Nursing homes should bar most family and friend visits, the industry says.
Nursing homes and assisted living centers should take unprecedented action to curtail most social visits, and should even take steps to keep some employees away, to slow the spread of the new coronavirus, the industry said on Tuesday.
The recommendation follows an outbreak of the virus in the region around Seattle, where five long-term care facilities have been hit with cases, including a facility in Kirkland, Wash., where 18 residents have died. There have now been more than 800 cases of coronavirus in the United States, including 27 deaths.
“The mortality rate is shocking,” said Mark Parkinson, president and chief executive officer of the American Health Care Association. He said that the death rate might well exceed the 15 percent reported in China for people aged 80 and older who were infected.
The challenge of the virus “is one of the most significant, if not the most significant” issues the industry has ever faced, he said.
Industry officials said they are recommending that nursing homes should allow people to enter only if it is essential.
Staff members, contractors and government officials should be asked, “Do you need to be in-building to operate?” said Dr. David Gifford, the health care association’s chief medical officer.
As for family members, he said, “Our recommendation is they should not be visiting.”
Anyone who does visit, he said, should be screened carefully at reception and anyone who has signs of illness should be turned away.
New York creates a “containment zone” in New Rochelle.
With New Rochelle, a small city just north of New York City in Westchester County, emerging as the center of the state’s outbreak, Gov. Andrew M. Cuomo of New York on Tuesday announced a targeted containment strategy to halt the spread of the virus.
The state’s plan focuses on a “containment area” in New Rochelle with a one-mile radius centered around a synagogue believed to be at the center of the cluster, officials said.
Schools and other large gathering facilities like community centers and houses of worship within the area will be closed for two weeks beginning on Thursday, Mr. Cuomo said. Businesses such as grocery stores and delis would remain open. The state did not plan to close streets or implement travel restrictions, he said.
“You’re not containing people,” he said. “You’re containing facilities.”
The state also planned to deploy the National Guard to the containment area to clean the schools and deliver food to quarantined residents, Mr. Cuomo said.
The cluster in Westchester County first came to the authorities’ attention last week, when a lawyer who lives in New Rochelle and works in Manhattan, Lawrence Garbuz, became the second person in New York to be diagnosed with coronavirus last week.
On Tuesday, Gov. Andrew M. Cuomo said that 173 cases had been confirmed statewide. In Westchester County, there were 108 cases and in New York City, 36 cases of the virus, he said. New Jersey on Tuesday also announced new cases, bringing its total to 15.
Across Europe, no consistency in containment tactics.
With the first reported cases in Cyprus, the coronavirus is now present in every country in the European Union, health officials said on Tuesday, hours after Italy imposed sweeping travel restrictions across the whole country.
But the measures taken by the bloc’s member states to contain the virus varied widely from country to country, often with little relation to the actual size of the outbreaks, reflecting the lack of international coordination.
Greece and the Czech Republic announced that all schools and universities would close, though each country’s caseload is in the dozens, far fewer than some of their neighbors.
“We may decide on additional emergency measures later,” the Czech prime minister, Andrej Babis, said in a statement on Tuesday. “It is necessary to take active, exceptional measures at the start of an epidemic.”
Spain, with one of the largest outbreaks, closed all education centers in the Madrid region, but not nationwide. In Poland, Poznan, a city in the west of the country, closed schools, swimming pools and other public places after a single infection was discovered.
Worldwide, schooling has been disrupted for more than 300 million students.
Across the Continent, countries also increased travel regulations and guidelines.
Austria barred travelers from Italy without health certificates, and Switzerland was considering a similar measure.
Serbia has temporarily barred travelers from the worst-affected places, including Italy, while Croatian officials said that people entering from “highly infected areas” would face a mandatory 14-day quarantine.
Italy, with the worst outbreak outside of China, had more than 10,000 infections and 600 deaths by Tuesday. France and Spain each reported on Tuesday that they had more than 1,600 cases; Germany, had more than 1,200.
The authorities in France were resisting taking the kind of sweeping preventive measures seen in Italy or Japan.
“We are only at the beginning of this epidemic,” President Emmanuel Macron of France said on Tuesday after visiting an emergency call center in Paris. “We have anticipated, we have prepared ourselves.”
From a port in California to Columbia University in New York City, a sense of crisis grows in the U.S.
Passengers aboard the Grand Princess, the cruise ship stranded for days off California and now docked at the Port of Oakland, were expected to step up the disembarking process on Tuesday.
They will be met by workers in protective gear who have been preparing a large-scale quarantine operation for the 21 people infected with the coronavirus, along with the thousands of other passengers. The crew will remain onboard and the ship will head back to sea while they complete a 14-day quarantine.
The outbreak on the ship was just one of many fronts in the battle to slow the spread of virus across the United States.
Schools were shut down, major universities have canceled in-person classes and companies across the country were asking employees to work from home.
Known cases of coronavirus in the United States surged to more than 800.
On Tuesday, the Fulton County school system, which covers the suburbs of Atlanta, became the largest U.S. school district to close after an employee tested positive for the virus. Schools in Snohomish County, near the center of the crisis in Washington State, were also closed after an employee in the transportation department tested positive.
Harvard and Ohio State joined a growing list of universities and colleges that have decided to suspend in-person classes, including New York University, University of California, Berkeley, the University of Washington, Stanford, Columbia, Princeton and Rice. Amherst College, a private liberal arts school in Massachusetts, took precautions even further, ordering all students to leave campus by next week, unless they receive special permission to stay.
The disruptions echo significant changes to American life taking place from coast to coast. In California, which is experiencing a significant outbreak, officials in Santa Clara County escalated their recommendations to limit mass gatherings and ordered a mandatory ban, starting Wednesday at midnight.
Trump pitches a tax cut to a skeptical Congress.
President Trump briefed Senate Republicans on Tuesday on his ideas for an economic stimulus package to respond to the coronavirus, including a payroll tax cut.
But the idea of a payroll tax reduction is running into bipartisan opposition on Capitol Hill, where Democrats are openly hostile to the idea and some Republicans are skeptical, including Senator Mitch McConnell, the Republican leader.
Mr. Trump has suggested the tax cut as part of an array of measures to boost the economy, which some experts fear is headed into a recession.
But Mr. McConnell, of Kentucky, has privately discouraged discussion of the idea, according to people familiar with his thinking. Two other top Senate Republicans, John Cornyn of Texas and Charles E. Grassley of Iowa, have said they do not think a stimulus package is necessary at this point.
Mr. Trump discussed the coronavirus response with Senate Republicans at their policy luncheon on Tuesday, along with Steven Mnuchin, his treasury secretary, and Larry Kudlow, his top economic adviser.
“Stay calm. It will go away,” Mr. Trump, who has been accused of understating the seriousness of the epidemic, told reporters after the meeting. “It’s really working out and a lot of good things are going to happen.”
Democrats insist that any government response be tailored narrowly to the needs of patients and workers directly affected by the virus. They want enhanced unemployment benefits for those who lose their jobs, paid sick leave for people who must miss work and affordable testing and treatment for those who get sick.
Speaker Nancy Pelosi dismissed suggestions that the House would decamp from Washington because of the coronavirus.
“We are the captains of the ship,” she said at a closed door Democratic meeting focused on addressing the growing health epidemic, according to two people present. “We are the last to leave.”
But she and her top lieutenants indicated they were unlikely to approve any additional emergency measures related to this week, before leaving town for a previously scheduled recess.
Coachella organizers are in talks to postpone the festival to avoid canceling.
Organizers of the Coachella Valley Music and Arts Festival are in talks to postpone next month’s event to avoid outright cancellation, according to a person briefed on the negotiations who was not authorized to speak about it.
The postponement is not certain and would require the festival’s top acts to agree to move their performances to October, from April 10-12 and April 17-19, this person said. This year’s lineup features Travis Scott, Frank Ocean and a reunion of Rage Against the Machine, along with dozens of other acts.
Even if rescheduled, the postponement of Coachella, the giant pop festival in the picturesque desert of Southern California, could disrupt the annual concert season. The event, founded in 1999, draws up to 125,000 people a day and is a bellwether for the multibillion-dollar touring business.
Coachella joins a long list of cultural events that have been postponed or canceled over coronavirus fears, including the South By Southwest festival, which was set to begin on Friday. On Monday, Pearl Jam announced the postponement of its North American tour, and Neil Young said he was considering postponing his own tour.
Pearl Jam wrote on its website that it had searched for other options, “but the levels of risk to our audience and their communities is simply too high for our comfort level.”
On Friday, the South by Southwest festival was canceled just a week before it was set to start. Festival organizers have since said that they would be laying off one-third of their full-time staff.
Executives at the major promotion companies and talent agencies — among them Live Nation, AEG, WME, Creative Artists Agency and Paradigm — have formed a task force to share information and establish practices for dealing with virus-related problems and delays.
The F.D.A. halts overseas inspections of drugs and devices.
The Food and Drug Administration said on Tuesday that it would stop routine inspections of food, drugs and medical devices overseas through April, citing the worldwide spread of the coronavirus.
The agency had already pulled back its inspectors from China, which is the largest source of raw ingredients for many drugs, like aspirin, ibuprofen and penicillin.
But this global action means that F.D.A. inspections would also be discontinued in India, the world’s leading manufacturer of generic drugs. Last year, the agency said it conducted 3,103 inspections at overseas plants. The agency also tests samples of food, drugs, tobacco, veterinary products and cosmetics imported to the United States.
In recent years, several types of drugs have had to be recalled because of contamination at the production level, many of which contained ingredients made in China. Those recalls prompted the F.D.A. to revamp some of its procedures.
The agency has also been monitoring the nation’s drug supply chain, identifying several drugs that could face shortages if the epidemic in China and elsewhere lasts for months. It has said that at least one drug is currently in short supply in the United States because of difficulties related to the coronavirus, but has not said which one.
Hospitals have struggled for years with hundreds of shortages of essential medicines, many of them generic products made overseas.
Concern grows for the homeless in America.
Medical researchers say the 550,000 people currently homeless across the United States are more susceptible to contracting the disease caused by the coronavirus because of the cramped quarters in shelters, the sharing of utensils and the lack of hand-washing stations on the streets.
Chronically homeless people often have underlying medical conditions and lack reliable health care, meaning that, once infected, they are far more likely to get very sick or die. One study last year found that 30 percent of homeless people had chronic lung disease.
“We should be very worried,” said Dr. Helen Chu, an infectious disease specialist in Seattle, which has high rates of homelessness. So far, none of the more than 100 confirmed cases in Washington State have been among the homeless population.
Several cities in California have large homeless populations that are vulnerable to an outbreak, as do Austin, Texas; Phoenix; Portland, Ore.; and Washington D.C. Officials in New York City, which has the largest homeless population in the country, issued an 11-page document instructing shelters to screen people for symptoms and to quickly identify and isolate those who had contracted the virus “as much as possible.”
Under a single tent in downtown San Diego, one shelter sleeps more than 300 people, a majority of them older than 50. Numbered bunk beds are spaced just two feet apart.
“We’re just saying our prayers,” said Bob McElroy, the head of the shelter. “If it gets in here, it would be a disaster.”
On the Iran-Iraq border, friends are kept at arm’s length.
The border police commander rose quickly to meet the visitors who entered his office on the Iraq-Iran border recently, among them a fellow officer and a friend. Like many millions of Iraqi men, he usually hugs male friends and family, or kisses them at least once on both cheeks when they meet — a sign of friendship, of a bond between them.
But the commander, Brig. Gen. Ahmed Juma Abid, stopped short, and held his hands twisted together behind his back, looking down awkwardly.
“I am sorry,” he said, as if he were ashamed. “You know, corona.”
Instead of shaking the visitor’s hand, he reached out and squeezed his heavily clad arm, but kept him at arm’s length. General Abid, who runs a busy crossing with Iran — where the government has reported 8,042 cases and 291 deaths since the outbreak began — said he felt a responsibility to ensure the virus did not spread widely in Iraq.
“Frankly, our tradition is to embrace, kiss and shake hands,” he said. “But now, I say no,”
The lack of physical contact is not such an issue between women and men because typically the two sexes do not touch in public. Even shaking hands with the opposite gender is seen as slightly odd, or as a Western convention.
But for men, there is a sense of having to choose between safety from the virus, which is transmitted through touch, and rudeness.
It almost makes a person feel a little lonely, one tribal sheikh said. Another described the awkwardness of introducing physical distancing among his tribesmen.
Investors nervously return to the market after a Wall Street rout.
Some buyers moved back into the markets on Tuesday, a day after the coronavirus and a battle among the world’s biggest oil producers shook the global financial scene and caused the steepest one-day decline in U.S. stock prices in more than a decade.
On Wall Street, the S&P 500 rose more than 3 percent in early trading on Tuesday, but then slipped back, and was up about 1 percent by mid-afternoon. European stocks were down, while Asian markets rose.
Stocks were somewhat buoyed after Mr. Trump on Monday night said he would work with Congress on measures to help the economy amid signs of a worsening outbreak in the United States. But the gains did not come close to making up for the global plunge on Monday.
The S&P 500 fell nearly 8 percent on Monday, its sharpest daily decline since December 2008. In Asia and Europe on Monday, some of the biggest financial exchanges flirted with, or crossed into, bear market territory.
Investors still showed plenty of signs of nervousness on Tuesday. Yields on U.S. government debt rose slightly but remained close to record lows.
The price of oil, which had slumped by a quarter on Monday, rose more than 7 percent on Tuesday, with futures tracking the price of Brent crude trading at about $36.85 a barrel.
Life locked down in Italy: the morning after.
The grand piazzas are empty. The traffic circles are quiet. And people who would normally be sipping their morning espresso in cafes from Milan to Rome are notably absent.
Late Monday, Prime Minister Giuseppe Conte ordered the most severe nationwide limits on travel in Europe, adopting the playbook used by China to contain the virus.
Such draconian measures will undoubtedly prove complicated in a society that prizes individual freedom. But with more than 9,000 cases of infection and nearly 500 deaths, drastic action was needed, Mr. Conte said.
Travel was allowed for work, for health reasons and for trips to buy food and other supplies. But the police can impose penalties if the rules are broken.
The Italian news agency ANSA reported on lines of up to an hour to enter supermarkets in Naples on Tuesday morning, with problems exacerbated by the mandate that people stand about three feet apart.
The Italian national health system geared for an upsurge in critical cases, and the national procurement agency moved to buy equipment for thousands of new intensive-care beds.
Laura Castelli, deputy economy minister, told a radio program that payments on mortgages “for individuals and households” would be suspended throughout Italy. The measure is likely to be part of a fiscal package to bolster the economy that the government is expected to discuss further on Wednesday.
Little international aid is flowing to poorer regions to fight the epidemic.
Wealthy nations, international institutions, companies and foundations have committed little more than $1 per person on Earth to help fight the coronavirus epidemic in countries with fewer resources, according to a study released on Tuesday.
Those donors have pledged $8.3 billion as of Monday, according to the Kaiser Family Foundation, a health policy research group, and the bulk of that, $6 billion, is from the World Bank.
The second-largest commitment is $1.285 billion from the United States government, but other governmental contributions lag far behind; the next-biggest are $140 million from the European Union and $55 million from Germany.
Far more money has been committed to counteract the economic effects of the epidemic, including $50 billion from the International Monetary Fund.
Much of the money contributed to contain the disease, itself, is going to the World Health Organization, Red Cross groups and local agencies in low- and middle-wealth countries, primarily China, which has had the bulk of the cases. Infections have been recorded in more than 100 countries.
Even a country with a highly advanced health care system like Italy can find itself struggling to deal with the new illness, raising concerns about how less-developed countries will respond.
“At this point in the world, we are as strong as the country least prepared to respond because viruses don’t respect borders. They want to travel the world,” said Jen Kates, senior vice president for global health at the Kaiser Family Foundation. “It is requiring a global response and we don’t know if it’s enough. Time will tell.”
Foundations, businesses and charities accounted for 9 percent of the pledges and donations, led by Tencent, the Chinese internet giant whose messaging app WeChat has over a billion monthly users, at $214.7 million, followed by the Chinese e-commerce giant Alibaba at $144 million, and the Bill and Melinda Gates Foundation with $100 million.
Reporting and research was contributed by Alissa J. Rubin, Elisabetta Povoledo, Vanessa Swales, Iliana Magra, Raphael Minder, Constant Méheut, Joanna Berendt, Jason M. Bailey, Marc Santora, Jason Horowitz, Jorge Arangure, Jan Hoffman, Sheryl Gay Stolberg, Peter S. Goodman, Clifford Krauss, Claire Fu, Ben Sisario, Annie Karni, Elsie Chen, Choe Sang-Hun, Maria Abi-Habib, Amber Wang, Nicholas Kulish, Zoe Mou, Niki Kitsantonis, Richard Pérez-Peña, Julie Hirschfeld Davis, Nicholas Fandos and Noah Weiland.