Rapidly increasing caseloads across Europe and the United States are raising grave fears of another surge in coronavirus cases as winter approaches and people around the world chafe under pandemic restrictions impeding their daily lives — and livelihoods.
The spikes come as officials scramble to institute targeted restrictions on business, schools and travel — and to avoid the blanket lockdowns that paralyzed economic activity in the spring.
But it may be too late to avoid them. President Emmanuel Macron of France announced on Wednesday that, starting on Saturday, the authorities would impose a curfew between 9 p.m. and 6 a.m. in the Paris region and in the areas around eight other major cities, for at least four weeks. The measure is part of a renewed state of emergency which allows the national government to restrict public gatherings and movement countrywide. It had been declared for the first time in the spring but ended in July.
“We need this, and if we don’t want to take harsher measures in 15 days, or three weeks, or one month, we have to do it and comply with it,” Mr. Macron said.
He added that the government would later seek a two-week extension of the curfew in Parliament, for a total of six weeks. The curfew will be applied in the regions of Paris, Grenoble, Lille, Lyon, Aix-en-Provence and Marseille, Montpellier, Rouen, St.-Etienne and Toulouse, covering roughly 18 million residents.
France, Spain and the United Kingdom have all added more cases per capita than the United States over the last seven days ending Tuesday, according to a New York Times database. Over the same time period, the virus death rates ticked above 1 per 100,000 in all of those countries except for France, where it was at 0.9, but they remain far below the early days of the pandemic.
There is also growing concern about the damage a second virus wave could sow in the formerly Communist countries of Central Europe, many of which have weak health care systems facing critical shortages of doctors and nurses and inadequate testing programs. In the Czech Republic, virus deaths reached 2.9 per 100,000 people for the seven days ending Tuesday.
And in Russia, which reported its largest daily increase in infections on Wednesday, President Vladimir V. Putin sought refuge from the torrent of bad news by announcing that the Russian government had approved a second vaccine.
The International Federation of Red Cross and Red Crescent Societies on Wednesday urged European governments to take action quickly to protect those vulnerable to the virus, and to its disastrous economic effects.
“We know it is a very difficult moment which requires difficult decisions: solving the health crisis will help solve the economic and social one,” said Dr. Emanuele Capobianco, head of health and care for the organization.
Across the Atlantic, cases are trending upward in 39 American states, pushing the country’s case curve to its highest level since August. Those states include much of the Northeast, which is starting to backslide after months of progress, the Midwest and Mountain West, where uncontrolled outbreaks have strained hospitals.
Hospital beds are filling with virus patients, especially in the Northern Plains states, according to data compiled by the Covid Tracking Project. Its data showed that 36,051 people were hospitalized with Covid-19 as of Tuesday evening, a higher number than at any time since Aug. 29.
Even as testing remains insufficient in much of the country, 16 states each added more new cases in the seven-day period ending Monday than they had in any other weeklong stretch of the pandemic. North Dakota and South Dakota are reporting more new cases per person than any state has previously. And in Wisconsin, home to 10 of the country’s 20 metro areas with the highest rates of recent cases, crews are preparing a field hospital at the state fairgrounds.
“While we are hopeful we can flatten the curve enough to never have to use the facility, Wisconsinites across our state are struggling and they are rightfully scared of this virus,” Gov. Tony Evers wrote to legislative leaders this week.
President Trump is past the point of infectiousness and does not pose a safety risk to others, according to Dr. Anthony S. Fauci, the nation’s top infectious disease expert, who has reviewed data from Mr. Trump’s coronavirus tests.
Combined with the fact that Mr. Trump is more than 10 days out from the onset of symptoms, Dr. Fauci said in an interview Wednesday, “we feel confident that we can say with a high degree of confidence that he is not transmissible.”
The White House physician, Dr. Sean P. Conley, provided Mr. Trump’s test results after NBC News made it a requirement for Mr. Trump to participate in a town-hall-style event on Thursday night, said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases.
On Tuesday, Dr. Fauci and Dr. Clifford Lane, a clinical director at the National Institutes of Health, assessed Mr. Trump’s results from a P.C.R. test — the gold standard lab diagnostic for the coronavirus — as well as multiple negative results on a rapid antigen test, Abbott’s BinaxNOW. They also looked at results from attempts to grow live virus from Mr. Trump’s samples.
“We were just given the data, and we made a determination from the data,” Dr. Fauci said.
Results from multiple P.C.R. tests indicate that the amount of virus in Mr. Trump’s body has been steadily decreasing, Dr. Fauci said. The latest result has a cycle threshold — a proxy for viral load — of 34.3, “which is just about where you want it to be,” he said.
According to data provided by the Centers for Disease Control and Prevention, people with a threshold over 33 carry little to no live virus. Dr. Fauci also indicated that he had reviewed data from attempts to grow live virus from Mr. Trump’s samples but said he did not know where those tests had been done. Such experiments usually require a laboratory with extremely high safety levels.
For the second time this week, the Southeastern Conference has postponed a college football game because of the coronavirus pandemic, unnerving the league less than a month into the season that sustains an economic and cultural juggernaut throughout the South.
The league said Wednesday that Saturday’s game between No. 10 Florida and Louisiana State, the reigning national champion, would not be played until at least Dec. 12, a week before the conference title game.
The postponement came two days after Florida’s coach, Dan Mullen, described the football program as “a model of safety” during the pandemic and a day after the team paused football activities because of “an increase” in positive tests for the virus.
Florida’s game against L.S.U., which was to be played in Gainesville, Fla., was the 29th Football Bowl Subdivision game since last August to be upended because of the pandemic, and the third Power 5 matchup to be postponed this week.
The Big 12 Conference announced on Sunday that Baylor and Oklahoma State would not play this weekend because of an outbreak at Baylor. And on Monday, the SEC postponed a game between Missouri and Vanderbilt after Vanderbilt concluded that once injuries, opt-outs and virus-related concerns were considered, it would not have enough scholarship players available to compete on Saturday.
Treasury Secretary Steven Mnuchin said on Wednesday that he did not expect an economic relief package to be enacted before the Nov. 3 election as he and Speaker Nancy Pelosi of California have continued to struggle to reach an agreement on a broad package to support the economy.
Negotiators on Wednesday resumed discussions over a coronavirus relief package, even though Democrats and Republicans remain wildly divided over the scope and size of another stimulus bill.
Speaking at a Milken Institute conference on Wednesday, Mr. Mnuchin said that his conversation with Ms. Pelosi was “comprehensive” but indicated that important differences remained. He said that it was unlikely that a deal could be reached an enacted before the election.
“At this point, getting something done before the election and executing on that will be difficult,” Mr. Mnuchin said.
Ms. Pelosi and Mr. Mnuchin spoke on Wednesday for about an hour, discussing the language of the administration’s latest $1.8 trillion framework as compared to House Democrats’ $2.2 trillion stimulus plan, which Ms. Pelosi pushed through the House earlier this month.
They agreed to speak again on Thursday.
“One major area of disagreement continues to be that the White House lacks an understanding of the need for a national strategic testing plan,” Drew Hammill, a spokesman for Ms. Pelosi, said on Twitter. “The Speaker believes we must reopen our economy & schools safely & soon, & scientists agree we must have a strategic testing plan.”
The Treasury secretary suggested that the gap on the top-line cost of the bill was not that wide, but that the differences on the policies within a package remained significant. He said that the White House had already made big compromises on funding for state and local governments and that Republicans continued to want liability protections for businesses that were seeking to reopen during the pandemic.
“We continue to make progress on certain issues; on certain issues we continue to be far apart,” he said.
Mr. Mnuchin criticized Democrats for insisting on a comprehensive bill and not passing smaller bills on areas where the two sides agreed. He said that people and businesses needed immediate assistance and estimated that there was $300 billion unused relief money that could be repurposed with Congressional approval.
“Let’s not wait for the big bang and everything being perfect,” he said.
President Trump has pushed negotiators to “go big!!!” days after abruptly ending talks, but Senate Republicans remain reluctant to accept a broad sweeping bill, citing concerns about the cost of such a package after approving nearly $3 trillion in legislation earlier this year.
Senator Mitch McConnell of Kentucky, the majority leader, has said he plans to have the Senate vote to advance a scaled-back bill that would amount to a fraction of the $2.2 trillion bill Ms. Pelosi has demanded, but that is unlikely to pass without the Democratic support needed to clear the 60-vote threshold.
As New York State continues to fight the apparent resurgence of the coronavirus in several hot spots, Gov. Andrew M. Cuomo on Wednesday threatened to withhold state funds from local governments that do not successfully enforce shutdowns on schools and restrictions on gathering.
Mr. Cuomo specifically mentioned New York City and Orange and Rockland counties in the northern suburbs, including the town of Ramapo and village of Spring Valley, all of which have areas with the highest positivity rates of the state. Mr. Cuomo said he was frustrated by reports of continued gathering in those areas, including at schools and houses of worship, despite restrictions imposed by the state last week.
“Hopefully that will motivate them,” the governor said of local governments.
The governor did not provide details on what sources of funding would be withheld, or how much money could be denied to local governments, but said the state “could impound all funds.”
Hours later, a spokesman for Mayor Bill de Blasio of New York City criticized the governor’s comments.
“What drives NYC’s COVID response and enforcement is the threat of a second wave, not threats of federal or state funding cuts,” the spokesman, Bill Neidhardt, said on Twitter.
The Rockland County executive, Ed Day, said in a statement that he generally supported the governor’s restrictions and that the county had taken steps to enforce them. But he singled out both Ramapo and Spring Valley, saying that those localities, which have a majority of the county’s cases, “flat out refuse to enforce the governor’s executive orders.”
Mr. Cuomo also said that the state would withhold funds from both public and private schools that had already violated state orders, including those in “red zones,” or areas with the most severe restrictions, that had not closed as required. The schools will be notified in letters beginning on Wednesday, he said.
Statewide, the daily rate of positive tests results was 1.1 percent, Mr. Cuomo said. But in the red zones, the positivity rate was at 6.29 percent, up from 4.13 the day before.
And hospitalizations in the state increased to 938, up 15 from the day prior, the governor said. The state has seen a sustained increase in hospitalizations over the last 10 days.
In a news conference earlier on Wednesday, Mr. de Blasio said that the city’s seven-day average positivity rate was at 1.46 percent. He also sounded an upbeat note on positivity rates in the red zones.
“Leveling off is the right phrase,” Mr. de Blasio said, without specifying positivity rates in the zones.
At his briefing, Mr. Cuomo also criticized a sweet 16 birthday party held in Suffolk County on Long Island. The party took place on Sept. 25 at the Miller Place Inn, and has been connected to 37 cases, according to a statement on Tuesday from Suffolk County’s executive, Steve Bellone. There were 81 guests in attendance, well over the 50 currently permitted under state rules.
In an interview on Wednesday, Mr. Bellone said that there had been multiple complaints about health rule violations at the inn before the party. The inn, which has closed temporarily, was fined $12,000 for violating both county and state regulations.
Establishments that act irresponsibly threaten the health and “economic recovery for the whole community,” Mr. Bellone said, “and that’s why it’s so critical that bad actors are brought to task.”
The owners of the inn could not immediately be reached for comment on Wednesday.
As of Tuesday, the county’s health department was quarantining 270 people, and 11 were in isolation. Mr. Bellone said that, as “a result of the connection to this party,” one school had been closed, and 34 more schools had students who had to quarantine or isolate.
Without swift contact tracing from the health department, Mr. Bellone said, “the community spread would be out of control.”
Mr. Cuomo also said on Wednesday that the state would fine the promoters of an outdoor concert in Southhampton in July that the state said drew more than 2,150 people. Video footage of the event showed attendees crowding together.
Mr. Cuomo said that the state had concluded that social-distancing guidance was not followed or enforced at the concert, where the D.J. duo the Chainsmokers and the chief executive of Goldman Sachs performed.
The state also planned to penalize the town of Southhampton, which will no longer be able to approve permits for group gatherings without first receiving state approval, Mr. Cuomo said.
More than seven months into the coronavirus pandemic, the rules and regulations that govern daily life in the United States continue to vary widely, forcing people to interpret a checkerboard map of mask requirements, restaurant occupancy restrictions and travel guidelines.
What a person can and cannot do — go to a nightclub, throw a Halloween party, get a nose piercing — largely depends on where that person lives.
Many residents of Florida are free to work out at indoor gyms, eat inside at restaurants and mingle in crowded bars. But a resident of Los Angeles County, Calif., can do none of those things.
“Right now we really have 50 different experiments going on,” said L. Scott Benson, a professor at the University of Utah’s Division of Public Health.
Throughout the pandemic, discordant protocols across state lines have frustrated governors and public health officials trying to contain the spread of coronavirus.
In March, Gov. Andy Beshear of Kentucky lamented that residents could hop the border into neighboring Tennessee and eat at indoor restaurants. Those types of variations continue today, and even exist within individual states.
“They’re realizing that, well, if bars across the river are open, you can always go over to the bar over there,” said Robert D. Duval, a professor in West Virginia University’s Department of Health Policy, Management & Leadership. He added that people have to understand that such behavior prolongs the need for the rules in the first place.
On Tuesday, Gov. Gary Herbert of Utah unveiled new rules that apply on a county-by-county basis depending on the rates of virus transmission. Under the restrictions, a resident of Wasatch County could attend a social gathering of 10 people or fewer, while a person in neighboring Duchesne County could attend a gathering with as many as 50 people.
Mr. Benson and other public health experts said a one-size-fits-all coronavirus response would be impractical. People in rural areas require different rules than those in dense, urban populations, they say.
This week, two high-profile, late-stage clinical trials — Johnson & Johnson’s test of a coronavirus vaccine and Eli Lilly’s study of a Covid-19 drug — were put on pause because of possible safety concerns. Just a month earlier, AstraZeneca’s vaccine trial was paused after two volunteers became seriously ill.
Clinical trials experts said these delays were comforting, in a way: They show that the researchers were following proper safety procedures. But for now, details about the nature of the volunteers’ illnesses are scant. And although pauses of vaccine trials are not unusual, some experts said that pausing treatment trials — like that of Eli Lilly’s antibody drug — is rarer, and perhaps more worrisome.
That trial was testing the treatment on hospitalized patients — a group that was already sick, and in which declines in health would not be surprising. So for a trial like that one to be paused, the safety concerns must have been significant, they said.
“I’ve done 50-plus monitoring committees, and it’s quite a rare thing to do,” said Tim Friede, a biostatistician at University Medical Center Göttingen in Germany, referring to his role as a safety monitor for drug trials.
For now, the companies behind the trials aren’t saying much. In a statement in September, AstraZeneca said it paused its trial to investigate “a single event of an unexplained illness.” But two vaccinated volunteers reportedly developed the same condition, an inflammation of the spinal cord called transverse myelitis.
Johnson & Johnson said that it was pausing its vaccine trial because of an “unexplained illness.” Eli Lilly’s trial of the antibody treatment was paused because of a — so far undisclosed — health difference between the group that received the drug and the group that received a placebo.
When people volunteer for a late-stage trial, known as Phase 3, they randomly get a treatment or a placebo, and neither they nor their doctor knows which one they received. In the weeks that follow, they’re carefully monitored. People in a vaccine trial may get a checkup each month and record any symptoms they experience in a journal. People who get a drug while they’re hospitalized may be given blood tests and medical exams.
More than 38 million people worldwide have been infected with the coronavirus, and as of Monday, fewer than five of those cases have been confirmed by scientists to be reinfections.
Nevertheless, fears of repeat bouts of illness, impotent vaccines and unrelenting lockdowns were raised anew when a case study about a 25-year-old man in Nevada was published on Monday. The man, who was not named, became sicker the second time that he was infected with the virus, a pattern the immune system is supposed to prevent.
And rare as these cases may be, they do indicate that reinfection is possible, said Akiko Iwasaki, an immunologist at Yale University, who wrote a commentary accompanying the Nevada case study, published in The Lancet Infectious Diseases.
The New York Times asked more experts what is known about reinfections with the coronavirus.
It’s impossible to know how widespread the phenomenon is, they told us. To confirm a case, scientists must look for significant differences in the genes of the two coronaviruses causing both illnesses. In the U.S., many people were not tested unless they were sick enough to be hospitalized. Even then, their samples were usually not preserved for genetic analysis, making it impossible to confirm suspected reinfections.
Plus, a resurgence of symptoms doesn’t prove reinfection. More likely, these are people experiencing symptoms connected to the original infection.
But people with a second bout may pass the virus to others. An infection in a patient in Hong Kong was discovered only because of routine screening at the airport, and the man was isolated in a hospital even though he had no symptoms. But his viral load was high enough that he could have passed the virus to others.
An outbreak of infections in Hamilton, Ontario, has been linked to a single spin studio that Canadian officials said appeared to be complying with public health regulations before dozens of people who attended classes there contracted the virus.
Spinco, the company that operates the studio, has locations across Canada and asks participants in its classes to observe a rigorous set of safety procedures on its website, including wearing masks whenever not actively working out.
Health officials have linked 44 cases directly to the studio, including 42 patrons and two staff members, according to data on the city’s website. But efforts to trace the contacts of all those infected are continuing, and officials have already identified at least 17 more people infected through secondary “household spread,” according to the Canadian Broadcasting Corporation.
The event has caused the biggest spike in new cases in Hamilton since May, according to the city’s coronavirus statistics.
The outbreak at the Spinco studio follows others associated with cycling classes elsewhere in Canada, including one in Calgary in July in which more than 40 participants contracted the virus at a cycling club where staff from several local gyms had gathered to work out together. Health officials said the event renews questions about the safety of group workout classes, in which participants are breathing heavily in enclosed spaces for extended periods, and instructors often coach vocally throughout.
Doug Ford, Ontario’s premier, moved to shut down gyms elsewhere in the province last week, including in major urban areas such as Toronto and Ottawa, after concerning spikes in cases. Hamilton gyms remain open for the moment. Officials in Quebec also ordered gyms closed earlier this month.
Britain has long been divided on how it handles the pandemic, with England, Northern Ireland, Scotland and Wales taking divergent paths. Their differences were on display once again on Wednesday as Northern Ireland announced a four-week lockdown, and England’s three-tier system got off to a chaotic start in the northern city of Liverpool.
Northern Ireland, with a population of about 1.8 million people, is reporting an average of nearly 900 new daily cases this week, compared with an average of just over 100 during the height of the first wave of the pandemic in mid April, according to figures compiled by the Belfast Telegraph.
In response, it will close schools two weeks, and pubs and restaurants for a full month (takeout and delivery excluded). These changes will begin rolling out on Friday. Retail shops will be allowed to remain open.
Arlene Foster, Northern Ireland’s first minister, announced the new measures in the regional legislature, known as Stormont, noting a “very worrying increase” in the number of new coronavirus cases. While localized restrictions have been in place for some time, cases have continued to surge.
“This is deeply troubling and more steps are urgently needed,” Ms. Foster said.
Of the region’s nearly 22,000 total recorded cases, more than a quarter have occurred in the past seven days.
Liverpool, meanwhile, entered the “very high” alert level on Wednesday under England’s new three-tier system. Restrictions include a ban on meeting those from different households indoors and the closure of pubs and bars.
As bars closed at 10 p.m. on Tuesday, patrons poured into the street in Liverpool’s Concert Square. Videos posted online showed crowds of mostly young people packed together, embracing and dancing in the street, even as area hospitals are bracing for a new wave of coronavirus admissions.
Liverpool’s five members of Parliament have been highly critical of their region being singled out and have called for a broader national lockdown.
The measures come as Prime Minister Boris Johnson of Britain faces criticism for ignoring scientific advice for a brief nationwide lockdown — saying it would come at too high a cost — and instead implementing the new three-tier system.
In other news around the world:
As the politicians governing Madrid continue to fight against a federal state of emergency imposed last Friday on Spain’s capital region, a second wave of the virus is spreading faster in other parts of the country. In the northeastern region of Catalonia, the authorities approved new restrictions, including a 15-day closure of all bars and restaurants, except for takeaway food. Shops must limit their occupancy rate at 30 percent. “We are in an extremely complicated situation,” the acting regional leader of Catalonia, Pere Aragonès, said on Twitter. The number of cases in Catalonia has risen about 40 percent in the past week. In Navarra, whose regional capital is Pamplona, which has in recent days superseded Madrid as the region with the highest official infection rate, new restrictions came into force on Tuesday that included closing playgrounds and outdoors sports areas, as well forcing restaurants to close at 10 p.m. (Because of an editing error, an earlier version of this item misstated Navarra’s relationship to Pamplona.)
For some companies, the only response to the pandemic has been to hunker down and try to avoid running out of cash before their customers can return.
Pret, the 37-year-old British sandwich and coffee chain that’s ubiquitous in central London, is now clearly willing to try anything:
Pret wants to sell its food in supermarkets, and has already begun selling coffee beans on Amazon.
It has signed up to all the major food delivery platforms to bring its sandwiches, soups and salads to its work-from-home customers.
It opened a so-called dark kitchen in North London to prepare its food strictly for delivery, modeled on the success of Sweetgreen and Shake Shack, and hopes to open another dark kitchen in either New York or New Jersey soon.
It is devising a special menu of hot evening meals for delivery, such as a Chipotle Chicken Burrito Bowl.
And then there is the coffee subscription, an effort to drive people back to the stores: Five drinks a day made by a barista (coffees, teas and smoothies) for 20 pounds ($26) a month. On the face of it, it could be an extraordinarily good deal. With two lattes a week, a subscriber will break even. And the first month is free. (Small print: You can’t order five drinks at once — there must be 30 minutes between each drink order.)
From rural India, he worshiped President Trump like a god, praying to a life-size statue of the American leader in his backyard every morning.
Bussa Krishna, a widowed farmer in his 30s, became a fan about four years ago, when the president appeared to him in a dream to predict that India’s national cricket squad would beat its archrival, Pakistan, in a cricket match.
India won, “and from that day he started worshiping Donald Trump,” said Vivek Bukka, one of his cousins.
The young farmer was also drawn to Mr. Trump’s “straightforward ways and blunt speech,” said Vemula Venkat Goud, the headman of Mr. Krishna’s village in the southern state of Telangana.
As Mr. Krishna’s devotion to Mr. Trump intensified, he commissioned the construction of a shrine in his backyard with the life-size statue, Mr. Vivek said. He worshiped it for an hour or two each morning, as one might when praying to gods in the Hindu pantheon.
When Mr. Trump announced that he had tested positive for the coronavirus, Mr. Krishna was devastated.
“I feel very sad that my god, Trump, has contracted the coronavirus,” he said in a tearful video on Facebook. “I ask everyone to pray for his speedy recovery.”
He stopped eating to show solidarity with the president, his family said, and fell into a deep depression. On Sunday, he died of cardiac arrest. There is no evidence linking his death to his fasting.