The spread of the coronavirus in the United States in recent weeks has been worse than it seems, not because of how it has been spreading but where.
The virus has been pummeling some of the least populous states in the country, but the relatively low numbers can be deceptive. The surges in rural areas have been just as severe as the spikes in densely populated cities in the Sun Belt over the summer.
North Dakota, South Dakota and Montana, for example, have announced the country’s highest number of cases on a per capita basis. Already, the North Dakota and South Dakota numbers exceed the per capita figures seen at the peak of summer surges in the Sun Belt.
Other states with large rural areas — including Wyoming, Idaho, West Virginia, Nebraska, Iowa, Utah, Alaska and Oklahoma — have recently recorded more cases in a seven-day stretch than in any other week of the pandemic.
“We, as North Dakotans, find ourselves in the middle of a regional Covid storm,” Gov. Doug Burgum said Wednesday.
But population can skew perspective.
Wessington Springs, S.D., or Shelby, Mont., are unlikely to produce the same alarming imagery amid a pandemic as New York City or Houston, where mobile morgues and packed E.R. hallways became icons of suffering.
In the last seven days, Florida had the highest number of virus-related deaths in the nation, 764. But the state has more than 21 million residents.
North Dakota had only 78 deaths — but it has a population of 762,000.
Governor Burgum warned of “additional adversity and perhaps deadlier outcomes” after months of watching from afar as other places faced large outbreaks.
“And,” he said, “we’re doing this at a time when perhaps our citizens and parents and many are fatigued at the stress of managing this for so long.”
It is hardly just the country’s less populated regions that have health experts worried. Numbers are up across the country, and around the world.
“I don’t know why anybody would think it’s not so bad,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston and an expert on contagious diseases. “We went to a low of around 35,000 cases per day late in the summer. Now we’re up to over 50,000, with those numbers climbing every day. Nationally, it’s going back up, and I’m really worried that we’re seeing a big increase.”
But the pattern appears to be shifting.
In the more populous states where case increases are being seen, including Wisconsin and Illinois, the worst numbers are not coming from the largest population centers.
In Wisconsin, rural counties in the state’s northeast, as well as midsize metropolitan areas like Oshkosh, Appleton and Sheboygan, are reporting the most discouraging data. In Illinois, cases are rising around Chicago, but the per capita figures are much worse around the far-smaller cities of Rockford and Decatur, as well as in rural counties in the state’s south.
Rapidly increasing caseloads across Europe are raising grave fears of another surge in coronavirus cases as winter approaches and people around the world chafe under pandemic restrictions that impede their daily lives — and their livelihoods.
Officials are scrambling to devise targeted restrictions on business, schools and travel, in the hope of avoiding the blanket lockdowns that paralyzed economic activity in the spring.
But that may be impossible.
On Wednesday, President Emmanuel Macron of France announced that, starting on Saturday, the authorities will impose a curfew from 9 p.m. to 6 a.m. in the Paris region and around eight other major cities. The curfews will run for at least four weeks.
The measure is part of a renewed state of emergency that allows the national government to restrict public gatherings and movement countrywide. It was first declared in the spring but had 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 said the government would seek a two-week extension of the curfew in Parliament, for a total of six weeks. It is to be applied in the regions of Paris, Grenoble, Lille, Lyon, Aix-en-Provence and Marseille, Montpellier, Rouen, St.-Etienne and Toulouse, affecting roughly 18 million residents.
In Germany on Wednesday, Chancellor Angela Merkel and state governors agreed to nationwide restrictions on social gatherings and domestic travel, in response to a rise in infections. Germany recorded a record 6,638 new cases on Wednesday.
“I am convinced that what we do — and what we don’t do — in these coming days and weeks will be decisive in how we get through this pandemic,” Ms. Merkel at a news conference.
In 10 days, she said, the authorities will discuss if stricter guidelines are needed.
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 mitigate 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.
Nick Saban, the University of Alabama’s coach and one of the most powerful figures in college sports, said Wednesday that he had tested positive for the coronavirus.
Saban’s announcement came as — for the second time this week — the Southeastern Conference postponed a game because of the coronavirus, unnerving fans and players less than a month into the season that sustains an economic and cultural juggernaut throughout the South.
During a news conference conducted over Zoom, Saban, seemingly alone and wearing a face mask around his neck, said he had been “very surprised” to learn he was infected. He was tested as part of Alabama’s daily screening of its football program.
“I personally think I did a really good job of trying to manage my personal space,” Saban said. “And that would be what I’ve informed our players to try to do, because you have to respect this disease.”
Saban said in a statement that he was asymptomatic and staying at his home in Tuscaloosa. Alabama’s athletic director, Greg Byrne, also tested positive, the university said.
“Both immediately left the facility and went to their homes to self-isolate after receiving that information,” Dr. Jimmy Robinson, Alabama’s team doctor, and Jeff Allen, the football team’s head athletic trainer, said in a statement. “At this point in time, the positive tests are limited to those two individuals. All individuals who are considered high-risk contacts have been notified and will follow quarantine guidelines.”
Saban, Alabama’s coach since 2007, has won five national championships at Alabama and one at Louisiana State. He said that Steve Sarkisian, the offensive coordinator, would oversee game preparations at the football complex while he worked from home.
The second-ranked team is scheduled to play No. 3 Georgia on Saturday.
But the Southeastern Conference 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., is the 29th Football Bowl Subdivision game since last August to be upended because of the pandemic.
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 conference 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.
Dr. Anthony S. Fauci, the nation’s leading infectious disease expert, took issue on Wednesday with President Trump’s repeated claims that 100 million doses of coronavirus vaccine would be ready by the end of the year.
“For a vaccine that is proven safe and effective, it’s not going to be 100 million doses,” Dr. Fauci said in an interview streamed live with the “CBS Evening News” anchor and managing editor Norah O’Donnell.
Dr. Fauci agreed that there may be millions of vaccine doses ready by January from the six companies now developing them in partnership with the federal government, but he stressed that they must each be vetted before they would be made available to the public. Right now, there are several vaccine candidates whose safety and effectiveness should be known by November or December, Dr. Fauci said.
He said he expected that there would be widespread distribution of a vaccine by the end of April. The federal government’s goal is 700 million doses, he said.
Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, has had an increasingly contentious relationship with Mr. Trump as the pandemic has spread. During the interview with Ms. O’Donnell, he made no secret of his concerns about Mr. Trump’s continued campaign events, which tend to include many maskless participants.
“When you have congregate settings and people are close to each other, and you don’t have everyone wearing a mask, that is a risky situation,” Dr. Fauci said. Even a partially open space, such as an airplane hanger, is not safe, according to Dr. Fauci.
He said he was pleased by Mr. Trump’s recovery from the virus, but cautioned that others in the president’s position — age 74 and overweight — should not assume they would also do as well.
Such thinking, Dr. Fauci said, would be like watching someone drive 95 miles an hour without crashing and thinking, “So, I can go ahead and speed and not get into an accident.”
“There are a lot of people his age and weight that did not do as well as the president did,” Dr. Fauci said.
After receiving a heavy infusion of monoclonal antibodies to treat his bout of Covid-19, President Trump declared that he is immune to the virus that causes it and talked privately about wearing a Superman T-shirt under his dress shirt when he left the hospital.
Even as the president has exulted in his supposed imperviousness to the coronavirus that is resurging across parts of the country, he has delighted in portraying former Vice President Joseph R. Biden Jr. as vulnerable and cloistered, wearing masks “every time you see him.”
But if the president is in fact now immune to the virus, he may not remain so, scientists warn. His treatment may have prevented his body from making the antibodies necessary for long-term protection.
The experimental monoclonal antibodies Mr. Trump received were produced by the drug company Regeneron and will wane in a matter of weeks, as the synthetic molecules are known to do. Unless they are replenished, Mr. Trump may be left more susceptible to the virus than most patients who had Covid-19 and recovered, several experts warned.
Moreover, the steroid treatment the president received early in the course of his illness suppresses the body’s natural immune response, including its propensity to make antibodies of its own.
“He may be not protected the second time around, especially because he didn’t develop his own antibodies,” said Akiko Iwasaki, an immunologist at Yale University.
Most people who are infected with the coronavirus produce antibodies that should protect them from a second infection. It’s unclear how long this immunity lasts. Research into other coronaviruses suggests that it may be up to a year, experts have said.
As New York State continues to fight the apparent resurgence of the coronavirus in several hot spots, Gov. Andrew M. Cuomo threatened at one point on Wednesday to withhold state funds from local governments that do not successfully enforce shutdowns on schools and restrictions on gathering.
During a morning call with reporters, 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 in 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 could be withheld, or how much money could be denied to local governments, though he said the state “could impound all funds.” His office later said no withholding of funds was imminent, characterizing Mr. Cuomo’s comments as a warning. (Later in the day, he issued an executive order authorizing such moves.)
Still, a spokesman for Mayor Bill de Blasio of New York City criticized the governor’s comments, suggesting that such tactics were counterproductive.
“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 could 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 would be notified in letters beginning on Wednesday, he said.
Statewide, the daily rate of positive test 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 Sept. 25 birthday party on Long Island that left 37 people infected and 270 in quarantine. Steve Bellone, Suffolk County’s executive, said in a statement that 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 owners of the inn, which has closed temporarily, will be fined $12,000, officials said Wednesday.
Decisions about whether to reopen schools in the United States this fall were driven more by politics and teachers’ unions than by scientific evidence about the risk of coronavirus infection, according to research by political scientists at Boston College and the University of North Texas.
Their working paper, which draws on a database of school reopening plans for more than 10,000 of the nation’s roughly 13,000 school districts, has not been peer reviewed. But its findings are in line with those of previous research on what has driven decisions about school reopenings during the pandemic.
The authors, Michael T. Hartney and Leslie K. Finger, evaluated the influence of different factors on a district’s decision. They found that a school system’s size and the share of the vote won there by Donald J. Trump in 2016 were by far the strongest predictors of whether schools opened in person — far more so than the average daily rate of new coronavirus cases in the county where a district was located.
Independent public health experts argued that school districts should make decisions about reopening based on local data about the transmission of the virus, as well as schools’ ability to put in place safety measures like social distancing and adequate ventilation. But the decisions quickly took on a political bent, the authors said.
President Trump’s demands that schools reopen and his insistence that the worst of the pandemic was behind the country were embraced by his followers, who pushed for schools to reopen, while hardening the conviction of some educators and parents that teaching in person was unsafe.
Senior White House officials put pressure this summer on the Centers for Disease Control and Prevention to play down the risks of sending children back to the classroom, frustrating public health experts.
At the same time, as caseloads began to climb again in some parts of the country, teachers’ unions increasingly sought to protect their members by opposing in-person instruction. As a result, most large districts started the year remotely.
“There may not be a Democratic or Republican way to ‘clean the streets,’” the paper’s authors wrote, “but, according to our findings, there are two distinctly partisan approaches to reopening America’s schools.”
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.
With cases surging in Wisconsin, Gov. Tony Evers issued an order last week that would limit indoor dining at most bars and restaurants to 25 percent capacity. But that order was blocked on Wednesday by a county circuit judge over concerns that it disproportionately affected smaller businesses which would be unable to operate profitably under such tight restrictions.
“This is a dangerous decision that leaves our state without a statewide effort to contain this virus,” a spokesperson for Evers, Britt Cudaback, said. “We will be challenging the decision, and in the meantime, we need Wisconsinites to stay home and help us prevent the spread of Covid-19.”
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.
Barron Trump, the president’s youngest son, tested positive for the coronavirus at one point, Melania Trump, the first lady, revealed on Wednesday, adding that he has since tested negative.
The White House had previously said that Barron Trump, 14, had tested negative for the virus. But Mrs. Trump said in a statement Wednesday that “my fear came true when he was tested again and it came up positive.”
“Luckily he is a strong teenager and exhibited no symptoms,” she said. She did not say when he tested positive, only that he has since tested negative.
President Trump, speaking briefly to reporters, said Wednesday that Barron Trump was doing “fine.”
Several studies have suggested that children under 10 are about half as likely as adults to be infected. But teenagers may be just as likely as adults to become infected and to transmit the virus to others.
Mrs. Trump said she had also tested negative for the virus, although she did not specify what test was used, and said she hoped “to resume my duties as soon as I can.”
Mr. Trump, who was hospitalized, has played down his symptoms, including a shortness of breath, and focused only on showing off that he has recovered. Mrs. Trump, on the other hand, described the “rollercoaster” symptoms she experienced.
“I experienced body aches, a cough and headaches, and felt extremely tired most of the time,” she said.
And unlike Mr. Trump, who has been promoting an experimental drug as a “cure” for Covid-19, the disease caused by the coronavirus, Mrs. Trump said she “chose to go a more natural route in terms of medicine, opting more for vitamins and healthy food.”
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.
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.