Covid-19 cases top 40 million
U.S., India lead world count
LONDON — The number of confirmed covid-19 cases across the planet has surpassed 40 million, but experts say that is only the tip of the iceberg when it comes to the true impact of a pandemic that has upended life and work around the world.
The milestone was hit Monday morning, according to Johns Hopkins University, which collates reports from around the world.
The actual tally is likely to be far higher, as testing has been uneven or limited, many people have had no symptoms and some governments have concealed the true number of cases. To date, more than 1.1 mil
lion confirmed virus deaths have been reported, although experts also believe that number is an undercount.
The U.S., India and Brazil are reporting by far the highest numbers of cases — 8.1 million, 7.5 million and 5.2 million, respectively — although the global increase in recent weeks has been driven by a surge in Europe, which has seen more than 240,000 confirmed virus deaths.
As of last week, new cases per day were on the rise in 44 U.S. states, with many of the biggest surges in the Midwest and Great Plains, where resistance to wearing masks and taking other precautions has been running high and the virus has often been seen as just a big-city problem. Deaths per day were climbing in 30 states.
The World Health Organization said last week that Europe had a reported a record weekly high of nearly 700,000 cases and said the region was responsible for about a third of cases globally. Britain, France, Russia and Spain account for about half of all new cases in the region, and countries like Belgium and the Czech Republic are facing more intense outbreaks now than they did in the spring.
WHO said the new measures being taken across Europe are “absolutely essential” in stopping covid-19 from overwhelming its hospitals. Those include new requirements on mask-wearing in Italy and Switzerland, closing schools in Northern Ireland and the Czech Republic, closing restaurants and bars in Belgium, implementing a 9 p.m. curfew in France and having targeted, limited lockdowns in parts of the U.K.
The agency said several European cities could soon see their intensive care units overwhelmed and warned that governments and citizens should take all necessary measures to slow the spread of the virus, including bolstering testing and contact tracing, wearing masks and following social distancing measures.
In Iran, the single-day toll on Monday smashed a record set less than a week ago, with 337 deaths confirmed as a resurgence of infections is overwhelming hospitals.
On social media, Iranian news outlets dubbed the day “Black Monday” and lamented the grim milestone.
In Poland, the government is quickly transforming the National Stadium in Warsaw into a field hospital to handle the surging number of infected people, officials said. It is also making preparations to create other temporary facilities as hospitals are filling up, threatening a major crisis.
WHO has previously estimated about 1 in 10 of the world’s population — about 780 million people — have been infected with covid-19, more than 20 times the official number of cases. That suggests the vast majority of the world’s population is still susceptible.
Some researchers have argued that allowing covid-19 to spread in populations that are not obviously vulnerable will help build up herd immunity and is a more realistic way to stop the pandemic instead of the restrictive lockdowns that have proved economically devastating.
But WHO Director-General Tedros Adhanom Ghebreyesus has warned against the belief that herd immunity might be a viable strategy, saying this kind of protection needs to be achieved by vaccination, not by deliberately exposing people to a potentially fatal disease.
“Allowing a dangerous virus that we don’t fully understand to run free is simply unethical,” Tedros said last week.
The U.N. health agency said it hopes there might be enough data to determine if any of the vaccines now being tested are effective by the end of the year. But it warned that first-generation vaccines are unlikely to provide complete protection and that it could take at least two years to bring the pandemic under control.
Logistics experts also say that some 3 billion of the world’s 7.8 billion people live in areas that lack the infrastructure to refrigerate vaccines safely, a challenge that is sure to slow the delivery to those areas. This includes most of Central Asia, much of India and southeast Asia, Latin America except for the largest countries, and all but a tiny corner of Africa.
FOCUSING TACTICS
After entire nations were shut down during the first surge, some countries and U.S. states are trying more targeted measures as cases rise again around the world, especially in Europe and the Americas.
New York’s new round of virus shutdowns zeroes in on individual neighborhoods, closing schools and businesses in hot spots measuring just a couple of square miles.
Spanish officials limited travel to and from some parts of Madrid before restrictions were widened throughout the capital and some suburbs.
Italian authorities have sometimes quarantined spots as small as a single building.
While countries including Israel and the Czech Republic have reinstated nationwide closures, other governments hope smaller-scale shutdowns can work this time, in conjunction with testing, contact tracing and other initiatives they’ve built up.
The concept of containing hot spots isn’t new, but it’s being tested under new pressure as authorities try to avoid a dreaded resurgence of illness and deaths, this time with economies weakened from earlier lockdowns, populations chafing at the idea of renewed restrictions and some communities complaining of unequal treatment.
Some scientists say a localized approach, if well-tailored and explained to the public, can be a nimble response at a complex point in the pandemic.
“It is pragmatic in appreciation of ‘restriction fatigue’ … but it is strategic, allowing for mobilization of substantial resources to where they are needed most,” said Dr. Wafaa El-Sadr, who is following New York City’s efforts closely and is on some city advisory boards.
Other scientists are warier. “If we’re serious about wiping out covid in an area, we need coordinated responses across” as wide a swath as possible, said Benjamin Althouse, a research scientist with the Institute for Disease Modeling in Washington state.
In a study that has been posted online but not published in a journal or reviewed by independent experts, Althouse and other scientists found that amid patchwork control measures in the U.S. this spring, some people traveled farther than usual for such activities as worship, suggesting they might have responded to closures by hopscotching to less-restricted areas.
Still, choosing between limited closures and widespread restrictions is “a very, very difficult decision,” Althouse said. “I’m glad I’m not the one making it.”
Early in the outbreak, countries tried to quell hot spots from Wuhan, China — where a stringent lockdown was seen as key in squelching transmission in the world’s most populous nation — to Italy, where a decision to seal off 10 towns in the northern region of Lombardy evolved within weeks into a nationwide lockdown.
After the virus’s first surge, officials fought flare-ups with city-sized closures in recent months in places from Barcelona, Spain, to Melbourne, Australia.
In the English city of Leicester, nonessential shops were shut down and households banned from mixing in late June.
The infection rate fell, dropping from 135 cases per 100,000 to about 25 cases per 100,000 in about two months.
Proponents took that as evidence that localized lockdowns work. Skeptics argued that summertime transmission rates were generally low anyway in the United Kingdom, where the official death toll of more than 43,000 stands as Europe’s highest.
With infection levels and deaths rising anew in Britain, scientists have advised officials to implement a national twoweek lockdown. Instead, the government Monday carved England into three tiers of coronavirus risk, with restrictions ranging accordingly.
“As a general principle, the targeting of measures to specific groups or geographical areas is preferable to onesize-fits-all measures, because they allow us to minimize the damage that social distancing inevitably imposes on society and the economy,” said Flavio Toxvaerd, who specializes in economic epidemiology at the University of Cambridge.
MASKS TO GO
The Centers for Disease Control and Prevention on Monday recommended in new guidelines that all passengers and workers on planes, trains, buses and other public transportation wear masks.
The guidance was issued amid pressure from the airline industry, surging cases of the coronavirus in the United States and strong evidence on the effectiveness of masks in curbing transmission, CDC officials said.
The recommendations fall short of what transportation industry leaders and unions had sought, and come long after evidence in favor of mask-wearing was established.
The CDC had previously drafted an order under the agency’s quarantine powers that would have required all passengers and employees to wear masks on all forms of public transportation, according to a CDC official who spoke on condition of anonymity to discuss internal deliberations. Such orders typically carry penalties. The order was blocked by the White House, the official said.
Monday’s recommendation followed a request from Vice President Mike Pence to CDC Director Robert Redfield, CDC officials said. Although the agency already recommends the use of masks generally, the new language is worded more strongly and gives the airline industry more cover to press for mask-wearing, one CDC official said.
In a statement Monday, the agency said “transmission of the virus through travel has led to — and continues to lead to — interstate and international spread of the virus.” It added: “Local transmission can grow quickly into interstate and international transmission when infected persons travel on public conveyances without wearing a mask and with others who are not wearing masks.”