Tag Archives: Coronavirus

One in five U.S. children with coronavirus may need hospital care: CDC

By Gene Emery

NEW YORK (Reuters) – Up to 20% of U.S. children infected by the novel coronavirus require hospitalization, with infants under age 1 most likely to be in that group, according to the government’s first in-depth analysis of the disease in the youngest patient population.

Compared with adults, children infected with the coronavirus are less likely to have symptoms and more likely to have a mild illness, the U.S. Centers for Disease Control and Prevention’s (CDC) analysis also found.

That confirms published studies from China, where the virus originated, suggesting the illness known as COVID-19 might be overlooked in children even as they are spreading it to adults.

Although children under age 18 make up 22% of the U.S. population, they accounted for only 1.7% of the 149,082 confirmed COVID-19 cases for which the patient’s age was known, researchers wrote in the CDC’s Morbidity and Mortality Weekly Report.

Up to 2% of infected children required intensive care unit admission, the analysis found.

The rates for children are significantly lower than for adults under age 65, up to a third of whom require hospitalization, with up to 4.5% needing intensive care.

CDC researchers emphasize the findings are still based on incomplete data, as most cases lacked information on disease symptoms, severity or patients’ underlying conditions.

Despite the limitations, the data show COVID-19 may be producing different symptoms in the young.

While 56% of children for whom data was available had fever, the rate was 71% in adults. Cough was a symptom in 54% of kids versus 80% of adults. Shortness of breath developed in 13% of those under 18 versus 43% of adults under age 65.

Muscle aches and pains, sore throat, headache, and diarrhea were also less common in children.

One child who tested positive for the disease had no symptoms at all. Three infected children have died.

More than 355,000 people in the United States have tested positive for the disease, with coronavirus-related deaths crossing the 10,000 mark on Monday.

Among all the 2,572 cases in U.S. children through April 2, 33% were in New York City, 23% were from the rest of New York, 15% were in New Jersey and 29% were from the rest of the country.

The first pediatric case in the U.S. was reported to the CDC on March 2.

(Reporting by Gene Emery; editing by Nancy Lapid and Bill Berkrot)

New York, New Jersey see early signs of coronavirus ‘flattening’

By Nathan Layne and Peter Szekely

NEW YORK (Reuters) – The governors of New York and New Jersey said on Monday their states were showing tentative signs of a “flattening” of the coronavirus outbreak, but they warned against complacency as the nationwide death toll topped 10,000 and the number of cases reached 350,000.

New York Governor Andrew Cuomo said confirmed coronavirus-related deaths reached 4,758 as of Monday, an increase of 599 from Sunday, compared with an increase of 594 during the previous 24 hours. On Friday, the state’s death toll increased by 630.

Cases in the state, the U.S. epicenter of the pandemic, increased by 7 percent in 24 hours to 130,680, Cuomo said. Hospitalizations, admissions to intensive care units and intubations – the process of inserting a breathing tube for use in mechanical ventilation – had all declined, signs of a “possible flattening of the curve.”

“While none of this is good news, the possible flattening of the curve is better than the increases that we have seen,” Cuomo told a daily briefing, referring to the shape of the curve when deaths are illustrated on a graph.

The tentative signs of progress sent U.S. stocks sharply higher, with the S&P 500 index up nearly 5.5%. The broadly based index is now down about 22 percent from its Feb. 19 peak. At its March low, it was more than 30 percent off its apex.

Cuomo warned that the numbers remain grim and that it was uncertain the state had turned the corner, saying: “If we are plateauing, we are plateauing at a high level.”

In neighboring New Jersey, the state with the second-highest number of cases and deaths, Governor Phil Murphy told a briefing, “Our efforts to flatten the curve are starting to pay off.” There was a 24 percent per day increase in positive cases on March 30 and it was a 12 percent increase on Monday.

All told, New Jersey has confirmed more than 41,000 cases and more than 1,000 coronavirus-related deaths,

Murphy warned that if social-distancing and hand-washing guidelines were relaxed, a surge of cases would overwhelm the healthcare system with “disastrous” results.

To stop his state from backtracking, Cuomo extended until April 29 an order to keep non-essential businesses and schools closed. He also doubled maximum fines for ignoring social distancing to $1,000.

“This virus has kicked our rear end,” Cuomo said. “Now is not the time to slack off from what we are doing.”

At least one model offered hope that the death rate was slowing in the United States. The University of Washington model, one of several cited by U.S. and some state officials, now projects U.S. deaths at 81,766 by Aug. 4, down about 12,000 from a projection over the weekend.

White House medical experts have forecast that between 100,000 to 240,000 Americans could die in the pandemic, even if sweeping orders to stay home are followed.

‘PEAK DEATH WEEK’

Despite the hopeful tone in New York and New Jersey, a national U.S. health official said the country was entering what he called the “peak death week.”

The U.S. death toll, numbering 10,297 on Monday, was rapidly closing in on Italy and Spain, the countries with the most fatalities to date at nearly 16,000 and more than 13,000 respectively, according to a Reuters tally of official data.

“It’s going to be the peak hospitalization, peak ICU week and unfortunately, peak death week,” Admiral Brett Giroir, a physician and member of the White House coronavirus task force, told ABC’s “Good Morning America” on Monday.

He raised particular alarm for New York, New Jersey, Connecticut and Detroit, Michigan.

“Whether you live in small-town America or you live in the ‘Big Apple,’ everyone is susceptible to this and everyone needs to follow the precautions we’ve laid out,” Giroir said on NBC’s “Today” show.

More than 90% of Americans are under stay-at-home orders issued by state governors while eight states still were holding out on imposing such restrictions.

In Michigan, the governor said three major health systems have less than three days until face shields run out and less than six days until surgical gowns run out.

Certain medications that hospitals must give patients when using ventilators are also running low, said John Fox, president of Beaumont Health, one of Michigan’s largest health care systems.

‘NEED HEROES’

New York City Mayor Bill de Blasio said that a shortage of medical professionals was replacing a lack of equipment as the city’s primary need and called for an additional 45,000 clinical personnel for April.

“More and more, the challenge is going to be personnel,” de Blasio told reporters outside a surgical gown manufacturing facility. “We need these supplies, but we also need heroes to wear them.”

The city has reported more than 3,100 deaths, and it may resort to temporarily burying the dead in an unspecified park, said Mark Levine, chair of the New York City Council health committee.

“Soon we’ll start ‘temporary interment’. This likely will be done by using a NYC park for burials (yes you read that right). Trenches will be dug for 10 caskets in a line,” Levine wrote on Twitter. “It will be done in a dignified, orderly – and temporary – manner. But it will be tough for NYers to take.”

Levine later told Reuters that the city has not yet identified any parkland as a temporary burial site if needed.

(Reporting by Nathan Layne, Peter Szekely and Barbara Goldberg; additional reporting by Doina Chiacu and Susan Heavey; Writing by Daniel Trotta and Grant McCool; Editing by Frank McGurty, Howard Goller and Cynthia Osterman)

With hospitals stressed, U.S. enters ‘peak death week’ in coronavirus crisis

By Doina Chiacu and Susan Heavey

WASHINGTON (Reuters) – The United States entered what an official called the “peak death week” of the coronavirus on Monday while a watchdog report said hospitals were struggling to maintain and expand capacity to care for infected patients.

The U.S. death toll, now at more than 9,600, was rapidly closing in on Italy and Spain, the countries with the most fatalities to date at nearly 16,000 and about 12,500 respectively, according to a Reuters rally of official data.

“It’s going to be the peak hospitalization, peak ICU week and unfortunately, peak death week,” Admiral Brett Giroir, a physician and member of the White House coronavirus task force, told ABC’s “Good Morning America” on Monday.

He raised particular alarm for the states of New York, New Jersey, Connecticut and the city of Detroit.

Results of a national March 23-27 survey showed that “severe shortages” of testing supplies and long waits for test results were limiting the ability of hospitals to keep track of the health of staff and patients, the U.S. Department of Health and Human Services Office of Inspector General said. https://bit.ly/2xOZfof

“Hospitals also described substantial challenges maintaining and expanding capacity to care for patients,” said the report, described as a snapshot of the issues hospitals faced in mid-March. Efforts were being made to address those issues, it said.

The survey, which included information from 323 hospitals, confirmed reports that shortages of beds, ventilators and protective gear were creating chaotic conditions, with patients, isolated from their families, dying alone.

Meanwhile, more than 90 percent of Americans are under stay-at-home orders issued by state governors.

The watchdog said hospitals reported “that changing and sometimes inconsistent guidance from federal, State, and local authorities … confused hospitals and the public.” Widespread shortages of personal protective equipment put hospital staff and patients at risk, it said.

GLIMMER OF HOPE Despite the grim warnings, at least one model offered hope that the death rate was slowing.

The University of Washington model, one of several cited by U.S. and some state officials, now projects U.S. deaths at 81,766 by Aug. 4, down about 12,000 from a projection over the weekend.

The model, which is frequently updated with new data, projects the peak need for hospital beds on April 15 and for daily deaths at 3,130 on April 16.

Trump, who has oscillated between issuing dire warnings and expressing optimism that contradicts the views of his medical experts, tweeted “USA STRONG!” and “LIGHT AT THE END OF THE TUNNEL!” on Monday.

Trump has deferred to state governors for issuing stay-at-home orders.

Eight states, all with governors from Trump’s Republican Party, have yet to order residents to stay home: Arkansas, Iowa, Nebraska, North Dakota, South Carolina, South Dakota, Utah and Wyoming. Georgia, which has recorded 6,600 cases and more than 200 deaths, ordered residents to stay home but then allowed some beaches to reopen.

In Washington, D.C., and other places, some people flouted the social distancing guidelines over the weekend. Sunshine and warm weather brought hordes of people out to bike trails and open spaces near the Potomac River. While a number of people wore masks, some groups moved together in close proximity.

TASK FORCE CLASH

White House trade adviser Peter Navarro on Monday acknowledged that members of the White House coronavirus task force disagreed over the weekend about the efficacy of a malaria drug, hydroxychloroquine, for use against the disease.

Navarro had clashed with Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, Axios reported. Fauci and other top health advisers have argued there have not been enough studies done to prove the drug was effective against COVID-19, the respiratory disease caused by the new coronavirus.

U.S. President Donald Trump has made his opinion on the drug well known and personally pressed federal health officials to make the drug available to treat coronavirus, two sources have told Reuters. [nL1N2BS06Q]

In an interview on CNN on Monday, Navarro said 29 million tablets of hydroxychloroquine were sitting in a warehouse.

He told CNN that at the task force meeting on Saturday, “there was unanimous agreement” that the Federal Emergency Management Agency “would immediately begin surging hydroxy into the hot zones to be dispensed only between a doctor and a patient decision not the federal government.”

(Reporting by Doina Chiacu, Susan Heavey and Peter Szekely; Writing by Daniel Trotta and Grant McCool; Editing by Frank McGurty and Howard Goller)

 

Tiger at New York’s Bronx Zoo tests positive for coronavirus

By Nathan Layne

(Reuters) – A tiger at the Bronx Zoo in New York City has tested positive for the respiratory disease caused by the novel coronavirus, in the first known case of a human infecting an animal and making it sick, the zoo’s chief veterinarian said on Sunday.

Nadia, the 4-year-old Malayan tiger that tested positive, was screened for the COVID-19 disease after developing a dry cough along with three other tigers and three lions, the Wildlife Conservation Society, which manages the zoo, said in a statement. All of the cats are expected to recover, it said.

The virus that causes COVID-19 is believed to have spread from animals to humans, and a handful of animals have tested positive in Hong Kong.

But officials believe this is a unique case because Nadia became sick after exposure to an asymptomatic zoo employee, Paul Calle, chief veterinarian at the Bronx Zoo, told Reuters. Calle said they did not know which employee infected the tiger.

“This is the first time that any of us know of anywhere in the world that a person infected the animal and the animal got sick,” Calle said, adding that they planned to share the findings with other zoos and institutions. “Hopefully we will all have a better understanding as a result.”

While the other tigers and lions were also exhibiting symptoms, the zoo decided to test only Nadia because she was the sickest and had started to lose her appetite, and they did not want to subject all the cats to anesthesia, Calle said.

“The tigers and lions weren’t terribly sick,” he said.

Nadia underwent X-rays, an ultrasound and blood tests to try to figure out what was ailing her. They decided to test for COVID-19 given the surge in cases in New York City, the epicenter of the outbreak in the United States.

The first tiger at the zoo, which has been shut since mid-March, began showing signs of illness on March 27, according to the U.S. Department of Agriculture National Veterinary Services Laboratories, which performed the test.

(Reporting by Nathan Layne in Wilton, Connecticut; Editing by Daniel Wallis)

Loss of taste and smell key COVID-19 symptoms, app study finds

By Kate Kelland

LONDON (Reuters) – Losing your sense of smell and taste may be the best way to tell if you have COVID-19, according to a study of data collected via a symptom tracker app developed by scientists in Britain and the United States to help monitor the coronavirus pandemic.

Almost 60% of patients who were subsequently confirmed as positive for COVID-19 had reported losing their sense of smell and taste, data analysed by the researchers showed.

That compared with 18% of those who tested negative.

These results, which were posted online but not peer-reviewed, were much stronger in predicting a positive COVID-19 diagnosis than self-reported fever, researchers at King’s College London said.

The app, which the researchers say could help slow the outbreak and identify more swiftly those at risk of contracting COVID-19, can be downloaded via the URL covid.joinzoe.com.

If enough people participate in sharing their symptoms, the scientists said, the app could also provide healthcare systems with critically valuable information.

“This app-based study is a way to find out where the COVID-19 hot spots are, new symptoms to look out for, and might be used as a planning tool to target quarantines, send ventilators and provide real-time data to plan for future outbreaks,” said Andrew Chan, a professor of medicine at Harvard Medical School in the United States who is co-leading the study.

Of 1.5 million app users between March 24 and March 29, 26% reported one or more symptoms through the app. Of these, 1,702 also reported having been tested for COVID-19, with 579 positive results and 1,123 negative results.

MATHEMATICAL MODEL

Using all the data collected, the research team developed a mathematical model to identify which combination of symptoms – ranging from loss of smell and taste, to fever, persistent cough, fatigue, diarrhoea, abdominal pain and loss of appetite -was most accurate in predicting COVID-19 infection.

“When combined with other symptoms, people with loss of smell and taste appear to be three times more likely to have contracted COVID-19 according to our data, and should therefore self-isolate for seven days to reduce the spread of the disease,” said Tim Spector, a King’s professor who led the study.

Trish Greenhalgh, a professor of primary care health sciences at Britain’s Oxford University and who is not involved in the study, said it was the first to demonstrate scientifically and in a large population sample that loss of smell is a characteristic feature of COVID-19.

Spector’s team applied their findings to the more than 400,000 people reporting symptoms via the app who had not yet had a COVID-19 test, and found that almost 13% of them are likely to be infected.

This would suggest that some 50,000 people in Britain may have as yet unconfirmed COVID-19 infections, Spector said.

(Reporting by Kate Kelland, editing by Grant McCool and Gareth Jones)

Residents take coronavirus surveillance into their own hands

By Thin Lei Win and Beh Lih Yi

ROME/KUALA LUMPUR (Thomson Reuters Foundation) – A week after Malaysia ordered a partial lockdown to slow the spread of the coronavirus, construction supervisor Hafi Nazhan saw residents in his affluent Kuala Lumpur neighbourhood jogging outside.

He took photos of people flouting the stay-at-home order and published them on Twitter, receiving hundreds of shares. Hafi’s followers informed the police, who subsequently arrested 11 joggers in his neighbourhood.

They were charged with violating the movement restriction order and each fined 1,000 ringgit ($230) in court.

“I was upset some people did not take this stay-at-home order seriously. These are well-educated people,” Hafi, 26, told the Thomson Reuters Foundation, adding that police were spurred into taking action after his tweets went viral.

As governments around the world urge citizens to stay indoors to contain the deadly virus, concerned communities are taking surveillance matters into their own hands, reporting alleged breaches of quarantine and questioning anyone they deem suspicious.

The respiratory disease – which emerged in China late last year – has infected roughly 1.2 million people and killed about 65,000, according to a global tally by Johns Hopkins University.

In Singapore, a Facebook post by a man sharing a photo of himself enjoying a bowl of bak kut teh – pork rib soup – in a restaurant when he should be self-quarantining at home was so widely circulated that officials stepped in.

Singapore’s law minister ordered an investigation and the immigration authorities told local media the man was likely to be charged, although they did not respond to requests seeking comment.

In New Zealand, which is under a one-month shutdown, a police website set up to allow residents to report their neighbours who break isolation rules crashed hours after going live.

The website has received about 14,000 reports in less than a week since its March 29 launch, New Zealand police said in an email. They reportedly include people playing frisbee and holding parties.

In Italy, which has been under lockdown for weeks, fraying tempers have led to people being insulted from balconies or photographed and put on social media.

In Spain, locals have also begun posting videos of people going for a run, walking in the park, riding a bike – all prohibited activities – on social media.

HEALTH VS. PRIVACY

Such tip-offs and videos have sparked a debate over digital ethics with some arguing that normal privacy rules do not apply in a health emergency because the information is in the public interest.

“When we are all threatened with the risk of catching a lethal, incurable disease I see no reason why individuals should not report their legitimate concerns to the authorities,” said David Watts, former privacy commissioner for Australia’s Victoria state.

“There is not much point having privacy rights when you are dead,” added Watts, who now teaches information law and policy at Melbourne-based La Trobe University.

For David Lindsay, law professor at the University of Technology Sydney, privacy is “not an absolute right and must always be balanced against other rights and interests”.

“The balance struck obviously depends upon circumstances, and a global pandemic is an extreme event,” he said.

Still, both Watts and Lindsay said the balance between privacy and surveillance should be reset when the pandemic is over.

Others, like Joseph Cannataci, the United Nations special rapporteur on the right to privacy, fear surveillance measures ranging from facial recognition to phone tracking could outlast the current crisis.

“Dictatorships and authoritarian societies often start in the face of a threat,” he told the Thomson Reuters Foundation this week.

STIGMA AND FEAR

Community surveillance could also end up being used “in a malicious way, particularly to replicate prejudice or bias”, warned Raman Jit Singh Chima, Asia policy director at digital rights group Access Now.

“Often the people who might be reported on will be the least privileged, or might be belong to, in the case of India, lower caste communities or people who have to work outside,” he said.

Human rights experts worry that the tens of thousands of migrant workers who returned to Myanmar after a shutdown in neighbouring Thailand’s left them jobless will come under intense scrutiny.

In a village in central Myanmar, locals would not allow a young man who returned from Thailand to stay in his home, said Khin Zaw Win, a Yangon-based political analyst.

Foreigners have also been targeted on social media, with a Facebook video showing agitated residents in a neighbourhood in Mandalay, Myanmar’s second largest city, who described barging into a building after seeing Chinese visitors coughing.

Filmed Tuesday night, it has received more than 1 million views and 10,000 shares.

“The public is being very sensitive at the moment … when the key in this kind of situation is that you should help each other,” said Khin Zaw Win.

“Some of it have to do with the narrative that (coronavirus) was brought here from abroad. I think the panic is even scarier than the virus,” he added.

Myanmar so far has about 20 confirmed cases of the virus, with the health ministry warning of a “major outbreak” after the return of migrant workers from Thailand.

Officials have also reminded the public that failure to report people suspected of being infected could lead to jail sentences of up to a month.

“From the point of view of public health, surveillance and tracking is essential. The faster and the more effectively you can enforce it, the better,” said Sid Naing, Myanmar country director for health charity Marie Stopes International.

“But it should not be done in a way that breeds hatred and fear. It should be done based on understanding and support,” he said.

“At the moment, the state cannot provide full surveillance so people started doing it themselves because they are terrified … but there are stigma and discrimination behind the fear and those are the problems.”

(Reporting By Thin Lei Win @thinink and Beh Lih Yi @behlihyi, additional reporting from Sophie Davies in Barcelona, editing by Zoe Tabary. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers the lives of people around the world who struggle to live freely or fairly. Visit http://news.trust.org)

Factbox: Latest on the spread of the coronavirus around the world

(Reuters) – Global cases of the new coronavirus have passed 1 million and more than 64,000 people have died, a Reuters tally showed on Sunday, in a pandemic that has hammered the world economy.

DEATHS AND INFECTIONS

* Reuters tally of reported cases and deaths.

* For an interactive graphic tracking the global spread, open here.

* U.S.-focused tracker with state-by-state and county map, open here.

EUROPE

* Parisians have been warned not to succumb to the tempting sunny spring weather and to remain indoors to help fight the spread of the coronavirus that has killed 7,560 in France.

* Italy’s health minister outlined plans on Sunday for broader testing and beefed-up health services as part of a package of measures that would follow a future easing of the country’s lockdown.

* Britain will have to impose further restrictions on outdoor exercise if people flout lockdown rules, Health Secretary Matt Hancock said.

* Queen Elizabeth will call on Britons to take on the challenge and disruption caused by the outbreak with good-humored resolve when she makes an extremely rare address to rally the nation on Sunday.

* The rate of new infections and deaths in Spain slowed again on Sunday as the country, suffering from one of the world’s worst outbreaks of the pandemic, began its fourth week under a near-total lockdown.

* Pope Francis marked a surreal Palm Sunday in an empty St. Peter’s Basilica, urging people living through the pandemic not to be so concerned with what they lack but how they can ease the suffering of others.

AMERICAS

* President Donald Trump told Americans to brace for a big spike in coronavirus fatalities in the coming days, as the country faces what he called the toughest two weeks of the pandemic.

* More than 306,000 people have tested positive in the United States and over 8,300 have died, according to a Reuters tally.

* The number of crew on the USS Theodore Roosevelt aircraft carrier who have tested positive for the coronavirus has risen 13% in the past 24 hours to 155, the Navy said on Saturday, in the wake of the firing of the carrier’s captain.

* Brazil’s lower house of Congress approved a constitutional amendment for a “war budget” to separate coronavirus-related spending from the government’s main budget and shield the economy as the country surpassed 10,000 confirmed cases.

ASIA

* Mainland China reported 30 new coronavirus cases on Saturday, up from 19 a day earlier as the number of cases involving travelers from abroad as well as local transmissions increased, highlighting the difficulty in stamping out the outbreak.

* India is restricting the export of most diagnostic testing kits, as coronavirus cases topped 3,350 on Sunday. The country has imposed a three-week nationwide lockdown to slow the spread of the disease.

* Australian health officials said they were cautiously optimistic about the slowing spread of the coronavirus but warned social distancing restrictions are to stay in place for months.

MIDDLE EAST AND AFRICA

* Dubai imposed a two-week lockdown and Saudi Arabia sealed off parts of the Red Sea city of Jeddah as Gulf states tightened measures in big cities to contain the spread of the coronavirus.

* Egyptian President Abdel Fattah al-Sisi postponed the launch of mega-projects including the Grand Egyptian Museum and moving civil servants to a planned new capital city to 2021 from 2020 due to the coronavirus outbreak, the presidency said.

ECONOMIC FALLOUT

* The job losses suffered in March as the U.S. economy shut down were widespread but still were disproportionately felt in a handful of employment sectors and by women, the young and the less educated.

* The pandemic has brought the global economy to a standstill and plunged the world into a recession that will be “way worse” than the global financial crisis a decade ago, the head of the International Monetary Fund said on Friday.

* Global stock markets sank on Friday following more signs that the pandemic would take a massive toll on economic growth. [MKTS/GLOB]

(Compiled by Frances Kerry)

U.S. braces for ‘hardest, saddest’ week as virus deaths surpass 9,000

(Reuters) – The United States enters one of the most critical weeks so far in the coronavirus crisis with the death toll exploding in New York, Michigan and Louisiana and some governors calling for a national order to stay at home.

New York, the hardest-hit state, reported on Sunday that there were nearly 600 new deaths for a total of 4,159 deaths and 122,000 total cases.

Bodies of victims of COVID-19, the flu-like respiratory disease caused by the coronavirus, were stacked in bright orange bags inside a makeshift morgue outside the Wyckoff Heights Medical Center in Brooklyn, according to photos provided to Reuters.

New York Governor Andrew Cuomo said new hospitalizations had fallen by 50% and, for the first time in at least a week, deaths had fallen slightly from the prior day, when they rose by 630.

But he cautioned that it was not yet clear whether the crisis in the state was reaching a plateau.

“The coronavirus is truly vicious and effective at what the virus does,” Cuomo told a daily briefing. “It’s an effective killer.”

U.S. Surgeon General Jerome Adams warned on Fox News Sunday that hard times were ahead but “there is a light at the end of the tunnel if everyone does their part for the next 30 days.”

“This is going to be the hardest and the saddest week of most Americans’ lives, quite frankly. This is going to be our Pearl Harbor moment, our 9/11 moment, only it’s not going to be localized,” he said. “It’s going to be happening all over the country. And I want America to understand that.”

Places such as Pennsylvania, Colorado and Washington, D.C. are starting to see rising deaths. The White House coronavirus task force warned this is not the time to go to the grocery store or other public places.

Most states have ordered residents to stay home except for essential trips to slow the spread of the virus in the United States where over 321,000 people have tested positive and more than 9,100 have died, according to a Reuters tally.

However, a few churches were holding large gatherings on Palm Sunday, the beginning of Holy Week in Christian churches.

“We’re defying the rules because the commandment of God is to spread the Gospel,” said Tony Spell, pastor at the Life Tabernacle megachurch in a suburb of Baton Rouge, Louisiana. He has defied state orders against assembling in large groups and has already been hit with six misdemeanors.

Louisiana has become a hot spot for the virus, on Saturday reporting a jump in deaths to 409 and more than 12,000 cases.

Governor John Bel Edwards told CNN on Sunday that the state could run out of ventilators by Thursday.

White House medical experts have forecast that between 100,000 to 240,000 Americans could be killed in the pandemic, even if sweeping orders to stay home are followed.

President Donald Trump warned on Saturday that there were “very horrendous” days ahead.

Still, Wisconsin’s Republican-controlled legislature decided to hold in-person voting for its presidential primary on Tuesday, when Democratic-led Colorado will also go ahead with local elections.

Washington state Governor Jay Inslee, a Democrat, whose state recorded the country’s first confirmed COVID-19 infection but has since seen cases flatten after early action to shutter activity, said if other states do not also impose strict measures, the virus will simply circulate.

“It would be good to have a national stay-at-home order,” he told NBC News’ “Meet the Press” program. “Even if Washington gets on top of this fully, if another state doesn’t, it could come back and come across our borders two months from now.”

Republican Arkansas Governor Asa Hutchinson, however, defended his refusal to order statewide restrictions, saying the situation was being watched closely and that his more “targeted approach” was still slowing the spread of the virus.

“We will do more as we need to,” he told NBC.

Kate Lynn Blatt, 38, a property manager from rural Pottsville, Pennsylvania, said she was astounded that her state’s governor, Tom Wolf, waited until April 1 to issue a statewide stay-at-home order.

“We were shocked. I can’t believe Trump hasn’t issued a nationwide order and I still can’t believe there are states that are still open,” Blatt said.

(Reporting by Susan Heavey and Amanda Becker in Washington and Daniel Trotta; Writing by Lisa Shumaker; Editing by Daniel Wallis)

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Latest on the spread of the coronavirus around the world

(Reuters) – Global cases of the new coronavirus have shot past 1 million with more than 54,000 fatalities, a Reuters tally showed on Friday, as death tolls soared in the United States and western Europe while the world economy nosedived.

DEATHS AND INFECTIONS

** Reported cases have surpassed 1.03 million globally and nearly 54,500 people have died, according to a Reuters tally.

** For an interactive graphic tracking the global spread, open https://tmsnrt.rs/3aIRuz7 in an external browser.

** U.S.-focused tracker with state-by-state and county map, open https://tmsnrt.rs/2w7hX9T in an external browser.

EUROPE

** Spain overtook Italy for the first time for the number of confirmed cases, but the overnight death toll fell from the previous day.

** Hospitals in Catalonia, Spain’s second worst-hit region, are at “maximum stress”, the regional leader said.

** Switzerland’s government boosted its powers to force firms to make more critical medical supplies.

** Scientific advisers to the Italian government said a reliable antibody blood test to find out who has already had the virus would give a better picture of Italy’s epidemic and could possibly be identified within days.

** The southerly region of Chechnya became the first in Russia to introduce a night curfew.

** Cases in Ireland’s nursing homes have increased four-fold in the space of a week.

** Britain’s prime minister, Boris Johnson, said on Friday he was remaining in isolation with mild symptoms, seven days after he was confirmed to be infected. Queen Elizabeth will make an extremely rare address to the nation on Sunday.

** A new hospital opened in London to provide thousands of extra beds, after being installed in a huge conference centre in just nine days. Britain’s health minister said the curve of deaths could peak on Easter Sunday.

** French high-school students have had their graduation exam, the “baccalaureat”, cancelled for first time since it was instituted two centuries ago under Napoleon.

** Poland is working on a smartphone app to help trace sufferers and mitigate the outbreak.

** Latvia reported its first death.

AMERICAS

** U.S. House Speaker Pelosi said that $350 billion in already-passed coronavirus spending was not enough for small businesses, and she wants more money in next bill being developed now in the Democrat-run House.

** New York state suffered its deadliest single day with 562 deaths, Governor Andrew Cuomo said.

** New York City hospitals and morgues struggled to treat the severely ill and bury the dead, and San Francisco secured 4,500 rooms in its now-empty hotels for the homeless.

** Two Dutch ocean liners stuck at sea due to an onboard outbreak were allowed to dock in Florida.

** Canada has recorded almost 12,000 cases and the daily death toll jumped by almost 20%.

** Brazil faces a tense few weeks, with supplies of medical and protective equipment running low and shipments from China not expected to arrive for another month.

** Mexico’s deputy health minister said there were no plans for border closures, as Mexico’s death toll jumped to 50 from 37.

ASIA AND THE PACIFIC

** The top official in the central Chinese city of Wuhan, where the virus was first identified, warned residents to stay vigilant and avoid going out, even as the latest data showed a decline in new cases in mainland China and no new infections in the city.

** Confusion reigned in some Hong Kong pubs and bars after authorities ordered a two-week closure, with many food outlets uncertain if the latest restrictions applied to them.

** The U.S. sounded the alarm about a surge in cases in Japan, adding to a chorus of prominent domestic voices who have called for more decisive action.

** Taiwan and the United States discussed how to get “closer coordination” between the island and the World Health Organization during the outbreak, drawing a rebuke from China.

** Kyrgyzstan reported its first death.

MIDDLE EAST AND AFRICA

** More than 2 million workers in Turkey have lost their jobs due to containment measures, the main opposition party said, as the government moved towards tightening curbs on movement.

** Israel locked down an ultra-Orthodox Jewish town badly affected by the virus.

** A United Nations official voiced concern over prisoners after reports of unrest in jails in countries including Iran, one of the worst hit in the world.

** Flight restrictions are hampering efforts to wipe out locust swarms threatening to devastate more crops in eastern Africa, the U.N. Food and Agriculture Organization said.

** Coronavirus has infected more than 3,000 people in sub-Saharan Africa and killed about 100, prompting some of the world’s poorest countries to shut land and sea borders.

** Norway called for more money to help the Palestinian Territories get through the pandemic.

ECONOMIC FALLOUT

** Global stock markets sank following more signs that the COVID-19 pandemic would take a massive toll on economic growth, while oil prices continued to rally on hopes of a cut to global supply.

** The global recession that economists polled by Reuters say is under way due to the coronavirus pandemic will be deeper than thought a few weeks ago, although most are clinging to hopes of a swift rebound.

** The impact of the coronavirus, and for some the oil market crash, are putting at least half a dozen countries at risk of having their debt downgraded to a ‘junk’ rating.

** The U.S. economy shed 701,000 jobs in March, ending a historic 113 straight months of employment growth.

** The Swiss government is doubling the size of its emergency loan scheme to $41 billion after being flooded by requests for help from businesses.

** Sri Lanka’s central bank cut its benchmark interest rates by a further 25 basis points, its second such reduction in three weeks.

** The head of Britain’s Society of Motor Manufacturers and Traders urged the government to support car suppliers, some of which were set to run out of money within weeks.

(Compiled by Sarah Morland and Milla Nissi; Editing by Tomasz Janowski, William Maclean, Sriraj Kalluvila, Nick Macfie and Kevin Liffey)