As Coronavirus Cases Near 2 Million, Countries Try to Look Beyond Peak: Live Coverage

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Credit…Alessandro Grassani for The New York Times

With confirmed cases of the coronavirus nearing the 2 million mark, and close to 120,000 dead, the pandemic remains a potent threat around the world even as some countries begin to take careful steps to lift restrictions intended to suffocate the virus.

Outbreaks in many countries are still considered far from their peaks. Prime Minister Narendra Modi of India extended a nationwide lockdown for nearly three more weeks, leaving 1 billion people under severe restrictions and urging Indians not to “let our guard down.”

The Parliament in Turkey approved a measure calling for the release of tens of thousands of prisoners in an effort to stem the spread of the virus behind bars.

In Britain, the plight of patients in nursing homes has risen to the fore after England’s chief public health officer said on Monday that nearly 100 more facilities had registered cases of the coronavirus in a 24-hour period. More than 2,000 homes have reported confirmed cases. The situation drew comparisons to Spain, where nursing homes have been ravaged by the virus.

But countries where the number of new cases is starting to slow down are looking for ways to ease the economic sting of strict lockdown measures, and across Europe, governments are mobilizing a return to some level of normalcy.

Small measures to open back up have been introduced across the continent.

Spain allowed some construction work to resume and a few factories to reopen on Monday. Austria and Italy followed with a gradual easing of restrictions that allowed some small shops to reopen. But there are still strict guidelines in place, with shoppers in Austria required to wear masks and in Italy, a country brutalized by the virus, an even-more stringent lockdown continues until May.

Denmark will allow children under 11 to return to schools and nurseries later this week, after a month of closures. Poland plans to begin to “slowly start unfreezing the economy,” the country’s health minister said on Tuesday.

In the United States, where cases of the virus are still on the rise, governors on both coasts have begun to consider measures to begin to restart the economy. But President Trump made clear that he intended to be the one making those arrangements.

“The president of the United States calls the shots,” Mr. Trump said at a news conference on Monday. “They can’t do anything without the approval of the president of the United States.”

But even as nations weigh loosening restrictions, the International Monetary Fund on Tuesday issued a stark warning on Tuesday that the global economy this year faces the worst downturn since the Great Depression, projecting that the global economy will contract by 3 percent in 2020.

As Wuhan was engulfed by the coronavirus, the Chinese author Fang Fang worked late into the night, writing a daily chronicle of life and death in her home city, where the global pandemic began.

Her online diary, though sometimes censored, became vital reading for tens of millions of Chinese readers — a plain-spoken, spontaneous view into Wuhan residents’ fears, frustrations and hopes during their 11 weeks under lockdown in their homes.

Her account has recently drawn bitter condemnation from zealous Chinese nationalists who have called plans to publish a translation in English an effort to malign the government and undermine the heroic image of Wuhan. Fang Fang, who uses her pen name rather than her birth name, Wang Fang, said that she did not want to be cast as either a cheerleader for the government or as a reflexively embittered critic.

She called herself a witness, highlighting the bravery of doctors, street cleaners and neighbors helping neighbors, while vowing to hold to account officials who let the virus spread. She began the diary on Jan. 25, two days after the Wuhan lockdown began.

“If authors have any responsibilities in the face of disaster, the greatest of them is to bear witness,” she said in an interview. “I’ve always cared about how the weak survive great upheavals. The individuals who are left out — they’ve always been my chief concern.”

Fears are rising for residents of nursing homes in Britain, already seen as a population at risk, after more than 2,000 facilities in the country have reported cases of the coronavirus.

England’s chief medical officer, Prof. Chris Whitty, confirmed the number at a government news briefing on Monday and said that 92 more homes had confirmed cases in the previous 24 hours.

Care England, a charity representing independent care services, has estimated that nearly 1,000 deaths from coronavirus have gone uncounted in care homes; only 217 are noted in the most recent official figures for care home deaths in England and Wales, which run up to April 3.

The government faces criticism for not including deaths in nursing homes in the official daily coronavirus toll. As of Tuesday, the country had reported 93,873 coronavirus cases and 12,107 deaths in hospitals. Professor Whitty acknowledged that the published figures of deaths outside hospitals were delayed, and said the government was working to shorten that lag.

Care workers in nursing homes and hospices have also raised the alarm over a severe shortage of personal protective equipment, or P.P.E., and say supplies are being diverted to hospitals.

“Our members are telling us that they simply are not getting the P.P.E. they need,” said Theresa Fyffe, head of the Royal College of Nursing’s independent sector. “And there is evidence of hospices and care homes asking for donations of gloves, goggles and aprons; this situation simply cannot continue.”

Two care workers in Britain were reported to have died from coronavirus last week, according to the social care charity Methodist Homes.

Data from five European countries has found that around half of the deaths from coronavirus are occurring in care homes, according to a study published by the London School of Economics on Monday.

In an assessment of statistics from Italy, Spain, France, Ireland and Belgium, it found that care home residents accounted for between 42 and 57 percent of reported deaths so far.

Indonesia, a nation that had been widely criticized for lack of coronavirus testing and limited social distancing measures, has seen a rapid uptick in coronavirus deaths in recent days, with 60 new fatalities reported on Tuesday.

Health experts have warned for weeks that Indonesia could face a calamity on the scale of Iran or Italy and that its beleaguered health system was not prepared to handle a large number of critically ill patients.

Indonesia’s death toll of 459 is second only to China in East Asia. And the official death toll, while high, only accounts for some cases: Patients suspected of having Covid-19 who died before being tested are not taken into account.

Indonesia, the world’s fourth most populous country with 270 million people, has conducted minimal testing and has been slow to adopt social distancing measures.

Indonesia’s president, Joko Widodo, declared a national disaster on Monday, which could make the country eligible for international assistance. But he announced no new restrictions aimed at curbing the spread of the virus.

Nearly 10 percent of those reported dead have been medical personnel, including 22 doctors and six dentists, according to the Indonesian Medical Association, and 12 nurses according to the Indonesian Nurses Association.

Last week, the governor of Jakarta, the capital, imposed a partial shutdown, restricting transportation within the city and a banning religious, social and cultural gatherings. Other major cities in the metropolitan area imposed similar restrictions.

The International Monetary Fund has warned that the global growth is headed for its worst performance since the Great Depression, with a new forecast predicting the world economy will contract by 3 percent in 2020.

The stark forecast, issued on Tuesday in the fund’s World Economic Outlook, took into account the weeks of shuttered factories, quarantines and national lockdowns in response to the coronavirus pandemic that have caused economic output around the world to collapse.

This year’s fall in output would be far more severe than the last recession, when the world economy contracted by less than 1 percent between 2008 and 2009. A 3 percent decline in global output would be the worst since the Great Depression, the fund said.

“As countries implement necessary quarantines and social distancing practices to contain the pandemic, the world has been put in a Great Lockdown,” said Gita Gopinath, the fund’s chief economist. “The magnitude and speed of collapse in activity that has followed is unlike anything experienced in our lifetimes.”

Prime Minister Narendra Modi of India extended a nationwide lockdown on Tuesday for nearly three more weeks, preventing more than 1 billion from leaving their homes.

He lauded the country for acting aggressively against the coronavirus and urged Indians not to “let our guard down.”

In an address to the nation, Mr. Modi said extending the existing 21-day lockdown until May 3 was necessary to prevent a spike in cases and that tougher restrictions could follow. He applauded Indians for following the measures “like a dedicated soldier.”

“If you look at it only economically, it has been expensive,” Mr. Modi said of the lockdown. “But you can’t put a price on the lives of Indians.”

Mr. Modi said some relaxations to the lockdown could be implemented after April 20 in certain areas if they showed strict observance of the rules. But for now he urged all 1.3 billion Indians to wear masks, stay inside, respect health care workers and help older people.

India has a relatively low number of confirmed infections, with about 10,000 cases, 339 deaths and a doubling rate of about six days. But a rapid spread could be devastating. Health care facilities are poor, and hundreds of millions of Indians live in dense urban areas, making it difficult to follow social distancing.

Officials have faced staggering challenges to enforce the lockdown, which abruptly went into effect on March 25 with just four hours notice.

Thousands of migrant workers were initially trapped in big cities, far from their home villages. Some embarked on hundred-mile journeys by foot to reach their homes.

“If we have patience, we will defeat the coronavirus,” he said.

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transcript

‘What Disease Are We Treating?’: Why Coronavirus Is Stumping Many Doctors

Doctors say the coronavirus is challenging core tenets of medicine, leading some to abandon long-established ventilator protocols for certain patients. But other doctors warn this could be dangerous.

“This disease has challenged everything that we believed was right six weeks ago.” “It’s different than anything we’ve seen before, and maybe the way we’ve taken care of things is not the right way of doing it.” “There is a lively and healthy debate, that I think is a good debate, about what the right thing to do here is.” “I’m concerned that if we continue on the path that we’re on, that hundreds of thousands of lives and lungs may be at risk.” “It’s actually kind of vital that we not deviate from those treatment protocols because we know that they reduce mortality.” “Low oxygen levels.” “They will tire out within a few hours. So what’s your next step?” “Before Covid-19, I would recommend putting you on a breathing machine.” “I would have rushed to intubate.” “Because that was probably the right thing to do.” “I know when to put in a breathing tube. I’ve worked long enough, and I’ve worked enough places with enough people. But in this disease, it is extremely confusing, you know, it just doesn’t make sense. Listen, I stocked up for the apocalypse, like most people. Now, I just can’t believe that I ever thought that I’d somehow be home to make all my frozen food. On a normal day in an I.C.U., you have very sick patients. Patients will — are dying, but this is just different. It’s just — you have a disease we don’t understand that is very deadly with patients that are scared and staff that are scared, and on top of that, it does not appear that we have a good treatment strategy other than a ventilator. And we don’t — we’re not sure when to put a breathing tube in. The crux of it is, we don’t want to put a breathing tube into someone who doesn’t need it knowing that there’s a 70 percent chance they’ll die, and then we don’t want to not put it into someone who would need it too late. When you go to the E.R., and there’s like 40 people that need oxygen, and they all look terrible, but they can all talk to you.” “And no apparent distress whatsoever.” “And then you get them on a monitor, and you look up, and you see this oxygen saturation of 45 percent or 50 percent.” “And telling myself this is impossible. This is not possible. How can this be?” “It’s just not compatible with life to have an oxygen saturation that low.” “You know, this is strange. It’s out of a horror movie.” “I’ve been unable to sleep because I’m trying to wrap my head around it. This goes against anything I’ve ever believed.” “The paradigm of ARDS is not matching with the patients that I’m seeing, so it’s like trying to fit a square peg into a round hole.” “The core of the core of the core — it is just, what disease are we treating? And are we treating something that is naturally ARDS, or are we not?” “We protect the lung against what we do to the lung. Protect it from what? From what we do in mechanical ventilation.” “So what he is saying is that we just have to be gentle. People will need a ventilator, and those that do need as high oxygen as possible, as little pressure as possible, in order to buy time until this demon virus stops.” “These patients have ARDS. I think the editorial has both been misinterpreted, and I think people have misunderstood that it’s just that. It’s an editorial. It’s not a study and it’s not a trial. I don’t doubt that people have seen some cases with some terrifyingly low oxygen numbers. On average, they’re as sick as prior cohorts with ARDS.” “I just think it’s important to say that it’s not a settled question. Every hospital in the world is probably solving its problems slightly differently.” “We’re using an early intubation strategy here, and of our first 66 patients, already a third of them have been extubated. I’m arguing for evidence-based medicine, which is something that we all purported to agree with before this outbreak hit. We have large, randomized, controlled trials. The patients in those trials had met the same diagnostic criteria that our current patients meet. We should apply the results of the trials.” “Today, we do not rush to intubate. Intubate shouldn’t — has become the last resort, and the protocol once they’re intubated has changed drastically.” “So within the last two weeks, I mean, what has been unacceptable has become very acceptable. Some of these patients don’t need to be intubated. You watch them carefully. You make sure their oxygenation is adequate, and they can recover.” “I am not saying we don’t need ventilators, but perhaps we need to think about how we’re using them. Somebody, and preferably people that are not taking care of patients every day, needs to look at the disease and figure out how we can treat it better.” “The truth will come out eventually. In the meantime, the question is: What do we do until that happens? And yes, I’m nervous. I’m scared everyday when I go into work, but I’m just trying to do the best I can.”

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Doctors say the coronavirus is challenging core tenets of medicine, leading some to abandon long-established ventilator protocols for certain patients. But other doctors warn this could be dangerous.CreditCredit…The New York Times

Doctors are questioning the care protocols for coronavirus patients, particularly the use of ventilators. That has led to a heated debate amid practitioners, with some warning that abandoning long-established policies could be dangerous.

In the video above, doctors at the center of the outbreak voice their fears about making the wrong decisions as the virus upends everything they thought they knew about treating patients in severe respiratory distress.

The pandemic has also presented challenges to the field of medical publishing, particularly for “preprint servers,” where medical researchers post early versions of their findings. They aim to improve communication between scientists, by allowing them to share promising information months before their research has gone through protracted peer review and official publication.

They’ve seen a huge surge in online traffic amid the outbreak — including many readers who lack the scientific expertise to understand them in their proper context. The same has happened with peer-reviewed journals.

“Science is a conversation,” said Dr. Ivan Oransky, a physician and co-founder of Retraction Watch, a blog that reports on retractions of scientific papers. “Unfortunately people in times of crisis forget that science is a proposition and a conversation and an argument. I know everybody’s desperate for absolute truth, but any scientist will say that’s not what we’re dealing with.”

As the coronavirus spreads through Russia and shuts down more of the country’s economy, a related health threat is growing along with it: alcohol abuse.

The frustration, anxiety and boredom of a partial lockdown have combined with a widespread, false belief across the former Soviet Union that drinking vodka can treat or prevent disease.

Vodka sales have spiked — up 65 percent in Russia in the last week of March — along with alcohol-related domestic violence. Hospitals and clinics are girding for an increase in alcohol-related admissions.

“The lid is still on, for now, but the pot is already boiling,” said Dr. Aleksei Kazantsev, head doctor of a private addiction treatment center in Moscow.

President Vladimir V. Putin has campaigned against alcoholism, and official figures show consumption about one-third lower than in 2003, but heavy drinking remains commonplace.

Anti-alcoholism activists say Russia should restrict alcohol sales as long as limits on people’s movement are in place. Rather than rather than waiting for Moscow to act, about a dozen of Russia’s 85 regions, largely rural areas, have limited sales.

It was not until April 6 that the health minister, Mikhail Murashko, said on state television that “trying to treat all this with alcohol” would produce coronavirus patients who “can’t be saved anymore.”

After months of downplaying the virus and publicizing statistics that experts said were much too low, Russia’s government has begun to acknowledge that the pandemic is serious and spreading fast. On Tuesday, the official counts reached 21,102 infections and 170 deaths.

Moscow and many other regions are allowing residents to leave their homes only for urgent matters or short dog walks. Mr. Putin has declared that all Russians in nonessential jobs must be allowed to stay home, with pay, for the entire month of April.

Italy and Spain, the two European nations so far hardest hit by the coronavirus outbreak, have both taken small steps toward loosening the restrictions that proved key to stemming their devastating outbreaks. Denmark, Poland and Austria did the same.

But France, Britain and others said it was premature to relax their controls.

The European Commission, the executive arm of the European Union, urged countries to coordinate their lockdown exit strategies. It will adopt a set of recommendations this week, including keeping restrictions in place until there has been a significant, sustained decline in new cases.

After extending a lockdown from April 13 to May 3, the Italian government reopened some stores on Tuesday, including stationers, bookshops and children’s clothing stores, a sign of a gradual return to normalcy. But the loosening will not apply in regions where infection rates have yet to decline significantly — including Lombardy, Piedmont and Campania — and some other regions took their own approaches.

“Stores, bans and walks. Italy becomes a puzzle,” read a headline in Rome daily La Repubblica Tuesday, a nod to the scattered approach. Italy’s total number of confirmed cases was just shy of 160,000 and deaths surpassed the 20,000 mark on Monday.

On Tuesday, the second half of Spain’s 17 regions reopened factories and building sites, a day after the others began a gradual return to work. While the easing of measures has triggered a debate over safety, many factories are so far only recalling just a fraction of their work forces.

Spain registered a slight uptick in deaths on Tuesday — 567 overnight, with the total surpassing 18,000 since the start of the crisis.

The morning after President Emmanuel Macron of France addressed the nation to extend a national lockdown until May 11, France’s interior minister, Christophe Castaner, said on Tuesday that starting to lift measures from that date was “not a certainty, but an objective.”

Chinese exports of much-needed N95 respirators, surgical masks and other personal protection equipment were delayed for a fourth day on Tuesday as China’s customs agency left unresolved a crucial regulatory issue.

Responding to complaints from Europe that some medical supplies had quality problems, the China’s customs administration issued a new regulation on Friday that each shipment of medical supplies must be inspected for quality before it can be exported.

As a result, millions of masks, thousands ventilators and other equipment have sat on factory floors for days or weeks, waiting for clearance. Planes chartered to take gear to the United States have waited, empty, at Chinese airports.

At the same time, some American officials say that reliance on Chinese supplies — even acceptance of gifts from China — supports Beijing’s propaganda efforts.

The customs agency ordered two weeks ago that only factories with medical certification from the Chinese government could continue to export medical supplies, temporarily blocking products from many factories.

Customs offices have interpreted the new rule as requiring both factory certification and quality inspection. Few medical supplies meet both standards.

At a monthly news conference on Tuesday in Beijing to release China’s export and import data, the customs agency’s spokesman, Li Kuiwen, declined to say whether both rules applied.

“More interpretation of these regulations will be given by China Customs at relevant news conferences,” he said.

In the meantime, exports are stalling and foreign criticism is rising.

“Double-layering of regulations is excessive and is red tape,” said Omar Allam, a former Canadian trade official who is now the chief executive of a global trade consultancy. “The Chinese are really choking the export of personal protection equipment supplies to the countries that need it most.”

Turkey’s Parliament passed a law on Tuesday that would allow for the release of up to 90,000 prisoners to ease overcrowding and protect detainees from being infected.

The new law is set to reduce sentences and give early release to 45,000 people in minimum-security prisons, and 45,000 from regular prisons, which amounts to nearly one third of the total prison population. Those released will be ordered to stay at home, as Turkey has been gradually restricting the movement of its population.

The releases will not include those convicted of terrorism-related crimes, an exemption that covers most political prisoners and people imprisoned after an attempted coup in 2016.

The bill was supported by 279 lawmakers, while 51 voted against it, according to the Anadolu Agency, a Turkish state-run news agency. President Recep Tayyip Erdogan’s political party, the Justice and Development Party, proposed the bill. Its nationalist allies, the Nationalist Movement Party, has been pushing for the bill for months.

Opposition parties have criticized the law for excluding journalists and opponents of Mr. Erdogan who were imprisoned after the coup attempt.

Prisoners detained for sex offenses, drug offenses and first-degree murder were also excluded.

Justice Minister Abdulhamit Gul on Monday said there were 17 cases of the coronavirus in five prisons, and that three inmates had died. Turkey has recorded 56,956 coronavirus cases and 1,198 deaths.

In the United States and around the world, outbreaks have spread quickly in prisons, where social distancing is impossible. Some prisons have released inmates to contain outbreaks, though critics say officials have been too slow to act.

Austria began loosening its nationwide coronavirus lockdown on Tuesday, allowing hardware and home-improvement stores to reopen, in the first easing of restrictions since Chancellor Sebastian Kurz shuttered all nonessential shops last month.

In a small, tentative step toward restarting the country’s economy, customers wearing face masks waited in store lines across the country on Tuesday morning. So far, the Alpine nation has reported 14,041 coronavirus cases, with 368 deaths.

Austria joins a handful of other European nations that this week began easing restrictions, if in small steps, as their economies groan under the strain of the shutdown. Spain allowed construction workers and some factory workers to resume their jobs on Monday, and Italy has allowed some shops to reopen.

Rudolf Anschober, Austria’s health minister, cautioned residents to abide by rules put in place to guarantee their safety.

“I urge everyone to take the security measures of this first step of reopening seriously and uphold the regulations of entering shops, maintaining a distance, wearing a protective covering over their mouth and nose, which is also required in public transport,” he said during a Monday news conference.

Shops of 400 square meters, around 4,300 square feet, or less, hardware stores and gardening centers were allowed to reopen, but shoppers are required to wear a mask or covering over their faces and noses and maintain a distance from one another.

The stores are only allowed to admit a limited number of customers at a time and those found in violation of the regulations face fines of 3,600 euros, or around $3,940. Shopping centers are not allowed to reopen until May 2.

The Ugandan musician and opposition politician Robert Kyagulanyi, popularly known as Bobi Wine, has come up with a plan to help Africans who have become targets of xenophobia in China: fly them out.

The announcement comes days after Africans in the Chinese city of Guangzhou said they had been subjected to forced evictions and arbitrary quarantines as Beijing ramped up efforts to fight against imported coronavirus cases. Anti-foreigner sentiment grew in the southern Chinese city after a recent cluster of cases was reportedly linked to its Nigerian community.

In a statement posted on Twitter, Mr. Wine said he had partnered with an American businessman to airlift Africans and African-Americans affected by the attacks “to a country in Africa that is willing to receive them.”

Together with Neil Nelson, chief executive of the Atlanta Black Star media firm, the two were also ready to evacuate to the United States those who hold American citizenship or permanent residency.

Videos and images of Guangzhou’s black residents facing harassment from police, sleeping in the streets and being refused service in stores and restaurants have surfaced online. On Monday, McDonald’s apologized after a video circulated online showing an employee at one of its restaurants in Guangzhou holding up a sign that read, “From now on, black people are not allowed to enter the restaurant.”

The incidents in China have drawn condemnation from leaders across the African continent, with nations including Nigeria and Uganda summoning their Chinese ambassadors. The authorities in China have said they have “zero tolerance for discrimination” and have promised to work to improve conditions.

The official Chinese news agency Xinhua said on Tuesday that 111 people from African countries had tested positive for the coronavirus in Guangzhou. More than 4,500 Africans there have been subject to nucleic acid testing since early April, the report said, citing the local authorities.

The doctor paused before banging on the front gate, gesturing to his companions in hazmat suits and masks to stand back so they would not be the first thing the home’s occupants saw.

“This is very sensitive, very difficult,” said Dr. Wissam Cona of the provincial Health Department in Najaf, Iraq. The father at this home had begged him not to come with a retinue of health workers, saying he felt ashamed in front of his neighbors.

For Iraq, one of the biggest obstacles in fighting the coronavirus is the stigma associated with illness and quarantine. People avoid being tested, prevent family members from getting tests and delay seeking medical help until they are catastrophically ill.

That may help explain Iraq has relatively few confirmed coronavirus cases: 1,352 as of Monday. Iran, with roughly twice Iraq’s population, has more than 71,000.

“It is true we have cases that are hidden, and that is because people don’t want to come forward and they are afraid of the quarantine and isolation,” said Dr. Hazim al-Jumaili, a deputy health minister.

The stigma attached to illness and quarantine in Iraq and other Middle Eastern countries reflects cultural and religious beliefs, but also distrust of the government and bitter experience: Given the ragged state of Iraq’s health care system, some fear going to the hospital could be fatal.

“Some believe the virus means that God is displeased with them, or maybe it is a punishment for a sin so they don’t want others to see that they are sick,” said Dr. Emad Abdul Razzak, a consulting psychiatrist at Iraq’s Health Ministry.

Prime Minister Kyriakos Mitsotakis of Greece said in a televised national address on Monday that the “return to normal life will happen gradually and in phases,” as he cautioned citizens against visiting each other ahead of the Orthodox Easter celebrations this week.

“This is the most critical week,” Mr. Mitsotakis told the Greek people, after thanking them for their trust and discipline.

The death toll in Greece, where at least 2,145 out of about 10.7 million people have tested positive for the virus, reached 101 on Tuesday, local media reported.

The Greek government implemented social distancing measures before the first coronavirus death in the country on March 12, and has made it mandatory for citizens to text the government or fill out a form every time they leave their house.

But not all churches in Greece have accepted the restrictions, with some priests violating the government’s instructions ahead of Orthodox Easter. On Sunday, a priest in Athens gave holy communion to citizens from the back door of a church and then argued that communion doesn’t transmit the virus, while others communed inside a church in Corfu, according to local reports.

Nikos Hardalias, the deputy minister for civil protection, condemned their actions on Sunday and asked the prosecuting authorities to intervene.

“Churches will be closed to the public throughout the Holy Week,” Mr. Hardalias said on Monday, adding that the majority of the church and public have abided by the rules, with just the two exceptions.

“Some need to finally realize that they are not more faithful Christians than others,” he said.

While the world may see Japan as a futuristic land of humanoid robots and intelligent toilets, inside its offices, managers maintain a fierce devotion to paper files, fax machines, business card exchanges, face-to-face meetings and official corporate seals.

The stamps, known as hanko or inkan, are used in place of signatures on the stream of documents that fill Japan’s workplaces. They have become a symbol of a hidebound office culture that makes it difficult or impossible for many Japanese to work from home even as the country’s leaders say working remotely is essential to keeping Japan’s coronavirus epidemic from spiraling out of control.

Companies applying for government telework subsidies have reported needing to print out 100 or more pages of documents and deliver them in person.

A survey last month by the Ministry of Land, Infrastructure, Transport and Tourism found that fewer than 13 percent of workers were able to work from home. And those who have the option of teleworking fear harm to their careers.

Forced to balance the needs of the office and the risks to their own health, employees like Shuhei Aoyama, 26, say they are losing patience with the country’s work traditions. “It’s not so much our company’s culture as it is Japanese culture that’s causing the problems,” he said.

“Why do we have to put each other at risk just for something trivial like a hanko?” Yoshitaka Hibi, a professor of Japanese literature at Nagoya University, wrote in a Twitter post that was liked more than 28,000 times.

“This is our chance. For the love of god, someone please destroy this custom,” he added.

President Trump, who has repeatedly said it was up to governors to manage the response to the coronavirus pandemic, said on Monday that he would be the one deciding when to reopen the country. His remarks came as governors on each coast said they were working together to determine when and how to ease restrictions.

Democratic governors expressed skepticism about Mr. Trump’s remarks, which raised constitutional questions and signaled the possibility of a major clash if the president tries to reopen businesses in states where governors still want things shut.

The governors of California, Oregon and Washington are working on a regional approach, as are the governors of New York, Pennsylvania, Connecticut, Delaware, Massachusetts, New Jersey and Rhode Island.

While Mr. Trump has predicted that the economy will bounce back quickly once stay-at-home orders are lifted, evidence points to a long and slow recovery.

Republicans and Democrats in Congress are locked in a stalemate over what should be in an emergency aid package, with Democrats seeking more money for state and local governments, hospitals, food assistance and rapid testing. And the Census Bureau said it was seeking a four-month pandemic-related delay in delivering to Congress the population data used to reapportion the House of Representatives.

Cities and states approached the arrival of the coronavirus with different levels of aggressiveness. Internal emails show that city officials in New Orleans, now one of the country’s virus hot spots, believed there was only a very small chance that someone with the coronavirus would attend its Mardi Gras celebration in late February. Experts now think the festivities accelerated the spread of the virus.

More than 100 million children could be at risk for measles because countries are suspending immunization programs to reduce the risk of coronavirus infection, international public health leaders warned on Monday.

So far, 24 low- and middle-income countries, including Mexico, Nigeria and Cambodia, have paused or postponed such programs, according to the Measles and Rubella Initiative, a consortium whose members include UNICEF, the American Red Cross, the World Health Organization, the United Nations Foundation and the Centers for Disease Control and Prevention.

Unlike wealthier countries, where parents typically make appointments to follow a vaccine schedule at clinics or private pediatric offices, these countries inoculate large numbers of infants and children in communal settings.

Dr. Robin Nandy, the chief of immunization for UNICEF, acknowledged that finding the balance between guarding against the spread of Covid-19, the illness caused by the coronavirus, and preventable diseases like measles was delicate and difficult.

Reporting was contributed by Richard Pérez-Peña, Karen Zraick, Anton Troianovski, Oleg Matsnev, Sophia Kishkovsky, Monika Pronczuk, Wudan Yan, Elisabetta Povoledo, Raphael Minder, Aurelien Breeden, Richard C. Paddock, Ceylan Yeginsu, Abdi Latif Dahir, Megan Specia, Melissa Eddy, Carlotta Gall, Ben Dooley, Makiko Inoue, Keith Bradsher, Edward Wong, Paul Mozur, Kai Schultz, Hari Kumar, Elaine Yu, Kate Taylor, Sebastian Modak, Alissa J. Rubin, William J. Broad, Miriam Jordan, Annie Correal, Ben Dooley and Makiko Inoue contributed reporting.