Health workers react as people applaud from their houses in support of the medical staff that are working in COVID-19 outbreak in Barcelona, Spain, Monday, March 16, 2020. Spain is restoring border controls and severely restricting who can enter the country. Interior Minister Fernando Grande-Marlaska announced Monday that from midnight only Spaniards or residents in Spain, people who work just across the border or who have a compelling need will be allowed through. For most people, the new coronavirus causes only mild or moderate symptoms. For some it can cause more severe illness. (AP Photo/Joan Mateu)

Health workers react as people applaud from their houses in support of the medical staff that are working in COVID-19 outbreak in Barcelona, Spain, Monday, March 16, 2020. Spain is restoring border controls and severely restricting who can enter the country. Interior Minister Fernando Grande-Marlaska announced Monday that from midnight only Spaniards or residents in Spain, people who work just across the border or who have a compelling need will be allowed through. For most people, the new coronavirus causes only mild or moderate symptoms. For some it can cause more severe illness. (AP Photo/Joan Mateu)

MADRID (AP) — The battle to contain the coronavirus reached new urgency, as more governments locked down borders and ordered new closures and restrictions and pleas went out to funnel masks and ventilators to places struggling with soaring numbers of sick patients.

The growing sense of crisis rocked financial markets Monday, particularly on Wall Street, where the Dow Jones Industrial Average plunged 12.9%. Investors’ fears that the pandemic will throw the economy into a recession sent the market to its worst one-day loss since 1987.

The shift in the battle lines was made clear by tallies showing cases outside China have surpassed those inside it and Spain now has the fourth-most cases in the world. The central Chinese city that was the former epicenter where the viral illness was first detected in December was down to just one new case on Tuesday.

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With the number of cases worldwide topping 181,000, a surge of patients in Madrid’s hospitals fueled worries across Europe of what lies ahead.

“There is no easy or quick way out of this extremely difficult situation,” said Mark Rutte, the prime minister of the Netherlands, in the first televised speech by a Dutch premier since 1973.

Only China, Italy and Iran have more infections than Spain, where the number increased by roughly 20%, to 9,191 and fatalities rose to 309, according to the Spanish Health Ministry. It switched to a new reporting system, so the actual number may be higher.

A somber Rutte told viewers “a large part” of the Netherlands’ 17 million people are likely to contract the virus. So far, 1,413 people have tested positive and 24 have died. The government closed schools, restaurants and bars and banned gatherings of more than 100 people.

Countries from Canada to Switzerland, Russia and Malaysia announced sharp new restrictions on the movement of people across their borders.

“We have a window of time at the moment to slow the spread of the virus,” said Ulrike Demmer, a spokeswoman for Germany’s government, which reversed its earlier insistence that border controls would not work. It imposed new limits on crossings with France, Austria, Switzerland, Denmark and Luxembourg, after German infections increased by more than 1,000 over 24 hours.

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With much-needed ventilators in short supply, the British government asked manufacturers, including automakers Ford and Rolls-Royce, to convert some of their assembly lines to making the life-saving equipment.

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“We are facing what is an unprecedented situation and that is going to require an unprecedented response,” said James Slack, a spokesman for Prime Minister Boris Johnson.

Around the world, fast-changing rules and restrictions tore up the script for daily life. Bars, pubs and restaurants were closed or restricting orders to takeout and delivery. Cemeteries in the Croatian capital restricted attendance at funerals to the closest relatives. U.S. casinos went dark, not just in Las Vegas, but in more than a dozen states.

Malaysia banned travel in and out of the country for two weeks and is allowing only essential services to stay open. France allowed people to leave home only to buy food, go to work, or do other essential tasks, restrictions President Emmanuel Macron said were heightened because people hadn’t complied with earlier guidelines and “we are at war.”

The first confirmed cases of COVID-19 were reported in Somalia, which has one of Africa’s weakest health systems after nearly three decades of conflict between the government and the al-Qaida-linked al-Shabab extremist group.

As the pandemic expanded its reach, China and South Korea were trying to hold their hard-fought gains. China is quarantining new arrivals, who in recent days have accounted for an increasing number of cases, and South Korea starting Thursday will increase screenings of all travelers arriving from overseas.

China on Tuesday reported 21 new cases of the virus, 20 of them imported. Just one new case was confirmed in Wuhan, the Hubei provincial capital where the illness was first detected in late December. The update raised China’s totals to 80,881 cases and 3,226 deaths.

China this week relaxed travel restrictions in Hubei, sending thousands of workers back to long-shuttered factories.

Most of the world’s 78,000 recovered patients are in China. The virus causes only mild or moderate symptoms, such as fever and cough, for most people, but severe illness is more likely in the elderly and people with existing health problems.

In the United States, officials urged older Americans and those with chronic health conditions to stay home, and recommended all group gatherings be capped at 50 people.

Americans returning from abroad encountered chaotic airport health screenings that clearly broke all virus-fighting rules against having packed crowds close together.

School closings in 56 countries kept more than 516 million students home, the United Nations said. New York City joined those ranks Monday, closing a school system with 1.1 million students.

European Commission President Ursula von der Leyen suggested a 30-day ban on people entering the bloc for non-essential travel reasons.

“The less travel, the more we can contain the virus,” she said in a video message.

A number of EU member countries have, so far, resisting such far-reaching controls. But many went ahead with measures to sharply curtail activities inside their borders.

Switzerland’s government declared a state of emergency, ordering shops, restaurants, bars and other facilities shut down. The measures exclude health-care operations as well as supermarkets, but also include entertainment and leisure facilities, which will be closed until April 19.

“We need to do everything possible to slow the advance of the coronavirus,” Swiss President Simonetta Sommaruga said, urging people to practice social distancing and follow government guidelines.

Still, some countries have resisted more stringent measures to contain the virus.

In Britain, bars and restaurants remained open and there was no ban on large events. The prime minister’s spokesman said closing schools hadn’t been ruled out, but “the scientific and medical advice is that that’s not a step which we should be taking at this point in time.”

Italy reported another jump in infections Monday, up more than 3,000 to 27,980. With 2,158 deaths — including 349 more in just the last 24 hours — Italy now accounts for well over a quarter of the global death toll. Cases, however, slowed in Lombardy, the hardest-hit region.

In Spain, a cut in the frequency of commuter trains created considerable crowds during rush hour.

Wearing blue latex gloves, cleaner Mari Carmen Ramírez said she, like many others, couldn’t afford to risk her salary of 950 euros ($1,042) per month.

“I fear the coronavirus, but I fear more not being able to pay the utility bills,” the 55-year-old said. “When this is all over, how are we going to eat?”

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Geller reported from New York. Associated Press writers Mike Corder in Amsterdam, Jovana Gec in Belgrade, Frank Jordans in Berlin, Jill Lawless in London, Colleen Barry in Milan, Italy, Ken Moritsugu in Beijing, Kim Tong-hyung and Hyung-jin Kim in Seoul, South Korea and Eileen Ng in Kuala Lumpur, Malaysia contributed to this report.

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Follow AP coverage of the virus outbreak at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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The Associated Press receives support for health and science coverage from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.