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A drive-through Covid-19 testing event in Bismarck, N.D., last month. The state is leading the nation in virus cases per capita.Credit…Tim Gruber for The New York Times

In Ohio, more people are hospitalized with the coronavirus than at any other time during the pandemic. North Dakota, which is leading the nation in coronavirus cases per capita, reported more than 1,000 cases on Tuesday, the state’s worst daily total yet. And as of Monday, 16 states had added more cases in the prior week than in any other seven-day stretch.

After weeks of spread and warnings in certain areas, a third surge of coronavirus infections has now firmly taken hold across much of the United States.

The latest wave — which is raging most acutely in the Midwest and the West, but is also spreading in various areas around the country — threatens to be the worst of the pandemic yet.

Its arrival comes as cooler weather is forcing people indoors, setting up a grueling winter that will test the discipline of many Americans who have grown weary of wearing masks and turning down invitations to see family and friends. Over the last week, the country has averaged about 59,000 new cases a day, the most since the beginning of August. The daily total could soon surpass 75,687, a record previously set on July 16.

The high case count — which has so far not translated to soaring deaths — in part reflects increased testing. With about one million people tested on many days, the country is getting a far more accurate picture of how widely the virus has spread than it did in the spring.

But the latest developments also reflect a serious new level of the outbreak. Hospitalizations, the most accurate picture of how many people are seriously sick from the virus, are on the rise nationwide, worrying many public health officials. A rise in deaths tends to lag behind a spike in cases. And deaths are creeping up in places: Officials in Wisconsin reported 36 on Tuesday, a single-day record.

Deaths among hospitalized patients have also dropped, to 7.6 percent from 25.6 percent in the spring, according to one study. That may be because doctors have better treatments at hand, and the patients are younger and in better health on average than those in the first wave.

Still, Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota, recently offered an ominous warning: With infections rising and compliance eroding, he said, “the next six to 12 weeks are going to be the darkest of the entire pandemic.”

The artist Shane Reilly outside his home in Austin, Texas, last month, updating a memorial to Texans who have died from Covid-19.Credit…Tamir Kalifa for The New York Times

The pandemic has caused nearly 300,000 deaths in the United States through early October, the Centers for Disease Control and Prevention said in a report released Tuesday. The tally includes not only deaths directly caused by the coronavirus but also nearly 100,000 fatalities that are indirectly related but would not have occurred if not for the virus.

The study is an attempt to measure excess deaths — fatalities from all causes that statistically exceed those normally occurring in a certain time period.

Many experts believe this measure tracks the pandemic’s impact more accurately than the case fatality rate. The figure includes deaths from Covid-19 that were misclassified or missed and deaths from emergencies like heart attacks that went untreated because people were afraid to go to the hospital.

Hidden in the new numbers from the C.D.C. is a statistic that may not mean as much as it appears: While the pandemic has taken the greatest toll on older citizens, the biggest percentage increase in excess deaths has occurred among young adults ages 25 to 44, among whom there was a 26.5 percent increase — as compared with an increase of 14.4 percent in those over 85, a group with a large proportion of the nation’s excess deaths.

But in nonpandemic times, the death rate among people in that age group is very low, so a disaster such as Covid-19 can easily bump up their death statistics without adding up to large numbers of excess deaths.

Excess deaths among Black people and Hispanics of all age groups also rose compared with previous years, the C.D.C. reports. Hispanics experienced a 54 percent increase, while Black people saw a 33 percent rise.

By comparison, the increase for white Americans was 12 percent, according to the C.D.C.

Another report, published in the Proceedings of the National Academy of Sciences, finds that in April nearly half of the nation’s excess deaths were in New York and New Jersey. A third were in people over age 85.

But excess deaths are only part of the story, noted the authors of that paper, led by Amy Finkelstein, a professor of economics at M.I.T. While deaths last spring were concentrated in New York and New Jersey, the economic ravages from the pandemic extended nationwide, even in states with almost no deaths.

Job losses in New York and New Jersey were just a fraction — 7 percent — of job losses throughout the country. And while deaths were concentrated in older people, half of those who lost their jobs nationwide were ages 25 to 44.

Concentrating on case counts or death counts, they conclude, provides only a partial picture of the pandemic’s devastation.

“Health crises concentrated in one part of the country and one age group may have substantial economic spillovers that are felt throughout the rest of the country and on other age groups,” the authors wrote.

Dr. Stephen Hahn, the F.D.A. commissioner, is caught between pressure from the White House and distraught agency scientists who wonder if he can protect their work.Credit…Oliver Contreras for The New York Times

In what might be the final months of the Trump administration, Dr. Stephen M. Hahn, the head of the Food and Drug Administration, seems to be trying to save the agency from the fate of the Centers for Disease Control and Prevention, whose scientists have been stripped of much of their authority and independence in responding to the pandemic.

To many F.D.A. scientists, Dr. Hahn has been a disappointment. Under his leadership, the F.D.A. authorized hydroxychloroquine for hospitalized Covid-19 patients despite a lack of evidence, only to reverse the decision once the drug was tied to severe side effects.

In late August, Dr. Hahn made a significant error at a news conference with the president announcing the approval of plasma treatments for Covid-19, greatly exaggerating its benefits. He later publicly corrected the record.

That debacle seems to have been a turning point for Dr. Hahn and agency scientists.

On Sept. 10, F.D.A. directors wrote a joint statement, warning that political interference could destroy the agency’s credibility. Dr. Hahn tweeted his support of the statement, and later that day noted that new vaccine guidelines were coming.

Experts in the Office of Vaccines Research and Review drafted new guidelines, to make its standards unmistakable to drugmakers and reassure jittery Americans that the agency would not cut corners when assessing a vaccine’s safety and effectiveness.

Within days of submitting the guidelines to the White House, F.D.A. scientists, fearing they would never be made public, decided to include them in the briefing materials for an outside group of vaccine experts scheduled to meet on Oct. 22. They slipped a version into the appendix of the committee’s briefing materials, with a new title.

Executives from Johnson & Johnson and Merck, each with vaccine candidates, called for the guidelines’ release. Dr. Albert Bourla, Pfizer’s top executive, wrote on Twitter that he had faith in the F.D.A.’s ability to set standards.

The same morning, the materials were quietly posted online. The White House was given about an hour’s notice, according to a senior administration official. Later that day, the White House abruptly cleared the guidelines, which were then posted to the F.D.A. website.

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 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 Tuesday, more than 64,200 new cases and at least 517 new deaths were reported in the United States. Over the last 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 last 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 last 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.

President Trump and other politicians have repeatedly warned that lockdowns and similar measures could cause at least as much distress as they prevent, in particular by increasing the risk of overdoses and suicides because of economic hardship. But the evidence for that claim is sparse; on Monday, a study posted on Medrxiv, a prepublication site, found that in Massachusetts, the suicide rate during the state’s lengthy stay-at-home advisory last spring remained steady, neither increasing nor decreasing.

The analysis is being submitted to a journal; it has not yet undergone peer review.

“This narrative that longer stay-at-home policies drive suicides doesn’t bear out,” said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston and the lead author of the study. “At least in a state that had a very long stay-at-home advisory, which, for all intents and purposes, was a shutdown. It was a ghost town here.”

Dr. Faust led a team of researchers from Harvard and Yale who compared suicide rates from March to May, when the state was largely shut down, with the rates during the same months in 2019, which were in line with previous years. The team adjusted for background trends (U.S. rates have been increasing steadily for many groups since at least 2008) and for the numbers of deaths still under investigation as possible suicides. The rate this spring was unchanged from previous years — just under one suicide a month per 100,000 people.

“Our data are reassuring that an increase in suicide deaths in Massachusetts during the stay-at-home advisory did not occur,” the authors concluded. “Moving forward, effective prevention efforts will require comprehensive attention to the full spectrum of mental health services.”

The Andbe Home, a privately owned nursing home facility in Norton, Kan., that has announced “a full Covid outbreak.”Credit…Dana M. Paxton/Norton Telegram, via Associated Press

At the Andbe Home, a private nursing home in northern Kansas, a single resident tested positive for the coronavirus on Oct. 7. Two weeks later, all 62 residents have become infected, along with at least 12 staff members, and 10 of the residents have died.

That is how hard, and how fast, the virus can hammer the vulnerable in the rural Great Plains and Mountain West, where the pandemic is now raging. States in the region that were little affected in the spring and summer and tended to see the virus as a distant threat now have some of the highest per capita infection rates in the country.

“It is with great sadness and concern that I announce that we have a full Covid outbreak in our home, despite the precautions we have been taking since March,” Megan Mapes, the administrator of the Andbe Home, wrote Friday on Facebook.

The home has barred all visitors, and residents are isolated in their rooms, Ms. Mapes wrote.

Covid-19 is known to be particularly lethal to adults in their 60s and older who have underlying health conditions, which has put nursing home populations at a higher risk of being infected and dying. In 15 states, the number of residents and workers at nursing homes who have died accounts for at least half of all deaths from Covid-19.

Coming in a small community, such an outbreak inevitably hits home for many people. “My grandmother was one of the 10 deaths,” Jamie McCreery posted on Facebook. “I’m shattered and angry, but not at this facility or the workers,” who have known the residents and their families for many years.

With a population of just 5,400, Norton County, where the Andbe Home is located, is the hardest-hit county in Kansas right now, relative to its size. The county is grappling with two serious outbreaks — in the nursing home and in the Norton Correctional Facility, a state prison where 18 prisoners and three officers have tested positive. Of the 340 cases the county has reported in all, more than 300 have come this month.

The virus spreads readily in congregate living facilities like prisons, group homes and college dorms, and nursing homes have suffered some of the worst outbreaks, because older people with health issues are among the most vulnerable to the disease.

More than 540,000 coronavirus infections and more than 84,000 deaths have been reported among residents and employees of nursing homes and other long-term care facilities for older adults in the United States, according to a New York Times database.

Deaths in the facilities represent about 38 percent of total coronavirus deaths in the country, a slight decline from late June, when nursing homes made up about 43 percent of U.S. deaths. However, the decline may be temporary, experts warn, amid a new surge of cases.

The American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living communities across the country, released a report on Tuesday warning that U.S. nursing homes could be facing another spike.

Danielle Ivory, Mitch Smith and Timothy Williams contributed reporting.

A Red Cross volunteer measures the temperature of man in Buenos Aires in June, during a government-ordered lockdown to curb the spread of the coronavirus.Credit…Natacha Pisarenko/Associated Press

Argentina has become the fifth country in the world to surpass one million confirmed Covid-19 cases.

With a population of around 45 million, Argentina is by far the smallest country on the list, which also includes the United States, India, Brazil and Russia, according to worldwide tracking by The Times.

Almost 100,000 of Argentina’s cases have been detected in the last seven days, reflecting how infections are soaring in the country, and experts worry that the true total could be far higher. Argentina’s reported test positivity rate has hovered around 50 percent for weeks and has reached as high as 75 percent, but the reliability of that data has been questioned recently, with reports that many negative test results were not recorded.

Argentina reported 12,982 new cases and 451 deaths on Monday. In total, 26,716 people have died of the coronavirus in the country, a fatality rate of 2.7 percent, according to the Health Ministry.

Argentina received praise early in the pandemic for imposing a strict quarantine in mid-March. It closed its borders and managed to keep the coronavirus largely under control while other South American countries, including neighboring Brazil, suffered gigantic outbreaks.

Though certain restrictions have since been relaxed, much of Argentina remains under some type of lockdown order.

Once concentrated in the Buenos Aires metropolitan area, the virus has since spread to much of the country, including remote areas with scarce medical resources, even though domestic flights and long-distance buses and trains have largely been grounded.

Argentina’s early success in controlling the virus, which was accompanied by a sharp increase in approval ratings for President Alberto Fernández, led to what some critics call an undue focus on the lockdown as the main strategy to combat the crisis.

“What they failed to do in parallel was containment and mitigation of the pandemic,” said Adolfo Rubinstein, an epidemiologist who was health minister under the previous president, Mauricio Macri, who was defeated by Mr. Fernández last year. “They needed to go out and detect community cases early, and mitigate the expansion of the pandemic.”

A pub in Roswell, N.M., where Gov. Michelle Lujan Grisham on Tuesday announced new restrictions on businesses like bars and restaurants that bring patrons and employees into close contact.Credit…Joel Angel Juarez for The New York Times

With the number of coronavirus infections reaching record levels in New Mexico, Gov. Michelle Lujan Grisham announced new restrictions on Tuesday in the hopes of tamping down the virus’s spread.

The governor indicated that the new policies are driven in part by the state’s health system’s being overwhelmed with inpatient coronavirus cases, which has led to 81 percent of all adult hospital beds and 71 percent of intensive care unit beds being filled.

Those policies go into effect Friday, and apply to restaurants and bars, retail stores and other businesses that typically involve close contact between patrons and employees. Any that report four or more positive coronavirus cases over a two-week period will have to close their doors for 14 days. All retail establishments across New Mexico, including grocery stores, will have to close at 10 p.m. each night, and the state will also close state museums and historical sites to visitors.

“This last week has been scary,” Governor Lujan Grisham said. “It’s been unsettling and upsetting to see everybody’s hard work and sacrifice undone in only a few short weeks. That is the awful, relentless nature of this virus.”

Over the last week, there have been an average of 563 cases per day, an increase of 139 percent from the average two weeks earlier, according to a New York Times database.

New Mexico’s positivity rate is 6.5 percent and climbing fast, as an indicator of the virus’s rapid spread.

According to state contact tracers, restaurants and bars remain a top source of possible exposure to the coronavirus. Those that offer indoor dining will now have to be certified by the state to do so, including consenting to health checks for employees, as well as keeping a record of patrons to assist with contact tracing if needed. Certification will be required after Oct. 30, and indoor dining capacity will be limited to 25 percent of an establishment’s usual maximum.

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Johnson Announces Highest Coronavirus Restrictions for ManchesterPrime Minister Boris Johnson of Britain said the highest level of coronavirus restrictions would be imposed for Manchester, which includes forbidding indoor socializing by people from different households.

Across the world, the countries that are waging the most successful fights against coronavirus are adopting regional and local measures to protect their populations. And that’s why last week, we launched the three local Covid alert levels for England with interventions based on the prevalence of the virus in local areas. Since then we’ve been undertaking discussions with local leaders in those parts of the country, which are currently bearing the brunt of the second wave of this epidemic. I don’t want anybody to think that your actions, our actions, are in vain or the efforts in vain because our collective action across the country has brought the R number well below its natural rate of about 3. As a result, the virus is not spreading as quickly as it did in February and March. Informed by the data that we’ve just seen, I can announce that Greater Manchester will move to the Very High Alert level. That means that pubs and bars must close unless they’re serving substantial meals. Households can’t mix indoors or in most outdoor settings. In some public outdoor spaces, groups must be limited to the Rule of Six. And we strongly advise against travel into and out of the area.

Prime Minister Boris Johnson of Britain said the highest level of coronavirus restrictions would be imposed for Manchester, which includes forbidding indoor socializing by people from different households.CreditCredit…Jon Super/Associated Press

Prime Minister Boris Johnson of Britain announced on Tuesday that Greater Manchester, the country’s second-largest urban area, would be put under the highest level of virus restrictions, shutting many pubs and bars and forbidding indoor socializing by people from different households.

The announcement came despite opposition from the area’s mayor, Andy Burnham, who had pushed for greater financial aid for affected residents, and amid a spike in cases around Europe that has reinvigorated the debate over how to balance economic and health concerns.

“I know these restrictions are tough on businesses and on individuals,” Mr. Johnson said. “Not to act would put Manchester’s N.H.S. and the lives of many of Manchester’s residents at risk.”

Mr. Johnson pointed to the area’s growing outbreak — it has reported more cases over the last seven days than any other place in England, according to a Times database. He added that he hoped that local officials would work with the central government to implement the restrictions, which take effect Friday.

The government will provide some 22 million pounds in aid, which Mr. Burnham argued was woefully insufficient. Talks over relief funds collapsed shortly before the announcement was made, though Mr. Johnson indicated they could be restarted.

“At no point today were we offered enough to protect the poorest people in our communities through the punishing reality of the winter to come,” Mr. Burnham said.

In London on Tuesday, Heathrow Airport, the country’s largest, began offering rapid tests for £80 ($104) to Hong Kong-bound passengers to meet its entry requirements, in an effort to encourage travel. The service will initially be offered for four weeks, and passengers must book it ahead of time. The tests will be done by private-sector nurses, with results expected within an hour.

Ireland on Monday became the first European country to reimpose a national lockdown, in a dramatic U-turn for the government, which two weeks ago fell short of imposing the highest level of restrictions despite advice from public health experts. The six-week period will begin on Wednesday.

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Ireland Reimposes National LockdownIreland will impose a six-week lockdown to curb the spread of coronavirus cases with the hope of reopening in time for Christmas.

In the effort to suppress the virus, we have already introduced what is probably Europe’s strictest regime. As a result of this, we can see some evidence that these restrictions have been effective in slowing the growth and spread of the virus. However, as the daily figures show, these restrictions on their own have not been enough to significantly reduce the levels of infection. The government has decided that the evidence of a potentially grave situation arising in the weeks ahead is now too strong. Therefore, for a period of six weeks, from midnight on Wednesday night, the entire country will move to Level 5 of the framework for living with Covid-19. Even as the winter comes in, there is hope and there is light. If we pull together over the next six weeks, we will have the opportunity to celebrate Christmas in a meaningful way. Every Christmas is important, but this year it is particularly so.

Ireland will impose a six-week lockdown to curb the spread of coronavirus cases with the hope of reopening in time for Christmas.CreditCredit…Paul Faith/Agence France-Presse — Getty Images

And in Italy’s northern region of Lombardy, the original center of the country’s outbreak, officials announced that they intended to impose a curfew aimed at curbing nightlife, especially in Milan, starting Thursday.

“The curfew is the best solution to hit the contagion, and it shouldn’t have serious repercussions on the economic situation,” Lombardy’s president, Attilio Fontana, told the Italian newspaper La Repubblica on Tuesday, “It will allow us to avoid stricter measures.”

The president of Campania, in southern Italy, said on Tuesday that he would also request a curfew. He said previously that the move was aimed at preventing Halloween celebrations, which he labeled “immense, stupid Americanata.”

Italians are desperate to avoid new lockdowns after enduring Europe’s longest one. But Prime Minister Giuseppe Conte said on Sunday that while officials were preparing to avoid a generalized lockdown, more circumscribed ones could not be ruled out.

Senate Majority Leader Mitch McConnell of Kentucky spoke at his weekly news conference on Capitol Hill on Tuesday.Credit…Anna Moneymaker for The New York Times

Senator Mitch McConnell, Republican of Kentucky and the majority leader, told Republican senators privately on Tuesday that he has advised the White House not to strike a deal with Speaker Nancy Pelosi on a new stimulus bill before Election Day, cautioning against reaching an agreement that most in the party cannot accept.

Mr. McConnell’s counsel, confirmed by three Republicans familiar with his remarks, threw cold water on President Trump’s increasingly urgent push to enact a fresh round of pandemic aid before he faces voters on Nov. 3. It came just before Ms. Pelosi’s spokesman gave an upbeat assessment of talks on Tuesday between her and Steven Mnuchin, the Treasury secretary, saying they had found “common ground as they move closer to an agreement.”

Ms. Pelosi had said earlier on Tuesday that she was “optimistic” a deal could be reached with the Trump administration in the coming days. But Mr. McConnell’s remarks underscored the divisions among Republicans that have long hampered a compromise, and which have broken out into an extraordinarily open intraparty feud just two weeks before the election.

Republicans are growing increasingly anxious that Mr. Trump and his team are too eager to reach a multitrillion-dollar agreement and are conceding far too much to the Democrats. They fear that a vote on any large bipartisan stimulus would force colleagues who are up for re-election into a difficult choice of defying the president or alienating their fiscally conservative base by embracing the big-spending bill he has demanded.

Senate Republicans were also concerned that any vote on such a package could interfere with the Senate’s hasty timetable for confirming Judge Amy Coney Barrett to the Supreme Court by early next week. Mr. McConnell said he told the White House he was particularly concerned a deal before then could inject unwanted unpredictability into the schedule, according to the Republicans, who requested anonymity because they were not authorized to discuss a closed party luncheon.

Mr. McConnell made it clear that he knew his counsel was likely to leak, making reference to the possibility that his remarks could appear in the news media, two of the Republicans said.

A short time later, outside the hearing room where Republicans met privately, Mr. McConnell told reporters the Senate would consider a broad bipartisan stimulus deal if the White House and Democrats struck one. But he would not say if it would hold a vote before Election Day, and members of his leadership team have warned that Republican votes could be hard to come by in the chamber.

“If a presidentially supported bill clears the House, at some point we’ll bring it to the floor,” he said, without elaborating on the timetable.

He made his comments around the same time that Ms. Pelosi and Mr. Mnuchin were speaking by phone, in what Drew Hamill, Ms. Pelosi’s spokesman, described as a productive discussion that would continue on Wednesday. He said her target of reaching a deal by the end of the day had yielded progress.

“Today’s deadline enabled the speaker and secretary to see that decisions could be reached and language could be exchanged, demonstrating that both sides are serious about finding a compromise,” Mr. Hammil wrote on Twitter.

Yet Mr. McConnell was pursuing a different track. He forced a test vote Tuesday afternoon on a narrow measure that would revive the Paycheck Protection Program, a popular small-business loan program. While Democrats support the program, most of them opposed the narrow bill, contending that a far broader package was needed. It received support from a majority of senators, 57-40, but fell short of the 60 votes that most major legislation needs to advance.

Commuters on a crowded railway platform in Chennai, India, last week. The country’s prime minister has urged citizens not to relax their antivirus precautions during holiday time.Credit…Arun Sankar/Agence France-Presse — Getty Images

In a televised address Tuesday night, Prime Minister Narendra Modi of India urged citizens to tighten up their vigilance against the coronavirus as the Hindu festival season approaches.

“Recently, we saw many photos and videos which clearly proved that people have lowered their guard,” he said. “This isn’t right.”

In the next few weeks, more than a billion Indians will celebrate several major Hindu holidays, including Dussehra and Diwali, and authorities are worried about people packing together.

India is rapidly catching up to the United States in terms of its reported infections, almost 7.6 million known cases there compared with 8.2 million in the United States. India had been outpacing the United States in new infections, reaching nearly 100,000 new daily infections in mid-September. But in recent days that number has come down. As of Monday, the seven-day average for new daily cases in India was approximately 61,000, according to a New York Times database, just slightly higher than the average over the same time in the United States.

Some experts say that the decline might reflect that the virus is reaching a plateau in India. Other scientists caution that the decrease could also be explained by a shift in testing methods. India is increasingly using cheaper, less reliable rapid antigen tests.

Mr. Modi said that the precautions taken by Indians since the pandemic started have left India in a “stable situation.” But he cautioned that “We must not let it deteriorate.”

He emphasized that India’s death rate remained much lower than those of the United States and other Western countries. And he promised that his government was making “all efforts” to ensure that every Indian has access to a coronavirus vaccine once it is available.

Treating a Covid-19 patient at Elmhurst Hospital in New York in May. A new study found that hospitalized coronavirus patients had a higher risk of 17 complications as compared with hospitalized flu patients.Credit…Erin Schaff/The New York Times

It has becoming increasingly clear that while most people infected with the coronavirus have a relatively mild disease, symptoms can be gravely serious for some, leading to hospitalization, serious complications and death. But how much more dire are its consequences than those of influenza, which infects an estimated 45 million Americans each year and kills an average of 61,000?

Researchers at the Centers for Disease Control and Prevention now have some estimates, based on data from the Department of Veterans Affairs.

In a paper published in the Oct. 20 issue of the C.D.C.’s Morbidity and Mortality Weekly Report, Jonathan Cates and his colleagues found that hospitalized coronavirus patients had a higher risk of 17 complications as compared with hospitalized flu patients, including more than twice the risk of pneumonia. Covid patients were also more than five times as likely to die in the hospital — 21 percent of them died there, compared with 3.8 percent of those hospitalized with flu. More than a third of the Covid patients were admitted to an intensive care unit; fewer than a fifth of influenza patients spent time in an ICU.

Black and Hispanic Covid patients did worse than white ones, with greater risks of respiratory, neurological and kidney complications.

The V.A. data were from the electronic health records of 3,948 patients hospitalized with Covid between March 1 and May 31 and 5,453 patients hospitalized with flu between Oct. 1, 2018 and Feb. 1, 2020.

A researcher in a laboratory at Imperial College London.Credit…Kirsty Wigglesworth/Associated Press

Researchers at Imperial College London are planning to deliberately infect healthy volunteers with the coronavirus early next year as part of the world’s first effort to study how people immunized with different vaccines respond to controlled exposure to the virus.

The study, known as a human challenge trial, is scheduled to begin in January at a quarantine facility in London with 34 million pounds, or $44 million, of British government funding, the government announced on Tuesday.

Such a study could save time in the race to winnow down a large number of vaccine candidates.

Rather than testing vaccines the usual way — by waiting for vaccinated people to encounter the virus in their homes and communities — researchers would expose them to the virus in a controlled setting.

In the first stage of the study, scientists will try to determine the smallest doses of the virus required to infect people. The scientists will test gradually increasing doses of virus on up to 90 healthy volunteers from 18 to 30 years old until they reach a level that reliably infects them.

Once they have decided on a dose — potentially by late spring, the government said — researchers will begin to compare a set of coronavirus vaccine candidates by immunizing people and then deliberately infecting them. The government will decide which vaccines to test, but it has not announced them yet.

It is possible that by early next year, some of the vaccine candidates now undergoing trials will have already received approval.

But experts in medical ethics are divided over whether such a study is acceptable, largely because there is no highly effective treatment for Covid-19. The Imperial College London researchers said they would use the antiviral medicine remdesivir, but that drug has been found to have only modest benefit. Most other challenge trials have involved diseases like cholera and typhoid, which can be quickly and reliably cured with drugs.

Schools across the country have grappled with how to minimize virus transmission in classrooms.Credit…Carlo Allegri/Reuters

To reduce the number of students sent home to quarantine after exposure to the coronavirus, the Billings Public Schools, the largest school district in Montana, came up with an idea that has public health experts shaking their heads: Reshuffling students in the classroom four times an hour.

The strategy is based on the definition of a “close contact” requiring quarantine — being within 6 feet of an infected person for 15 minutes or more. If the students are moved around within that time, the thinking goes, no one will have had “close contact” and be required to stay home if a classmate tests positive.

Greg Upham, the superintendent of the 16,500-student school district, said in an interview that contact tracing had become a huge burden for the district, and administrators were looking for a way to ease the burden when they came up with the movement idea. It was not intended to “game the system,” he said, but rather to encourage the staff to be cognizant of the 15-minute window.

In an email to administrators last week, Mr. Upham encouraged staff to “whenever possible, disrupt the 15-minute timeline through movement, distancing, and masking.”

Infectious disease experts say that moving students around every few minutes is actually more likely to increase transmission of the virus, by exposing more people to an infected student. It will also complicate contact tracing efforts, they said.

“That is not an evidence-based practice or sound scientific policy,” said Dr. Jennifer Nuzzo, an epidemiologist at the John Hopkins Center for Health Security who has been supportive of reopening schools for in-person instruction.

The 15-minute, 6-foot definition is a guideline for identifying who might be at greater risk of infection, not a hard-and-fast rule about when it can or cannot happen, Dr. Nuzzo said, adding that a person can certainly become infected in less time or from farther away, especially indoors.

Dr. Sarah Fortune, chair of the department of immunology and infectious diseases at Harvard’s school of public health, said the 15-minute definition was meant to help contact tracers “effectively and efficiently identify people with the highest risk and target intervention to them.”

Kelly Hornby, principal of Billings West High School, wrote in an email to his staff last week that moving students around every few minutes and then returning them to their original desks would help dissipate airborne droplets containing coronavirus, to the point “where the risk of being contaminated is greatly reduced.”

Dr. Fortune disagreed with that idea. “The particles that transmit Covid, they hang out in the air, and they spread through the air, and the aerosols can hang out for a very long time,” she said. “So stirring that air up or moving around from your spot doesn’t really limit your exposure or risk.”

San Diego school employees directed families in cars as they lined up in April to receive computers for remote learning. School trustees say the difficulties surrounding remote learning have contributed to racial disparities.Credit…Gregory Bull/Associated Press

The the second-largest public school system in California is overhauling its grading system in an attempt to address what its board of trustees said were “discriminatory practices” that have worsened during the pandemic.

The San Diego Unified School District, with about 105,000 students, said it would de-emphasize behavioral factors like classroom conduct, allow students to retake tests, and base each student’s final grade more on the student’s grasp of material at the end of the grading period, rather than on homework, quizzes or mid-term exams.

“We’re not getting rid of grades; we’re not eliminating homework; we’re not eliminating attendance as a responsibility for students,” said Richard Barrera, the vice president of the board. “But if a student gets a few bad grades and then aces the final, we’re saying that shouldn’t just average to a C.”

Mr. Barrera said the new district-wide “standards-based grading” policy, approved last week, was already being used in the system’s elementary schools and is now being expanded into middle and high schools.

The idea was under discussion before the pandemic, stemming from disproportionate numbers of failing grades among Black and Latino students, and from the death of George Floyd at the hands of police in Minnesota. But it gained new urgency this fall, as the difficulties of remote learning deepened disparities in student performance.

Only 7.2 percent of white students in San Diego’s secondary schools received grades of D or F in the last school year, according to district data, compared with 20 percent of Black students, more than 22 percent of Latino students and more than 23 percent of Native American students.

Forty-six percent of the district’s students overall are Latino, 12 percent are Asian-Pacific Islander, 8 percent are Black and a small proportion are Native American, he said. Two-thirds of the teachers are white.

“We focused on becoming an anti-racist school district,” Mr. Barrera said.

The grading change has drawn criticism from some conservatives, who say it diminishes the idea of academic excellence. But Kevin Beiser, a trustee who teaches middle-school math in a nearby district, said standards-based grading is meant to mitigate inequities like teachers conflating behavior with academic achievement, or affluent students having greater access to tutors.

“It doesn’t matter when you learn how to solve for x in algebra, as long as you learn it before the end of the school year,” he said.

Dr. Anthony S. Fauci, director of National Institute of Allergy and Infectious Diseases.Credit…Doug Mills/The New York Times

President Trump doubled down on Tuesday attacking Dr. Anthony S. Fauci, the nation’s top disease expert, saying “he’s been wrong” throughout the pandemic.

“The only thing I say is he is a little bit sometimes not a team player. But he is a Democrat,” Mr. Trump said Tuesday during an interview with Fox News. Mr. Trump has previously said without evidence that Dr. Fauci is a Democrat, even as Dr. Fauci has served in both Republican and Democratic administrations.

A day earlier, Mr. Trump attacked Dr. Fauci as “a disaster” during a conference call with his campaign staff just two weeks away from the election. “People are tired of hearing Fauci and these idiots,” he said on the call.

Dr. Fauci has been distancing himself from the White House and has warned Americans to “hunker down” and prepare for a difficult winter — a message that directly conflicts with Mr. Trump’s rosy assessment that the country is rounding a corner on the virus, even as it set a record recently for the highest number of new virus cases in a day since July.

“It’s good if people trust him,” Mr. Trump said Tuesday, blaming news media for pitting the two men against each other.

Dr. Fauci’s position is “a view,” Mr. Trump said, adding that the president’s new virus adviser, Dr. Scott W. Atlas, has “a different view.”

Dr. Atlas is a neuroradiologist with no experience in infectious disease or epidemiology.

“By the way, everybody has a different view,” Mr. Trump said.

At a campaign rally Monday evening in Prescott, Ariz., Mr. Trump invoked Dr. Fauci as a way of ridiculing the coronavirus plan of his Democratic opponent, Joseph R. Biden Jr.

“Biden wants to lock it down. He wants to listen to Dr. Fauci,” the president said, referring to coronavirus-related restrictions on the economy. (Dr. Fauci, addressing a group of pathologists last week, said no one wants to “shut down the country again.”)

The Biden campaign, which has been emphasizing a promise to listen to science over politics, responded with relish: “Mr. President, you’re right about one thing: The American people are tired. They’re tired of your lies about this virus.”

Global Roundup

A production facility for Sinovac Biotech, a Chinese drug company, in Beijing.Credit…Kevin Frayer/Getty Images

Chinese vaccines have been administered to 60,000 people in clinical trials, many of them around the world, and none of them have experienced any serious adverse reactions, a senior Chinese official said on Tuesday.

The figures came from Tian Baoguo, a senior official at China’s Ministry of Science and Technology, who spoke at a news conference. “Initial results show that they are safe,” he said.

China has four vaccine candidates in Phase 3 trials, the last stage of testing before regulatory approval. Because the outbreak is largely under control in China, these trials are conducted in more than 10 countries.

Within China, the Chinese government has not waited for clinical trials to conclude before vaccinating tens of thousands of people. Officials have already laid out plans to give shots to even more people, citing emergency use. But scientists have warned that taking a vaccine that has not completed Phase 3 trials carries health risks. On Sunday, the eastern Chinese city of Yiwu stopped the sale of a coronavirus vaccine after dozens of people demanded to be inoculated over the weekend.

China is expected to produce up to 610 million doses of coronavirus vaccines by the end of this year, Zheng Zhongwei, head of China’s coronavirus vaccine development task force said at the news conference, adding output will grow next year.

In other developments around the world:

Starting Tuesday, Heathrow Airport in London will offer one-hour coronavirus tests to travelers to Hong Kong and Italy, which require arriving passengers to show a negative test result. Heathrow, one of the busiest airports in the world, typically sees more than 80 million passengers a year.



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