Istanbul deaths suggest a wider outbreak than Turkey admits.
Turkey has surpassed China in its number of confirmed coronavirus cases, as the tally rose to more than 90,000 by Monday, with deaths reaching at least 2,140, according to official government figures. But the true death toll may be much higher.
Data compiled by The New York Times from records of deaths in Istanbul indicate that Turkey is grappling with a far bigger calamity from the coronavirus than official figures and statements indicate. The city alone recorded about 2,100 more deaths than expected from March 9 to April 12, based on weekly averages from the last two years, far more than officials reported for the whole of Turkey during that time.
While not all those deaths are necessarily directly attributable to the coronavirus, the numbers indicate a striking jump in fatalities that has coincided with the onset of the outbreak, a preliminary indicator that is being used by researchers to cut through the fog of the pandemic and assess its full toll in real time.
The government maintains that it acted swiftly, stopping flights and border crossings from five of the most affected countries in February and closing schools, restaurants and bars in mid-March when the first case of infection was confirmed.
But by then, the statistics compiled by The Times show, the damage was done. And medical professionals say that Turkey did not do enough to halt international travelers, and neglected contact tracing and community care.
“In February, they did nothing, although it was known the disease was there,” Dr. Sinan Adiyaman, head of the Turkish Medical Association, said in an interview.
The government announced its first death from Covid-19 on March 17. But the statistics compiled by The Times suggest that even around that time, the number of deaths overall in Istanbul was already considerably higher than historical averages, an indication that the virus had arrived several weeks earlier.
Any death statistics in the midst of a pandemic are tricky to pin down and must be considered preliminary. Many European countries are engaged in trying to improve their death statistics, which they now acknowledge are incomplete.
President Trump said on Monday that he intended to close the United States to people trying to immigrate into the country to live and work, his most wide-ranging attempt yet to seal the country off from the rest of the world.
In recent weeks, the Trump administration has said health concerns justified moving swiftly to bar asylum seekers and undocumented immigrants from entering the country, alarming immigration activists who have said that Mr. Trump and his advisers were using a global pandemic to further hard-line immigration policies.
Mr. Trump also defended his administration’s handling of coronavirus testing, saying the nation had excess capacity even as some governors insisted that they lacked crucial materials, including nasal swabs and chemical reagents.
He framed the debates around testing in political terms, saying that Democrats wanted maximum testing “because they want to be able to criticize.” Testing has also emerged as a sticking point in negotiations between Congress and the administration on small-business aid, with Democrats pushing for a national testing strategy and Republicans, wary of placing the onus on the White House to devise and carry out such a strategy, arguing that states should set their own plans.
The Republican governors of Georgia, Tennessee and South Carolina moved to let some businesses reopen, including gyms, restaurants and beaches, though social distancing protocols will remain in effect to varying degrees. In South Carolina, for example, retail stores were told to operate at 20 percent occupancy or at five customers per 1,000 square feet, whichever is less.
The reopening announcements came as the outbreak continued to spread in parts of the nation, and modest crowds gathered to protest stay-at-home orders in several states. A prison in Ohio, the Marion Correctional Institution, is now the largest reported source of virus infections in the nation.
And although the curve is beginning to flatten in New York, the country has added more than 25,000 new cases a day for the past week, with Massachusetts particularly hard hit and clusters emerging in several other states.
As the coronavirus overwhelms the health care system, people with other illnesses are struggling to find treatment. Nearly one in four cancer patients reported delays in their care.
And in Texas, after an appeals court ruling, abortion is effectively banned in the state.
Oil prices plummeted on Monday as the economic crisis set off by the pandemic continued to destroy demand. Storage tanks in the United States that hold all the unused crude are near full capacity.
Shake Shack announced that it was returning a $10 million small-business aid loan from a federal program amid mounting criticism that large chains had been favored over smaller entities.
The head of the World Health Organization’s emergencies program warned on Monday that even if a vaccine against the coronavirus were quickly developed, manufacturing and distributing it could prove extraordinarily difficult.
There is no approved treatment for or vaccine against infection with the coronavirus. More than two dozen companies have announced vaccine programs; at least three candidates already are in human trials.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has warned that a vaccine is at least 18 months away. Other experts say even that timeline is optimistic.
The development process is important, but manufacturers must begin planning to scale up manufacturing capacities to meet global demand when a successful vaccine is discovered, said Dr. Michael Ryan, head of the W.H.O.’s emergencies program.
Billions of people around the globe eventually may need vaccination. Modern vaccines, made with DNA and RNA, require specialized facilities; it is not clear who could make them.
And it will be important that vaccines go where they are most needed, not simply to the countries that can afford them. The W.H.O. is working with government leaders and nonprofits like the Bill and Melinda Gates Foundation and the Coalition for Epidemic Preparedness Innovations to ensure that means for equitable vaccine distribution are in place when the time comes, Dr. Ryan said.
“We’ve worked for over 20 years trying to ensure that products like vaccines are distributed in emergencies on the basis of epidemiological need,” Dr. Ryan said at a news briefing. “We intend to do exactly the same here.”
The agency has a long history of distributing vaccines to countries in need, including the meningitis, yellow fever, cholera and polio vaccines. Yet mass vaccination campaigns are still logistically difficult and often met with resistance in the community.
“As a global health architecture, we’re not very good at delivering vaccines in people other than children — in adults,” Dr. Ryan said.
“If this is to work, it will require one of the greatest scientific, one of the greatest political, one of the greatest financial, one of the greatest public health operations in a generation,” he added.
Hong Kong on Tuesday extended a range of social distancing measures to May 7 as a precaution, a day after reporting no new coronavirus infections for the first time since early March.
Those measures, which had been set to expire on Thursday, include a ban on public gatherings of more than four people, along with widespread closures of gyms, bars and playgrounds, among other facilities.
Hong Kong has been praised for the early steps that its government took to contain the virus, including closing schools and ordering civil servants to work from home. For weeks, that helped to keep the semiautonomous Chinese territory’s overall caseload in the low hundreds.
But over the last month, Hong Kong has battled a second wave of infections that were fueled in large part by residents who were returning from Europe and the United States. It now has over 1,000 confirmed cases and four deaths, but has recorded five or fewer new cases each day since April 12.
In mainland China, where the global outbreak began, officials on Tuesday reported 11 new cases, four of them imported, but no new deaths. China has recorded 4,632 deaths and more than 88,000 infections.
China said that six of its seven new locally transmitted cases were in Heilongjiang, a border province with Russia that has recently emerged as a hotspot for infections. The other was in Guangdong Province, next to Hong Kong.
In Old Cairo, a subdued Ramadan looms as the virus shutters the city.
For over a thousand years, Cairo’s oldest mosques kept their doors open — through the Black Death of the 14th century, the devastating cholera epidemics of the 19th century and the Spanish flu in the winter of 1918 that claimed 140,000 Egyptian lives.
Then the coronavirus hit.
On the first day of the lockdown at Al Azhar, a famed center of scholarship that opened in A.D. 972, tears flowed down the cheeks of the muezzin, Sheikh Mohamed Rashad Zaghloul, as he made the call to prayer in an empty hall.
“It was hard on my heart,” he said after midday prayers one day last week at the mosque, where a stray cat meandered between the ancient pillars. “When I call people, nobody can come. It feels like God is refusing us.”
The shuttered ancient mosques are a harbinger of another event that will be jarringly altered by the pandemic. Ramadan, the holy month of fasting, begins at the end of this week and promises this year to be the strangest experienced by any Cairene, not to mention 1.8 billion Muslims worldwide.
A sacred period that is rooted in gathering — at mosques, homes and on the streets — will be replaced with a month of solitary prayer, stifled celebrations and gnawing anxiety over the silent march of a virus that has closed a city that never, ordinarily, sleeps.
“This Ramadan is going to be flavorless,” said Abdul Rehman, 19, at the deserted lantern store he tends in Khan el Khalili, the city’s most famous bazaar.
When President Trump told governors that they needed to step up their efforts to secure medical supplies, Gov. Larry Hogan of Maryland took the entreaty seriously and negotiated with suppliers in South Korea to obtain coronavirus test kits.
“The No. 1 problem facing us is lack of testing,” said Mr. Hogan, a Republican, who has been among the many critics of the Trump administration’s repeated claims that states have adequate testing provided by the federal government. “We can’t open up our states without ramping up testing.”
In recent days, his wife, Yumi Hogan, a Korean immigrant who speaks fluent Korean, had been on the phone in the middle of the night helping to secure the final deal with two labs to sell Maryland the tests.
“Luckily we had a very strong relationship with Korea,” Mr. Hogan said. “But it should not have been this difficult.”
On Saturday, a Korean Air flight arrived at Baltimore-Washington International Airport carrying 5,000 test kits, which officials said would give the state the ability to make 500,000 new tests. The Food and Drug Administration and other agencies gave their seal of approval for the kits as the plane was landing.
Other states, desperate for things like personal protective equipment and other medical gears, have moved to acquire it, often stealthily, from other nations.
In January, at a restaurant in Guangzhou, China, one diner infected with the novel coronavirus but not yet feeling sick appeared to have spread the disease to nine other people. One of the restaurant’s air-conditioners apparently blew the virus particles around the dining room.
There were 73 other diners who ate that day on the same floor of the five-story restaurant, and the good news is they did not become sick. Neither did the eight employees who were working on the floor at the time.
Chinese researchers described the incident in a paper that is to be published in the July issue of Emerging Infectious Diseases, a journal published by the Centers for Disease Control and Prevention. The field study has limitations. The researchers, for example, did not perform experiments to simulate the airborne transmission.
That outbreak illustrates some of the challenges that restaurants will face when they try to reopen. Ventilation systems can create complex patterns of air flow and keep viruses aloft, so simply spacing tables six feet apart — the minimum distance that the C.D.C. advises you keep from other people — may not be sufficient to safeguard restaurant patrons.
The social nature of dining out could increase the risk. The longer people linger in a contaminated area, the more virus particles they would likely inhale. Eating is also one activity that cannot be accomplished while wearing a mask. Virus-laden droplets can be expelled into the air through breathing and talking, not just through coughs and sneezes.
On the other hand, all of the people who became sick at the restaurant in China were either at the same table as the infected person or at one of two neighboring tables. The fact that people farther away remained healthy is a hopeful hint that the coronavirus is primarily transmitted through larger respiratory droplets, which fall out of the air more quickly than smaller droplets known as aerosols, which can float for hours.
Iran continued its gradual rebooting of its economy on Monday by reopening traditional bazaars and modern shopping malls and lifting travel restrictions around the country, while Iraq loosened a curfew it has had in place for nearly five weeks.
The Iranian government has called its plan “smart distancing,” rather than the strict social distancing measures imposed by most other countries hoping to flatten the rate of infection as they fight the coronavirus pandemic. But not much distancing was observed as commuters packed trains and buses and shoppers crowded the narrow, winding passageways that shape Tehran’s traditional bazaar.
President Hassan Rouhani of Iran said he was considering opening religious shrines, a potential vector for spreading the virus, two weeks earlier than scheduled based on requests from custodians of the religious centers.
Health officials in the country, one of the first outside China to be hit hard by the virus, continued to warn that another surge of patients and deaths was inevitable. Different branches of the government sent conflicting messages to the public about the pros and cons of easing restrictions while the contagion had not been contained, testing was not widely available and the numbers of patients and deaths continued to surge.
“Contact among the public has increased with the opening of shopping centers and people moving around on public transportation,” said Alireza Zali, the head of Iran’s coronavirus relief committee. There has been a steady increase in people contracting the virus and being hospitalized, Mr. Zali said, including a 2 percent increase in patients being admitted to intensive care units within the past 24 hours.
The health ministry said on Monday that 1,294 new cases were reported in the past 24 hours and that 91 people had died. Iran’s official tally stands at 5,209 people dead and 83,505 infected.
In Iraq, the decision on Monday to lift the curfew will allow some private sector workers, including those working in clothing stores and on construction sites, to return to work, along with government employees.
Iraqis will be allowed to leave their home and neighborhoods from 6 a.m. to 7 p.m. for work or for buying food or going to pharmacies or medical appointments.
“Those who are carpenters, blacksmiths, car mechanics, barbers and others are permitted to work during the day as long as no more than three people are in the establishment at one time,” the official order said. Electricians and computer store workers are also included.
Mosques will remain closed and so will restaurants, sporting events and cinemas.
Iraq has a relatively low number of cases, 1,574 as of April 20, and 82 deaths.
Reporting was contributed by Carlotta Gall, Farnaz Fassihi, Jennifer Steinhauer, Jason Schreier, Mike Ives, Jin Wu, Dan Levin, Alissa J. Rubin, Declan Walsh and Kenneth Chang.