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The White House’s coronavirus coordinator on Monday warned that the pandemic could kill as many as 200,000 Americans in even a best-case scenario as state officials intensified their stay-at-home directives — further erasing any hope that the country would have a speedy recovery from the global health crisis.

As deaths across the world from covid-19 climbed above 37,000 and those in the United States rose to more than 2,900, federal and state officials offered grim warnings that the country should expect things to get worse before they get better.

Deborah Birx, the coronavirus coordinator, told NBC News that the United States could record 200,000 deaths even “if we do things together well, almost perfectly.” President Trump, who a day earlier announced that officials would extend their guidance to Americans to practice social distancing through the end of April, said the move was necessary to prevent catastrophe: He now expects that virus-related deaths will not peak for an additional two weeks.

“We could save more than 1 million American lives,” Trump said in a briefing at the White House on Monday. “Our future is in our own hands, and the choices and sacrifices we make will determine the fate of this virus.”

The comments underscored the reality that Americans probably will need to suffer many more weeks of economic and social pain to save lives, and even then, their efforts cannot fully prevent a disaster.

The United States continued to lead the world in confirmed cases, with more than 160,000 officially reported as of Monday evening. Hot spots were popping up across the country, with the crisis accelerating in and around inland cities as cases soared and deaths mounted.

Michigan, which Trump said Monday was “becoming a hotbed,” reported an 18 percent surge in cases from a day earlier, along with more than 50 additional deaths — bringing its total fatalities to 184. Michigan’s nearly 6,500 confirmed cases was the third-highest total in the nation, behind New Jersey (more than 16,600) and New York (more than 66,000).

Michigan Gov. Gretchen Whitmer (D) said that the state’s increase was “to be expected” and that the number of cases will continue rising. Joneigh Khaldun, the state’s chief medical executive, said that Michigan is still in the “early stages” of spread, that cases had not yet peaked and that some hospitals in the state’s southeast region, near Detroit, were “at capacity.”

“We know we’re on the up slope right now of cases,” Khaldun said. “We know our hospitals are going to need more beds. We’re going to need thousands more ventilators, and a lot of people are going to get sick.”

Louisiana Gov. John Bel Edwards (D) announced that the number of infections in the state rose by 485 in the past 24 hours to 4,025 as of noon Monday, and deaths climbed by 34 to 185. Birx warned that all states are moving on the “same curve,” and Anthony S. Fauci, the nation’s top infectious-disease expert, said he expects the virus to recur in the fall — albeit in a more prepared country.

Trump said the United States has administered more than 1 million tests, and Health and Human Services Secretary Alex Azar said authorities are testing 100,000 samples a day.

Locally, Maryland, the District and Virginia joined other states that have issued stay-at-home orders to residents, threatening legal repercussions to those who buck warnings and venture out for nonessential activities. The order from Virginia Gov. Ralph Northam (D) sets a preliminary expiration date of June 10, subject to change. Trump said officials had “talked about” a nationwide stay-at-home order but said Monday it was “pretty unlikely at this time.”

The Dow Jones industrial average, the S&P 500 and the Nasdaq posted strong finishes Monday of 3 percent gains or more, with the Dow gaining nearly 700 points. But the quarter will still mark a historically bad one for the markets.

There was fresh evidence of economic pain when Macy’s, the country’s largest department store chain famous for its Thanksgiving Day parade, announced that it was furloughing most of its U.S. workforce after losing nearly all its sales because of coronavirus-related store closures. The company said it will keep “the absolute minimum workforce” for basic operations, with a focus on its digital business, distribution centers and call centers.

Kohl’s and Gap also announced furloughs of about 80,000 each.

Congress last week approved a $2 trillion stimulus package designed to blunt the impact of the virus, and House Speaker Nancy Pelosi (D-Calif.) told reporters Monday that lawmakers are considering new legislation focused on infrastructure, protections for front-line workers and funding for the District.

Lawmakers learned Monday that one of their own could be in the crosshairs for possibly taking advantage of his position during the crisis.

The Justice Department is investigating stock trades that Sen. Richard Burr (R-N.C.) made as the outbreak began, a person familiar with the matter said Monday. Burr, chairman of the Senate Intelligence Committee, received frequent briefings and reports on the threat of the virus.

In mid-February, Burr sold 33 stocks that he and his spouse held, with an estimated value of between $628,033 and $1.7 million, Senate financial disclosures show. It was the largest number of stocks he had sold in one day since at least 2016, records show. Burr, who has said he did nothing wrong, had asked the Senate Ethics Committee for a review of his stock sales amid uproar about the possible influence of coronavirus briefings.

Pharmaceutical giant Johnson & Johnson announced Monday that the company is moving forward with a lead coronavirus vaccine candidate, with the first human tests projected to begin by September. Testing to demonstrate that vaccines are safe and effective is typically a years-long process, but the company said it anticipates its experimental vaccine could be available under specific “emergency use” authorization by early next year.

More immediately, the Food and Drug Administration gave emergency approval to a Trump administration plan to distribute millions of doses of anti-malarial drugs to hospitals across the country, saying it is worth the risk of trying unproven treatments to slow the disease in seriously ill coronavirus patients.

There have been a few small, anecdotal studies that show a possible benefit of the drugs — hydroxychloroquine and chloroquine — in relieving the acute respiratory symptoms of covid-19 and clearing the virus from infected patients. Health experts warn that the drugs’ well-known side effects — headaches, nausea, vision loss and possible exacerbation of heart problems — could become more common with wider use.

In a Fox News interview Monday, Trump predicted that April would be a “month of achievement,” adding: “We will win, and it’ll be fairly soon.” But health officials suggested that the most imminent achievement would be one of mitigation: keeping enough people well so hospitals have the resources to handle the seriously ill, and building enough capacity to handle overflow.

Trump said during his White House briefing that the federal government plans to distribute hundreds of ventilators across the country, including hard-hit Michigan, New Jersey, Illinois and Louisiana.

California Gov. Gavin Newsom (D) announced Monday that he is creating a “California health corps” to recruit medical students and retired doctors for the front line. In the past four days, he said, hospitalizations in his state have doubled, and the load in intensive care units has tripled.

In New York — which, so far, has been the state hit hardest — Gov. Andrew M. Cuomo (D) said Monday afternoon that more than 1,200 people had died of covid-19, up more than 250 from the day before. He said the number of people hospitalized also continues to increase, though the rate seems to have slowed.

“To me, we’re beyond staggering already,” Cuomo said.

Bracing for the possibility that hospitals might become overwhelmed, two Navy hospital ships made their way to New York and Los Angeles to help take on non-covid patients from institutions that reach their capacity.

At a ceremony Monday morning shortly after the USNS Comfort docked in New York Harbor, New York Mayor Bill de Blasio (D) said at least half of his city’s 8.6 million residents could eventually contract coronavirus, though he said the vast majority of the cases will result in mild symptoms.

Standing in front of the hulking white ship, de Blasio warned that the Comfort’s 1,000 hospital beds represent just a fraction of the city’s medical needs — which he said could reach three times the current 20,000 beds in the city. The New York National Guard deployed a fatality search-and-recovery team to work with the city’s medical examiner to help handle those killed by the virus, authorities said.

“With what we know now, we may have to add 40 USS Comforts, as amazing as that sounds,” de Blasio said.

Cuomo said the state has had trouble acquiring needed medical equipment, especially ventilators, which he said have become far more expensive as hospitals across the country compete to buy them. He urged the nation to look at his state as a glimpse into their future.

“Tomorrow,” Cuomo said, “it’s going to be somewhere else.”

The crisis also continued to reverberate globally.

Italy, which has recorded the most fatalities of any country thus far, reported more than 800 deaths, bringing its total to more than 11,500, officials said Monday. But Angelo Borrelli, who is leading Italy’s coronavirus response, told reporters that Italy had determined that an additional 1,590 had recovered from the virus, the highest number of recoveries since the first case was recorded in February.

The health ministry of Iran, another country struggling with the virus, said that its virus-related death roll had reached more than 2,700, as state media reported unrest inside several of the country’s prisons.

Michael Ryan, executive director of the World Health Organization’s Emergencies Program, said at a news conference that the new covid-19 cases now being recorded probably were the result of exposures two to three weeks ago — meaning there will be a lag in how officials can assess the impact of social distancing and other measures.

He said officials are hopeful that some of the countries hit hardest, particularly Spain and Italy, are nearly to the point of stabilizing. But even after that, he said, there is much to do.

“The question is, how do you go down?” Ryan said. “And going down isn’t just about a lockdown and let go. To get down from the numbers, not just stabilize, requires a redoubling of public health efforts to push down.

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