The coronavirus epidemic continued to prompt new travel restrictions and emergency declarations around the world, with the U.S. State Department on Sunday warning citizens against cruise travel and Italy resorting to a massive lockdown affecting millions of people.

The epidemic ravaging northern Italy can be traced to an outbreak at a car parts manufacturer in Germany, according to a study by Italian virologists — findings that are likely to shatter assumptions that German authorities had successfully contained the first major cluster in Europe.

In the United States, the death toll rose to 21 on Sunday to include two more residents of an infection-stricken nursing home. U.S. cases have surpassed 500 and affected more than 30 states, as well as the District of Columbia, where a church rector had the city’s first confirmed infection. Maryland announced two more cases on Sunday, while Virginia reported one more.

With positive cases reported among attendees of major gatherings — including a conservative conference attended by the president — some political organizations have reassessed their plans for large-scale events. But Sen. Bernie Sanders (I-Vt.) said Sunday that he is moving forward with plans to hold campaign rallies ahead of Tuesday’s primaries in six states.

In China, where the outbreak has begun to subside, a hotel in the southeast that served as a quarantine facility for 71 people collapsed late Saturday, killing at least 10 people and trapping scores in the rubble.

Here are the latest developments:

  • U.S. citizens, particularly those with health issues, should not travel by cruise ship, the State Department announced Sunday.
  • Nine patients have now tested positive in the D.C. area.
  • Seventeen of the coronavirus deaths in the country are in Washington state’s King County, where a nursing home outbreak has killed the elderly, strained staff and left families deeply worried.
  • Egypt announced its first coronavirus fatality, a 60-year-old German tourist.
  • After being stuck in limbo for days off the coast of San Francisco, the virus-stricken Grand Princess cruise ship is headed to Oakland, Calif., on Monday to dock, the cruise line said early Sunday.
3:56 a.m.
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Five new likely cases reported in Georgia, Hawaii

Health officials in Georgia and Hawaii reported new likely cases of the coronavirus Sunday, as the number of total cases in the United States continues to climb past 530.

In Georgia, Gov. Brian P. Kemp (R) said that four people in the greater Atlanta area had tested positive for the rapidly spreading virus.

All four — two in Cobb County, one in Cherokee County, and one in Fulton County — tested positive for covid-19, the disease caused by the virus. They have been hospitalized as their test results await confirmation by the Centers for Disease Control and Prevention.

None of the cases are related, Kemp said, and it is unclear how the people contracted the virus. Georgia had previously announced five confirmed cases of the virus, in addition to two other presumptive cases.

In Hawaii, Gov. David Ige (D) announced the state’s second likely case of the coronavirus late Sunday, in an elderly resident of Oahu.

The man had traveled to Washington state, Ige said at a news conference, according to KHON, and began to feel sick on March 2. Upon returning to Hawaii two days later, he went immediately to an urgent care facility and was then hospitalized.

Positive test results for both the Oahu man and Hawaii’s first reported patient are also awaiting CDC confirmation.

3:52 a.m.
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Universities switch to online classes temporarily amid coronavirus fears

Stanford University canceled in-person classes for the final two weeks of the quarter, switching to online instruction amid rising concern about the coronavirus outbreak.

As the coronavirus first reported in China spreads in the United States, several schools have taken this step as a precaution, hoping to avoid further infections on campus.

The University of Washington, which has more than 55,000 students on three campuses, announced Friday that it would switch to virtual classes, and some smaller schools in and near the hard-hit Seattle area, such as Pacific Lutheran University, announced similar plans.

On Sunday, Rice University in Houston canceled in-person classes for the week of March 9 and canceled gatherings of 100 or more people through the end of April. An employee tested positive for covid-19 earlier this week after traveling out of the country, university officials said in issuing the alert.

In New York, where multiple cases have been identified, Columbia University announced Sunday that classes were canceled Monday and Tuesday and that the university strongly discouraged nonessential gatherings of more than 25 people.

The decisions, which affect tens of thousands of students and faculty members, will be closely watched as university leaders grapple with how best to fight the outbreak.

Read more here.

3:04 a.m.
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Three states now have more than 100 coronavirus patients each

Three states now have more than 100 coronavirus patients each as the number of cases in the United States tops 500.

Washington state continued to lead the country in confirmed patients, with public health authorities reporting 136 cases. Two newly announced deaths at a nursing home there pushed the state’s death toll to 18 on Sunday.

California on Sunday announced 114 positive tests, including 14 cases where the infection was transmitted in the community. More than 10,000 people in the state are self-monitoring after returning to the United States through San Francisco International Airport or Los Angeles International Airport, officials said.

New York’s case total reached 106, up 16 from the day before. Announcing the updated numbers at a news conference, Gov. Andrew M. Cuomo (D) slammed the federal government for not doing enough to allow widespread coronavirus testing and said that he would be “nervous” if the state’s patient tally did not increase.

“The more tests we run, the better,” Cuomo said.

2:54 a.m.
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Stocks plunge amid oil price war caused by coronavirus outbreak

Stock futures sank deep into the red Sunday, with the Dow Jones industrial average expected to open as much as 1,200 points down Monday morning, as a new oil war sparked by the coronavirus outbreak sent prices plummeting.

The price of West Texas Intermediate crude, largely used in the United States, fell from about $41 to $32 a barrel Sunday night, a low not seen in four years. Although the tumble should lower prices at the pump for consumers, it is terrible news for stock markets, as well as oil companies and their massive workforces, which could face hard times ahead.

Asian markets plunged on the news, with Japanese stocks falling 4 percent after they opened. Australia’s market declined 5 percent at the open. Meanwhile, the yield on the U.S. 10-year treasury momentarily slipped below .5 percent for the first time in history on Sunday night as investors fled for safe havens.

2:45 a.m.
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Puerto Rico announces first presumptive case of covid-19

Puerto Rico has announced it first presumptive case of covid-19 after an Italian tourist aboard a cruise ship from Fort Lauderdale, Fla., arrived in San Juan and began feeling ill.

Gov. Wanda Vázquez Garced said the 68-year-old woman, who is from northern Italy, showed signs of respiratory distress similar to the virus’s symptoms while aboard the Costa Luminosa vessel. She was treated on board and transported early Sunday from the ship to the emergency room at Ashford Presbyterian Community Hospital in San Juan. The woman and her husband, who is not showing symptoms, were isolated at the hospital.

Last month, the governor put together a task force to prepare for the virus’s arrival but said the U.S. commonwealth did not have any local capacity for testing. Test kits would not be available on the island archipelago for at least another week. The specimen taken from the sick woman will be sent early Monday to the Centers for Disease Control and Prevention in Atlanta for confirmation.

Puerto Rico has experienced an economic crisis that has led to a collapsing health-care system in recent years. Those problems have been aggravated by devastating natural disasters, including Hurricane Maria in 2017 and, more recently, successive powerful earthquakes. As one of the United States’ poorest territories, the island of more than 3 million people has a high prevalence of chronic disease, and more than half the population relies on government assistance for food and health care.

1:31 a.m.
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Virus’s spread in China continues to slow

China on Sunday announced 40 new cases of coronavirus and 22 additional deaths — a sign that the epidemic was continuing to slow in the country where it began.

Daily new infections in China had dropped into double digits Friday for the first time since figures began coming out in January.

As usual, the toll in China was concentrated in Hubei province, the outbreak’s epicenter. Twenty-one of the reported deaths were in Hubei, and 36 of the new cases were in its capital city, Wuhan. But even in Wuhan, Chinese officials have been signaling optimism. The Communist Party boss there said Friday he would begin a citywide “thankfulness education” campaign to encourage people to show their appreciation for leaders helping the country combat coronavirus.

China’s infections total 80,735, while deaths total more than 3,100, the government says.

More than 19,000 coronavirus patients remain in the hospital, with about 5,000 of them deemed critical, health authorities said. The government reports that 58,600 people have recovered and been discharged.

1:30 a.m.
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Cruz, Gosar say they interacted with CPAC patient and will self quarantine

HOUSTON — Sen. Ted Cruz (R-Tex.) and Rep. Paul A. Gosar (R-Ariz.) said Sunday that they interacted with an attendee at last month’s Conservative Political Action Conference who has tested positive for covid-19, the disease caused by the coronavirus.

Cruz said that he shared a brief conversation and handshake with the attendee 10 days ago and that he is not experiencing any symptoms.

I feel fine and healthy,” he said.

According to his statement, Cruz was not required to self-quarantine but will stay at his Texas home “until a full 14 days have passed since the CPAC interaction.”

“Everyone should continue to treat this outbreak seriously and be driven by facts and medical science,” he said.

Gosar, who represents Arizona’s 4th Congressional District, tweeted Sunday evening that he and three of his senior staff members are under self-quarantine after “sustained contact at CPAC with a person who has since been hospitalized" with coronavirus. Gosar said his office will be closed for the week.

Late Saturday, the American Conservative Union announced that a person who attended CPAC less than two weeks ago had tested positive. President Trump, Vice President Pence and other top White House officials had appeared at the four-day event in Maryland.

White House press secretary Stephanie Grisham said neither Trump nor Pence was in “close proximity to the attendee,” but ACU Chairman Matt Schlapp told The Washington Post on Saturday that he had interacted with the infected person at the event. The precise chronology could not be learned, but Schlapp did shake Trump’s hand onstage on the last day of the conference.

12:11 a.m.
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D.C. woman unable to be tested highlights confusion

A story of a D.C. woman who had traveled through the Seoul airport and was unable to access a coronavirus test made the rounds on social media over the weekend, highlighting the confusion many Americans feel about the spread of the virus and who should be tested.

Maggie McDow, 46, of the Forest Hills section of the District, said that, to her alarm, the D.C. Department of Health overruled an emergency room doctor treating her Friday at George Washington University Hospital, preventing her from being tested for the virus. She wrote about the experience in a Facebook post shared widely on Saturday.

“It’s really worrisome to me when a doctor feels you should have a test and someone’s overruling them,” McDow said in a phone interview Saturday while self-quarantined with achiness and chills. “To me, that’s just wrong.”

A top Health Department official said McDow did not qualify for a test because airport exposure, even in a country such as South Korea with community spread of the disease, does not warrant testing. “We bring a different perspective to that single clinical encounter,” said Anjali Talwalkar, senior deputy director for the community health administration at the D.C. Department of Health. She made the comments Saturday evening at a news conference in the District. “An airport is not considered by CDC to be that kind of exposure.”

D.C. Mayor Muriel E. Bowser (D) sought to quell concern about the case.

“I will be very sure that our health department has checked and double checked to make sure that we’re are making the test available to everyone who meets the guidelines,” she said at the news conference. She added that the District would consider contacting people who previously didn’t warrant testing, if the guidelines change.

The situation left McDow frustrated about halfway through a period of self-isolation that kept her away from her 13- and 14-year-old daughters for more than two weeks.

McDow rushed to her flight for a week-long trip to Thailand on Feb. 23. When she arrived on her layover in Seoul, she learned that the worries about the virus had exploded overnight. She quickly bought a face mask during her 1½-hour layover and proceeded to her connection. After a week in Thailand, she began to feel sick on her flight home to Dulles, and in the next few days twice contacted the D.C. Department of Health for guidance, she said.

She said she was told that she was low risk, but finally went to the emergency room at GWU Hospital, where she said a doctor ruled out the flu and other illnesses and wanted to test her for coronavirus, but District health officials refused.

“I didn’t know I should have stayed in Thailand to get better medical care,” McDow said. “We’re supposed to be the best in the world at this. There’s just a false sense of security.”

11:45 p.m.
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Iowa announces first three cases, all passengers aboard cruise ship in Egypt

Iowa officials on Sunday evening announced the state’s first three cases of covid-19.

The patients live in Johnson County and were passengers aboard a cruise ship in Egypt, Gov. Kim Reynolds (R) told reporters at a news conference. One is between the ages of 41 and 60, while the others are between 61 and 80, officials said. Two had underlying health conditions.

The governor’s office said in a news release that none of the three required hospitalization and that all are recovering at home.

“While these are the first cases, it may not be the last and it’s why Iowans must continue to practice safe habits like hand washing and staying home from work when sick,” Reynolds said in the release.

11:09 p.m.
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Pelosi, Schumer call for paid sick leave, unemployment insurance in any stimulus plan

House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) said Sunday that any coronavirus economic stimulus plan from the administration must include paid sick leave and unemployment insurance, among other worker-friendly provisions.

Their statement comes as administration officials are considering a variety of economic responses to the coronavirus, including possibly targeted tax breaks for affected travel and tourism industries.

“We are demanding that the administration prioritize the health and safety of American workers and their families over corporate interests,” Schumer and Pelosi said.

They called for inclusion of paid sick leave; enhanced unemployment insurance; expanded food stamp, school lunch and other nutrition programs; widespread and free coronavirus testing; and anti-gouging provisions.

10:28 p.m.
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Italy provides the first glimpse of a coronavirus lockdown, European-style

ROME — Italy on Sunday implemented a complicated and urgent plan to restrict the movement of about 16 million people, a measure that unleashed confusion about how it could be enforced and whether it would be enough to slow the spread of the coronavirus.

The plan to lock down large swaths of the north was the first major attempt by a democracy during the coronavirus crisis to radically halt the routines of daily life — an effort that will have significant effects on civil liberties. But in the hours before and after the measure became law, people continued to stream out of the northern hubs of Milan and Venice on trains and planes for southern Italy or elsewhere in Europe.

Sunday, then, provided the first glimpse of a coronavirus lockdown, European-style — a test of how the open-borders spirit of this continent might change as countries grapple with the scale and risks of the disease.

Read more here.

10:08 p.m.
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Maryland confirms two more coronavirus cases, bringing state’s total to 5

Two more people have tested positive for the novel coronavirus in Maryland, bringing the state’s total confirmed cases to five, Gov. Larry Hogan (R) tweeted Sunday evening.

The two newly announced patients include a Harford County woman in her 80s and a Montgomery County man in his 60s. Both were infected overseas and were hospitalized, though the man has been released, authorities say.

Health officials do not believe there is a major risk of community exposure or a connection to earlier cases in Montgomery County, meaning the state has no evidence of community transmission.

“We continue to hope for the best, and actively plan for the worst,” Hogan said in a statement. “I encourage all Marylanders to remain calm, but to take this seriously and continue to stay informed.”

Sixty-two tests for the virus have come back negative, the governor said.

Hogan said he would update the public further at 3:30 p.m. Monday, nearly 22 hours after announcing the state’s new cases.

Spokesman Michael Ricci said the governor has a previously scheduled appearance at a conference of firefighters and a noon call about the coronavirus response with Vice President Pence and other governors.

The event will also serve as a bill-signing ceremony for an emergency measure that grants him immediate access to up to $50 million to respond to the crisis. The governor declared a state of emergency late last week as Maryland announced its first positive tests. Nine people have now tested positive in the D.C. region.

9:51 p.m.
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Canada to evacuate citizens on board the Grand Princess cruise ship

TORONTO — Canada will evacuate its citizens from the Grand Princess cruise liner, the country’s foreign ministry said Sunday, after the United States asked its northern neighbor for assistance repatriating Canadians.

“Given our shared border, Canada recognized the importance of working together with the United States to limit the spread of covid-19 within North America and beyond,” said a statement from Global Affairs Canada, referring to the disease caused by the novel coronavirus. “The extent and frequency of interaction amongst cruise passengers and the close quarters found on most cruise ships presents a unique environment where covid-19 can easily spread.”

A government-chartered plane will evacuate the 237 Canadians who are on the ship. The plane will depart San Francisco and arrive at a Canadian military base in Trenton, Ontario, where the passengers will be quarantined for 14 days.

It is not clear when the flight will depart. The ship, which is carrying more than 3,500 people, is expected to dock in Oakland, Calif., on Monday.

More than 50 people in four provinces have tested positive for the novel coronavirus in Canada. Most of the cases are travel-related, but there has been community transmission in British Columbia, where officials declared an outbreak at a long-term care home on Saturday. Several provinces have cases linked to the Grand Princess.

Adrian Dix, the provincial health minister, urged Canadians to reconsider cruises. “There are risks that can’t fully be calculated right now,” he told reporters.

9:38 p.m.
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U.S. can impose lockdown similar to Italy’s on parts of the country, health official says

The United States could follow Italy’s recent plan to restrict a large portion of its population to prevent the new coronavirus from spreading, according to the government’s top health expert.

Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told Fox News’s Chris Wallace on Sunday that it’s possible for the country to implement a policy similar to Italy’s. The boot-shaped country launched a plan early Sunday morning that will limit about 16 million people in much of the northern areas from moving about.

“You don’t want to alarm people, but given the spread we see, you know, anything is possible,” Fauci said. “That’s the reason why we’ve got to be prepared to take whatever action is appropriate to contain and mitigate the outbreak.”

Fauci, a prominent expert on infectious diseases, went on to say that a vaccine that proves to be effective against the novel coronavirus will probably take about a year or a year and half. The comment was in contrast to President Trump’s comments last week that a vaccine could be available within months.

“The test we’re doing right now, getting it into phase one trial, is the fastest we’ve ever done,” Fauci said. “Don’t confuse that with when you can put it in someone’s arm in a deployable way.”

Fauci also clarified who can get tested with the 1.1 million Centers for Disease Control and Prevention kits distributed to nonpublic health labs. Vice President Pence said earlier Sunday anyone seeking a test can get one.

A doctor actually orders the test for a person, Fauci said. He warned the public, especially elderly people and those with underlying health conditions, to distance themselves from crowds or public places. “Above all, don’t get on a cruise ship,” he said. “That is a health issue.”