Virus Surges in New Jersey, Where It Was Once Contained

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New Jersey contained the virus. Now it’s surging there again.

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New Jersey Gov. Phil Murphy is advising residents against non-essential out-of-state travel.Credit...Noah K. Murray/Associated Press

Coronavirus cases in New Jersey, an early epicenter of the pandemic, are on the rise again, doubling over the last month to an average of more than 900 new positive tests a day, a worrisome reversal of fortune for a state that had driven transmission rates to some of the nation’s lowest levels.

After an outbreak several weeks ago in a heavily Orthodox Jewish town near the Jersey Shore, cases are now rising in counties across the state, driven, officials say, by indoor gatherings.

The state’s health commissioner has said there are signs of “widespread community spread” for the first time since New Jersey successfully slowed the spread of a virus that has claimed the lives of more than 16,000 residents. A small, densely packed state, New Jersey has the highest virus fatality rate in the country.

Gov. Philip D. Murphy said Monday that residents should refrain from all but necessary out-of-state travel.

“The numbers are up,” Mr. Murphy said. “They’re up — up and down the state.”

Under a quarantine policy adopted by New Jersey, New York and Connecticut, New Jersey now exceeds the threshold — an average of 10 cases for every 100,000 residents for seven days — used to determine which states should be included in the travel advisory. Thirty-eight other states are on the list.

The uptick comes as other parts of the Northeast and states across the country are confronting similar surges of infections and hospitalizations as the pandemic stretches into its eighth month, with a death toll that now exceeds 219,000, according to a New York Times database.

Mr. Murphy, who has been conservative in allowing the state to reopen, said he would consider targeted shutdowns to curb the spread, as Connecticut and New York have done, but he suggested that would not cure the problem.

Public health experts are alarmed by a ‘herd immunity’ theory endorsed by Trump officials.

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Dr. Scott W. Atlas, an adviser to President Trump.Credit...Erin Scott for The New York Times

As the coronavirus pandemic erupted this spring, two professors at Stanford University — Dr. Jay Bhattacharya and Dr. Scott W. Atlas — bonded over a shared concern that lockdowns were creating economic and societal devastation. (An earlier version of this post misstated Dr. Atlas’s surname.)

Now Dr. Atlas is President Trump’s science adviser, a powerful force inside the White House. And Dr. Bhattacharya is one of three authors of the so-called Great Barrington Declaration, a scientific treatise that calls for allowing the coronavirus to spread in order to achieve “herd immunity” — the point at which enough people have been infected to stall transmission of the pathogen.

The Centers for Disease Control and Prevention and leading experts have recently concluded, using different scientific methods, that as many as 90 percent of Americans are still vulnerable to infection.

While Dr. Atlas and administration officials have denied advocating the herd immunity approach, they have praised the ideas in the declaration. The message is aligned with Mr. Trump’s vocal opposition to lockdowns on the campaign trail, even as the country grapples with renewed surges of the virus.

The central proposition is that to contain the coronavirus, people “who are not vulnerable should immediately be allowed to resume life as normal” while those at high risk are protected from infection.

Under that scenario, younger Americans should return to workplaces, schools, shops and restaurants, while older Americans would remain cloistered from the virus as it spreads, recipients of such services as grocery deliveries and medical care.

It argues that eventually so many younger Americans will have been exposed, and presumably will have developed some immunity, that the virus will not be able to maintain its hold on the communities.

The manifesto does not contain details on how the strategy would work in practice, nor do its authors have expertise in implementing public health programs. Dr. Anthony S. Fauci, the government’s top infectious disease expert, dismissed the declaration as unscientific, dangerous and “total nonsense,” as well as unethical, particularly for multigenerational families and communities of color.

The idea has alarmed and angered other public health researchers. On Wednesday, about 80 published a manifesto of their own, the John Snow Memorandum (named after a legendary epidemiologist), saying that this approach would endanger one-third of the U.S. population who have conditions that put them at high risk from severe Covid-19, and result in perhaps a half-million deaths.

“I think it’s wrong, I think it’s unsafe, I think it invites people to act in ways that have the potential to do an enormous amount of harm,” said Dr. Rochelle Walensky, an infectious disease expert at Harvard University and one of the signatories to the Snow memo. “You don’t roll out disease — you roll out vaccination.”

Tracking the Coronavirus ›

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Trump calls Fauci a ‘disaster.’

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Dr. Anthony S. Fauci, director of National Institute of Allergy and Infectious Diseases.Credit...Pool photo by Graeme Jennings

President Trump attacked Dr. Anthony S. Fauci, the government’s top infectious disease expert, in a conference call on Monday with campaign aides, calling the doctor a “disaster” and saying, “People are tired of hearing Fauci and these idiots, all these idiots who got it wrong.”

He continued his criticism of Dr. Fauci, the overwhelmingly popular director of the National Institute of Allergy and Infectious Diseases, after landing in Arizona for the first of two scheduled rallies in the state, which is experiencing a rise in coronavirus cases.

Speaking to reporters after deplaning Air Force One, Mr. Trump called Dr. Fauci “a very nice man” but complained that he “loves being on television” and has made “a lot of bad calls.” Asked why he didn’t fire Dr. Fauci, Mr. Trump said, “He’s been there for about 350 years. I don’t want to hurt him.”

At a campaign rally on Monday in Arizona, where polls show that the president is trailing Mr. Biden, Mr. Trump also faulted the news media for excessive coverage of the coronavirus.

“They’re getting tired of the pandemic, aren’t they?” Mr. Trump said in Prescott, in central Arizona. “You turn on CNN. That’s all they cover. Covid, Covid, pandemic, Covid, Covid.”

The attack on Dr. Fauci comes as the United States has seen more coronavirus cases — over 8 million — and more deaths — nearly 220,000 — than any other nation in the world. The president’s advisers have tried to get him to lay off the infectious diseases specialist, who remains popular.

Dr. Fauci pushed back against complaints that he had flip-flopped over the use of masks, saying that admitting a mistake after examining further data shows honesty.

The conflict began Sunday night on the CBS News program “60 Minutes,” when Dr. Fauci said it was “absolutely” no surprise that President Trump got sick with the coronavirus, given his lax attitude toward social distancing guidance.

“I was worried that he was going to get sick when I saw him in a completely precarious situation: crowded, no separation between people and almost nobody wearing a mask,” Dr. Fauci said in the CBS interview. He was referring to an event at the White House in September to announce the nomination of Amy Coney Barrett for the Supreme Court.

“When I saw that on TV, I said, ‘Oh, my goodness, nothing good can come out of that — that’s got to be a problem,’” Dr. Fauci said. “Sure enough, it turned out to be a super-spreader event.”

Numerous people who attended the event later tested positive for the coronavirus, including the president.

Dr. Fauci, who has often been at odds with the president, sharpened his stance against an ad run by Mr. Trump’s re-election campaign that appeared to show the doctor praising the president’s handling of the coronavirus. Dr. Fauci said his words were taken out of context, and that their use in the ad was inappropriate because he never endorses candidates.

“I got really ticked off,” he said.

Mr. Trump’s attacks on Dr. Fauci led Senator Lamar Alexander of Tennessee to become the latest Republican to distance himself from the president. “Dr. Fauci is one of our country’s most distinguished public servants,” said Mr. Alexander, who is retiring this year. “He has served six presidents, starting with Ronald Reagan. If more Americans paid attention to his advice, we’d have fewer cases of Covid-19, and it would be safer to go back to school and back to work and out to eat.”

The National Academy of Medicine honored Dr. Fauci on Monday with the academy’s first Presidential Citation for Exemplary Leadership, citing his “distinguished service as a trusted adviser to six U.S. presidents during public health crises” and “steady leadership during the Covid-19 pandemic.”

In his acceptance speech, Dr. Fauci said that to inspire public trust and confidence in vaccines, people needed to hear consistent messages from the government, not conflicting ones.

Wisconsin judge upholds governor’s order restricting indoor dining.

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In rural Wisconsin, many restaurants will be limited to ten indoor patrons.Credit...Bing Guan/Reuters

A judge in Wisconsin, the site of the one of the worst outbreaks of a resurgent coronavirus, has upheld an executive order by Gov. Tony Evers that limits public gatherings to 25 percent of a building or room’s capacity.

“This critically important ruling will help us prevent the spread of this virus by restoring limits on public gatherings,” said the governor’s office in a statement. “This crisis is urgent. Wisconsinites, stay home.”

The ruling means in rural Wisconsin, many restaurants, taverns, and supper clubs with no maximum capacity set by local authorities will be limited to ten patrons dining-in at a time, according to the Tavern League of Wisconsin, which requested a temporary injunction on Emergency Order #3 from the circuit court judge.

The state has reported more than 22,500 new coronavirus cases in the last week, according to a New York Times database, putting Wisconsin behind only North Dakota, South Dakota and Montana in terms of new infections per capita.

The Tavern League, which sued for relief against the executive order, represents about 5,000 small businesses, according to Scott Stenger, who heads the league’s government affairs outreach. “We don’t take suing anybody lightly, let alone the governor of our state,” Mr. Stenger said. “It’s not something we’d do before.”

Mr. Stenger said the league had not been consulted ahead of time about the emergency order, and did not have an opportunity to help craft regulations that might better help eateries and bars across the rural parts of the state stay open while still taking precautions to protect their customers.

The issue is especially acute in rural areas of Wisconsin, where there are often no set capacity limits for restaurants and taverns. By default, those businesses will be limited to ten patrons.

Without economic assistance from the state, or from Congress, Mr. Stenger said that more of his members will likely go out of business.

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California plans to have a ‘second set of eyes’ on vaccines once they’re approved.

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Gov. Gavin Newsom of California.Credit...Daniel Kim/The Sacramento Bee, via Associated Press

California will have its own independent panel of experts review any federally approved coronavirus vaccines before they are administered to residents, Gov. Gavin Newsom said on Monday.

“Of course we won’t take anyone’s word for it,” he said in a news briefing. He emphasized that the “second set of eyes” on potential vaccines is part of California’s broader efforts to make sure that vaccines get equitably distributed to communities that are most vulnerable.

While Mr. Newsom acknowledged that the vaccine approval process has been politicized, he said, “It doesn’t matter who the next president is, we’re going to maintain our vigilance.”

The announcement came after Gov. Andrew M. Cuomo of New York said that his state would also review vaccines approved by the federal government — although Mr. Cuomo tied the move to doubts raised when President Trump suggested that he would reject tougher F.D.A. guidelines. “Frankly, I’m not going to trust the federal government’s opinion,” Mr. Cuomo said in late September.

On Sunday, Mr. Cuomo, as head of the bipartisan National Governors Association, posed additional questions about how the Trump administration will ensure that states are able to get and distribute vaccines.

Mr. Newsom said that his state is working with the federal government on its vaccination plans, but that experts from California’s prestigious academic and health care institutions are helping to figure out expected logistical challenges. They include where to store vaccines that must be kept cold, how to notify people about when to get their second shots and how to guarantee that rural communities have access to vaccines.

Mr. Newsom cautioned against being “overly exuberant” about the prospect of widespread vaccination; he said that won’t happen until next year. “This vaccine will move at the speed of trust,” he said.

California’s new case rates have stayed relatively low, even as the state has expanded testing and gradually lifted restrictions on businesses. Still, the governor implored residents not to let their guard down as the holidays approach.

European countries impose targeted restrictions, desperate to avoid full lockdowns.

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Ireland will increase coronavirus restrictions in response to a new surge of infections.Credit...Paul Faith/Agence France-Presse — Getty Images

Countries across Europe announced new restrictions on Monday in an effort to halt a strong second wave of the virus, as the global tally of cases passed 40 million. Cases have been detected in nearly every country around the world, and at least 1.1 million people have died.

Officials are desperate to avoid a second economically damaging blanket lockdown, and are instead seeking to tighten restrictions in a more precise fashion. Here’s the latest.

Ireland will be imposing its highest level of restrictions starting on Wednesday night, Prime Minister Michael Martin announced on Monday. Nonessential businesses will be mandated to close, restaurants and pubs will be limited to takeout, and people will not be allowed to travel more than five kilometers (three miles) from their homes. Schools and construction sites will remain open, however, the public broadcaster RTE reported. The restrictions, which will remain in effect for six weeks, come after the country set new daily case records four times in the past week. “If we pull together over the next six weeks we will be able to celebrate Christmas in a meaningful way,” Mr. Martin said.

In Spain, the region of Navarre announced on Monday the country’s most drastic regional measures yet to contain the second wave. As of Thursday, Navarre will stop its residents from leaving their region except for work or emergency reasons. It will also close for 15 days its bars and restaurants, and force all shops, sports venues and other establishments to close by 9 p.m. The measures come after Navarre reported an average of 945 cases per 100,000 inhabitants over the past 14 days, three times the national average.

Austria, which reported 1,121 daily cases of the virus on Monday, announced new limits on the number of people who could meet privately starting Friday: six indoors and 12 outdoors. The country has reported nearly 10,000 cases in the past week, more than at any time in March, when the government imposed a nationwide lockdown. The restrictions were lifted over the summer as numbers dropped and the country sought to attract tourists, an important source of income for the alpine nation.

In Italy, Prime Minister Giuseppe Conte announced that mayors will have the power to close streets or squares where people tend to gather after 9 p.m., while restaurants, bars and pubs will be allowed to serve seated customers — up to six per table — until midnight. Drinking outside of restaurants or bars will be permitted only until 6 p.m., and gaming and betting halls will close at 9 p.m. Italy has so far fared better than its European counterparts, but infections have been rising in recent weeks, with a record 11,705 new cases reported on Sunday.

France imposed a nightly curfew in nine cities, including Paris, over the weekend, and asked people throughout the country to limit gatherings to six people to halt an alarming spike in cases. On Monday, the office of President Emmanuel Macron announced that the first lady, Brigitte Macron, was in quarantine after being exposed to someone who had tested positive. Ms. Macron has not shown any symptoms, the office said in a statement.

Slovenia’s government declared a 30-day state of emergency after cases of the virus more than doubled in the past week, Reuters reported. The government will ban movement between regions that have been most affected by the pandemic and introduce a nightly curfew beginning at 9 p.m. starting Monday, Interior Minister Ales Hojs said at a news conference. Mr. Hojs said that all public and religious events would be banned, and that the number of people allowed to gather would be reduced to six from 10. Slovenia has reported 4,845 coronavirus cases in the past week, a spike from 2,255 cases the week before.

Britain has reported an average of nearly 17,000 new cases a day over the past week, according to a New York Times database, with almost a thousand new daily cases in Wales.

Wales will enter a national lockdown starting Friday night, the country’s first minister, Mark Drakeford, announced on Monday. The “firebreak” lockdown, which will last until Nov. 9, will require residents to remain at home and force pubs, restaurants and nonessential shops to close. Mr. Drakeford said “there are no easy choices in front of us” and called the lockdown “our best chance of regaining control of the virus” and avoiding strain on the National Health Service.

About 2.3 million of the 3.1 million people in Wales were already living under local lockdowns. and the country has effectively shut its borders to travel from other parts of Britain.

And officials in Bucharest, the Romanian capital, announced that schools, theaters and indoor dining will be closed for at least two weeks, and that masks will become mandatory in all public spaces. The city reported on Sunday that the virus rate over the previous 14 days had exceeded three cases per 1,000 residents, a red line for imposing stricter rules. After keeping the virus largely in check during the initial months of the pandemic, Romania has seen cases triple over the past month. While the schools will switch to online learning, there is deep concern that many students lack tablets and other necessary materials.

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Get vaccinated right away? Polls find growing hesitation in the U.S.

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A patient enrolled in Pfizer’s vaccine clinical trial at the University of Maryland School of Medicine in Baltimore.Credit...University of Maryland School of Medicine, via Associated Press

As the Trump administration has pressed publicly for top-speed development and approval of a coronavirus vaccine, while researchers and public health experts warned of the dangers of rushing the process, the idea of getting the vaccine as soon as it is available is losing appeal for many Americans, especially Black Americans, recent surveys show.

In a STAT-Harris poll of about 2,000 people, conducted Oct. 7-10 and published Monday, 58 percent of respondents said they would get vaccinated right away, down from 69 percent who said the same in August.

The decline was twice as steep among Black respondents: just 43 percent said in October that they would get the vaccine, down from 65 percent in August.

Rob Jekielek, managing director of The Harris Poll, which has been asking the question throughout the pandemic, said two news events appeared to have played a role in the falloff: the back-and-forth between the Food and Drug Administration and the White House over vaccine guidelines, and President Trump’s Covid-19 diagnosis and treatment.

“The politicization of the process is having a huge negative effect, especially with Black Americans,” he said in an interview.

Pew Research Center polls that framed a question on the issue somewhat differently also found growing hesitation over a vaccine: About 51 percent of adult respondents said in September that they would definitely or probably get a vaccine if one were available, down from 72 percent who said the same in May. The surveys included more than 10,000 respondents and had a margin of sampling error of plus or minus 1.6 percentage points.

“It’s pretty clear the public is concerned about the pace of the vaccine approval process and have outstanding questions about safety,” said Alec Tyson, associate director of Pew Research.

Polls conducted for CNN by the market research firm SSRS asked, “If a vaccine to prevent coronavirus infection were widely available at a low cost, would you, personally, try to get that vaccine, or not?” Sixty-six percent of respondents said yes in May; just 51 percent did in October. The polls’ margin of error was plus or minus 3.3 percentage points.

And in an ABC News/Ipsos poll last month, 64 percent of respondents said they would take a “safe and effective coronavirus vaccine,” down from 74 percent in May. Those polls had a margin of error of 4.9 points.

In a bright spot for N.Y.C. schools, 10,676 tests yield just 18 positives.

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A public school in Brooklyn this month. Mayor Bill de Blasio of New York planned to reimpose restrictions on schools in neighborhoods where coronavirus cases were on the rise.Credit...Angela Weiss/Agence France-Presse — Getty Images

For months, as New York City struggled to start part-time, in-person classes, fear grew that its 1,800 public schools would become vectors of coronavirus infection.

But nearly three weeks into the in-person school year, early data from the city’s first effort at targeted testing has shown the opposite: a surprisingly small number of positive test results.

Out of 15,111 staff members and students tested randomly by the school system in the first week of its testing regimen, the city has gotten back results for 10,676. There were only 18 positives: 13 staff members and five students.

And when officials put mobile testing units at schools near Brooklyn and Queens neighborhoods that have had new outbreaks, only four positive cases turned up — out of more than 3,300 tests conducted since the last week of September.

New York City is facing fears of a second wave of the virus brought on by localized spikes in Brooklyn and Queens, which have required new shutdown restrictions that included the closure of more than 120 public schools as a precaution.

On Monday, Mayor Bill de Blasio said that city continued to see a “leveling off” in those areas and officials had seen “particular progress” in central Queens, the mayor said. But he did not provide data for those areas.

Across the city, the seven-day average positivity rate was at 1.62 percent, the mayor said. When he first announced an uptick in cases about three weeks ago, the positivity rate was 1.38 percent.

Shortly afterward on Monday, Gov. Andrew M. Cuomo said that data in different hot spot areas across the state where he had imposed restrictions by zones would continue to be reviewed, and that the state would “announce changes to the zones” on Wednesday. Zone sizes could be made larger or smaller, he said, adding that “we have total flexibility in these zones.”

Statewide, the daily positivity rate was 1.21 percent, he said, while the “red zones,” which have the most severe restrictions in place, had a positivity rate of 3.31 percent. Hospitalizations statewide, which have been steadily increasing in recent weeks, are 934.

But for now, at least, New York City’s sprawling system of public schools, the nation’s largest, is an unexpected bright spot as the city tries to recover from a pandemic that has killed more than 20,000 people and severely weakened its economy.

In September, New York became the first big urban district to reopen schools for in-person learning.

Roughly half of the city’s students have opted for hybrid learning, where they are in the building some days, but not others. The approach has enabled the city to keep class sizes small.

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Cuomo’s virus crackdown angers Catholics, who say they’re singled out.

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Claudia Balderas, 51, attended the first in-person Mass in almost four months at Saint Bartholomew Roman Catholic Church in the Queens in early July. Catholic leaders are upset with restrictions by Gov. Cuomo again limiting attendance in areas where coronavirus is surging.Credit...Jessie Wardarski/Associated Press

Over the last two weeks, Catholic leaders in New York have voiced their deep disapproval with Gov. Andrew M. Cuomo over his decision to sharply limit attendance at houses of worship in areas that are seeing a surge of new coronavirus cases.

The governor’s decision was largely aimed at trying to rein in congregants in Orthodox Jewish synagogues in New York City and in Orange and Rockland Counties, where some members have flouted social distancing and mask regulations.

But it also affected other houses of worship, including about two dozen parishes in the diocese covering Queens and Brooklyn, where Catholic officials have sued Mr. Cuomo in federal court, insisting that they have been abiding by the rules and should not be punished.

“We’ve gone above and beyond what they have recommended and mandated,” said Dennis Poust, a spokesman for the New York State Catholic Conference. “So if there’s an animus, it’s coming from his end, not our end.”

Leaders of the Diocese of Brooklyn and the Archdiocese of New York have also criticized the restrictions, which have closed nonessential businesses and limited occupancy in so-called red zones to 25 percent of building capacity or a mere 10 people, whichever is lower.

“To have all of the steps we’ve taken be ignored, and to face the prospect of indefinite unreasonable restrictions placed upon our churches is just not fair!” Cardinal Timothy M. Dolan wrote in a blog post last week. “Why are churches being singled out? Why especially are those houses of worship that have been exemplary, strict and successful in heeding all warnings, being shut down again?”

GLOBAL ROUNDUP

Poland’s de facto leader goes into quarantine, and other news from around the world.

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Jaroslaw Kaczynski, center, at his swearing-in as deputy prime minister in Warsaw on Oct. 6. Credit...Radek Pietruszka/EPA, via Shutterstock

Poland’s deputy prime minister and de facto leader, Jaroslaw Kaczynski, is going into quarantine after learning that he had been in contact with someone infected with the coronavirus, a government spokesman said, adding that Mr. Kaczynski, who is 71, “feels well and will continue performing his duties from home.”

Mr. Kaczynski did not wear a mask when he handed out an award at a ceremony last week, and briefly took off his mask when he was sworn in as deputy prime minister on Oct. 6.

Poland largely resisted the first wave of the pandemic with an early lockdown that began in March. But after it reopened all its schools for in-person instruction in early September, case counts started climbing, and the country is now battling a major surge of infections and hospitalizations. Poland has reported 49,950 new cases in the last seven days, according to a New York Times database, and 175,766 in all, with more than 3,500 Covid-19-related deaths.

With hospital beds filling up, there is particular concern about the damage that the virus could sow in Poland, which has a relatively weak health care system and one of the lowest ratios of doctors and nurses to residents in the European Union.

To deal with the surge, the government is transforming the national stadium in Warsaw into a field hospital. The health minister, Adam Niedzielski, said on Monday that temporary Covid-19 hospitals would also be set up in other major cities, and that he was in discussions with private hospitals about making more beds available. Mr. Niedzielski warned that if the virus continued to spread at its current pace, the country could soon be facing as many as 20,000 new cases a day.

In other developments around the world:

  • Restrictions on nonessential travel between the United States, Canada and Mexico will be extended until Nov. 21, Chad Wolf, the acting secretary of Homeland Security, announced on Monday. “We are working closely with Mexico & Canada to identify safe criteria to ease the restrictions in the future & support our border communities,” Mr. Wolf wrote on Twitter. In the past seven days, Canada has reported 16,284 cases, which works out to 44 per 100,000 people; Mexico, 33,724 cases, or 27 per 100,000; and the U.S., 396,305 cases, or 119 per 100,000.

  • Officials in Melbourne, Australia, announced some easing of one of the world’s strictest lockdowns, allowing residents to travel up to 25 kilometers from their homes and up to 10 people from two households to socialize outdoors. Dan Andrews, the premier of the state of Victoria, drew a contrast between the situation there and in Britain, where there have been fewer restrictions despite a surge in cases. “Back in August and at our peak, we reported 725 daily cases. At the same time, the U.K. recorded 891,” he said in a statement. “Today, as Victoria records two new cases, the U.K. hit 16,171. And as we continue easing our restrictions, they are being forced to increase theirs.”

  • Twenty-five crew members aboard a livestock carrier docked at a port in Western Australia have tested positive for the coronavirus. The ship, the Al Messilah, has 52 crew members, and the authorities warned that further positive test results were possible.

  • Prime Minister Sanna Marin of Finland has tested negative for coronavirus, her office said on Monday. She left a European Union summit in Brussels prematurely on Friday because she had come in contact with people who later tested positive. “The prime minister will continue her self-isolation and she will be tested again on Monday,” the office said in a statement. Ms. Marin’s voluntary quarantine will end if the second test result proves negative, her office added.

  • South Africa’s health minister, Dr. Zwelini Mkhize, said that he and his wife, Dr. May Mkhize, had tested positive for the coronavirus and that he was optimistic that they would “fully recover.” Dr. Mkhize was tested on Saturday after showing mild symptoms, and both he and his wife are in quarantine at home. South Africa, which has recorded at least 703,000 cases of the coronavirus, has largely reopened its economy.

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Cuomo says N.Y. won’t enforce restrictions on three neighbors, after confusion over quarantine for Pennsylvania travelers.

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Diners in Marlboro, N.J., in September. Despite a sharp uptick in cases in New Jersey, Gov. Andrew M. Cuomo of New York said there was no practical way to require travelers from there to quarantine.Credit...Michael Loccisano/Getty Images

Despite an uptick of coronavirus cases in New Jersey, Connecticut and Pennsylvania, New York officials said on Tuesday that travelers from those three neighboring states would not be required to quarantine, though each state meets the qualifications for the restriction.

The announcement came with no small amount of confusion: A senior adviser to the governor confirmed that Pennsylvania would be added to the quarantine list, and Mr. Cuomo later indicated in a news conference that New Jersey and Connecticut would not be required to quarantine, but he did not initially mention Pennsylvania.

But the governor later clarified in a statement that enforcement from Pennsylvania would also be too difficult to maintain, considering the vast number of people who cross the state’s northern border into New York and its eastern border into New Jersey.

That rationale was also articulated by Mr. Cuomo in reference to Connecticut and New Jersey, two neighbors to New York that have worked together for months to try to coordinate a response to the coronavirus crisis.

“There is no practical way to quarantine New York from New Jersey and Connecticut,” Mr. Cuomo, a third-term Democrat, said in a morning news conference. “There are just too many interchanges, there are too many interconnections, there are too many people that live in one place and work in the other.”

Adding to the confusion, Beth Garvey, special counsel to Mr. Cuomo, said during the morning news conference that New Jersey and Connecticut were both “being added” to the list on Tuesday, despite Mr. Cuomo earlier suggesting they would not be. In a brief aside after Ms. Garvey’s remarks, the governor said “Pennsylvania, we have the same basic issue.”

None of the states were on a quarantine list released on Tuesday afternoon by the governor’s office.

Still, Mr. Cuomo said that all nonessential travel among New York and the three states should be avoided and promised he would issue more guidance on that point on Wednesday.

New York did add two states to its list on Tuesday: Maryland and Arizona. All told, 40 states and territories are now on the travel advisory list, which Mr. Cuomo referred to as “really a bizarre outcome” considering that New York once faced one of the worst outbreaks in the country.

On Monday, more than 64,200 new cases and at least 517 new deaths were reported in the United States. Over the past week, there have been an average of 59,269 cases per day, an increase of 34 percent from the average two weeks earlier, and fears are growing in New York about a potential second wave. Two weeks ago, Mr. Cuomo closed nonessential businesses in parts of Queens and Brooklyn where positivity rates had spiked.

Since late June, New York, New Jersey and Connecticut have worked in concert to create a list of states from which travelers to the region are subject to a two-week quarantine.

Essential workers have been exempt from the quarantine since it began in June. Other workers who cross state lines have technically been subject to the advisory, but officials have also said that the quarantine is only required by those who spend at least 24 hours in a state on the list — which would exclude most commuters.

The quarantine was intended to apply to any person arriving from an area with a positivity rate higher than 10 per 100,000 residents over a 7-day rolling average or an area with a 10 percent or higher positivity rate over a 7-day rolling average.

New Jersey has a population of about 8.88 million people, and so anything over an average of about 888 new cases puts the state above that threshold. According to a New York Times database, New Jersey has seen an average of 1,016 cases per day in the past week, an increase of 54 percent from the average two weeks earlier.

For Connecticut, the threshold is around 356, and its daily average in the past week was at 378 cases per day.

Though New York has seen a significant increase in cases in parts of New York City and its suburbs, its overall positivity rate has remained lower than its neighbors. On Tuesday, Mr. Cuomo said the daily rate was 1.32 percent statewide, and 2.91 percent in the so-called red zones, areas where he recently imposed severe restrictions as virus hot spots sprang up across the state. Hospitalizations in the state increased by eight, to 942.

In New York City, Mayor Bill de Blasio said Tuesday that the citywide seven-day average positivity rate was at 1.58 percent.

An earlier version of this item incorrectly described when more than 64,200 new cases and at least 517 new deaths were reported in the U.S. It was Monday, not Tuesday.

Australia welcomed New Zealanders to visit only two states. They’re now traveling around the country.

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Passengers arriving in Australia on a flight from Sydney to Perth were escorted to buses by police officers because of potential violations of the government’s travel bubble arrangement.Credit...Paul Kane/Getty Images

New Zealanders, under a travel arrangement announced earlier this month with Australia, are allowed to visit the states of New South Wales and the Northern Territory, which have seen relatively low cases of the coronavirus.

But some appear eager to keep on traveling.

Gaps have emerged in the arrangement, meant to be the start a travel bubble that would later encompass Australia, after New Zealanders who entered the country via participating states have traveled on to other parts of Australia for vacations, or to visit friends and family.

But the rules for where they could travel after arriving are unclear, and many have caught connecting flights to other cities, including Melbourne — which has been under some of the strictest lockdown laws in the world after a second wave of the virus hit in July.

Initially, the state government of Victoria, the state that encompasses Melbourne, took the position that the dozens of passengers were unwelcome and sent police to track them down. It later backtracked, acknowledging that anyone from New Zealand, which has for the second time eliminated the virus, did not pose a risk to the state.

Michael Outram, the head of the Australian Border Force, said that the states had never raised objections to New Zealanders entering the country.

“Once a passenger leaves the international terminal, once they depart the customs controlled area, the back of the baggage hall, they cease to be an international traveler or passenger, they’ve entered Australia,” Mr. Outram told reporters on Monday.

The bubble, he added, “stops at the international terminal.”

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A vaccine that has not completed clinical trials finds strong demand in China.

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A packaging facility of the Chinese vaccine maker Sinovac Biotech during a government-organized media tour in Beijing last month.Credit...Thomas Peter/Reuters

The eastern Chinese city of Yiwu has stopped the sale of a coronavirus vaccine after dozens of people demanded to be inoculated over the weekend, underlining the popularity of the treatment that has not even completed late-stage clinical trials.

Hundreds of people in Yiwu stood in line for a coronavirus vaccine after the government opened up bookings to the general public, the BBC reported on Sunday. The local government had said on Friday it would allow people to be vaccinated on an “emergency use” basis, a day after the neighboring city of Jiaxing announced the same.

The vaccine in Yiwu was made by a private company, Sinovac Biotech, according to The Paper, a Shanghai-based news website. Sinovac’s vaccine is in Phase 3 trials, the last stage of clinical trials before approval. Scientists have warned that taking a vaccine before the completion of clinical trials carries health risks.

On Sunday, The Beijing News, a state-run newspaper, cited a person familiar with the Yiwu health department as saying that the supply of vaccines had stopped and that people should not travel to the city to be vaccinated. But a representative from Yiwu’s center for disease control and prevention told The New York Times that local hospitals were still providing coronavirus vaccinations. He declined to confirm whether the sale had been suspended or provide more details.

According to the newspaper, the local government’s intention was to find out what demand was like for “emergency users,” defined mainly as people who had to travel from Yiwu, an export powerhouse in China.

The high demand for the vaccine in China highlights the potential shortfall that local governments could face once a treatment is approved. Unlike in the United States — where a growing number of polls have found that many people would not get a coronavirus vaccine in part because they feel the Trump administration is pushing for its approval before fully weighing the safety and efficacy data — many people in China are flocking to get one.

China has indicated it would expand the number of “emergency users” for a vaccination program, saying it plans to target people at higher risk of being exposed to the virus such as travelers and health care workers. Tens of thousands of people have already been vaccinated, including government officials and executives of vaccine companies.

Kenya’s health minister warns of a second wave as cases rise.

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Kenya’s government offered free coronavirus tests in the capital of Nairobi on Sunday.Credit...Tony Karumba/Agence France-Presse — Getty Images

Across Kenya, people in bars are hoisting drinks in proximity and taking to the dance floors of reopened nightclubs. Churches and mosques have started hosting congregations, schools have partially reopened, and the notorious traffic in cities like Nairobi has partly resumed.

After almost five months of a strict lockdown and dusk to dawn curfew, the authorities in Kenya last month eased the restrictions meant to curb the spread of the pandemic. But on Sunday, Health Minister Mutahi Kagwe said the relaxation of the rules could lead to a second wave of the coronavirus. He said the percentage of positive test results had increased this month, after restrictions were lifted, and admissions to intensive care units had increased in recent days. Large number of cases were also reported in prisons.

“We can confidently point to a potential crisis unless we take some immediate action to avert this,” Mr. Kagwe said in a press briefing on Sunday. “We can choose to sink or swim.”

Mr. Kagwe blamed the rise in cases on the resumption of large public events including political rallies, weddings and burials. He said club owners weren’t enforcing social distancing and were not asking their patrons to wear masks.

Mr. Kagwe also accused health workers — hundreds of whom have tested positive and have protested lack of adequate protective gear — of getting lax about protection.

“These times are not normal and please don’t treat them normally,” he warned. “Normal behavior will have abnormal consequences.”

Kenya has reported nearly 45,000 cases of the coronavirus and 832 deaths, according to a New York Times database.

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The total number of virus cases around the world has surpassed 40 million.

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Treating a Covid-19 patient in Madrid last week.Credit...Oscar Del Pozo/Agence France-Presse — Getty Images

The global total of coronavirus cases has passed 40 million, according to a New York Times database as of Monday, with at least 1.1 million people deaths, and the virus has been detected in nearly every country.

The United States and Europe are seeing strong second waves of the virus. Unlike during the first wave, most countries are trying hard to avoid blanket lockdowns, tightening restrictions in steps and hoping to get the virus under control. Pandemic fatigue has set in for many people.

Anticipating coronavirus vaccines, UNICEF plans to stockpile more than half a billion syringes.

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Humanitarian aid at a UNICEF warehouse in Copenhagen last week.Credit...Associated Press

UNICEF, the world’s largest single buyer of vaccines, is not waiting for approval of the first coronavirus vaccines for widespread use. The U.N. agency said Monday that it was purchasing and distributing more than half a billion single-dose syringes and other critical equipment in countries where it operates, to be ready when the time comes.

In a statement, UNICEF said the advance stockpiling — a collaboration with GAVI, the Vaccine Alliance — was part of a larger plan to amass one billion syringes by 2021 to guarantee a supply “and help ensure that syringes arrive in countries before the Covid-19 vaccines.”

Henrietta H. Fore, the executive director of UNICEF, said the agency was anticipating that the vaccination effort would be “one of the largest mass undertakings in human history” and was working to avert the possibility that vaccines would be available but the means to administer them would not.

“In order to move fast later, we must move fast now,” Ms. Fore said.

As a rule, when it comes to syringe manufacturing and distribution, little moves particularly quickly.

Unlike vaccines, which are heat sensitive and so are usually shipped by air, syringes, which have a shelf life of five years, generally make their way to their destination by sea, UNICEF said.

UNICEF said it expected to obtain the half-billion syringes by the end of the year. The agency said it was also procuring five million safety boxes for disposal of used syringes, as well as solar-powered refrigerators to store the vaccines in countries with scant access to electric power.

The UNICEF announcement came against a backdrop of uncertainty over precisely when any of the dozens of vaccines in various stages of development around the world would become widely available. The first are expected in coming months.

The Trump administration has publicly refused to join the international collaborative agreement known as Covax, under which the World Health Organization, GAVI and the Coalition for Epidemic Preparedness Innovations have collaborated to ensure that rich and poor countries simultaneously receive new coronavirus vaccines.

Instead, the U.S. government has pursued a unilateral vaccine development program known as Operation Warp Speed. It has paid $11 billion to six vaccine companies that agreed to supply at least 100 million doses each, along with options for millions more, earmarked exclusively for the United States.

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