Live Coronavirus Updates: Global Death Toll Surpasses Half a Million

Half a million people are dead as confirmed virus cases top 10 million.

The global total of deaths from the coronavirus has passed 500,000, according to a New York Times database, while the number of confirmed cases surpassed 10 million.

The grim markers were hit on Sunday as countries around the world struggled to keep new infections from reaching runaway levels while simultaneously trying to emerge from painful lockdowns.

In April, roughly a month after the World Health Organization declared the outbreak a pandemic, deaths topped 100,000. In early May, the figure climbed to 250,000.

More than a quarter of all known deaths have been in the United States.

The number of confirmed infections — which took about 40 days to double — may be substantially underestimated, public health officials say. Data released last week by the Centers for Disease Control and Prevention indicated that the actual figures in many regions are probably 10 times as high as reported.

The Times has also found that the actual death toll in the United States and more than two dozen other countries is higher than has been officially reported. Limited testing availability has often made it difficult to confirm that the virus was the cause of death.

In the United States, early hot spots emerged in the Northeast, particularly the New York metropolitan area, but the recent surge has occurred primarily in the South and the West, forcing some states to retreat from reopening plans.

Other countries, particularly Brazil and India, are also being hit with a large wave of new infections.

And while dozens of countries that took early steps to contain and track the pandemic have been able to control the virus within their borders, experts fear that fatigue with lockdowns and social distancing has allowed the virus to spread with renewed intensity.

Paranoid hallucinations plague many virus patients who end up in the I.C.U.

Kim Victory was paralyzed on a bed and being burned alive.

Just in time, someone rescued her, but suddenly, she was turned into an ice sculpture on a fancy cruise ship buffet. Next, she was a subject of an experiment in a lab in Japan. Then she was being attacked by cats.

Nightmarish visions like these plagued Ms. Victory during her hospitalization this spring for severe respiratory failure caused by the coronavirus.

“It was so real, and I was so scared,” said Ms. Victory, 31, now back home in Franklin, Tenn.

To a startling degree, many coronavirus patients are reporting similar experiences. Called hospital delirium, the phenomenon has previously been seen mostly in a subset of older patients, some of whom already had dementia, and in recent years, hospitals adopted measures to reduce it.

Now, the condition is bedeviling coronavirus patients of all ages with no previous cognitive impairment. Reports from hospitals and researchers suggest that about two-thirds to three-quarters of coronavirus patients in I.C.U.’s have experienced it in various ways. Some have “hyperactive delirium,” paranoid hallucinations and agitation; some have “hypoactive delirium,” internalized visions and confusion that cause patients to become withdrawn and incommunicative; and some have both.

At a Houston hospital bracing for a virus peak, new patients are often young.

Measures to cope with the surge and to plan for its peak were evident over the weekend at Houston Methodist Hospital, which called nurses to work extra shifts, brought new laboratory instruments on line to test thousands more samples a day and placed extra hospital beds in an empty unit about to be reopened as patients filled new coronavirus wards.

Melissa Estrada was among those being treated. She said she had tried to be careful about the virus, keeping her three children at home and always wearing a mask at the grocery store.

But over the weekend Ms. Estrada, 37, was fighting the virus at the hospital. She probably contracted the virus while attending a dinner with relatives who had also been cautious, she said. Within days, all four adults and several children who had been at the gathering tested positive.

“It was really, really scary,” Ms. Estrada said of her illness. She worried constantly about leaving her children motherless. “You hear about it and you think it’s the older people or the people with underlying issues,” she said. “And I’m healthy. I don’t understand how I got this bad.”

During the virus’s first peak in April, the majority of patients testing positive in the Methodist hospital system were older than 50. Now the majority are, like Ms. Estrada, relatively young.

“What I’m seeing is that they’re pretty sick — the younger ones are pretty sick,” said Tritico Saranathan, a charge nurse on one of Methodist’s virus wards. “They’re struggling a lot with respiratory issues. They’re having a hard time breathing,” she added, “just feeling like death.”

Most affluent countries are keeping the virus in check. The U.S. is not. Here’s why.

In today’s edition of The Morning, David Leonhardt discussed why the surge in cases in the United States is worse than those in other rich countries. He writes:

It can sometimes seem as if the entire world is suffering from a new coronavirus outbreak. There have been cases at food markets in Beijing, nightclubs in South Korea, meatpacking plants in Britain and Germany, nail salons in Ontario, and restaurants, bars and churches across the southern and western United States.

But these outbreaks are not all the same. The ones in the U.S. are of a larger order of magnitude than those in any other affluent country.

Consider this chart, which shows the number of new cases per week, adjusted for population size:

Most other high-income countries are dealing with modest numbers of new cases — often an inevitable consequence of reopening — and the countries are responding aggressively. Many are following the advice of public health experts, ordering social distancing, mask-wearing and partial lockdowns and doing their best to track people who came in contact with new patients.

The United States is not. President Trump and many governors continue to flout scientific advice and send mixed messages about the seriousness of the virus.

Drug maker settles on price for medicine to treat virus.

After weeks of donating the antiviral drug remdesivir to hospitals with severely ill coronavirus patients, the drug’s maker, Gilead Sciences, announced today that it has settled on a price — $390 per vial, which works out to be roughly $2,340 per treatment course.

The company said this price, which it will charge in all developed nations, is far below the drug’s value. A large federal study found that remdesivir shortened recovery time in severely ill patients by four days on average. Four days in the hospital would cost about $12,000 per patient, Gilead’s chief executive, Daniel O’Day, said in a statement on Monday.

Gilead said it would charge more to private insurers: $520 per vial, or $3,120 for a five-day course. Since private insurers expect discounts from the list price, the list price must be higher, Mr. O’Day said. That also means uninsured patients would be charged $520 per vial.

Until recently remdesivir was the only drug shown to help severely ill Covid-19 patients. But the benefits were modest, and the drug did not improve survival in those patients.

The Department of Health and Human Services said on Monday that the Trump administration had struck “an amazing deal” with Gilead. The company would supply 500,000 vials of the drug through September, enough to treat 232,000 patients. Hospitals would pay the wholesale price of $520 per vial.

Gilead’s last shipment of 120,000 treatment courses of donated drug is going out today.

The new supply will be distributed to hospitals based on need. After September, however, H.H.S. will no longer be involved in remdesivir distribution.

The virus is battering Africa’s growing middle class.

As the virus spreads in many countries in Africa, it is threatening to push as many as 58 million people in the region into extreme poverty, experts at the World Bank say. But beyond the devastating consequences for the continent’s most vulnerable people, the pandemic is also whittling away at one of Africa’s signature achievements: the growth of its middle class.

For the last decade, Africa’s middle class has been pivotal to the educational, political and economic development across the continent. New business owners and entrepreneurs have created jobs that, in turn, gave others a leg up as well.

Educated, tech-savvy families and young people with money to spare have fed the demand for consumer goods, called for democratic reforms, expanded the talent pool at all levels of society, and pushed for high-quality schools and health care.

About 170 million out of Africa’s 1.3 billion people are now classified as middle class. But about eight million of them could be thrust into poverty because of the coronavirus and its economic fallout, according to World Data Lab, a research organization.

“We have been working hard to build better lives,” James Gichina, a tour van driver, said of his colleagues in the tourist sector. Now, he said, “We have nothing.”

U.S. Roundup

Cases in Florida surge fivefold in two weeks.

Over the weekend, Florida crushed its previous record for new coronavirus cases, reporting 9,585 infections on Saturday. An additional 8,530 were reported on Sunday.

Six-hour lines formed in Jacksonville as thousands of people flocked to get drive-through tests. Orange County, home to Orlando, has seen an explosion of coronavirus: Nearly 60 percent of all cases there came in the past two weeks.

Much of Florida’s new surge in cases has followed the reopening of beaches, bars, restaurants and other social activities.

“I’m one of the people who contributed to the 9,000-person day,” said Ian Scott, a 19-year-old college sophomore in Orlando who tested positive on Friday. He has no idea how he got it.

“We’re seeing positive, positive, positive, positive,” he said. “My generation says: ‘Let’s get this over with. Let’s suck it up for two weeks, sit in our rooms, play video games, play with our phones, finish online classes, and it’s over.”

Mr. Scott barely felt sick, and was fine by the time the test results came back. Patients like him could help account for the fact that while Florida’s daily case count has increased fivefold in two weeks, the rate of deaths has not increased so far. State records show that hospitalization rates have inched up but are not at crisis levels.

Elsewhere around the United States:

• In California, Gov. Gavin Newsom on Sunday ordered bars in seven counties to close, and he recommended other bars across the state do the same. Despite early restrictions and a calculated reopening, coronavirus cases are rising in the state.

• Even Hawaii, which has the fewest deaths linked to the virus and gained a reputation for imposing some of the toughest restrictions for visitors, is seeing a resurgence of infections. On the state’s most populous island, Oahu, an uptick in cases was reported on Sunday by the Honolulu mayor, Kirk Caldwell, who called the spike alarming but said the infections were detected quickly and that the people who tested positive were isolated.

• Gov. Jay Inslee of Washington told the CBS show “Face the Nation” that there was a “reasonable probability” of “very broad scale” activities resuming on college campuses this year. Any return to campus would require adequate testing capability, social distancing and wearing masks, he said.

• Black people account for more than 22 percent of the virus cases in Maine, but make up 1.6 percent of the state’s population, Sara Gideon, the speaker of the state House, said in a video posted on Twitter. Ms. Gideon, a Democrat who is running for the U.S. Senate against the Republican incumbent Susan Collins, said it was a reminder of the structural inequities and institutional racism in the health care system.

China approves a vaccine candidate for use by the country’s military.

A coronavirus vaccine candidate has received approval from the Chinese government for use by the country’s military.

CanSino Biologics, a pharmaceutical company based in the northeastern city of Tianjin, said on Monday that its Ad5-nCoV vaccine received a one-year designation as a “military specially-needed drug” from the country’s Central Military Commission. The candidate is being developed jointly with the Beijing Institute of Biotechnology in the Academy of Military Medical Sciences.

The designation means the vaccine can be developed through the military’s system for producing pharmaceuticals for use by China’s armed forces, but its use is limited to the military. The military and government regulators have additional procedures for approving such a vaccine for civilian use.

“The Ad5-nCoV is currently limited to military use only and its use cannot be expanded to a broader vaccination range without the approval of the Logistics Support Department,” CanSino said in a filing.

CanSino has conducted Phase 1 and Phase 2 trials on the vaccine candidate. It said the trials “showed good safety profile” and the “overall clinical results indicate that the Ad5-nCoV has potential to prevent diseases caused by SARS-CoV-2,” the official name of the new coronavirus.

Reuters reported that CanSino cited commercial secrets in declining to say whether inoculation of the vaccine candidate was optional or mandatory.

Buyer beware: Mask exemption cards listed for sale online are fake.

Cards for sale that claim to exempt people from wearing masks during the coronavirus pandemic are fraudulent, federal officials said.

The cards — about the size of a business card and featuring a red, white and blue eagle logo — say the bearer is exempt from ordinances requiring them to wear masks in public.

“Wearing a face mask posses a mental and/or physical risk to me. Under the Americans with Disability Act (ADA), I am not required to disclose my condition to you,” reads the card, which misspells “poses” and incorrectly names the Americans With Disabilities Act.

There’s also a warning that businesses or organizations can be reported to the Freedom to Breathe Agency, the group behind the cards. One version of the cards featured the Justice Department’s logo and listed a legitimate phone number where complaints about violations of the Americans with Disabilities Act can be submitted.

The cards were being sold online in boxes of at least 500 for $49.99.

The cards were created in response to complaints, the group selling them said in an email, and as “an educational tool” to help people “understand their legal and human rights so they can stand up to the unlawful, unscientific and unconstitutional mandates.”

The founder of the Freedom to Breathe Agency, Lenka Koloma, advertised the cards on her Facebook page, and they were sold on a site created through the commerce platform Shopify. The site was unavailable on Sunday afternoon.

British city may be left out when restrictions are lifted this week.

Britain is set to lift restrictions on pubs, restaurants, hotels, barbershops and salons and other venues on Saturday, but the city of Leister, in central England, might not be included after a regional outbreak of the virus, the city’s mayor said.

The mayor, Sir Peter Soulsby, told the radio station LBC on Monday that the government was considering whether to “extend for two weeks the present level of restrictions after the rest of the country has them lifted on the 4th of July.”

The city of more than 340,000 people has recorded a total of 2,987 coronavirus cases since the beginning of the pandemic, with 866 coming in the past two weeks, according to figures from Public Health England.

Mr. Soulsby said he did not feel an extension of the restrictions was justified by the figures.

Separately, the police in Cumbria, in northwest England, said they had issued several fines over the weekend after discovering 200 campers in the Lake District. Camping is still off limits under lockdown rules. The fines came a few days after sunbathers swarmed British beaches during a particularly hot spell last week.

With flights banned, a son sailed solo across the Atlantic to reach his father.

The idea of spending what he thought could be “the end of the world” away from his family back in his home country seemed intolerable to the 47-year-old Argentine on a tiny Portuguese island, but Argentina had canceled all international flights.

“I didn’t want to stay like a coward on an island where there were no cases,” Juan Manuel Ballestero said. “I wanted to do everything possible to return home. The most important thing for me was to be with my family.”

Especially, he said, because his father was about to turn 90.

So Mr. Ballestero loaded his 29-foot sailboat with canned tuna, fruit and rice and set sail in mid-March from Porto Santo, Portugal, for what turned out to be an 85-day odyssey across the Atlantic.

Mr. Ballestero’s relatives, used to his itinerant lifestyle, knew better than to try to talk him out of it.

“The uncertainty of not knowing where he was for 50-some days was very rough,” said his father, Carlos Alberto Ballestero. “But we had no doubt this was going to turn out well.”

Mr. Ballestero has spent much of his life sailing, with stops in Venezuela, Sri Lanka, Bali, Hawaii, Costa Rica, Brazil, Alaska and Spain.

Now he is back home.

Mr. Ballestero made it to his native Mar del Plata on June 17, and was startled by the hero’s welcome he received. A medical worker tested him for the virus on the dock, and when it came back negative, he was allowed to set foot on Argentine soil.

“What I lived is a dream,” he said. “But I have a strong desire to keep on sailing.”

How to safely return to your exercise routine

Now that stay-at-home restrictions are easing, some are heading to the nearest reopened park or playground for exercise. Here’s how to do so safely.