American Exceptionalism-- Under Trump

I was talking with one of my oldest friends early in the pandemic. He had locked himself up in his small New York City apartment and was extremely stressed out, insisting his spouse, who would walk down and then back up the 8 flights of stairs to the lobby to pick up delivered items they had ordered, immediately put all clothing into their washer and dryer. My friend didn't need a mask. He wasn't leaving his apartment and no one was coming in. He's not a very political guy-- maybe moderately political, having been a union member-- but he was happy enough to hear me heap blame on Trump for the way the pandemic was unfolding. But when I mentioned that Cuomo was also doing a bad job, my friend lost it. He came close to hanging up on me in anger. Cuomo (who only represents his own career ambitions and the wealthy donor class), he said with passion, was all New Yorkers had protecting them. He wasn't capable of hearing that Cuomo's reluctance to take bold action early doomed New York to what has turned out to be 448,140 confirmed cases-- more than any other states other than California, Florida and Texas-- and 32,815 deaths, the most, by far, than any other state. With 23,036 cases per million residents, New York has had a worse pandemic than any states other than Louisiana, Arizona and Florida (although Mississippi is catching up rapidly). New York's 23,036 cases per million stacks up poorly against the worst-hit western European nations':

• New York- 23,036 cases per million
• Sweden- 8,111 cases per million
• Spain- 7,582 cases per million
• Belgium- 6,137 cases per million
• Iceland- 5,652 cases per million
• Ireland- 5,335 cases per million
• Portugal- 5,107 cases per million
• U.K.- 4,537 cases per million
• Switzerland- 4,169 cases per million
• Italy- 4,122 cases per million
• Netherlands- 3,325 cases per million
• France- 2,996 cases per million
• Germany- 2,568 cases per million

American political leadership failed and failed miserably. In New York's case, it was clearly bipartisan failure. Trump may be far worse than Cuomo, and Cuomo may look relatively good compared to Trumpist shills like Ron DeSantis (R-FL), Doug Ducey (R-AZ), Greg Abbott (R-TX), Kim Reynolds (R-IA) and Kristi Noem (R-SD), but if New Yorkers think it's enough that they have relatively better governance than South Dakota... well then Andrew Cuomo is just what the doctor ordered.

In his epic NY Times report yesterday, The Unique U.S. Failure To Control The Virus, David Leonhardt puts the blame not just on the American tradition of prioritizing individualism over social good (ie, selfishness) but also on abysmal political leadership. The pandemic, he shows, has been worse for the U.S. than for any other developed country-- by far. "Over the past month," he wrote, "about 1.9 million Americans have tested positive for the virus. That’s more than five times as many as in all of Europe, Canada, Japan, South Korea and Australia, combined. Even though some of these countries saw worrying new outbreaks over the past month, including 50,000 new cases in Spain the outbreaks still pale in comparison to those in the United States. Florida, with a population less than half of Spain, has reported nearly 300,000 cases in the same period. When it comes to the virus, the United States has come to resemble not the wealthy and powerful countries to which it is often compared but instead to far poorer countries, like Brazil, Peru and South Africa, or those with large migrant populations [slaves], like Bahrain and Oman. As in several of those other countries, the toll of the virus in the United States has fallen disproportionately on poorer people and groups that have long suffered discrimination. Black and Latino residents of the United States have contracted the virus at roughly three times as high of a rate as white residents."

Leonhardt's reporting attributes the U.S. experience of the pandemic on "a tradition of prioritizing individualism over government restrictions. That tradition is one reason the United States suffers from an unequal health care system that has long produced worse medical outcomes-- including higher infant mortality and diabetes rates and lower life expectancy-- than in most other rich countries. The second major theme is... that the poor results in the United States stem in substantial measure from the performance of the Trump administration." I suppose the failures in Florida, Texas, Mississippi, Iowa, Arizona, etc can be attributed to the Trump administration, but what about the failures of governmental leadership in New York, New Jersey, California, Nevada and Illinois, where anti-Trumpist governance is, well... absolute.

In no other high-income country-- and in only a few countries, period-- have political leaders departed from expert advice as frequently and significantly as the Trump administration. President Trump has said the virus was not serious; predicted it would disappear; spent weeks questioning the need for masks; encouraged states to reopen even with large and growing caseloads; and promoted medical disinformation.

In recent days, Mr. Trump has continued the theme, offering a torrent of misleading statistics in his public appearances that make the situation sound less dire than it is.

Some Republican governors have followed his lead and also played down the virus, while others have largely followed the science. Democratic governors have more reliably heeded scientific advice, but their performance in containing the virus has been uneven.

“In many of the countries that have been very successful they had a much crisper strategic direction and really had a vision,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, who wrote a guide to reopening safely for the American Enterprise Institute, a conservative research group. “I’m not sure we ever really had a plan or a strategy-- or at least it wasn’t public.”

Together, the national skepticism toward collective action and the Trump administration’s scattered response to the virus have contributed to several specific failures and missed opportunities, Times reporting shows:

• a lack of effective travel restrictions;
• repeated breakdowns in testing;
• confusing advice about masks;
• a misunderstanding of the relationship between the virus and the economy;
• and inconsistent messages from public officials.

Already, the American death toll is of a different order of magnitude than in most other countries. With only 4 percent of the world’s population, the United States has accounted for 22 percent of coronavirus deaths. Canada, a rich country that neighbors the United States, has a per capita death rate about half as large. And these gaps may worsen in coming weeks, given the lag between new cases and deaths.

For many Americans who survive the virus or do not contract it, the future will bring other problems. Many schools will struggle to open. And the normal activities of life-- family visits, social gatherings, restaurant meals, sporting events-- may be more difficult in the United States than in any other affluent country.

A travel policy that fell short

In retrospect, one of Mr. Trump’s first policy responses to the virus appears to have been one of his most promising.

On Jan. 31, his administration announced that it was restricting entry to the United States from China: Many foreign nationals-- be they citizens of China or other countries-- would not be allowed into the United States if they had been to China in the previous two weeks.

It was still early in the spread of the virus. The first cases in Wuhan, China, had been diagnosed about a month before, and the first announced case in the United States had come on Jan. 21. In announcing the new travel policy, Alex M. Azar II, the secretary of health and human services, declared that the virus posed “a public health emergency.” Mr. Trump described the policy as his “China ban.”

After the Trump administration acted, several other countries quickly announced their own restrictions on travel from China, including Japan, Vietnam and Australia.

But it quickly became clear that the United States’ policy was full of holes. It did not apply to immediate family members of American citizens and permanent residents returning from China, for example. In the two months after the policy went into place, almost 40,000 people arrived in the United States on direct flights from China.

Even more important, the policy failed to take into account that the virus had spread well beyond China by early February. Later data would show that many infected people arriving in the United States came from Europe. (The Trump administration did not restrict travel from Europe until March and exempted Britain from that ban despite a high infection rate there.)

The administration’s policy also did little to create quarantines for people who entered the United States and may have had the virus.

Authorities in some other places took a far more rigorous approach to travel restrictions.

South Korea, Hong Kong and Taiwan largely restricted entry to residents returning home. Those residents then had to quarantine for two weeks upon arrival, with the government keeping close tabs to ensure they did not leave their home or hotel. South Korea and Hong Kong also tested for the virus at the airport and transferred anyone who was positive to a government facility.

Australia offers a telling comparison. Like the United States, it is separated from China by an ocean and is run by a conservative leader-- Scott Morrison, the prime minister. Unlike the United States, it put travel restrictions at the center of its virus response.

Australian officials noticed in March that the travel restrictions they had announced on Feb. 1 were not preventing the virus from spreading. So they went further.

On March 27, Mr. Morrison announced that Australia would no longer trust travelers to isolate themselves voluntarily. The country would instead mandate that everyone arriving from overseas, including Australian citizens, spend two weeks quarantined in a hotel.

The protocols were strict. As people arrived at an airport, the authorities transported them directly to hotels nearby. People were not even allowed to leave their hotel to exercise. The Australian military helped enforce the rules.

Around the same time, several Australian states with minor outbreaks shut their own borders to keep out Australians from regions with higher rates of infection. That hardening of internal boundaries had not happened since the 1918 flu pandemic, said Ian Mackay, a virologist in Queensland, one of the first states to block entry from other areas.

The United States, by comparison, imposed few travel restrictions, either for foreigners or American citizens. Individual states did little to enforce the rules they did impose.

“People need a bit more than a suggestion to look after their own health,” said Dr. Mackay, who has been working with Australian officials on their pandemic response. “They need guidelines, they need rules-- and they need to be enforced.”

Travel restrictions and quarantines were central to the success in controlling the virus in South Korea, Hong Kong, Taiwan and Australia, as well as New Zealand, many epidemiologists believe. In Australia, the number of new cases per day fell more than 90 percent in April. It remained near zero through May and early June, even as the virus surged across much of the United States.

In the past six weeks, Australia has begun to have a resurgence-- which itself points to the importance of travel rules. The latest outbreak stems in large part from problems with the quarantine in the city of Melbourne. Compared with other parts of Australia, Melbourne relied more on private security contractors who employed temporary workers-- some of whom lacked training and failed to follow guidelines-- to enforce quarantines at local hotels. Officials have responded by banning out-of-state travel again and imposing new lockdowns.

Still, the tolls in Australia and the United States remain vastly different. Fewer than 300 Australians have died of complications from Covid-19, the illness caused by the virus. If the United States had the same per capita death rate, about 3,300 Americans would have died, rather than 158,000.

Enacting tough travel restrictions in the United States would not have been easy. It is more integrated into the global economy than Australia is, has a tradition of local policy decisions and borders two other large countries. But there is a good chance that a different version of Mr. Trump’s restrictions-- one with fewer holes and stronger quarantines-- would have meaningfully slowed the virus’s spread.

Traditionally, public health experts had not seen travel restrictions as central to fighting a pandemic, given their economic costs and the availability of other options, like testing, quarantining and contact tracing, Dr. Baeten, the University of Washington epidemiologist, said. But he added that travel restrictions had been successful enough in fighting the coronavirus around the world that those views may need to be revisited.

“Travel,” he said, “is the hallmark of the spread of this virus around the world.”

The double testing failure

On Jan. 16, nearly a week before the first announced case of the coronavirus in the United States, a German hospital made an announcement. Its researchers had developed a test for the virus, which they described as the world’s first.

The researchers posted the formula for the test online and said they expected that countries with strong public health systems would soon be able to produce their own tests. “We’re more concerned about labs in countries where it’s not that easy to transport samples, or staff aren’t trained that thoroughly, or if there is a large number of patients who have to be tested,” Dr. Christian Drosten, the director of the Institute for Virology at the hospital, known as Charite, in Berlin.

It turned out, however, that the testing problems would not be limited to less-developed countries.

In the United States, the Centers for Disease Control and Prevention developed their own test four days after the German lab did. C.D.C. officials claimed that the American test would be more accurate than the German one, by using three genetic sequences to detect the virus rather than two. The federal government quickly began distributing the American test to state officials.

But the test had a flaw. The third genetic sequence produced inconclusive results, so the C.D.C. told state labs to pause their work. In meetings of the White House’s coronavirus task force, Dr. Robert R. Redfield, the C.D.C. director, played down the problem and said it would soon be solved.

Instead, it took weeks to fix. During that time, the United States had to restrict testing to people who had clear reason to think they had the virus. All the while, the virus was quietly spreading.

By early March, with the testing delays still unresolved, the New York region became a global center of the virus--without people realizing it until weeks later. More widespread testing could have made a major difference, experts said, leading to earlier lockdowns and social distancing and ultimately less sickness and death.

“You can’t stop it if you can’t see it,” Dr. Bruce Aylward, a senior adviser to the director general at the World Health Organization, said.

While the C.D.C. was struggling to solve its testing flaws, Germany was rapidly building up its ability to test. Chancellor Angela Merkel, a chemist by training, and other political leaders were watching the virus sweep across northern Italy, not far from southern Germany, and pushed for a big expansion of testing.

By the time the virus became a problem in Germany, labs around the country had thousands of test kits ready to use. From the beginning, the government covered the cost of the tests. American laboratories often charge patients about $100 for a test.

Without free tests, Dr. Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn, said at the time, “a young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people.”

Germany was soon far ahead of other countries in testing. It was able to diagnose asymptomatic cases, trace the contacts of new patients and isolate people before they could spread the virus. The country has still suffered a significant outbreak. But it has had many fewer cases per capita than Italy, Spain, France, Britain or Canada-- and about one-fifth the rate of the United States.

The United States eventually made up ground on tests. In recent weeks, it has been conducting more per capita than any other country, according to Johns Hopkins researchers.

But now there is a new problem: The virus has grown even more rapidly than testing capacity. In recent weeks, Americans have often had to wait in long lines, sometimes in scorching heat, to be tested.

One measure of the continuing troubles with testing is the percentage of tests that come back positive. In a country that has the virus under control, fewer than 5 percent of tests come back positive, according to World Health Organization guidelines. Many countries have reached that benchmark. The United States, even with the large recent volume of tests, has not.

“We do have a lot of testing,” Ms. Rivers, the Johns Hopkins epidemiologist, said. “The problem is we also have a lot of cases.”

The huge demand for tests has overwhelmed medical laboratories, and many need days-- or even up to two weeks-- to produce results. “That really is not useful for public health and medical management,” Ms. Rivers added. While people are waiting for their results, many are also spreading the virus.

In Belgium recently, test results have typically come back in 48 to 72 hours. In Germany and Greece, it is two days. In France, the wait is often 24 hours.

The double mask failure

For the first few months of the pandemic, public health experts could not agree on a consistent message about masks. Some said masks reduced the spread of the virus. Many experts, however, discouraged the use of masks, saying-- somewhat contradictorily-- that their benefits were modest and that they should be reserved for medical workers.

“We don’t generally recommend the wearing of masks in public by otherwise well individuals because it has not been up to now associated with any particular benefit,” Dr. Michael Ryan, a World Health Organization official, said at a March 30 news conference.

His colleague Dr. Maria Van Kerkhove explained that it was important to “prioritize the use of masks for those who need them most.”

The conflicting advice, echoed by the C.D.C. and others, led to relatively little mask wearing in many countries early in the pandemic. But several Asian countries were exceptions, partly because they had a tradition of mask wearing to avoid sickness or minimize the effects of pollution.

By January, mask wearing in Japan was widespread, as it often had been during a typical flu season. Masks also quickly became the norm in much of South Korea, Thailand, Vietnam, Taiwan and China.

In the following months, scientists around the world began to report two strands of evidence that both pointed to the importance of masks: Research showed that the virus could be transmitted through droplets that hang in the air, and several studies found that the virus spread less frequently in places where people were wearing masks.

On one cruise ship that gave passengers masks after somebody got sick, for example, many fewer people became ill than on a different cruise where people did not wear masks.

Consistent with that evidence was Asia’s success in holding down the number of cases (after China’s initial failure to do so). In South Korea, the per capita death rate is about one-eightieth as large as in the United States; Japan, despite being slow to enact social distancing, has a death rate about one-sixtieth as large.

“We should have told people to wear cloth masks right off the bat,” Dr. George Rutherford of the University of California, San Francisco, said.

In many countries, officials reacted to the emerging evidence with a clear message: Wear a mask.

Prime Minister Justin Trudeau of Canada began wearing one in May. During a visit to an elementary school, President Emmanuel Macron of France wore a French-made blue mask that complemented his suit and tie. Zuzana Caputova, the president of Slovakia, created a social media sensation by wearing a fuchsia-colored mask that matched her dress.

In the United States, however, masks did not become a fashion symbol. They became a political symbol.

Mr. Trump avoided wearing one in public for months. He poked fun at a reporter who wore one to a news conference, asking the reporter to take it off and saying that wearing one was “politically correct.” He described former Vice President Joseph R. Biden Jr.’s decision to wear one outdoors as “very unusual.”

Many other Republicans and conservative news outlets, like Fox News, echoed his position. Mask wearing, as a result, became yet another partisan divide in a highly polarized country.

Throughout much of the Northeast and the West Coast, more than 80 percent of people wore masks when within six feet of someone else. In more conservative areas, like the Southeast, the share was closer to 50 percent.

A March survey found that partisanship was the biggest predictor of whether Americans regularly wore masks-- bigger than their age or whether they lived in a region with a high number of virus cases. In many of the places where people adopted a hostile view of masks, including Texas and the Southeast, the number of virus cases began to soar this spring.

In March I asked almost everyone member of Congress I know for a photo of themselves wearing a mask. Only two replied enthusiastically, one progressive, Andy Levin (D-MI) and one moderate, Tom Suozzi (D-NY). A month later, no one would mind being photographed wearing a mask, but in March (when I was already walking around Los Feliz in an improvised HazMat outfit, members of Congress were still reticent about being seen in a mask. That was worrying at the time.

There was foresight under those masks-- Andy Levin (l) & Tom Suozzi (r)

The first rule of virus economics

Throughout March and April, Gov. Brian Kemp of Georgia and staff members held long meetings inside a conference room at the State Capitol in Atlanta. They ordered takeout lunches from local restaurants like the Varsity and held two daily conference calls with the public health department, the National Guard and other officials.

One of the main subjects of the meetings was when to end Georgia’s lockdown and reopen the state’s economy. By late April, Mr. Kemp decided that it was time.

Georgia had not met the reopening criteria laid out by the Trump administration (and many outside health experts considered those criteria too lax). The state was reporting about 700 new cases a day, more than when it shut down on April 3.

Nonetheless, Mr. Kemp went ahead. He said that Georgia’s economy could not wait any longer, and it became one of the first states to reopen.

“I don’t give a damn about politics right now,” he said at an April 20 news conference announcing the reopening. He went on to describe business owners with employees at home who were “going broke, worried about whether they can feed their children, make the mortgage payment.”

Four days later, across Georgia, barbers returned to their chairs, wearing face masks and latex gloves. Gyms and bowling alleys were allowed to reopen, followed by restaurants on April 27. The stay-at-home order expired at 11:59 p.m. on April 30.

Mr. Kemp’s decision was part of a pattern: Across the United States, caseloads were typically much higher when the economy reopened than in other countries.

COVID-Kemp (R-GA)

As the United States endured weeks of closed stores and rising unemployment this spring, many politicians-- particularly Republicans, like Mr. Kemp-- argued that there was an unavoidable trade-off between public health and economic health. And if crushing the virus meant ruining the economy, maybe the side effects of the treatment were worse than the disease.

Dan Patrick, the Republican lieutenant governor of Texas, put the case most bluntly, and became an object of scorn, especially from the political left, for doing so. “There are more important things than living,” Mr. Patrick said in a television interview the same week that Mr. Kemp reopened Georgia.

It may have been an inartful line, but Mr. Patrick’s full argument was not wholly dismissive of human life. He was instead suggesting that the human costs of shutting down the economy-- the losses of jobs and income and the associated damages to living standards and people’s health-- were greater than the costs of a virus that kills only a small percentage of people who get it.

“We are crushing the economy,” he said, citing the damage to his own children and grandchildren. “We’ve got to take some risks and get back in the game and get this country back up and running.”

The trouble with the argument, epidemiologists and economists agree, was that public health and the economy’s health were not really in conflict.

Early in the pandemic, Austan Goolsbee, a University of Chicago economist and former Obama administration official, proposed what he called the first rule of virus economics: “The best way to fix the economy is to get control of the virus,” he said. Until the virus was under control, many people would be afraid to resume normal life and the economy would not function normally.

The events of the last few months have borne out Mr. Goolsbee’s prediction. Even before states announced shutdown orders in the spring, many families began sharply reducing their spending. They were responding to their own worries about the virus, not any official government policy.

And the end of lockdowns, like Georgia’s, did not fix the economy’s problems. It instead led to a brief increase in spending and hiring that soon faded.

In the weeks after states reopened, the virus began surging. Those that opened earliest tended to have worse outbreaks, according to a Times analysis. The Southeast fared especially badly.

In June and July, Georgia reported more than 125,000 new virus cases, turning it into one of the globe’s new hot spots. That was more new cases than Canada, France, Germany, Italy, Japan and Australia combined during that time frame.

Americans, frightened by the virus’s resurgence, responded by visiting restaurants and stores less often. The number of Americans filing new claims for unemployment benefits has stopped falling. The economy’s brief recovery in April and May seems to have petered out in June and July.

In large parts of the United States, officials chose to reopen before medical experts thought it wise, in an attempt to put people back to work and spark the economy. Instead, the United States sparked a huge new virus outbreak-- and the economy did not seem to benefit.

“Politicians are not in control,” Mr. Goolsbee said. “They got all the illness and still didn’t fix their economies.”

The situation is different in the European Union and other regions that have had more success reducing new virus cases. Their economies have begun showing some promising signs, albeit tentative ones. In Germany, retail sales and industrial production have risen, and the most recent unemployment rate was 6.4 percent. In the United States, it was 11.1 percent.

The message is the response

The United States has not performed uniquely poorly on every measure of the virus response.

Mask wearing is more common than throughout much of Scandinavia and Australia, according to surveys by YouGov and Imperial College London. The total death rate is still higher in Spain, Italy and Britain.

But there is one way-- in addition to the scale of the continuing outbreaks and deaths-- that the United States stands apart: In no other high-income country have the messages from political leaders been nearly so mixed and confusing.

These messages, in turn, have been amplified by television stations and websites friendly to the Republican Party, especially Fox News and the Sinclair Broadcast Group, which operates almost 200 local stations. To anybody listening to the country’s politicians or watching these television stations, it would have been difficult to know how to respond to the virus.

Mr. Trump’s comments, in particular, have regularly contradicted the views of scientists and medical experts.

The day after the first American case was diagnosed, he said, “We have it totally under control.” In late February, he said: “It’s going to disappear. One day-- it’s like a miracle-- it will disappear.” Later, he incorrectly stated that any American who wanted a test could get one. On July 28, he falsely proclaimed that “large portions of our country” were “corona-free.”

He has also promoted medical misinformation about the virus. In March, Mr. Trump called it “very mild” and suggested it was less deadly than the common flu. He has encouraged Americans to treat it with the antimalarial drug hydroxychloroquine, despite a lack of evidence about its effectiveness and concerns about its safety. At one White House briefing, he mused aloud about injecting people with disinfectant to treat the virus.

These comments have helped create a large partisan divide in the country, with Republican-leaning voters less willing to wear masks or remain socially distant. Some Democratic-leaning voters and less political Americans, in turn, have decided that if everybody is not taking the virus seriously, they will not either. State leaders from both parties have sometimes created so many exceptions about which workplaces can continue operating normally that their stay-at-home orders have had only modest effects.

“It doesn’t seem we have had the same unity of purpose that I would have expected,” Ms. Rivers, the Johns Hopkins epidemiologist, said. “You need everyone to come together to accomplish something big.”

Across much of Europe and Asia, as well as in Canada, Australia and elsewhere, leaders have delivered a consistent message: The world is facing a deadly virus, and only careful, consistent action will protect people.

Many of those leaders have then pursued aggressive action. Mr. Trump and his top aides, by contrast, persuaded themselves in April that the virus was fading. They have also declined to design a national strategy for testing or other virus responses, leading to a chaotic mix of state policies.

“If you had to summarize our approach, it’s really poor federal leadership-- disorganization and denial,” said Andy Slavitt, who ran Medicare and Medicaid from 2015 to 2017. “Watch Angela Merkel. Watch how she communicates with the public. Watch how Jacinda Ardern in New Zealand does it. They’re very clear. They’re very consistent about what the most important priorities are.”

New York-- both the city and the state-- offers a useful case study. Like much of Europe, New York responded too slowly to the first wave of the virus. As late as March 15, Mayor Bill de Blasio encouraged people to go to their neighborhood bar.

Soon, the city and state were overwhelmed. Ambulances wailed day and night. Hospitals filled to the breaking point. Gov. Andrew M. Cuomo-- a Democrat, like Mr. de Blasio-- was slow to protect nursing home residents, and thousands died. Earlier action in New York could have saved a significant number of lives, epidemiologists say.

By late March, however, New York’s leaders understood the threat, and they reversed course.

They insisted that people stay home. They repeated the message every day, often on television. When other states began reopening, New York did not. “You look at the states that opened fast without metrics, without guardrails, it’s a boomerang,” Mr. Cuomo said on June 4.

The lockdowns and the consistent messages had a big effect. By June, New York and surrounding states had some of the lowest rates of virus spread in the country. Across much of the Southeast, Southwest and West Coast, on the other hand, the pandemic was raging.

Many experts now say that the most disappointing part of the country’s failure is that the outcome was avoidable.

What may not have been avoidable was the initial surge of the virus: The world’s success in containing previous viruses, like SARS, had lulled many people into thinking a devastating pandemic was unlikely. That complacency helps explains China’s early mistakes, as well as the terrible death tolls in the New York region, Italy, Spain, Belgium, Britain and other parts of Europe.

But these countries and dozens more-- as well as New York-- have since shown that keeping the virus in check is feasible.

For all of the continuing uncertainty about how this new coronavirus is transmitted and how it affects the human body, much has become clear. It often spreads indoors, with close human contact. Talking, singing, sneezing and coughing play a major role in transmission. Masks reduce the risk. Restarting normal activity almost always leads to new cases that require quick action-- testing, tracing of patients and quarantining-- to keep the virus in check.

When countries and cities have heeded these lessons, they have rapidly reduced the spread of the virus and been able to move back, gingerly, toward normal life. In South Korea, fans have been able to attend baseball games in recent weeks. In Denmark, Italy and other parts of Europe, children have returned to school.

In the United States, the virus continues to overwhelm daily life.

“This isn’t actually rocket science,” said Dr. Thomas R. Frieden, who ran the New York City health department and the C.D.C. for a combined 15 years. “We know what to do, and we’re not doing it.”

This morning, as Señor Trumpanzee was flying to Ohio for a campaign appearance with Gov. Mike DeWine, DeWine was routinely tested and found positive for COVID-19-- and then negative a few hours later. What an elaborate way of getting out of having to see Trump! In any case, what a shame that he didn't infect Trump! Ohio had 1,165 new cases confirmed today, bringing their total caseload to 97,490. Remember this? Millions of Americans have watched it.

Moscow Mitch Referred To Himself As The Grim Reaper-- And Now The Whole GOP Is A Party Of Death

Trump Tsunami by Nancy Ohanian

David Feldman tapes a radio show/podcast with me every Monday. The new one-- with special guest eastern Washington state congressional candidate Chris Armitage-- will be posted online late tonight. David and I are pals and it feels like we've known each other for decades. Last week, though, he pissed me off no end by weaving some kind of cockamamie scenario and asking me to respond to it. I almost blew a gasket. He came up with something absolutely nonsensical-- "what if the the death rate goes down; will Trump win in November?" What kind of a crazy question is that? What if Trump gives everyone in the country-- or in the swing states-- a check for $100,000; will he win in November? What if Martians invade? What if Ivanka turns into a talking marlin?

The second spike of the first wave is upon us-- and, thanks to Trump and incompetent governors, it is a doozy. Yesterday, as you've no doubt read, Florida reported its worst one-day numbers ever-- 15,300-- which is not just Florida's worst daily report, but the worst daily report of any state anywhere... ever. Yes, worst than New York's or New Jersey's worst days. That brought Florida's cases to 269,811-- 12,562 cases per million Floridians. Those numbers, reported yesterday, were for Saturday, a day the whole country reported 61,719 new cases. Yesterday the national increase was 58,349 bringing the total number of Americans who Trump has infected to 3,413,995--  and rapidly rising.

And it isn't just Florida where new cases are out of control. Yesterday, judging by nothing but their one day reports these 10 states-- not even counting Florida-- were all pandemic disaster zones:

• California +7,702
• Texas +6,091
• Arizona- 2,537
• Georgia +2,525
• South Carolina +1,949
• North Carolina +1,910
• Alabama +1,640
• Ohio +1,398
• Louisiana +1,319
• Tennessee +954

Why are those statistics important? Because in several weeks they will represent hospitals overrun with patients-- as they already are in Texas, Florida and Arizona-- and patients starting to die in larger numbers. In a statement to New Yorkers yesterday, Andrew Cuomo said "What's happening elsewhere in the United States is very concerning to us here at home, and our ability to avoid the same fate rests on New Yorkers' willingness to wear masks, socially distance and wash their hands, and local governments' willingness to enforce state guidelines. Today's numbers remain low and stable, but it is up to us to keep it that way. Being New York Tough isn't easy, but New Yorkers have shown the nation that we can effectively fight the virus when we all come together, and I urge them not to give up any ground now."

New York State is closely monitoring an uptick in COVID-19 cases in Rensselaer County, a number of which are being investigated as being linked to several individuals who tested positive for COVID-19 after traveling back to New York from Georgia. They are in isolation and the New York State Department of Health and Rensselaer County Health Department are conducting contact tracing.

On Friday, Cuomo predicted that the northeast will be hot again because of the surge in cases across the country. " Speaking on WAMC radio, he said the state government is "doing everything we can. The quarantine, we have an enforcement mechanism. But, you know, how do you catch somebody driving in, right? I mean, it’s very very difficult, it’s trying to catch water in a screen... You’re going to see our numbers and the Northeast numbers probably start to increase because the virus that you see now in the south and the west, California has real trouble, it’s going to come back here... The other states don’t take the same precautions. It rises up in the other states and then is going to come back here from the other states. That’s what’s going to happen. The only question is how far up our rate goes. But you can’t have it all across the country and not come back. You think nobody’s coming here from California and these states?"

Yesterday the Associated Press reporter "A long-expected upturn in U.S. coronavirus deaths has begun, driven by fatalities in states in the South and West, according to data on the pandemic. The number of deaths per day from the virus had been falling for months, and even remained down as states like Florida and Texas saw explosions in cases and hospitalizations-- and reported daily U.S. infections broke records several times in recent days. Scientists warned it wouldn’t last. A coronavirus death, when it occurs, typically comes several weeks after a person is first infected. And experts predicted states that saw increases in cases and hospitalizations would, at some point, see deaths rise too. Now that’s happening."

“It’s consistently picking up. And it’s picking up at the time you’d expect it to,” said William Hanage, a Harvard University infectious diseases researcher.

According to an Associated Press analysis of data from Johns Hopkins University, the seven-day rolling average for daily reported deaths in the U.S. has increased from 578 two weeks ago to 664 on July 10-- still well below the heights hit in April. Daily reported deaths increased in 27 states over that time period, but the majority of those states are averaging under 15 new deaths per day. A smaller group of states has been driving the nationwide increase in deaths.

...Deaths first began mounting in the U.S. in March. About two dozen deaths were being reported daily in the middle of that month. By late in the month, hundreds were being reported each day, and in April thousands. Most happened in New York, New Jersey and elsewhere in the Northeast.

Deaths were so high there because it was a new virus tearing through a densely populated area, and it quickly swept through vulnerable groups of people in nursing homes and other places, said Perry Halkitis, the dean of the Rutgers University School of Public Health in New Jersey.

Many of the infections occurred before government officials imposed stay-at-home orders and other social-distancing measures. The daily death toll started falling in mid-April-- and continued to fall until about a week ago.

Researchers now expect deaths to rise for at least some weeks, but some think the count probably will not go up as dramatically as it did in the spring-- for several reasons.

First, testing was extremely limited early in the pandemic, and it’s become clear that unrecognized infections were spreading on subways, in nursing homes and in other public places before anyone knew exactly what was going on. Now testing is more widespread, and the magnitude of outbreaks is becoming better understood.

Second, many people’s health behaviors have changed, with mask-wearing becoming more common in some places. Although there is no vaccine yet, hospitals are also getting better at treating patients.

Another factor, tragically, is that deadly new viruses often tear through vulnerable populations first, such as the elderly and people already weakened by other health conditions. That means that, in the Northeast at least, “many of the vulnerable people have already died,” Halkitis said.

Now, the U.S. is likely in for “a much longer, slower burn,” Hanage, the Harvard researcher, said. “We’re not going to see as many deaths (as in the spring). But we’re going to see a total number of deaths, which is going to be large.”

But Disney is opening its properties... pandemic be damned.





Generally, Americans are aghast at Trump's incompetent-- even sociopathic-- handling of the pandemic and are ready to let him know what they think of him and his enablers in November. The new Ipsos poll for Reuters released Friday show that an increasing a majority of registered voters disapprove of how Trump has handled the pandemic (57%), and only 37% approve, which is the lowest number since Ipsos began tracking in early March. When asked who they would vote for if the election were held today, voters prefer Biden over Trump 43% to 37%.

Why Can't The U.S. Handle The Pandemic? Trump And His Enablers Couldn't Do A Worse Job If They Wanted To!

Before whistles started blowing, and back when Florida Governor Ron DeSantis could still get away with reporting insanely low numbers of COVID cases in his state, he issued a foolish executive order mandating visitors to Florida from New York, New Jersey and Connecticut self-isolate for 14 days before enjoying all that a Florida spring has to offer. Now the tri-state area is healing, while Florida is becoming one of the worst-hit states in the country. On Thursday, New York reported 803 new cases, New Jersey 430 and Connecticut just 81. Meanwhile, Florida reported a record-breaking 3,207 new cases (4,001 cases per million-- worse than Italy's 3,939!). Yesterday, Florida reported another record-breaking day: 3,822 new cases, bring their cases per million to 4,179. Texas' Greg Abbott did the same thing-- a 14 day quarantine for New York traveller to Texas. And now Texas is another state where the pandemic is ravaging the population-- 3,357 new cases Thursday and a rapidly increasing cases per million number, 3,541 on Thursday.

In fact, Florida and Texas are such messes that New York Governor Andrew Cuomo, almost as much an asshole as DeSantis and Abbott, mused that he's considering quarantining people coming from Florida and other states where the pandemic is out of control.

"If you went to Florida, you had to quarantine for two weeks because they were afraid that New Yorkers were bringing the virus to their state. Fast forward a 100 days, now we’re afraid they’re bringing the virus to our state," said Cuomo. "The number of people who are getting infected and getting sick and walking into a hospital is going up in these states. Undeniably. And you can go state by state. It’s Arizona. It’s Texas. It’s Florida... It’s 20 states on the increase." Cuomo's a dickhead who was largely responsible for New York's catastrophe by moving too slow as it began ramping up. In the mass media, he loves to play the hero but a look at the New York States timeline shows Cuomo as a villain in every way except in comparison to Trump and his ideologue governors and the low bar they've set.

Meanwhile, leaders of countries around the world are looking at America's spiking new cases and shuddering. The cases per day in the U.S. have been rising. Wednesday it was 26,228 new cases and 6,756 cases per million. Thursday it was +27,924 and 6,840 cases per million, as the U.S. regained the number one slot in new cases from Brazil. Yesterday, Washington Post reporter Rick Noack wrote that the rest of the world is dumbfound by the disastrous American response to the pandemic. "As coronavirus cases surge in states across the South and West of the United States," he wrote, "health experts in countries with falling case numbers are watching with a growing sense of alarm and disbelief, with many wondering why virus-stricken U.S. states continue to reopen and why the advice of scientists is often ignored."

China’s actions over the past week stand in stark contrast to those of the United States. In the wake of a new cluster of more than 150 new cases that emerged in Beijing, authorities sealed off neighborhoods, launched a mass testing campaign and imposed travel restrictions.

Meanwhile, President Trump maintains that the United States will not shut down a second time, although a surge in cases has convinced governors in some states, including Arizona, to walk back their opposition to mandatory face coverings in public.

Commentators and experts in Europe, where cases have continued to decline, voiced concerns over the state of the U.S. response. A headline on the website of Germany’s public broadcaster read: “Has the U.S. given up its fight against coronavirus?” Switzerland’s conservative Neue Zürcher Zeitung newspaper concluded, “U.S. increasingly accepts rising covid-19 numbers.”

And this isn't just about states with backwards Republican governors like Texas, Arizona, Florida, Nebraska, South Carolina, South Dakota, Georgia and Iowa. California Governor Gavin Newsom-- a junior version of Cuomo-- is doing miserable job as well and California's pandemic is now spinning out of control and badly as Texas' and Florida's. I see it in my own neighborhood, where mandates about wearing masks are not enforced at all and where half the people don't bother. California had the most new cases on Thursday (3,787) and the cases per million shot up to 4,227 per million.

Bay Area counties still benefit from early closings before Newsom understood or developed the backbone to take action and while San Francisco (+38) Santa Clara (+75), Alameda (+105), San Mateo (+25), Contra Costa (+40) and Marin (+18) are all working diligently and successfully to keep the pandemic under control, the Southland is increasingly a disaster-zone. Los Angeles County reported 1,038 new cases Thursday, Riverside 516, San Diego 238 and San Bernardino 238. Noack wrote that Thomas Gerlinger, a professor of health sciences at the University of Bielefeld in Germany explained that "Many scientists appeared to have reached an adequate assessment of the situation early on [in the United States], but this didn’t translate into a political action plan." It took the U.S. much longer than other countries to ramp up testing capacity. Ostrich-like, Trump and Pence are extremely hostile to testing and blame it on America's "bad ratings." The U.S. is far behind other countries in testing, even though Trump deceitfully claims he's built the greatest testing apparatus in the universe. Leaving out postage-stamp-sized countries here are the tests per million:

• Denmark- 151,314
• Russia- 111,846
• U.K.- 109,513
• Spain- 103,232
• Portugal-102,682
• Belgium- 93,836
• Israel- 87,495
• Belarus- 86,978
• U.S.- 80,799
• Italy- 79,908

He noted that "Whereas the U.S. response to the crisis has at times appeared disconnected from American scientists’ publicly available findings, U.S. researchers’ conclusions informed the actions of foreign governments. 'A large portion of [Germany’s] measures that proved effective was based on studies by leading U.S. research institutes,' said Karl Lauterbach, a Harvard-educated epidemiologist who is a member of the German parliament for the Social Democrats, who are part of the coalition government. Lauterbach advised the German parliament and the government during the pandemic. Despite its far older population, Germany has confirmed fewer than 9,000 coronavirus-linked deaths, compared to almost 120,000 in the United States. (Germany has about one-fourth of the United States’ population.)... Regarding the effectiveness of face masks, Lauterbach added, “we almost entirely relied on U.S. studies.” Germany was among the first major European countries to make face masks mandatory on public transport and in supermarkets."

After consulting U.S. research and German studies, for instance, German leaders agreed to make reopening dependent on case numbers, meaning restrictions snap back or reopening gets put on hold if the case numbers in a given region exceed a certain threshold.

Meanwhile, several U.S. states have reopened despite rising case numbers.

“I don’t understand that logic,” said Reinhard Busse, a health management professor a the Technical University of Berlin.

...[W]hile most Germans disapproved of Trump before the pandemic, even his staunchest critics in Germany were surprised by how even respected U.S. institutions including the Centers for Disease Control and Prevention (CDC) struggled to respond to the crisis.

The CDC, for instance, initially botched the rollout of test kits in the early stages of the outbreak.

“Like many other aspects of our country, the CDC’s ability to function well is being severely handicapped by the interference coming from the White House,” said Harvard epidemiologist Lipsitch. “All of us in public health very much hope that this is not a permanent condition of the CDC.”

Some observers fear the damage will be difficult to reverse. “I’ve always thought of the CDC as a reliable and trusted source of information, said Wiles, the New Zealand specialist. “Not anymore.”

Separately, a team of Post reporters wrote that "Fears of a new wave of coronavirus infections are spurring officials in many states, such as California, to require that people wear face coverings outside the home. But mandatory mask-wearing continues to be controversial, particularly among conservatives. The sheriff of Orange County, California, says he won’t enforce the statewide mandate, while Nebraska’s Republican governor has threatened to withhold funding from any communities that require masks to be worn in official buildings. Several studies this month support wearing masks to curb coronavirus transmission, and the Centers for Disease Control and Prevention recommends their use as a protective measure."

And Trump's Death Cult Rally tonight is expected to be a catastrophe for Oklahoma, even though early data is showing no uptick in COVID transmission from the Black Lives Matters protests. "'“Bad idea' doesn’t begin to capture how reckless and vicious it is to pack an arena on a steamy night with thousands of rambunctious hotheads in the midst of a coronavirus outbreak," wrote Virginia Heffernan for the L.A. Times. "The disease, which has killed some 120,000 Americans so far, rips through populations fastest when people are crowded indoors and shouting for extended periods. Check, check, check, check. The Tulsa rally has it all. Except masks and social distancing. This week, a Tulsa lawsuit sought to make safety measures mandatory at the rally. 'If ASM Global'-- which runs the rally arena-- 'moves forward with the event without adequate review, planning, training, protective equipment, and safeguards, cases of COVID-19-- and the unavoidable attendant deaths — will rise,' the lawsuit said. A Tulsa judge denied the request; it’s now at the state Supreme Court. Meanwhile, the campaign has required ticketholders to swear they won’t sue if they do get sick. And rallygoers will be issued hand sanitizer and masks, but nothing is mandatory. Given that Trump is still shaking hands and refusing to mask up, even health-conscious attendees are likely to pack themselves in and go mask-free, if only as a sign of respect for their devil-may-care hero. This rally is really shaping up to be a teeming petri dish inside a wrecking ball inside a juggernaut."

On Thursday, Oklahoma confirmed 450 new cases and 2,364 cases per million.

New York City Started Re-Opening Yesterday-- Cautiously

America 2020 by Nancy Ohanian

Yesterday, as states and cities rush to re-open, some carefully, others not, the Washington Post ran a piece by Joel Achenbach, Shutdowns prevented 60 million coronavirus infections in the U.S., study finds. "Shutdown orders," he wrote, "prevented about 60 million novel coronavirus infections in the United States and 285 million in China, according to a research study published Monday that examined how stay-at-home orders and other restrictions limited the spread of the contagion. A separate study from epidemiologists at Imperial College London estimated the shutdowns saved about 3.1 million lives in 11 European countries, including 500,000 in the United Kingdom, and dropped infection rates by an average of 82 percent, sufficient to drive the contagion well below epidemic levels."

The two reports, published Monday in the journal Nature, provide fresh evidence that aggressive and unprecedented shutdowns, which caused massive economic disruptions and job losses, were necessary to halt the exponential spread of the novel coronavirus.

But the overwhelming majority of people remain susceptible to the virus. Only about 3 percent to 4 percent of people in the countries being studied have been infected to date, said Samir Bhatt, senior author of the Imperial College London study.

“This is just the beginning of the epidemic: we’re very far from herd immunity,” Bhatt said Monday in an email. “The risk of a second wave happening if all interventions and precautions are abandoned is very real.”

The first study, from researchers at the University of California at Berkeley, examined six countries-- China, the United States, France, Italy, Iran and South Korea-- and estimated how 1,717 interventions, such as stay-at-home orders, business closings and travel bans, altered the spread of the virus. The report concluded that those six countries collectively managed to avert 62 million test-confirmed infections. Because most people who are infected never get tested, the actual number of infections that were averted is much higher-- about 530 million in the six countries, the Berkeley researchers estimated.

Timing is crucial, the study found. Small delays in implementing shutdowns can lead to “dramatically different health outcomes.” The report, while reviewing what worked and what made little difference, is clearly aimed at the many countries around the planet that are still early in their battle against the coronavirus.

“Societies around the world are weighing whether the health benefits of anti-contagion policies are worth their social and economic costs,” the Berkeley team wrote. The economic costs of shutdowns are highly visible-- closed stores, huge job losses, empty streets, food lines. The health benefits of the shutdowns, however, are invisible, because they involve people not sickened.

That spurred the researchers to come up with their estimates of infections prevented. The Berkeley team did not produce an estimate of lives saved.

Achenbach is a health-and-politics reporter but J. David Goodman covers lobbying, fund-raising and the influence of money in politics. Interesting that the NY Times assigned him the job of covering the reopening of New York City. But with Cuomo in charge, it was a sensible approach. "Exactly 100 days since its first case of coronavirus was confirmed, New York City, which weathered extensive hardship as an epicenter of the worldwide outbreak, is set to take the first tentative steps toward reopening its doors on Monday," he wrote on Sunday. "Getting here took the sacrifice of millions of New Yorkers who learned to live radically different lives. More than 205,000 have been infected, and nearly 22,000 have died."

As many as 400,000 workers could begin returning to construction jobs, manufacturing sites and retail stores in the city’s first phase of reopening-- a surge of normalcy that seemed almost inconceivable several weeks ago, when the city’s hospitals were at a breaking point and as many as 800 people were dying from Covid-19 on a single day.

Many retail stores, battered by months of closure, are readying to do business again on Monday, starting with curbside and in-store pickup. Construction companies are adding safety features and stockpiling masks and gloves. Manufacturers, whose shop floors have idled since March, are testing machines.

State and city officials said they were optimistic that the city would begin to spring back to life. Testing is robust, reaching 33,000 people on a recent day. And new infections are now down to around 500 a day-- half as many as there were just a few weeks ago.

That is low enough for New York City’s corps of contract tracers, who began work last week, to try to track every close interaction and, officials hope, stop a resurgence of the virus.

New confirmed cases on Sunday and Monday for New York state was 1,018 and 1,064. NYC was 460 and 389:

Brooklyn- 168 and 129
Queens- 114 and 134
Bronx- 98 and 74
Manhattan- 54 and 42
Staten Island- 26 and 10

Suffolk County, a big suburb on Long Island, filled with crackpot Republicans who refused to wear masks or social distance, had 291 new cases on Sunday and 364 on Monday, each day the worst of any county in New York state. Commuters from Suffolk County could well spread the contagion in the city. Cuomo, who is always trying to take credit for NYC's progress, even though thousands became sick because he was so slow to recognize and act on the pandemic early on, said "You want to talk about a turnaround-- this one, my friends, is going to go in the history books."

New York City, like nine other regions in the state, was required to meet seven health-related metrics before beginning reopening. New York City was the last part of the state to do so; much of upstate has already moved on to Phase 2, which allows most stores, offices and hair salons to open, with restrictions on capacity and social distance.

The road back will undoubtedly be challenging. More than 885,000 jobs vanished during the outbreak, and strong gains are not expected for the city until 2022. The city budget hemorrhaged tax revenue and now faces a $9 billion shortfall over the next year.

And the reopening has been complicated by the vast protests for racial justice that have swept the city for more than a week and have forced government officials and business owners to unexpectedly adjust their plans.

Hundreds of stores were burglarized by looters who took advantage of the protests to prey on commercial districts, from Midtown to the Bronx. Shop owners scrambled to cover windows in plywood rather than reaching for welcome banners. Police officers enforced a nightly curfew.

...Even before the protests, some public health officials were privately fretting that the timeline set by Governor Cuomo and Mayor de Blasio was too ambitious. They worried that infections could increase as people returned to work and commuters began to take the subway again.

But the Metropolitan Transportation Authority said it did not believe that rush hour would meaningfully return on Monday-- or anytime soon. Even when schools and Broadway are allowed to open in the fourth and final phase of the reopening, the authority is projecting ridership will be under 70 percent.

One person briefed on the authority’s planning said officials there expected the trains to be at well below 50 percent capacity at least through Labor Day-- a calculation based on the idea that many office workers would continue to work remotely into the fall.

Many business leaders, particularly those in office-based jobs like technology and finance, are watching the transit system for signs that it is safe. The authority has embarked on large-scale cleanings and required riders to wear masks, but said social distancing may not be possible if subways and buses carry anywhere close to their normal loads.

...Some businesses are taking it slowly and carefully.

Only about a third of textile workers in the city are expected to be back at work on Monday, said Edgar Romney, the secretary-treasurer of their union, Workers United/SEIU. Businesses that are operating have altered their shifts to reduce crowding and installed plastic shields to separate tightly packed sewing machines.

But many, particularly in Midtown Manhattan, have remained closed, he said.

For retailers, the picture is even more complex. Just opening the doors does not guarantee that customers will return. Curbside pickup does not make a lot of sense for many retailers either, particularly in Manhattan.

Business groups said many retailers were waiting for the next phase to venture out, when outdoor dining is allowed, office workers are permitted to return and shoppers are able to enter and browse around all types of stores, local business groups said.

The earliest that could begin would be late June, based on state mandates that each phase last at least two weeks. But Mayor de Blasio said on Thursday that he did not anticipate the city moving into the next phase until early July.

“Businesses can be ready, but are the consumers ready?” asked Thomas J. Grech, president of the Queens Chamber of Commerce. “I want to demonstrate to the buying public, to the consumers out there, that the businesses are making it safe.”

When more than 100 workers return next week to Newlab, a technology hub in the Brooklyn Navy Yard, they will have the option of wearing a device that buzzes every time two colleagues get too close to each other-- a high-tech way to enforce social distancing.

The devices, made by StrongArm Technologies, a company based in the hub, were already being worn by most of the 80 or so workers deemed essential.

“In the first week, people were getting buzzed all the time,” said Shaun Stewart, the chief executive of Newlab. “It flashes and it vibrates. That alone, that immediately changes your behavior and your perspective on distancing.”

The city’s contact tracing efforts are far less high tech. But for the past week, newly infected New Yorkers have been receiving calls from the new corps of tracers. City Hall did not provide figures for how many people they were able to reach.

“The beginning of any program is challenging,” said Jay Varma, an adviser to Mr. de Blasio on public health. But so far, he said, “people are willing to participate, they’re willing to give information about their health conditions and about their close contacts.”

Still, a jump in cases could overwhelm the system, as happened at the start of the pandemic in New York in March.

Officials are watching barometers of the virus’s spread closely, from new positive tests to emergency room data, for any sign that the newly flattened curve of infection might be arcing upward again.

The work of contact tracing has taken on new urgency because of the public outpouring of anger at the death of George Floyd, a black man killed in Minneapolis on May 25 in a confrontation with four police officers... [which] raised questions about how mass gatherings might spread the virus, with some participants not observing social distancing.

“On the public health side, this has been a really long, arduous nearly 100 days of something none of us had never dealt with before, and then you see that activity, of course you’re concerned,” said Jim Malatras, a close adviser to Mr. Cuomo. “The top blew off. The top blew off across this country.”

Mr. Malatras said he envisioned several possible results of the demonstrations.

People who are asymptomatic could transmit the disease far beyond the ranks of the protesters. Or, if there is no immediate surge of infections, some New Yorkers may begin to doubt strict adherence to social distancing.

The impact of having crowds of at least 20,000 protesters on the streets would not be apparent for as long as two weeks, officials cautioned.

“The mayor is appropriately concerned about the risk of a resurgence due to the mass gatherings that have occurred,” said Mr. Varma, adding that “there is a lot that we don’t know about how people’s behavior will change after June 8.”

He said, however, that because the protests took place outdoors and many demonstrators wore masks, the risks may have been lessened.

The state and the city will not make a decision about moving to the second phase of reopening for at least two weeks, at which point the public health effects of the protests should be more clear, officials said.