A high school football game in Davison, Mich., in September. Michigan will suspend all in-person learning for high school and college students for three weeks.
A high school football game in Davison, Mich., in September. Michigan will suspend all in-person learning for high school and college students for three weeks.

In Chicago, a sweeping stay-at-home advisory goes into effect on Monday. Philadelphia is expected to announce new restrictions on movement later in the day. In-person classes for high school and college students in Michigan have been canceled.

From a statewide, two-week lockdown in New Mexico to a new mask mandate in North Dakota, governors and mayors across the United States are taking increasingly stringent steps to slow the coronavirus after a staggering one million cases were recorded in the country over the past week alone. Cases are rising in 48 states.

Dr. Anthony S. Fauci, the nation’s top infectious disease specialist, said on Sunday that 200,000 more people could die by spring if Americans did not more fully embrace public health measures, even with an effective vaccine.

As President Trump has refused to concede the election, Dr. Fauci said health officials had not begun working with the transition team for President-elect Joseph R. Biden Jr. He also said Mr. Trump had not attended a meeting of his coronavirus task force in “several months.”

Dr. Fauci’s warning came as more states announced new measures to limit the spread of the virus.

Michigan will suspend all in-person learning for college and high school students and indoor dining for three weeks, Gov. Gretchen Whitmer said. Other indoor gathering places, like casinos and movie theaters, must also close as part of the order, which takes effect Wednesday.

“This is the worst public health emergency our nation has faced in over a century, and our response has got to reflect the same level of urgency,” Ms. Whitmer said on Sunday as she announced new restrictions.

Dr. Scott W. Atlas, Mr. Trump’s coronavirus adviser, responded to the news of Michigan’s tighter restrictions in a tweet, writing, “The only way this stops is if people rise up. You get what you accept.”

Dr. Atlas, a radiologist, is not an epidemiologist or an infectious disease expert. He has made contrarian arguments, including that the science of mask wearing is uncertain.

In October, officials in Michigan revealed a plot to abduct Ms. Whitmer, who has been the subject of criticism from right-wing protesters for earlier measures she imposed to try to control the virus.

Ms. Whitmer’s announcement came just after Gov. Jay Inslee of Washington said he was ordering fitness facilities and restaurants to stop serving customers indoors, shutting down museums and limiting retail stores to 25 percent of capacity indoors.

As new cases in New Jersey hit a sobering new high over the weekend, with nearly 9,000 reported infections over two days, Gov. Philip D. Murphy announced new gathering limits, bringing the state more in line with New York and Connecticut. No more than 10 people can gather indoors, effective at 6 a.m. Tuesday, down from 25. Outdoor gatherings should not exceed 150 people, starting next Monday. “Particularly with the holidays coming up, we’ve got to plead with people to not let their hair down,” Mr. Murphy said on Monday in an interview with MSNBC.

The governors’ announcements and blunt assessments echoed the stark warnings of Dr. Michael Osterholm, an adviser to Mr. Biden who said the virus was the most dangerous public health crisis since the 1918 influenza pandemic, which killed an estimated 50 million worldwide, including some 675,000 Americans.

“My worst fear is we will see what we saw happening in other countries, where people were dying on the streets,” Dr. Osterholm said on the NBC program “Meet the Press.” “The health care system is breaking, literally breaking.”

A volunteer receiving Moderna’s vaccine in July in Binghamton, N.Y.
A volunteer receiving Moderna’s vaccine in July in Binghamton, N.Y.

The drugmaker Moderna announced on Monday that its coronavirus vaccine was 94.5 percent effective, based on an early look at the results from its large, continuing study.

Researchers said the results were better than they had dared to imagine. But the vaccine will not be widely available for months, probably not until spring.

Moderna is the second company to report preliminary data on an apparently successful vaccine that offers hope of reining in a surging pandemic that has infected more than 53 million people worldwide and killed more than 1.2 million. Pfizer, in collaboration with BioNTech, was the first, reporting more than 90 percent effectiveness one week ago.

Pfizer and Moderna were the first to announce early data on large studies, but 10 other companies are also conducting big Phase 3 trials in a global race to produce a vaccine, including efforts in Britain, China, Russia, India and Australia. More than 50 other candidates are in earlier stages of testing.

Researchers test vaccines by inoculating some study participants and giving others placebos, and then watching the two groups to see how many people get sick. In Moderna’s study, 95 people contracted Covid: five who were vaccinated, and 90 who received placebo shots of salt water. Statistically, the difference between the two groups was highly significant. And of the 95 cases, 11 were severe — all in the placebo group.

Moderna, based in Cambridge, Mass., developed its vaccine in collaboration with researchers from the Vaccine Research Center, part of the National Institute of Allergy and Infectious Diseases.

Dr. Anthony S. Fauci, director of the infectious disease institute, said in an interview, “I had been saying I would be satisfied with a 75 percent effective vaccine. Aspirationally, you would like to see 90, 95 percent, but I wasn’t expecting it. I thought we’d be good, but 94.5 percent is very impressive.”

A coronavirus memorial for Detroit residents. About a third of the U.S. population knows someone who has died from the virus.
A coronavirus memorial for Detroit residents. About a third of the U.S. population knows someone who has died from the virus.

As coronavirus cases surge in almost every part of the United States, researchers say the country is fast approaching what could be a significant tipping point — a pandemic so widespread that every American knows someone who has been infected. But, as reflected in the polarized response to the virus, the public remains deeply divided about how and whether to fight it, and it is unclear whether seeing friends and relatives sick or dead will change that.

Many who have seen people close to them seriously affected say they are taking increased precautions. Others, though, are focusing on how most people recover and are shrugging off the virus, and calls for concerted efforts to combat it.

The alarming numbers in the United States — the highest case numbers and death toll in the world — underscore a reality found in small towns, big cities and suburbs alike: The coronavirus has become personal.

Researchers estimate that nearly all Americans have someone in their social circle who has had the virus. About a third of the population knows someone who has died from the virus, researchers say. But not everyone is hunkering down in fear or taking precautions as simple as wearing a mask.

Nearly 2.2 million Americans have lost a close family member to Covid-19, the disease caused by the coronavirus, research has shown, with troubling emotional and financial effects for children, widows and parents. Kristin Urquiza, 39, of San Francisco, said she continues to have nightmares about her father’s death from the disease in late June in Arizona. Rosie Davis, a skin laser technician in Carrollton, Texas, has been attending remote grieving classes since her mother died in May at a hospital.

“I will never have closure because I was not able to be next to her when she passed,” Ms. Davis said.

A doctors’ protest in Barcelona last month. Spanish medics are confronting a second wave of coronavirus with better protective equipment but lower morale.
A doctors’ protest in Barcelona last month. Spanish medics are confronting a second wave of coronavirus with better protective equipment but lower morale.

Last March, as the coronavirus was tearing across Spain, Lídia Bayona Gómez started to suffer bouts of vomiting and coughing.

A nursing home worker, she treated herself as a potential Covid-19 case, isolating and getting tested. The results came back negative, twice. With her weight dropping and her urine turning red, she made repeated attempts to see a doctor and in late April, on a phone consultation, one told her to stay home and prescribed medicine for gastroenteritis and a urinary tract infection.

But the pain kept getting worse and in late June, her sister took her to an emergency hospital unit. In mid-July, she underwent a 12-hour surgery to remove two cancerous tumors. She died nine days later, at age 53.

It was not an isolated tragedy.

Hospitals and other health care centers have been forced to devote most of their resources to Covid-19 patients, and doctors are warning that a growing number of cases of cancer and other serious illnesses are going undetected. That toll is beginning to be reflected in lawsuits.

The details of Ms. Bayona Gómez’s care are part of a lawsuit brought by her sister, Fátima Bayona, who wants Spain’s public prosecutors to charge the local health authorities in the northern city of Burgos with gross negligence.

Carmen Flores, the president of an association that helps patients or their relatives take legal action, said her association had helped file more than 50 lawsuits since September, when Spain and other countries were hit by a second wave of coronavirus infections.

Unlike in some other countries, Spain’s government does not report how many medical lawsuits are filed each year. But Ms. Flores said that, judging by her monitoring of courtroom filings across the country, the number appears to have risen so far this year by at least 30 percent.

Some lawsuits accuse doctors of refusing to see patients in person; others assert that doctors rushed to the wrong conclusions or did not want to touch patients because of the risk of Covid-19.

Global Roundup

Prime Minister Boris Johnson in London on Wednesday. He was hospitalized for the coronavirus in April.
Prime Minister Boris Johnson in London on Wednesday. He was hospitalized for the coronavirus in April.

Seven months after he battled a serious case of Covid-19, the disease caused by the coronavirus, Prime Minister Boris Johnson of Britain announced on Sunday that he was quarantining after coming into contact with a lawmaker later found to be infected.

Mr. Johnson’s office said in a statement that he felt fine and was showing no symptoms.

Experts say it is still too early to know how long immunity to the coronavirus lasts, but reinfection with the virus is thought to be very rare for at least many months after the first illness.

Mr. Johnson went into isolation after the National Health Service’s test-and-trace program contacted him and said he had been exposed to the coronavirus. On Thursday, he spent about half an hour with a member of Parliament who tested positive after feeling ill.

Other than isolating himself, Mr. Johnson is conducting business as usual, officials said. “He will carry on working from Downing Street, including on leading the government’s response to the coronavirus pandemic,” his office’s statement said.

The prime minister had a close call with the virus in April, when he was hospitalized and spent three days in intensive care.

Mr. Johnson has been accused repeatedly of taking a lackadaisical approach to the pandemic, but when he emerged from the hospital he appeared chastened.

In an emotional five-minute video, Mr. Johnson thanked the country’s National Health Service, declaring it had “saved my life, no question.”

Over three months in the summer, the portion of people in Britain with detectable antibodies to the coronavirus fell by about 27 percent. Experts say it’s normal for levels of antibodies to drop after the body clears an infection. However, when needed, immune cells already carry a memory of the virus and can churn out fresh antibodies.

In other developments around the world:

  • Officials in the impoverished Gaza Strip announced more than 400 new infections on Sunday, the highest single-day total since the first cases of community transmission were discovered in the territory in late August. The authorities ordered almost all shops to start closing down at 5 p.m. A nightly curfew beginning at 8 p.m. is already in place. As of Sunday morning, 10,532 people in Gaza — whose population is relatively young — have been infected and 48 have died, according to the Health Ministry.

  • India will fly doctors into the region around New Delhi, double the number of tests it carries out and ensure that people wear masks, in an effort to contain the spread of coronavirus in the capital, officials said on Sunday, according to Reuters. “Delhi has witnessed a huge surge in daily active cases which is likely to worsen over next few weeks,” the health minister, Harsh Vardhan, said in a tweet.

A restaurant open for take out in Nice, France.
A restaurant open for take out in Nice, France.

In today’s edition of the Morning newsletter, David Leonhardt writes:

As the coronavirus has surged again in recent weeks, much of the United States has chosen to keep restaurants open and schools closed. Much of Europe has done the opposite.

The European approach seems to be working better.

Look at this chart, which shows the number of new daily virus cases in five countries, adjusted for population size:

As you can see, both the U.S. and Europe have been coping with severe outbreaks, with caseloads rising even faster in much of Europe than in the U.S. during much of this fall. But over the past two weeks, France, Germany, Spain and Britain have managed to reduce their growth rates.

What is Europe doing differently? It is cracking down on the kind of indoor gatherings that most commonly spread the virus. England closed pubs, restaurants, gyms and more on Nov. 5 and announced they would remain closed until at least Dec. 2. France, Germany’s regional governments and the Catalonia region of Spain have also shut restaurants, among other businesses.

“I’m sure the Europeans didn’t want to restrict their activities any more than we do,” Janet Baseman, an epidemiologist at the University of Washington, told me over the weekend. “Everyone is tired and ready for this to end, but we have to accept the reality of the data before us.”

Many Americans have resisted accepting that reality. Across much of the country, restaurants remain open for indoor dining. Last week, New York State announced a new policy that public health experts consider to be a bizarre middle ground: Businesses with a liquor license can stay open until 10 p.m.

The one indoor activity that appears to present less risk is school, especially elementary school. Why? Young children seem to spread the virus less often than adults do. “Research has shown that if you put social-distancing protocols in place, school is actually quite a safe environment,” Andreas Schleicher, who studies schools for the Organisation for Economic Co-operation and Development in Paris, told NPR.

Closing schools and switching entirely to remote learning, on the other hand, has big social costs. Children are learning less, and many parents, mostly mothers, have dropped out of the labor force. The U.S. is suffering from both of these problems and from a raging pandemic.

There are no easy answers, to be sure. Closing restaurants and other businesses creates economic hardship (which some European countries are trying to reduce through government aid).

And the virus is now spreading so rapidly in the U.S. that keeping schools open does pose risks, including the chance that teachers, janitors and other workers infect one another. To keep schools open in a safe way, the U.S. would probably first need to close other public places. Only a few states — including Michigan, Oregon, New Mexico and Washington — have closed indoor dining recently.

“The U.S. case and hospitalization numbers we’re seeing right now are chilling,” Baseman said.

But if there are no perfect solutions to the pandemic, there are better and worse ones. Right now, the U.S. seems to be falling well short of what’s possible.

An illegal fight club in the Bronx borough of New York was shut down on Saturday.
An illegal fight club in the Bronx borough of New York was shut down on Saturday.

Sheriff’s deputies in New York City broke up an unlicensed fight club, known as “Rumble in the Bronx,” on Saturday night. Many of those crowding inside were drinking, smoking hookah and not wearing masks, the authorities said.

More than 200 people had stood shoulder to shoulder shouting as two men sparred at the center of a Bronx warehouse. Some people hung over the barricades, social media showed, craning their necks for a better view. When one man knocked out the other, the crowd erupted in a thunderous roar.

The amateur fight would have been illegal before the pandemic, but with coronavirus cases spiking in the city, it risked being a dangerous underground event.

The leader of the club, Michael J. Roman, 32, and nine others were arrested and charged with unlawful assembly, health and alcohol code violations and participating in a prohibited combative sport. They were also each fined $15,000.

Just days earlier, Gov. Andrew M. Cuomo of New York had tightened restrictions in an effort to control the spread of the virus. Private indoor and outdoor gatherings statewide are now limited to 10 people, and gyms, bars and restaurants must close at 10 p.m.

“Bars, restaurants, gyms, house parties, that’s where it’s coming from, primarily,” Mr. Cuomo said last week.

Hours before breaking up the fight club, sheriff’s deputies had also disbanded a party in Brooklyn with nearly 200 guests and another in Manhattan with over 200 people.

Since July, Sheriff Joseph Fucito’s office has shut down at least one large illegal event each weekend.

A radical Islamic leader returned to Indonesia last week from self-imposed exile in Saudi Arabia to spread his idea of a “moral revolution.” But health experts worry that he is doing more to spread the coronavirus.

The cleric, Rizieq Shihab, and his backers have held gatherings after his arrival Tuesday that attracted thousands of people, including a chaotic welcome at Jakarta’s Soekarno-Hatta International Airport that clogged airport roads and the international terminal.

The events ignored social-distancing requirements and limits on the size of gatherings. They also demonstrated the influence of Mr. Rizieq, the founder of the Islamic Defenders Front, which was once best known for raiding bars and smashing alcohol bottles.

Mr. Rizieq, who claims to be a descendant of Muhammad, has maintained a large following despite fleeing the country in 2017 while facing a pornography charge over salacious text messages with a woman who was not his wife. The charge has since been dropped.

Mr. Rizieq hosted a wedding for his daughter Saturday that drew about 10,000 guests. The government’s coronavirus task force, rather than ordering that the wedding be canceled, donated 20,000 masks and gallons of hand sanitizer for the event.

On Monday, two high-ranking police chiefs were fired for their mishandling of the events. Mr. Rizieq was fined about $3,500 on Sunday for flouting coronavirus regulations at the wedding — a token amount for him and his organization.

The police also announced that they would question Jakarta’s governor, Anies Baswedan, an ally of Mr. Rizieq, about his role in allowing the wedding to take place. The two met last week after the cleric’s return.

“I want to emphasize that the safety of the people is the highest law,” Indonesia’s president, Joko Widodo, said in a statement released after the chiefs’ firings were announced. “During this pandemic we have decided on social restrictions, including the dispersal of crowds.”

Mr. Rizieq, who apparently left Saudi Arabia because the government did not extend his residence permit, said he planned to travel around Indonesia promoting his ideas of strict adherence to Islam. The possibility that he could draw large crowds was another concern for health experts.

Indonesia, which has the world’s fourth-largest population, reports nearly half a million cases and more than 15,000 deaths, the worst record in East Asia.

On Friday, it hit a new daily high of 5,444 cases.

But health experts say that Indonesia’s testing is too limited and that it is missing far more cases of the virus than it finds.

Pandu Riono, an epidemiologist at the University of Indonesia, says the total could be 10 to 20 times higher than the official number, putting it at five million to 10 million cases.

Dicky Budiman, an Indonesian epidemiologist at Australia’s Griffith University, estimated that the total is at least three times higher, about 1.5 million cases.

“We are already experiencing a silent outbreak in the community,” Dr. Budiman said. “We will face a serious problem when the most vulnerable get this virus.”

Dr. Perri Klass, a physician and writer for The New York Times, spoke with a number of pediatricians about some of the most pressing coronavirus questions they are getting in their practices and how they are battling misinformation:

  • Dr. Kelly Fradin, a pediatrician in New York City, said, “One of the interesting things about the pandemic is I’ve seen misinformation in both extremes, pushing people toward bleaching their produce and avoiding all outdoor exercise, and then misinformation pushing people toward being blasé about the virus.”

  • Dr. Nusheen Ameenuddin, a community pediatrician at the Mayo Clinic and the chairwoman of the American Academy of Pediatrics council on communications and media, said, “Social media misinformation and disinformation on network and cable news channels really undermines science and evidence.” The A.A.P. group has started to work with companies like Facebook and Twitter.

  • Dr. Dipesh Navsaria, an associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health who is president of the Wisconsin chapter of the American Academy of Pediatrics, recalled a woman asking him about a story that mouthwash could prevent Covid-19. “I pointed out to her, this is a respiratory virus, I hope no one’s pouring mouthwash in their nose, and she stopped and thought about it — it was fairly obvious to this layperson that it doesn’t make sense.”

  • “There’s a definite fear that seems to go in two very different directions, I suspect often based around one’s political leanings because all this has become politicized,” Dr. Navsaria said.

  • On vaccines, Dr. Ameenuddin said, “Vaccine hesitancy and misinformation is nothing new for pediatricians.” But in recent months, she said, “parents of the children I take care of who have vaccinated with confidence have been asking me questions about the safety of a possible Covid vaccine.”