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U.S. testing needs “a huge technology breakthrough.”

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

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

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

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

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

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

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

Americans should expect social distancing guidelines to continue for months, Dr. Birx said in a televised interview on Sunday.

Dr. Birx was asked on “Meet the Press” about a claim by Vice President Mike Pence, who said on Thursday, “Honestly, if you look at the trends today, I think by Memorial Day weekend we will largely have this coronavirus epidemic behind us.” Mr. Pence made the statement on Geraldo Rivera’s radio show.

Dr. Birx responded that she thought Mr. Pence was being hopeful, based on trends in places like Detroit and Louisiana where case counts appear to have peaked. But she also said, “social distancing will be with us through the summer.”

Throughout the interview with Chuck Todd, Dr. Birx seemed to be taking pains to avoid directly contradicting or undermining the White House’s messages about the pandemic.

Asked about President Trump’s recent suggestions that household disinfectants or sunlight might be used as a treatment, she noted that direct sunlight had shown promise in shortening the virus’s half-life on surfaces. “This is not a treatment,” she said.

Mr. Todd asked Dr. Birx if she was concerned that the president’s statements — including his repeated promotion of anti-malaria drugs that are unproven for coronavirus and can cause serious heart problems — were undermining the credibility of scientists on the administration’s coronavirus task force.

“I think all of us are very clear, and very clear in our discussions with the American people, how we’re looking and utilizing data to drive decision-making within the task force,” Dr. Birx said.

As a handful of states relaxed social distancing guidelines over the weekend, Gov. Jared Polis of Colorado defended new rules in his state allowing curbside retail deliveries and phasing in store openings and elective surgery.

“What matters a lot more than the date that the stay-at-home ends is what we do going forward, and how we have an ongoing, sustainable way, psychologically, economically and from the health perspective, to have the social distancing we need,” Governor Polis, a Democrat, said on “State of the Union,” the CNN Sunday morning talk show.

“Otherwise, if we can’t succeed in doing that on an ongoing basis, the stay-at-home was for nothing,” he said.

States have struggled to navigate competing demands to keep both residents and the economy alive. A handful, including Alaska, Georgia, Oklahoma, South Carolina and Tennessee, have begun partly reopening some businesses, like hair salons, gyms and bowling alleys.

Gov. Gretchen Whitmer of Michigan, a Democrat whose coronavirus policies have been the target of protests, said on the ABC program “This Week” that her aggressive approach had saved lives. The governor has extended her stay-at-home order until May 15, but she relaxed a number of social distancing policies on Friday, allowing in-state travel and some recreational activities.

Colorado’s stay-at-home order expired over the weekend. Governor Polis has said all retail businesses could start curbside pickup of purchases now, and that large workplaces will be allowed to reopen at 50 percent of capacity on May 4.

Still, he acknowledged continuing uncertainty about the effects of such measures, and promised to adjust the rules “in real time” based on a number of metrics, including mobility and incidence of Covid-19 cases in the state.

Several Colorado counties have submitted their own reopening plans, asking for waivers to state rules, and at least one — Weld County, northeast of Denver — drew the governor’s ire by announcing that all businesses there could reopen.

Gov. Larry Hogan of Maryland, a Republican, said his state would not start to reopen until the number of deaths there declined for 14 straight days. “I’m going to be very cautious,” he said on “This Week.” “We’re going to make decisions on science.”

Maryland has reported 17,766 confirmed coronavirus cases, with 797 related deaths, according to data collected by The New York Times.

Governors criticized President Trump’s recent comments on the use of disinfectant as a possible treatment for the virus, saying calls to health departments and poison control centers had increased in recent days.

“When the person with the most powerful position on the planet is encouraging people to think about disinfectant, whether it was serious or not, people listen,” Ms. Whitmer said. “Unequivocally, no one should be using disinfectant to digest it to fight Covid-19. Please don’t do it. Just don’t do it.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A walk in the park brings tense flare-ups: Back off, you’re too close. Oh really? Then stay home. A loud neighbor, once a fleeting annoyance of urban life, is cause for complaint to the city. Wake at noon, still tired. The city’s can-do resilience has given way to resignation and random tears.

The journey that began in March with an us-against-it unity, with homemade masks and do-it-yourself haircuts and Zoom happy hours, has turned into a grim slog for many. It felt as if the city had cautiously approached a promising bend in the road, a new page on the calendar, only to find nothing, and beyond that, ever more of the same.

A feeling of sadness shot through with frayed nerves could be felt in conversations in and around New York City as the coronavirus outbreak in the world’s epicenter dragged toward its sixth week, its end still too far off to see.

“This is the week where I feel like I have accepted this, and given up,” Euna Chi of Brooklyn wrote in an email. “My daily commute to the couch feels ‘normal.’”

The cancellation, suspension or postponement of sports across the country has shut down what would usually be a busy period of competition and championships that unites many small towns.

The girls’ basketball team at Gruver High School in the Texas panhandle won its first state title in early March, and a week later came the boys’ opportunity. Texas is a state that embraces high school sports perhaps more extravagantly than any other, so police cruisers and fire trucks escorted the team bus as it left for San Antonio.

But after the Gruver Greyhounds and other contenders practiced in the morning and early afternoon on March 12, they got the news on their cellphones that the tournament was being suspended. The Gruver players stayed for a night in San Antonio and were treated to a consolation dinner.

“Some kids ate about six pounds of steak,” said Brittin East, the Gruver coach. “It was good to get their minds off everything.” But the long bus ride home the next day was somber.

As schools closed, and group practices became prohibited, coaches and players improvised. Some shot baskets in their driveways or at local parks. Another flipped tractor tires to maintain his strength, hoping to be ready when the tournament resumed.

But on April 17, Texas ordered all public and private schools to remain closed through the rest of the academic year. The high school athletic association then canceled the basketball tournament completely.

On the first day in weeks that the White House did not hold a briefing on the coronavirus, President Trump lashed out at the news media on Twitter for asking “hostile questions” and suggested that his daily appearances were no longer worth his time.

The tweet came two days after Mr. Trump suggested at a briefing that an “injection inside” the human body with a disinfectant could help combat the coronavirus. Despite a lack of scientific evidence, Mr. Trump has long pushed various ideas against the virus, like sunlight and warmer temperatures as well as an array of drugs, including the malaria drug hydroxychloroquine, which he has promoted as a “what have you got to lose” remedy. Medical experts have since stepped up warnings about the drugs’ possibly dangerous side effects.

Since Thursday’s assertion, Mr. Trump has been angrily tweeting about the his media coverage after a damaging news cycle that his aides have privately admitted was self-inflicted.

Officials have also said that they were skeptical that Mr. Trump would fully retreat from a scenario in which he took questions from reporters.

Officials inside the White House are also discussing replacing Alex M. Azar II, the health and human services secretary, after a string of news reports about the administration’s slow response to the coronavirus and a separate controversy over an ousted department official, two senior administration officials said.

Mark Meadows, President Trump’s new chief of staff, is among the aides considering removing Mr. Azar once the height of the coronavirus crisis abates, the officials said. The discussions were first reported by Politico and The Wall Street Journal.

Two senior administration officials said on Saturday that no imminent changes were planned.

Among the possible replacements are Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, and Dr. Deborah Birx, a key member of the coronavirus task force.

Mr. Trump has become angry with Mr. Azar in recent weeks, after articles in The Washington Post and The New York Times detailed decisions and discussions related to the administration’s response to the coronavirus. Mr. Trump, who has closely followed the coverage, was upset that he was being blamed, while Mr. Azar was portrayed in a more favorable light, aides said, adding that the president was also suspicious that Mr. Azar was trying to save his own reputation at the president’s expense.

Other officials were angry that, after Mr. Azar and other top department officials forced out Dr. Rick Bright, the head of a key drug and vaccine development agency, Mr. Azar told Vice President Mike Pence in front of a crowded task force meeting that Dr. Bright had been promoted.

But on Saturday, the White House issued a full-throated defense of Mr. Azar, calling the rumors false.

“The Department of Health and Human Services, under the leadership of Secretary Azar, continues to lead on a number of the president’s priorities,” Judd Deere, a White House spokesman, said in a statement. “Any speculation about personnel is irresponsible and a distraction from our whole-of-government response to Covid-19.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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