Trump says he has been taking hydroxychloroquine, a drug whose effectiveness against the virus is unproven.
President Trump said Monday that he has been taking hydroxychloroquine, an antimalarial drug whose effectiveness against the coronavirus is unproven, for about a week and a half as a preventive measure, saying he had no symptoms of Covid-19.
The drugs can cause dangerous abnormalities in heart rhythm in virus patients, the F.D.A. warned, saying that they should be used only in clinical trials or hospitals where patients can be closely monitored for heart problems.
And on Monday a doctor overseeing a national trial said that he agreed.
“There are no data that pre-exposure prophylaxis is effective to prevent coronavirus,” Dr. David Boulware of the University of Minnesota, who is overseeing a national trial to test whether hydroxychloroquine can prevent infections, said in a statement. “It may be. It may not be. We do not know. The only way I would recommend taking hydroxychloroquine is within a clinical trial.”
Mr. Trump has in recent weeks stopped talking about the drug that he had been touting as a possible miracle cure. But on Monday, he appeared to relish telling reporters that he was taking it, with approval from the White House physician.
The outbreak spread to the White House this month, where two members of the staff — one of the president’s personal valets and Katie Miller, the spokeswoman for Vice President Mike Pence — tested positive. After that, the White House ordered all West Wing employees to wear masks at work unless they are sitting at their desks; the order did not apply to the president, who has resisted wearing masks.
Early studies of hydroxychloroquine in the laboratory showing that the drug could block the virus from attacking cells prompted early enthusiasm. But the studies of the drug in humans so far have largely proved disappointing, and some have pointed to serious side effects in people with heart problems.
“I’m not going to get hurt by it,” Mr. Trump said, claiming he was making the revelation in order to be transparent with Americans. “It has been around for 40 years for malaria, for lupus, for other things. I take it. Front-line workers take it. A lot of doctors take it. I take it.”
Several doctors questioned the wisdom of taking the unproven drug, given the possible risks.
“I think it’s a very bad idea to be taking hydroxychloroquine as a preventive medication,” said Dr. Eric Topol, a cardiologist and the director of the Scripps Research Translational Institute in La Jolla, Calif. “There are no data to support that, there’s no evidence, and in fact there is no compelling evidence to support its use at all at this point.”
Dr. Topol said that the risk of developing a potentially fatal arrhythmia because of hydroxychloroquine could come without warning and did not happen only in people with heart conditions. “We can’t predict that; in fact, it can happen in people who are healthy,” he said. “It could happen in anyone.”
Dr. David Maron, a cardiologist and the chief of the Stanford Prevention Research Center, said in an interview that in his opinion “the risk-benefit ratio doesn’t make sense.”
In 2018, the White House physician reported that Mr. Trump had an LDL cholesterol level of 143, well above the desired level of 100 or less. Some cardiologists who are not associated with the White House said that his cholesterol levels raised heart concerns.
Mr. Trump made a trip in November to Walter Reed National Military Medical Center that was not listed on his public schedule. He stayed for about two hours for what White House officials said were routine tests, but since the visit had not been revealed in advance and came only nine months after his last annual physical, it touched off much discussion about whether the president had an undisclosed health issue.
Mr. Trump, 73, is the oldest man ever sworn in for a first term as president, and he is known for his love of fast food and takes pride in not exercising. At his checkup last year he weighed 243 pounds, which is considered obese for a man of his reported height of 6 feet 3 inches. He has been reported in the past to be taking rosuvastatin, a lipid-lowering drug, to control his cholesterol.
Several doctors said they were alarmed that Mr. Trump was using the bully pulpit of the presidency to tell the public he takes a drug that has not been proven to be effective against the coronavirus, but which does have known risks.
“It sets a precedent: The president is a leader, and things come down from the top,” said Dr. Paul C. Thompson, the chief of cardiology emeritus at Hartford Hospital in Connecticut. “If someone in a leadership position is doing something most physicians would recommend against because of a lack of proof of efficacy and the possibility of harm, that is a problem.”
Dr. Scott Solomon, a professor of medicine at Harvard Medical School, said: “Trump taking it himself is up to him. But what is irresponsible is the example he is setting.”
And Dr. Steven E. Nissen, the chief academic officer of the The Miller Family Heart, Vascular & Thoracic Institute at the Cleveland Clinic, said hydroxychloroquine was “not an innocent therapy,” adding that he had treated a number of patients who developed a life-threatening arrhythmia, which the drug can cause.
“This disorder can be lethal,” Dr. Nissen said. “My concern would be that the public not hear comments about the use of hydroxychloroquine and believe that taking this drug to prevent Covid-19 infection is without hazards. In fact, there are serious hazards.”
Dr. Nissen noted that hydroxychloroquine had long been known to cause a dangerous abnormal heartbeat, but that it had stayed on the market because it treated serious conditions such as lupus and rheumatoid arthritis. But other drugs with the same dangerous side effect have been withdrawn, because they treated less serious ailments. One example is the allergy drug Seldane, which was removed from the market in the 1990s.
The presidency is a powerful megaphone, particularly in times of crisis. In April, after Mr. Trump mused dangerously at a White House briefing about the possibility that the injection of disinfectants into the human body could help combat the virus, confused callers flooded state health hotlines, and the makers of Clorox and Lysol pleaded with Americans not to inject or ingest their products.
Alex M. Azar II, the secretary of Health and Human Services, sharply criticized the World Health Organization on Monday, saying its handling of the outbreak in China led to unnecessary deaths.
“We must be frank about one of the primary reasons that this outbreak spun out of control,” Mr. Azar said. “There was a failure by this organization to obtain the information that the world needed, and that failure cost many lives.”
Mr. Azar’s comments were a strident amplification of criticism by President Trump and Republicans in Congress who have castigated the W.H.O. for what they have described as a bungled response to the outbreak in China by promoting misinformation from Beijing. The health agency has denied the claims and insisted that it was transparent and open.
Tedros Adhanom Ghebreyesus, the director general of the W.H.O., on Monday appeared to bow to calls by member states for an evaluation of its handling of the pandemic, saying the agency would review “lessons learned” about its global response. But Mr. Tedros’s remarks did not address Mr. Trump’s demands that the health agency investigate unproven allegations that the virus originated in a lab in China.
President Xi Jinping of China, in a pointed challenge to Mr. Trump, offered on Monday to provide $2 billion in the fight against the pandemic and called on other nations to increase their contributions to the W.H.O.
Mr. Xi’s remarks were likely to ratchet up pressure on Mr. Trump, who last month announced that the United States would withhold its annual contribution of about $550 million to the organization, accusing it of promoting disinformation from China about the outbreak.
In his remarks, Mr. Xi also defended his country’s handling of the outbreak and appeared to brush aside calls for an independent investigation into the origins of the virus — a demand the United States has been promoting — saying such forensics should wait until the crisis had subsided.
The $2 billion would be a vast increase in China’s contribution to the W.H.O., which last year totaled $43 million. In April, after the United States announced it would cut funding to the organization, Beijing said it would provide an additional $30 million.
The drug maker Moderna said on Monday that the first coronavirus vaccine to be tested in people appeared to be safe and able to stimulate an immune response against the virus.
The findings, which helped give Wall Street its best day in about six weeks, are based on results from the first eight people who each received two doses of the experimental vaccine starting in March.
Those people, healthy volunteers ages 18 to 55, made antibodies that were then tested in human cells in the lab and were able to stop the virus from replicating — the key requirement for an effective vaccine. The levels of those so-called neutralizing antibodies matched the levels found in patients who had recovered after contracting the virus in the community. Two more age groups — 55 to 70, and 71 and over — are now being enrolled to test the vaccine.
Though encouraging, the findings do not prove that the vaccine works. Only larger, longer studies can determine whether it can prevent people in the real world from getting sick. Moderna’s technology, involving genetic material from the virus called mRNA, is relatively new and has yet to produce any approved vaccine.
Moderna produced the vaccine in collaboration with the National Institute of Allergy and Infectious Diseases, which is led by Dr. Anthony S. Fauci and has been leading the clinical trials. That institute, part of the federal National Institutes of Health, is also involved in research on other experimental coronavirus vaccines.
If those trials go well, a vaccine could become available for widespread use by the end of this year or early 2021, Dr. Tal Zaks, Moderna’s chief medical officer, said in an interview. The number of doses that could be ready is unclear, but Dr. Zaks said, “We’re doing our best to make it as many millions as possible.”
Despite the uncertainties, the company’s announcement rapidly encouraged investors, who also welcomed a pledge from the Federal Reserve chairman that there was “really no limit” to what the central bank could do with its emergency lending facilities.
The S&P 500 rose more than 3 percent Monday — Moderna’s shares rose 20 percent — while stock benchmarks in Europe were 4 percent to 6 percent higher.
The rally had all the characteristics of one focused on the prospects for a return to normal. Travel stocks, like United Airlines, Expedia Group and Marriott International, were among the best performers in the S&P 500.
Oil prices also moved higher, with West Texas Intermediate, the U.S. standard crude, rising above $30 a barrel for the first time since March. Government bond prices fell.
Texas, the second-most populous state, took more steps to reopen on Monday when Gov. Greg Abbott, a Republican, announced that office workers could return to work in limited capacities and child care services could reopen immediately. Little League games, sleepaway camps and vacation Bible camps could open beginning May 31, he said.
Mr. Abbott’s latest round of easing restrictions came after the state reported its deadliest day yet last week — 58 deaths between Wednesday and Thursday — and recorded 1,801 new infections on Saturday, the highest single-day increase the state has seen.
Mayor Eric Johnson of Dallas said he believed that the increase was connected to Mr. Abbott’s earlier lifting of constraints, telling CNN that he thought it was “more than likely connected in some way to the opening of restaurants and movie theaters and retail and our malls up to 25 percent occupancy a couple weeks ago.” Mr. Abbott attributed the higher number to increased testing in hot spots, including in the Amarillo area, which he said would not reopen as fast as the rest of the state.
In Michigan, where thousands of autoworkers began returning to work on Monday for the first time in weeks, Gov. Gretchen Whitmer, a Democrat, announced that retail businesses, bars and restaurants with limited seating could reopen with restrictions in the Traverse City area and in the Upper Peninsula, two regions hit less hard than other parts of the state.
“Keep your wits about you,” she urged. “Let’s not all go rushing out and force a closure eventually. What we want to do is keep moving forward.”
The order is especially important for the tourist hub of northwest Michigan, which has already canceled the popular National Cherry Festival and Traverse City Film Festival in July.
“We want to be measured about how we invite people back and how we reopen our businesses,” Mayor Jim Carruthers of Traverse City said. “It’s been horrible to see all the shops and restaurants closed.”
In Massachusetts, another hard-hit state, Gov. Charlie Baker, a Republican, on Monday presented a four-phased strategy to gingerly resume public life, replacing his stay-at-home advisory with a new one, “safer at home.”
The four stages, which begin on Monday and last for three weeks each, are known as “start,” “cautious,” “vigilant” and “new normal,” with each new phase replacing the previous guidelines with slightly looser ones. Progress from one stage to the next is contingent on a continuing decline in the spread of the virus, Mr. Baker said.
“If we don’t keep up the fight, and don’t do the things that we all know we have to do and know we can do, we run the risk of creating a second spike in the fall,” he said.
Across the country, governors are weighing the risks of reopening their states with the need to minimize economic harm. The pendulum will move further toward the economy this week, when several more states, including Connecticut, Kentucky and Minnesota, move to reopen. If current trends hold, New York City is expected to meet the state’s criteria to begin reopening in the first half of June, the mayor said.
But even governors who have allowed certain returns to business have expressed hesitance, and public health officials have been warning for weeks that reopening too soon could lead to a devastating second outbreak.
“This is really the most crucial time,” Gov. Mike DeWine of Ohio, a Republican, said Sunday on CNN. “And the most dangerous time.”
Stores and malls could reopen in Minnesota beginning Monday. The enormous Mall of America, in Bloomington, has said that it does not plan to reopen its shops until June 1. On Wednesday, hard-hit Connecticut is expected to reopen salons, museums and office buildings. By Friday, stores and restaurants are expected to open back up in Kentucky.
On the eve of a hearing to assess federal relief measures, a group of Democrats on the Senate Banking Committee wrote a letter to Jerome H. Powell, the chairman of the Federal Reserve, and Steven Mnuchin, the Treasury secretary, urging them to take greater risks in a lending program meant to keep credit flowing to midsize businesses.
The so-called Main Street lending program, first unveiled March 23, has yet to get up and running. When it does, it will be backed by $75 billion of the $454 billion that Congress gave the Treasury Department as part of the CARES relief law to support the Fed’s emergency loan efforts.
Mr. Powell and Mr. Mnuchin will testify before the Senate Banking Committee on Tuesday.
Senator Mark Warner of Virginia, a Democrat, has expressed concern that the program is taking too long to get started, and that its terms are too cautious, limiting the chances that it will lose taxpayer money but also potentially curbing its effectiveness.
“The vast majority of these firms are not seeking public assistance due to risky behavior,” the senators wrote, adding that “should firms fail to receive affordable financing terms under these facilities, many will be left with a choice between declaring bankruptcy, posing long-term risks to the economy or opening up too quickly.”
They wrote the letter as a new Congressional Oversight Commission raised questions about how the Federal Reserve and Treasury Department were administering emergency bailout funds in its inaugural assessment of the $500 billion program.
The report is the first in what will be a monthly review of how the funds are being used. The money, which was allocated as part of the $2 trillion CARES Act, is being used to provide grants and loans to airlines and companies that are vital to national security and to backstop lending programs designed by the Fed.
The report said that Treasury had yet to disburse the $46 billion in grant and loan money to airlines or businesses critical to national security. Thus far, it has used only $37.5 billion for the Fed’s Secondary Market Corporate Credit Facility, which purchases outstanding corporate bonds through a special purpose vehicle.
The bipartisan commission is made up of two Republicans, Senator Patrick J. Toomey of Pennsylvania and Representative French Hill of Arkansas, and two Democrats, Bharat Ramamurti, a former economic adviser to Senator Elizabeth Warren, and Representative Donna Shalala of Florida.
Hotlines in California were deluged on Monday as the state began taking applications for $75 million in cash assistance to help undocumented immigrants weather the economic downturn.
The one-time grants of $500 per person or $1,000 per household will be awarded to about 150,000 people who phone in on a first-come, first served basis, state officials said. Philanthropic organizations and private donors pledged an additional $50 million, for another 100,000 immigrants, Miriam Jordan reports.
There are an estimated 10.6 million undocumented immigrants in the U.S., of whom 2 million live in California, more than any other state.
Undocumented immigrants are among the most vulnerable during the pandemic; many work in jobs in homes, hotels and restaurants that have been shut down during the lockdowns.
In anticipation of the payments, people looking for information on how to apply over the weekend directed a flurry of calls to the 12 nonprofit organizations contracted to vet the applications. By Monday, when the phone lines opened, many people reported they could not get through.
The sign-ups were being conducted almost entirely by telephone to avoid hazardous in-person contacts.
To qualify for the money, applicants must prove they are undocumented, out of work because of the health crisis and not eligible for federal stimulus checks or unemployment benefits.
Groups opposed to the program sued to block the state from using taxpayer dollars, arguing that it was illegal. The cases were dismissed by the court.
Amid continued questions about the small business loan program, Trump says he supports relaxing terms.
Mr. Trump said on Monday that he was open to relaxing the terms of a federal program to help distressed small businesses weather the crisis, even as new questions arose about who is able to benefit from the program.
During a round table at the White House, restaurant executives pressed Mr. Trump to extend the forgiveness period for loans under the Paycheck Protections Program from eight weeks to 24 weeks, a change that the president said “should be easy.”
For the loans to be forgiven, businesses must show that they kept their workers on payroll and used three quarters of the money on employment costs.
“The eight-week period is simply not enough time,” said Will Guidara, the owner of Eleven Madison Park, who attended as part of the newly created Independent Restaurant Coalition.
Treasury Secretary Steven Mnuchin, who oversees the program with the Small Business Administration, said he believes there is bipartisan support for such a change.
Monday was the deadline for businesses that got money from the program — which was designed to help mom-and-pop shops struggling during the pandemic — to return it under tightened eligibility rules that the administration imposed after several big companies benefited.
So far, at least 61 public and private companies have returned their small-business loans, according to data compiled by The Times. Among the companies that have returned loans are Ruth’s Chris Steak House, Shake Shack and the shoe start-up Allbirds.
But the majority of money extended to public companies has so far not been returned, and a new survey found that many minority-owned businesses are on the brink of closing permanently because they have been unable to obtain the federal loans.
The survey, conducted by the Global Strategy Group for two equal-rights organizations, Color of Change and UnidosUS, included interviews with 500 Black and Latino business owners and 1,200 workers from April 30 to last Monday. Just 12 percent of the owners who applied for loans from the program reported receiving what they had asked for, and nearly half said they anticipated having to permanently close in the next six months.
By comparison, in a survey of small businesses by the Census Bureau from April 26 to May 2, three-quarters said they had asked for a loan and 38 percent of them said they had received one.
“If we don’t get policies to protect these communities,” said Rashad Robinson, the president of Color of Change, “we will lose a generation of black and brown businesses, which will have deep impacts on our entire country’s economy.”
The state’s standards that New York City has yet to meet are:
A rate of new hospitalizations below 2 per 100,000 residents a day. In New York City, that works out to around 170 per day. According to the state, the number in the city is around 200 per day.
In the regions that can restart, construction, manufacturing, and wholesale trade can resume. Some retail businesses may open for curbside service only. Five regions became eligible on Friday and a sixth, around Buffalo, can reopen on Tuesday, Gov. Andrew M. Cuomo said Monday.
Other activities that are allowed include drive-in movies, landscaping and gardening businesses and “low-risk recreational activities” like tennis.
For Memorial Day weekend, beaches in New York City will be technically open, Mr. de Blasio said, but there cannot be any swimming, sports or gatherings. He also said Monday that he did not want to see people traveling long distances to get to them, especially on mass transit. He did not say how the city would enforce those limits.
Beaches in New Jersey, Connecticut, Delaware and elsewhere in New York State will open for swimming then, albeit with crowd limits and social distancing rules in place on the sand.
The city is prepared to fence off the beaches if they start to get crowded, the mayor warned.
Mr. Cuomo reported on Monday that 106 more people in the state had died of the virus, the lowest one-day toll since March 26. And he revealed the results of the virus test he took on live television on Sunday: negative.
Gov. Ralph Northam of Virginia announced on Monday that the city of Virginia Beach would be allowed to reopen its beaches with some restrictions on Friday, just before Memorial Day weekend.
Several states on the East Coast, including Delaware, New Jersey and New York, have recently announced plans to reopen their beaches before the unofficial start of summer.
And the Florida Keys will reopen to visitors on June 1, officials announced, after two months under lockdown, with the only access roads closed off by checkpoints.
The archipelago has been blocked off to anyone who does not work or live there since late March. Hotels were ordered closed, and visitors who flew in through the airport were screened and instructed to self-isolate for two weeks.
The stringent measures worked: Monroe County had just 100 confirmed cases and three deaths, according to state data. The three heavily populated counties to the north — Miami-Dade, Broward and Palm Beach — had a total of more than 25,000 cases and 1,000 deaths.
Under Virginia Beach’s new plan, residents and visitors will be permitted to sunbathe, swim, fish and surf, with beach parking being limited to 50 percent capacity. Group sports, alcohol consumption, speakers, tents and umbrella groupings will still be banned.
“These rules must be followed — you must be responsible,” said Mr. Northam, who added that he would close beach access if social distancing measures were not followed.
Virginia began to relax restrictions on businesses and places of worship last week as part of the three-phase plan to reopen the state, which has a stay-at-home order until June 10.
The order has not stopped residents from going to the beaches even when they were still considered closed. Over the weekend, the Oceanfront in Virginia Beach felt like any other hot summer’s day, with children playing in the water and beachgoers catching some rays.
“Virginia’s beaches offer important mental health benefits, rest, relaxation and exercise,” Mayor Bobby Dyer of Virginia Beach said. “I believe we have a great plan, and I am prepared to stand by this great plan to ensure that when we open, we will be the safe beach that is required.”
One type of job is on the rise: contact tracing.
More than 11,000 people across the United States are employed as contact tracers working to track and stop the spread of the virus, and local health departments plan to hire thousands more. The work is mostly phone-based and can be done from home. The jobs can be full- or part-time, often with an hourly wage of $17 to $25; some include benefits.
Keep up with Times correspondents around the globe.
Japan’s economy becomes the largest to officially enter a recession. A Canadian military jet crashes during a flyover for virus workers.
Reporting was contributed by Ellen Barry, Alan Blinder, Neal E. Boudette, Max Brimelow, Jane E. Brody, Julie Chang, Matthew Conlen, Michael Cooper, Pedro Cota, Melina Delkic, Emily Flitter, Jacey Fortin, Dana Goldstein, Abby Goodnough, Denise Grady, Kathy Gray, Kristen Hwang, Andrew Jacobs, Miriam Jordan, Annie Karni, Adam Liptak, Michael Mason, Alex Matthews, David McCabe, Sarah Mervosh, David Montgomery, Andy Newman, Sharon Otterman, Nadja Popovich, Alan Rappeport, Frances Robles, Rick Rojas, Marc Santora, Michael Schwirtz, Anjali Singhvi, Jeanna Smialek, Kaly Soto, Sheryl Gay Stolberg, Eileen Sullivan, Katie Thomas, Neil Vigdor and Michael Wilson.