Live Covid-19 Global Updates – The New York Times

In photos and videos released by the White House, there was hardly any sign that President Trump is sick, and painting in the broadest of strokes, his doctors offered a fairly rosy portrait of his condition.

But to some outside experts who examined that portrait closely, some things seemed off.

How much, for example, should people make of the president’s fluctuating oxygen levels? And why did his doctors decide to begin treatment with a steroid drug?

Too some infectious disease experts, there were signs that Mr. Trump may be suffering a more severe case of Covid-19, the disease caused by the coronavirus, than his physicians have acknowledged.

“This is no longer aspirationally positive,” Dr. Esther Choo, a professor of emergency medicine at Oregon Health & Science University in Portland, said of the doctors’ statements. “And it’s much more than just an ‘abundance of caution’ kind of thing.”

Based his doctors’ account, Mr. Trump’s symptoms appear to have rapidly progressed since he announced early Friday that he had tested positive for the coronavirus.

Mr. Trump had a “high fever” on Friday, and there were two occasions when his blood oxygen levels dropped, his doctors said, including to a level that can indicate that a patient’s lungs are compromised. The symptom is seen in many patients with severe Covid-19.

The president’s medical team also said that he had been prescribed dexamethasone. The drug is a steroid used to head off an immune system overreaction that kills many Covid-19 patients. And it is generally reserved for those with severe illness.

“The dexamethasone is the most mystifying of the drugs we’re seeing him being given at this point,” said Dr. Thomas McGinn, physician in chief at Northwell Health, the largest health care provider in New York State.

The drug, he said, is normally not used unless the patient’s condition seems to be deteriorating.

“Suddenly, they’re throwing the kitchen sink at him,” Dr. McGinn said. “It raises the question: Is he sicker than we’re hearing, or are they being overly aggressive because he is the president, in a way that could be potentially harmful?”

Of course, given the patient, there may be another explanation.

Some experts raised an additional possibility: that the president is directing his own care, and demanding intense treatment despite risks he may not fully understand. The pattern even has a name: V.I.P. syndrome.

As President Trump and some of his associates test positive for the coronavirus, the number of new cases reported each day across the United States has been slowly rising.

The country is at a key moment in the pandemic, and spread of the virus could worsen significantly through the autumn, experts fear, as colder weather forces people indoors. Every day, some 43,000 new cases are being reported — far fewer than during the surge in the summer, but still an uncomfortably large number.

Some of the country’s least populous states are now seeing their highest infection rates.

When coastal cities suffered in the spring, cases remained relatively scarce across most of the nation’s midsection. But since late summer, North Dakota and South Dakota have added more cases per capita than any other state.

Utah recorded 1,387 new cases on Sunday, a single-day record. Four states — Wisconsin, Indiana, Montana and Wyoming — have added more cases in the last week than in any other seven-day stretch of the pandemic.

One significant change from the spring and early summer has been the return of college students to campuses.

The New York Times has identified more than 130,000 cases at more than 1,300 American colleges since the pandemic began.

Some of the worst trouble spots have calmed. Florida is now averaging about 2,300 new cases a day, roughly one-fifth of what it was seeing at its worst. In Arizona, daily case reports have dropped to about 500 on average, down from more than 3,600.

New infections have also plunged in Georgia, Louisiana and South Carolina. Mississippi and Alabama have made significant progress since midsummer as well, though case numbers there remain high.

California and Texas have also seen drops in case numbers. Both states, however, have recorded more than 800,000 cases.

Over a busy weekend of medical briefings, the American public has been looking to Dr. Sean P. Conley — a Navy commander and doctor of osteopathy who has been the White House physician since 2018 — for reassurance about President Trump’s condition.

Instead, experts say, Dr. Conley has delivered confusion and obfuscation. He even confessed that he had misled the public on Saturday about Mr. Trump’s treatment to reflect the “upbeat attitude” of the White House.

On Saturday, he ducked questions about whether Mr. Trump had been on oxygen, then revealed on Sunday that indeed, the president had been on oxygen — an indicator that Mr. Trump’s illness may be classified as “severe.” On Sunday, Dr. Conley was similarly evasive, sidestepping questions about whether the president’s X-rays revealed any lung damage or pneumonia. “I’m not going to get into specifics of his care,” he said.

Caring for any president presents unique challenges. Like all doctors, Dr. Conley is bound by the Hippocratic oath to respect his patient’s wishes for privacy and to keep secret that which “ought not to be spoken of outside.” He is also a Navy officer caring for the commander in chief, whose orders he is obliged to follow.

But all of that must be balanced against the public’s right to have information about the health of the leader of the free world. And this particular leader, Mr. Trump, is well known for not wanting to look weak.

Dr. Conley is supervising a team of medical experts at Walter Reed National Military Medical Center, including Dr. Sean Dooley, a pulmonologist, as well as an outside expert, Dr. Brian Garibaldi, the director of the biocontainment unit at Johns Hopkins Hospital in Baltimore.

To the surprise of many in medicine, one doctor not being consulted is Dr. Anthony S. Fauci, one of the world’s leading experts on infectious diseases. (Dr. Fauci is on the White House coronavirus task force, but he was sidelined when his statements of fact about the virus irritated the president.)

No matter what Dr. Conley says or does not say, his colleagues in medicine agree on one thing: If he is going to put himself in the position of answering questions about the president’s care, he has to answer truthfully and to the fullest extent possible.

“You can’t both wear the white coat and lie, evade, obfuscate the situation,” said Dr. Ezekiel Emanuel, a bioethicist at the University of Pennsylvania, “because you are using the white coat to give yourself credibility.”

New York City police officials have instructed all officers to wear masks in public or risk discipline, as the department faces mounting criticism over officers’ failure to comply with a state mandate that people wear face coverings in public when social distancing is not possible.

The Police Department’s directive, issued on Friday in memos and a video, came after elected officials repeatedly called out the police for flouting the mask mandate they are supposed to enforce. About 400 officers have been assigned to nine neighborhoods in Brooklyn and Queens where there have been upticks in coronavirus cases and where the city plans to close nonessential businesses and schools this week.

Terence A. Monahan, the chief of department and the highest-ranking uniformed officer, appeared in a video sent to officers on Friday instructing them to wear masks in public areas, department facilities and where they cannot be socially distanced.

“It is our responsibility to set the example for our great city and do everything we can to help ensure that we do not have another hospitalized member bring this deadly infection into our homes or have another funeral,” he said.

A memo sent later in the day added that the requirement applies to shared offices, elevators, halls and bathrooms, and at all times in the first 14 days of an officer’s return from places with a travel advisory. But officials carved out exceptions when officers are eating and drinking, adjusting their masks or having difficulty breathing.

global roundup

Six months ago, for the first time in its history, the Peace Corps suspended all operations as the coronavirus raced around the globe. Now it is preparing to send volunteers back into the field.

But the planning for the redeployment of Americans around a world shaken by the pandemic comes as the agency faces renewed questions about the quality of its medical care, touched off in part by the death of a 24-year-old volunteer from undiagnosed malaria.

The volunteer, Bernice Heiderman, died alone in a hotel room in Comoros, off Africa’s east coast, in 2018, after sending desperate text messages to her family. She told them that her Peace Corps doctor was not taking her complaints seriously.

An investigation by the agency’s inspector general documented a string of problems. Ms. Heiderman’s doctor, the investigation found, had “limited training in tropical medicine,” and failed to test for malaria — an obvious diagnosis. And the agency’s medical experts in Washington, with whom he consulted, never asked him to.

“Had she received timely treatment,” the inspector general concluded, “she could have made a rapid, full recovery.”

In March, the Peace Corps evacuated more than 7,000 volunteers from more than 60 countries. It is now accepting applications for them to return to service. If conditions permit, officials said, some may return to their posts by the end of the year, and new volunteers may begin as early as Jan. 1.

The agency said in an emailed statement that it “continues to grieve the tragic loss of volunteer Bernice Heiderman” and that it had “initiated several steps to further strengthen health care for volunteers.”

In other global developments:

• Pope Francis criticized the lack of unity in the world’s response to the coronavirus pandemic in a document released on Sunday. “Aside from the different ways that various countries responded to the crisis, their inability to work together became quite evident,” Francis said in the encyclical, the most authoritative form of papal teaching. “For all our hyperconnectivity, we witnessed a fragmentation that made it more difficult to resolve problems that affect us all.”

• With President Trump hospitalized with Covid-19, Secretary of State Mike Pompeo will cut short a trip to Asia this week, canceling stops in South Korea and Mongolia but continuing with a visit to Japan. Mr. Pompeo earlier alluded to the possibility of curtailing his Asia visit because of the infections in the president’s circle, but a State Department spokeswoman, Morgan Ortagus, did not specify why the schedule had been changed in a statement on Saturday.

“I learned a lot about Covid,” the president of the United States assured his fellow citizens, looking straight into the camera on Day 3 of his stay at the Walter Reed National Military Medical Center.

But what have Americans learned?

It may just be how little they still seem to know about the virus — and about the most famous patient in the world.

When did President Trump and his aides first realize he might be infected? When exactly did his treatment begin? Did he know he might be ill and meet with supporters anyway? And were his doctors being fully forthcoming about just how he sick he might be?

There were questions, too, about just what a president who has mocked mask wearing, encouraged crowded political rallies, advanced dubious treatments and at times even dismissed the seriousness of the virus threat has learned from his own personal encounter with Covid-19, the disease caused by the virus.

“I get it, and I understand it,” Mr. Trump said in the video he posted from the Walter Reed military hospital in Bethesda, Md., late Sunday afternoon. But it was anyone’s guess if he was chagrined at the situation he now found himself in.

The president did not use the video as an opportunity to urge people to be careful: to wear masks and maintain social distance. He did use it to laud his political supporters, some of whom were gathered outside the hospital complex.

Then, seasoned reality show performer that he is, he broke the fourth wall, confiding to viewers that he planned to pay those supporters a surprise visit.

A little while later, he made good on his word. The president infected with a disease that has killed more than 200,000 Americans got into a tightly sealed S.U.V. accompanied by Secret Service agents for a quick drive-by wave.