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In Southern California, a heat wave this weekend foreshadowed the likely challenges that lay ahead for governors and mayors trying to sustain social distancing efforts as spring turns to summer.

Despite pleas from state and local leaders to stay home, tens of thousands of people flocked to beaches that were open in Orange County on Saturday. Photographs of Newport Beach and Huntington Beach showed large crowds staking out patches of sand with beach towels and umbrellas. The Orange County Register reported that as many as 40,000 people went to the beach in Newport Beach on Friday.

In neighboring Los Angeles County, all beaches remained closed this weekend.

“We won’t let one weekend undo a month of progress,” Mayor Eric Garcetti of Los Angeles wrote on Twitter on Sunday. “While the sunshine is tempting, we’re staying home to save lives. The places we love — our beaches, hiking trails — will still be there when this is over. And by staying home, we’re making sure our loved ones will be too.”

Dr. Deborah Birx, the White House coronavirus response coordinator, said Americans should expect social distancing guidelines to continue for months. “Social distancing will be with us through the summer,” she said Sunday on NBC’s “Meet the Press.”

In New York, Governor Andrew M. Cuomo, while encouraging continued social distancing, said during his daily briefing on Sunday that it was unreasonable to expect people to stay inside all the time when summer arrives, especially in the most populous part of the state.

“We need summer activities in downstate New York,” Mr. Cuomo said. “You can’t tell people in a dense urban environment all through the summer months: ‘We don’t have anything for you to do. Stay in your apartment with the three kids.’ That doesn’t work. There’s a sanity equation here also that we have to take into consideration.”

Nevada’s economy has been one of the fastest growing in the country. Then, practically overnight, the glittering Las Vegas Strip shut down, throwing thousands of waitresses, bartenders, hotel cleaners and casino workers out of work, often without severance or benefits, and leaving the most bustling and storied stretch of the state’s economy boarded up and empty.

“If you were to imagine a horror movie when all the people disappear, that’s what it looks like,” said Larry Scott, the chief operating officer of Three Square, Southern Nevada’s only food bank, describing the Vegas strip. “You can’t imagine that there is a circumstance that could possibly cause that. I couldn’t have.”

As the bottom fell out of the American economy, few places have been hit harder than Las Vegas, where a full third of the economy is in the leisure and hospitality industry, more than in any other major metropolitan area in the country. Most of these jobs cannot be done from home.

Nearly 350,000 people in Nevada have filed for unemployment since the crisis began, the highest number in the history of the state. Las Vegas-based economic research firm Applied Analysis estimates the city’s current jobless rate is about 25 percent — nearly double the rate during the Great Recession — and rising.

“From an analytical standpoint, this is unprecedented,” said Jeremy Aguero, a principal analyst with the firm. “We have no frame of reference for what we are seeing.”

The dependence on tourism and hospitality means that, as governors and mayors across the country wrestle with the question of when to reopen their economies, Las Vegas faces particular pressure. Mayor Carolyn Goodman argued last week that casinos should reopen and allow people to get sick. But Nevada Gov. Steve Sisolak, said the state was “clearly not ready to open.”

A different type of coronavirus test is required to screen the U.S. population on the necessary scale, Dr. Birx said Sunday, saying that it will take “a huge technology breakthrough” to get there.

What’s needed, she said on NBC’s “Meet the Press,” is a screening test that detects antigens, like the screening tests used for flu, strep and other diseases. Antigens stimulate the body to produce antibodies, and are essentially evidence of an immune response.

“We have to be able to detect the antigen, rather than constantly trying to detect the actual live virus or the viral particles itself, and to really move into antigen testing,” she said. The current RNA tests, which are more precise but more laborious, would then be used to confirm diagnoses.

Dr. Birx also spoke about another category of tests, those for antibodies, which indicate past exposure rather than detect a current infection. She said she thought the World Health Organization was being “very cautious” in its recent report that found no evidence that people who have recovered from the virus and have antibodies are protected from a second infection.

Reliable antibody tests will be vital as states begin reopening their economies and allowing people to return to work and public spaces. A recent analysis of 14 antibody tests by a team of scientists found that only three delivered consistently reliable results, and even those had some flaws.

On CNN’s “State of the Union,” Dr. Birx did not disagree with the W.H.O.’s statement, but she said the C.D.C. and F.D.A. were gathering data that would help improve and refine antibody tests. “With all of that data together, I think, it’s going to create a very clear picture about antibodies,” she said.

Dr. Birx acknowledged that the nation was not using existing testing capacities to the fullest. She said the administration was working with states to identify all their testing sites and supply the needed swabs and chemical reagents.

As a handful of states relaxed social distancing guidelines over the weekend, they have struggled to navigate competing demands to keep residents safe and the economy open. Here’s a look at how some of those states have approached that balancing act:

  • Although Alaska has allowed businesses and restaurants in most parts of the state to reopen with some restrictions in place on April 24, the city of Anchorage has delayed its reopening to Monday.

  • Arkansas will allow simple elective surgeries to take place.

  • With Colorado’s stay-at-home order expiring over the weekend, Gov. Jared Polis rolled out new rules allowing curbside retail deliveries, phasing in elective surgery and store openings. Large workplaces can open at 50 percent capacity on May 4.

  • In Georgia, gyms, barbershops, tattoo parlors and spas in the state reopened last Friday. Houses of worship were allowed to resume in-person services, and restaurants and theaters can reopen Monday.

  • Hawaii’s stay-at-home order was set to end April 30 but was extended Sunday until the end of May. Gov. David Ige said he planned to ease restrictions on beaches and would allow for certain surgeries under the extended order.

  • Kentucky will permit visits for medical diagnostics, radiology, and non-urgent in-person appointments and outpatient care.

Several African-American leaders in Georgia, including the mayors of Atlanta, Savannah and Augusta, criticized the decision by Gov. Brian Kemp to allow gyms, barbershops, tattoo parlors and spas in the state to reopen last Friday, houses of worship to resume in-person services, and restaurants and theaters to reopen on Monday.

That stance seemed to put them in agreement with President Trump, who said the move was “too soon.” But Stacey Abrams, who ran against Mr. Kemp in 2018, distanced herself from the president.

“I give President Trump no credit,” she told Jake Tapper on CNN. “He actually caused this challenge, by tweeting for weeks that we should liberate our economies. And when someone took him up on it, he did as he normally does, which is bend to what he thinks public opinion is.”

Critics of the early reopening include influential clergy members like Jamal Bryant, pastor of New Birth Missionary Baptist, an Atlanta-area megachurch, and the Rev. Dr. Raphael Warnock, who is running for the U.S. Senate in a special election against Senator Kelly Loeffler, a Republican appointed to the seat by Governor Kemp. Dr. Warnock is the senior pastor at Ebenezer Baptist, Martin Luther King Jr.’s home church.

Mr. Bryant, in a Facebook Live video, said the reopening was “derelict of responsibility” and “absent of moral integrity,” and aimed specifically at places African-Americans like to gather, like salons and barbershops, right after many people had received their stimulus checks.

Mr. Kemp has called his policy a measured return. “I think this is the right approach at the right time,” he told reporters. “It’s not just throwing the keys back to these business owners.”

When Ms. Abrams was asked about accusations that the governor’s move showed disregard for black people, she said, “I will tell you that, in the state of Georgia, African-Americans comprise 32 percent of the population, yet we’re 54 percent of the deaths.”

She added, “We know that communities of color suffer from systemic inequities that can be addressed in this pandemic, but only if the federal government pays attention, and if states do what they can to protect their communities.

In Teaneck, N.J., half of the town’s volunteer ambulance corps is out sick, in quarantine or staying home to avoid potential exposure to the coronavirus. In Rockville, Md., a hard-hit Washington suburb, more than 10 percent of the 160-member volunteer ambulance force has stopped taking shifts. And in a rural Iowa county with one of the state’s highest infection rates, the Dysart Ambulance Service has just 22 volunteers sharing two ambulances and covering 150 square miles.

As the virus has continued its spread into suburbs and rural towns, overwhelming hospitals and emergency medical workers, it also has taken a toll on scores of volunteer emergency response units, many of which are the sole responders in critical and urgent situations.

“Even if the worst-case scenarios from Covid-19 don’t play out, you’re going to have a lot of departments that are in a really difficult spot,” said David Finger, chief of legislative and regulatory affairs for the National Volunteer Fire Council, which represents firefighters and other emergency responders.

More than 80 percent of the nation’s 30,000 fire departments are entirely or mostly volunteer, providing emergency care to about one-third of the country’s population. And while more than 60 percent of the fire departments across the nation provide basic or advanced life support, those in smaller rural communities — areas already dangerously short on health care and often dependent on part-time volunteers to transport patients to hospitals — are less likely to offer emergency medical services.

“I’ve never seen anything like this,” said Jules Scadden, the director of emergency medical services in Dysart, Iowa, a farming community in Tama County, where an outbreak at a nursing home led to more than 230 positive cases and seven deaths.

Demotion of the vaccine chief ‘is going to set us back,’ a former F.D.A. head says.

The Trump administration’s abrupt sidelining last week of Dr. Rick Bright, who led the federal agency involved in developing a coronavirus vaccine, is likely to delay progress and cause other complications, according to Dr. Scott Gottlieb, who was the F.D.A. commissioner until August 2019.

Speaking Sunday on the CBS program “Face the Nation,” Dr. Gottlieb praised Dr. Bright, who led the Department of Health and Human Services’ Biomedical Advanced Research and Development Authority, or BARDA.

“He was effective,” Dr. Gottlieb said. “I think changing leadership in that position right now, certainly, is going to set us back. It’s hard to argue that that’s not going to have some impact on the continuity.” He added. “Businesses, companies that need to collaborate with BARDA, are a little bit more reluctant now to embrace BARDA, now that there is a cloud hanging over it and some uncertainty about the leadership.”

The drug was repeatedly described by President Trump and his allies as a potential “game changer,” but in clinical trials so far, the results have been poor.

“I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” he said.

As officials warn that a fifth round of federal aid will probably be necessary to mitigate the economic damage from the coronavirus pandemic, Democrats in Congress are doubling down on their insistence that the next round include money for state and local governments.

Unlike the federal government, states must balance their budgets, and have seen their tax revenue plummet with the shutdown of much of the economy, even as surging unemployment and emergency response needs have drained their resources.

Kevin Hassett, a senior adviser to the White House, acknowledged that the federal government would probably have to help the states. “The economic lift for policymakers is an extraordinary one,” he said.

Senator Mitch McConnell, Republican of Kentucky and the majority leader, has repeatedly said in recent days that he would like to wait before pursuing another sweeping package, given that Congress has already approved nearly $3 trillion in economic aid of various kinds in two months. But Democrats say aid for states and localities cannot wait.

House Speaker Nancy Pelosi, Democrat of California, blocked the most recent bill, which replenished a loan program for small businesses, until it included money for hospitals and testing. But Republicans balked at including more funds for states and localities, and the bill ultimately passed without it.

On Sunday, Ms. Pelosi rejected the suggestion that Democrats could have done more. Asked to respond to criticism from Gov. Andrew M. Cuomo of New York, Ms. Pelosi said on the CNN program “State of the Union”: “Just calm down. We will have state and local, and we will have it in a very significant way.”

As for the most recent bill, she said, “Judge it for what it does. Don’t criticize it for what it doesn’t.”

Steven Mnuchin, the Treasury secretary, declined to weigh in on the debate on Sunday.

“This is something we’ll consider but our focus right now is really on execution,” Mr. Mnuchin said on Fox News. “If we need to spend more money, we will, and we’ll only do it with bipartisan support.”

Separated from Boston by the Mystic River, Chelsea, Mass., is a world apart, a first stop for immigrant families — Lithuanian, Polish, Irish, and more recently, Honduran and Guatemalan — who cannot afford the bigger city’s sky-high rents.

It has a population density of nearly 17,000 people per square mile, with whole families crowding into single rooms in triple-decker rowhouses, buildings with high rates of lead paint, asbestos and air pollution.

This spring, the virus collided disastrously with the city’s overcrowded housing. A warning flare came in the second week of April, when, late at night, a young mother called the city housing authority from the street; she had disclosed her test results to her roommates, and they had kicked her out.

“It dawned on me that this situation was going to replicate itself,” said Thomas Ambrosino, Chelsea’s city manager, “and we better have a solution.”

For Paul Nowicki, the director of operations for the housing authority in the city, one difficulty has been safeguarding residents in a building when he cannot locate infected people.

Many leaders will face the same stubborn challenge: How, in a country that values its citizens’ medical privacy and autonomy, can authorities separate the sick from the well?

The question is an urgent one if public life is to resume.

A wide stretch of West Virginia and Ohio is fighting the coronavirus pandemic with 530 fewer hospital beds than it had last year, after a for-profit company shut down three of the area’s larger hospitals.

Beginning in 2014, Alecto Healthcare Services acquired the three hospitals: Fairmont Medical Center in Fairmont, W.Va., Ohio Valley Medical Center in Wheeling, W.Va., and East Ohio Regional Hospital in neighboring Martins Ferry, Ohio. Employees expected the new ownership to put the institutions on solid footing after years of financial struggle.

Instead, decisions made by Alecto wound up undercutting patient care and undermining the hospitals’ finances, according to more than two dozen interviews with doctors, nurses, other staff members, government officials and patients, as well as a review of court records.

Doctors were fired to save on salaries; many patients followed them elsewhere. Medical supplies ran short. Vendors went unpaid. Finally, one after another, the three hospitals ceased operating.

The counties they serve have already recorded 171 coronavirus cases and nine deaths. Hundreds of people whose lungs were scarred by decades in coal mines are vulnerable to a devastating respiratory syndrome caused by the virus, doctors said.

“We’ve now got a hospital that existed for over 100 years that, in the middle of a pandemic, sits empty,” said Jonathan Board, chairman of the Marion County Chamber of Commerce’s board of directors, referring to Fairmont.

Dr. John Wolen, the former trauma chief at Ohio Valley, now works at Wheeling Hospital and is bracing for an influx of patients. “The extra capacity that we will absolutely need is not going to be there,” he said.

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Reporting was contributed by Ellen Barry, Pam Belluck, Jonah Engel Bromwich, Emily Cochrane, Shaila Dewan, Sarah Kliff, Dan Levin, Jeré Longman, Joel Petterson, Rick Rojas, Vanessa Swales, Sabrina Tavernise, Neil Vigdor and Michael Wilson.