The U.S. government's foremost infection disease expert says the United States could experience more than 100,000 deaths and millions of infections from the coronavirus pandemic.
Dr. Anthony Fauci, speaking on CNN's "State of the Union" on Sunday, offered his prognosis as the federal government weighs rolling back guidelines on social distancing in areas that have not been as hard-hit by the outbreak at the conclusion of the nationwide 15-day effort to slow the spread of the virus.
"I would say between 100,000 and 200,000 cases," he said, correcting himself to say he meant deaths. "We're going to have millions of cases." But he added "I don't want to be held to that" because the pandemic is "such a moving target."
About 125,000 cases of COVID-19 in the U.S. had been recorded as of Sunday morning, with over 2,100 dead. It is certain that many more have the disease but their cases have not been reported.
Dr. Deborah Birx, head of the White House coronavirus task force, said parts of the country with few cases so far must prepare for what's to come. "No state, no metro area, will be spared," she said on NBC's "Meet the Press."
Most people who contract COVID-19 have mild or moderate symptoms, which can include fever and cough but also milder cases of pneumonia, sometimes requiring hospitalization. The risk of death is greater for older adults and people with other health problems. Hospitals in the most afflicted areas are straining to handle patients and some are short of critical supplies.
The United States has reported more than 2,000 COVID-19 deaths, according to the latest tally from Johns Hopkins University's Center for Systems Science and Engineering (CSSE).
As of 6:40 p.m. on Saturday (2240 GMT), there were more than 121,000 confirmed cases in the United States, with 2,010 deaths, an interactive map maintained by the CSSE showed.
New York state's cases have topped 52,000, followed by states of New Jersey and California, with 11,124 and 5,065 cases respectively, according to the update.
As COVID-19 cases continued increasing, U.S. President Donald Trump floated an idea on Saturday of putting in place an "enforceable quarantine" on travel for some of the hardest-hit areas.
"Some people would like to see New York quarantined because it's a hot spot - New York, New Jersey, maybe one or two other places, certain parts of Connecticut quarantined. I'm thinking about that right now," Trump told reporters at the White House.
"We might not have to do it but, there's a possibility that sometime today we'll do a quarantine - short term," he added.
New York Governor Andrew Cuomo, in an interview with CNN on Saturday, said that he did not believe a possible New York quarantine was legal and that it would be a "federal declaration of war."
"It would be chaos and mayhem," said Cuomo, who has ordered New York residents to stay at home as much as possible. "It's totally opposite everything he's been saying. I don't think it is plausible. I don't think it is legal."
Globally, the number of COVID-19 cases has exceeded 650,000, with more than 30,000 deaths, while nearly 140,000 people have recovered from the disease, according to the latest tally on Saturday.
President Donald Trump backed away from calling for a quarantine for coronavirus hotspots in New York, New Jersey and Connecticut, instead directing Saturday night that a "strong Travel Advisory" be issued to stem the spread of the outbreak.
Vice President Mike Pence tweeted that the CDC was urging residents of the three states "to refrain from non-essential travel for the next 14 days."
The notion of a quarantine had been advocated by governors, including Republican Gov. Ron DeSantis of Florida, who sought to halt travelers from the heavily affected areas to their states. But it drew swift criticism from the leaders of the states in question, who warned it would spark panic in a populace already suffering under the virus.
Trump announced he reached the decision after consulting with the White House task force leading the federal response and the governors of the three states. He said he had directed the Centers for Disease Control and Prevention "to issue a strong Travel Advisory, to be administered by the Governors, in consultation with the Federal Government."
He added: "A quarantine will not be necessary."
New York Gov. Andrew Cuomo, who has criticized the federal government's response as his state became the country's virus epicenter, said roping off states would amount to "a federal declaration of war." Cuomo said the prospect of a quarantine didn't come up when he spoke with Trump earlier Saturday, adding that he believed it would be illegal, economically catastrophic, "preposterous" and shortsighted when other parts of the U.S. are seeing cases rise, too.
"If you start walling off areas all across the country, it would be totally bizarre, counterproductive, anti-American, anti-social," Cuomo told CNN. He added that locking down the nation's financial capital would shock the stock market and "paralyze the economy" at a time when Trump has indicated he's itching to get the economy back on track.
Trump made his initial remarks while on a trip to Norfolk, Virginia, to see off a U.S. Navy hospital ship heading to New York City to help with the pandemic. At the event, he spoke to a sparse crowd at the naval base and cautioned Americans to take virus protections, even though he himself, at 73, is in a high-risk category and among those who have been advised to refrain from all non-essential travel.
The federal government is empowered to take measures to prevent the spread of communicable diseases between states, but it's not clear that means Trump can ban people from leaving their state. It has never been tested in the modern era — and in rare cases when any quarantine was challenged, the courts generally sided with public health officials.
Courts have ruled consistently for years that the authority to order quarantines inside states rests almost entirely with the states, under provisions in the Constitution ceding power not explicitly delegated to the federal government to states. The federal government, though, would have power under constitutional clauses regulating commerce to quarantine international travelers or those traveling state to state who might be carriers of deadly diseases.
Still, "it is entirely unprecedented that governors or the president would prevent people from traveling from one state to another during an infectious disease outbreak," said Lawrence Gostin, a Georgetown University law professor and public health specialist who questioned Trump's ability to order a quarantine on states.
But as Trump traveled to Norfolk, he tweeted: "I am giving consideration to a QUARANTINE of developing "hot spots", New York, New Jersey, and Connecticut. A decision will be made, one way or another, shortly."
"A lot of the states that are infected but don't have a big problem, they've asked me if I'll look at it, so we're going to look at it," Trump said.
When asked about legal authority for quarantine, the incoming White House chief of staff, Mark Meadows, said officials are "evaluating all the options right now."
Administration officials were discussing less-stringent measures as well. One idea under consideration would be to tell residents of the hard-hit areas to isolate themselves and not travel for two weeks, just as the Centers for Disease Control and Prevention has instructed anyone who recently left New York to self-quarantine for 14 days, according to one person familiar with the negotiations who spoke on condition of anonymity to discuss ongoing deliberations.
The measure wouldn't necessarily come with any legal force or penalty, just the hope that people would comply in an effort to try to contain the virus spread.
The governors of Florida, Maryland, South Carolina and Texas already have ordered people arriving from the New York area to self-quarantine for at least 14 days upon arrival. In a more dramatic step, Rhode Island police have begun pulling over drivers with New York plates so that the National Guard can collect contact information and inform them of a mandatory, 14-day quarantine.
Trump said the idea of isolating many in the trio of Democratic strongholds in the Northeast was pushed by DeSantis, one of the president's most outspoken supporters. It came a day after Trump made clear he wanted governors to be grateful when asking for federal support for the pandemic.
Trump said people "go to Florida and a lot of people don't want that. So we'll see what happens." He later clarified it would not affect truckers or people transiting through, and would not affect trade.
Florida is a perennial swing state, and one Trump must win come November — plus he recently moved his residence from New York to Florida. It also has a population of 21 million with a large percentage of old people, who are particularly vulnerable to the virus.
DeSantis confirmed he had spoken with the president about the possibility of a quarantine for the New York City area. Speaking Saturday to reporters, DeSantis said Florida will soon set up a checkpoint along Interstate 95 to screen travelers from that area, similar to one already in place along Interstate 10 to screen people from Louisiana. Many airports in Florida also are screening travelers from certain areas, requiring them to self-isolate for 14 days.
The U.S. leads the world in reported cases with more than 121,000. There were roughly 2,000 deaths recorded by Saturday night, according to John Hopkins University.
New Jersey Gov. Phil Murphy, a Democrat, said he did not talk about quarantining the tri-state area in his recent conversation with Trump, and learned of the president's comments as he walked into Saturday's daily briefing.
"Until further notified we're going to keep doing exactly what we're doing, because we believe the data and the facts are on our side in terms of this aggressive, as aggressive as any American state right now, in terms of social distancing and flattening the curve," he said.
Connecticut Gov. Ned Lamont, also a Democrat, said at a news conference that Trump's words about a quarantine have created a "certain amount of confusion" and that "confusion can lead to panic." He said such a quarantine order would be "impossible to enforce given the spider web of roads" and that he hoped the White House would clarify what it wants.
After speaking in Norfolk, Trump watched as the USS Comfort slowly made its way out of port. The 1,000-bed hospital ship had been undergoing planned maintenance, but was rushed back into service to aid the city.
It is scheduled to arrive Monday at a Manhattan pier days after its sister ship, the USNS Mercy, arrived in Los Angeles to perform a similar duty on the West Coast.
For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, or death. The vast majority of people recover.
For many in the public health and political worlds, Dr. Deborah Birx is the sober scientist advising an unpredictable president. She's the data whisperer who will help steer President Donald Trump as he ponders how quickly to restart an economy that's ground to a halt in the coronavirus pandemic.
Others worry that Birx, who stepped away from her job as the U.S. global AIDS coordinator to help lead the White House coronavirus response, may be offering Trump cover to follow some of his worst instincts as he considers whether to have people packing the pews by Easter Sunday.
In coming days, immunologist Birx will be front and center in that debate along with the U.S. government's foremost infection disease expert, Dr. Anthony Fauci, as well as Vice President MIke Pence. Birx will bring to the discussion what she fondly refers to as her sheet music — data on testing, mortality, demographics and much more.
"What the president has asked us to do is to assemble all the data and give him our best medical recommendation based on all the data," Birx told reporters. "This is consistent with our mandate to really use every piece of information that we can in order to give the president our opinion that's backed up by data."
But will Trump listen?
The president has sent mixed messages on that. He plans to meet with the two doctors and Pence on Monday to review the latest data on the spread of the disease. His administration's original 15-day guidelines promoting social distancing expire Tuesday.
Over a matter of weeks, Trump has veered from playing down the virus threat to warning Americans it could be summer before the pandemic is under control. And in more recent days, he's talked eagerly about having parts of the country raring back by Easter in two weeks.
As the president's message has vacillated, Birx has emerged as one of the most important voices laying out the administration's pandemic response. She has a way of spelling out the implications of the virus to Americans in personal terms while offering reassurances that the administration is approaching the pandemic with a data-driven mindset.
Former Health and Human Services Secretary Kathleen Sebelius, who helped shepherd Birx's ambassadorial nomination through the Senate in the Obama administration, said it's like Birx and Fauci have become a tag team for science in the midst of calamity.
"I can't imagine how complicated it is to have a boss –- if you will — who insists on saying things on a regular basis that are just not true and aren't based on any science," Sebelius said.
In her public comments, Birx has taken pains to avoid publicly contradicting Trump when he's offered some decidedly unscientific riffs, unlike Fauci, a professional mentor, who has been known to push back pointedly.
Instead, her messaging has toggled between providing digestible interpretations of what the data is saying about the spread of the virus and offering relatable pleas to the American public to practice social distancing to help stem the disease.
In recent days, Birx has received praise from Trump backers and pushback from some fellow scientists after she minimized what she called "very scary" statistical modeling by some infectious disease experts.
One study, published this month by Harvard University epidemiologists, found that the need to maintain social distancing remains crucial in the weeks ahead to prevent the American healthcare system from becoming overwhelmed by new cases.
"The scenario Dr. Birx is 'assuring' us about is one in which we somehow escape Italy's problem of overloaded healthcare system despite the fact that social distancing is not really happening in large parts of the US," Marc Lipsitch, a co-author of the study, wrote on Twitter.
Birx also has drawn criticism for asserting that there are still beds in intensive care units and a "significant" number of ventilators available in hospitals around New York City -- the area hardest hit by virus. That message doesn't jibe with the dire warnings of city hospital workers, who in recent days have said they're ill-equipped and in danger of being overwhelmed by patients stricken with the virus.
Birx's friends and colleagues say she is one of the adults in the room who is providing the president with clear-headed advice and giving Americans the information they need to stay safe.
"She's a tough cookie," said Michael Weinstein, who heads the AIDS Healthcare Foundation and got to know Birx professionally after she was named the global AIDS coordinator in 2014. "She's 100% about the data."
In the sea of men in dark suits who have been appearing with Trump for daily briefings, the 63-year-old mother of two with a fondness for colorful scarves stands out. Her seemingly endless scarf collection was even fodder for comedian Paula Poundstone recently on the NPR quiz show "Wait Wait...Don't tell me!"
Birx's resume is impressive: She is a U.S. Army physician and recognized AIDS researcher who rose to the rank of colonel, head of the global AIDS program at the Centers for Disease Control and Prevention, and a rare Obama administration holdover as the State Department's ambassador-at-large leading a U.S. taxpayer-funded worldwide campaign to stop the spread of HIV/AIDS.
Birx has also developed a reputation as a tough boss. Some who fall under her watch at the global effort known as PEPFAR have complained that the leadership of her office has been"dictatorial" and "autocratic," according to a State Department Office of Inspector General audit released earlier this year.
"She has somewhat of a reputation of being a hard task-master," said John Auerbach, head of the nonprofit Trust for America's Health.. "She is incredibly hard-working, someone who was driven and would drive other people to work really hard and to do their best work."
Birx has also been perhaps the most outspoken in calling for Americans to be mindful in how they are interacting with others. And she's made the case in personal terms.
The doctor says she's avoided visiting with her young grandchildren as she practices social distancing, and she's spoken in admiring tones of her two millennial daughters when making the case that younger Americans' actions will play a key role in determining how quickly the country can contain the virus.
She also has spoken of her grandmother living with a lifetime of guilt, because she caught the flu at school as a girl and, in turn, infected her mother — one of an estimated 50 million people worldwide who died in the 1918 influenza epidemic.
"She never forgot that she was the child that was in school that innocently bought that flu home," Birx said of her grandmother.
Birx, who declined to be interviewed for this article, told a Christian TV network popular with Trump's evangelical base that she's confident that the president is, like her, a student of data.
"He's been so attentive to the scientific literature and the details and the data," Birx told CBN. "I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues because in the end, data is data."
An upstate New York doughnut shop is featuring the likeness of the doctor leading the country's battle with coronavirus on its sweet treats.
Donuts Delite in Rochester began selling hundreds of doughnuts with Dr. Anthony Fauci's face, surrounded by white frosting and topped off with patriotic sprinkles.
The exclusive treats have been selling "like crazy" since the store put them on display Monday, according to Nick Semeraro, franchisee of the café.
The shop's decision was inspired by the 79-year-old doctor's straightforward communication style and calm demeanor while he's been advising millions of Americans amid a pandemic.
The infectious disease expert has served as an adviser to every president since Ronald Reagan and President Donald Trump has coined him as a star on his administration's coronavirus task force.
Therefore, putting Fauci's face smack down in the middle of a doughnut felt like an obvious choice for Semeraro.
"We're watching the news like everyone else," Semeraro told the Democrat & Chronicle on Thursday. "He's on TV giving us the facts; you've got to respect that. We're bipartisan, we stay neutral, but you've got to give credit where credit's due."
In addition, the shop hopes this new addition to their menu brings "light to a humbling experience," Semeraro said, and some cheer to customers, "even if it's just while you're wolfing down that doughnut."