# Coronavirus update: U.S. death toll tops 223,000; rural hospitals are filling and the Dakotas lead the nation by new infections

NBC counted an even higher total, 77,640 new cases based on their analysis, and said it was a record one-day tally.

There are currently 41,010 Americans in hospitals with COVID-19, according to the Covid Tracking Project, the highest level since Aug. 28.

New cases are rising at the fastest clip in the Dakotas and neighboring states, which some say are the result of the Sturgis Motorcycle Rally, an event beloved by bikers that attracted a reported 500,000 to the small South Dakota town in August. At the time of the rally, many were filmed freely mixing in bars, tattoo parlors and restaurants without wearing face masks or social distancing.

While the full extent of the transmission rate from the event is unclear, given the failure to fully trace the contacts of bikers who returned to home states across the nation, the Washington Post said it counted more than 330 cases and at least one death directly linked to the rally, based on a survey of health departments in 23 states that provided the paper with data.

Read: Sturgis motorcycle rally in South Dakota in August linked to more than 250,000 coronavirus cases, study finds

That number is understood to be a vast underestimation of the true tally, since asymptomatic spread often goes undetected and many bikers have not been tested.

South Dakota has six out of 10 of the hot-spot counties in the U.S. identified by the New York Times tracker. South Dakota’s overall hospital system is at about 65% capacity, according to the state health of department. In North Dakota, hospitals are at 88% capacity and in some areas, patients are being sent away.

The problem in rural areas is exacerbated by the fact that so many hospitals in remote areas have shut down in recent years. Since 2005, 174 rural hospitals in the U.S. have closed, according to the Cecil G. Sheps Center for Health Services Research, a unit of the University of North Carolina that tracks the data. Since 2010, 132 rural hospitals have closed, the data shows.

Dr. Esther Choo, an emergency room physician who practices at Oregon Health & Science University in Portland, described the problem in an interview with MarketWatch’s Jaimy lee.

“Sometimes people drive in from rural areas three hours away,” she said. “it’s such a big deal for them to get in. And if they’re getting sicker, the last thing they can do is hop in a car and drive themselves back and they don’t have a family member who can bring them back. And we’re sitting there wondering, ‘the full observation period is to day 10. I don’t have enough hospital beds to keep you.’ And yet I’m worried about sending you home, but the standard of care is really to aggressively send people home.”

On the medical front, Gilead Sciences Inc.
GILD,
+0.58%
 won Food and Drug Administration approval for its Veklury COVID-19 treatment for patients who have been hospitalized with COVID-19 infections.

The antiviral drug, until now called remdesivir, in early May received an emergency use authorization (EUA), which is a less rigorous type of regulatory authorization used during public-health emergencies.

Veklury is the first COVID-19 therapy to receive a full FDA approval during the pandemic and has been considered the standard of care when it comes to treating hospitalized patients since it received emergency authorization.

Read also: Dr. Zeke Emanuel says this is what it will take to fully reopen the U.S.

However, some doctors questioned the approval process, which comes after a batch of mixed data for the drug. A World Health Organization study found the drug had no impact on survival — it does not stop people from dying. At best, it can reduce recovery times in hospitalized patients.

Critics have also questioned why the FDA did not hold an advisory committee meeting to discuss the risks and benefits of the drug. In the traditional FDA approval process, a group of independent clinical experts convene for a public meeting to discuss experimental therapies before an FDA decision. They vote on whether the agency should approve a drug. The FDA isn’t required to follow the committee’s recommendation, but it often does.

See: Trump’s vaccine czar says the first vaccine should be submitted for emergency authorization around Thanksgiving

In other news:

• The EU’s disease control agency warned that transmission levels of COVID-19 in 23 member countries and the United Kingdom were now of “serious concern,” Agence France-Presse reported. All EU countries except Cyprus, Estonia, Finland and Greece fall into that category, according to the European Centre for Disease Prevention and Control’s (ECDC) latest assessment, up from only seven countries a month ago. “The continuing increases in Covid-19 infections… pose a major threat to public health, with most countries having a highly concerning epidemiological situation,” ECDC director Andrea Ammon said in a statement.

• Spanish Prime Minister Pedro Sanchez said Spain’s real total of COVID-19 cases is above 3 million, citing extrapolations from a nationwide antibody study, Reuters reported. Sanchez made the comment at a news briefing. The Johns Hopkins data currently shows Spain with a little more than 1 million cases.

• Chicago Mayor Lori Lightfoot said businesses will have to shut down by 10 p.m. under a new curfew that aims to contain the spread of the virus, CNN reported. The move is an effort to avoid “catastrophic” results later, Lightfoot said during a news conference. “This is a critical moment for us and is really going to determine what we all experience for months to come,” said Lightfoot. “There’s no other option. It doesn’t exist.” The curfew goes into effect Friday and will last for two weeks. Cook County, where Chicago is based, has the third-highest number of confirmed cases of COVID-19 in the nation at 170,039, the Johns Hopkins data shows, while 5,390 people have died.

• The Czech Republic’s health minister is set to lose his job after he was photographed visiting a Prague restaurant in a breach of emergency coronavirus regulations he had put forward in an effort to win the country’s increasingly desperate battle against coronavirus, the Guardian reported. Roman Prymula was photographed without a face mask — another breach of rules — getting into his ministerial car after leaving the Rio restaurant, the paper reported. The Czech Republic has 223,065 confirmed cases of COVID1-19, the Johns Hopkins data show, and at least 1,845 people have died.

Read now:Northern Italy sees resurgence of COVID-19 infections, with hospitalizations rising

Latest tallies

The number of confirmed cases of COVID-19 world-wide now stands at 41.9 million, Johns Hopkins data shows, and the death toll is 1.14 million. At least 28.4 million people have recovered from COVID-19.

Brazil has the second highest death toll at 155,900 and is third by cases at 5.3 million. India is second in cases with 7.8 million, and third in deaths at 117,306.

Mexico has the fourth highest death toll at 87,415 and 10th highest case tally at 874,171.

The U.K has 44,661 deaths, the highest in Europe and fifth highest in the world, and 813,465 cases.

China, where the disease was first reported late last year, has 91,077 cases and 4,739 fatalities, according to its official numbers.

What’s the economy saying?

The U.S. economy expanded in October at the fastest pace in 20 months, a new survey showed, but companies acted cautiously with coronavirus still spreading and the presidential election potentially trigging a major shift in business rules, MarketWatch’s Jeffry Bartash reported.

The IHS Markit PMI indexes for both the service and manufacturing sides of the economy rose in October. The index is compiled from surveys of senior business executives.

The index for services such as health care, technology and hospitality, by far the largest sector of the economy, climbed to 56.0 in October from 54.6 in the prior month. It was the highest level in 20 months.

The index for the smaller but still large U.S. manufacturing sector, meanwhile, edged up to 53.3 from 53.2. That was a 21-month high.

See also:These are the stocks to short when a COVID vaccine is ready, says JPMorgan

What are companies saying?

• American Express Co.
AXP,
-3.51%
reported a third-quarter profit that missed expectations, while revenue topped forecasts. Revenue fell 20% to $8.75 billion, due primarily to declines in card member spending amid the pandemic, but topped the FactSet consensus of $8.66 billion. Provisions for credit losses declined to $665 million from $879 million. “Since the lows of mid-April, we have seen a steady recovery in our overall spending volumes,” said Chief Executive Stephen Squeri. “In fact, we had positive year-over-year growth in non-[travel and expense] spending, which has long accounted for the large majority of our overall volumes.”

• Bloomin’ Brands Inc.
BLMN,
-6.71%
reported third-quarter losses that were narrower than expected during the pandemic. Revenue of $771.3 million was down from $967.1 million last year but ahead of the $753.0 million FactSet consensus. U.S. comparable sales at Outback Steakhouse were down 10.4%, Carrabba’s Italian Grill fell 9% and Bonefish Grill sank 22.5%. Bloomin’ didn’t furlough its workers during the first stages of the pandemic, a decision that David Deno, the company’s chief executive said was “paying off.” “Across the U.S. portfolio, we experienced consistent weekly sales momentum throughout the third quarter as we adapted to this evolving environment,” he said, highlighting that the company was able to hold on to 50% of the off-premise volume it had when restaurants were closed even as dining rooms reopening during the third quarter. Bloomin’ did not provide guidance due to the uncertainty of the pandemic.

• Capital One Financial Corp.
COF,
+2.49%
 reported third-quarter profit and sales above Wall Street expectations. “We are leaning in to resilience and we continue to be well served by the choices we made before the pandemic,” founder and Chief Executive Richard D. Fairbank said in a statement. Capital One earned $2.4 billion, or $5.06 a share, in the quarter, compared with $1.3 billion, or $2.69 a share, in the third quarter of 2019. Adjusted for one-time items, the company earned $5.05 a share. Sales rose to $7.4 billion from $6.7 billion a year ago. Analysts polled by FactSet expected adjusted EPS of $2.14 on sales of $6.7 billion.

• Illinois Tool Works Inc.
ITW,
+2.05%
reported third-quarter profit and revenue that fell, amid the negative impacts of pandemic, but beat Wall Street expectations. Net income declined to $582 million, or $1.83 a share, from $660 million, or $2.04 a share, in the year-ago period. The FactSet consensus for earnings per share was $1.47. Revenue fell 4.9% to $3.31 billion, but was above the FactSet consensus of $2.98 billion. Operating margin declined to 23.8% from 25.0%, weighed down by lower volume and higher restructuring expenses.

See also: Will Intel’s struggles be AMD’s gains?

Related:Intel stock plunges 10% after data-center sales drop more than expected

• Mattel Inc.
MAT,
+10.64%
reported fiscal third-quarter results that blew past Wall Street estimates. Mattel reported net income of $316 million, or 91 cents a share, compared with net income of $70.6 million, or 20 cents a share, in the year-ago quarter. Revenue jumped 10% to $1.63 billion from $1.48 billion a year ago. Analysts surveyed by FactSet had expected net income of 39 cents a share on revenue of $1.465 billion. Mattel shares are down 4% this year as it continues to feel the effects of the pandemic.

• Socket Mobile Inc.
SCKT,
+90.41%,
a maker of bar code scanners, reported a more-than quadrupling in third-quarter profit, although the company warned that results weren’t complete and subject to goodwill impairment. Trading volume ballooned to 5.8 million shares, enough to make the stock the most actively traded ahead of the open, and well above the full-day average of about 308,000 shares. “All numbers that would be negatively impacted by an adjustment to goodwill are asterisked,” the company said. Late Thursday Socket said net income rose to $424,000, or 6 cents a share, from $94,000, or 1 cent a share in the year-ago period. The company said reported net income didn’t include goodwill impairment, because the company and its auditors didn’t complete the annual review in time, citing uncertainties and complications associated the pandemic. Revenue fell 17.5% from last year, but rose 51% from the second quarter, to $4.1 million