Coronavirus Live Updates: States Raise Alarms Over Dwindling Medical Supplies

The White House signaled Saturday that American companies were increasing efforts to restock hospitals with crucial supplies during the coronavirus pandemic, but it again stopped short of more assertive steps that some state and local leaders have been demanding.

At a news conference on Saturday at the White House, Vice President Mike Pence said the federal government had ordered “hundreds of millions” of N-95 masks for health care facilities across the country, but he did not say precisely when they would be delivered to workers. And President Trump said another company, Hanes, was now on the roster of major corporations coordinating with the administration.

The White House’s moves appeared unlikely to satisfy calls for more aggressive action from Washington as the nation grappled with a coast-to-coast reorientation of American life. More than 21,000 cases have been confirmed in the United States, a number expected to soar in the coming weeks.

Officials in a number of states, including New York and California, have issued dire predictions and warned of dwindling supplies of crucial gear, like protective equipment, and what they believe will be a vast demand for ventilators.

Mr. Trump has sent conflicting signals on how the federal government might solve the supply issues. On Saturday, he said that he had not used the Defense Production Act — which empowers the government to mobilize the private sector to increase the production of scarce goods — because companies were stepping up voluntarily. He cited Hanes and General Motors, which he said would make masks and ventilators.

“We want them on the open market from the standpoint of pricing,” Mr. Trump said.

A Hanes spokesman said the company had agreed to make up to six million masks a week along with a group of other yarn and clothing companies after Trump administration officials reached out about a week ago. The masks will not be the highly sought-after N-95 masks. Hanes is negotiating a contract with the U.S. government to supply the masks at market rates, the spokesman said.

Other companies the administration announced coordination with include Honeywell and 3M. Mr. Trump also said Pernod Ricard USA had repurposed production facilities in four states to manufacture hand sanitizer, with the first delivery expected on Tuesday. Tim Cook, the chief executive of Apple, said on Saturday that the company would donate millions of masks to health professionals fighting the virus in the U.S. and Europe.

Meanwhile, luxury and fashion and manufacturers are pivoting from clothing to surgical masks and other protective gear.

Separately, the Food and Drug Administration announced on Saturday that it would permit a Silicon Valley company, Cepheid, to start selling a diagnostic test that could determine in about 45 minutes whether a patient has the virus that causes Covid-19.

Vice President Mike Pence and his wife, Karen Pence, tested negative for the coronavirus, a spokeswoman for Mr. Pence said Saturday night.

At a White House news briefing on Saturday, Mr. Pence disclosed that he and Ms. Pence would be tested later that afternoon after an official in his office tested positive.

The White House physician advised him that he “has no reason to believe I have been exposed,” Mr. Pence said, noting that the person in his office had not come into close contact with Mr. Pence or President Trump.

“I am pleased to report that he is doing well,” Mr. Pence said of the employee, whom he did not name, adding that the person “has not been to the White House since Monday.”

The White House first disclosed the employee’s illness on Friday evening. Mr. Pence’s spokeswoman, Katie Miller, said in a statement that “further contact tracing is being conducted in accordance with C.D.C. guidelines,” but she did not immediately reply to a request for more details about the official’s role.

Several former and current Trump administration officials have self-quarantined over concerns of exposure to the virus. Those include Mick Mulvaney, the former acting White House chief of staff, and Stephanie Grisham, the White House press secretary.

Last week, Ivanka Trump, the president’s daughter and adviser, stayed home “out of an abundance of caution” after an Australian official she recently met with tested positive for the coronavirus, a White House spokesman said. By Friday, she had returned to work. A person familiar with the situation said she had tested negative for the virus.

Gov. David Ige of Hawaii, seeking to slow the increase of coronavirus cases in his state, on Saturday ordered a mandatory 14-day quarantine for everyone arriving in Hawaii, including both tourists and returning residents. He said his order was the first of its kind in the nation.

“The threat of Covid-19 is extremely serious, and it requires extreme actions,” he said in a news conference.

Under Mr. Ige’s emergency proclamation, returning residents are to quarantine in their homes, with visitors to stay in their hotel rooms or rented lodgings. They are to leave only to seek medical care.

Mr. Ige said in a Facebook post that failure to follow the order would be a misdemeanor punishable by a fine of up to $5,000, up to a year’s imprisonment or both.

The Hawaii Department of Health on Saturday reported 48 cases of coronavirus in the state, an increase of 11 from the day before. A majority of the state’s cases are linked to travel, according to Mr. Ige.

The mandate will go into effect on Thursday. The governor said the delay was to give tourists time to cancel or postpone their trips, which he said he hoped they would do.

“We know that our economy will suffer from this action,” he said. But it is necessary, he added, to “flatten the curve” so that the state’s health care system is not overwhelmed.

Doctors should be wearing gloves, gowns, eye gear and masks when treating coronavirus patients. But for weeks, hospitals have been running dangerously low on essential supplies and many medical professionals on the front lines do not have adequate protection.

Why is this happening?

A widespread buying of masks by anxious consumers and the prolonged outbreak in China diminished the supply. Even before the coronavirus emerged, China produced about half of the world’s masks. During the outbreak, it expanded its mask production by nearly 12-fold but continues to hoard its supply.

The outbreak also came after a particularly mask-intensive few months. Wildfires in California and in Australia had already diminished some humanitarian organizations’ supplies.

Ideally, clinicians would be using a new, tightly-sealed respirator, like the N95, with each patient. These are thicker than standard surgical masks, and are designed to fit more tightly around the mouth and nose to block out much smaller particles.

The Food and Drug Administration said that neither surgical masks nor N95s should be shared or be reused, but the C.D.C. updated its recommendations to optimize the limited supply of protective gear.

“As a last resort,” the C.D.C. said “homemade masks” like a bandanna or a scarf can be used, although their protective ability is unknown.

Experts say masks and respirators are not effective for protecting the general public, but are crucial for health care workers.

Italy has imposed a lockdown, deployed the army and risked its economy to try to stop the spread of the coronavirus.

Yet its toll is growing more staggering by the day: On Saturday, officials reported 793 additional deaths, by far the largest single-day increase so far. Italy has surpassed China as the country with the highest death toll, becoming the epicenter of a shifting global pandemic.

And the virus’s effects are being felt throughout Europe. Poland has reported fewer than 500 cases, but one of the country’s hospitals was shut down and evacuated on Saturday after 30 patients and staff members were found to have the virus. France, one of the hardest hit countries in Europe, raised its totals to 14,459 confirmed cases and 562 deaths, and said it had ordered over 250 million face masks from French and foreign suppliers.

The governor of the German state of Baden-Wurttemberg asked hospitals in his state to estimate capacity in their intensive care units, so that French patients in need of respirators from the heavily hit Alsace region can be transferred for treatment.

The German authorities banned people in Berlin from meeting in groups of more than 10 people, with the exception of lawmakers, courts and those providing essential services, and Spain’s health ministry reported a surge in the number of coronavirus deaths to 1,326 and total cases to 25,000, a rise of about 25 percent from a day earlier.

In the Madrid region, which has had 60 percent of Spain’s cases, hospitals are overflowing and facing equipment shortages. Officials ordered that a field hospital with about 5,500 beds be set up in the Spanish capital’s main exhibition center. In the Valencia region, three field hospitals have been added, with a combined 1,000 beds. Hotels have also been converted into hospitals in Madrid and Catalonia, where 122 people have died.

But Italy’s struggle is among the world’s most pronounced, and it is increasingly being seen as a tragic warning for other countries to heed, in part because it is still paying the price of early mixed messages by scientists and politicians. The people who have died in staggering numbers recently — more than 2,300 in the last four days — were mostly infected during the confusion of a week or two ago.

Schools and businesses around the country have closed. Local economies have unraveled. Medical facilities, which are bearing the brunt of the outbreak, are facing a shortage of crucial supplies.

But there are ways to lend a helping hand. Those seeking to only give money could consider donating to GlobalGiving, which connects nonprofits, donors and companies. Money received will help send emergency medical workers to communities in need.

Relief International focuses on supporting medical professionals with supplies. It operates in 16 countries and it recently focused its efforts on helping Iran, where more than 20,000 infections have been reported. Similarly, Heart to Heart International is distributing urgently needed equipment and medication to its global partners.

The outbreak has caused a severe blood shortage, according to the American Red Cross. It’s now asking healthy donors to give blood, platelets or plasma.

Keeping families and children fed while schools are closed is a concern for many communities. World Central Kitchen works to distribute meals to children in New York City, Washington, D.C. and Little Rock, Ark. The program will expand to Los Angeles on Monday. The Covid-19 Response fund from Feeding America will support thousands of food pantries and hundreds of food banks across the country.

There are also specific organizations dedicated to supporting children, including UNICEF, Save the Children and First Book, which aims to deliver seven million books to children in the United States while schools are closed.

In a letter to congressional leaders on Saturday, the chief executives of major airlines, UPS and FedEx said that they would postpone mass layoffs and stock buybacks and dividends if Congress secured a large enough bailout for their industry.

“We are united as an industry and speaking with one voice,” wrote the group, which included the heads of Southwest Airlines, Delta Air Lines, United Airlines and American Airlines. “We urge you to swiftly pass a bipartisan bill with worker payroll protections to ensure that we can save the jobs of our 750,000 airline professionals.”

If Congress approves at least $29 billion in grants for the industry, the executives said they would commit to no furloughs or layoffs through August. If an equal amount in loans is passed, they would commit to limits on executive compensation and to freezing stock buybacks and dividends for the life of the loan.

In a separate letter to senators on Saturday, Sara Nelson, the president of the Association of Flight Attendants union, echoed the call for grants tied to employment, criticizing Senate Majority Leader Mitch McConnell’s plan to provide the industry with loans.

“Federal aid designed for payroll is the only way to prevent massive layoffs,” she said. “Loans won’t cut it.”

Ms. Nelson also said that such aid should be tied to limits on buybacks, executive pay and dividends, as well as protecting union contracts.

President Trump sent a letter to North Korea’s leader, Kim Jong-un, expressing his willingness to help the North battle the coronavirus, according to North Korea, which responded by expressing gratitude.

“I would like to extend sincere gratitude to the U.S. president for sending his invariable faith to the Chairman,” said Kim Yo-jong, the North Korean leader’s sister and policy aide, in a statement carried by the North’s state-run Korean​ Central​ News Agency. Ms. Kim lauded Mr. Trump’s decision to write the letter as “a good judgment and proper action.”

In the letter, Mr. Trump “wished the family of the Chairman and our people well-being,” Ms. Kim said, referring to his brother by one of his official titles.

According to Ms. Kim, Mr. Trump also explained his plan to move relations between the two countries forward and “expressed his intent to render cooperation in the anti-epidemic work, saying that he was impressed by the efforts made by the Chairman to defend his people from the serious threat of the epidemic.”

The White House confirmed that Mr. Trump had sent Mr. Kim a letter but did not comment on its specifics.

Mr. Trump and Mr. Kim have repeatedly touted their unusual relationship. But relations between Pyongyang and Washington ​have cooled since the leaders’ second summit meeting, held in Vietnam in February of last year, collapsed over differences regarding how quickly North Korea should dismantle its nuclear weapons program and when Washington should ease sanctions.

The Federal Emergency Management Agency issued a Major Disaster Declaration for New York, meaning billions of dollars in federal aid could be coming to New York as the rising number of coronavirus cases shows no sign of abating.

As of Saturday, 10,356 New York state residents had tested positive for the virus. With 6 percent of the U.S. population, the state now accounts for nearly half of the cases in the country tallied by The New York Times.

Stay-at-home orders in New York, New Jersey and Connecticut are set to go into effect over the next couple days. New Jersey’s takes effect at 9 p.m. Saturday, New York’s at 8 p.m. on Sunday and Connecticut on Monday at 8 p.m. Nonessential businesses are ordered closed and residents are being asked to remain indoors unless exercising or shopping for food or medicine.

On Friday, Gov. Andrew M. Cuomo said that one million N-95 protective masks were being sent to hospitals in New York City and another 500,000 to Long Island. The state had also identified about 6,000 ventilators from “places all across the globe” for purchase, the governor said.

With coronavirus threatening to overwhelm New York hospitals, state officials are considering turning landmark locations like the Jacob K. Javits Convention Center into makeshift hospitals.

The U.S. Army Corps of Engineers is also looking at other locations, including two at State University of New York campuses on Long Island, and at the Westchester Convention Center. The Army Corps is expected to outfit the centers with hospital equipment as soon as Mr. Cuomo tours and green lights the locations, officials said.

Dr. Marty Brueggemann, the chief medical officer at Virginia Mason Memorial in Yakima, Wash., warned Saturday that the hospital could run out of life-preserving ventilators by April 8 if the case projections don’t improve and the hospital isn’t able to acquire other machines.

Dr. Brueggemann said he’s witnessed a jarring juxtaposition of what’s going on inside the hospital, which is controlling visitors and preparing for an onslaught of patients, only to leave the facility and find people out in the community gathered in large groups, making clear to him that the general population doesn’t grasp the gravity of the situation.

“We will have to decide who gets a ventilator and who doesn’t,” Dr. Brueggemann said. “That’s only 19 days away.”

Washington’s Department of Health has told local leaders that only the highest-priority areas will have access to the government’s stockpile of protective equipment, including N95 masks.

Long-term care facilities with confirmed infections and hospitals with the largest number of confirmed cases are at the top of the list, while sites lower down include homeless shelters or medical facilities that don’t have confirmed cases. The agency cautioned that not all requests will be fulfilled, and leaders at places like neighborhood health clinics have already seen weeks pass without requests being approved.

Experts predict an explosive growth in the number of critically ill patients in some areas of the U.S., similar to that occurring now in Italy.

Efforts are being made to suppress the outbreak and expand medical capacity. But if forced to ration, medical workers ask, how do they make the least terrible decision? Who even gets to decide, and how are their choices justified?

In the United States, some guidelines already exist for this grim task. In an effort little known even among doctors, federal grant programs helped hospitals, states and the Veterans Health Administration develop what are essentially rationing plans for a severe pandemic. Now those plans, some of which may be outdated, are being revisited for the coronavirus outbreak.

In California, even as officials have pushed for widespread testing, health authorities have issued guidance to hospitals that they’re to restrict testing, reflecting a lack of testing kits and crucial medical supplies like masks and gowns.

The shift suggests that the state may never get a handle on exactly how many people are infected, because many who have only mild symptoms or believe they were in contact with an infected person but are not themselves sick are being told they do not qualify for testing.

The United States was late to identify the severity of the crisis, and officials say it is too late to pursue the strategy of South Korea, which instituted widespread testing to contain the pandemic. Instead, in California and other states, the focus is on identifying those that are the most sick and trying to save lives.

In new guidance released to California hospitals on Friday from the state’s department of public health, hospitals were told that, “broad scale testing is not available.” Hospitals, the letter said, should focus on testing only the most severe cases: patients who are already hospitalized and showing symptoms of Covid-19; residents and staff of long-term care facilities who have symptoms; and health care workers who have been in contact with patients and have come down sick.

“Persons with mild respiratory symptoms who do not otherwise need medical care and who are not in one of the above groups should not be routinely tested for COVID-19,” according to the letter.

In line with the state’s directives, Los Angeles County Public Health issued a letter on Thursday to area hospitals warning of the increase of community transmission — cases in which there is no known contact with an infected person or travel to a coronavirus hot spot — and that hospitals should limit testing to protect health care workers and the demand for supplies.

Reporting was contributed by Katie Rogers, Mariel Padilla, Vanessa Friedman, Jessica Testa, Maggie Haberman, Kate Taylor, Amelia Nierenberg, Mike Baker, Sheri Fink, Derrick Bryson Taylor, Niraj Chokshi, Aurelien Breeden, Melissa Eddy, Raphael Minder, Joanna Berendt, Jason Horowitz, Elisabetta Povoledo, Choe Sang-Hun and Tim Arango.