Children lose parents as thousands flee after Equatorial Guinea blast

By Aaron Ross

(Reuters) – Hospitals have run out of morgue space and are piling bodies into refrigerated shipping containers. Radio and television stations are flooded with calls trying to locate the parents of unaccompanied children. Thousands have fled for the countryside.

Three days after a series of explosions levelled much of Equatorial Guinea’s largest city Bata, killing at least 105 people and injuring more than 600 others, its residents are still coming to grips with the full scale of the tragedy.

Drone footage aired on state television showed block after block of public housing in the coastal city either completely destroyed or close to it, the remnants of their roofs and walls strewn across the neighborhood’s dirt roads.

“There are many children without parents,” said a teacher in Bata, who asked not to be named for fear of reprisals from the authorities in the tightly-controlled central African country. “In the long (term) what do we do with those children?”

The reclusive government blamed the explosions on fires set by farmers living near the military base and the negligent handling of dynamite stocks by the military unit guarding them.

It has decreed three days of national mourning from Wednesday, declared Bata a catastrophe zone, unblocked 10 billion ($18.19 million) CFA francs for the response and appealed for international aid.

Firefighters continued to comb the rubble on Wednesday for bodies as onlookers wept, state television showed. The authorities appealed for donations of blood and basic goods.

A five-year old girl was pulled on Wednesday from the rubble of a house in the military camp where the blast occurred, Equato-Guinean media AhoraEG said.

Officials have been forced to turn to refrigerated containers to store bodies, said the teacher and Alfredo Okenve, a human rights activist who lives in exile in Europe.

Okenve said his information indicated the number of deaths was between 150 and 200, significantly higher than the government’s official toll of 105.

The government’s information ministry did not immediately respond to written questions.

TRAUMATISED

Bata residents are traumatized from the explosions, which lasted for hours on Sunday, and fearful of additional blasts.

The first explosion “was so big that all of us and the people around us were shouting: ‘This is a bomb, this is a bomb!'” said the teacher.

“People were crying, shouting, running, trying to stay somewhere, but it was panic. We started to see police cars and firemen and people bleeding. It was awful.”

The health ministry said in a tweet that it was deploying psychiatrists and psychologists.

The United Nations said on Wednesday that the World Health Organization and children’s agency UNICEF had mobilized teams to control infection and provide logistical support. Spain has sent a first batch of emergency aid.

The former Spanish colony has been run by President Teodoro Obiang Nguema, Africa’s longest-serving leader, since 1979.

It is the Central African country’s worst tragedy in recent memory, and while the government, charitable organizations and private citizens have kept everyone fed and sheltered for now, most of Equatorial Guinea’s 1.4 million people live in poverty.

The country is also suffering a double economic shock from the coronavirus pandemic and a drop in the price of crude oil, which provides about three-fourths of state revenue.

State media has provided wall-to-wall coverage of the disaster, including the appeals over the lost children, a rarity in a country that human rights activists consider one of Africa’s most repressive and where bad news is often suppressed.

Okenve said the scale of the tragedy had left the government with no choice.

“If there is information coming out, it is because it is impossible to control,” he said.

($1 = 549.9000 Central African CFA franc BEAC)

(Reporting by Aaron Ross in DAKAR; editing by Philippa Fletcher)

India virus infections at three-week high, Mumbai hires marshals to enforce mask-wearing

NEW DELHI (Reuters) – India reported on Friday its biggest jump in new coronavirus infections in three weeks, with 13,193 cases, while thousands of marshals fanned out to enforce mask wearing across the financial capital of Mumbai, which is battling a recent spurt.

The tally of confirmed infections is 10.96 million, the second highest after the United States, with more than 156,000 deaths. But actual infections could range as high as 300 million, a government serological survey showed this month.

In recent days, 75% of India’s new cases have been reported from the southern state of Kerala and Maharashtra, home to Mumbai, a densely populated city of 20 million people. The two states already had the highest number of reported infections.

Health experts suggest the re-opening of educational institutes in Kerala and resumption of suburban train services in Mumbai could be key factors.

After a gap of 11 months, Mumbai resumed on Feb. 1 full suburban train services, which before the pandemic carried a daily average of 8 million people.

The city has begun hiring marshals to enforce mask wearing. Out of nearly 5,000 marshals, around 300 would be deployed on the rail network, city authorities said.

Indians have largely given up on masks and social distancing, Reuters reporting shows.

“Coronavirus … has not yet left the country,” the health ministry said on Twitter. “We still need to follow COVID-appropriate behavior. No carelessness till there is a cure.”

Despite the recent rise in infections, India’s daily tally of new cases remains well below a mid-September peak of nearly 100,000. Testing numbers have also fallen to about 800,000 a day from more than 1 million.

Since starting its vaccine campaign in mid-January, India has administered nearly 10 million doses, aiming to cover 300 million people by August.

(Reporting by Krishna N. Das and Anuron Kumar Mitra; Editing by Simon Cameron-Moore)

J&J adds to COVID-19 vaccine armory with 66% efficacy in global trial

By Julie Steenhuysen

(Reuters) – Johnson & Johnson said on Friday that its single-dose vaccine was 66% effective in preventing COVID-19 in a large global trial against multiple variants which will give health officials another weapon to tackle the coronavirus.

In the trial of nearly 44,000 volunteers, the level of protection against moderate and severe COVID-19 varied from 72% in the United States, to 66% in Latin America and just 57% in South Africa, from where a worrying variant has spread.

A high bar has been set by two authorized vaccines from Pfizer/BioNTech and Moderna, which were around 95% effective in preventing symptomatic illness in pivotal trials when given in two doses.

Those trials, however, were conducted mainly in the United States and before new variants emerged.

The top U.S. infectious disease specialist Anthony Fauci said the variations in effectiveness around the world underlined the need to vaccinate as many people as quickly as possible to prevent new variants from emerging.

“It’s really a wake up call for us to be nimble and to be able to adjust as this virus will continue for certain to evolve,” Fauci said.

J&J’s main goal was the prevention of moderate to severe COVID-19, and the vaccine was 85% effective in stopping severe disease and preventing hospitalization across all geographies and against multiple variants 28 days after immunization.

That “will potentially protect hundreds of millions of people from serious and fatal outcomes of COVID-19,” Paul Stoffels, J&J’s chief scientific officer, said of the results, which were based on 468 symptomatic cases.

SEEKING APPROVAL

J&J plans to seek emergency use authorization from the U.S. Food and Drug Administration next week. It has said it plans to deliver 1 billion doses in 2021 and will produce the vaccine in the United States, Europe, South Africa and India.

Public health officials are counting on the J&J vaccine to increase much-needed supply and simplify immunization in the United States, which has a deal to buy 100 million doses of J&J’s vaccine and an option for an additional 200 million.

J&J said the vaccine would be ready immediately upon emergency approval, but Stoffels declined to say how many doses.

“Right now, any protection and additional vaccine is great. The key is not only overall efficacy but specifically efficacy against severe disease, hospitalization, and death,” Walid Gellad, a health policy associate professor at the University of Pittsburgh, said.

Michael Breen, Director of Infectious Diseases and Ophthalmology at research firm GlobalData said “Most countries are still desperate to get their hands on doses, regardless of whether or not the vaccine is considered highly effective. Moderately effective will do just fine for now.”

None of the vaccine recipients in the J&J trial died from COVID-19, compared with 5 in the placebo group, the National Institutes of Health said. Three deaths in the vaccine group overall, but none were determined to be from the virus. That compares with 16 deaths overall in the placebo arm, it added.

Unlike the Pfizer and Moderna vaccines, J&J’s does not require a second shot weeks after the first or need to be kept frozen, making it a strong candidate for use in parts of the world where transportation and cold storage are an issue.

SOUTH AFRICAN VARIANT

Several studies have emerged this month showing that a South African variant has mutated in areas of the virus that are key targets of vaccines, reducing their efficacy.

“What we are learning is there is different efficacy in different parts of the world,” Stoffels told Reuters.

In a sub-study of 6,000 volunteers in South Africa, Stoffels said, the J&J vaccine was 89% effective at preventing severe disease. In the South Africa portion of the trial, 95% of cases were infections with the South African variant.

“I am overwhelmed by the fact that this vaccine protected against severe disease even in South Africa,” said Glenda Gray, the joint lead investigator of the South African vaccine trial.

Gray, who is the chief executive of the South African Medical Research Council, said this is by far the best vaccine for South Africa to fight the mutant strain and can prevent a large number of hospitalizations and deaths.

A mid-stage trial of a Novovax coronavirus vaccine in South Africa also showed lower efficacy, proving to be 60% effective among volunteers who didn’t have HIV. In a separate, late-stage trial in Britain it was 89.3% effective.

In the J&J trial, which was conducted in eight countries, 44% of participants were from the United States, 41% from Central and South America and 15% from South Africa. Slightly more than a third of the volunteers were over 60.

J&J’s vaccine uses a common cold virus to introduce coronavirus proteins into cells in the body and trigger an immune response, whereas the Pfizer/BioNTech and Moderna vaccines use a new technology called messenger RNA (mRNA).

(Reporting by Julie Steenhuysen; Additional reporting by Manas Mishra, Dania Nadeem and Manojna Maddipatla in Bengalaru and Rebecca Spalding and Michael Erman in New York; Writing by Alexander Smith; Editing by Caroline Humer, Peter Henderson, Edwina Gibbs and Keith Weir)

U.S. disease experts: Don’t travel for Thanksgiving

By Rebecca Spalding and Manojna Maddipatla

(Reuters) – The Centers for Disease Control and Prevention on Thursday urged Americans not to travel during next week’s Thanksgiving holiday to mitigate the spread of the coronavirus as cases of COVID-19 spike around the United States.

The travel advice is a “strong recommendation,” not a requirement, CDC official Henry Walke said on a call with reporters. The federal agency said it was making the recommendation after many states across the country experienced a surge in coronavirus cases in recent weeks.

“We’re alarmed with the exponential increase in cases, hospitalizations, and deaths,” Walke said.

The CDC advised against gathering with anyone who has not lived in the same household for at least 14 days, the incubation period for the coronavirus. Officials said they were also posting recommendations on their website on how to stay safe during the holidays for those Americans who do choose to travel.

“It is the right advice. We are in a major surge in the U.S. with hospitals inundated,” Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, said at a Reuters forum. “There are some that will travel nonetheless, but, hopefully, they will put in place some common-sense measures to limit the damage the virus can cause.”

While the CDC recommended virtual gatherings, for those who do gather in person, guests should bring their own food and utensils and celebrate outdoors if possible, it said.

If celebrating indoors, it recommends that Americans open windows and put fans in front of open windows to pull fresh air into the room where guests are sitting. It also suggests limiting the number of people near where food is being prepared.

The Wednesday before Thanksgiving is typically the busiest travel day of the year in the United States, as Americans gather with friends and family around the country. Shares in airlines and hotel companies have plummeted since the outbreak began as government officials have advised against unnecessary travel.

The AAA travel agency has said it anticipates at least a 10 percent drop in the number of travelers this Thanksgiving, the largest single-year drop since 2008. Based on its October models, it forecasts 50 million Americans will travel for the holiday, compared with 55 million in 2019.

With the CDC recommendations, it expects that number now to be even lower.

United Airlines, American Airlines and Southwest Airlines each said on Thursday that bookings were weakening due to the spike in COVID-19 cases, and United said cancellations were rising.

(Reporting by Rebecca Spalding, Tracy Rucinski, David Shepardson and Lisa Pauline Mattackal; Editing by Chizu Nomiyama, Jonathan Oatis and Peter Henderson)

Fears of COVID-19 resurgence spread to East Coast as grim U.S. records mount

By Maria Caspani and Anurag Maan

NEW YORK (Reuters) – As COVID-19 infections, hospitalizations and deaths surge across the United States, more signs emerged that a second wave could engulf areas of the Northeast, which managed to bring the pandemic under control after being battered last spring.

In New Jersey, one of the early U.S. hotspots, a spike in cases in Newark, the state’s largest city, prompted Mayor Ras Baraka to implement aggressive measures, including a mandatory curfew for certain areas, to contain the spread of the virus.

New York state and city officials also reported a worrying rise in the seven-day average infection rate that raised the specter of stricter mitigation measures adopted at the height of the pandemic.

“This is our LAST chance to stop a second wave,” New York City Mayor Bill de Blasio wrote on Twitter on Wednesday as he announced the seven-day average positivity rate citywide was 2.52%. The city’s public school system, the largest in the country, would have to shut down if that figure reached 3%.

“We can do it, but we have to act NOW,” he said.

The United States as a whole reported more than 1,450 deaths on Tuesday, the highest single-day count since mid-August, according to a Reuters analysis.

U.S. COVID-19 cases climbed for seven days straight to reach more than 136,000 as of late Tuesday while hospitalizations, a key metric of the pandemic, crossed 60,000 for the first time since the pandemic began.

In Newark, the positivity rate hovered at 19%, more than double the state’s 7.74% seven-day average, Baraka said in a statement released on Tuesday.

“Stricter measures are required in the city’s hotspots in order to contain the virus and limit the spread,” he said.

New Jersey Governor Phil Murphy announced some restrictions on Monday in response to a rise in COVID-19 cases in the state, and outbreaks among bartenders.

New York Governor Andrew Cuomo said in a press release on Tuesday that New York’s positivity rate had climbed above 3% for the first time in weeks.

In Maryland, where the positivity rate stood at 5.6% on Wednesday, officials warned about rising COVID-19 hospitalizations. More than 800 people were being treated for the coronavirus at state hospitals as of Wednesday, according to Mike Ricci, the communications director of Governor Larry Hogan, the highest daily count since April, a Reuters tally showed.

A record number of people died of coronavirus in several Midwest and western states on Tuesday, including in Alaska, Indiana, Missouri, North Dakota, Wisconsin and Wyoming.

Officials in states hardest-hit by the virus pleaded with residents to stay home as much as possible and heed the advice of experts by wearing masks, washing their hands and social distancing.

“It’s not safe to go out, it’s not safe to have others over — it’s just not safe. And it might not be safe for a while yet,” Wisconsin Governor Tony Evers said during a primetime address on Tuesday. “So, please, cancel the happy hours, dinner parties, sleepovers and playdates at your home.”

(Reporting by Maria Caspani in New York and Anurag Maan in Bengaluru, Editing by Nick Macfie)

Florida reports record increase in COVID-19 deaths for second day in a row

(Reuters) – Florida reported a record increase in new COVID-19 deaths for a second day in a row on Wednesday, with 217 fatalities in the last 24 hours, according to the state health department.

Florida also reported 9,446 new cases, bringing its total infections to over 451,000, the second highest in the country behind California. Florida’s total death toll rose to 6,457, the eighth highest in the nation, according to a Reuters tally.

(Reporting by Lisa Shumaker; Editing by Chris Reese)

Bolsonaro threatens WHO exit as COVID-19 kills ‘a Brazilian per minute’

By Lisandra Paraguassu and Ricardo Brito

BRASILIA (Reuters) – President Jair Bolsonaro threatened on Friday to pull Brazil out of the World Health Organization after the U.N. agency warned Latin American governments about the risk of lifting lockdowns before slowing the spread of the novel coronavirus throughout the region.

A new Brazilian record for daily COVID-19 fatalities pushed the county’s death toll past that of Italy late on Thursday, but Bolsonaro continues to argue for quickly lifting state isolation orders, arguing that the economic costs outweigh public health risks.

Latin America’s most populous nations, Brazil and Mexico, are seeing the highest rates of new infections, though the pandemic is also gathering pace in countries such as Peru, Colombia, Chile and Bolivia.

Overall, more than 1.1 million Latin Americans have been infected. While most leaders have taken the pandemic more seriously than Bolsonaro, some politicians that backed strict lockdowns in March and April are pushing to open economies back up as hunger and poverty grow.

In an editorial running the length of newspaper Folha de S.Paulo’s front page, the Brazilian daily highlighted that just 100 days had passed since Bolsonaro described the virus now “killing a Brazilian per minute” as “a little flu.”

“While you were reading this, another Brazilian died from the coronavirus,” the newspaper said.

Brazil’s Health Ministry reported late on Thursday that confirmed cases in the country had climbed past 600,000 and 1,437 deaths had been registered within 24 hours, the third consecutive daily record.

Brazil reported another 1,005 deaths Friday night, while Mexico reported 625 additional deaths.

With more than 35,000 lives lost, the pandemic has killed more people in Brazil than anywhere outside of the United States and the United Kingdom.

Asked about efforts to loosen social distancing orders in Brazil despite rising daily death rates and diagnoses, World Health Organization (WHO) spokeswoman Margaret Harris said a key criteria for lifting lockdowns was slowing transmission.

“The epidemic, the outbreak, in Latin America is deeply, deeply concerning,” she told a news conference in Geneva. Among six key criteria for easing quarantines, she said, “one of them is ideally having your transmission declining.”

In comments to journalists later Friday, Bolsonaro said Brazil will consider leaving the WHO unless it ceases to be a “partisan political organization.”

President Donald Trump, an ideological ally of Bolsonaro, said last month that the United States would end its own relationship with the WHO, accusing it of becoming a puppet of China, where the coronavirus first emerged.

Bolsonaro’s dismissal of the coronavirus risks to public health and efforts to lift state quarantines have drawn criticism from across the political spectrum in Brazil, where some accuse him of using the crisis to undermine democratic institutions.

But many of those critics are divided about the safety and effectiveness of anti-government demonstrations in the middle of a pandemic, especially after one small protest was met with an overwhelming show of police force last weekend.

Alfonso Vallejos Parás, an epidemiologist and professor of public health at the National Autonomous University of Mexico, said infections are high in Latin America as the virus was slow to gain a foothold in the region.

“It is hard to estimate when the pace of infection will come down,” he said.

(Reporting by Lisandra Paraguassu and Ricardo Brito; Additional reporting by Gabriela Mello in Sao Paulo, Gram Slattery and Pedro Fonseca in Rio de Janeiro and Adriana Barrera in Mexico City; Editing by Brad Haynes, Rosalba O’Brien and Leslie Adler)

Lockdowns may have averted 3 million deaths in Europe by curbing COVID-19: study

By Kate Kelland

LONDON (Reuters) – Wide-scale lockdowns including shop and school closures have reduced COVID-19 transmission rates in Europe enough to control its spread and may have averted more than three million deaths, researchers said on Monday.

In a modeling study of lockdown impact in 11 nations, Imperial College London scientists said the draconian steps, imposed mostly in March, had “a substantial effect” and helped bring the infection’s reproductive rate below one by early May.

The reproduction rate, or R value, measures the average number of people that one infected person will pass the disease on to. An R value above 1 can lead to exponential growth.

The Imperial team estimated that by early May, between 12 and 15 million people in the 11 countries – Austria, Belgium, Britain, Denmark, France, Germany, Italy, Norway, Spain, Sweden and Switzerland – had been infected with COVID-19.

By comparing the number of deaths counted with deaths predicted by their model if no lockdown measures had been introduced, they found some 3.1 million deaths were averted.

“Measuring the effectiveness of these interventions is important, given their economic and social impacts, and may indicate which course of action is needed to maintain control,” the researchers said in a summary of their findings.

A second study by scientists in the United States, published alongside the Imperial-led one in the journal Nature, estimated that anti-contagion lockdown policies implemented in China, South Korea, Italy, Iran, France and the United States prevented or delayed around 530 million COVID-19 cases.

Focusing their analysis on these six countries, the U.S. research team compared infection growth rates before and after the implementation of more than 1,700 local, regional and national policies designed to slow or halt the spread of COVID-19, the disease caused by the new SARS-CoV-2 coronavirus.

They found that without anti-contagion policies in place, early infection rates of SARS-CoV-2 grew by 68% a day in Iran and an average of 38% a day across the other five countries.

Using econometric modeling normally used in assessing economic policies, they found lockdowns had slowed the infection rate with “measurable beneficial health outcomes in most cases”.

(Reporting by Kate Kelland, editing by Gareth Jones)

Mexico overtakes U.S. coronavirus daily deaths, sets records

MEXICO CITY (Reuters) – Mexico overtook the United States in daily reported deaths from the novel coronavirus for the first time on Wednesday, with the health ministry registering a record 1,092 fatalities it attributed to improved documenting of the pandemic.

Latin American has emerged in recent weeks as a major center for coronavirus. Brazil, where the virus has hit hardest in the region, also reported a record number of deaths on Wednesday.

The Mexican government had previously predicted the pandemic would peak in early May and under U.S. pressure has begun reopening its vast auto industry, which underpins billions of dollars of business through cross-border supply chains.

However, plans to further relax social distancing measures this week were put on hold in recognition of the fact that infections had not yet begun coming down.

Wednesday saw a record 3,912 new infections, with the number of daily deaths more than twice the previous record of 501.

The total number of known cases in Latin America’s second-largest economy is now 101,238 and its tally of deaths is 11,729, making it the seventh country with most deaths from the virus, according to the John Hopkins Center for Systems Science and Engineering.

Deputy Health Minister Hugo Lopez-Gatell attributed the sharp jump in numbers to a new mortality committee established by the Mexico City government to better identify which deaths in the capital were caused by the virus.

“Over the past 20 or 25 days, we have had various cases that were slowly passed on to the registry, for various reasons,” he said. “A technical committee has specifically been carrying out complementary methods.”

The committee was established after growing criticism that Mexico’s very limited testing rate meant most cases and deaths from COVID-19, the illness caused by the virus, were not being registered. A Reuters investigation concluded that fatalities could be 2.5 times higher than reported.

Mexico’s government has previously admitted the real number of fatalities was higher than the official count.

It was not clear if the inclusion of more deaths registered by the Mexico City committee would push daily numbers higher in future.

Mexico, with just over a third of the population of the United States, is at an earlier stage of the pandemic curve than its neighbor and the government has acknowledged that deaths could eventually surpass 30,000.

U.S. daily reported deaths were 1,045 on Wednesday, government data showed.

(Reporting by Mexico City Newsroom; Editing by Frank Jack Daniel and Peter Cooney)

Factbox: Where states stand as U.S. reaches 100,000 coronavirus deaths

By Peter Szekely

(Reuters) – Less than four months after a 57-year-old California woman died and was later found to be the country’s first COVID-19 fatality, the coronavirus U.S. death toll topped 100,000 people on Wednesday, according to a Reuters tally.

The grim milestone is by far the largest of any country, although by population, several Western European countries, led by Belgium, have much higher death rates.

The outbreak set off a patchwork of responses by the 50 states and the District of Columbia, some of which were hammered by the global pandemic while others were barely touched.

Initial actions ranged from sweeping business shutdowns and orders to shelter in place to less drastic guidance and regional closings. All states have loosened at least some restrictions in recent weeks, but still require or recommend precautions, such as social distancing or masks. Almost all states have ended in-class instruction at public schools for the academic year.

Below are summaries of how the states and the District of Columbia are coming back from the economic slowdown they orchestrated to combat the pandemic, based on Reuters reporting, a Reuters tally of infections and deaths as of Wednesday, and data compiled by the National Governors Association:

ALABAMA: 12 deaths per 100,000. Total deaths: 581. Total cases: 15,775. After its stay-at-home order expired at the end of April, the state moved to a “Safer at Home” order that urged residents to minimize travel and banned public gatherings unless social distancing can be maintained. The order was amended to continue until July 3. The state has allowed retail stores to operate at 50% of capacity, while restaurants, bars, gyms and some personal care services were allowed to reopen with restrictions. State beaches also were reopened.

ALASKA: 1 death per 100,000. Total deaths: 10. Total cases: 411. On May 8, the state entered the second phase of a five-step reopening process that allows offices, restaurants, swimming pools, personal care and other retail businesses to operate at 50% of capacity, and bars, gyms and theaters to operate at 25% of capacity. Social and religious gatherings are limited to 50 people with social distancing.

ARIZONA: 11 deaths per 100,000. Total deaths: 831. Total cases: 17,262. After the state’s stay-at-home order expired on May 15, bars, pools, gyms and ballparks without fans were allowed to reopen, though social distancing policies remain in place. Non-essential retailers, including barbershops, reopened on May 8 and dine-in service at restaurants reopened on May 11.

ARKANSAS: 4 deaths per 100,000. Total deaths: 119. Total cases: 6,180. The state responded to the outbreak in March with piecemeal measures, not a sweeping shutdown, and is now relaxing them. Restaurants were allowed to resume dine-in service at 33% capacity on May 11, personal service businesses, such as barbershops, were allowed to reopen on May 6, gyms were allowed to reopen on May 4. Large venues, such as movie theaters and sports arenas, were allowed to reopen on May 18, and restaurant bars could reopen on May 19, all with capacity limits. Since May 14, travelers from any international location, Connecticut, New York, New Jersey or New Orleans have been required to self-quarantine for 14 days.

CALIFORNIA: 10 deaths per 100,000. Total deaths: 3,824. Total cases: 99,769. The most populous U.S. state is in the second step of a four-stage reopening process after leading the country to close businesses and lockdown residents in March. The reopening is being phased in by county and business sector. Some statewide commerce is allowed, including curb-side retail sales and limited in-store shopping, manufacturing and office work. Some counties were permitted to open limited dine-in restaurant service, barbershops and hair salons. State beaches, bars, gyms and large venues, such as theaters, remain closed. On May 18, Governor Gavin Newsom said professional sports could return by early June under strict guidelines that include no fans.

COLORADO: 23 deaths per 100,000: Total deaths: 1,352. Total cases: 24,565. After a month-long “stay-at-home” order, the state moved to a looser “safer-at-home” order on April 27 that phases in activities, while still barring gatherings of 10 or more and requiring residents to stay within 10 miles (16 km) of home. On May 1, personal services, such as hair salons, and in-person shopping at non-critical stores resumed with restrictions. On May 4, commercial employers could have up to 50% of their employees on-site but were encouraged to have them work from home. Bars remain closed, but on Wednesday restaurants were allowed to resume seating customers, either outdoors or inside at 50% of capacity.

CONNECTICUT: 106 deaths per 100,000. Total deaths: 3,769. Total cases: 41,303. Two months after issuing a stay-home order, the state, among the country’s hardest hit, began loosening commercial restrictions on May 20. With restrictions, the new order allows offices to reopen, stores to allow onsite shopping and restaurants to offer outdoor table service. Unlike some neighboring states, Connecticut never closed manufacturing, construction or curbside retail service. Bars, gyms and personal service businesses remain closed. DELAWARE: 34 deaths per 100,000. Total deaths: 344. Total cases: 9,096. The state is gradually reopening the activities and businesses it shuttered on March 23 when residents were told to shelter in place, an order that has been extended to May 31. On May 8, most non-essential retailers were allowed to do curbside pickup sales, while several others, including hair care shops, were allowed to open for business with restrictions. Wider limited reopenings, including beaches, malls and restaurants and bars at 30% of capacity are set for June 1, although meeting facilities, sports venues and nail salons will remain closed.

DISTRICT OF COLUMBIA: 62 deaths per 100,000. Total deaths: 445 Total cases: 8,406. Unlike most states that have moved to expand economic activity, the U.S. capital extended its stay-at-home order to June 8 because its efforts to curb the spread of the disease, had not met federal reopening guidelines. All but essential businesses, including grocery stores and restaurant take-out sales, remain closed. The district, among the country’s hardest-hit areas, was considering reopening parks.

FLORIDA: 11 deaths per 100,000: Total deaths: 2,319. Total cases: 52,634. The expiration of the state’s stay-at-home order on May 4 enabled most counties to reopen businesses, including retailers, dine-in restaurants, personal care services and gyms. Three heavily populated South Florida counties were slower to accept the reopenings, with Palm Beach, the home of U.S. President Donald Trump’s resort, joining a week later and Miami-Dade and Broward announcing some incremental reopenings afterward. The city of Miami Beach, which was hit hard by the virus, set its reopening of restaurant dining for May 25.

GEORGIA: 18 deaths per 100,000. Total deaths: 1,907. Total cases: 44,421. Georgia was the first state to emerge from lockdown as Governor Brian Kemp relaxed restrictions on April 24 over the objections of some local officials. The move allowed retail stores, dine-in restaurants, gyms and personal care businesses to open their doors, along with places of worship.

HAWAII: 1 death per 100,000. Total deaths: 17. Total cases: 643. The state, which relies heavily on tourism, requires all visitors arriving on the islands through June 30 to self-quarantine for 14 days. While the reopening of some businesses began on May 7, a stay-at-home order remains in effect through May 31. Retailers have been allowed to operate, except in Honolulu and Maui, and outdoor recreational facilities, including beaches, are open. More reopenings are expected on June 1.

IDAHO: 4 deaths per 100,000. Total deaths: 79. Total cases: 2,699. The state began its incremental reopening on May 1, the day after its stay-at-home order expired, by allowing places of worship to operate. Dine-in restaurants, gyms and personal care service businesses were allowed to open on May 16. More openings are expected on May 30.

ILLINOIS: 39 deaths per 100,000. Total deaths: 4,923. Total cases: 113,195. Illinois has taken only tentative steps away from the stay-at-home order Governor J.B. Pritzker issued in March. Since April, retail curbside sales and some manufacturing have been permitted, and state parks were opened. The stay-at-home order in place through May 29 bars non-essential travel, encourages work-from-home and restricts religious activities to gatherings of up to 10 people or drive-in services.

INDIANA: 30 deaths per 100,000. Total deaths: 2,030. Total cases: 32,437. Since May 4, the state has been phasing in the reopening of its economy in most regions, following the expiration of its March 23 stay-at-home order. The steps toward relaxation have allowed retailers and personal care services to do business, while restaurants and bars that serve food to could reopen their dining areas. Manufacturers, offices and places of worship also were free to operate.

IOWA: 15 deaths per 100,000. Total deaths: 490. Total cases: 18,360. One of a handful of states that did not issue a shutdown order, Iowa has been gradually unwinding the piecemeal restrictions it implemented in March but is keeping social distancing requirements. By May 15, all dine-in restaurants, gyms, hair salons and other personal service businesses were allowed to reopen. Large venue businesses, including theaters and zoos, were allowed to open on May 20, and bars were set to resume business on May 28. Gatherings of more than 10 people remain banned through May 27.

KANSAS: 6 deaths per 100,000. Total deaths: 205. Total cases: 9,337. The state has been in a phased reopening since May 4 when Governor Laura Kelly’s earlier stay-at-home order expired. Under the May order, retailers, offices, hair salons, gyms and restaurant dining areas were permitted to reopen, while bars and theaters remained closed. Further reopening steps are expected.

KENTUCKY: 9 deaths per 100,000. Total deaths: 394. Total cases: 8,951. The state is in the process of a phased-in reopening following a March 22 shutdown order. On May 11, manufacturing, construction and office workers were allowed to go back to their workplaces with restrictions. The reopenings also extended to horse racing tracks, including the state’s internationally known Churchill Downs, but without spectators. Limited reopenings at 33% of capacity were applied to retailers on May 20 and restaurants on May 22. Other targeted reopenings include personal care services on May 25 and gyms and movie theaters on June 1. Bars remain closed.

LOUISIANA: 58 deaths per 100,000. Total deaths: 2,722. Total cases: 38,497. With New Orleans among the areas hit hardest by the outbreak, Governor John Bel Edwards issued a stay-at-home order on March 22, but began a gradual unwinding of it on May 15. The new order permits several businesses, including restaurant dining areas, shopping malls, salons and barber shops, places of worship, casinos, racetrack, gyms and most other businesses to operate at 25% of their customer capacity. Parks are also open.

MAINE: 6 deaths per 100,000. Total deaths: 81. Total cases: 2,137. Maine, which has had a stay-at-home order in effect since April 2, began a regionally phased-in reopening approach on May 1. Car washes and auto dealerships were allowed to operate statewide, but the reopening of other retailers and restaurant dining areas was limited to some rural counties. On May 19, Governor Janet Mills delayed the reopening of salons and gyms, but opened the state’s campgrounds in time for the Memorial Day holiday weekend.

MARYLAND: 39 deaths per 100,000. Total deaths: 2,392. Total cases: 48,423. After shutting down the state on March 30 with a stay-at-home order that also banned gatherings of more than 10 people, Governor Larry Hogan began reopening commerce on May 15. The new order allowed a broad range of retail stores, drive-in movie theaters, personal care services, manufacturers and places of worship to reopen in much of the state. The initial reopening phase also covered beaches and campgrounds, but not dine-in restaurants and gyms. Some localities chose to remain closed.

MASSACHUSETTS: 94 deaths per 100,000. Total deaths: 6,473. Total cases: 93,693. Massachusetts, among the states hardest hit by pandemic, began to emerge from a March 23 stay-at-home order with a phased-in reopening on May 18. The new order by Governor Charlie Baker, the first in a series, allowed the resumption of manufacturing, construction and worship services. It also sets May 25 for the reopening of curbside retail sales, office buildings, salons, car washes and drive-in movie theaters. Bars, dine-in restaurants, gyms and personal care services remain closed.

MICHIGAN: 53 deaths per 100,000. Total deaths: 5,334. Total cases: 55,608. Michigan, scene of protests by groups of armed demonstrators calling for a resumption of commerce, has been one of the most locked-down states since March 24. It began relaxing restrictions by region on May 11 by allowing some retailers to do curbside sales. Another order allowed retailers and car dealerships to do business by appointment starting May 22. Some manufacturing, construction and restaurants also were allowed to resume operation in certain areas. The current stay-at-home order is set to expire after Thursday.

MINNESOTA: 16 deaths per 100,000. Total deaths: 942 Total cases: 22,464. The state has loosened its March shutdown order over the past few weeks, allowing manufacturing and office employees back to work, but requiring that workers who can work from home do so. Gatherings of more than 10 people are still prohibited, although drive-in gatherings are permitted. On May 17, Governor Tim Walz reopened parks and many recreation areas and allowed retailers and malls to open their doors while limiting customers to 50% of capacity. A planned reopening of bars and dine-in restaurants is set for June 1. Gyms and personal care services remain closed.

MISSISSIPPI: 22 deaths per 100,000. Total deaths: 670. Total cases: 14,044. A shelter-in-place order issued on April 3 lasted only a matter of weeks, before being loosened for a phased-in resumption of commerce, starting with retailers operating their stores at 50% of capacity. Since then, the reopening has extended to dine-in restaurants and bars, gyms, casinos, salons, barbershops and state parks.

MISSOURI: 11 deaths per 100,000. Total deaths: 696. Total cases: 12,492. After the expiration of a shelter-at-home order, restaurants were allowed to seat customers in their dining areas on May 4, and retailers were allowed to open their doors, but with limits ranging from 10% to 25% of customer capacity, depending on the size of the store. Also reopened were gyms, entertainment venues, personal care services and campgrounds. Manufacturing, construction and office employees were allowed to return to their workplaces.

MONTANA: 2 death per 100,000. Total deaths: 17. Total cases: 481. A phased-in business restart began on April 27, following the expiration of a March stay-at-home order. Allowed to reopen were retail stores, restaurants and bars, salons and barber shops, gyms and entertainment venues. Places of worship were also reopened. In early May, some public schools reopened their classrooms in Montana, one of the very few states to allow it.

NEBRASKA: 9 deaths per 100,000. Total deaths: 167. Total cases: 12,619. One of the few states not to issue a blanket stay-at-home order, Nebraska began to relax its limited, regionally varied “directed health measures” on May 4 with the resumption of elective surgeries. While Governor Pete Ricketts limited public gatherings and urged Nebraskans to stay home, construction, manufacturing and office work continued. Restaurants, which were restricted to takeout in some regions, were allowed to serve a limited number of dining patrons by May 11. Bars and large venue businesses were either operating with limited capacity or ordered to stay closed through May 31.

NEVADA: 13 deaths per 100,000. Total deaths: 396. Total cases: 8,114 While Las Vegas casinos remain closed, Nevada has been phasing in an economic restart after ordering a statewide shutdown in March. Starting on May 9, restaurants were allowed to seat guests, retailers could operate at 50% of capacity, barbershops and salons could serve customers and drive-in theaters could roll movies. The state’s legal brothels, gyms, and indoor malls are among the businesses still closed.

NEW HAMPSHIRE: 16 deaths per 100,000 Total deaths: 214. Total cases: 4,231. While the state’s March 27 stay-at-home order remains in effect at least through the end of May, some pockets of the economy have been allowed to restart. Starting in May, retailers were allowed to open their doors to customers at up to 50% of capacity. Gyms, barbershops and hair salons also could reopen, while restaurants could seat customers outside and drive-in movie theaters could operate. Construction workers were allowed to return to their jobs.

NEW JERSEY: 126 deaths per 100,000. Total deaths: 11,339. Total cases: 156,628. The country’s most dense state and one of the hardest hit by the outbreak is emerging from a sweeping March shutdown order incrementally. While bars and dine-in restaurant service remain closed, non-essential construction, curbside pickup for non-essential retailers and drive-in businesses resumed on May 18. Parks reopened in early May, and beaches were set to reopen on May 22. On Tuesday, Governor Phil Murphy opened the way for the state’s professional sports teams to come back to train and compete.

NEW MEXICO: 15 deaths per 100,000. Total deaths: 325. Total cases: 7,130. With a March 24 stay-at-home order in effect until at least the end of May, New Mexico has taken limited steps to reopen its economy, though not in all regions. Retail stores were allowed to open at 25% of their customer capacities, places of worship, parks and golf courses have opened and offices were allowed to operate at 25% of capacity. Bars, restaurant dining areas, gyms and personal care services remain closed.

NEW YORK: 150 deaths per 100,000. Total deaths: 29,339. Total cases: 369,883. A strict March shutdown and stay-at-home order in the most severely affected U.S. state was slowly being lifted by region. Its reopening moves began in mid-May in several upstate areas that were largely unaffected by the surge of cases in the New York City area, and extended to areas along the Hudson River and Long Island on Tuesday and Wednesday, all with social distancing and other restrictions. Construction can resume and retailers may offer curbside pickup or open their doors with capacity limits in those areas. Drive-in movie theaters were among a handful of outdoor, low-risk businesses allowed to reopen statewide on May 15, and state beaches reopened for Memorial Day weekend. Governor Andrew Cuomo on Sunday invited the state’s sports teams to come back to train and compete in empty arenas. Dine-in restaurants, bars and personal care services remain closed.

NORTH CAROLINA: 7 deaths per 100,000. Total deaths: 794. Total cases: 24,628. The state has moved incrementally to reopen its economy even as a March 30 stay-at-home order remained in effect through most of May. Starting on May 22, retail stores, restaurant dining areas and personal care services were allowed to operate at 50% of their customer capacity. Places of worship and some outdoor recreational areas were also reopened. Earlier in May, the beaches of the state’s Outer Banks were reopened to non-residents.

NORTH DAKOTA: 7 deaths per 100,000. Total deaths: 56. Total cases: 2,439. The state responded to the outbreak with “a low-mandate, high-compliance approach” that left the “vast majority” of its economy open, according to Governor Doug Burgum. March shutdowns of bars, dine-in restaurants, gyms, movie theaters and personal care services, were lifted on May 1 with distancing constraints. Banquet hall gatherings of up to 250 people were permitted on May 15, but sports arenas and entertainment venues remain closed. Most travelers from other countries must quarantine for 14 days.

OHIO: 17 deaths per 100,000. Total deaths: 2,044. Total cases: 33,439. The state is slowly unwinding a number shutdown orders it issued in March, including a March 22 stay-at-home order. Manufacturing, construction and office workers were allowed to return to their workplaces on May 4. Retailers could reopen in early May, but only for curbside pickup or by appointment, a limited number of customers at a time. Personal care services, including salons and barber shops, could reopen on May 15, and restaurants can serve customers in outdoor seating areas. On Tuesday, the state reopened fitness centers and a variety of sports and recreational facilities, ranging from batting cages to bowling alleys.

OKLAHOMA: 8 deaths per 100,000. Total deaths: 322. Total cases: 6,229. The state, among the few not to issue a sweeping statewide shutdown order, has undone the selective closings it ordered in March, which mostly affected businesses in counties where there was community spread of the disease. By May 15, dine-in restaurants, bars, personal care services, gyms, theaters, houses of worship and sports venues were allowed to reopen with social distancing and other restrictions. A “Safer at Home” order directs older residents and those with pre-existing conditions to limit travel. Travelers coming to Oklahoma from six severely infected states are required to quarantine for 14 days.

OREGON: 4 deaths per 100,000. Total deaths: 148. Total cases: 3,967. Oregon has taken a regional approach to reopen its economy after a number of shutdown orders, including one to “Stay Home, Save Lives,” were issued in March. Retail stores were allowed to reopen with restrictions earlier in May, while restaurant dining areas, gyms and personal care services in many parts of the state were also allowed to operate.

PENNSYLVANIA: 41 deaths per 100,000. Total deaths: 5,273. Total cases: 73,553. With an April 1 stay-at-home order in effect until at least June 4, the state has taken tentative steps to restart its economy in phases and by region. So far, construction workers have been allowed to return to their job sites, and retail stores have been allowed to reopen with restrictions in some counties. Bars, dine-in restaurants, gyms and personal care services remain closed.

RHODE ISLAND: 60 deaths per 100,000. Total deaths: 655. Total cases: 14,353. Since a stay-at-home order expired on May 8, Rhode Island has gradually reopened businesses sector by sector. Manufacturing, construction and office employees have been allowed to return to their workplaces. Retail stores were allowed to operate with restrictions, restaurants may seat customers in outdoor areas, and parks and golf courses are open. Bars and gyms remain closed, but plans are in place to allow fitness classes, salons and barbershops and indoor restaurant dining at 50% of capacity to resume on June 1. At least some beaches reopened on the May 25.

SOUTH CAROLINA: 9 deaths per 100,000. Total deaths: 446. Total cases: 10,416. After shutting down most businesses for a matter of weeks in late March and early April, the state has been allowing them to reopen, starting in late April. Retail stores, gyms, restaurant dining areas and salons and barbershops have been allowed to operate with restrictions. Zoos, amusement parks, museums and other attractions were set to reopen on May 22.

SOUTH DAKOTA: 6 deaths per 100,000. Total deaths: 54. Total cases: 4,710. The state did not shut down businesses or issue a stay-at-home order, but many businesses throughout the state, including meat packers, closed temporarily because of the outbreak. Governor Kristi Noem issued a “Back to Normal” plan on April 28 that offers guidance for business reopenings and encourages social distancing and other precautions.

TENNESSEE: 5 deaths per 100,000. Total deaths: 353. Total cases: 21,306. After closing businesses and ordering residents to stay home in late March and early April, Tennessee has started to reopen its economy, except in some regions. Dine-in restaurants, retail stores, gyms, personal care services and places of worship have been allowed to operate with restrictions. Bowling alleys and arcades also were allowed to reopen, but bars, theaters and sporting and entertainment venues remain closed. Office employees were allowed to return to their workplaces with restrictions.

TEXAS: 5 deaths per 100,000. Total deaths: 1,551. Total cases: 57,475. Since its stay-at-home order expired on April 30, Texas has reopened much of its economy by region. In most areas, retail stores, restaurant dining areas, shopping malls, movie theaters and personal care services were allowed to operate at 25% of capacity. Places of worship also have been allowed to operate with restrictions. Manufacturing and office workers were allowed to return to their workplaces. Starting on May 31, the state will allow professional sports to be played without spectators.

UTAH: 3 deaths per 100,000. Total deaths: 105. Total cases: 8,706. While the state did not issue a blanket shut-down order, some selected businesses were ordered closed locally in March, including personal care and dine-in restaurant services and movie theaters. A March 27 “Stay Safe, Stay Home” directive from Governor Gary Herbert asks residents to stay home where possible and reminds businesses to comply with hygiene and distancing measures. Herbert has gradually lowered the state’s color-coded alert status from high-risk red, and declared most counties to be at low-risk yellow on May 16. The status permits the opening of all businesses, bars and dine-in restaurants with precautions.

VERMONT: 9 deaths per 100,000. Total deaths: 54. Total cases: 971. After the state’s stay-at-home order expired in mid-May, retail stores were allowed to operate with restrictions and state parks and golf courses could open. Public worshipping was limited to drive-in services and fitness center activity was restricted to outdoor classes. Manufacturing, construction and office employees were allowed to return to their workplaces. Bars, restaurant dining areas and personal care services remain closed.

VIRGINIA: 14 deaths per 100,000. Total deaths: 1,281. Total cases: 40,249. Although a March 30 stay-at-home order remains in effect, the state has phased in much of its economic reopening, except in the suburban areas surrounding Washington, D.C. Retailers and personal care services can operate with restrictions, restaurants and bars were allowed to offer outdoor seating and fitness centers were permitted to offer outdoor classes. Places of worship were allowed to operate, and campgrounds were reopened.

WASHINGTON: 14 deaths per 100,000. Total deaths: 1,078. Total cases: 20,181. In Washington, the first state to have a COVID-19 casualty, some counties have been allowed to reopen businesses even as a March 25 shutdown order remains in effect. The reopenings include retail sales, restaurant dining, personal care services and some fitness center activities, all with restrictions. In select counties, manufacturing, construction and office employees were allowed to return to their workplaces with restrictions. Parks and golf courses were reopened, and public worshipping is limited to drive-in services.

WEST VIRGINIA: 4 deaths per 100,000. Total deaths: 74. Total cases: 1,867. In West Virginia, among the last states to be hit by a coronavirus infection, businesses have been reopening since a stay-at-home order expired on May 3. The reopenings include restaurant dining areas at 50% of capacity, retail stores, personal care services and gyms, all with restrictions. State parks, campgrounds and drive-in movie theaters are also open. Bars, movie indoor movie theaters, playgrounds, zoos and bowling alleys are among the businesses that were still closed.

WISCONSIN: 9 deaths per 100,000. Total deaths: 539. Total cases: 16,462. After the state Supreme Court struck down Governor Tony Evers’ stay-at-home order on May 13, the pace of the state’s economic reopening was left to each locality. In what one restaurant trade group official called “a little bit of the Wild, Wild West,” some allowed bar and restaurant owners to open, while others kept their lockdowns in place.

WYOMING: 2 deaths per 100,000. Total deaths: 13. Total cases: 850. Although Wyoming was among a handful of states that did not issue sweeping shutdown orders, it closed select businesses on March 20, including bars, dine-in restaurants, theaters, personal care services and gyms. On March 25, Governor Mark Gordon urged residents to stay home whenever possible. The targeted shutdowns were rescinded on May 15 and the limit on public gatherings was expanded to 25 from 10.

(Reporting by Peter Szekely; Additional reporting by Steve Gorman in Los Angeles; Editing by Lisa Shumaker)