The U.S. death toll from the coronavirus illness COVID-19 climbed toward 232,000 on Tuesday as American voters headed to the polls to elect a president, and the head of the White House task force created to manage the pandemic issued a dire warning.

Dr. Deborah Birx said in an internal report that the U.S. is entering the “most deadly phase of this pandemic,” explicitly contradicting President Donald Trump, who has recently claimed on numerous occasions that the country is “rounding the corner” on the pandemic, according to the Washington Post.

The Post reported Monday night that Birx issued the internal report earlier in the day, urging “much more aggressive action” and warning that “we are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality.”

“This is not about lockdowns — [i]t hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented,” Birx stated in the report, according to the Post. The memo also reportedly warned against the type of mass gatherings that Trump has been holding around the country in the election run-up. The New York Times independently confirmed the Post’s reporting.

Trump has repeatedly downplayed the severity of the COVID-19 pandemic, saying of late, including in a midday visit on Election Day to his campaign’s headquarters in suburban Virginia, that the U.S. was about to “round the corner” after earlier promises that the virus would “disappear” or “vanish” as if by “miracle.”

The U.S. counted another 93,223 cases of COVID-19 on Monday, according to a New York Times tracker, and at least 533 Americans died. The U.S. leads the world with 9.3 million cases and 231,968 deaths, or about a fifth of the global totals, according to data aggregated by Johns Hopkins University.

In the past week, the U.S. has averaged 85,512 cases a day, up 44% from the average two weeks ago, the tracker shows.

There are currently 48,470 COVID-19 patients in U.S. hospitals, according to the COVID Tracking Project, the highest number since Aug. 11 and up 57% from a month ago.

Birx’s comments echo the sentiments of fellow task-force member Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, who warned at the weekend that “we’re in for a whole lot of hurt” unless drastic action is taken to contain the spread as winter continues. On Sunday, former FDA administrator Dr. Scott Gottlieb told CBS News that “things are getting worse around the country,” specifically warning that Thanksgiving could be an “inflection point” that leads to an even worse situation in December.

Several European countries, facing their own resurgences of the virus after it appeared largely contained during the summer, have reimposed lockdowns, imposed curfews and limited the number of people allowed to gather indoors.

Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and founder of Ariadne Labs, told MarketWatch that it’s “never too late to save another 100,000 lives.” In a wide-ranging interview with MarketWatch’s Jaimy Lee, Gawande said the public needs to pressure the Trump administration on urgent current needs, including working with Congress for testing funding and a consistent message on face masks.

“There are some basic things that can make a huge difference in whether we have another 200,000 deaths by the end of the winter. We could be at half a million deaths by the end of the winter,” he said.

The answer to managing the pandemic has been “really clear,” he said, listing the need for social distancing and not gathering in large numbers. “I think pandemic fatigue has set in,” he said. “But the virus does not care.”

See: Election Day dawns in U.S. as voters choose between Trump and Biden: live blog

In other news:

• Liverpool’s 500,000 residents will be tested for COVID-19 under the U.K. government’s first trial of citywide mass testing, aimed at curbing the spread of the coronavirus by identifying as many infected people as possible, MarketWatch’s Lina Saigol reported. Under the mass-testing program, dubbed “Operation Moonshot,” everyone living and working in Liverpool will be offered repeat COVID-19 testing, whether or not they have symptoms, with hundreds of thousands of new, rapid-turnaround tests deployed. Around 2,000 military personnel will arrive in Liverpool on Thursday to help roll out the program, which starts on Nov. 6. The pilot will involve a mix of existing swab tests and new lateral flow tests, which can provide a result within an hour without the need to use a laboratory.

See also: ‘Au revoir, bon courage!’ Parisians begin Lockdown 2.0 with somber resignation

• German Health Minister Jens Spahn said hundreds of thousands of Germans are in quarantine after testing positive for COVID-19 or coming in contact with someone who has, Reuters reported. Spahn made the comment at his first press briefing since he tested positive, and said he felt humbled and grateful that his symptoms were not worse. Germany has 569,598 confirmed cases of COVID-19, according to the Johns Hopkins data, and 10,262 people have died.

• Belgium has been forced by a surge in coronavirus cases to start air lifting severely ill patients to Germany, the Guardian reported. Belgium has been hit hard by the outbreak and has the second highest death rate per capita in the world, after Peru. With a population of 11 million, Belgium has had 447,355 confirmed cases of the virus and 11,858 fatalities, the Johns Hopkins data show. It has a death rate of 102.76 per 100,000 people, second to Peru‘s death rate of 107.77 per 100,000 people.

• Data released by the Centers for Disease Prevention and Control show that pregnant women are at greater risk of death and severe illness from COVID-19 than women who are not pregnant. The data show that pregnant women are more likely to end up in intensive-care units than nonpregnant women. “This finding might be related to physiologic changes in pregnancy, including increased heart rate and oxygen consumption, decreased lung capacity, a shift away from cell-mediated immunity, and increased risk for thromboembolic disease,” the authors wrote. Pregnant women between 35 and 44 years old were nearly four times as likely to need ventilation and twice as likely to die than nonpregnant women of the same age.

France, Germany Impose Lockdown Measures as Coronavirus Cases Rise

Latest tallies

The number of confirmed cases of COVID-19 worldwide now stands at 47.4 million, the Johns Hopkins data show, and the death toll is 1.2 million. At least 31.4 million people have recovered from COVID-19.

Brazil has the second highest death toll at 160,253 and is third by cases at 5.6 million.

India is second in cases with 8.3 million, and third in deaths at 123,097.

Mexico has the fourth highest death toll at 92,100 and 10th highest case tally at 933,155.

The U.K has 46,943 deaths, the highest in Europe and fifth highest in the world, and 1.1 million cases, or ninth highest in the world.

China, where the disease was first reported late last year, has had 91,461 cases and 4,739 fatalities, according to its official numbers.

What are companies saying?

• AMC Entertainment Holdings Inc.

 reported that 539 of its 600 theaters in the U.S. had reopened in the third quarter. AMC reported a third-fiscal-quarter loss of $905.8 million, or an adjusted $5.70 a share, compared with a net loss of $54.8 million, or an adjusted 55 cents a share, in the year-ago quarter. Revenue plummeted 91% to $119.5 million from $1.32 billion a year ago. Analysts surveyed by FactSet had expected a loss of $4.85 a share on revenue of $84 million. AMC shares are down 70% this year as the company continues to suffer from shuttered theaters across the nation because of the coronavirus pandemic.

• Bausch Health Cos. Inc.

  posted better-than-expected revenue for the third quarter, offsetting weaker-than-expected profit. The former Valeant’s numbers, “clearly demonstrate our recovery from the COVID-19 pandemic is in progress,” said Chief Executive Joseph Papa. Revenue at the company’s core Bausch + Lomb/International segment fell 1% to $1.169 billion, and accounted for about 55% of the overall revenue. Salix sales fell 10% to $496 million, while Ortho Dermatologics sales fell 2% to $144 million. The company is still expecting full-year revenue to range from $7.80 billion to $8.00 billion, compared with a FactSet consensus of $7.9 billion.

See also: COVID-19 drives sales of Newell Brands items like contactless hand sanitizers and iced coffee makers

• USA Today parent Gannett Inc.

  posted a narrower-than-expected net loss for the third quarter and revenue that topped estimates as the company enjoyed a rapid rebound from the second-quarter impact of the pandemic. Revenue rose to $814.5 million from $376.6 million, ahead of the $776 million FactSet consensus. “Our third quarter results showed a significant and rapid rebound from the second quarter impact of the COVID pandemic and economic shut down,” said Chief Executive Michael Reed. The company passed 1 million digital subscriptions in the quarter, up 31% from a year ago. The company also made progress in reducing its debt, selling $100 million of noncore assets and real estate. “We’ll apply the net proceeds of these sales to reduce our total debt outstanding to $1.633 billion. We are targeting another $100 million of debt repayment by early next year and remain focused on refinancing our credit agreement during the first half of 2021, said Reed.

• Johnson Controls International PLC

  the building products company, reported fiscal fourth-quarter profit and revenue that fell, given the effects of the pandemic, but beat expectations and provided an upbeat first-quarter outlook. Sales declined 5.1% to $5.95 billion, but was above the FactSet consensus of $5.67 billion, with building solutions revenue for all geographic regions beating forecasts. For the fiscal first quarter, the company expects adjusted EPS of 39 cents to 41 cents, above the FactSet consensus of 38 cents.

• Sysco Corp.
the provider and distributor of food products to restaurants and other businesses, reported fiscal first-quarter profit and sales that fell from last year as the pandemic weighed on its food service business, but still beat Wall Street expectations with results improving throughout the quarter. Sales dropped 23.0% to $11.78 billion, just above the FactSet consensus of $11.734 billion. U.S. food service sales fell 25.7% to $7.9 billion, and international food service sales declined 25.7% to $2.2 billion. “Although our first quarter 2021 results continue to be impacted by the pandemic, we are pleased with our overall expense management and our ability to produce positive free cash flow and a profitable quarter despite a 23% reduction in sales,” said Chief Executive Kevin Hourican.

• Wayfair Inc.’s stock

  soared after the e-commerce home retailer reported third-quarter earnings that beat expectations. Revenue of $3.84 billion was up from $2.31 billion last year and ahead of the FactSet consensus of $3.66 billion. “Category momentum is vibrant, demand is moving online at an accelerated pace, and we expect the home to be even more important than usual when it comes to celebrating the holidays this year,” said Niraj Shah, chief executive of the company, with people spending more time in their homes during the pandemic. The number of direct customers rose 50.9% to 28.8 million during the quarter. Repeat customers placed 71.9% of orders, or 11.3 million, during the third quarter. And the average order value was $243, down from $252 year-over-year.

Additional reporting by Mike Murphy.

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