Trump Returns Home After Downplaying Disease, but Doctor Says He Isn’t ‘Out of the Woods’

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Trump Returns Home After Downplaying Disease, but Doctor Says He Isn’t ‘Out of the Woods’

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Trump Leaves Hospital, but Doctor Says He Isn’t ‘Out of the Woods’

President Trump left the Walter Reed medical center after spending three nights there being treated for Covid-19. His physician, Dr. Sean P. Conley, said earlier in the day that the president was not “out of the woods yet.”

[camera shutters] [from off-camera] “Mr. President, how many staff are sick?” “How many of your staff are sick?” [President Trump] “Thank you very much. Thank you.” [from off-camera] “Do you think you might be a superspreader, Mr. President?” [camera shutters]

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President Trump left the Walter Reed medical center after spending three nights there being treated for Covid-19. His physician, Dr. Sean P. Conley, said earlier in the day that the president was not “out of the woods yet.”

After spending three nights at the Walter Reed medical center, President Trump returned on Monday evening to the White House, where he will continue to receive treatment for Covid-19. His physician, Dr. Sean P. Conley, had said earlier in the day that the president was not “out of the woods yet.”

Mr. Trump, wearing a mask and a suit, passed through the hospital’s large golden doors, paused atop a flight of steps and pumped his fist a few times at chest level. He did not respond to shouted questions from the news media as he walked past, unaccompanied. “Thank you very much, everybody,” he said with a wave.

Mr. Trump then boarded a black S.U.V. that drove him to his presidential helicopter, Marine One, for the short flight to the White House. He offered a thumbs-up just before stepping onto his helicopter, which departed just after 6:45 p.m. for the 10-minute flight.

After landing on the South Lawn, Mr. Trump ascended a flight of stairs and then turned to face his helicopter — and the live television cameras — and removed his mask before giving the departing Marine One a long salute.




Trump Removes Mask Despite Coronavirus Infection

After President Trump arrived at the White House from the hospital on Monday, he climbed stairs to a balcony and took off his mask.

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After President Trump arrived at the White House from the hospital on Monday, he climbed stairs to a balcony and took off his mask.CreditCredit…Anna Moneymaker for The New York Times

He then turned and walked into the White House residence — without donning his mask. Several masked people, including what appeared to be an official photographer capturing the moment, were inside.

The three major network newscasts on ABC, CBS and NBC carried it all live, the kind of blanket television coverage that Mr. Trump relishes. But after climbing the stairs, Mr. Trump appeared to be short of breath.

At a briefing earlier in the day, Dr. Conley said, “Over the past 24 hours, the president has continued to improve,” adding, “He’s met or exceeded all standard hospital discharge criteria.”

The president’s doctors evaded some key questions about the president’s condition, including his lung function and the date of his last negative coronavirus test before he tested positive. They said that he had received a third dose of the antiviral drug remdesivir, and that he has continued to take dexamethasone, a steroid drug that has been shown to be beneficial to patients who are very sick with Covid-19.

“We’re looking to this weekend,” Dr. Conley said. “If we can get through to Monday, with him remaining the same or improving better yet, then we will all take that final deep sigh of relief.”

Dr. Conley did not give a firm answer about whether Mr. Trump would be confined to his residence. The West Wing is experiencing a growing outbreak, with Mr. Trump’s press secretary, Kayleigh McEnany, joining the list on Monday of his close aides who have tested positive.

The doctors’ remarks came after Mr. Trump tweeted that he would be returning to the White House, which is equipped with a medical suite. In doing so, as he has throughout the pandemic, he downplayed the seriousness of a virus that has killed more than 210,000 people in the United States, writing in his post, “Don’t be afraid of Covid. Don’t let it dominate your life.”

After returning home, the president later posted a video on Twitter, where he again downplayed the virus, saying, “One thing that’s for certain: don’t let it dominate you; don’t be afraid of it. You’re going to beat it.”

That exhortation quickly resonated, with some Democrats, scientists and relatives of victims denouncing the president as cavalier and dismissive about a disease that has killed so many, sickened more than 7.4 million and upended daily life across the country.

It was not the first time Mr. Trump has drawn criticism for being cavalier about the pandemic. On Sunday, when he left his quarters at Walter Reed to wave to supporters from an S.U.V., some doctors and others noted the “irresponsibility” of being in a sealed vehicle and potentially exposing Secret Service agents for an unnecessary stunt.

Critics also noted the president is receiving care that isn’t available to most people, including an experimental antibody treatment that is still being tested in clinical trials and has been given to only a few hundred people.

The manufacturer, Regeneron, has said that most of those who have gotten the cocktail have done so as participants in the trials, although in a handful of cases they have received it outside of the studies, as Mr. Trump did.

Dr. Conley would not discuss the findings of a scan of Mr. Trump’s lungs, which can be affected by the respiratory virus. His doctors had earlier said that his blood oxygen levels had dropped at least twice, and that he had received supplemental oxygen, which would indicate that his lungs were not functioning properly.

“There are HIPAA rules and regulations that restrict me in sharing certain things for his safety and his own health and reasons,” Dr. Conley said, referring to a federal law that restricts what type of patient information health professionals can share. On Sunday, Dr. Conley was also evasive, avoiding questions about whether any lung damage or pneumonia was revealed by the president’s X-rays.

Mr. Trump’s return home was a dramatic turn of events given that just a day earlier, his medical team had presented mixed messages about his condition, saying that the president was feeling well but also revealing that he had been prescribed the steroid dexamethasone, which is typically not used unless someone needs mechanical ventilation or supplemental oxygen.

Some medical experts said on Monday that given Mr. Trump’s risk factors — he is 74, male and overweight — he should be closely watched for at least the first week of his infection because some patients quickly deteriorate several days into their illness.

“I think it would be disastrous to be in a situation where he gets really sick at the White House, and you’re having to emergency transfer him,” said Dr. Céline Gounder of N.Y.U. Grossman School of Medicine, who has been caring for Covid-19 patients. “To me, it’s not safe.”

Dr. Mangala Narasimhan, the director of critical care services for Northwell Health, the largest health care provider in New York State, said that if the president does not need oxygen, it may be reasonable for him to go home, given that he can receive medical treatment at the White House.

But she said the information about his condition was too limited to allow outside experts to assess his condition. “We’re all guessing,” she said.

She, too, warned that Mr. Trump was heading into a critical period. “There could be a very rapid decline in these patients,” she said, adding that some develop blood clots in their lungs and other pulmonary problems, and need to be quickly put on ventilators.

Credit…Anna Moneymaker for The New York Times

Public health experts had hoped that President Trump, chastened by his own infection with the coronavirus and the cases that have erupted among his staff members, would act decisively to persuade his supporters that wearing masks and social distancing were essential to protecting themselves and their loved ones.

But instead, tweeting on Monday from the military hospital where he had been receiving state-of-the-art treatment for Covid-19, the president yet again downplayed the deadly threat of the virus.

“Don’t be afraid of Covid,” he wrote. “Don’t let it dominate your life.”

The president’s comments drew outrage from scientists, ethicists and doctors, as well as some people whose relatives and friends were among the more than 210,000 people who have died in the United States.

“I am struggling for words — this is crazy,” said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania. “It is just utterly irresponsible.”

Fiana Garza Tulip, 40, who lives in Brooklyn and lost her mother to the virus, wrote in a text message that she was “reeling” after reading Mr. Trump’s tweet, which she described as a “slap in the face” and a “painful reminder that our president is unfit for office and that he does not care about human life.”

“My mom, a respiratory therapist, couldn’t get tested at her hospital where she worked, she had to look for two days for a testing site while feeling the effects of Covid, she didn’t want to go to a hospital because she said it was worse there and she didn’t want to call an ambulance because it was too expensive. So she stayed home for a week and lost her pulse as soon as the medics put her on a gurney.”

Shane Peoples, 41, whose parents, Darlene and Johnny Peoples, died of the coronavirus on the same day in September, said the president’s comments were frustrating.

“Is he actually trying to put more lives at risk?” Mr. Peoples said. “He needs to be held accountable for the deaths that could have been prevented if he never downplayed it.”

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical School in Tennessee, called the president’s message “dangerous” because it encouraged his followers to ignore basic recommendations to keep themselves safe.

“It will lead to more casual behavior, which will lead to more transmission of the virus, which will lead to more illness, and more illness will lead to more deaths,” Dr. Schaffner said.

Mr. Trump has often ignored the recommendations of public health experts, repeatedly mocking people for wearing masks, for example.

“I don’t wear masks like him,” he said of the Democratic presidential candidate, Joseph R. Biden Jr., at a debate last week. “Every time you see him, he’s got a mask. He could be speaking 200 feet away from them, and he shows up with the biggest mask I’ve ever seen.”

Upon Mr. Trump’s return on Monday evening from the Walter Reed medical center, he climbed the steps of the White House, turned to face the TV cameras that were carrying the news live, and removed his mask.

Credit…Federica Narancio/Associated Press

Top White House officials are blocking strict new federal guidelines for the emergency release of a coronavirus vaccine, objecting to a provision that would almost certainly guarantee that no vaccine could be authorized before the election on Nov. 3, according to people familiar with the approval process.

Facing a White House blockade, the Food and Drug Administration is seeking other avenues to ensure that vaccines meet the guidelines. That includes sharing the standards with an outside advisory committee of experts — perhaps as soon as this week — that is supposed to meet publicly before any vaccine is authorized for emergency use. The hope is that the committee will enforce the guidelines, regardless of the White House’s reaction.

The struggle over the guidelines is part of a monthslong tug of war between the White House and federal agencies on the front lines of the pandemic response. White House officials have repeatedly intervened to shape decisions and public announcements in ways that paint the administration’s response to the pandemic in a positive light.

That pattern has dismayed a growing number of career officials and political appointees involved in the administration’s fight against a virus that has killed more than 210,000 people in the United States.

The vaccine guidelines carry special significance: By refusing to allow the F.D.A. to release them, the White House is undercutting the government’s effort to reassure the public that any vaccine will be safe and effective, health experts fear.

“The public must have full faith in the scientific process and the rigor of F.D.A.’s regulatory oversight if we are to end the pandemic,” the biotech industry’s trade association pleaded on Thursday, in a letter to President Trump’s health secretary, Alex M. Azar II, asking for release of the guidelines.

Credit…Jacquelyn Martin/Associated Press

The coronavirus outbreak in the West Wing continued to spread on Monday, as the White House press secretary and two of her deputies joined the list of aides close to President Trump who have tested positive for the virus, heightening fears that more cases are still to come.

The press secretary, Kayleigh McEnany, announced on Twitter that she had tested positive and would be quarantining. Ms. McEnany said she had previously tested negative several times, “including every day since Thursday,” but health experts said she may have been infectious for days — including when she spoke briefly to reporters without a mask outside the White House on Sunday.

Two other members of the press team, Karoline Leavitt and Chad Gilmartin, who is Ms. McEnany’s relative, also tested positive — but learned about their status before Ms. McEnany, according to two people familiar with the diagnoses.

The revelations came amid many unanswered questions about whether Mr. Trump could relocate to the White House without endangering himself and others and suggested that the White House does not have control of the virus.

Vice President Mike Pence, who tested negative on Sunday, was scheduled to travel to Utah ahead of Wednesday night’s vice-presidential debate. Mr. Pence also plans to attend campaign events in Arizona and Florida this week before stopping in his home state of Indiana to vote early.

His doctor said in a statement on Friday that Mr. Pence was not quarantining because, as of that time, he had not been close enough to any individuals known to have the coronavirus for long enough to qualify as “a close contact” at high risk of infection.

Credit…Al Drago for The New York Times

Despite almost daily disclosures of new coronavirus infections among President Trump’s close associates, the White House is making little effort to investigate the scope and source of its outbreak.

According to a White House official familiar with the plans, the administration has decided not to trace the contacts of guests and staff members at the Sept. 26 Rose Garden celebration for Judge Amy Coney Barrett, Mr. Trump’s Supreme Court nominee. At least 11 people who attended the event, including the president and the first lady, have since tested positive.

Instead, it has limited its efforts to notifying people who came in close contact with Mr. Trump in the two days before his Covid diagnosis on Thursday evening. The White House official, who declined to be identified because he was not authorized to speak about the matter, said that the administration was following guidelines from the C.D.C.

The contact tracing efforts have consisted mostly of emails notifying people of potential exposure, rather than the detailed phone conversations necessary to trace all contacts of people who have been exposed. These efforts, typically conducted by the C.D.C., are being run by the White House Medical Unit, a group of about 30 doctors, nurses and physician assistants, headed by Dr. Sean Conley, the White House physician.

“This is a total abdication of responsibility by the Trump administration,” said Dr. Joshua Barocas, a public health expert at Boston University, who has advised the city of Boston on contact tracing. “The idea that we’re not involving the C.D.C. to do contact tracing at this point seems like a massive public health threat.”

Credit…Doug Mills/The New York Times

Two weeks after the Centers for Disease Control and Prevention removed online guidance about airborne transmission of the coronavirus, the agency has replaced it with language citing new evidence that the virus can spread beyond six feet indoors, adrift in the air.

“These transmissions occurred within enclosed spaces that had inadequate ventilation,” the new guidance said. “Sometimes the infected person was breathing heavily, for example while singing or exercising.”

Notably, the C.D.C.’s new guidance softens a previous statement referring to the coronavirus as “an airborne virus,” a term that may have required hospitals to treat infected patients in specialized rooms and health care workers to wear N95 masks anywhere in a hospital.

The new version says the virus can be spread by both larger droplets and smaller aerosols released when people “cough, sneeze, sing, talk, or breathe.” But while the virus can be airborne under some circumstances, this is not the primary way the virus spreads.

The C.D.C.’s revisions come as the Trump administration is contending with a rising number of such infections among the president’s inner circle. Kayleigh McEnany, the White House press secretary, announced on Monday morning that she was positive for the coronavirus, the latest in a string of political figures heading into isolation following what may have been a so-called super-spreader event at the White House last month.

Despite the time that former Vice President Joseph R. Biden spent with President Trump during the presidential debate in Cleveland last week, Mr. Biden is continuing to campaign because he did not meet the C.D.C. requirement for close contact — less than six feet of distance from an infected person.

But in a statement accompanying the new guidance, the C.D.C. said, “People are more likely to become infected the longer and closer they are to a person with Covid-19.”

Mr. Trump talked loudly and at length during the debate, which experts said could have released 10 times as much virus as breathing alone.




‘Better Safe Than Sorry,’ Cuomo Says After School Closings

Gov. Andrew M. Cuomo of New York announced that he would close schools on Tuesday in areas where there has been a spike in coronavirus cases.

On the schools in these areas not all of them have been tested. So we don’t have data on all of the schools in these hotspot clusters — that troubles me. They have sampled some schools in the clusters, but not all the schools. And these are the hotspot clusters, right? So you have to prioritize testing. You want to go to these schools first because you know they are in hotspot clusters. So some schools in those clusters we have not yet done testing on. Better safe than sorry. I would not send my child to a school in a hotspot cluster that has not been tested, where I did not have proof that the infection rate was low in that school. I would not send my child. I am not going to recommend or allow any New York City family to send their child to a school that I wouldn’t send my child. We’re going to close the schools in those areas tomorrow.

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Gov. Andrew M. Cuomo of New York announced that he would close schools on Tuesday in areas where there has been a spike in coronavirus cases.CreditCredit…Spencer Platt/Getty Images

Gov. Andrew M. Cuomo of New York refused on Monday to allow New York City to close nonessential businesses in nine hot spots in Brooklyn and Queens where the coronavirus has spiked, pre-empting a plan announced the day before by Mayor Bill de Blasio.

The governor suggested that the ZIP codes that were being used to identify hot spots were too imprecise to guide shutdowns. The more pressing problem, he said, lay in schools and houses of worship, including many that cater to Orthodox Jews, rather than businesses that “are not large spreaders.”

The dissonance in messages from the state’s two most prominent politicians created confusion for residents, business owners and parents in the affected areas and drew scrutiny to the conflict between city and state over how to tackle early signs of a second wave of the virus in its onetime epicenter.

The governor’s announcement also seemed to be yet another manifestation of his long feud with Mr. de Blasio. Mr. Cuomo has frequently second-guessed or overruled the mayor, who is also a Democrat, during their tenures. Those clashes were cast in sharp relief during the early days of the pandemic, with the city and state at odds over the timing of shutting down the city’s businesses and its schools, among other issues.

On Monday, that disconnect continued, as Mr. Cuomo accelerated the mayor’s plan to close schools in newly hard-hit areas, moving the closure date up a day to Tuesday, and forcing parents in those areas to again rejigger their schedules to accommodate changes in their children’s routines. Mr. Cuomo said he spoke with Mr. de Blasio and Michael Mulgrew, the president of the city’s teachers’ union, among other local officials, on Monday morning and added that all were in agreement on the need for additional data on cases at specific schools.

Mr. Cuomo did not rule out closing nonessential businesses or public spaces in the near future, and top aides suggested a state plan could be unveiled as soon as Tuesday. Mr. Cuomo said his administration was reviewing how best to do it without relying on geographic delineations from ZIP codes, which he said were arbitrary and might not accurately capture the areas where new cases are going up.

“A ZIP code is not the best definition of the applicable zone,” he said. “If you have to circumscribe an area, make sure you have the right boundaries.”

Cuomo administration officials later suggested that the boundaries for business closures could even exceed the ZIP codes where the increases are now occurring.

On Monday afternoon, not long after the governor’s news conference, Mr. de Blasio said at a news conference of his own that he still planned to close nonessential businesses in the nine ZIP codes. He added later that “we obviously will follow state law, and if the state does not authorize restrictions we’re not going to act. But I find that very unlikely at this point.”

Mr. Cuomo had also announced that the state would take over supervision of enforcement of mask and social-distancing rules in the hot spot clusters, presumably putting the State Police in charge of New York City Police Department officers. He added that local governments would need to provide personnel.

The mayor said that he did not believe that the state could seize control of enforcement from local governments but that he agreed with Mr. Cuomo on the need for aggressive enforcement and “stronger restrictions that will allow us to turn the tide.”

Credit…Doug Mills/The New York Times

President Trump’s declaration that he would leave Walter Reed National Military Medical Center, where he was being treated for the coronavirus, left health professionals stunned. But even if he were not the president, his doctors would have to take extraordinary measures to keep him in the hospital against his will.

Under ordinary circumstances, a patient who wanted to leave the hospital against the recommendation of his or her doctor might be asked to sign a discharge form acknowledging that he or she was declining further treatment. At times, psychiatrists are called in to determine if the patient is capable of making such a decision.

In the medical lexicon, this is called leaving “A.M.A.” — against medical advice. Roughly 2 percent of all patients do so, for varying reasons, often because they need to juggle work and home obligations. If the patient leaving against medical advice had a contagious disease, he or she would be asked to pledge to follow public health guidelines to keep those around him or her safe.

“Having an infectious illness itself is not a reason to keep someone in the hospital,” said Dr. Leana Wen, a former commissioner of health for the city of Baltimore. “But if there is a suspicion that a patient will knowingly and purposefully endanger others, there would need to be a discussion had about keeping that patient in the hospital against his will.”

That discussion would be a complicated legal one, governed by state and local public health laws — and the Constitution. Both Dr. Wen and Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, raised tuberculosis — a highly infectious disease — as an applicable analogy.

In Baltimore, Dr. Wen said, the public health department routinely stepped in to ensure that patients in the hospital for tuberculosis treatment were kept there if “they gave us reason to believe that if they were to leave that they would not take the medications that were prescribed and then they would be at high risk for infecting others.” She said law enforcement often became involved.

In Tennessee, Dr. Schaffner said, doctors would be required to seek permission from a judge. The burden of proof is on the health care system, he said, “to document that the person is a substantial hazard to others and then they can be confined until they complete their therapy.”

The federal Centers for Disease Control and Prevention has published a handbook on tuberculosis control laws as a guide for medical professionals. “Courts have struggled to determine when government authority to promote the population’s health justifies encroaching upon established individual rights,” the handbook says.

The White House physician, Dr. Sean P. Conley, told reporters on Monday that Mr. Trump had not pushed his doctors to “do anything that was beyond safe and reasonable practice.” And he noted that at the White House, Mr. Trump would have “24-7 world-class medical care surrounding him.”

Even so, Dr. Conley acknowledged that Mr. Trump is not yet in the clear, and said he would not “take that final deep sigh of relief” until at least next Monday, because the next few days will be critical. Other experts have raised blunt questions about why Mr. Trump would go home — even to the White House — so soon after diagnosis, especially given the unpredictable course of Covid-19, the disease caused by the coronavirus.

“I’m worried about in two days he might suddenly crash and then on an emergency basis he would have to be rushed back,” Dr. Schaffner said.

He also raised questions about the president’s decision to leave Walter Reed for an impromptu ride in a motorcade through surrounding Bethesda, Md., on Sunday afternoon. Ordinarily doctors want patients to self-isolate until they are 10 days from the onset of symptoms, and three days without symptoms.

“I’d be surprised if it were with medical concurrence,” Dr. Schaffner said.

Credit…Doug Mills/The New York Times

Dr. Sean P. Conley runs the White House Medical Unit and holds the title of physician to the president. He is also a commander in the Navy, which means his patient is also his commander in chief. The arrangement turns the traditional power dynamic between doctor and patient on its head, with Dr. Conley ultimately forced to choose between compliance and disobedience should President Trump disagree with his recommendations.

“The president has been a phenomenal patient during his stay here, and he’s been working hand in glove with us and the team,” Dr. Conley said at a news conference at Walter Reed National Military Medical Center in Bethesda, Md., hours before the president’s departure from the hospital Monday afternoon. Dr. Conley refused to answer some of the questions asked by reporters, citing medical privacy laws.

That right to privacy under the 1996 Health Insurance Portability and Accountability Act can be waived by patients if they so choose, allowing doctors to share otherwise protected information with the public. It appears that Mr. Trump has waived only information that supports the idea that he is rapidly returning to good health.

After a news conference on Saturday during which Dr. Conley provided a rosy view of the president’s condition, he admitted that he had misled the public to reflect the “upbeat attitude” of the White House.

“All of these decisions fall at the feet of the president ultimately, and that is putting hospitals and doctors in a bad position,” said David Lapan, a former official at the Homeland Security and Defense Departments and a retired Marine colonel. “When the doctors come out and say things in news conferences that are either seen as untrue or obfuscating, that reflects poorly on the doctor and the military.”

Credit…Abedin Taherkenareh/EPA, via Shutterstock

Iran’s coronavirus crisis worsened on Monday, with a record numbers of deaths and new infections, as the capital, Tehran, went into partial shutdown for a week.

The restrictions in Tehran, which went into effect on Saturday, include fines for anyone not wearing a mask in public. The government ordered the shutdown of schools, gyms, cafes, cinemas, beauty salons, museums and mosques, even for Friday prayers.

The health ministry on Monday reported 235 deaths from the virus, the highest daily count in Iran since the disease was first reported there in February. Masoud Mardani, a member of the government’s coronavirus committee, told the newspaper Etemad that the true death toll was several times higher than the official tally.

The ministry reported 3,902 new infections on Monday — another record — and 2,000 people hospitalized. Doctors warned on state TV that hospitals across the nation had reached full capacity and there were no more empty beds in intensive care units in Tehran.

President Hassan Rouhani announced the new restrictions as his government came under fire for taking a relatively passive stance on the crisis, referred to as the “inshallah” approach, from the Arabic expression meaning “God willing” or “if God wills.”

“Unfortunately, Tehran in terms of enforcing health regulation is like a city with nobody in charge,” said Hossein Kermanpour, the spokesman for the country’s regulatory body for health care.

The government said that all of Iran’s 31 provinces are considered hot spots, but Tehran is the worst.

Mr. Rouhani said on Saturday that only 53 percent of Iranians were following health protocols such as social distancing and wearing masks. He said “regulations and oversight” would increase, and he authorized local coronavirus committees in each province to enforce one-week shutdowns.

Credit…Ethan Miller/Getty Images

N.F.L. officials announced new rules on Monday to get teams to adhere to health protocols after the postponement of two games this week.

The changes are in addition to earlier guidelines to wear protective masks, to physically distance where possible and to limit access to locker rooms and other places where players and coaches congregate, and they offer a degree of remote monitoring to ensure compliance.

Roger Goodell, the league’s commissioner, said the changes included the introduction of a leaguewide video system to monitor whether players and staff members were wearing personal protective equipment like masks while inside team facilities and while traveling. The league is also limiting the number of free agent tryouts per week and placing bans on gatherings outside team facilities.

Existing coronavirus protocols were established with the players’ union following a call between the league office, team owners, general managers and head coaches. The consequences for not following those guidelines have included fining head coaches $100,000 for being seen during games not wearing masks properly, with another $250,000 assessed against their teams.

Before the season began, some league officials expected coronavirus outbreaks, in part because team owners and players chose not to create a closed community, or “bubble,” and instead have allowed personnel to leave the relatively secure team facilities after practice every day, dramatically increasing the odds of exposure.

“The big thing for us is to not get comfortable,” Goodell said before the start of the season. “We’re dealing with a lot of uncertainty.”

Credit…Alex Wroblewski/Reuters

As President Trump and some of his associates test positive for the coronavirus, the number of new cases reported each day across the United States has been slowly rising.

The country is at a key moment in the pandemic, and spread of the virus could worsen significantly through the autumn, experts fear, as colder weather forces people indoors. Every day, some 43,000 new cases are being reported — far fewer than during the surge in the summer, but still an uncomfortably large number.

Some of the country’s least populous states are now seeing their highest infection rates.

When coastal cities suffered in the spring, cases remained relatively scarce across most of the nation’s midsection. But since late summer, North Dakota and South Dakota have added more cases per capita than any other state.

Utah recorded 1,387 new cases on Sunday, a single-day record. Four states — Wisconsin, Indiana, Montana and Wyoming — have added more cases in the last week than in any other seven-day stretch of the pandemic.

One significant change from the spring and early summer has been the return of college students to campuses.

The New York Times has identified more than 130,000 cases at more than 1,300 American colleges since the pandemic began.

Some of the worst trouble spots have calmed. Florida is now averaging about 2,300 new cases a day, roughly one-fifth of what it was seeing at its worst. In Arizona, daily case reports have dropped to about 500 on average, down from more than 3,600.

New infections have also plunged in Georgia, Louisiana and South Carolina. Mississippi and Alabama have made significant progress since midsummer as well, though case numbers there remain high.

California and Texas have also seen drops in case numbers. Both states, however, have recorded more than 800,000 cases.

“I’m actually disturbed and concerned about the fact that our baseline of infections is still stuck at around 40,000 per day,” Dr. Anthony S. Fauci, the country’s leading expert on infectious disease, said Monday on CNN. “That’s no place to be when you’re trying to get your arms around an epidemic and get it to a very low baseline as you get into a situation where you’re going to be indoors more than outdoors.”

Credit…Jon Super/Associated Press

England’s perpetually troubled coronavirus testing system was recently felled by a technical problem involving an overly large spreadsheet, lawmakers said on Monday. The glitch caused nearly 16,000 positive test results to go unrecorded in the country’s official tallies.

Those unrecorded positive test results dramatically changed the picture of England’s widening coronavirus outbreak, pushing it closer to the brink of fresh restrictions on travel and socializing.

While the people who tested positive received their own results, their names were not fed into the country’s contact tracing system, leaving tens of thousands of people in the dark about their exposure.




‘Incredible What They’re Doing,’ Johnson Says of Vaccine Team

On Monday, Prime Minister Boris Johnson of Britain spoke of the incredible work the vaccine team is doing, and noted that the increase in coronavirus cases across England is not surprising.

The incidents that were seeing in the cases really sort of corresponds to pretty much where we thought we were. And to be frank, I think the slightly lower numbers that we’d seen, you know, didn’t really reflect where we thought the disease was likely to go. So I think it’s — these numbers are realistic. The crucial thing is that in the next few days, week, we will see more clearly whether some of the restrictions that we’ve put in, the extra enforcement of the Rule of 6, the extra enforcement of self-isolation, the rules en masse and so on — all the stuff that has come in, we’ll see whether that starts to work in in driving down the virus. But you know, this is all very much in our hands. I went to see the scientists at Oxford at the Edward Jenner Institute, the AstraZeneca team. Incredible what they’re doing. You really feel that they must be on the verge of it. But, you know, it’s got to be properly tested. It’s got to be properly validated, and we’re not there yet. Obviously, if and when we get a vaccine then the crucial thing will be to ensure that we have sufficient supplies in this country that we’re able to make it in this country, distribute it fast in this country. And clearly, the priority for a vaccine will be as I think Kate Bingham among others have said, will be those who are the most vulnerable groups.

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On Monday, Prime Minister Boris Johnson of Britain spoke of the incredible work the vaccine team is doing, and noted that the increase in coronavirus cases across England is not surprising.CreditCredit…Tolga Akmen/Agence France-Presse — Getty Images

Because of the glitch, English health officials reported daily new infections in the middle of last week that were several thousand cases lower than they should have been. On Wednesday and Thursday, the country was reporting roughly 7,000 new daily cases, when the actual count was above 10,000.

“This isn’t just a shambles,” Jonathan Ashworth, the opposition Labour Party’s lead lawmaker on health issues, said in the House of Commons on Monday. “It’s much worse.”

Matt Hancock, the health secretary for the Conservative government, attributed the problem to a “legacy” data collection system used by England’s health officials.

Health officials said that some files with positive test results exceeded the maximum size that their systems could handle. They said they were now splitting large files to ensure that they do not get stuck again.

Credit…Pool photo by Johanna Geron

The European Commission said Monday that 179 staff members had tested positive for the coronavirus since the start of the pandemic, while its leader continued to self-isolate after being exposed to the virus during an official visit to Portugal last week.

Ursula von der Leyen, the president of the European Commission, was exposed during her trip to someone who later tested positive. While she had tested negative twice, Ms. von der Leyen was expected to continue quarantining until Tuesday, in accordance with local rules in Brussels.

Charles Michel, the president of the European Council, which is the other major E.U. institution, had to self-isolate in late September after a member of his security staff tested positive, leading to the postponement of an important E.U. leaders’ summit on foreign policy. He eventually tested negative for the virus.

The infections at the heart of the bloc’s bureaucracy, in offices primarily in Brussels, but also in Luxembourg and Italy, have driven home that the bloc, which runs on constant meetings, may need to change the way it does business.

Ms. von der Leyen, for example, came under criticism for traveling to Portugal last week, as her visit did not seem necessary. She said Monday that she would cancel a planned visit to Greece to collect an award this week.

Credit…Anna Moneymaker for The New York Times

Dr. Anthony S. Fauci, the nation’s leading infectious disease expert and to many a trusted voice throughout the pandemic, said he has confidence in the doctor overseeing President Trump’s care, Dr. Sean P. Conley, a Navy commander and doctor of osteopathy who has been the White House physician since 2018.

“Personally, I have not been involved in the direct care of the president,” Dr. Fauci said Monday on CNN, a fact that has come as a surprise to many in medicine. “But I might comment that my colleagues that I know, including Sean Conley, are very good physicians and they’re very qualified, so I am really confident that the president of the United States is getting the optimal care that you can get with the team over at Walter Reed.”

Americans have been looking to Dr. Conley who, over a busy weekend of medical briefings, has at times delivered confusion and obfuscation about the president’s condition. Dr. Conley even confessed that he had misled the public on Saturday about Mr. Trump’s treatment to reflect the “upbeat attitude” of the White House.

On Saturday, he ducked questions about whether Mr. Trump had been on oxygen, then revealed on Sunday that indeed, the president had been on oxygen — an indicator that Mr. Trump’s illness may be classified as “severe.” On Sunday, Dr. Conley was similarly evasive, sidestepping questions about whether the president’s X-rays revealed any lung damage or pneumonia. “I’m not going to get into specifics of his care,” he said.

Caring for any president presents unique challenges. Like all doctors, Dr. Conley is bound by oath to respect his patient’s wishes for privacy and to keep secret that which “ought not to be spoken of outside.” He is also a Navy officer caring for the commander in chief, whose orders he is obliged to follow.

But all of that must be balanced against the public’s right to have information about the health of one of the world’s most powerful leaders. And this particular leader, Mr. Trump, is well known for not wanting to look weak.

Dr. Conley is supervising a team of medical experts at Walter Reed National Military Medical Center in Bethesda, Md., including Dr. Sean Dooley, a pulmonologist, as well as an outside expert, Dr. Brian Garibaldi, the director of the biocontainment unit at Johns Hopkins Hospital in Baltimore.

No matter what Dr. Conley says or does not say, his colleagues in medicine agree on one thing: If he is going to put himself in the position of answering questions about the president’s care, he has to answer truthfully and to the fullest extent possible.

“You can’t both wear the white coat and lie, evade, obfuscate the situation,” said Dr. Ezekiel Emanuel, a bioethicist at the University of Pennsylvania, “because you are using the white coat to give yourself credibility.”

Credit…Charlotte Kesl for The New York Times

The plight of the entertainment industry deepened on Monday as the British company Cineworld, which owns Regal Cinemas in the United States, said it would temporarily close all 663 of its movie theaters in the United States and Britain. The move was expected to affect 40,000 employees in the United States and 5,000 in Britain.

The chain had reopened in parts of the United States and Europe over the summer, but about 200 theaters, mostly in California and New York, have been shut since the pandemic began in the spring.

The news sent Cineworld’s stock spiraling. It fell as much as 60 percent when the stock market opened in London on Monday. It was later trading about 38 percent lower on the day.

The company said it could not entice viewers back without a pipeline of new films. The news came after Metro-Goldwyn-Mayer announced on Friday that it would push back the release date of the latest James Bond film, “No Time to Die,” to April from this fall — the second time its release date has been delayed because of the pandemic.

Mooky Greidinger, the chief executive of Cineworld, said on Sky News that delays in the opening of many films — including “Mulan,” “Black Widow,” “Wonder Woman 1984,” as well as the Bond movie — meant the company “didn’t have the goods” for customers.

“It’s the wrong decision from the studios to move the movies in such a way,” Mr. Greidinger said.

He added that he felt the company had been able to reopen with enough health and safety precautions to welcome back customers, and cited “Tenet,” the Christopher Nolan film that opened in August and September, as the most significant release this year. It has made more than $300 million in the box office globally, but just $45 million of that was in the United States.

The delays by studios in releasing what would have been blockbuster movies before the pandemi, is hurting theaters all over the world. Tim Richards, the chief executive of Vue International, said that the studios were being too U.S.-centric by not acknowledging reopenings in Europe and China. “We are struggling. We are absolutely struggling,” he said on Sky News.

Mr. Greidinger did not specify when Cineworld and Regal theaters might reopen. That “might be in two months,” he said, or even “a little bit longer.”

In September, Cineworld reported a pretax loss of $1.6 billion for the first half of 2020. In total, the company operates 780 cinemas and is leaving open about 100 locations in Poland, the Czech Republic, Slovakia, Hungary, Bulgaria and Romania. Last year, 90 percent of the company’s revenue was generated in the United States and Britain.

In a memo to employees in Britain, Mr. Greidinger said: “Unfortunately, we cannot operate without a proper flow of products and sadly, you, like I, have seen audience numbers dwindle to tiny and unsustainable levels and the delay of Bond has been a huge blow.”

He did not say what would happen to workers’ jobs. The British government has announced a new job support program, in which employers and the government would share the cost of topping up the wages of employees whose hours were reduced. It will replace a more generous furlough program that ends this month. Echoing critics of the government’s new plan, Mr. Greidinger told employees that because it places a greater financial burden on employers, it “cannot work for us when we have almost no income.”

Global Roundup

Credit…Cesar Manso/Agence France-Presse — Getty Images

Two midsize Spanish cities, León and Palencia, were ordered on Monday by the regional authorities to apply lockdown restrictions similar to those that came into force in Madrid last weekend, underlining the extent to which a second wave of coronavirus infections is spreading beyond Spain’s capital region.

The new restrictions mean that residents of León and Palencia, which are in the northwestern region of Castile and León, will not be able to leave their cities as of Tuesday. Both have reached an infection rate of more than 500 cases per 100,000 residents.

Over the last seven days, Spain has reported 73,451 new cases, which works out to 157 cases per 100,000 residents, according to a Times database. As of Monday, almost 11,000 people were being treated in hospitals across the country for Covid-19, the disease caused by the virus, including 1,580 people in intensive care units.

In other global developments:

  • Bars in Paris will close for two weeks starting on Tuesday, the authorities there announced on Monday, as France tries to stem a surge of coronavirus cases in its capital. The measure will also affect most cafes, which in many cases serve alcohol, but little or no food. Restaurants will be able to remain open if they follow a strict health protocol. Local health officials said the capital had been above the thresholds for the top alert level — more than 250 coronavirus cases per 100,000 people generally, more than 100 per 100,000 among the elderly, and more than one-third of intensive care beds used for Covid-19 patients — since last Thursday.

  • Nicolas Maduro, the leader of Venezuela, has said his son and sister plan to take part in clinical trials of a coronavirus vaccine developed in Russia. Russian health officials in August said they were the first in the world to register a vaccine for emergency use outside of clinical trials, but no other countries have followed their lead with the Russian vaccine. The vaccine, called Sputnik V, has not been tested in late-stage clinical trials that show whether a vaccine is effective and whether it has side effects. Those trials are underway in Russia, Belarus and Venezuela. Russia also plans to test the vaccine in Brazil, India and the United Arab Emirates. In the trial, Mr. Maduro’s family members will receive either a placebo or the vaccine. Mr. Maduro said he planned to take the Russian vaccine once the trial is completed.

  • New Zealand will lift restrictions on Auckland, its most populous city, from midnight on Wednesday, joining the rest of the nation. Restrictions had been reinstated after a cluster of infections emerged, but after the city reported no new infections for 10 consecutive days, Prime Minister Jacinda Ardern said on Monday that a second wave there had almost certainly been “eliminated.”

Credit…Ammar Awad/Reuters

Israel was the first country to enter a second national coronavirus lockdown, but with new daily cases of the coronavirus reaching up to 9,000 recently, and with public trust in the government plummeting, there has been little letup in a growing sense of chaos and loss of control.

Several factors are complicating its struggle with a surge in coronavirus cases and deaths that, relative to the size of the population, is among the worst in the world.

Curbs on protests under the new lockdown — limiting gatherings to 20 masked people, two meters apart and no farther than about half a mile from their homes — have backfired. Israelis calling for the resignation of Prime Minister Benjamin Netanyahu, who is standing trial on corruption charges and has been a focus of blame over the country’s handling of the pandemic, have staged hundreds of smaller demonstrations, even as protesters face an increase in attacks by their opponents and the police are also accused of violence.

The authorities are also struggling to prevent large gatherings in the country’s ultra-Orthodox communities during the Jewish High Holy Days, which began on Sept. 18 and extend until Oct. 11. Dr. Ronni Gamzu, Israel’s coronavirus czar, said last week that 40 percent of those testing positive came from the ultra-Orthodox community, even though it makes up only about 13 percent of the population.

Some Hasidic sects insisted on holding indoor prayers to celebrate Sukkot, the Jewish harvest holiday. Stormy confrontations broke out on Sunday in some ultra-Orthodox areas.

But the large weddings that were blamed for a surge of infections among Israel’s Arab minority over the summer have subsided, after Arab mayors acted to enforce restrictions on large gatherings. There has been a significant decline in new cases among Arab citizens of Israel.

Credit…Joshua Lott for The New York Times

Six months ago, for the first time in its history, the Peace Corps suspended all operations as the coronavirus raced around the globe. Now it is preparing to send volunteers back into the field.

But the planning for the redeployment of Americans around a world shaken by the pandemic comes as the agency faces renewed questions about the quality of its medical care, touched off in part by the death of a 24-year-old volunteer from undiagnosed malaria.

The volunteer, Bernice Heiderman, died alone in a hotel room in Comoros, off Africa’s east coast, in 2018, after sending desperate text messages to her family. She told them that her Peace Corps doctor was not taking her complaints seriously.

An investigation by the agency’s inspector general documented a string of problems. Ms. Heiderman’s doctor, the investigation found, had “limited training in tropical medicine,” and failed to test for malaria — an obvious diagnosis. And the agency’s medical experts in Washington, with whom he consulted, never asked him to.

“Had she received timely treatment,” the inspector general concluded, “she could have made a rapid, full recovery.”

In March, the Peace Corps evacuated more than 7,000 volunteers from more than 60 countries. It is now accepting applications for them to return to service. If conditions permit, officials said, some may return to their posts by the end of the year, and new volunteers may begin as early as Jan. 1.

The agency said in an emailed statement that it “continues to grieve the tragic loss of volunteer Bernice Heiderman” and that it had “initiated several steps to further strengthen health care for volunteers.”

Credit…Mike Belleme for The New York Times

The death of 19-year-old Chad Dorrill, a student at Appalachian State in North Carolina, has shaken the rural campus in the Blue Ridge Mountains, prompting questions about whether the college is doing enough to keep its students and faculty safe.

Young people have generally been at lower risk of developing severe Covid-19, and there have been only a few student deaths linked to the coronavirus. But Mr. Dorrill’s death has made the virus real for his classmates.

“It’s not a hoax, that this virus really does exist,” said Emma Crider. “Before this, the overall mentality was ‘out of sight, out of mind.’”

As if to underscore that point, cases at Appalachian State, part of North Carolina’s state university system, spiked sharply last week. On Thursday, the school canceled a football game and announced outbreaks in four residence halls, two fraternity houses, the volleyball team and the football program. The school’s dashboard shows more than 700 confirmed Covid-19 cases since early June, across a 20,000-student campus.

Appalachian State has not conducted the kind of costly, widespread mandatory testing and tracing of people with and without symptoms that has helped control the virus at some campuses. Rather, the school has offered voluntary testing at its student health center and at “pop-up” test sites where students can walk up and be tested twice weekly.

That approach, the school’s website says, is based on C.D.C. guidance, which has advised against testing all students upon arrival. Health experts have criticized that guidance as weak and confusing, but many large public colleges have used it as the basis of their approaches.

In the wake of Mr. Dorrill’s death and the spike in cases, tensions are rising over whether Appalachian State needs to take stronger measures to contain the virus.

“There has been polarization between those who say, ‘Just wear a mask, we’ll be OK,’ and the faculty who just don’t want to be in the room,” said Rick Rheingans, chairman of Appalachian State’s department of sustainable development, who has been tracking the school’s health measures. “My argument has been that we need rigorous testing and active tracing, quarantining and isolation. We can’t reopen if we’re not safe.”

Credit…Jose A. Alvarado Jr. for The New York Times

New York City police officials have instructed all officers to wear masks in public or risk discipline, as the department faces mounting criticism over officers’ failure to comply with a state mandate that people wear face coverings in public when social distancing is not possible.

The Police Department’s directive, issued on Friday in memos and a video, came after elected officials repeatedly called out the police for flouting the mask mandate they are supposed to enforce. About 400 officers have been assigned to nine neighborhoods in Brooklyn and Queens where there have been upticks in coronavirus cases and where the city plans to close nonessential businesses and schools this week.

Terence A. Monahan, the chief of department and the highest-ranking uniformed officer, appeared in a video sent to officers on Friday instructing them to wear masks in public areas, department facilities and where they cannot be socially distanced.

“It is our responsibility to set the example for our great city and do everything we can to help ensure that we do not have another hospitalized member bring this deadly infection into our homes or have another funeral,” he said.

A memo sent later in the day added that the requirement applies to shared offices, elevators, halls and bathrooms, and at all times in the first 14 days of an officer’s return from places with a travel advisory. But officials carved out exceptions when officers are eating and drinking, adjusting their masks or having difficulty breathing.

Credit…Mary Altaffer/Associated Press

Most shoppers these days are able to routinely buy common household items like toilet paper, paper towels, pasta and beans that were in short supply in the early weeks of the pandemic. But Clorox wipes remain stubbornly elusive.

With cleanliness on the minds of many guarding against the virus, the wipes have become the pandemic version of the must-have toy of the holiday season. Across social media, shoppers share where and when to find wipes made by Clorox, or Lysol — which is owned by Reckitt Benckiser Group — or wipes from other brands. (Only Clorox and a handful of other wipes have been approved by regulators to kill coronavirus.)

All of the hullabaloo around its disinfecting wipes has been a strange turn of events for Clorox, which started making and selling liquid bleach as a household cleaning product back in 1916, and presents a big challenge for Linda Rendle, a 17-year veteran of the company who took over as its chief executive officer in mid-September.

The company said it was struggling because demand for the wipes had surged 500 percent in the past few months. After increasing production, Clorox is making one million canisters of disinfecting wipes each day. (Executives wouldn’t say how that compared with before the pandemic.) It plans to further increase production early next year.

Before the pandemic, Clorox — which also makes Glad trash bags, Kingsford charcoal and Pine Sol cleaner — told Wall Street analysts that, at best, the company would see a 1 percent increase in sales for its fiscal year 2020.

“I learned a lot about Covid,” the president of the United States assured his fellow citizens, looking straight into the camera on Day 3 of his stay at the Walter Reed National Military Medical Center.

But what have Americans learned?

It may just be how little they still seem to know about the virus — and about the most famous patient in the world.

When did President Trump and his aides first realize he might be infected? When exactly did his treatment begin? Did he know he might be ill and meet with supporters anyway? And were his doctors being fully forthcoming about just how he sick he might be?

There were questions, too, about just what a president who has mocked mask wearing, encouraged crowded political rallies, advanced dubious treatments and at times even dismissed the seriousness of the virus threat has learned from his own personal encounter with Covid-19, the disease caused by the virus.

“I get it, and I understand it,” Mr. Trump said in the video he posted from the Walter Reed military hospital in Bethesda, Md., late Sunday afternoon. But it was anyone’s guess if he was chagrined at the situation he now found himself in. Officials on his campaign have continued to defend his flouting of public health guidelines; over the weekend, they refused to acknowledge that it could have led to his infection and the infections of other Republicans.

The president did not use the video as an opportunity to urge people to be careful: to wear masks and maintain social distance. He did use it to laud his political supporters, some of whom were gathered outside the hospital complex.

Then, seasoned reality show performer that he is, he broke the fourth wall, confiding to viewers that he planned to pay those supporters a surprise visit.

A little while later, he made good on his word. The president infected with a disease that has killed more than 200,000 Americans got into a tightly sealed S.U.V. accompanied by Secret Service agents for a quick drive-by wave.

Some doctors, nurses and therapists have a prescription for helping us through this pandemic: Try a little laughter.

Humor is not just a distraction from the crisis, said Dr. Michael Miller, a cardiologist at the University of Maryland School of Medicine in Baltimore. It’s a winning strategy to stay healthy in the face of it.

“Heightened stress magnifies the risk of cardiovascular events, including heart attacks and strokes,” Dr. Miller said. “Having a good sense of humor is an excellent way to relieve stress and anxiety and bring back a sense of normalcy during these turbulent times.”

Laughter releases nitric oxide, a chemical that relaxes blood vessels, reduces blood pressure and decreases clotting, Dr. Miller said. An epidemiological study of older men and women in Japan confirmed that those who tend to laugh more have a lower risk of major cardiovascular illness. Possessing a healthy sense of humor is also associated with living longer, an epidemiological study from Norway reported, although the correlation appears to be stronger for women than for men.

Armed with this growing body of research, Dr. Miller prescribes “one good belly laugh a day” for his patients. It’s not just going “ha, ha,” he explained, but a “deep physiological laugh that elicits tears of joy and relaxation.”