Dr. Deborah L. Birx, who has carefully straddled the line between science and politics as she helps lead the Trump administration’s coronavirus response, delivered a stark private warning on Monday, telling White House officials that the pandemic is entering a new and “deadly phase” that demands a more aggressive approach.
The warning, contained in a private memo to White House officials as the nation’s daily coronavirus caseload has broken records and approached 100,000, amounted to a direct contradiction of President Trump’s repeated — and inaccurate — assertions that the pandemic is “rounding the corner.”
In the memo, Dr. Birx suggested that Mr. Trump and his advisers were spending too much time focusing on preventing lockdowns and not enough time on controlling the virus.
“We are entering the most concerning and most deadly phase of this pandemic,” Dr. Birx wrote, adding: “This is not about lockdowns — it hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”
The memo’s existence was reported earlier by The Washington Post. A top White House official who has seen it confirmed its contents.
The blunt message was a striking one for Dr. Birx, the White House coronavirus response coordinator, who at least in public has taken care not to criticize the president or his administration. Her sharp critique reflects a growing concern among government scientists and public health experts that the worst of the pandemic is yet to come.
Dr. Birx, a respected AIDS researcher, was named the coronavirus response coordinator in March. The job has required her to manage the work of the White House coronavirus task force, tracking and orchestrating the government’s effort to contain the outbreak. In the early days of the pandemic, she projected a calm, authoritative presence — and a steady counterpoint to the mixed messages from Mr. Trump.
But her tendency to remain silent as the president spread misinformation has hurt her reputation, and some of her old allies in the AIDS advocacy world have turned against her, saying openly that she has lost credibility in their eyes.
A nation with nearly 8 percent unemployment and mourning more than 231,000 Covid deaths, where four out of five Americans say they feel nervous about the country’s future, gets a final chance Tuesday to decide which candidate is best equipped to lead it past those daunting numbers.
The division and anxiety are evident in conversations among voters in long lines outside early voting places and across browning autumn lawns where warring yard signs pit neighbor against neighbor. In the middle of the country, where case counts are surging and college football games were postponed after much angst this past weekend, the worry is all connected, from people on either side of the political chasm.
The coronavirus trends are especially pronounced in several battleground states, including Wisconsin and Michigan, which Joseph R. Biden Jr. is fighting to win back for the Democrats after President Trump’s victories there in 2016, and where infection rates were ticking up as the calendar wound down.
A fundamental unease about the country hovers over most other concerns voters describe as they cast ballots: The future of America troubles them more than whether they may lose a job in this recession, whether they could become ill in this pandemic, whether they could personally be harmed by violent crime.
In national polling by The New York Times and Siena College, voters across the political spectrum say they worry that the next generation of Americans will be worse off. And they are concerned America could lose its democracy.
Across the country, the virus outlook is bleak and getting bleaker. Infection numbers are trending upward in 41 states, and more than 20 states have set weekly case records in recent days. The nation has averaged at least 85,000 cases per day over the past week, the most yet. Deaths, which tend to lag cases, have climbed more slowly to about 800 daily, still well below the spring peak.
Much of the recent increase has been driven by explosive growth in the same Northern battleground states that could decide the presidential race.
Poll workers are scrubbing down voting machines before and after each ballot. Voters are being asked to bring their own pens. And, in some states, officials are sending polling places hundreds of thousands of gloves, masks and social-distancing markers.
Those are among the precautions being taken as voters in the United States fan out to the polls on Tuesday in the midst of a surge of coronavirus infections that has swamped hospitals and set daily records for new cases in some states.
The efforts are intended not only to keep voters and poll workers from becoming infected, but also to make it safe for people who are already sick or isolating to vote, the Centers for Disease Control and Prevention said over the weekend.
The agency said that those people have a right to vote, too. It recommended that voters keep at least six feet from others and issued a six-step guide to help people prepare for voting. Among the suggestions: Bring your own supplies, including two masks, tissues, hand sanitizer with 60 percent alcohol, water and a black ink pen.
“You should also let poll workers know that you are sick or in quarantine when you arrive at the polling station,” the center said.
In sending voters to the polls in the middle of an uncontrolled outbreak, the United States is trying an experiment that few other countries have attempted. More than 60 countries have postponed votes since the outbreak first took hold, the Council on Foreign Relations has said, while those that did hold elections have struggled to make them safe.
The C.D.C. guidelines align with measures that many polling stations around the country are taking to keep safe on Tuesday.
Paul Pate, the secretary of state for Iowa, said that his office had distributed 145,000 gloves, 200,000 masks and 11,000 social-distancing markers to be used by voters and poll workers.
In Virginia, one city official said that plexiglass was being erected and that personal protection equipment would be distributed to anyone entering the polling station.
The state of Ohio has also purchased personal protection equipment, including clear shields, to protect voters and poll workers. Voting machines are to be cleaned before and after each vote, according to a Dayton news station.
The Illinois Department of Public Health issued its own Election Day guidelines to polling locations. The agency recommended having separate entrances and exits if possible and replacing shared objects like pens with single-use items.
Few groups have witnessed more of the virus’s horrors than caregivers — frontline workers who have grappled with the public health crisis while trying to help older people at risk of isolation, distress and, in some cases, death. The deaths of almost 40 percent of all Americans killed by the coronavirus have been linked to nursing homes and similar facilities — indoor spaces crowded with vulnerable adults. The share is even higher in Pennsylvania, where deaths in nursing and personal-care facilities account for close to two-thirds of coronavirus deaths statewide.
In interviews ahead of the election with more than a dozen caregivers in Pennsylvania, one of the country’s most important battleground states, they described how their experiences are shaping their political outlooks. It has hardened some convictions and transformed some caretakers, otherwise apolitical, into activists. It has forced others to reassess their beliefs about American exceptionalism, the role of government in their lives and their industry, and their decision about whom to vote for in November.
“Nine months ago, I would have told you that I was 100 percent behind Trump,” Bob Lohoefer, a nursing director in Philadelphia and a lifelong Republican, said of the president. “But as a result of Covid, I’m not 100 percent sure where I stand now.”
The problems Pennsylvania has encountered are emblematic of the nation as a whole: There were struggles to procure personal protective equipment, difficulties with rapid testing, staffing shortages, disagreements between local, state and federal government agencies and new rules piled onto an already heavily regulated industry.
“If you don’t see it, you really don’t understand how difficult it is,” said Louise Santee, a longtime caregiver who brought a curling iron to work to calm a resident who could not understand why she could no longer go to the hairdresser. “It is truly heart-wrenching when you see what this has done to our people.”
Two days after abruptly announcing plans to put England back into a lockdown, Prime Minister Boris Johnson faced a mutiny on Monday from members of his Conservative Party, who said he went too far, and scalding criticism from opposition leaders, who said he acted too late to stem a second wave of the coronavirus.
Mr. Johnson’s decision, a reluctant reversal after weeks of stubbornly resisting a lockdown, seemed to please almost no one. His allies in the right-wing press have turned on him, as have disgruntled business leaders.
The about-face even reopened fault lines from the debate over Britain’s withdrawal from the European Union, as Nigel Farage, the pro-Brexit leader, said he would rebrand his Brexit Party with a new name, Reform U.K., and a platform of opposing the lockdown.
A somber Mr. Johnson defended himself in Parliament, apologizing for the economic pain caused by the lockdown but insisting there was no alternative. At the current rate of infections and hospitalizations, he said, England’s hospitals would have to turn away patients within weeks.
The Labour Party’s leader, Keir Starmer, endorsed the lockdown. But he accused the prime minister of dithering for 40 days after his scientific advisers recommended taking this step — a delay that he claimed had cost lives.
Mr. Johnson’s now-defunct program of targeted restrictions, he said, “not only failed to stop the second wave, they been swept away by it.” Mr. Starmer called for a two-week “circuit breaker” lockdown nearly three weeks ago.
For all the criticism of Mr. Johnson, his latest plans are not likely to be derailed. While a handful of Conservative members of Parliament said they would oppose the lockdown measure when it comes up for a vote on Wednesday, the prime minister’s 80-seat majority, plus the seal of approval from the Labour Party, all but guarantees that it will be approved by the House of Commons.
Still, the swelling unrest in Conservative ranks, the rising strength of the opposition and the re-emergence of Mr. Farage as a threat from the right add up to a treacherous landscape for Mr. Johnson.
Colorado once looked like it had gotten a grip on the coronavirus. Gov. Jared Polis, a Democrat, is a zealous mask wearer who imposed a statewide mandate. Hospitalization levels stayed low for much of the summer and fall. The state even began dismantling two emergency field hospitals it set up early in the pandemic.
But that grip has slipped. Daily reports of new cases are soaring to record heights, and the number of patients hospitalized with Covid-19 has tripled since early September.
The Colorado Department of Public Health and Environment is now warning that hospitalizations in the state are likely to blast through the peaks of last April and could overwhelm the state’s intensive care units by January.
“It’s really a very scary rise,” Dr. Jonathan Samet, the dean of the Colorado School of Public Health, said in an interview. “Clearly, Coloradans have lapsed.”
Health officials said there was no single reason or particular hot spot fueling the increase in the state this time, unlike earlier spikes that were driven by outbreaks in long-term care homes and meatpacking plants or by students partying at the University of Colorado.
The state health department estimated that one in every 219 people in Colorado is infectious, making it likelier now than it was in the summer for uninfected people to catch the virus.
Colder weather and early snowstorms are starting to drive people back indoors. Mountain towns that rely on winter tourists are now torn: Do they accept the pain of shutting down the restaurants and bars that bring in the après-ski dollars, or do they let their communities become hubs of coronavirus transmission?
Denver, which reported a record 461 cases one day last week, has imposed tighter limits on retailers, offices and public gatherings and ordered people to wear face masks outdoors. A dozen counties across the state have also ratcheted restrictions back up.
Dr. Samet said pandemic fatigue and people’s yearning for normalcy after months of lockdown and mask wearing may be playing a part in the recent surge.
“Everybody’s impatient,” he said. “People want to have their lives back. But it’s too early to do that.”
Education Roundup
The District of Columbia Public Schools said on Monday that it was canceling its plan to bring some elementary school students back to schools next week, after teachers staged a sickout to protest the plan.
Mayor Muriel Bowser announced in October that the district would bring back 7,000 students in prekindergarten through fifth grade on Nov. 9. Priority for in-person seats would be given to students who were homeless, disabled or learning English as a second language.
The plan had drawn opposition from not only teachers, but also some principals and parents, because of safety concerns, the way that students were chosen, and the fact that many students would have had to change teachers midyear.
Negotiations between the district and the teachers’ union fell apart over the weekend, with a major sticking point being the union’s insistence that no teacher should be forced to return to teaching in-person, the president of the Washington Teachers Union, Elizabeth A. Davis, said on Monday.
In other education news around the United States:
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More than one million parents in New York City must decide in the next two weeks whether to send their children into classrooms this school year or keep them learning from home, likely until at least next fall. The city had said parents could opt into the hybrid program (part in-person, part online) every few months, but Mayor Bill de Blasio changed course after only a quarter of the district’s 1.1 million students have shown up for in-person classes since September, far fewer than predicted.
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Amid new restrictions on gatherings and businesses, Gov. Charlie Baker of Massachusetts suggested that he did not plan to order schools closed in an effort tamp down transmission of the virus. Schools “need to stay open,” he said, adding that in-person learning is “hugely important for the educational and social development of kids.”
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A Connecticut judge on Monday denied a conservative group’s emergency request to block Gov. Ned Lamont’s requirement that students wear masks in school. The group, CT Freedom Alliance, had argued that the mask requirement posed an immediate danger to students. The judge said in his decision that “no emergency exists” and that “there is very little evidence of harm at all.”
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A small liberal arts school in upstate New York, Skidmore College, suspended 46 students over the weekend, the majority of whom had violated rules meant to protect against the coronavirus, a college spokeswoman said.
Global Roundup
Britain will conduct its first coronavirus testing on a citywide scale in Liverpool, a city of half a million people in northern England that has been among the country’s worst-hit areas.
Everyone working or living in the city will be offered tests, even if they are asymptomatic, Prime Minister Boris Johnson said on Tuesday, days after announcing a monthlong nationwide lockdown set to begin this week.
The testing in Liverpool — in workplaces, schools and universities, and hospitals and nursing homes — will begin on Friday, a day after nonessential business and pubs and restaurants across the country will be forced to close.
Liverpool has reported over 410 weekly cases per 100,000 inhabitants, one of the highest numbers in the country. “These tests will help identify the many thousands of people in the city who don’t have symptoms but can still infect others without knowing,” Mr. Johnson said in a statement. He added that millions of additional tests could be distributed elsewhere in Britain if the results are conclusive in Liverpool.
Britain has struggled to contain the spread of a virus that has claimed the lives of over 55,000, the highest toll in Europe. For months, Mr. Johnson has vowed to increase testing capacities and reach the threshold of 10 million people tested every day, but what he once described as a “world beating” test-and-trace program has remained riddled with delays, technical glitches and poorly trained contact tracers.
In other developments around the world:
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Hong Kong will require all travelers arriving from anywhere outside mainland China to quarantine for 14 days at a hotel starting Nov. 13, and to present confirmation of a hotel room reservation in the city for the entire period, the government said Tuesday. “In view of the severe global pandemic situation, Hong Kong cannot afford to drop its guard on entry prevention and control measures,” a government spokesman said. The Chinese territory reported nine new coronavirus cases on Tuesday, including two linked to a cluster from a “staycation” on a picturesque island.
Researchers in Germany may have some good news for frustrated concertgoers around the world whose activities have been constrained by the spread of the coronavirus.
An analysis of an indoor concert staged by scientists in August suggests that the impact of such events on the spread of the coronavirus is “low to very low” as long as organizers ensure adequate ventilation, strict hygiene protocols and limited capacity, according to the German researchers who conducted the study.
“There is no argument for not having such a concert,” Dr. Michael Gekle, part of the team at Martin Luther University Halle-Wittenberg that conducted the study, said in an interview. “The risk of getting infected is very low.”
The study was posted online and announced at a news conference on Thursday but has not yet been peer reviewed.
The test event, one of the first close examinations of how a virus might be transmitted among a crowd at an indoor venue, was closely watched in the global entertainment industry, which has been hampered by lockdown restrictions in most countries since the pandemic broke out early this year.
Some experts expressed skepticism about the results, saying they needed to be replicated and reviewed, and that more information was needed about how researchers used the modeling.
Dr. Gabriel Scally, president of epidemiology and public health at the Royal Society of Medicine, said the findings were potentially “useful,” but that it might be difficult to replicate the controls that the researchers had implemented at many real-life events.
With the approach of Thanksgiving in the United States and the December holidays during a surge in coronavirus cases, the increased risks presented by travel — either contracting or spreading the virus — are challenging the industry during what is normally one of its busiest seasons.
The market research firm Destination Analysts found in a recent Coronavirus Travel Sentiment Index Study, a weekly survey of 1,200 Americans, that 28 percent expected to travel for the holidays. In the same survey, 53 percent said they had traveled for the holidays last year.
Here are five things we know about holiday travel:
There will be fewer fliers, but don’t expect an empty plane.
Scoring a seat without a neighbor sharing your armrest is getting harder, and travelers should prepare for more crowded planes. Among the four largest carriers in the United States, only Delta Air Lines has remained committed to leaving its middle seats open during the holidays, through Jan. 6.
Be cautious of Covid-19 testing as a safe-travel passport.
Increasingly, airlines are promoting testing for Covid-19 as a way to reassure travelers that flying is safe.
In October, United began offering Covid-19 testing at San Francisco International Airport to fliers bound for Hawaii, which requires negative test results in order to avoid quarantining for 14 days.
While roughly half of respondents with holiday travel plans told Destination Analysts that they would not undergo testing before their holiday travels, a third said they would.
Preserve your bubble away from home.
Testing is one way families and friends might consider merging their bubbles for the holidays. Dr. Emily Landon, an associate professor of medicine and an infectious disease expert at the University of Chicago, advises families to quarantine for up to 14 days before testing.
Meeting at a neutral site, like a vacation home rental, will decrease the chances of encountering other strangers.
Prepare to quarantine.
Many destinations require visitors or returning residents to quarantine. The Centers for Disease Control and Prevention recommends checking state, territorial, tribal and local health websites for current restrictions.
Many of the quarantine mandates rely on self-monitoring. But breaking a quarantine order in New York can cost up to $10,000 in fines or up to 15 days in prison.
Driving offers more control.
“The advantage of driving is the environment is much more controlled,” said Dr. Henry Wu, the director of Emory TravelWell Center and an associate professor of infectious diseases at Emory University School of Medicine, adding that “ideally, you’re driving with your immediate family you live with.”
But, he warned, “if you’re picking up folks from other households, that increases the risk someone might be infected and you’re exposed. And it’s a small, tight environment.”
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