Covid-19 News: Live Updates – The New York Times

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The Mountain West, which for months avoided the worst of the pandemic, has rapidly devolved into one of the most alarming hot spots in the United States, which recorded its eight millionth confirmed case on Thursday.

Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the pandemic. And the spread through sparsely populated areas of rural America has created problems in small towns that lack critical resources — including doctors — even in ordinary times.

Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week. Reports of new infections have recently reached record levels in Alaska, Colorado and Idaho. And Montana, where more than half of the state’s cases have been announced since August, is averaging more than 500 cases per day.

One place where the infections have spread has been local jails, which are confined, often crowded spaces. They are risky venues for inmates and workers, but the short-term holding facilities also pose a threat for surrounding communities because people filter in and out of them constantly.

For months, the jail in central Montana’s Cascade County was free of the coronavirus, which seemed as distant a threat as it did in much of the rural Mountain West.

Then a few people who had the virus were arrested. By the time Paul Krogue, the jail’s medical director, realized there was a problem, nearly 50 inmates were infected. After weeks battling to contain the outbreak, Mr. Krogue got a call that infections were spreading to a side of the jail that had been virus-free.

“I just kind of lost it, like, ‘My God, I don’t know how much longer I can do this,’” Mr. Krogue, a nurse practitioner, recalled. “I was just scared that I’m not going to be able to see it through, that I’m going to get sick — you just feel so exhausted and it’s just a lot.”

Now more than 300 inmates and staff members have been infected in a facility meant to hold 365 people, Cascade County’s first major outbreak in a region where the virus is suddenly surging.

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Pfizer’s chief executive said on Friday that the company would not apply for emergency authorization of its coronavirus vaccine before the third week of November, ruling out President Trump’s assertion that a vaccine would be ready before Election Day on Nov. 3.

In a statement posted to the company website, the chief executive, Dr. Albert Bourla, said that although Pfizer could have preliminary numbers by the end of October about whether the vaccine works, it would still need to collect safety and manufacturing data that would stretch the timeline to at least the third week of November.

Close watchers of the vaccine race had already known that Pfizer wouldn’t be able to meet the Food and Drug Administration’s requirements by the end of this month. But Friday’s announcement represents a shift in tone for the company and its leader, who has repeatedly emphasized the month of October in interviews and public appearances.

In doing so, the company had aligned its messaging with that of the president, who has made no secret of his desire for an approved vaccine before the election. Mr. Trump even singled out the company by name and said he had spoken with Dr. Bourla, whom he called a “great guy.”

Dr. Eric Topol, a clinical trial expert at Scripps Research in San Diego, said that while Pfizer officials had assured him that a vaccine would likely not be authorized before the election, the company’s letter on Friday was “even more solid about their not being part of any political machinations.”

“This is good, really good,” said Dr. Topol, who was one of 60 public health officials and others in the medical community to sign a letter to Pfizer urging it not to rush its vaccine.

Dr. Bourla has pushed back against any suggestion that the company’s vaccine timeline was politically motivated. In September, Pfizer was the driving force behind a pledge by nine vaccine companies to “stand with science” and not put forward anything that had not been properly vetted.

Earlier this month, he published an open letter to employees that said he “would never succumb to political pressure” and expressed disappointment that “we find ourselves in the crucible of the U.S. presidential election.”

Pfizer is one of four companies testing a coronavirus vaccine in late-stage clinical trials in the United States, and it has been the most aggressive in its timeline estimates. Moderna, AstraZeneca and Johnson & Johnson have said that later in the year is more likely, matching the predictions of federal health officials.

AstraZeneca and Johnson & Johnson’s trials have been paused for potential safety concerns, which could further delay their outcomes.

Credit…Alex Wroblewski/Reuters

As the coronavirus caseload in the United States soars past eight million, epidemiologists warn that nearly half of the states are seeing surges unlike anything they experienced earlier in the pandemic.

Reports of new cases this month have trended upward in all but 11 states, and more than 65,000 cases were announced across the country on Thursday, the most in a single day since July.

Uncontrolled outbreaks in the Midwest and Mountain West are driving the surge, according to a New York Times database. Some of the states with the most extreme growth had relatively few cases until recently, and rural hospitals have been strained.

Per capita, North Dakota and South Dakota are adding more new cases than any states have since the start of the pandemic. Wisconsin has seven of the 10 metropolitan areas in the United States with the highest rates of recent cases.

“What’s happening in the Upper Midwest is just a harbinger of things to come in the rest of the country,” said Michael Osterholm, an infectious-diseases expert at the University of Minnesota.

Further west, Colorado, Montana and New Mexico — fueled in part by a surge in the county that includes Albuquerque — were among the 19 states that were reporting seven-day records as of Thursday night. New infections are also emerging at record levels in Idaho and Wyoming.

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Signs of the uptick are already appearing east of the Mississippi River.

In the Northeast, where cases have been relatively low since a spring surge, the number of new ones is moving upward again. And in the South, where cases spiked this summer, there are worrisome trends in West Virginia and Kentucky.

The number of cases alone is not a full measure of the nation’s outbreak, in part because they come at a time when testing is more widespread than it was a few months ago. Deaths from Covid-19 have also been relatively flat in recent weeks, with an average of about 700 per day.

Still, said Caitlin Rivers, an epidemiologist at Johns Hopkins University, “we are headed in the wrong direction.”

“That’s reflected not only in the number of new cases but also in test positivity and the number of hospitalizations,” she added. “Together, I think these three indicators give a very clear picture that we are seeing increased transmission in communities across the country.”

High levels of infection in colleges and universities, Dr. Osterholm said, are serving as one source of the spread. Transmission also has been prevalent at events such as funerals, family barbecues and birthday parties, he said, adding that the comeback of sporting events and dining has also added to the spread this fall.

“Pandemic fatigue has clearly set in for large segments of the population,” he said.

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, said on Thursday that the current situation was worrying as winter approaches.

But President Trump continued to downplay the resurgence of this virus, saying he did not support the strictest restrictions by local officials to limit its spread.

“We’re not doing any more lockdowns,” he said. “We’re doing fine.”

U.s. Roundup

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Six months after a virus outbreak on the aircraft carrier Theodore Roosevelt triggered a political tsunami in Washington that led to the firing of the ship’s captain and the subsequent resignation of his boss — the acting secretary of the Navy — the novel coronavirus has returned to the ship.

The Navy said that two sailors aboard the nuclear-powered Roosevelt, which is at sea near San Diego, tested positive for the virus in the past three days. Both of the sailors have been evacuated, and the people aboard the ship with whom they had contact have been quarantined.

“The sailors self-reported after experiencing symptoms, received immediate medical treatment, and were transported off the ship for isolation,” said Commander Zach Harrell, a spokesman for the Naval Air Forces. He said that contact tracing aboard the ship had been completed.

The reappearance of the virus aboard the Roosevelt immediately sparked worries among crew members who remember the torturous experience of the spring, when an onboard outbreak spread to some 1,100 sailors, and led to a weekslong stay in Guam and the firing of the ship’s commander, Capt. Brett Crozier, after he wrote a widely distributed letter appealing for help.

After he was fired by a political appointee of President Trump, the saga took on new meaning. A video of hundreds of cheering sailors yelling “Captain Crozier!” as he departed the aircraft carrier, went viral. Efforts by the acting Navy secretary at the time, Thomas B. Modly, to right the crisis ended up leading to his resignation.

In other news from around the United States:

Credit…Jeff Haynes/Associated Press

The Indianapolis Colts on Friday joined the growing group of N.F.L. teams dealing with a potential outbreak of coronavirus cases, announcing that “several individuals” had tested positive and that the team was closing its practice facility. Hours later, the New England Patriots — who had just emerged from a virus-inflicted week off — called off their Friday session after recording at least one new positive test result.

The news of the new Patriots positive came a day after two of the team’s most important players, quarterback Cam Newton and cornerback Stephon Gilmore — the reigning N.F.L. defensive player of the year — were taken off the team’s reserve/Covid-19 list and returned to practice.

Both were expected to return in time to face the Denver Broncos on Sunday afternoon. The team said the game, which had been postponed a week, would go ahead as planned. The team is waiting for the results of a follow-up test for a second player to confirm whether he is also positive.

In Indianapolis, the Colts called off practice ahead of their own Sunday game after testing turned up several positive results.

“The team is currently in the process of confirming those tests,” the Colts said in a statement. “In the meantime, the practice facility will be closed and the team will work remotely while following N.F.L. protocols.”

The Colts are among a number of league teams to announce positive tests in the past few weeks, a group that includes the Tennessee Titans, the Patriots and, on Thursday, the Atlanta Falcons. The New York Jets reported a positive test last week and sent their players home for a day, but later announced the result had been a false positive.

The series of outbreaks has scrambled the N.F.L. schedule, forced the league to strengthen its virus protocols and threaten teams who violate them, and raised serious questions about whether the seasons can be completed on time. Several games have been postponed or rescheduled already, each one causing a cascading series of changes in the complicated matrix that is the league’s schedule.

Any complications with Sunday’s Patriots-Broncos game, though, could create the most serious scheduling issues to date. When the league postponed the teams’ meeting last weekend because of the Patriots’ initial outbreak, it solved the scheduling problem by allowing both teams to use the open date as their bye week, and shuffled several games against other opponents later in the season.

But teams only get one bye per season, and without that flexibility, the league has little choice but to try to play Sunday’s game — provided the Patriots do not confirm any additional cases — or pursue adding an 18th week to the calendar to allow for makeup games.

The N.F.L. has already toughened its virus rules, and threatened teams with punishment for breaking them. This week, the league announced its latest changes to its protocols, including the requirement that anyone with so-called high-risk exposure to a person who has tested positive must be isolated for at least five days, even if the person tests negative and is asymptomatic.

It was not clear if the Colts’ tests had involved players; like several other teams, the statement that was released was opaque.Indianapolis (3-2) is scheduled to host the Cincinnati Bengals (1-3-1) on Sunday.

Credit…Sergio Perez/Reuters

In a flurry of memos released this week and last, the White House physician, Dr. Sean Conley, declared that President Trump no longer posed a transmission risk to others — an assessment, he noted, that was largely based on the results of “advanced diagnostics.”

Outside experts have also said that Mr. Trump, who reportedly began feeling sick about two weeks ago, is probably no longer contagious.

But in fact there exists no test that can definitively determine whether someone who was infected with the coronavirus can still spread it.

“We do not have a test for cure, and we do not have a test for infectiousness,” said Omai Garner, a clinical microbiologist at the University of California, Los Angeles.

Not all coronavirus tests are designed to detect the same parts of the virus. And a negative on one test does not necessarily guarantee a negative on another.

As recently as Tuesday, for instance, a rapid antigen test called the BinaxNOW was unable to detect the coronavirus in Mr. Trump. But results yielded from a laboratory test, which used a slower but more accurate technique called polymerase chain reaction, or P.C.R., showed he still carried genetic material from the virus at low levels in his body.

“We don’t just look at these tests in the context of ‘Coronavirus, yes or no,’” said Karissa Culbreath, a clinical microbiologist at TriCore Reference Laboratories in New Mexico.

There is no definitive threshold at which researchers can say someone is or is not infectious, she said, and it’s very possible to be antigen negative but P.C.R. positive.

Credit…Atef Safadi/EPA, via Shutterstock

A small charity in Jerusalem is offering an under-the-radar service treating mostly ultra-Orthodox and older Covid-19 patients in their homes, even in severe cases where health experts say it could endanger lives.

Drawing on the services of a few doctors — and dozens of volunteers, most without medical training — it operates out of a basement in Mea Shearim, a Jerusalem stronghold of the most extreme anti-Zionist Jewish sects that shun cooperation with the state.

The charity has attracted patients who sense that remaining with family — and avoiding public hospitals — outweighs the risks. But the project is also tinged with a general distrust of government among the ultra-Orthodox community, which appears to be increasingly going it alone in handling the pandemic and many other aspects of daily life.

Since the home-care initiative was reported by Israel’s N12 news service this week, health officials and experts have responded with a mix of condemnation and curiosity.

Dr. Sharon Elrai-Price, a senior Health Ministry official, denounced the operation as a “dangerous” departure and said the ministry was looking into the legality of some aspects of it. But Dr. Gabriel Barbash, a leading Israeli professor of epidemiology, is among those who view the charity’s approach as a possible way to ease the load on hospitals and worthy of further study.

The debate comes as Israel is under its second national lockdown after daily infection and death rates soared to among the highest in the world, and ultra-Orthodox areas top the virus hot spots. Health officials say that about 50 percent of those aged over 65 and under 18 who are infected in Israel are from the ultra-Orthodox community, though it makes up no more than 13 percent of the country’s nine million citizens.

The actual infection numbers may be even higher: The charity does not report coronavirus cases to the authorities, which may be skewing the national virus data on which policymakers base their decisions.

Credit…Frederic J. Brown/Agence France-Presse — Getty Images

As the coronavirus pushes the curve of U.S. infections upward for a third time, public officials and families are rethinking how to celebrate Halloween, balancing the risk of increased transmission with the interests of a public reluctant to give up holiday traditions.

In several states, including California and Massachusetts, governors have discouraged trick-or-treating but not issued an outright ban. Public health experts, along with the Centers for Disease Control and Prevention, have warned that the practice could lead to a spike in cases.

“I’m advising people to stay home,” said Dr. Dean A. Blumberg, the chief of the Pediatric Infectious Diseases Division at the University of California Davis Children’s Hospital. “It doesn’t seem worth it to me. It doesn’t seem worth the risk, not only for the family to risk transmission but for the community to result in outbreaks like we saw after Memorial Day.”

The C.D.C., in its Halloween safety guidelines, classified traditional trick-or-treating as a high-risk activity, along with indoor haunted houses and crowded costume parties.

The agency, along with some public officials, is imploring families to find new, safer ways to celebrate. They suggest costume contests via Zoom, candy scavenger hunts in the home or yard and scary movie nights.

If a family does decide to trick-or-treat, experts have urged families and children to wear protective masks in addition to costume masks.

Teresa Tomb, one of the organizers of an annual Halloween parade in Lexington, Ky. — the theme of which combines zombies with Michael Jackson’s “Thriller” — said the city canceled the parade this year, but replaced it with a socially distant, multi-day gathering at a park, where people can dress up and dance in their zombie costumes.

“You kind of reach a certain acceptance that this is what we have to do,” she said. “It will just be a special year.”

Credit…Christopher Lee for The New York Times

Remdesivir, the only antiviral drug authorized for treatment of Covid-19 in the United States, fails to prevent deaths among patients, according to a study of more than 11,000 people sponsored by the World Health Organization.

The drug was granted emergency authorization by the Food and Drug Administration on May 1 after a trial by the National Institutes of Health found that remdesivir modestly reduced the time to recovery in hospitalized. President Trump received the antiviral after he began showing symptoms earlier this month.

“This puts the issue to rest — there is certainly no mortality benefit,” said Dr. Ilan Schwartz, an infectious-disease physician at the University of Alberta in Canada.

But other scientists said the design of the W.H.O.’s sprawling clinical trial, which collected data from hundreds of hospitals, meant the conclusions were not definitive.

Conducted in dozens of countries with various health care systems and inconsistent treatment protocols, the data are difficult to analyze and compare, said Dr. Peter Chin-Hong, an infectious-disease expert at the University of California, San Francisco.

The findings, which were posted online on Thursday, have not yet been peer-reviewed or published in a scientific journal.

The W.H.O.’s study, called the Solidarity trial, enrolled 11,266 adults with Covid-19 in 405 hospitals in 30 countries. The participants were given four drugs singly or in combination: remdesivir, hydroxychloroquine, lopinavir, interferon or interferon plus lopinavir. About 4,100 received no drug treatment.

In the end, no drug or combination reduced mortality, the chances that mechanical ventilation would be needed, or time spent in the hospital, compared with the patients who were not given drug treatment.

Still, several experts noted that some of the drugs in the trial may benefit people with Covid-19 earlier in the course of their illness.

Global Roundup

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A city in eastern China has started inoculating some people against the coronavirus with a vaccine that has not finished late-stage clinical trials, ignoring warnings from scientists that the campaign could carry major health risks.

The announcement on Thursday, by health officials in the eastern city of Jiaxing, highlights how China has expanded its mass vaccination campaign even before rigorous testing concludes. The push has bewildered several scientists, who have pointed out that China’s outbreak has been well under control for months.

The vaccine, developed by the private Chinese company Sinovac Biotech, is being provided on an “emergency use” basis in Jiaxing, the local Center for Disease Control and Prevention said on Thursday. The agency said the government would prioritize people in relatively high-risk jobs, including medical workers, port inspectors and public service personnel.

After that, ordinary citizens would be allowed to make reservations at community-level vaccination sites, the agency said. Two doses would be made available to people aged 18 to 59 for around $60, to be given at an interval of 14 to 28 days.

Since July, Chinese vaccine makers have vaccinated tens of thousands of employees at state-owned companies, government officials and executives from vaccine companies. The Chinese government has indicated in recent weeks that it would expand the campaign to include teachers, travelers and supermarket workers.

Zhejiang, the eastern province where Jiaxing lies, “has steadily and orderly promoted the emergency use of the coronavirus vaccine” Chen Guangsheng, a top provincial official in charge of epidemic prevention efforts, said on Friday. He added that Zhejiang had also started “the voluntary vaccination of key recommended subjects.”

Mr. Chen told a news briefing that the government had administered 743,000 doses of flu and coronavirus vaccines. An official refused to provide a breakdown.

Mr. Chen’s comments prompted several Chinese media outlets to misreport that the figure was referring to the number of people who had taken a vaccine for the coronavirus.

In other global developments:

  • Greece imposed a lockdown on the northern region of Kozani on Friday, closing shops and restaurants and banning travel outside the region after a spike in new cases. The restrictions will apply until Oct. 29. Kozani is the first Greek region to reimpose such measures, and will also ban gatherings and require face masks in public. Schools remain open. Although Greece has done relatively well in curbing the spread of the virus compared to its European neighbors, recording just under 24,000 cases and 482 deaths, recent weeks have seen cases rise.

  • Under rules starting Friday in Scotland, couples who marry or enter into civil partnerships will no longer be required to wear face masks during the ceremony. In workplaces, masks will now be mandatory in cafeterias, except for when seated at a table, and, starting Monday, face coverings will be required in communal areas in offices. The country already requires face masks to be worn on public transport, in shops and other indoor public spaces.

  • A Berlin court ruled against a city order that forced bars and restaurants to close at 11 p.m., but upheld a ban on alcohol sales starting at the same time. The decision, in which the justices said that it was not apparent that the rule on closings would help to contain the virus, came less than a week after the restrictions went into effect. The justices relied on data from health authorities who found that most new infections come from private parties or institutions like senior homes, hospitals, places of worship, or travel. City officials had not yet decided whether to appeal.

  • Prime Minister Sanna Marin of Finland said she had left a European Union summit in Belgium “as a precautionary measure” and was returning home to undergo a coronavirus test, The Associated Press reported. She had attended a meeting in Finland on Wednesday with a lawmaker who later tested positive for the virus. Ms. Marin’s announcement came a day after the European Commission’s president, Ursula von der Leyen, left the summit because one of her close staff members tested positive. Also Friday, a special European Union meeting on China scheduled for next month in Berlin was canceled as cases in the German capital continued to rise.


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Prime Minister Boris Johnson of Britain addressed the rising coronavirus cases in Manchester, England, saying the best way to curb the spread was through targeted responses.CreditCredit…Andy Rain/EPA, via Shutterstock

For Prime Minister Boris Johnson of Britain, the pandemic and the looming domestic upheaval it has overshadowed — Brexit — are linked.

The economic turmoil unleashed by the pandemic has raised the pressure on Mr. Johnson to avoid the self-inflicted disruption of ruptured negotiations with the European Union over Britain’s withdrawal.

The prime minister has now reached a moment of truth on the two issues that have dominated Britain this year: the pandemic and the withdrawal talks. But he is still playing for time, a strategy that could put lives or livelihoods at risk if he waits too long.

On Thursday, Mr. Johnson inched closer to imposing more limits on the country. But he stuck to his argument that the best way to curb the coronavirus was through targeted responses, not the two-week nationwide lockdown pushed by the opposition Labour Party and his own scientific advisers.

The prime minister also seemed ready to string out trade talks with Brussels, letting a self-imposed deadline pass on Thursday without a deal. While Mr. Johnson could torpedo the negotiations on Friday, after a two-day summit meeting of European Union leaders, analysts said the British government still appeared eager to strike an agreement by the legal deadline of Dec. 31.

Mr. Johnson’s reluctance to move decisively on either front, the virus or Brexit, risks making both worse, analysts say.

Dragging out the talks with Brussels could put Britain in a bind if the two sides hit an impasse as the clock runs out. Putting off a short lockdown — which experts have dubbed a “circuit breaker” — could necessitate a longer lockdown later, according to medical experts.

“If you’re going to do it, do it early, fast and hard,” said Devi Sridhar, chair of the global public health program at the University of Edinburgh. “The longer they delay, the less likely a two-week circuit breaker will work.”

Most bars and pubs will be closed starting Saturday in Lancashire, in northwest England, as the region of about one million people moves into the highest level of the country’s three-tier alert system, which is reserved for areas with the highest rates of infection. People will also be barred from socializing indoors with members of other households.

The federal budget deficit soared to a record $3.1 trillion in the 2020 fiscal year, official figures showed on Friday, as the coronavirus pandemic fueled enormous government spending while tax receipts plunged as households and businesses struggled with economic shutdowns.

The shortfall underscores the long-term economic challenge facing the United States as it tries to emerge from the sharpest downturn since the Great Depression. Interest rates are low — meaning it costs less for the government to borrow money — but the ballooning deficit is already complicating policy choices as Republicans resist another large stimulus package, citing concerns about the U.S. debt burden.

The deficit — the gap between what the U.S. spends and what it earns through tax receipts and other revenue — was $2 trillion more than what the White Houses budget forecast in February. It was three times as large as the $984 billion deficit in the 2019 fiscal year.

In a statement accompanying the annual budget report, Treasury Secretary Steven Mnuchin highlighted the extraordinary level of money that has been pumped into the economy this year to combat the virus and prop up the economy.

Federal spending enabled a $600 weekly unemployment benefit on top of state benefits, a remarkably effective expansion of the safety net.

It helped pay many workers more than their lost wages. It enabled families to spend more than during normal times. It even allowed households to put away savings as the economy was teetering.

When the money stopped at the end of July, workers quickly burned through those reserves. Of the savings many households were able to build up over the course of four months of unusually generous government help, much of it was gone by the end of August, according to banking data from about 80,000 households receiving unemployment and analyzed by researchers at the JPMorgan Chase Institute and the University of Chicago.

Two and a half months after the benefits ended, Congress and the White House have been unable to reach an agreement on a broad stimulus package to revive them. Faced with dwindling savings and constant bills, most households face a dilemma.

“The choices are to stop spending on regular everyday purchases, or stop making payments like mortgages, student loans, auto loans, credit cards,” said Peter Ganong, an economist at the University of Chicago who studied the banking data. “That’s a terrible choice for a family to have to make. It’s a terrible choice for the macro economy.”

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Credit…Adek Berry/Agence France-Presse — Getty Images

Indonesia, where coronavirus cases have been rising steadily for months, has overtaken the Philippines and now leads Southeast Asia in the number of reported cases and deaths from the coronavirus.

Together, Indonesia and the Philippines account for nearly 90 percent of the confirmed cases in the region, and both countries expect to see their economies contract this year.

As of Friday, Indonesia has reported 353,461 cases and the Philippines 351,750. More significantly, Indonesia’s death toll of 12,347 is nearly double that of the Philippines and is the highest in East Asia.

“Indonesia’s death rate has always been high, and it shows that we have failed in the early detection of cases,” said Dicky Budiman, an Indonesian epidemiologist at Australia’s Griffith University. “Indonesia has to change its strategy by increasing testing massively and aggressively.”

Because of the lack of testing, he said, many patients come to the hospital only when they are too sick to be helped. The actual number of cases is likely to be two to 10 times higher than the official figure, he said.

The virus in the Philippines remains out of control, he added, but the government there has had more success in containing it by increasing its testing.

As a whole, Southeast Asia’s 11 countries have done relatively well in containing the virus. With a population of 655 million, the region reports about 820,000 cases. That is fewer than either California or Texas, which have much smaller populations, although both states have significantly higher testing rates.

Vietnam and Thailand have led the way, and neither country has reported a case of local transmission in weeks. Between them, they report fewer than 4,800 cases and only 94 deaths since the pandemic began.

But other countries, such as Myanmar and Malaysia, have seen a large spike in cases over the past 10 days and have imposed partial lockdowns in some areas. Both countries had limited the virus’s spread earlier this year but are now wrestling with the surge in cases even as they face possible leadership changes.

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