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The coronavirus outbreak could kill 100,000 to 200,000 Americans, the U.S. government's top infectious-disease expert warned on Sunday as smoldering hotspots in nursing homes and a growing list of stricken cities heightened the sense of dread across the country.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, made the dire prediction of fatalities on CNN, adding that millions in the U.S. could become infected.

By midafternoon, the U.S. had over 135,000 infections and 2,300 deaths, according to the running tally kept by Johns Hopkins University, though the true number of cases is thought to be considerably higher because of testing shortages and mild illnesses that have gone unreported.

Worldwide, more than 710,000 infections were reported, and deaths topped 33,000, half of them in Italy and Spain, where hospitals are swamped and the health system is at the breaking point.

New York State — where the death toll closed in on 1,000, up by more than 200 from the day before — remained the epicenter of the U.S. outbreak, with the vast majority of the deaths in New York City. But spikes in infections were recorded around the country, not only in metropolitan areas but in Midwestern towns and Rocky Mountain ski havens.

“This is not going to get better soon,” New York Gov. Andrew Cuomo said.

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The virus is moving fast through nursing homes, assisted living facilities and other places that house elderly or otherwise vulnerable people, spreading “like fire through dry grass," Cuomo said.

Since the U.S. saw its first major outbreak of the coronavirus earlier this month — centered at a nursing home in Kirkland, Wash. — a stream of facilities have battled infections among residents and staff.

A week ago, the Centers for Disease Control and Prevention said 147 nursing homes in 27 states had patients with COVID-19. The problem has only worsened since.

In Woodbridge, N.J., an entire nursing home relocated its residents after two dozen were confirmed infected and the rest were presumed to be. In Louisiana, at least 11 nursing homes, largely in the New Orleans area, have reported cases. In Mount Airy, Md., a death linked to the virus was recorded in a home where 66 people were confirmed infected.

Residents' loved ones are being kept away to try to slow the spread of the virus.

“I have a feeling that I very likely may never see my mother again,” said James Preller, whose 94-year-old mother, Ann Preller, is a resident at Peconic Landing, a retirement community near Green Point on New York's Long Island where seven have died in the past two weeks.

Brian Lee of Families for Better Care, an advocacy group for those living in long-term care facilities, said in a nursing home, "when we see an outbreak that's uncontrolled, it's practically a death sentence.” But he also said the way residents are being walled off from the outside world is as much of a concern as the virus itself.

In New York, the virus is overwhelming some of the city's poorest neighborhoods, with data showing high rates of infection in densely packed areas with big non-English-speaking populations.

Dr. Craig Smith, who heads the surgery department at New York-Presbyterian/Columbia University Medical Center, said the hospital will probably be forced into “apocalyptic scenarios” in the coming weeks in which ventilators and intensive care unit beds will need to be rationed.

“Yesterday tried my soul,” he wrote in an online posting.

Worry for the poorest was being echoed around the world.

In India, a lockdown covering the country's 1.3 billion people has put untold numbers out of work and left many families struggling to feed themselves. Tens of thousands in New Delhi were forced to flee their homes, with no way to pay the rent, journeying back to their native villages. Women in saris held babies on their hips. Others toted their belongings in bags normally used for cement.

Prime Minister Narendra Modi apologized for the hardships that the lockdown brought but said, “These tough measures were needed to win this battle.”

Though the U.S. leads the world in reported cases, five other countries have higher death tolls: Italy, Spain, China, Iran and France.

Italy reported more than 750 new fatalities Sunday, bringing the country's total to nearly 10,800. But the number of new infections showed signs of easing, with officials expressing cautious optimism that the most severe shutdown in the industrialized West is showing results.

Italy’s civil protection agency said more than 5,200 new cases were recorded in the last 24 hours, the lowest number in four days, for a total of almost 98,000 infections.

Spain moved to tighten its lockdown and ban all nonessential work as it hit another daily record of almost 840 dead. The country's overall official toll was more than 6,500.

Spain’s health emergencies chief, Fernando Simón, said the number of people in intensive care units keeps rising and hospitals are at their limits in several regions.

“That is why we have to strictly apply the control measures,” he said.

Egypt shut its beaches as cases in the Mideast surpassed 50,000. Police in the Philippines stepped up arrests of quarantine violators, and more tourists were evacuated from Mount Everest and the Indonesian island of Bali.

Poland is considering delaying its May 10 presidential election. Russia ordered borders to close on Monday, Moscow all but confined its 12 million residents to their homes, and the head of the Russian Orthodox called on believers to stay away from churches and pray at home instead.

A prominent French politician with the virus died, the country's first death of a senior official.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But for others, especially older adults and people with existing health problems, the virus can cause more severe illness, including pneumonia, and lead to death.

About 150,000 people have recovered, according to Johns Hopkins.

President Trump on Saturday backtracked on a threat to quarantine New York and neighboring states amid criticism and questions about the legality of such a move. But the CDC issued a travel advisory urging all residents of New York City and others in New York state, New Jersey and Connecticut to avoid all nonessential travel for 14 days.

Shocking as that is for Americans, that stopped short of the restrictions imposed in Europe or elsewhere. Parisians are fined if they try to leave the city, South Africans can't even buy liquor, and Serbians are upset over a ban on walking their dogs. In Italy, burials are being held with only one family member.

Some U.S. states began to try to limit exposure from visitors from harder-hit areas. Rhode Island National Guard troops went door to door in coastal communities to find New Yorkers. Florida is setting up checkpoints to screen visitors from Louisiana.

As others tightened controls, China continued to ease its restrictions, following the ruling Communist Party’s declaration of victory over the coronavirus. Flights from Hubei province at the epicenter of the country's outbreak resumed Sunday.

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The coronavirus outbreak could kill 100,000 to 200,000 Americans, the U.S. government's top infectious-disease expert warned on Sunday as smoldering hotspots in nursing homes and a growing list of stricken cities heightened the sense of dread across the country.


Fauci predicts 100K-200K coronavirus deaths in U.S.

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