Africa is desperately short of ventilators, among other essential supplies.
Limited testing means that it is impossible to know the true scale of coronavirus infections in Africa. But several countries on the continent are reporting rising caseloads, and the outbreaks could be catastrophic, in part because many countries lack essential medical supplies.
Case in point: Fewer than 2,000 working ventilators have to serve hundreds of millions of people in public hospitals across 41 of Africa’s 55 countries, the World Health Organization says, compared with more than 170,000 in the United States. Ten countries in Africa have none at all.
As for intensive care beds, the W.H.O. says there are just 5,000 across 43 African countries. That’s about five beds per million people, compared with about 4,000 beds per million in Europe.
Many experts also worry about chronic shortages of much more basic supplies that are needed to slow the spread of the disease and treat the sick on the continent: masks, oxygen and, even more fundamentally, soap and water.
And even if medical supplies do materialize, many countries will still lack trained medical personnel to run the machines, as well as a reliable electricity supply and piped oxygen.
With the coronavirus outbreak still raging within its borders, Iran on Saturday lifted the lockdown on its capital and called on government and private-sector employees to return to work.
The rest of Iran’s provinces had lifted a two-week lockdown and travel restrictions a week earlier. Schools and sporting events remain closed, and restaurants have been restricted to takeout.
President Hassan Rouhani has called his return-to-work policy a “smart distancing” strategy that will fight two enemies: the pandemic and the collapse of an economy that was already strained by international sanctions.
“Our message is the great people of Iran and all private and government entities, labor workers and engineers, despite fighting the coronavirus on one front, are also continuing the economic development of our country,” he said on Thursday.
About 5,000 people with the virus have died in Iran, including some of the country’s top officials, and about 80,000 have been infected, according to government figures. But local experts and health officials say that many others who showed symptoms of the virus have died or fallen ill without being tested.
Health officials say that easing the restrictions too soon risks another surge in infections.
Iran’s military held annual parades on Friday in Tehran and other cities. The parade typically shows off military hardware, but this year soldiers marched in protective gear, and ambulances and medical equipment replaced missiles and drones.
Public health officials in England have told doctors and nurses to forgo full-length protective gowns when treating coronavirus patients, a last-ditch measure to compensate for looming equipment shortages this weekend that health care workers said would put their lives at risk.
Officials previously said that medical workers should wear waterproof surgical gowns during high-risk procedures involving the coronavirus outbreak, reflecting World Health Organization guidance, medical groups said.
But that guidance changed as hospitals began running out of supplies, and Britain’s health secretary, Matt Hancock, said he could not guarantee that hospitals would have the protective gear they needed over the weekend.
Workers were advised to wear plastic aprons on top of coveralls instead.
“We are tight on gowns,” Mr. Hancock told lawmakers on Friday. “That is the pressure point at the moment.”
The changing guidance came as Britain said on Friday that a total of 14,576 people had died in hospitals from the coronavirus, a rise of 847 from the day before. The daily death toll has dropped from a peak of 980 a week ago.
The shortage of gowns could add to growing friction between staff groups and public health officials in England over protective gear. At least 50 front-line medical workers have died from the virus in Britain, and the Royal College of Nursing said recently that nurses should refuse to treat patients if there was inadequate protective gear.
Britain also remains far short of its goal of carrying out 100,000 tests a day by the end of April, with only 21,000 daily tests being completed as of Thursday. But Mr. Hancock said the country would return to trying to track down the contacts of people with symptoms of the virus, an effort the government had halted last month as the virus spread.
Singapore records another daily high, as a cluster linked to migrant dorms balloons.
Singapore on Saturday announced a record rise in new coronavirus infections for the third time this week, with most of the 942 new cases coming from crowded dormitories for migrant laborers.
The sharp rise underscores the risks faced by low-wage migrants who have built the modern city-state. As more than 1,600 cases were linked to their residences from Wednesday to Friday, the government promised changes in how the migrants, many from India and Bangladesh, are treated.
Singapore has been praised for its rigorous contact-tracing program, which quickly identified clusters of local transmission. But the coronavirus has spread rapidly through foreign laborers’ dormitories, where up to 20 people are crammed in each room, with shared kitchens and bathrooms.
After weeks of slow transmission, Singapore began recording a rapid rise in cases in March, as travelers from Europe and the United States brought the virus with them. But the health ministry said the number of new local cases had continued to drop, with 14 Singaporeans or permanent residents confirmed infected on Saturday.
As several countries race to create a working vaccine against the coronavirus and several trials are underway, a new survey in Ireland offers a glimpse of the hurdles health officials will face to vaccinate people around the world in an effort to stem the outbreak.
The survey, released on Thursday, suggested that 65 percent of respondents would definitely be willing to take a vaccine for Covid-19, the disease caused by the virus, and 9 percent would definitely not.
“Only 65 percent of people saying yes is staggeringly low, given what we are going through,” said Dr. Philip Hyland, an associate professor of psychology of Maynooth University, which carried out the survey in conjunction with Trinity College Dublin.
But he said there was room for optimism. “If the 26 percent of people who are saying maybe can be shifted to the yes category, then we would have over 90 percent uptake, which should be enough,” he said.
The survey sampled more than 1,000 people 19 days after Ireland imposed sweeping restrictions on movements. The report’s authors said that although the coronavirus’s spread was still poorly understood, a 60 percent vaccination rate might be enough to build “herd immunity” in the general population, although a higher figure would be desirable.
Dr. Frederique Vallieres, the director of Trinity College’s Center for Global Health, said that the 9 percent of people who opposed taking a vaccine included both ideological “anti-vaxxers” and people with underlying health conditions that would either prevent them from taking such vaccines or make them reluctant to do so.
She said that many of the undecided were concerned about the possible risks of any new vaccine and might be reassured by scientific evidence and public information campaigns when a vaccine emerged.
The Mexican government was ordered to extend its coronavirus protections to migrants in a ruling made public on Friday.
The ruling said that health care should be guaranteed to detainees and that temporary residency should be given to people found to be particularly vulnerable to Covid-19, the disease caused by the coronavirus, Reuters reported.
The order also said the government would have to identify symptomatic detainees, report the number of migrants who were detained and release members of vulnerable populations. Migrants were also to have access to information on ways to protect themselves.
Mexico, which has reported more than 6,200 cases and nearly 500 deaths from the virus, declared a health emergency on March 30 — after initial resistance. The ruling came after advocacy groups said that the government had not been adequately protecting migrants and asylum seekers. Last year, Mexico had more than twice the number of asylum requests that it had in 2018.
With businesses closed to slow the spread of the virus, President Andrés Manuel López Obrador said on Friday that $2.5 billion would be distributed next month to support the economy. He did not specify how the money would be sent, but he said there would be three million loans to small businesses.
World leaders have spent the past several weeks grappling with the unexpected, as country after country has seen the coronavirus emerge within its borders.
With the virus endangering people’s health and lockdowns ravaging the global economy, heads of government have taken different approaches in televised addresses and news briefings as they have explained their plans for combating the threat.
“The main questions for these leaders,” said Jill Rutter, a senior fellow at the London-based Institute for Government, “is: Can they convey a clear message and give people the reassurance they need while admitting this is an incredibly fast-moving, difficult world of real unknowns?”
They also must “show that they understand that this is a massive human tragedy,” she added.
It’s “quite a difficult balancing act,” she said.
The chief of staff to President Muhammadu Buhari of Nigeria, Mallam Abba Kyari, has died from Covid-19, one of the highest-profile deaths from the pandemic in Africa.
Mr. Kyari, who was in his 70s, died on Friday after battling the virus for nearly a month, a spokesman for the president said Saturday on Twitter. He had served Mr. Buhari since he took office in 2015.
Mr. Kyari was one of several current and former government officials across Africa to have contracted the virus or died from it in recent weeks. The list includes Jean-Joseph Mukendi, a top aide to the president of the Democratic Republic of Congo, who died of Covid-19 in late March.
In February, Nigeria became the first country in sub-Saharan Africa to record a coronavirus case, after an Italian contractor who had been in Milan tested positive. The country of 200 million people has reported just 493 cases and 17 deaths, according to data compiled by The New York Times.
Here’s what’s happening in other parts of the world:
Germany recorded a fourth straight day of a spike in new infections on Saturday. Data from the Robert Koch Institute for infectious diseases showed that coronavirus cases rose by 3,609, for a total of 137,439. The death toll rose by 242, to 4,110.
Guatemala’s president, Alejandro Giammattei, said on Friday that a large number of the migrants on a deportation flight from the United States to Guatemala this week were infected with the coronavirus.
The number of confirmed coronavirus cases in Japan rose to 10,000 on Saturday, the public broadcaster NHK said, just days after a state of emergency was extended to the entire nation in an attempt to slow the virus’s spread. More than 200 people have died from the virus in Japan, and Tokyo remains the hardest-hit area, reporting 201 new infections on Friday, a record, and 181 new cases on Saturday, NHK reported.
The harrowing details about the Résidence Herron nursing home in suburban Montreal continued to mount this week: Medical workers who had abandoned hungry and desperately ill patients. An owner with a long criminal history. Thirty-one dead in less than a month — five from confirmed cases of coronavirus.
Across Canada, nursing homes been devastated by the virus. This week, Canada’s chief public health officer, Dr. Theresa Tam, attributed about half of the country’s coronavirus deaths — which had reached over 1,300 as of Saturday morning — to long-term care homes.
The scale of deaths at these facilities has raised a difficult question: Beyond the obvious insidiousness of a highly contagious virus, how has this been possible in Canada, a country with a vaunted universal health care system and a culture of humanism?
Dr. Susan Bartlett, a clinical psychologist and professor of medicine at McGill Medical School, has counseled families about caring for their older parents. In addition to her professional expertise, she has a personal interest in the Résidence Herron catastrophe: Her 94-year-old mother was a resident at the Herron in 2018. The nursing home is now under police investigation amid accusations of gross negligence.
Dr. Bartlett said that while her mother’s care had initially been satisfactory, conditions at the residence deteriorated as the owners went on an aggressive cost-cutting spree and struggled to find qualified employees.
She said it was hard to fathom that the body bags leaving the residence amid the pandemic had not raised alarms sooner. “Why didn’t anyone scream at the top of their lungs?” she said.
Any effort by states to begin easing restrictions requires an expanded testing capacity to give people a sense of security, health experts say, and the United States is far behind in conducting enough tests to responsibly inform those decisions.
But Vice President Mike Pence said on Friday that the country now had the testing capacity to allow all states to move to begin the first phase of the White House’s guidelines for reopening their economies. And several top U.S. public health officials said the scale of the nation’s testing capacity — 3.7 million tests have been conducted — was underappreciated.
President Trump sought on Friday to portray testing as a state responsibility, even as many governors pleaded for more federal help.
At a White House briefing, Mr. Trump dismissed concerns that public health experts have raised about testing, claiming that “the United States has the most robust, advanced and accurate testing system anywhere in the world.” He rejected criticisms of its shortcomings as “false and misleading” and reiterated his position that “the governors are responsible for testing.”
And on Twitter, the president encouraged protests of social distancing restrictions in some states with stay-at-home orders. Governors in a handful of states have begun to outline their plans to ease restrictions, but protesters are pushing for a more rapid reset of pre-virus economic life.
Mr. Trump’s tweets were a departure from the more bipartisan tone he took on Thursday while announcing guidelines for how governors should carry out an orderly reopening of their states on their own timetables.
The Kurdish-led administration that governs northeastern Syria announced the first death in that region from Covid-19, the disease caused by the coronavirus, on Friday. As it turns out, the World Health Organization knew about the case for more than 11 days before informing the local authorities, a W.H.O. official said.
The W.H.O. official and the Kurdish administration, which oversees about one-third of Syria’s territory along the Turkish and Iraqi borders, said a 53-year-old man was admitted to a hospital on March 27. Doctors ran a test for the coronavirus and sent it to the Syrian capital, Damascus, for analysis.
The man died on April 2, the same day that his test came back positive. The authorities in Damascus, which has a hostile relationship with the Kurds, did not pass along that information.
The W.H.O. official, Rick Brennan, the regional emergency director for the eastern Mediterranean, said in an interview that the Syrian authorities informed the organization of the case on April 5, but because of “internal procedural problems and miscommunication,” it did not get word to the Kurds about it until Thursday — 11 days later.
The case illustrates how the political divisions left by Syria’s civil war could hinder a response if a major outbreak occurs. The government of President Bashar al-Assad in Damascus controls most of the country but has hostile relations with both the Kurdish-led administration that governs the northeast and the leaders of a rebel-held enclave in Idlib Province in the northwest.
Syria has reported only 38 cases of coronavirus and two deaths, but aid groups have warned that the virus could do great damage. Millions of Syrians have been displaced and impoverished through nine years of war, and much of the country’s health infrastructure has been badly damaged.
After America’s first major coronavirus outbreak hit Seattle last month, Uber’s chief executive said business in the city had plunged 60 to 70 percent. A month later, investors fear that Uber’s experience in Seattle is playing out across its entire business and that of its ride-hailing rival, Lyft.
The companies have never come close to being profitable, even when the economy was booming. Now they face an existential question: How will they and their drivers stay afloat in the age of lockdowns?
“There is no business,” said Rayann Aly, an Uber driver in Paris, one of the company’s largest markets in Europe. “People stay at home.”
For now, the two companies are apparently trying to wait out the disruptions. Uber is relying on surging business at its money-losing food delivery service, Uber Eats, and Lyft has created a temporary similar business.
Because drivers are not on the companies’ payrolls, the companies aren’t responsible for their health care or for vehicle maintenance. That gives them a measure of financial flexibility.
But if widespread shelter-in-place orders continue through the summer, analysts say, layoffs or furloughs among the companies’ thousands of office workers are possible.
As the pandemic’s global toll climbs, ventilators that pump oxygen into the lungs of critically ill patients have been embraced as the best hope for saving lives.
Some hospitals have been using CPAP and BiPAP machines, designed for people with sleep apnea, to keep patients breathing without having to resort to intubations and ventilators. Engineers have transformed hooded hair salon dryers into personal negative pressure chambers that deliver oxygen and limit the spread of aerosolized virus, lowering the infection risks for health care workers and other patients.
Pulmonologists across the country have been turning to a remarkably simple intervention: flipping patients onto their stomachs, which markedly improves oxygen levels for those in respiratory distress.
Doctors say these and other ad hoc measures have allowed many hospitals to weather the surge of desperately ill patients in recent weeks, and may have helped stave off the dire ventilator shortages and rationing that some had feared.
“Some of these are battlefield interventions that we would not normally use in hospitals, but this crisis has been an incredible spur for creativity and collaboration,” said Dr. Greg Martin, a pulmonologist in Atlanta and the president-elect of the Society of Critical Care Medicine. “The beauty of this is that we’re learning a lot and hopefully some of this will translate to things we can use in the future.”
Reporting was contributed by Benjamin Mueller, Dan Bilefsky, Ruth Maclean, Simon Marks, Abdi Latif Dahir, Elaine Yu, Andrew Jacobs, Nicholas Bogel-Burrough, Farnaz Fassihi, Abby Goodnough, Katie Thomas, Sheila Kaplan, Michael D. Shear, Sarah Mervosh, Steven Lee Myers, Ed O’Loughlin, Evan Easterling and Megan Specia.