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Westlake Legal Group > Posts tagged "Trump, Donald J" (Page 24)

‘It’s a Leadership Argument’: Coronavirus Reshapes Health Care Fight

Westlake Legal Group 24campaign-health1-facebookJumbo ‘It’s a Leadership Argument’: Coronavirus Reshapes Health Care Fight United States Politics and Government Trump, Donald J Presidential Election of 2020 Patient Protection and Affordable Care Act (2010) Health Insurance and Managed Care Coronavirus (2019-nCoV) Biden, Joseph R Jr

WASHINGTON — One of the thorniest debates in American politics is over health care. Now add a pandemic.

The future of America’s health insurance system has already been a huge part of the 2020 presidential race. At campaign events over the past year, voters have shared stories of cancer diagnoses, costly medications and crushing medical debt.

That was before more than 68,000 people in the United States tested positive for the coronavirus, grinding the country to a halt, upending lives from coast to coast, and postponing primary elections in many states. The virus has made the stakes, and the differing visions the two parties have for health care in America, that much clearer.

“Health care was always going to be a big issue in the general election, and the coronavirus epidemic will put health care even more top of mind for voters,” said Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation, a nonpartisan research organization. “Sometimes these health care debates can get a bit abstract, but when it’s an immediate threat to the health of you and your family, it becomes a lot more real.”

On Monday, Joseph R. Biden Jr. sent a letter to President Trump and Republican state officials that emphasized the sorts of immediate threats Americans are feeling, and criticized those Republicans for supporting litigation that targets the Affordable Care Act. The letter called it “unconscionable that you are continuing to pursue a lawsuit designed to strip millions” of coverage in the midst of a pandemic.

Mr. Biden sent his missive on a health care milestone: the 10th anniversary of when President Barack Obama signed the Affordable Care Act into law — with Mr. Biden, then the vice president and now the likely Democratic presidential nominee, standing by his side.

While the Democrats spent much of their primary fighting about whether to push for “Medicare for all” or build on the Affordable Care Act, the coronavirus crisis may streamline the debate to their advantage: At a time when the issue of health care is as pressing as ever, they can present themselves as the party that wants people to have sufficient coverage while arguing that the Republicans do not.

“A crisis like the coronavirus epidemic highlights the stake that everyone has in the care of the sick,” said Paul Starr, a professor of sociology and public affairs at Princeton who served as a health policy adviser in the Clinton White House. “It really strengthens the Democratic case for expanded health coverage, and that should work, I should think, to Biden’s advantage in a campaign against Trump.”

The virus is also having dire economic consequences, depriving Mr. Trump of a potent re-election argument rooted in stock market gains and low unemployment numbers. It is testing Mr. Trump’s leadership in the face of a national emergency like nothing he has encountered, and if voters give him poor marks, that could inflict lasting damage on his chances in November’s general election.

“It’s a leadership argument,” said Representative Donna E. Shalala, Democrat of Florida, who served as secretary of health and human services for President Bill Clinton. “Who do you want to be president of the United States when there’s a big health crisis?”

In addition, the virus is a providing an unmistakable reminder that Mr. Trump and Mr. Biden have starkly different views about the future of American health care — and starkly different records on the issue.

Four years ago, Mr. Trump ran for president promising to repeal the Affordable Care Act, popularly known as Obamacare. But his campaign pledge quickly turned into a debacle in the first year of his presidency when Republicans struggled and ultimately failed to repeal and replace the health law. In the midterm elections the next year, Democrats emphasized health care, highlighting issues like preserving protections for people with pre-existing conditions, and they won control of the House.

That line of argument has already surfaced in the 2020 election cycle. “Too many Montana families go to sleep at night worried about health care — coverage, costs, now the fear of coronavirus,” the narrator said in a recent ad targeting Senator Steve Daines, Republican of Montana, who is up for re-election. The ad was run by Protect Our Care, a liberal advocacy group that supports the Affordable Care Act and has set up a coronavirus “war room” aimed at holding Mr. Trump accountable over his handling of the crisis.

Mr. Trump is particularly vulnerable on the issue of health care. Over the course of his presidency, his administration has repeatedly taken steps to undermine the Affordable Care Act, including by arguing in court that the entire law should be invalidated. The Supreme Court agreed this month to hear an appeal in that case, which is the latest major challenge to the law. The court is not expected to rule until next year, but Democrats point to the Trump administration’s legal position as yet another example of the president’s desire to shred the Affordable Care Act.

All together, those steps by Mr. Trump and his administration amounted to something of a policy piñata for Mr. Biden and other Democrats to swing at in the general election, even before the coronavirus threat emerged.

“Trump wants to take health care away,” said Representative Ami Bera of California, a physician. “Democrats and Vice President Biden want to extend health care and make it affordable.”

In his campaign, Mr. Biden has already put a focus on health care, promising to build on the Affordable Care Act and create a so-called public option, an optional government plan that consumers could purchase. On the campaign trail, he has talked about his own exposure to the health care system, including when his late son, Beau Biden, had brain cancer. He has also regularly heard from people about their own struggles. “They walk up and grab me and say, ‘I just lost my daughter, cancer,’ or, ‘My son’s dying,’ or, ‘I have Stage 4,’” he recalled this year.

Andrew Bates, a spokesman for the Biden campaign, said Mr. Trump had “spent almost his entire presidency attempting to cost millions of Americans their health coverage,” adding: “The coronavirus outbreak, which Trump has egregiously mishandled, would be even more catastrophic if he had his way on health care.”

At a Fox News town hall event this month, Mr. Trump said he had not “been able to sell what a great job we’ve done” on health care. While the president and congressional Republicans failed at repealing the Affordable Care Act, they succeeded at undoing a key part of the law when, as part of their 2017 tax overhaul, they eliminated the tax penalty for people who go without insurance.

The Trump campaign has already attacked Mr. Biden over health care, including by arguing that he poses a threat to private health insurance with his proposal to create an optional government plan.

“As President Trump is leading our country and taking unprecedented action to stop the coronavirus, Joe Biden is campaigning on his Bernie Sanders-inspired, socialist health care agenda, which would take away Americans’ access to quality health care,” said Sarah Matthews, a Trump campaign spokeswoman. “Make no mistake about it, Biden’s government-run ‘public option’ is just another name for a government takeover of the entire health care system.”

And although the Affordable Care Act has gained in popularity during Mr. Trump’s presidency, Republicans can still point to rising health care costs as a problem that voters want to see addressed. In that vein, Senator Bill Cassidy, Republican of Louisiana and a physician, cited the substantial premiums and high deductibles that many consumers have.

“Democrats have to have a credible plan to control health care costs,” Mr. Cassidy said. “If you look at what the No. 1 concern is, it is the cost of health care.”

In the Democratic primary race, the health care debate has largely focused on the divide between moderate-leaning Democrats looking to build on the Affordable Care Act and progressives calling for Medicare for all, a government-run health insurance program. Mr. Biden and Mr. Sanders represent the two sides of that argument.

Mr. Sanders, the Vermont senator, faces long odds at catching up to Mr. Biden in the delegate race, but he has remained in the primary and continues to push progressive policy ideas, including on health care. In response to the virus, he has pointed once again to the need for Medicare for all.

“It is nearly impossible to believe that anyone can still think it’s acceptable to continue with a health care system that leaves tens of millions of people uninsured,” Mr. Sanders said this month. “The cruelty and absurdity of that view is more obvious in the midst of this crisis than it has ever been.”

In a poll this month by Morning Consult, four in 10 Americans said the coronavirus outbreak had made them more likely to support universal health care proposals in which everyone would receive their health insurance from the government.

Under the single-payer system that Mr. Sanders is proposing, private health insurance would be eliminated — a potential political vulnerability that Republicans would most likely exploit in the general election if the Democratic nominee supported Medicare for all. Mr. Biden, who has repeatedly criticized Mr. Sanders’s health care proposal during the primary, does not share that vulnerability.

At one of his final campaign stops before the virus shut down in-person campaigning, Mr. Biden visited a community health center in Grand Rapids, Mich., where he spoke of his pride in having worked with Mr. Obama to pass the Affordable Care Act.

“I’m running to protect the progress we fought for,” Mr. Biden said. He cast doubt on Mr. Sanders’s plans for a single-payer system and spoke about the urgent need to improve health care — now more evident than even two weeks ago.

Talking about the patients at that clinic, he said, “They can’t afford to wait for a revolution.”

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Job Vacancies and Inexperience Mar Federal Response to Coronavirus

Westlake Legal Group 26dc-virus-expertise1-facebookJumbo Job Vacancies and Inexperience Mar Federal Response to Coronavirus Wolf, Chad F. Wilkie, Robert Trump, Donald J Reed, Jack National Security Council Mulvaney, Mick Mnuchin, Steven T Homeland Security Department Hahn, Stephen M (1960- ) federal emergency management agency Customs and Border Protection (US) Cuccinelli, Kenneth T II Coronavirus (2019-nCoV) Centers for Disease Control and Prevention Bowser, Muriel E Bossert, Thomas P Bolton, John R

WASHINGTON — Of the 75 senior positions at the Department of Homeland Security, 20 are either vacant or filled by acting officials, including Chad F. Wolf, the acting secretary who recently was unable to tell a Senate committee how many respirators and protective face masks were available in the United States.

The National Park Service, which like many federal agencies is full of vacancies in key posts, tried this week to fill the job of a director for the national capital region after hordes of visitors flocked to see the cherry blossoms near the National Mall, creating a potential public health hazard as the coronavirus continues to spread.

At the Department of Veterans Affairs, workers are scrambling to order medical supplies on Amazon after its leaders, lacking experience in disaster responses, failed to prepare for the onslaught of patients at its medical centers.

Empty slots and high turnover have left parts of the federal government unprepared and ill equipped for what may be the largest public health crisis in a century, said numerous former and current federal officials and disaster experts.

Some 80 percent of the senior positions in the White House below the cabinet level have turned over during President Trump’s administration, with about 500 people having departed since the inauguration. Mr. Trump is on his fourth chief of staff, his fourth national security adviser and his fifth secretary of the Department of Homeland Security.

Between Mr. Trump’s history of firing people and the choice by many career officials and political appointees to leave, he now finds himself with a government riddled with vacancies, acting department chiefs and, in some cases, leaders whose professional backgrounds do not easily match up to the task of managing a pandemic.

“Right now for the life of me, I don’t know who speaks for D.H.S.,” said Janet Napolitano, a secretary of homeland security under President Barack Obama. “Having nonacting leadership, and I think having consistency in your leadership team and the accumulation of experience, really matters. And I think it would be fair to say the current administration hasn’t sustained that.”

One example is the Department of Veterans Affairs, which is legally meant to back up the nation’s health care system in an emergency. The secretary, Robert L. Wilkie, has no experience in emergency management, and he has been largely absent from meetings with senior officials on the pandemic. He recently fired his second in command, who had worked in past disasters, and his head of emergency preparedness retired. Mr. Wilkie took a short leave of absence two weeks ago as the crisis began to unfold in the United States.

Senior officials in the department say they are kept out of the loop on major decisions, such as whether it will continue Mr. Trump’s preferred policy of sending veterans into the community for care, and learn from the news media about how centers are interpreting guidelines.


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Many of the newcomers in agencies lack relationships with the private sector and lawmakers to accomplish basic goals.

One high-profile case came with eliminating a directorate at the White House’s National Security Council that was charged with pandemic preparations. In 2018, John R. Bolton, then Mr. Trump’s national security adviser, ousted Thomas P. Bossert, Mr. Trump’s homeland security adviser and longtime disaster expert. The directorate was folded into an office dedicated to weapons of mass destruction.

Equally notable may have been the resignation last year of Scott Gottlieb, the commissioner of the Food and Drug Administration, who was an early advocate for broad coronavirus testing and stronger mitigation policies. He was succeeded by Dr. Stephen M. Hahn, a noted oncologist, who has struggled during Senate hearings to explain some of his positions. The agency is largely viewed as slow in engaging the private sector to develop tests for the coronavirus. Many members of Mr. Gottlieb’s team departed with him, leaving the agency with many people new to their jobs.

The Department of Homeland Security, the agency tasked with screening at airports and carrying out the travel restrictions that were Mr. Trump’s first major action to combat the coronavirus, is full of vacancies. Of the 75 senior positions listed on the department’s website, 20 are either vacant or filled by acting officials.

Mr. Wolf is the acting homeland security secretary, and Kenneth T. Cuccinelli II, a representative on the coronavirus task force, is the department’s acting deputy secretary. The deputy administrators of the Transportation Security Administration and Federal Emergency Management Agency also serve in acting capacities. A federal judge also ruled that the process the Trump administration used to bring Mr. Cuccinelli to the department violated a federal vacancies law that stipulates open leadership positions must go to certain officials.

Mr. Wolf is familiar with airport security operations. He was part of the team that established the Transportation Security Administration and later served as the agency’s chief of staff. But the chaotic introduction of Mr. Trump’s travel restrictions this month against European countries struggling with the pandemic exemplified the erratic structure at the top of the department and the agencies it oversees, said Gil Kerlikowske, a former commissioner of Customs and Border Protection.

Mr. Kerlikowske said relationships with executives at airlines and at the airports were imperative. “The lack of experience and knowledge is kind of telling,” he said.

A spokeswoman for homeland security, Sofia Boza-Holman, said such criticism of the department was unwarranted. “That’s absolutely absurd,” she said. “D.H.S.’s leaders have been at the forefront in helping contain the Covid-19 crisis. Thanks to President Trump’s leadership, D.H.S. has been able to respond wherever and whenever needed.”

Mr. Cuccinelli alarmed the public last month when he took to Twitter to complain that he did not have access to a Johns Hopkins University map of the virus’s spread, leading critics to wonder why Mr. Cuccinelli, a member of the coronavirus task force, needed outside data.

Mr. Wolf drew similar criticism from lawmakers when he failed to provide basic information on the coronavirus outbreak at a Senate appropriations hearing. “Mr. Secretary, you’re supposed to keep us safe,” said Senator John Kennedy, Republican of Louisiana. “You’re the secretary of homeland security and you can’t tell me if we have enough respirators.”

Mr. Wolf said the United States was “several months” away from getting a vaccine. “Your numbers aren’t the same as C.D.C.’s,” Mr. Kennedy said, referring to the Centers for Disease Control and Prevention. “Don’t you think you ought to contact them?”

Even National Park Service vacancies have taken a toll. The park service — which has its own police force — in recent days closed some parking lots near the Tidal Basin on the National Mall, where the cherry blossoms attract huge crowds each year, and urged people to stay away. Mayor Muriel Bowser stepped in and limited access to the area and sent police officers and members of the National Guard to enforce the shutdown.

As he juggles negotiations on Capitol Hill and introduces emergency lending programs with the Federal Reserve, Steven Mnuchin, the Treasury secretary, is scrambling to have enough officials in place to accommodate the additional workload stemming from four emergency lending programs, two new stimulus bills and a delayed Tax Day, even as departures are in store. The Treasury Department’s acting assistant secretary for international finance, Geoffrey Okamoto, is leaving to be the first deputy managing director of the International Monetary Fund, and Brian McGuire, the assistant secretary for legislative affairs, is departing.

Perhaps the biggest challenge facing the Treasury Department is the thin staffing at the Internal Revenue Service. The tax collection agency has faced deep cuts to its budget over the last decade, leaving some of its technology out of date.

Now the I.R.S. must cope with Tax Day being delayed by three months and a deluge of questions from confused taxpayers calling employees that are teleworking. The shortfall in staff is likely to be especially problematic as the Treasury Department tries to send stimulus money to Americans by using the I.R.S.’s taxpayer database to track them down.

Even the Pentagon, which is broadly viewed as better positioned than many other agencies for the pandemic response, is not immune. More than a third of all Senate-confirmed civilian positions at the Defense Department are vacant or filled by temporary officials, a peak level for the administration outside of the transition period, according to Pentagon statistics. Of 60 senior positions, 21 lack permanent appointees.

Senator Jack Reed of Rhode Island, the top Democrat on the Senate Armed Services Committee, criticized Defense Secretary Mark T. Esper and Gen. Mark A. Milley, the chairman of the Joint Chiefs of Staff, this month about the imbalance. “These vacancies continue to challenge the department’s ability to effectively respond to national security challenges and undermine civilian inputs into the decision-making process,” Mr. Reed said.

Mick Mulvaney, who has served as Mr. Trump’s acting White House chief of staff since the beginning of 2019, was formally fired over Twitter on March 6, at the height of the coronavirus crisis.

Mr. Mulvaney has technically stayed on in his position, but since mid-March, he has been in self-isolation in South Carolina after announcing that he had been in contact with someone who had tested positive for the virus.

In previous administrations, the chief of staff has often played the key role in responding to crises.

Representative Mark Meadows of North Carolina, whom Mr. Trump announced as Mr. Mulvaney’s successor, has been seen at the White House in recent days, though he had not resigned from Congress.

Reporting was contributed by Alan Rappeport, Eric Lipton, Eric Schmitt, Michael D. Shear, and Sheila Kaplan.

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Senate Passes Aid Package

Here’s what you need to know:

ImageWestlake Legal Group merlin_170974869_0b304e49-864b-4bb4-830f-b4397104e229-articleLarge Senate Passes Aid Package Trump, Donald J Stimulus (Economic) New York City Modi, Narendra India Europe Cuomo, Andrew M Coronavirus (2019-nCoV)
Credit…Anna Moneymaker/The New York Times

The Senate voted unanimously on Wednesday to approve a sweeping, $2 trillion fiscal measure to shore up the United States economy as it weathers the devastation of the coronavirus pandemic, advancing the largest fiscal stimulus package in modern American history.

The House was expected to quickly take up the bill on Friday and pass it, sending it to President Trump for his signature.

The legislation would send direct payments of $1,200 to Americans earning up to $75,000 — which would gradually phase out for higher earners and end for those with incomes more than $99,000 — and an additional $500 per child. It would substantially expand jobless aid, providing an additional 13 weeks and a four-month enhancement of benefits, extending them for the first time to freelancers and gig workers and adding $600 per week on top of the usual payment.

The measure would also provide $350 billion in federally guaranteed loans to small businesses and establish a $500 billion government lending program for distressed companies reeling from the impact of the crisis, allowing the administration to take equity stakes in airlines that received aid to help compensate taxpayers. It would also send $100 billion to hospitals on the front lines of the pandemic.

The bill was the product of intense bipartisan negotiations among Republicans, Democrats and the White House. Three senators were absent from the late-night roll call because of the novel coronavirus. Senator Rand Paul, Republican of Kentucky, has contracted Covid-19, while two Utah Republicans, Senators Mitt Romney and Mike Lee, were in self-isolation out of an abundance of caution after spending time with Mr. Paul. Senator John Thune of South Dakota, the second-ranking Republican, also missed the vote because he wasn’t feeling well and had left Washington to return home out of an abundance of caution, a spokesman said.

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Wednesday that he was seeing indications that the virus could keep returning as a “seasonal, cyclic thing,” like the flu.

One of the key questions about the virus has been whether its spread would slow or stop in warm weather and return in cold weather, and Dr. Fauci suggested that it may follow that seasonal pattern.

“What we are starting to see now in the southern hemisphere,” he said, referring specifically to southern Africa, “is that we are having cases that are appearing as they go into their winter season. And if, in fact, they have a substantial outbreak, it will be inevitable that we need to be prepared that we will get a cycle around the second time.”

That makes it all the more important that scientists “have a vaccine available for that next cycle,” as well as “a menu of drugs that we have shown to be effective and shown to be safe,” he said.

As the virus spreads, school systems around the country are extending closings that superintendents once hoped would only last for a few weeks.

School districts in six Bay Area counties, including San Francisco, said on Wednesday that the schools would remain closed at least through May 1, and Maryland said the state would keep schools shuttered for another month, until at least April 24. In Connecticut, the governor extended the suspension of in-school classes through April 20 but indicated that students could stay at home until fall. And in Massachusetts, Gov. Charlie Baker said that he would keep schools closed at least through at least May 4.

“This is not an extended school vacation,” Mr. Baker said Wednesday, saying that schools would continue to develop programs for home instruction.

Some states have already gone farther. Virginia officials announced this week that schools would not reopen until the fall. Kansas Gov. Laura Kelly was the first to take that drastic step when, last week, she ordered all schools to close until the fall.


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At least 55 million K-12 students in every state have been affected by the coronavirus, according to Education Week, a website that is tracking the closings.

Chain stores are pushing the limits of what it means to be “essential” as governors and mayors mandate store closures. Several retailers — like Sears, Kmart, and Joann Fabric and Craft Stores — have provided employees with letters they can share, arguing that their businesses are essential. And there’s growing debate and legal action regarding whether gun dealers belong on the list.

All over the country, homebound Americans are crafting face masks to help shield doctors, nurses and others from the coronavirus. They are making masks for America, much as a previous generation manufactured ammunition and tended “victory gardens” during World War II.

The coronavirus relief package as drafted is a win for airlines, who got the bailout they asked for. But hotel owners, particularly small business owners who own the majority of brand-name hotels, are still worried over how quickly the money will be available and whether it will be enough to help, with travel expected to be down well into the summer. The bill includes tax breaks, but many businesses would not see cash refunds until 2021. And while the deal will get a lot of checks in the mail, the aid might soothe financial pain for only a few months. More may be needed soon.

As much of the Western United States braces for another fire season, which typically ramps up in the middle of May, some wildland managers find themselves with one less tool in their arsenal to mitigate risk. Prescribed burns, in which firefighters deliberately set lands ablaze with the goal of reducing brush, grasses and other easily ignitable material that can help fuel large fires, have been postponed in all Forest Service regions because of concerns over the coronavirus.

“This decision to temporarily postpone ignitions will prevent any effects from smoke that might further worsen conditions for those who are at risk in our communities,” Imani Lester, the acting National Press Officer for the United States Forest Service said in an email.

Older adults and people with underlying conditions like asthma are especially at risk for suffering adverse reactions to smoke from wildfires, which in recent years have been made worse by climate change. They are also more likely to become more severely ill from Covid-19, the disease caused by the virus.

Prescribed or controlled burns are planned to burn at lower intensity than wildfires and generate less air pollution as a result. They are typically managed in such a way to minimize the number of people who are affected by the smoke. And firefighters who primarily perform prescribed burns have a lower overall risk than those who perform other forms of wildland firefighting.

The postponement comes as much of the West is experiencing uncommonly good air quality in part because the coronavirus has led to fewer people driving and flying.

As the number of confirmed coronavirus cases in New York continued to grow — reaching more than 30,000 — Gov. Andrew M. Cuomo said on Wednesday that there were early signs that the state’s stringent restrictions on social gatherings could be slowing the virus’s spread.

The scale of the epidemic in New York City has led White House officials to advise people who have passed through or left the area to quarantine themselves for 14 days.

In a briefing on Wednesday, Mr. Cuomo said there were indications that social distancing measures put in place in New York appeared to be helping — but that more needed to be done. “The evidence suggests that the density control measures may be working,” he said.

On Sunday, for example, the state’s projections showed hospitalizations doubling every two days. By Tuesday, the estimates showed hospitalizations doubling every 4.7 days, he said — adding the caveat that such a projection was “almost too good to be true.”

He cited encouraging news from Westchester County, where the rate of infection has slowed. “We have dramatically slowed what was an exponential rate of increase,” Mr. Cuomo said. “That was the hottest cluster in the United States of America. We closed the schools, we closed gatherings, we brought in testing, and we have dramatically slowed the increase.”

But Mr. Cuomo said that more needed to be done, particularly to make it easier to maintain social distancing in New York City, the most densely populated major city in the United States.

New York State, which has tested more people than any other state, now has 30,811 confirmed cases, an increase of more than 5,000 since Tuesday morning. More than 200 people have already died statewide. New York City has 17,856 confirmed cases.

Video

transcript

‘People Are Dying’: 72 Hours Inside a N.Y.C. Hospital Battling Coronavirus

An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.”

[Machine beeping] “The frustrating thing about all of this is it really just feels like it’s too little, too late. Like we knew — we knew it was coming. Today is kind of getting worse and worse. We had to get a refrigerated truck to store the bodies of patients who are dying. We are, right now, scrambling to try to get a few additional ventilators or even CPAP machines. If we could get CPAP machines, we could free up ventilators for patients who need them. You know, we now have these five vents. We probably — unless people die, I suspect we’ll be back to needing to beg for ventilators again in another day or two. There’s a mythical 100 vents out there which we haven’t seen. Leaders in various offices, from the president to the head of Health and Hospitals, saying things like, ‘We’re going to be fine. Everything’s fine.’ And from our perspective, everything is not fine. I don’t have the support that I need, and even just the materials that I need, physically, to take care of my patients. And it’s America, and we’re supposed to be a first-world country. On a regular day, my emergency department’s volume is pretty high. It’s about 200 people a day. Now we’re seeing 400 or more people a day. At first, we were trying to isolate patients with cough and fever and be more careful around them, but we weren’t necessarily being extra careful around all the other patients. And then we started to realize that patients who were coming in with no fever but abdominal pain actually had findings on their X-rays and chest CTs that were consistent with this coronavirus, Covid-19. So someone in a car accident gets brought in and we get a CT scan of them, and their lungs look like they have coronavirus. We were seeing a lot of patients who probably had Covid, but we didn’t realize. Ten residents and also many, many of our nurses and a few of the attending physicians got sick. The anxiety of this situation is really overwhelming. All of the doctors, it’s hard for us to get tested even if we want to, even if we have symptoms. We’re exposed over and over again. We don’t have the protective equipment that we should have. I put on one N95 mask in the morning. I need to have that N95 mask on for every patient I see. I don’t take it off all day. The N95 mask I wore today is also the N95 mask I wore on Friday. We’re always worried that we’ll be out of N95 masks. What’s a little bit scary now is the patients that we’re getting are much sicker. Many of the young people who are getting sick don’t smoke, they’re healthy, they have no co-morbidities. They’re just young, regular people between the ages of 30 and 50 who you would not expect to get this sick. So many people are saying it’s going to be OK, everything’s fine, we have what we need. And if this goes on for a month or two or three or five like it did in China, and we’re already this strained, we don’t have what we need. I don’t really care if I get in trouble for speaking to the media. I want people to know that this is bad. People are dying. We don’t have the tools that that we need in the emergency department and in the hospital to take care of them, and — and it’s really hard.”

Westlake Legal Group nyc-hospital-2020-videoSixteenByNineJumbo1600 Senate Passes Aid Package Trump, Donald J Stimulus (Economic) New York City Modi, Narendra India Europe Cuomo, Andrew M Coronavirus (2019-nCoV)
An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.”CreditCredit…Colleen Smith

At Elmhurst Hospital Center in Queens, Dr. Ashley Bray performed chest compressions Tuesday on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus. All eventually died.

Elmhurst, a 545-bed public hospital, has begun transferring patients not suffering from coronavirus to other facilities as it moves toward becoming a facility dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.

A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.

“It’s apocalyptic,” said Dr. Bray, a general medicine resident at the hospital.

All of the more than 1,800 intensive care units in New York City are expected to be full by Friday, according to a FEMA leadership briefing obtained by The New York Times. Patients could stay for weeks, limiting space for newly sickened residents.

Recovered coronavirus patients appear to gain immunity to the virus, scientists say, but with some significant unknowns. Now they are testing treatments that could help end the pandemic.

On Tuesday, the Food and Drug Administration approved the use of plasma from recovered patients to treat some severe cases. And New York will begin testing serum from people who have recovered from the virus to treat those who are seriously ill.

A study in macaques infected with the new coronavirus suggested that once infected, the monkeys produce neutralizing antibodies and resist further infection. But it is unclear how long the monkeys, or people, would remain immune.

Still, even if people become reinfected, the second bout with the coronavirus would likely be much milder than the first, said Florian Krammer, a microbiologist at the Icahn School of Medicine at Mount Sinai in New York.

The quickest way to assess immunity is a test that looks for protective antibodies in the blood of people who have recovered. Antibody tests are used in a handful of countries, but are just widely coming to market in the West. Before the method can be put into wide use, scientists must address certain safety issues. Some pharmaceutical companies are hoping to sidestep some of those concerns by developing antibodies against the coronavirus in the laboratory.

Florida has a message for New Yorkers: Please don’t visit.

Hawaii, another state that thrives on tourism, is asking tourists to stay away for a month.

And Alaska is requiring a 14-day quarantine for anyone entering that state from, as Alaskans put it, Outside.

It is a rare circumstance in the United States, a country where travel between states is generally welcomed, that states are suddenly looking for ways to discourage residents of other states from coming into theirs. They are on particular alert for travelers from New York City, which has far more cases than any other area in the country.

Pennsylvania is poised to become the 10th state to delay its presidential primary election because of the coronavirus pandemic, with its State Senate voting in an extraordinary remote session Wednesday afternoon to move the contest from April 28 to June 2.

Gov. Tom Wolf, who has said he favors the delay, was expected to sign the measure as early as Wednesday evening.

With numerous states, including Indiana, Connecticut and Ohio, pushing or preparing to push their presidential primaries to June 2 because of the coronavirus pandemic, the votes that day will confer a huge bounty of delegates, second only to Super Tuesday in early March.

Although former Vice President Joseph R. Biden Jr. has built an all but insurmountable lead, June 2 — which is 10 weeks away — will be his first chance to clinch his party’s presidential nomination. Only then would he have a definitive reason to press for the withdrawal of his rival, Senator Bernie Sanders of Vermont, who has shown no inclination to leave a race that feels frozen in place.

Nine other states, as well as Puerto Rico, have taken action over the past two weeks to adjust the dates of their elections as the campaign calendar has been upended by the outbreak. Elections officials in New York are also considering postponing that state’s April 28 primary, with June 23 as the likely replacement.

Pennsylvania would be the sixth state to shift its primary to June 2, joining five other contests already scheduled for that Tuesday.

Even as the calendar shifted, state officials and voting rights advocates were concerned that the $400 million included in the Senate stimulus package to safeguard elections is far less than the amount states will need to implement voting by mail across the nation. The $400 million is one-fifth of the $2 billion that voting experts said was needed and that some Democrats had sought.

President Hassan Rouhani of Iran announced new restrictions on travel and public gatherings on Wednesday, in a belated attempt to contain the growing spread of the virus.

The rules will be in effect for nine days starting Thursday and ban travel in or out of cities unless for emergency purposes, the government said. Nonessential private businesses and open public spaces, including parks and gardens, were ordered to shut down. Violations will be penalized, the government warned.

“People must adjust to more difficult circumstances because we have no choice. Saving the lives of people is very important to us,” Mr. Rouhani said.

The majority of the government’s 2.4 million employees would be told to stay home, with exceptions in the health care and banking sectors, a government spokesman said.

The move comes after Mr. Rouhani was criticized for his management of the crisis, particularly for allowing Iranians to travel across the country last week for Nowruz, the Persian New Year. Iran’s transportation police estimated that 8.5 million people traveled for the holiday, risking further spread of the virus.

Iran’s health ministry said on Thursday that there were 27,017 cases across the country and that 2,077 people had died, including 43 medical workers.

The ministry has asked Iran’s parliament to continue suspending sessions for two more weeks and to resort to video calls for meetings.

Prince Charles, first in line to the British throne, has tested positive for the coronavirus, a spokesman for the royal family said on Wednesday.

Charles, 71, had been experiencing mild symptoms for days, but has “otherwise remained in good health” and is working from home, according to a statement released by Clarence House, the prince’s official residence.

“The Duchess of Cornwall has also been tested but does not have the virus,” the statement said, referring to Prince Charles’s wife. Both are now self-isolating at Birkhall, their home in Scotland.

It was impossible to tell who Prince Charles may have caught the virus from “owing to the high number of engagements he carried out in his public role during recent weeks,” Clarence House noted. Handshakes, meetings and public appearances are a daily reality for members of the royal family, and Prince Charles had taken part in a number of engagements this month.

Reporting and research were contributed by Farnaz Fassihi, Michael Cooper, Karen Zraick, Alan Blinder, Lara Jakes, Abby Goodnough, Jonah Engel Bromwich, Katie Thomas, Andrew Jacobs, Neal E. Boudette, Matt Richtel, Nicholas Kulish, Michael Rothfeld, Somini Sengupta, Joseph Goldstein, Mark Landler, Emily Cochrane, Katie Robertson, Andrew Higgins, Kendra Pierre-Louis, Johnny Diaz, Derrick Bryson Taylor, Nicholas Bogel-Burroughs, Patricia Mazzei, Julie Bosman, Marc Santora, Megan Specia, Raphael Minder, Anna Schaverien, Ed O’Loughlin, Trip Gabriel, Iliana Magra, Jeffrey Gettleman, Zolan Kanno-Youngs, Haley Willis, Robin Stein, Natalie Reneau, Drew Jordan, Matt Phillips, Noam Scheiber, Mike Isaac, Dan Levin, Sheera Frenkel and Apoorva Mandavilli.

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

coronavirus

Westlake Legal Group coronavirus coronavirus United States Trump, Donald J Stimulus (Economic) Senate New York City Fauci, Anthony S Coronavirus (2019-nCoV)

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ImageWestlake Legal Group merlin_170977980_706701e2-e2b2-46b7-b334-dcf92cab4a1b-articleLarge coronavirus United States Trump, Donald J Stimulus (Economic) Senate New York City Fauci, Anthony S Coronavirus (2019-nCoV)
Credit…Anna Moneymaker/The New York Times

The Senate voted unanimously on Wednesday to approve a sweeping, $2 trillion fiscal measure to shore up the United States economy as it weathers the devastation of the coronavirus pandemic, advancing the largest fiscal stimulus package in modern American history.

The House was expected to quickly take up the bill on Friday and pass it, sending it to President Trump for his signature.

The legislation would send direct payments of $1,200 to Americans earning up to $75,000 — which would gradually phase out for higher earners and end for those with incomes more than $99,000 — and an additional $500 per child. It would substantially expand jobless aid, providing an additional 13 weeks and a four-month enhancement of benefits, extending them for the first time to freelancers and gig workers and adding $600 per week on top of the usual payment.

The measure would also provide $350 billion in federally guaranteed loans to small businesses and establish a $500 billion government lending program for distressed companies reeling from the impact of the crisis, allowing the administration to take equity stakes in airlines that received aid to help compensate taxpayers. It would also send $100 billion to hospitals on the front lines of the pandemic.

The bill was the product of intense bipartisan negotiations among Republicans, Democrats and the White House. Three senators were absent from the late-night roll call because of the novel coronavirus. Senator Rand Paul, Republican of Kentucky, has contracted Covid-19, while two Utah Republicans, Senators Mitt Romney and Mike Lee, were in self-isolation out of an abundance of caution after spending time with Mr. Paul. Senator John Thune of South Dakota, the second-ranking Republican, also missed the vote because he wasn’t feeling well and had left Washington to return home out of an abundance of caution, a spokesman said.

Video

transcript

‘People Are Dying’: 72 Hours Inside a N.Y.C. Hospital Battling Coronavirus

An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.”

[Machine beeping] “The frustrating thing about all of this is it really just feels like it’s too little, too late. Like we knew — we knew it was coming. Today is kind of getting worse and worse. We had to get a refrigerated truck to store the bodies of patients who are dying. We are, right now, scrambling to try to get a few additional ventilators or even CPAP machines. If we could get CPAP machines, we could free up ventilators for patients who need them. You know, we now have these five vents. We probably — unless people die, I suspect we’ll be back to needing to beg for ventilators again in another day or two. There’s a mythical 100 vents out there which we haven’t seen. Leaders in various offices, from the president to the head of Health and Hospitals, saying things like, ‘We’re going to be fine. Everything’s fine.’ And from our perspective, everything is not fine. I don’t have the support that I need, and even just the materials that I need, physically, to take care of my patients. And it’s America, and we’re supposed to be a first-world country. On a regular day, my emergency department’s volume is pretty high. It’s about 200 people a day. Now we’re seeing 400 or more people a day. At first, we were trying to isolate patients with cough and fever and be more careful around them, but we weren’t necessarily being extra careful around all the other patients. And then we started to realize that patients who were coming in with no fever but abdominal pain actually had findings on their X-rays and chest CTs that were consistent with this coronavirus, Covid-19. So someone in a car accident gets brought in and we get a CT scan of them, and their lungs look like they have coronavirus. We were seeing a lot of patients who probably had Covid, but we didn’t realize. Ten residents and also many, many of our nurses and a few of the attending physicians got sick. The anxiety of this situation is really overwhelming. All of the doctors, it’s hard for us to get tested even if we want to, even if we have symptoms. We’re exposed over and over again. We don’t have the protective equipment that we should have. I put on one N95 mask in the morning. I need to have that N95 mask on for every patient I see. I don’t take it off all day. The N95 mask I wore today is also the N95 mask I wore on Friday. We’re always worried that we’ll be out of N95 masks. What’s a little bit scary now is the patients that we’re getting are much sicker. Many of the young people who are getting sick don’t smoke, they’re healthy, they have no co-morbidities. They’re just young, regular people between the ages of 30 and 50 who you would not expect to get this sick. So many people are saying it’s going to be OK, everything’s fine, we have what we need. And if this goes on for a month or two or three or five like it did in China, and we’re already this strained, we don’t have what we need. I don’t really care if I get in trouble for speaking to the media. I want people to know that this is bad. People are dying. We don’t have the tools that that we need in the emergency department and in the hospital to take care of them, and — and it’s really hard.”

Westlake Legal Group nyc-hospital-2020-videoSixteenByNineJumbo1600 coronavirus United States Trump, Donald J Stimulus (Economic) Senate New York City Fauci, Anthony S Coronavirus (2019-nCoV)
An emergency room doctor in Elmhurst, Queens, gives a rare look inside a hospital at the center of the coronavirus pandemic. “We don’t have the tools that we need.”CreditCredit…Colleen Smith

At Elmhurst Hospital Center in Queens, Dr. Ashley Bray performed chest compressions Tuesday on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus. All eventually died.

Elmhurst, a 545-bed public hospital, has begun transferring patients not suffering from coronavirus to other facilities as it moves toward becoming a facility dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.

A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.

“It’s apocalyptic,” said Dr. Bray, a general medicine resident at the hospital.

All of the more than 1,800 intensive care units in New York City are expected to be full by Friday, according to a FEMA leadership briefing obtained by The New York Times. Patients could stay for weeks, limiting space for newly sickened residents.

The urgent update from the Peace Corps landed abruptly in the email inboxes of volunteers on March 15: It was time to evacuate.

Miguel Garcia, a 27-year-old volunteer leader in the Dominican Republic, had a job to do. He had 24 hours to get 32 volunteers scattered across the country to Santo Domingo, the capital. Several were about eight hours away in hard-to-reach communities.

“Panic took over, and I was just mindlessly doing things,” Mr. Garcia said. “It wasn’t until I came home to an apartment that needed to be packed that it all hit me. I showered in cold water for about 45 minutes and cried, overwhelmed by all of the people I needed to communicate with and say goodbye to.”

For the first time in its nearly 60-year history, the Peace Corps has temporarily suspended its operations, evacuating more than 7,000 volunteers from posts in more than 60 countries because of the coronavirus pandemic.

An independent agency of the U.S. government created by President John F. Kennedy in 1961, the corps sends volunteers abroad to help with social and economic development projects. They dig wells, teach in schools and train people in everything from sewing to healthy breastfeeding.

In an open letter, Jody Olsen, the director of the Peace Corps, said the move was meant to protect volunteers and prevent them from being stranded during the pandemic. Within hours, volunteers were packing their bags, saying their farewells and rushing to designated meeting places as airlines canceled flights and countries began closing borders.

In interviews, volunteers described shock, confusion and heartbreak as they arrived back home in the United States.

“The situation in Morocco went so fast,” said Elizabeth Burke, 54, who had been in the country for less than a year, teaching English and working at a sewing cooperative. “It went from Moroccans not being aware of the coronavirus and what was going on to a complete shutdown.”

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Wednesday that he was seeing indications that the virus could keep returning as a “seasonal, cyclic thing,” like the flu.

One of the key questions about the virus has been whether its spread would slow or stop in warm weather and return in cold weather, and Dr. Fauci suggested that it may follow that seasonal pattern.

“What we are starting to see now in the southern hemisphere,” he said, referring specifically to southern Africa, “is that we are having cases that are appearing as they go into their winter season. And if, in fact, they have a substantial outbreak, it will be inevitable that we need to be prepared that we will get a cycle around the second time.”

That makes it all the more important that scientists “have a vaccine available for that next cycle,” as well as “a menu of drugs that we have shown to be effective and shown to be safe,” he said.

In states hit hard by the coronavirus, like New York and California, governors and mayors have mandated the closure of all but the obviously essential stores, like supermarkets and pharmacies. And the Department of Homeland Security has laid out guidelines for businesses across the country to follow when deciding whether to stay open, even in regions not known to be hot spots for the virus. The agency is careful to note that its definition of a “critical” work force is not an official standard, leaving it up to corporations to decide for themselves.

Given this latitude, retailers have kept thousands of stores open, even as health experts warn that the virus is likely to spread more widely across the country in the coming weeks.

At some Guitar Center stores, employees are still allowing customers to try out models of guitars. Dillard’s, a department store chain popular in the South, is still welcoming shoppers looking for clothing and makeup. And Michaels, the arts and crafts chain, says it is keeping many of its stores open to provide supplies to parents teaching their homebound children. “We are here for the makers,” the retailer said in an email to one concerned customer.

That some retail stores are staying open while other businesses have closed reflects the piecemeal approach to combating the pandemic in the United States. There are emergency orders limiting business to essential retailers in about half the country, but much of the South and West has no such government restrictions.

Coronavirus-related anxiety is real and likely impacting many aspects of your life, from your eating habits to the way your children are acting. There is also a grief that comes along with the loss of our daily routines and rituals. Here are some tips to help you get through these tough times.

Reporting was contributed by Julie Davis, Emily Cochrane, Nicholas Fandos, Michael Corkery, Sapna Maheshwari and Mariel Padilla.

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

Coronavirus Live Updates: Senate Moves Toward Passing Sweeping $2 Trillion Aid Deal

Westlake Legal Group coronavirus-live-updates-senate-moves-toward-passing-sweeping-2-trillion-aid-deal Coronavirus Live Updates: Senate Moves Toward Passing Sweeping $2 Trillion Aid Deal Trump, Donald J Stimulus (Economic) New York City Modi, Narendra India Europe Cuomo, Andrew M Coronavirus (2019-nCoV)

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ImageWestlake Legal Group merlin_170959563_437d5a77-1d03-4d28-b9b9-c56fe87da343-articleLarge Coronavirus Live Updates: Senate Moves Toward Passing Sweeping $2 Trillion Aid Deal Trump, Donald J Stimulus (Economic) New York City Modi, Narendra India Europe Cuomo, Andrew M Coronavirus (2019-nCoV)
Credit…Anna Moneymaker/The New York Times

The Senate on Wednesday moved toward a vote on a sweeping bipartisan deal to deliver $2 trillion in government relief to a nation increasingly under lockdown, watching nervously as the twin threats of disease and economic ruin grow more dire.

Reached after midnight, the rescue deal was the product of a marathon set of negotiations among Senate Republicans, Democrats and the White House that had stalled as Democrats insisted on stronger worker protections and oversight of a $500 billion fund to bail out distressed businesses.

“At last, we have a deal,” Senator Mitch McConnell, Republican of Kentucky and the majority leader, said on Wednesday. “In effect, this is a wartime level of investment into our nation.”

On a conference call on Wednesday morning, Mr. McConnell told Republican senators that the timing of a vote was unclear, but he hoped the measure could be wrapped up later Wednesday, according to a person on the call who insisted on anonymity to relate the private conversation.

The Democratic-led House is unlikely to take up the package until at least Thursday, when Speaker Nancy Pelosi hopes to approve it by unanimous consent, a practice usually reserved for minor, uncontroversial measures. In this case, it would ensure that House members, who are scattered across the country, do not have to travel back to Washington.

News of the agreement buoyed financial markets in Asia and Europe, and the optimism carried over to Wall Street. The S&P 500 had risen about 2 percent by midday.

The sheer size and scope of the package would have been unthinkable only a couple of weeks ago. Administration officials said they hoped that its effect on a battered economy would be exponentially greater than its $2 trillion cost, generating as much as $4 trillion in economic activity.

“This is not a moment of celebration, but one of necessity,” the minority leader, Senator Chuck Schumer, said as he took careful note of the changes his party had secured in the legislation. “To all Americans I say, ‘Help is on the way.’”

The legislation, which is expected to be enacted within days, is the biggest economic relief package in modern American history, dwarfing the $700 billion Wall Street bailout in 2008 and the $800 billion stimulus bill passed in 2009. The aim is to deliver critical financial support to businesses forced to shut their doors and relief to American families and hospitals reeling from the rapid spread of the disease and the resulting economic disruption.

As the number of confirmed coronavirus cases in New York continued to grow — reaching more than 30,000 — Gov. Andrew M. Cuomo said on Wednesday that there were early signs that the state’s stringent restrictions on social gatherings could be slowing the virus’s spread.

The scale of the epidemic in New York City has led White House officials to advise people who have passed through or left the area to quarantine themselves for 14 days.

In a briefing on Wednesday, Mr. Cuomo said there were indications that social distancing measures put in place in New York appeared to be helping — but that more needed to be done. “The evidence suggests that the density control measures may be working,” he said.

On Sunday, for example, the state’s projections showed hospitalizations doubling every two days. By Tuesday, the estimates showed hospitalizations doubling every 4.7 days, he said — adding the caveat that such a projection was “almost too good to be true.”

He cited encouraging news from Westchester County, where the rate of infection has slowed. “We have dramatically slowed what was an exponential rate of increase,” Mr. Cuomo said. “That was the hottest cluster in the United States of America. We closed the schools, we closed gatherings, we brought in testing, and we have dramatically slowed the increase.”

New York State, which has tested more people than any other state, now has 30,811 confirmed cases, an increase of more than 5,000 since Tuesday morning. New York City has 17,856 confirmed cases.

But Mr. Cuomo said that more needed to be done, particularly to make it easier to maintain social distancing in New York City, the most densely populated major city in the United States.

Mr. Cuomo said that the city would begin a limited pilot program to begin closing some streets to automobile traffic to give pedestrians more space outside, and to institute new rules to limit density in the city’s playgrounds.

“No basketball,” he said.

Governor Cuomo said that the nearly $2 trillion federal stimulus bill that Congress was racing to pass “would really be terrible for the state of New York.”

The governor said the bill would provide the state government with only $3.8 billion, at a moment when its response to the virus is increasing expenses — and the economic shutdown is driving down tax collections. Mr. Cuomo said that the state faces a potential revenue shortfall of between $9 billion and $15 billion, far more than the stimulus bill would provide. “That is a drop in the bucket, as to need,” he said.

But even as the crisis deepened in New York, which does not have enough hospital beds or equipment to handle the cases it expects, President Trump pressed to reopen the country for business by Easter, on April 12. The president issued his goal despite widespread warnings from public health experts that the worst effects of the outbreak were still to come and that lifting the restrictions now in place would result in unnecessary deaths.

The number of new coronavirus cases in the United States has rapidly increased in recent days, with more than 20,000 new cases diagnosed on Monday and Tuesday alone, in part because of expanded testing. That spike brings the country’s total cases to nearly 60, 000.

Mr. Cuomo has said that with cases doubling every three days in New York City, as many as 140,000 people might need urgent care in the next few weeks. In New York City, the 1.8-million-square-foot Jacob K. Javits Convention Center — which was scheduled to hold an expo for exotic flowers this week — looked more like a front-line military depot as workers rushed to transform the complex into a hospital to handle an imminent surge of patients.

And the state was still in dire need of critical equipment, particularly the ventilators needed to keep critically ill patients alive long enough for them to fight off the virus. The Trump administration promised to send 4,000 from the national stockpile, but Mr. Cuomo said the state needed tens of thousands more.

More than 200 people have already died statewide.

Charles, 71, had been experiencing mild symptoms for days, but has “otherwise remained in good health” and is working from home, according to a statement released by Clarence House, the prince’s official residence.

“The Duchess of Cornwall has also been tested but does not have the virus,” the statement said, referring to Prince Charles’s wife. Both are now self-isolating at Birkhall, their home in Scotland.

“The tests were carried out by the N.H.S. in Aberdeenshire, where they met the criteria required for testing,” the statement added.

It was impossible to tell who Prince Charles may have caught the virus from “owing to the high number of engagements he carried out in his public role during recent weeks,” Clarence House noted. Handshakes, meetings and public appearances are a daily reality for members of the royal family, and Prince Charles had taken part in a number of engagements this month.

Prince Charles is the eldest son of Queen Elizabeth II, who went into self-isolation last week, leaving Buckingham Palace for her country home, Windsor Castle.

Officials at Buckingham Palace said Charles last saw his mother on Thursday, March 12. Doctors estimate that the earliest the prince could have been infectious with the virus was the next day, March 13, though it was not clear how they had arrived at that assessment.

The incubation period for the coronavirus varies by patient, according to the World Health Organization, with most people showing symptoms about five days from the date they were infected. But it can incubate for as long as 14 days, which, given when Charles began showing symptoms, would be before he met with his mother.

A spokesman for Buckingham Palace said “the queen remains in good health.”

The queen, who turns 94 next month, released a message to the nation last week urging Britons to stay at home for the greater good of the community.

“I am certain we are up to that challenge,” she said in the statement. “You can be assured that my family and I stand ready to play our part.”

With the announcement, Charles joins a growing list of actors, musicians, athletes and public figures, including Senator Rand Paul of Kentucky and Prince Albert II of Monaco, who have also tested positive for the virus.

Some of the first actors to announce they had contracted the virus were Tom Hanks, Idris Elba and Daniel Dae Kim. Several N.B.A. players have tested positive, including two Utah Jazz stars and Kevin Durant, one of four players who has the virus on the Brooklyn Nets.

And at least three notable figures have died of complications related to the coronavirus: Terrence McNally, a Tony-winning playwright, Aurlus Mabele, a Congolese singer, and Manu Dibango, a saxophonist from Cameroon.

Investors started sizing up a $2 trillion coronavirus rescue package to shore up the American economy, and stocks climbed higher on Wednesday, adding to a surge the day before.

The S&P 500 rose about 2 percent by midday, and some of the companies expected to benefit from government help led the gains. Boeing was up more than 30 percent, and American Airlines jumped roughly 15 percent.

On Tuesday, stocks on Wall Street had their best day since 2008 on expectations of the relief deal. Democratic and Republican leaders in the Senate finally came to agreement in the early hours of Wednesday. The Senate was expected to vote on Wednesday.

Governments elsewhere were also laying out plans to help. On Monday, Germany prepared an emergency budget and rescue fund for companies and state-supported loans. European Union leaders were working on additional measures to help loosen up money for some countries to help soften the economic blow of the virus.

Though investors have welcomed the plans, few were willing to conclusively say that the worst of the market sell-off was over.

Calling for “discipline and responsibility” in confronting the coronavirus, President Vladimir V. Putin of Russia on Wednesday ordered a weeklong national holiday starting Saturday and announced the postponement of a referendum next month on whether he can rule until 2036.

In a televised address to the nation from his country residence outside Moscow, Mr. Putin stopped short of ordering a nationwide lockdown — as India and several European countries have done — but still warned that, despite the relatively few confirmed infections so far in Russia, it was “objectively impossible” to stop the virus from spreading.

The decision to postpone until further notice a vote scheduled for April 22 to endorse constitutional changes that would allow Mr. Putin to crash through term limits means that the virus has achieved a feat that has eluded the Kremlin’s largely powerless opponents: It has slowed the previously relentless march toward a coronation of Mr. Putin as president for life.

Mr. Putin, in his first public address about the pandemic, said, “We managed to restrain the spread of the disease, but it is impossible to completely block its infiltration.”

He added: “Don’t think that, ‘this doesn’t concern me.’ It concerns everyone.”

Mr. Putin said the national holiday would not apply to shops, pharmacies, public transport, banks or government offices.

He left up in the air whether the Kremlin would continue as planned with its biggest event of the year — nationwide celebrations on May 9 to mark the 75th anniversary of the Red Army’s victory over Nazi Germany. Current plans include a huge military parade through the center of Moscow and large gatherings of spectators.

Russia on Wednesday reported a sharp jump in confirmed cases, to 658. And while the figure is low compared with much of Western Europe and the United States, the 163 new infections on Wednesday constituted the largest one-day increase yet, stirring alarm that Russia could be following the same path.

Across India, crowds swarmed into food stores and cleaned out the shelves. At a fancy market in New Delhi, one man stuffed his Mercedes with groceries on Wednesday afternoon and then jumped behind the wheel and zoomed off — wearing blue rubber dishwashing gloves and a clear plastic face mask that looked like it would fit with a snorkel.

This is Day 1 of how India is coping with the world’s biggest coronavirus lockdown after 1.3 billion people — nearly a fifth of humanity — were ordered to stay inside unless vitally necessary.

India has reported relatively few coronavirus cases — fewer than 600 so far — but with the population density so high and the public health system so weak, Prime Minister Narendra Modi has imposed stringent measures to try to keep the country from sliding into the disaster that the United States, Italy and other countries face.

On Wednesday, most Indians, from the snowbound valleys in the Himalayas to tropical islands in the Andaman Sea, seemed to be following the rules — though the price for some will prove high.

With New York and California already instituting strict measures to stem the spread of the coronavirus, and doctors in Washington State dealing with the bleak reality that they may have to decide which patients to prioritize for care, the United States has begun to grapple with several major outbreaks nationwide at once.

In New York, the epicenter of the crisis in the country, cases exceeded 30,000 statewide by Wednesday, and in California, at least 2,500 cases had been confirmed, with those numbers expected to rise significantly in the coming days.

But even as the crisis escalated, the response to the pandemic has remained widely inconsistent. President Trump said on Tuesday that a national lockdown had never been under consideration and that he “would love to have the country opened up” by Easter, a goal that health experts have called far too quick.

Gov. Greg Abbott of Texas continued to resist calls to issue a statewide order to force millions to stay at home, but he did urge Texans to avoid going out.

A regulatory patchwork has unfolded in recent days in Texas — which has 700 confirmed infections and 11 deaths — with restrictions, curfews and stay-at-home orders that vary from county to county.

As states and local authorities grapple for adequate responses, the virus continues to claim more victims.

A 17-year-old California boy whose death was linked to the coronavirus on Tuesday may be one of the youngest victims of the outbreak in the United States, if the cause is confirmed by the C.D.C. Gov. Gavin Newsom of California said that half of the 2,102 people who had tested positive for the virus in his state were aged 18 to 49.

In Georgia, a 12-year-old girl who has Covid-19, the disease caused by the coronavirus, was placed on a ventilator this week. And in Kentucky, a person who went to a “coronavirus party” attended by young adults has tested positive, Gov. Andy Beshear said.

The Ice Palace, an Olympic-size skating rink in Madrid — a site of joy only months ago — is now being filled with the bodies of the dead.

The conversion of the sporting facility into a morgue underscored the dire situation in Spain, where the death toll passed 3,400 on Wednesday — putting the nation ahead of China and second only to Italy in the grim tally of fatalities.

“This is a very hard week because we are in the first stages of overcoming the virus, a phase in which we are approaching the peak of the epidemic,” Salvador Illa, the Spanish health minister, told the nation.

As the crisis in Spain deepened, the country’s military made an urgent appeal to NATO for assistance. Like many other countries, Spain has been struggling with a lack of medical supplies for testing, treatment and the protection of front-line workers.

In a statement, NATO said Spain’s military had asked for “international assistance,” seeking medical supplies to help curb the spread of the virus both in the military and in the civilian population.

The request specified 450,000 respirators, 500,000 rapid testing kits, 500 ventilators and 1.5 million surgical masks. But it was not clear when or if help would arrive.

Funeral parlors in Madrid are now handling about seven times as many bodies as they were one week earlier, according to officials. And workers said they had not been given any of the protective gear promised by the government, Juan José López Vivas, the deputy president of the national association of funeral parlors, told the television channel La Sexta.

The conversion of the ice rink to a morgue resonated across the country, a vivid illustration of the desperation of the moment.

“This surface, which has given me so many good hours, as well as some difficult moments, can now help people who have lost their loved ones take them to wherever they wish,” Javier Fernández, the two-time world champion Spanish figure skater, told the television channel Antena 3. “If they need all the ice skating rinks of Spain, I’m sure they will do that.”

The crisis continued to mount across the globe.

France, under lockdown for a week, has been increasingly aggressive in penalizing those who violate social distancing rules, issuing more than 100,000 fines. In London, the military was helping convert the sprawling Excel convention center in London into the 4,000-bed “N.H.S. Nightingale Hospital.”

On Wednesday, the United Nations said it hoped to raise $2 billion to fight the virus in 53 countries — in Africa, Asia, the Middle East and South America — suffering from instability.

With numerous states, including Indiana, Connecticut, Ohio and Pennsylvania, pushing or poised to push their presidential primaries to June 2 because of the coronavirus pandemic, the votes that day will confer a huge bounty of delegates, second only to Super Tuesday in early March.

Although former Vice President Joseph R. Biden Jr. has built an all but insurmountable lead, June 2 — which is 10 weeks away — will be his first chance to clinch his party’s presidential nomination. Only then would he have a definitive reason to press for the withdrawal of his rival, Senator Bernie Sanders of Vermont, who has shown no inclination to leave a race that feels frozen in place.

Some Democratic strategists see possible perils in the delay. Having to wait until June 2 for the next major chapter in the nominating race largely deprives Mr. Biden of a chance to rack up interim victories that would bring media attention; President Trump, on the other hand, is promoting his leadership in a global pandemic.

The government in Ireland said it would take control of all privately owned health care facilities and hospitals to create a single, free national health service to deal with the coronavirus outbreak until the crisis in the country had passed.

“There can be no room for public versus private when it comes to pandemic,” Simon Harris, the Irish health minister, said in a news conference in Dublin on Tuesday. He added that the step was necessary “for the common benefit of all of our people.”

The move will be a dramatic change for Ireland’s mixed public and private health system, which at present resembles a hybrid between the United States’ for-profit health system and the tax-funded public services that are the norm in much of Europe.

Leo Varadkar, the Irish prime minister, said the measure would bring 2,000 beds, nine laboratories and thousands of staff members into the public system. The private facilities have agreed to provide their services on a nonprofit basis for the duration of the pandemic.

The move to a single-payer, state-controlled health care system, even temporarily, could set a precedent in a country where there is already broad consensus that an entirely public, tax-funded system should be introduced.

Critics of the existing system, which allows many senior doctors on public salaries to treat private patients in publicly funded hospitals, say it encourages people to take out private insurance so they can pay extra to skip waiting lists in the public system.

California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington and the District of Columbia have opened enrollment under the Affordable Care Act to allow laid-off workers to get subsidized health insurance, and the Trump administration, which has been gunning to repeal the law, is considering opening the federal exchange to new customers.

Reporting and research were contributed by Michael Cooper, Karen Zraick, Alan Blinder, Lara Jakes, Jonah Engel Bromwich, Mark Landler, Emily Cochrane, Katie Robertson, Andrew Higgins, Johnny Diaz, Derrick Bryson Taylor, Nicholas Bogel-Burroughs, Marc Santora, Megan Specia, Raphael Minder, Anna Schaverien, Ed O’Loughlin, Trip Gabriel, Iliana Magra, Jeffrey Gettleman, Zolan Kanno-Youngs, Haley Willis, Robin Stein, Natalie Reneau, Drew Jordan, Matt Phillips, Noam Scheiber, Mike Isaac and Sheera Frenkel.

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Congress and White House Strike Deal for $2 Trillion Stimulus Package

Westlake Legal Group 25dc-virus-cong-1-facebookJumbo Congress and White House Strike Deal for $2 Trillion Stimulus Package United States Politics and Government United States Economy Trump, Donald J Treasury Department Senate Schumer, Charles E Republican Party Mnuchin, Steven T McConnell, Mitch Democratic Party Coronavirus (2019-nCoV)

WASHINGTON — Senators and Trump administration officials reached an agreement early Wednesday on a sweeping, roughly $2 trillion stimulus measure to send direct payments and jobless benefits to individuals as well as money to states and businesses devastated by the coronavirus pandemic.

The legislation, which is expected to be enacted within days, is the biggest fiscal stimulus package in modern American history, aimed at delivering critical financial support to businesses forced to shut their doors and relief to American families and hospitals.

Struck after midnight, the deal was the product of a marathon set of negotiations among Senate Republicans, Democrats and President Trump’s team that nearly fell apart as Democrats insisted on stronger worker protections and oversight over a new $500 billion fund to bail out distressed businesses.

The deal was completed after a furious final round of haggling between Steven Mnuchin, the Treasury secretary, and Senator Chuck Schumer, Democrat of New York and the minority leader, after Democrats twice blocked action on the measure as they insisted on concessions.

Mr. Mnuchin and Eric Ueland, the White House legislative affairs director, were on Capitol Hill late Tuesday and early Wednesday, shuttling between the Republican and Democratic leaders’ offices as they hammered out final details.

Senator Mitch McConnell, Republican of Kentucky and the majority leader, announced the deal on the Senate floor about 1:30 a.m. Eastern.

“At last, we have a deal,” he said, adding, “In effect, this is a wartime level of investment into our nation.”

Lawmakers and aides were still drafting portions of the bill early Wednesday morning. “I’m hopeful that over the next few hours, we’ll finish what’s left and be able to circulate it early in the morning,” Mr. Ueland told reporters on Capitol Hill.

A vote was expected in the afternoon, Mr. McConnell said, after the Senate reconvenes at noon.

The compromise was a package whose sheer size and scope would have been unthinkable only a couple of weeks ago. Its cost amounts to several hundreds of billions of dollars more than the entire United States federal budget for a year, and administration officials said they hoped that its effect on a battered economy would be exponentially greater, as much as $4 trillion.


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“This is not a moment of celebration, but one of necessity,” Mr. Schumer said as he took careful note of the changes his party had secured in the legislation. “To all Americans I say, ‘Help is on the way.’”

The resulting measure is an attempt to sustain the workers and businesses that are losing income as vast sections of the American economy are shutting down under quarantine orders and to help the economy rebound quickly once the pandemic abates.

It includes direct support for companies large and small that have lost all or most of their customers in recent weeks, and direct payments to low- and middle-income families. The package also includes measures meant to encourage companies to keep employees on their payrolls even if their businesses have shuttered temporarily — and it increases aid to workers who are laid off anyway or have had their hours and wages cut back.

“We have either, clear, explicit legislative text reflecting all parties or we know exactly where we’re going to land on legislative text as we continue to finish,” Mr. Ueland said.

The president, after lobbing insults at Democrats late Monday evening for their demands in the final stages of negotiations, called on lawmakers to approve the deal by the end of the day.

“Congress must approve the deal, without all of the nonsense, today,” Mr. Trump said on Twitter on Tuesday. “The longer it takes, the harder it will be to start up our economy. Our workers will be hurt!”

Mr. Mnuchin, preparing to leave Capitol Hill early Wednesday, described the measure to reporters as “a terrific bill.”

“I’ve spoken to the president many times today,” he said, “and he’s very pleased with this legislation and the impact that this is going to have.”

The measure will be the third legislative action taken by Congress this month to address the pandemic. Mr. Trump previously signed both a $8.3 billion in emergency aid and a sweeping package providing paid leave, free testing and additional aid for families affected by the pandemic into law.

The House is in recess, with some of its members sick or in quarantine and concerned about flying back to Washington. Leaders were considering approving the mammoth proposal by unanimous consent, a tactic usually reserved for minor, uncontroversial measures.

“What I’m saying is we want to do it as soon as possible. The best way to do that as soon as possible is to have agreement on the legislation,” said Speaker Nancy Pelosi of California, appearing on CNN. “We’re doing U.C. to make the biggest possible difference in the shortest period of time.”

In the final measure, lawmakers agreed to a significant expansion of unemployment benefits that would extend unemployment insurance by 13 weeks and include a four-month enhancement of benefits, officials familiar with the unfinished agreement said. Democrats said that it would allow workers to maintain their full salaries if forced out of work as a result of the pandemic.

In the interim, lawmakers also agreed to provide $1,200 in direct payments that would apply equally to workers with incomes up to $75,000 per year before phasing out and ending altogether for those earning more than $99,000. Families would receive an additional $500 per child.

After complaints from Democrats, a $500 billion fund — $425 billion for the Federal Reserve to leverage for loans in order to help broad groups of distressed companies and $75 billion for industry-specific loans — will now have far stricter oversight, in the form of an inspector general and a 5-person panel appointed by Congress, lawmakers said. Companies that accept money must also agree to halt any stock buybacks for the length of the government assistance, plus an additional year.

Democrats also secured a provision that will block Trump family businesses — or those of other senior government officials — from receiving loan money under the programs, Mr. Schumer said in a letter to Democrats.

Both Ms. Pelosi and Mr. Schumer, on separate calls laying out the deal for their Democratic colleagues, said they had secured $130 billion for hospitals, $55 billion more than originally agreed to, people familiar with the calls said, as well as $150 billion for state and local governments.

“Like all compromises, this bill is far from perfect,” Mr. Schumer said early Wednesday on the Senate floor. “But we believe the legislation has been improved significantly to warrant its quick consideration and passage.”

The agreement also includes $350 billion that would establish lending programs for small businesses, but only for those who keep their payrolls steady through the crisis. Small businesses that pledge to keep their workers would also receive cash-flow assistance structured as federally guaranteed loans. If the employer continued to pay its workers for the duration of the crisis, those loans would be forgiven.

Lawmakers in both chambers have also acknowledged that it is likely other legislative measures will be needed in the coming months to counter the consequences of the pandemic.

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New York Joins California as Millions More Americans Are Ordered to Stay Home

Westlake Legal Group new-york-joins-california-as-millions-more-americans-are-ordered-to-stay-home New York Joins California as Millions More Americans Are Ordered to Stay Home Trump, Donald J Shortages Newsom, Gavin New York State New York City Health Department (NYS) Garcetti, Eric M Cuomo, Andrew M Coronavirus (2019-nCoV) California
Westlake Legal Group merlin_170777988_3b2eb9be-9b11-4663-ae95-2bde5d532f00-facebookJumbo New York Joins California as Millions More Americans Are Ordered to Stay Home Trump, Donald J Shortages Newsom, Gavin New York State New York City Health Department (NYS) Garcetti, Eric M Cuomo, Andrew M Coronavirus (2019-nCoV) California

CHICAGO — America plunged into a deeper state of disruption and paralysis on Friday as New York and Illinois announced a broad series of measures aimed at keeping tens of millions of residents cloistered in their homes, following similar actions by California and a patchwork of restrictions from coast to coast.

The new, more stringent directives, in some of the country’s most populous states, were intended to slow the spread of the coronavirus that has swept across the country, sickening more than 17,000 people and claiming at least 214 lives. By the end of the weekend, at least 1 in 5 Americans will be under orders to stay home, and more states were expected to follow suit.

Increasingly severe shutdowns and restrictions on Americans’ movement — which public experts consider essential to reduce the alarming rate of infection — have turned much of the country quiet. Forty-five states have closed all their schools and the other five have closed at least some of them. Bars, restaurants and other gathering spots have been abruptly shuttered.

New York State has become the center of the outbreak, as its confirmed coronavirus cases have jumped to more than 7,000 and health officials have flagged with urgency a looming shortage of hospital beds and equipment. With 6 percent of the U.S. population, the state now accounts for over one-third of all confirmed cases in the country.

Gov. Andrew M. Cuomo of New York on Friday announced what he called “the most drastic action we can take,” essentially ordering the nation’s largest city and the rest of his state into a protective crouch: All nonessential businesses were ordered closed by 8 p.m. on Sunday, setting up a stark new reality for some 19 million residents, who were told to stay home as the state went “on pause.”

New York officials have issued a lengthy list of businesses and services that would be allowed to stay open, including nuts-and-bolts governmental duties like code enforcement to more practical concerns like automotive repair, child care and computer support.

Basic functions like grocery shopping, walking the dog and getting medicine or exercise were still to be permitted, but little else in the way of normal life. “We need everyone to be safe,” Mr. Cuomo said, acknowledging the severe economic and psychological impact of such an order. “Otherwise no one can be safe.”

New York City’s public transit system would continue to run, but the city it travels through was profoundly transformed from its usually bustling, never-sleep energy: Its restaurants and bars were closed; its schools, museums and theaters dark; and its gaudy central mall — Times Square — quieter than it has been in decades.

Hours after the New York announcement, Illinois followed. Gov. J.B. Pritzker issued an order for the state’s more than 12 million residents to stay home, beginning Saturday at 5 p.m. “For the vast majority of you already taking precautions, your lives will not change very much,” Mr. Pritzker said.

The actions taken by the governors are the most robust and far-reaching yet, grinding major cities across the country to a standstill.

At the White House, President Trump said the United States had reached agreements with Mexico and Canada to in effect close the borders to slow the spread of the virus, and would halt all nonessential travel across those borders beginning at midnight on Saturday. Wall Street suffered another grim day on Friday with the S&P 500 falling more than 4 percent and the Dow Jones industrial average dropping 913 points, closing below where it stood before Mr. Trump was inaugurated.

The coronavirus pandemic has sickened more than 254,500 people in at least 154 countries. As of Friday afternoon, at least 10,472 people have died, more than half of them outside mainland China.


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The cascade of statewide restrictions began on Thursday night, when Gov. Gavin Newsom of California declared a broad stay-at-home order for his state’s 40 million residents, a directive that included exceptions for transportation workers, grocery stores, banks and laundromats, among others.

“Home isolation is not my preferred choice,” said Mr. Newsom, pleading with Californians to comply in order to save lives.

A large number of state workers — firefighters, police officers, prison guards — have been deemed essential and are exempted from the stay-at-home order, Mr. Newsom said. But his office is still assessing and negotiating with union officials to determine how many nonessential state employees will be allowed to work remotely.

States have continued to grapple with differing strategies to contain the virus. Washington State, which has been at the forefront of the outbreak, introduced some of the strongest restrictions earlier this month but has yet to adopt formal stay-at-home orders for the whole state. Gov. Jay Inslee said his office was continuing to evaluate that option but he cited potential economic impacts as a factor in the decision.

He criticized those who may still be leaving their homes for social reasons and issued his own command: “Stay home unless it’s necessary to go out.”

The stricter requirements were coupled with an unusual loosening of other rules around the nation. Chicago has already stopped issuing parking tickets and collecting fines. The federal government postponed a deadline for filing tax returns to July 15 from April 15. Mr. Trump on Friday said federal student loan payments would be paused for at least 60 days. The governor of Nebraska ordered a 30-day extension of the deadline to renew driver’s licenses.

Americans, barely adapting to their new lives under the coronavirus outbreak, struggled to understand what the shelter-in-place orders would mean in practical terms, and which businesses would be allowed to remain open.

Mr. Cuomo’s action on Friday on restricting nonessential personnel came days after the governor had also ordered state and local governments to let at least 50 percent of their workers stay home. And while exactly who was considered essential was left up to local leaders and heads of state agencies, officials say many local governments were only requiring law enforcement, public safety and public works employees to report to work as usual.

“These provisions will be enforced,” Mr. Cuomo said at a briefing in Albany. “These are not helpful hints.”

Mr. Cuomo’s newest restrictions take effect Sunday night.

But many of the decisions for what is and is not essential will be open to interpretation, and across California, cities were struggling on Friday to determine what had primacy: the statewide order or the ones issued by counties and cities.

In the Bay Area, the first region to get a shelter-in-place order, cities have spent the past week wrestling with the question of what can remain open, and the bureaucracy — or lack of it — for deciding borderline cases.

Grocery stores and pharmacies are obviously essential, but what about bike repair shops, which many people need for transportation, or cannabis dispensaries, whose goods many consider medicine? In Alameda County, which surrounds Oakland, cities have asked the county health department for guidance, which in turn told cities that the decision is left to individual businesses. Thus, some establishments are closing, others are not, and cities — which are already overloaded with issues of public health and safety — are left to decide how to enforce rules that are mostly unclear.

In Los Angeles, an order signed by Mayor Eric Garcetti was explicit in which businesses can remain open, and included cannabis dispensaries, news media outlets, bicycle and auto repair shops, funeral homes and some farmers’ markets. Gun shops, which have seen a surge in business as the pandemic has spread, will close under the order.

On Friday, Californians kept some semblance of normal routines. In Los Angeles, residents were allowed to walk their dogs or go for a hike in the many canyons and hills around the city. And office workers were allowed to go to their offices on Friday and collect their belongings so they can begin working from home. But in a sprawling city where navigating traffic is a daily headache, for days the city has felt empty, its famous freeways uncluttered, with drivers able to get almost anywhere in less than a half-hour.

Officials said they did not expect to be heavy-handed on enforcement. In Los Angeles, the police can enforce the order by issuing misdemeanor tickets, but the authorities say they are counting on residents to abide by the rules out of social pressure. Mr. Garcetti said any residents who see someone violating the order should take it upon themselves to ask the offender to comply, although he added he is not looking for “tattletales around the city.”

“It’s a very light touch,” he said. “This is on 10 million people to self-enforce.”

Elsewhere in the United States, shelter-at-home rules were not so strict, but they were becoming more so every day — and many businesses and residents were choosing, by choice or by edict, to close up or stay home and take steps to avoid exposure among people.

In Hawaii, Gov. David Ige has issued sweeping directives to close bars and clubs, limit social gatherings to groups of 10, restrict restaurants to takeout service and other measures. He also “strongly encouraged” tourists to postpone vacations for 30 days, and mandated the screening of all passengers getting off cruise ships beginning on Friday.

On Friday afternoon, Mayor LaToya Cantrell of New Orleans issued a “stay home mandate” for her city. “The more people who stay home the more lives that we will save,” she said.

In sparsely populated South Dakota, 14 cases of coronavirus had been discovered as of Friday, with one death attributed to the coronavirus. Schools have been closed, people are working from home and everyone was being encouraged to practice social distancing. But the state government was not forcing new rules on anyone.

In Rapid City, a city of about 75,000 people, some restaurants remained open as usual on Friday, but others, like the Independent Ale House, had chosen to move to a takeout-only model of their own volition.

But there were tensions. Other places remained open, perhaps driven by a streak of American individualism that makes some bristle at the idea of going with the herd. “We’re still very frontier-oriented you know,” said Justin Henrichsen, the ale house owner. “You know, ‘You ain’t going to tell me what to do.’”

Julie Bosman reported from Chicago, and Jesse McKinley from Albany, N.Y. Reporting was contributed by Tim Arango from Los Angeles; Thomas Fuller from Moraga, Calif.; Conor Dougherty from Oakland, Calif.; Richard Fausset from Atlanta; and Mike Baker in Seattle.

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Trump’s Embrace of Unproven Drugs to Treat Coronavirus Defies Science

At a long-winded White House briefing on Friday, President Trump enthusiastically and repeatedly promoted the promise of two long-used malaria drugs that are still unproven against the coronavirus, but being tested in clinical trials.

“I’m a smart guy,” he said, while acknowledging he couldn’t predict the drugs would work. “I feel good about it. And we’re going to see. You’re going to see soon enough.”

But the nation’s leading infectious disease expert, Dr. Anthony S. Fauci, delicately — yet forcefully — pushed back from the same stage, explaining that there was only anecdotal evidence that the drugs, chloroquine and hydroxychloroquine, may be effective.

“The president feels optimistic about something, has feelings about it,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, emphasizing that he was a scientist. “I am saying it may be effective.”

Mr. Trump’s boosterish attitude toward the drugs has deepened worries among doctors and patients with lupus and other diseases who rely on the drugs, because the idea that the old malaria drugs could work against the coronavirus has circulated widely in recent weeks and fueled shortages that have already left people rushing to fill their prescriptions.

“Rheumatologists are furious about the hype going on over this drug,” said Dr. Michael Lockshin, of the Hospital for Special Surgery in Manhattan. “There is a run on it and we’re getting calls every few minutes, literally, from patients who are trying to stay on the drug and finding it in short supply.”

The moment of discord between Mr. Trump and one of the nation’s most trusted authorities on the coronavirus was a clash between opinion and fact. It threw Mr. Trump’s faith in his own instincts into conflict with the careful, evidence-based approach of scientists like Dr. Fauci, who has held his position since the presidency of Ronald Reagan. Mr. Trump appeared eager to sweep aside long-established standards for evaluating drugs in order to champion the remedy he favors.

The excitement about the drugs is based largely on reports from China and France that they seem to help patients. But researchers and Dr. Fauci have stressed that the reports are not based on carefully controlled studies, which are the only way to be sure a treatment really works.

As word of the drugs’ possible effects have spread around the globe, demand has surged, with hospitals ordering the treatments in a desperate effort to treat severely ill patients.

Two large generic manufacturers, Teva and Mylan, have said they are ramping up production of hydroxychloroquine, and Teva has said it will donate millions of pills to the U.S. government. The sole manufacturer of chloroquine, Rising Pharmaceuticals, has also said it is increasing production. In addition, the German company Bayer announced this week it was donating millions of pills of chloroquine to the U.S. government and would seek approval from the F.D.A. for its products to be used in the United States.


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Hydroxychloroquine is especially important for people with lupus, which can be life-threatening, Dr. Lockshin said. The drug can lower the risk of dying from lupus and prevent organ damage, and is considered the standard of care. If patients stop taking it after using it regularly for a long time, they can gradually become quite ill. He said it was particularly disturbing to think that people known to benefit from the drug could lose access to it because it is being diverted to a disease for which there is no solid evidence that it actually works.

“If there were justification for everyone taking it, that would be one thing,” Dr. Lockshin said. “It’s not hard to do the studies even in the midst of this crisis. We could have answers in a few weeks. But it’s being prescribed right and left.”

Dana Olita, 50, of Los Angeles, raced Thursday and Friday to refill her prescription for hydroxychloroquine, which she has taken for a decade to treat rheumatoid arthritis. Her pharmacist at CVS initially told her it was unavailable; then she was told on Friday that they had located enough to fill her prescription. “There are lots of people that desperately need this, and if we stop taking it, the problem to us is overwhelming,” she said.

A spokesman for CVS said the company was “closely monitoring the global pharmaceutical manufacturing environment and working with our suppliers to ensure we can continue filling prescriptions for pharmacy patients and plan members.” The company said it had adequate stocks of hydroxychloroquine but described the supply of chloroquine as “tight” and said it was taking steps to address the issue.

“I would hope that doctors would stick to the science and try to keep a cool head,” said Dr. Percio S. Gulko, chief of the division of rheumatology at the Icahn School of Medicine at Mount Sinai. “Somebody is prescribing it for people who are trying to get it, in some instances preventively. They may just be depriving the patients who do need it for an established indication, for a possibility or a speculation.”

“If it does turn out to be a success, we understand that there will be a need for more than has ever been available for patients with autoimmune diseases,” said Dr. David R. Karp, the president-elect of the American College of Rheumatology and chief of the rheumatic disease division at the University of Texas Southwestern Medical Center in Dallas. “We hope there will be a way for our patients to continue to access these medicines they’ve been taking for many years. Other medications can be used, but the safety profile gets much worse, and patients will likely have side effects.”

Judie Stein, of Sun Prairie, Wis., said she was stunned when she heard Mr. Trump pronounce the name of the drug she has taken for two years to treat rheumatoid arthritis. “When I was first prescribed this, nobody had heard of it,” said Ms. Stein, who is 59. She said she has a one-month supply of the drug and she quickly tried to refill her prescription yesterday. She has not yet received a confirmation. “If it’s readily available and has other uses, then fine, but when I say I really need it, I need it,” she said.

Dr. Michael Belmont, medical director of NYU Langone Orthopedic Hospital, said a number of his lupus patients had requested 90-day prescriptions for hydroxychloroquine, rather than the usual 30 days’ worth.

Noting that hydroxychloroquine was being widely used in coronavirus patients outside of controlled studies, he said, “It would be a shame if we use a lot of this and after all is said and done we are not able to determine with accuracy whether it had an effect or not.”

Onisis Stefas, the chief pharmacy officer for Northwell Health’s 23 hospitals, said the system began stocking up on hydroxychloroquine several weeks ago. He said the drug was being given to many coronavirus patients, but that Northwell’s 10 pharmacies were also setting aside supplies for patients who had been taking it regularly for lupus or rheumatoid arthritis.

Concerned about shortages, Mr. Stefas said, “The last thing I want to happen now is that, especially since President Trump and others have been mentioning this by name, is that people will go out and ask their doctors to write prescriptions, just in case.”

On Friday, Mr. Trump appeared to encourage Americans to do just that, arguing that there was little downside to taking a malaria drug that is already on the market.

“If you wanted, you can have a prescription. You get a prescription,” he said. “You know the expression, what the hell do you have to lose?”

ImageWestlake Legal Group 20VIRUS-DRUGS-articleLarge Trump’s Embrace of Unproven Drugs to Treat Coronavirus Defies Science your-feed-healthcare United States Politics and Government Trump, Donald J Rheumatoid Arthritis National Institute of Allergy and Infectious Diseases Mylan Inc Lupus Erythematosus Fauci, Anthony S Drugs (Pharmaceuticals) Coronavirus (2019-nCoV) Bayer AG
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Mnuchin Proposes $1,000 Checks in $1 Trillion Coronavirus Plan

Westlake Legal Group mnuchin-proposes-1000-checks-in-1-trillion-coronavirus-plan Mnuchin Proposes $1,000 Checks in $1 Trillion Coronavirus Plan United States Politics and Government United States Economy Unemployment Insurance Trump, Donald J Treasury Department Stimulus (Economic) Senate Republican Party Recession and Depression Pelosi, Nancy Mnuchin, Steven T McConnell, Mitch Layoffs and Job Reductions Law and Legislation House of Representatives Federal Aid (US) Democratic Party Coronavirus (2019-nCoV)
Westlake Legal Group 19dc-virus-cong1-facebookJumbo-v2 Mnuchin Proposes $1,000 Checks in $1 Trillion Coronavirus Plan United States Politics and Government United States Economy Unemployment Insurance Trump, Donald J Treasury Department Stimulus (Economic) Senate Republican Party Recession and Depression Pelosi, Nancy Mnuchin, Steven T McConnell, Mitch Layoffs and Job Reductions Law and Legislation House of Representatives Federal Aid (US) Democratic Party Coronavirus (2019-nCoV)

WASHINGTON — The White House and lawmakers scrambled on Thursday to flesh out details of a $1 trillion economic stabilization plan to help workers and businesses weather a potentially deep recession, negotiating over the size and scope of direct payments to millions of people and aid for companies facing devastation in the coronavirus pandemic.

Senate Republicans, racing to put their imprint on the crisis response, unveiled a package that would provide hundreds of billions of dollars in loans to big corporations and small businesses, large corporate tax cuts and checks of up to $1,200 for taxpayers. The plan would also place limits on a paid-leave program enacted this week to respond to the crisis.

But the 247-page measure, the product of a feverish round of negotiations among Republicans, was all but certain to face opposition from Democrats who have pressed for more generous paid-leave benefits and targeting help to workers and families rather than large corporations.

The details emerged as Washington grappled with the dimensions of an extraordinary government rescue effort that is likely to last for many months. At the White House, President Trump said he would be open to having the government take equity stakes in companies that require federal help, a move that would be unpopular with shareholders and would give the government more oversight over businesses.

But he also injected new uncertainty into the government’s response, suggesting it was not his responsibility to meet the needs of health care workers on the front lines of combating the disease. A day after he said he would use the Defense Production Act — a Korean War-era law that allows presidents to force American industry to ramp up production of critical equipment and supplies — Mr. Trump told reporters that he would rather rely on states to deliver equipment to health care workers.

“The federal government’s not supposed to be out there buying vast amounts of items and then shipping,” Mr. Trump said. “You know, we’re not a shipping clerk,” he said, adding that governors “are supposed to be doing it.”

On Capitol Hill, Republicans presented a bill that would offer bridge loans of up to $10 million each to small businesses, extend hundreds of billions of dollars in loans to large corporations in distressed industries and send checks as large as $1,200 per adult to individuals earning less than $99,000 per year. The payments would phase in for earners up to $75,000 — meaning lower earners would get smaller checks — and then phase out again at $99,000. Those who did not earn enough to pay income tax would receive much less: $600.

The proposal is different from one pitched on Thursday by Steven Mnuchin, the Treasury secretary, who said the administration wanted to send two waves of $1,000 checks to every American, one in April and one in May should the crisis persist.

The Senate bill also includes a raft of temporary changes to the tax code that would reduce the tax liability of large corporations, many of them overriding provisions in the 2017 tax overhaul that were meant to raise revenue to offset corporate rate cuts.

It would place new limits on a paid-leave program that Congress passed and Mr. Trump signed into law this week, shielding small business owners from any costs of paid leave for workers affected by the virus — and limiting how much pay those workers could receive if they are forced to stay home.


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A preliminary estimate by the Tax Foundation in Washington shows that the bill would cost at least $1 trillion. The small-business loans alone would be $300 billion, according to documents circulated on Thursday by Senate Republicans.

Mr. McConnell called for negotiations to begin with Senate Democrats on Friday, adding that Mr. Mnuchin, Larry Kudlow, the director of the National Economic Council, and Eric M. Ueland, the administration’s director of legislative affairs, would join them on behalf of the administration.

But little more than an hour after its release, the top House and Senate Democrats indicated that the legislation did not meet their standards.

“To earn Democratic support in the Congress, any economic stimulus proposal must include new, strong and strict provisions that prioritize and protect workers, such as banning the recipient companies from buying back stock, rewarding executives and laying off workers,” Speaker Nancy Pelosi and Senator Chuck Schumer of New York, the minority leader, said in a joint statement.

Calling the legislation a “significant next step,” Mr. McConnell vowed that the Senate would not leave until the rescue package had been approved, and said there could be a possible fourth relief package to follow as Congress seeks to address an extraordinary series of events.

But several of the Republican proposals are likely to be nonstarters for Democrats in both chambers, whose support is needed in order for the package to become law.

“Hopefully each side will give,” said Mr. Schumer of New York, the minority leader, speaking minutes after Mr. McConnell introduced the proposal. “We’ll come up with a good plan, we’ll send it to the president, and we will help to begin the long path to eradicate this awful virus.”

House Democrats, scattered across the country during an indefinite recess, have also been exchanging their own proposals over conference calls from their districts. Ms. Pelosi, who has spoken repeatedly with Mr. Mnuchin in recent days, has said her committee leaders were discussing the possibility of expanding unemployment insurance eligibility, refundable tax credits and funds for small businesses to ensure that workers continue to be paid.

One of the sticking points for members of both parties was the scope of the direct payment program, with some Republican senators pushing to strengthen unemployment insurance and loans for small businesses.

“Direct payments make sense when the economy is beginning to restart — it makes no sense now because it’s just money,” Senator Lindsey Graham, Republican of South Carolina, told reporters. “What I want is income, not one check. I want you to get a check you can count on every week, not one week.”

Others said it should be structured so that the lowest earners got the most help — not the other way around.

“Relief to families in this emergency shouldn’t be regressive,” Senator Josh Hawley, Republican of Missouri, said in a tweet. “Lower-income families shouldn’t be penalized.”

While there is general agreement about the need to speed economic help to millions of Americans, House Democrats are also debating the contours of their own proposal, including how to target the direct payments and the level of government intervention. During a private conference call on Thursday, they debated where to set the income cap on individuals who could receive government checks, according to three people familiar with the discussion who insisted on anonymity to describe the private call.

Representative Richard E. Neal of Massachusetts, the Democratic chairman of the Ways and Means Committee, which would have some jurisdiction over the issue, suggested capping the direct payments to individuals with incomes between $50,000 and $75,000, according to two people familiar with the discussion. Other lawmakers advocated raising the limit to individual incomes of $130,000, while others suggested universal payments.

And some Democrats believe the government should intervene more directly and take on payroll or other expenses for small businesses, arguing that could be a more targeted and effective way to keep them afloat and people employed.

Ms. Pelosi has said publicly and privately that she will consider including provisions that would expand eligibility for unemployment insurance, as well as using refundable tax credits to expedite funds directly toward people affected by the outbreak.

It is also likely that the House will address a request from the administration to distribute emergency aid to agencies on the front lines. Representative Nita M. Lowey of New York, the Democratic chairwoman of the House Appropriations Committee, told her colleagues on Thursday that her committee is expected to allocate between $100 billion and $150 billion, more than doubling the request, according to a person familiar with the remarks, and include it in the emerging package.

“Supplemental appropriations are an essential part of a whole-of-government strategy to address this pandemic, and it is irresponsible for Senate Republican leadership to omit these needed resources from its proposal,” said Evan Hollander, a spokesman for the House committee.

Earlier this month, Congress approved a first, $8.3 billion round of emergency money for federal health agencies, and this week it finalized a second measure — whose cost has yet to be tallied — to provide paid leave, jobless aid and food and health care assistance, as well as free coronavirus testing. Mr. Trump has signed both.

Time is of the essence in the talks. The news Wednesday night that two House lawmakers had tested positive for coronavirus after voting early Saturday has added pressure for senators to cut a swift deal on the package and depart Washington indefinitely.

The fiscal relief package unveiled Thursday is only one part of the administration’s plan, which some analysts now anticipate topping $1.5 trillion before the negotiations are completed. Mr. Mnuchin said the Treasury Department and the Federal Reserve were working in lock step and were prepared to do whatever was possible to provide liquidity to American companies so they could weather the crisis without laying off workers. The Federal Reserve said late Wednesday night that it would offer emergency loans to money market mutual funds, its latest in a series of steps to keep the financial system functioning and prop up the economy.

“What we’re really focused on is providing liquidity to American businesses and American workers,” Mr. Mnuchin said on the Fox Business Network on Thursday. “This is an unprecedented situation.”

He said he had advised the president to purchase oil, which is at historically low prices, and fill up America’s strategic reserve.

Economists are bracing for a deep recession. Analysts at J.P. Morgan said this week that the United States economy could contract by 14 percent in the second quarter of this year.

The Treasury Department has not released updated economic projections, but Mr. Mnuchin said that he expected the beginnings of growth again in the third quarter and a “gigantic” rebound in the final three months of the year.

Economic data is beginning to trickle out, offering a grim preview of the damage that lies ahead. Official figures released on Thursday showed claims for unemployment insurance reaching their highest level in more than two years.

“The coronavirus outbreak is already starting to have a significant impact on the economy,” said Andrew Hunter, a senior U.S. economist at Capital Economics. “Timelier reports of state-level data point to an unprecedented surge in layoffs over the next couple of weeks.”

The Treasury secretary indicated that he and the Federal Reserve chair, Jerome H. Powell, would use all the tools at their disposal to allow that workers and businesses to subsist for the next few months.

Reporting was contributed by Nicholas Fandos, Sheryl Gay Stolberg, Catie Edmondson and Katie Rogers.

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Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded

Westlake Legal Group 20dc-virus-warnings-jp3-facebookJumbo-v2 Coronavirus Outbreak: A Cascade of Warnings, Heard but Unheeded United States Politics and Government Trump, Donald J Romney, Mitt Obama, Barack National Security Council Monaco, Lisa O Klain, Ronald A Influenza Homeland Security Department Health and Human Services Department federal emergency management agency Epidemics Disasters and Emergencies Defense Department Coronavirus (2019-nCoV) Centers for Disease Control and Prevention

WASHINGTON — The outbreak of the respiratory virus began in China and was quickly spread around the world by air travelers, who ran high fevers. In the United States, it was first detected in Chicago, and 47 days later, the World Health Organization declared a pandemic. By then it was too late: 110 million Americans were expected to become ill, leading to 7.7 million hospitalized and 586,000 dead.

That scenario, code-named “Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration’s Department of Health and Human Services in a series of exercises that ran from last January to August.

The simulation’s sobering results — contained in a draft report dated October 2019 that has not previously been reported — drove home just how underfunded, underprepared and uncoordinated the federal government would be for a life-or-death battle with a virus for which no treatment existed.

The draft report, marked “not to be disclosed,” laid out in stark detail repeated cases of “confusion” in the exercise. Federal agencies jockeyed over who was in charge. State officials and hospitals struggled to figure out what kind of equipment was stockpiled or available. Cities and states went their own ways on school closings.

Many of the potentially deadly consequences of a failure to address the shortcomings are now playing out in all-too-real fashion across the country. And it was hardly the first warning for the nation’s leaders. Three times over the past four years the U.S. government, across two administrations, had grappled in depth with what a pandemic would look like, identifying likely shortcomings and in some cases recommending specific action.

In 2016, the Obama administration produced a comprehensive report on the lessons learned by the government from battling Ebola. In January 2017, outgoing Obama administration officials ran an extensive exercise on responding to a pandemic for incoming senior officials of the Trump administration.

The full story of the Trump administration’s response to the coronavirus is still playing out. Government officials, health professionals, journalists and historians will spend years looking back on the muddled messages and missed opportunities of the past three months, as President Trump moved from dismissing the coronavirus as a few cases that would soon be “under control” to his revisionist announcement on Monday that he had known all along that a pandemic was on the way.

What the scenario makes clear, however, is that his own administration had already modeled a similar pandemic and understood its potential trajectory.

The White House defended its record, saying it responded to the 2019 exercise with an executive order to improve the availability and quality of flu vaccines, and that it moved early this year to increase funding for the Department of Health and Human Services’ program that focuses on global pandemic threats.

“Any suggestion that President Trump did not take the threat of COVID-19 seriously is false,” said Judd Deere, a White House spokesman.

But officials have declined to say why the administration was so slow to roll out broad testing or to move faster, as the simulations all indicated it should, to urge social distancing and school closings.

Asked at his news briefing on Thursday about the government’s preparedness, Mr. Trump responded: “Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.”

The work done over the past five years, however, demonstrates that the government had considerable knowledge about the risks of a pandemic and accurately predicted the very types of problems Mr. Trump is now scrambling belatedly to address.


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Crimson Contagion, the exercise conducted last year in Washington and 12 states including New York and Illinois, showed that federal agencies under Mr. Trump continued the Obama-era effort to think ahead about a pandemic.

But the planning and thinking happened many layers down in the bureaucracy. The knowledge and sense of urgency about the peril appear never to have gotten sufficient attention at the highest level of the executive branch or from Congress, leaving the nation with funding shortfalls, equipment shortages and disorganization within and among various branches and levels of government.

The October 2019 report in particular documents that officials at the Departments of Homeland Security and Health and Human Services, and even at the White House’s National Security Council, were aware of the potential for a respiratory virus outbreak originating in China to spread quickly to the United States and overwhelm the nation.

“Nobody ever thought of numbers like this,’’ Mr. Trump said on Wednesday, at a news conference.

In fact, they had.

As early as the George W. Bush administration, homeland security and health officials focused on big gaps in the American response to a biological attacks and the growing risk of pandemics. The first test came in April 2009, just a few months after the start of President Barack Obama’s first term. A 10-year-old California girl was diagnosed with a contagious disease that would be called swine flu or H1N1, the first flu pandemic in more than 40 years.

The Centers for Disease Control and Prevention estimates that ultimately there were about 60.8 million cases in the United States, along with 274,304 hospitalizations and 12,469 deaths associated with H1N1.

The virus turned out to be less deadly than first expected. But it was a warning shot that officials in the Obama administration said they took seriously, kicking off a planning effort that escalated in early 2014, with the outbreak of Ebola in West Africa and ensuing fear that it could spread to the United States.

Ebola was less contagious than the flu, but far more deadly. It killed 11,000 people in Africa. But it could have been far worse. The United States sent nearly 3,000 troops to Africa to help keep the disease from spreading. While the containment effort was considered a success, inside the White House, officials sensed that the United States had gotten lucky — and that the response had revealed gaps in preparedness.

Christopher Kirchhoff, a national security aide who moved from the Pentagon to the White House to deal with the Ebola crisis, was given the job of putting together a “lessons learned” report, with input from across the government.

The weaknesses Mr. Kirchhoff identified were early warning signals of what has unfolded in the past three months.

His report concluded that the United States assumed more ability on the part of the World Health Organization than the agency actually had.

The United States had its own issues. There was no airplane in the U.S. fleet capable of evacuating an American doctor who was infected while treating patients in Liberia. The Pentagon was largely unprepared for the intervention that Mr. Obama ordered.

While the United States rapidly developed a way to screen air passengers coming into the country — borrowing from intelligence tools developed after the Sept. 11, 2001, attacks to track possible terrorists — Mr. Kirchhoff found deficiencies in even measuring how fast the virus was spreading.

On the plus side, the Obama White House had created an Ebola Task Force, run by Ron Klain, Vice President Joseph R. Biden Jr.’s former chief of staff, before a single case emerged in the United States. Congress allocated $5.4 billion in emergency funding to pay for Ebola treatment and prevention efforts in the United States and West Africa.

The money helped fund a little-known agency inside the Department of Health and Human Services in charge of preparing for future contagious disease outbreaks, the same office that in 2019 ran the Crimson Contagion exercise and other similar events in the years since.

After a man named Thomas Duncan, a Liberian citizen, became the first person given a diagnosis of Ebola on American territory in September 2014, errors resulted in the infection of two nurses and fear of a wider spread in the United States. (Mr. Duncan died, but the two nurses recovered.)

What is striking in reading Mr. Kirchhoff’s account today, however, is how few of the major faults he found in the American response resulted in action — even though the report was filled with department-by-department recommendations.

There were deficiencies “in personal protective equipment use, disinfection” and “social services for those placed under quarantine.”

There was confusion over travel restrictions, and the need “for a smoother sliding scale of escalation of government response, from local authorities acting on their own to local authorities acting with some federal assistance” to the full activation of the federal government.

The report concluded that “a minimum planning benchmark might be an epidemic an order of magnitude or two more difficult than that presented by the outbreak of Ebola in West Africa, with much more significant domestic spread.”

But one big change did come out of the study: The creation of a dedicated office at the National Security Council to coordinate responses and raise the alarm early.

“What I learned most is that we had to stand up a global biosecurity and health directorate, and get it enshrined for the next administration,” said Lisa Monaco, Mr. Obama’s homeland security adviser.

After Mr. Trump’s election, Ms. Monaco arranged an extensive exercise for high-level incoming officials — including Rex W. Tillerson, the nominee for secretary of state; John F. Kelly, designated to become homeland security secretary; and Rick Perry, who would become energy secretary — gaming out the response to a deadly flu outbreak.

She asked Tom Bossert, who was preparing to come in as Mr. Trump’s homeland security adviser, to run the event alongside her.

“We modeled a new strain of flu in the exercise precisely because it’s so communicable,” Ms. Monaco said. “There is no vaccine, and you would get issues like nursing homes being particularly vulnerable, shortages of ventilators.”

Ms. Monaco was impressed by how seriously Mr. Bossert, her successor, appeared to take the threat, as did many of the 30 or so Trump team members who participated in the exercise, details of which were reported by Politico.

But by the time the current crisis hit, almost all of the leaders at the table — Mr. Tillerson, Mr. Kelly and Mr. Perry among them — had been fired or moved on.

In 2018, Mr. Trump’s national security adviser at the time, John R. Bolton, ousted Mr. Bossert and eliminated the National Security Council directorate, folding it into an office dedicated to weapons of mass destruction in what Trump officials called a logical consolidation.

Asked about that shift on March 13, Mr. Trump told a reporter that it was “a nasty question,” before adding: “I don’t know anything about it.” Writing on Twitter the next day, Mr. Bolton lashed out at critics who said the shift had reflected disinterest in pandemic threats.

“Claims that streamlining NSC structures impaired our nation’s bio defense are false,” Mr. Bolton tweeted. “Global health remained a top NSC priority.”

In a statement, the National Security Council said it “has directors and staff whose full-time job it is to monitor, plan for, and respond to pandemics, including an infectious disease epidemiologist and a virologist.”

But in testimony to Congress last week, Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, suggested that ending the stand-alone directorate was ill-advised. “It would be nice if the office was still there,” he said.

On Feb. 10, nearly three weeks after the first coronavirus case was diagnosed in the United States, Mr. Trump submitted a 2021 budget proposal that called for a $693.3 million reduction in funding for the C.D.C., or about 9 percent, although there was a modest increase for the division that combats global pandemics.

The Crimson Contagion planning exercise run last year by the Department of Health and Human Services involved officials from 12 states and at least a dozen federal agencies. They included the Pentagon, the Department of Veterans Affairs and the National Security Council. Groups like the American Red Cross and American Nurses Association were invited to join, as were health insurance companies and major hospitals like the Mayo Clinic.

The war game-like exercise was overseen by Robert P. Kadlec, a former Air Force physician who has spent decades focused on biodefense issues. After stints on the Bush administration’s Homeland Security Council and the staff of the Senate Intelligence Committee, he was appointed assistant secretary of Health and Human Services for Preparedness and Response.

“He recognized early that we have a big problem and we needed much bigger budgets to prepare,” said Richard Danzig, the secretary of the Navy in the Clinton administration, who had worked with Mr. Kadlec.

The exercise played out in four separate stages, starting in January 2019.

The events were supposedly unspooling in real time — with the worst-case scenario underway as of Aug. 13, 2019 — when, according to the script, 12,100 cases had already been reported in the United States, with the largest number in Chicago, which had 1,400.

The fictional outbreak involved a pandemic flu, which the Department of Health and Human Services says was “very different than the novel coronavirus.” The staged outbreak had started when a group of 35 tourists visiting China were infected and then flew home to Australia, Kuwait, Malaysia, Thailand, Britain and Spain, as well as to the United States, with some developing respiratory symptoms and fevers en route.

A 52-year-old man from Chicago, who was on the tour, had “low energy and a dry cough” upon his return home. His 17-year-old son on that same day went out to a large public event in Chicago, and the chain of illnesses in the United States started.

Many of the moments during the tabletop exercise are now chillingly familiar.

In the fictional pandemic, as the virus spread quickly across the United States, the C.D.C. issued guidelines for social distancing, and many employees were told to work from home.

But federal and state officials struggled to identify which employees were essential and what equipment was needed to effectively work from home.

There also was confusion over how to handle school children. The C.D.C. recommended that states delay school openings — the exercise took place toward the end of the summer. But some school districts decided to go ahead with the start of school while others followed the federal advice, causing the same types of confusion and discrepancies that have marked the response to the coronavirus.

The exercise from last year then went on to predict how the situation on the ground in the United States would worsen as the weeks passed.

Confusion emerged as state governments began to turn in large numbers to Washington for help to address shortages of antiviral medications, personal protective equipment and ventilators. Then states started to submit requests to different branches of the federal government, leading to bureaucratic chaos.

Friction also emerged between the Federal Emergency Management Agency, which is traditionally in charge of disaster response, and the Department of Health and Human Services, another scenario playing out now.

But the problems were larger than bureaucratic snags. The United States, the organizers realized, did not have the means to quickly manufacture more essential medical equipment, supplies or medicines, including antiviral medications, needles, syringes, N95 respirators and ventilators, the agency concluded.

Congress was briefed in December on some of these findings, including the inability to quickly replenish certain medical supplies, given that much of the product comes from overseas.

These concerns turned more urgent at a hearing last Thursday on Capitol Hill, as lawmakers peppered officials with the Department of Health and Human Services with questions that sounded almost as if they had read the script from the fictional exercise, reflecting the shortage of respirators and protective gear.

Senator Mitt Romney, Republican of Utah, said last week that he blamed Congress and prior administrations for not increasing stockpiles of this type of equipment.

“That is an area we ought to consider making an investment in,” he added, making a point, apparently unknown to him, that the administration’s own simulation had made clear five months earlier.

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