfuscated and, at times, backtracked in counting the dead.
Adding to the complications, different jurisdictions are using distinct standards for attributing a death to the coronavirus and, in some cases, relying on techniques that would lower the overall count of fatalities.
A coroner in Indiana wanted to know if the coronavirus had killed a man in early March, but said that her health department denied a test. Paramedics in New York City say that many patients who died at home were never tested for the coronavirus, even if they showed telltale signs of infection.
In Virginia, a funeral director prepared the remains of three people after health workers cautioned her that they each had tested positive. But only one of the three had the virus noted on the death certificate.
Doctors now believe that some deaths in February and early March were likely misidentified as influenza or only described as pneumonia.
Even under typical circumstances, public health experts say that it takes months or years to compile data that is as accurate as possible on deaths in infectious outbreaks.
But they also say that an accurate count of deaths is an essential tool to understand a disease outbreak as it unfolds: The more deadly a disease, the more aggressively the authorities are willing to disrupt normal life. Precise death counts can also inform the federal government on how to target resources, like ventilators from the national stockpile, to the areas of the country with the most desperate need.
Queen Elizabeth II, in a rare televised address on Sunday, tried to rally her fellow Britons to confront the coronavirus pandemic with the resolve and self-discipline that have seen the nation through its greatest trials.
“I am speaking to you at what I know is an increasingly challenging time,” the queen said in taped remarks from Windsor Castle. The virus has infected at least 40,000 people in Britain, including her eldest son and heir, Prince Charles, and Prime Minister Boris Johnson. Mr. Johnson was admitted to the hospital for tests, the government said later on Sunday evening, underscoring how the virus has threatened the country’s political establishment.
The queen called it “a time of disruption in the life of our country: a disruption that has brought grief to some, financial difficulties to many, and enormous changes to the daily lives of us all.”
It is only the fourth time in her 66-year reign that the queen has addressed the British people, apart from her annual Christmas greeting — and it carries a distinct echo of the celebrated radio address her father, George VI, delivered in September 1939, as Britain stood on the brink of war with Germany.
“I hope in the years to come, everyone will be able to take pride in how they responded to this challenge,” the queen said, “and those who come after us will say that the Britons of this generation were as strong as any. That the attributes of self-discipline, of quiet good-humored resolve and of fellow-feeling still characterize this country.”
Mr. Johnson had been in isolation in his residence next door to 10 Downing Street, where officials said he was running a high temperature. Downing Street insisted the move was a precaution and that he remained at the helm of the government.
On Saturday, his 32-year-old girlfriend, Carrie Symonds, disclosed that she, too, is suffering symptoms. Ms. Symonds is pregnant.
While the queen fully adopted social distancing early in the pandemic, the British government came late to the need for such measures, with Mr. Johnson initially balking at ordering pubs and restaurants to close. He is now an ardent convert and recorded a video from his quarantine urging people — without much success — not to flock to London parks during a sun-kissed spring weekend.
Britain’s response to the pandemic has improved since that shaky start. The government has vowed to conduct 100,000 virus tests a week by the end of April, a tenfold increase over the current rate.
Countries around the world continued to struggle with the pandemic. On Sunday, the number of known cases was more than 1.2 million, with over 67,000 deaths.
In Spain, the authorities reported another drop in the death toll: 674 died overnight — the lowest in 10 days — for a total of about 12,400, second in the world to Italy. With more than 130,000 reported cases, however, Spain had the highest number in Europe as of Sunday morning.
South Sudan on Sunday confirmed its first case of Covid-19, the disease caused by the virus, according to the country’s vice president, Riek Machar. A 29-year-old woman who arrived in the country from Ethiopia on Feb. 28 was being treated in isolation.
In Iran, the death toll rose to 3,603, a health ministry spokesman told state television on Sunday. The spokesman, Kianush Jahanpur, said 151 people had succumbed in the past 24 hours. The nation, the Middle Eastern country worst-hit by the epidemic, now has 58,226 infections, he said.
In Jerusalem, Franciscan friars wearing surgical masks and gloves made house calls on Palm Sunday, delivering olive branches to Christians who are self-isolating as a precaution against the coronavirus. Jerusalem’s churches, like Muslim and Jewish places of worship, are closed to the public.
In the Vatican, Pope Francis celebrated Palm Sunday Mass without the tens of thousands of Romans, tourists and pilgrims who usually throng St. Peter’s Square. Looking pensive and sounding subdued, Francis led the first of several solemn Holy Week ceremonies that will shut out rank-and-file faithful from attending, as Italy’s lockdown measures forbid public gatherings. He said the pandemic should focus people’s attention on what is most important: using one’s life to serve others.
In Britain, the police are investigating fires at cellphone masts in three locations as possible arson, after the spread of unfounded rumors claiming links between 5G cellphone networks and the coronavirus.
The Irish prime minister, Leo Varadkar, who trained as a physician but stopped after seven years to go into politics, will work one session a week to help fight the coronavirus. It is reported that he will be helping to screen people for treatment and testing over the phone.
France reported 70,478 confirmed cases of Covid-19, up from 68,605 on Saturday. The country reported 8,078 deaths, up from 7,560 on Saturday.
Finland is drawing on a stockpile of medical supplies built up over decades to fight the pandemic. The country’s history, including fighting off a Soviet invasion in 1939, has taught the nation of 5.5 million to prepare for the worst, said Tomi Lounema, the chief executive of Finland’s National Emergency Supply Agency. On Sunday, Finland had recorded more than 1,880 cases and 25 deaths.The Navy captain who was removed from command of a coronavirus stricken aircraft carrier tests positive.
A Navy spokesman declined to comment on Captain Crozier’s Covid status.
The commander began exhibiting symptoms before he was removed from the warship on Thursday, two of his classmates said. Captain Crozier was fired following a leak to The San Francisco Chronicle of a letter he had emailed to Navy leaders that detailed the failures on the service’s part to provide the necessary resources to swiftly move sailors off the carrier and disinfect areas on board as the virus spread through the ship.
Secretary of Defense Mark T. Esper said Sunday on CNN’s “State of the Union” that there were 155 confirmed cases of Covid-19 among sailors aboard the aircraft carrier, and that more than half of the ship had been tested. So far there have been no hospitalizations.
“There is an investigation ongoing,” Mr. Esper said. “All the services at times relieve commanders without the benefit of an investigation up front because they’ve lost confidence in them. It’s certainly not unique to the Navy.”
The captain was being quarantined in “distinguished visitors quarters” on Naval Base Guam, according to two of his classmates. It is unclear when he was first tested for Covid-19 or when he received his results.
After weeks of allowing cruise ship passengers who were exposed to the coronavirus but had no symptoms to travel home on commercial flights with nothing more than a temperature check, the Centers for Disease Control and Prevention reversed course on Sunday.
Cruise companies will now have to charter flights to return passengers to their home cities, the agency said.
The move came just as Carnival Corporation was set to disembark about 1,000 passengers off the Coral Princess, which docked in Miami on Saturday. Two people died on the ship, and at least seven passengers and five crew members tested positive for Covid-19. Another passenger died on Saturday awaiting an ambulance, The Miami Herald reported.
Early in the crisis, cruise passengers were quarantined on military bases. In March, Carnival cruise line evacuated several hundred Americans and Canadians off the Costa Luminosa in a chartered flight from France to Atlanta, and the C.D.C. let them all travel to their home cities on commercial flights. Many got sick, and at least one person died.
As recently as last week, when two more infected Carnival ships arrived in Florida, the C.D.C. insisted that its protocol was to ensure that the passengers who did not have a fever should wear a mask, fly home and self-isolate for 14 days.
Now cruise companies have to arrange charters or private drivers. They may not use any public transportation or scheduled flights. The new guidance from the C.D.C. suggested the cruise lines would have to charter separate flights for people who have symptoms and those who do not.
Asked why the C.D.C. made the change, an agency spokeswoman said, “As community spread has increased over time, our recommendations have changed to reflect that.”
“In addition, our recommendations aim to keep people safe and healthy from the boat to their home for quarantine,” Kristen Nordlund, the spokeswoman, wrote in an email.
Roger Frizzell, a spokesman for Carnival Cruises, said the new protocol would present an enormous challenge.
“If this protocol holds,” Mr. Frizzell said, “it is going to be a very difficult task.”Coronavirus has pummeled a Brooklyn hospital and its patients.
Residents from the I.C.U. at the Brooklyn Hospital Center presented their cases to the attending physicians last week speaking in shorthand and at auctioneer-like speed.
“Admitted for acute hypoxic respiratory failure secondary to likely Covid-19.”
“Admitted for acute hypoxic respiratory failure secondary to confirmed Covid-19.”
“Admitted for acute hypoxic respiratory failure, high suspicion of Covid-19.”
Nearly every patient in a bed in the new intensive care unit, just as in the main one, was breathing with the help of a mechanical ventilator.
There were patients in their 80s and in their 30s. Patients whose asthma and diabetes helped explain their serious illness. And patients who seemed to have no risk factors at all. Patients from nursing homes. Patients who had no homes. Pregnant women, some of whom would not be conscious when their babies were delivered to increase their odds of surviving to raise their children.
This was the week that the coronavirus crisis pummeled hospitals throughout New York City, where deaths reached more than 2,000, as the governor warned that vital equipment and supplies would run short in just a few days. The mayor pleaded for more doctors, and hospital officials and political leaders said that the situation would get even worse.
At the Brooklyn Hospital Center — a medium-size independent community hospital — that toll was evident. Deaths attributed to the virus more than quintupled from the previous week. The number of inpatients confirmed to have Covid-19, the disease caused by the virus, grew from 15 to 105, with 48 more awaiting results. Hospital leaders estimated that about a third of doctors and nurses were out sick.
The hospital temporarily ran out of protective plastic gowns, of the main sedative for patients on ventilators, and of a key blood pressure medication. The sense of urgency and tragedy was heightened by a video, circulating online, showing a forklift hoisting a body into a refrigerated trailer outside the hospital.
Some nurses cared for five critically ill patients at a time, when the norm there was just two. The array of doctors, nurses, pharmacists and respiratory therapists accustomed to working in the I.C.U. needed reinforcements, so a podiatrist and two of her resident trainees, a neurosurgery physician assistant, surgery residents and a nurse anesthetist joined in to help.
Dr. James Gasperino, the chair of medicine and vice president for critical care at the hospital, conferred in the hallway with the director of respiratory therapy. The hospital had 98 ventilators, many acquired in recent days. Employees were running simulations to practice how they might use each ventilator to treat two patients, a difficult and risky proposition.
“We’re doing this because the alternative is death,” Dr. Gasperino said.
A tiger at the Bronx zoo has been confirmed to be infected with Covid-19, in what is believed to be a case of what one official called “human-to-cat transmission.”
“This is the first instance of a tiger being infected with Covid-19,” according to the U.S. Department of Agriculture, which noted that although only one tiger was tested, the virus appeared to have infected other animals as well.
“Several lions and tigers at the zoo showed symptoms of respiratory illness,” according to a statement by the Agriculture Department.
Public health officials believe that the large cats caught the virus from a zoo employee. The tiger appeared visibly sick by March 27.
In a statement, the Agriculture Department suggested that those infected with the virus should, “out of an abundance of caution,” avoid contact with their pets and other animals.
The Centers for Disease Control and Prevention has said that it is “aware of a very small number of pets outside the United States reported to be infected,” but that it does not have evidence that pets can spread the coronavirus.The F.D.A. chief raises the possibility that plasma from recovered coronavirus patients might protect the healthy.
A vaccine for coronavirus is still many months away, but on Sunday, the commissioner of the Food and Drug Administration pointed to another potential preventive treatment that he said could serve as a “bridge.”
The commissioner, Dr. Stephen M. Hahn, said that researchers are looking into whether a manufactured version of plasma from people who have already been infected with the virus could be administered preventively.
Researchers are already studying whether using plasma from those who have recovered — so-called convalescent plasma, which contains antibodies needed to ward off the virus — could be used to treat people who are suffering from the disease. It is being used on an experimental basis by doctors around the country.
Speaking on Sunday morning on the Fox News Channel, Dr. Hahn said that if convalescent plasma proved safe and effective, it could be pooled from many patients and manufactured into an injection called hyperimmune globulin, which could be given to people to prevent getting infected.
“We have to study it and we’re doing this quickly, but also as a prophylactic,” Dr. Hahn told the host, Maria Bartiromo. “And that acts as a bridge to get us to a vaccine.”
On Friday, the F.D.A. approved a clinical trial that will allow Johns Hopkins researchers to test whether convalescent plasma would be effective in treating people who are at high risk of being exposed to the virus, such as health care workers and other front-line responders.24 hours in Pandemic America.
A drug recovery meeting hosted online. A police officer wearing a face mask. A pastor without a congregation. A funeral director trying to bury the dead.
The merciless threat slipped into the country, emptying its streets, shuttering its stores, wrecking its economy and forcing its people to retreat indoors.
In this pandemic nation, once crowded cities now feel abandoned, as if everyone suddenly moved out. There is no rush hour. “Closed” signs hang from the front doors of business after business. But there are new connections, too.
For many, the coronavirus pandemic involves the most dramatic kind of fight — for life, for food, for money. For others, it can feel absurdly trifling as they stay inside — a fight against boredom, binge eating, isolation.
Twelve doctors at her hospital and the chief executive were sickened with the coronavirus. A colleague had died. Patients as young as 19 were being placed on ventilators.
But Michele Acito, the director of nursing at Holy Name Medical Center — in the hardest-hit town in New Jersey’s hardest-hit county — felt that she was holding up.
The pandemic that has crippled New York City is now enveloping New Jersey’s densely packed cities and suburbs. The state’s governor said on Friday that New Jersey was about a week behind New York, where the surging coronavirus has brought increasing anxiety among medical workers.
As of Sunday morning, at least 847 people in New Jersey had died of the virus, and 34,124 had been infected. New Jersey has the nation’s second-highest number of cases after New York, where about 115,000 people have been infected and more than 3,500 have died.
At Holy Name in Teaneck, just across the Hudson River from Manhattan, two doctors are among the 150 patients being treated for the virus. Two patients died within 72 hours.
One of them was Edna Acito, Ms. Acito’s mother-in-law. She had turned 89 on Thursday. A team of medical workers sang “Happy Birthday” from the hallway. The older woman’s nine children expressed their love through an iPad as Ms. Acito held her hand. She died early Saturday.
“You compartmentalize,” Ms. Acito, 57, said. “You go home. You shower it off. But when you have a family member here, you can’t scrub that off.”
Only days after the Democratic National Committee postponed the date of the presidential convention by a month because of concerns about the coronavirus, Joseph R. Biden Jr. suggested on Sunday that the party may instead have to hold a “virtual convention.”
“We’re going to have to do a convention,” Mr. Biden, the party’s likely nominee, said in an interview on ABC’s “This Week.” “We may have to do a virtual convention. I think we should be thinking about that right now. The idea of holding the convention is going to be necessary. But we may not be able to put ten, twenty, thirty thousand people in one place.”
The dates of Democratic National Convention, to be held in Milwaukee, had already been pushed back from mid-July to the week of Aug. 17, a week before Republicans plan to renominate President Trump in Charlotte, N.C.
Mr. Biden had first called for rescheduling of the convention last week in an appearance on “The Tonight Show.” Democratic officials have said they would be flexible on the format of the convention and follow public health guidance to not spread the contagious disease. The pageantry of a convention typically draws massive media attention, providing a boost for a challenger headed into the general election.
Mr. Trump has made clear he wants to hold the Republican convention in August.
Representative Jim Clyburn, Democrat of South Carolina and the House majority whip, said on Sunday that a special bipartisan committee created to oversee the government’s response to the coronavirus pandemic would focus on how it distributes emergency aid rather than how the administration addressed the threat.
“My understanding is that this committee will be forward-looking. We’re not going to be looking back on what the president may or may not have done back before this crisis hit,” Mr. Clyburn, who has been tasked with leading the committee, said on CNN’s State of the Union. “The crisis is with us.”
Speaker Nancy Pelosi last week announced the creation of the select committee, which would require a House vote, underscoring the urgency in Congress to keep a close watch on how Mr. Trump carries out the more than $2 trillion stimulus package that he signed into law. Her announcement that the panel would have subpoena power, set up the prospect of a new round of constitutional clashes over information about how the administration addressed the coronavirus threat, and drew the immediate denunciation of President Trump, who labeled it a “witch hunt.”
But Mr. Clyburn on Sunday said the committee would take a narrower focus.
“The question is whether or not the money that is appropriated will go to support” American workers, he said, “or whether or not this money will end up in the pockets of a few profiteers.”The surgeon general asks states without broad lockdown orders to ‘give us what you can.’ Arkansas says it is doing enough.
On Sunday, the United States surgeon general, Dr. Jerome M. Adams, asked governors in the nine states that do not have statewide stay-at-home orders to do what they could to limit their residents’ exposure.
“Give us what you can, so that we don’t overwhelm our health care systems over this next week,” he said during an appearance on the news show “Meet the Press.”
At least 311 million people nationwide are being urged to stay at home.
But Gov. Asa Hutchinson of Arkansas said that an order of that kind had not become necessary in his state.
In an interview with Chuck Todd on “Meet the Press,” Mr. Hutchinson, a Republican, said that Arkansas was acting aggressively in limiting the spread of the virus. He pointed to businesses that had been closed, and guidelines urging social distancing and encouraging people to wear masks.
But, he added that this week some 600,000 residents in his state will report to work.
“We have a targeted approach that is very strict,” he said. “We’re emphasizing social distancing, and we will do more as we need to.”Chinese-Americans, facing abuse, unite to aid hospitals.
Even as many Chinese-Americans have weathered racist remarks and some physical attacks over the coronavirus, small groups throughout New York and New Jersey are uniting to fight the pandemic in the United States.
Using mostly WeChat, they are creating vast networks and rallying their contacts in the United States and China to procure supplies for doctors and nurses.
Some equipment has come from China, from companies like Dasheng in Shanghai. And while some companies require bulk shipments, networking via multiple groups on WeChat has helped with that issue, said Tingzhou Wu, a spokeswoman for a group in Millburn, N.J.
“We’re saying, ‘Let’s chat. Do you guys want to buy this together?’” she said.
The Long Island Chinese American Association in New York has delivered more than 10,000 masks to three hospitals and nearly 8,000 surgical masks to the Visiting Nursing Service of New York. The Coalition of Asian-Americans in Private Practice has raised close to $250,000 since January and expects to get 80,000 N95 masks to New York hospitals this month.
A group of Chinese-American professors at Rutgers University in New Jersey raised $12,000 and collected more than 4,000 masks to support a hospital in New Brunswick. A church in Parsippany donated thousands of masks to hospitals and even to local gas stations, where attendants are legally required to pump customers’ gas.
“It’s been a community consensus,” said Maria Wu, another spokeswoman for the Millburn association. “We need to stand up and do something to protect the people who are protecting us.”
Especially since some of those people are dealing with discrimination on the front lines.Taking steps to insure your future
If you are among the over 6 million people applying for unemployment insurance this month, you are likely doing so for the first time. It’s important to understand how unemployment works and how it can help you in this time of need. Plus tips for making a will and starting an emergency fund.
Reporting was contributed by Mike Baker, Jeffrey Gettleman, Matina Stevis-Gridneff, Michael Crowley, Denise Grady, Sheri Fink, Azi Paybarah, Alexandra Stevenson, Tiffany May, Rick Rojas, Christina Anderson, Henrik Pryser Libell, Raphael Minder, Tammy La Gorce, Iliana Magra, John Ismay, Katie Thomas, Rick Rojas, Vanessa Swales, Shane Goldmacher, Frances Robles, Aurelien Breeden and Mark Landler.