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Britain Changing Protocols to Combat Virus Variant

A vaccination center in London in April. The British authorities are considering reintroducing local lockdowns to stem the spread of a coronavirus variant first detected in India.
A vaccination center in London in April. The British authorities are considering reintroducing local lockdowns to stem the spread of a coronavirus variant first detected in India.Credit…Justin Tallis/Agence France-Presse — Getty Images

LONDON — Prime Minister Boris Johnson of Britain said on Friday that vaccination protocols would be changed to swiftly deliver second doses to people over 50 to combat the spread of a coronavirus variant first detected in India, a warning sign for countries that are easing restrictions even though their own vaccination campaigns are incomplete.

“We believe this variant is more transmissible than the previous ones,” Mr. Johnson said at a news conference. What remained unclear, he said, was by how much. The infectiousness of the variant, known as B.1.617, remains the subject of intense study and some leading experts have said it is too early to assess its transmissibility.

If it proves significantly more transmissible, Mr. Johnson said, “we face some hard choices.” He added that there was no evidence that the variant was more likely to cause serious illness and death, and that there was no evidence to suggest vaccines were less effective against the variant in preventing serious illness and death.

While he said that England would not delay plans to ease restrictions on Monday, before a full reopening in June, he warned that the variant could force a change of course.

The numbers of cases involving B.1.617 rose to 1,313 cases this week in Britain from 520 last week, according to official statistics.

The extent to which the variant has spread globally is unclear, because most countries lack Britain’s genomic surveillance abilities. That ability has allowed Britain to spot the rise of concerning variants quickly, offering an early warning system of sorts, since a variant seen in one nation almost invariably pops up in others.

The B.1.617 variant has been found in virus samples from 44 countries and was designated a variant of concern by the World Health Organization this week, which means there is some evidence that it could have an impact on diagnostics, treatments or vaccines and needs to be closely monitored.

Most cases detected in Britain are in northwestern England. The focus has been on Bolton, a town of nearly 200,000 that has one of the country’s highest rates of infection and where health officials have warned of widespread community transmission of B.1.617. Some cases have also been reported in London. That rapid spread has led officials to debate speeding up dosing schedules and opening up access to shots in hot spots to younger age groups.

In Scotland, Nicola Sturgeon, the first minister, said on Friday that plans to ease restrictions in Glasgow would be delayed at least a week out of concern about an uptick in cases that officials said might be driven by the variant.

Much is unknown about the new variant, but scientists fear it may have driven the rise of cases in India and could fuel outbreaks in neighboring countries.

Dr. Maria Van Kerkhove, the technical lead of the W.H.O.’s coronavirus response, said a study of a limited number of patients, which had not yet been peer-reviewed, suggested that antibodies from vaccines or infections with other variants might not be quite as effective against B.1.617. The agency said, however, that vaccines were likely to remain potent enough to provide protection from serious illness and death.

British officials have said the variant appears to be even more contagious than the B.1.1.7 variant, which was detected last year in Kent, southeast of London, and swept across Britain in the winter, forcing the country into one of the world’s longest national lockdowns. The B.1.1.7 variant has now been found in countries around the world.

In the United States, the B.1.1.7 variant has become the predominant version of the virus, now accounting for nearly three-quarters of cases. But the U.S. surge experts had feared ended up a mere blip in most of the country. The nationwide total of daily new cases began falling in April and has now dropped more than 85 percent from the horrific highs of January.

Britain’s speedy vaccine campaign saved at least 11,700 lives and prevented 33,000 people from becoming seriously ill in England, according to research released by Public Health England on Friday.

Infections, serious illness and deaths have plummeted across Britain. Only 17 deaths were reported on Friday.

But the vaccination campaign has slowed since last month because of supply shortages and the need to start distributing second doses. The number of daily first doses on average last month was 113,000, far below the average of 350,000 daily doses administered in March. Only those over 38 are currently eligible.

Correction: 

An earlier version of this item misstated the affiliation of Christina Pagel, a science adviser. Ms. Pagel is a member of Independent SAGE, a group of expert advisers unaffiliated with the government. She is not a member of SAGE, a panel of government advisers.

A tour group in Manhattan the day after the federal guidance changed mask guidance for vaccinated people. New York said Thursday it was reviewing the recommendations.
A tour group in Manhattan the day after the federal guidance changed mask guidance for vaccinated people. New York said Thursday it was reviewing the recommendations.Credit…Benjamin Norman for The New York Times

Minnesota’s statewide mask mandate is over. But in Minneapolis, the state’s largest city, face coverings are still required.

In Michigan, Kentucky and Oregon, governors cheerily told vaccinated people that they could go out maskless. But mask mandates remained in force for New Yorkers, New Jerseyans and Californians.

So unexpected was new federal guidance on masks that in Kansas City, Mo., Mayor Quinton Lucas went from saying he would not change his mask order, to saying he would think about it, to announcing that he was getting rid of it altogether, all in the span of about seven hours.

Across the country, governors, store owners and people running errands were scrambling on Friday to make sense of the abrupt change in federal guidelines, which said fully vaccinated people could now safely go most places, indoors or outdoors, without a mask.

At least 20 states that still had mask mandates in place this week said by Friday evening that they would exempt fully vaccinated people or repeal the orders entirely, while at least five others with mask requirements had not announced any changes. The rapidly changing rules brought an end to more than a year of mandatory masking in much of the country, even as some said they were not yet ready to take off their face coverings.

“I’m going to wear a mask for a long time to come,” said Fanny Lopez, 28, who was grocery shopping in San Antonio on Friday morning while wearing a black cloth mask. “I trust the mask more than the vaccine. The government messages are confusing, telling us to wear a mask one day and the next day no.”

The sudden shift in public health advice resonated at every level of government, from City Hall in Hartsville, S.C., where a local mask mandate was allowed to expire, to Nevada’s Gaming Control Board, which said it was not practical “to attempt to enforce a mask mandate tethered to an individual’s vaccination status,” to the U.S. Capitol, where the attending physician said House members would still have to cover their faces on the floor of the chamber.

But the shift was perhaps most challenging for governors and big-city mayors, many of whom have expended significant political capital on mask orders in the face of protests and lawsuits, and who were not given a heads-up about the change in federal policy before it was announced on Thursday.

Mayor Lucas said he could not keep Kansas City’s order in place since there was no easy way to differentiate people who are fully vaccinated — now 36 percent of Americans — from the 64 percent who are not.

“While I understand the C.D.C.’s theory that they could just create a rule that says vaccinated folks go anywhere without a mask, and everybody else who’s unvaccinated will follow it, I don’t know if that’s the type of rule that was written in coordination with anyone who has been a governor or a mayor over the last 14 months,” said Mr. Lucas, a Democrat.

The new guidance from the Centers for Disease Control and Prevention, which came amid a steep drop in new cases and an expansion of vaccine eligibility to everyone 12 and older, signaled a shift toward pre-pandemic social norms, when no one thought twice about buying groceries or sitting down in their cubicle with a bare mouth and nose. Walmart announced on Friday that fully vaccinated employees and customers would no longer need to wear masks, and Costco issued a similar announcement.

“At least 20 times today I kept grabbing my short pockets looking for my face mask,” said Erik Darmstetter, who is fully vaccinated and owns Office Furniture Liquidations in San Antonio. “It wasn’t there. I keep forgetting we don’t need it anymore.”

Others were moving more slowly. Gov. Phil Murphy of New Jersey, a Democrat, said he would keep his state’s mask mandate in place, writing on Twitter that “we’re making incredible progress, but we’re not there yet.” And Gov. Charlie Baker of Massachusetts, a Republican, indicated he would revisit his state’s rules next week, but he did not announce any immediate changes.

When asked on Friday about how the C.D.C.’s guidelines would affect Mr. Biden’s executive order requiring masks on federal property, Jen Psaki, the White House press secretary, said at a news conference that it “may take a couple of days” to adopt the agency’s advice. She added that there are no plans to change the federal order mandating masks on public transportation.

On the question of possible vaccine passports, Ms. Psaki said the administration was prioritizing remained focused on the vaccination campaign, and that the administration was “not currently considering federal mandates,” and did not have plans to change its approach.

“We also understand that private sector companies may decide that they want to have requirements. That’s up to them to make that determination,” she said.

Administering a coronavirus shot during a vaccination day for homeless people in Montevideo, Uruguay, on Thursday.
Administering a coronavirus shot during a vaccination day for homeless people in Montevideo, Uruguay, on Thursday.Credit…Raul Martinez/EPA, via Shutterstock

BUENOS AIRES — For most of the past year, Uruguay was held up as an example for keeping the coronavirus from spreading widely as neighboring countries grappled with soaring death tolls.

Uruguay’s good fortune has run out. In the last week, the small South American nation’s Covid-19 death rate per capita was the highest in the world, according to data compiled by The New York Times.

As of Wednesday, at least 3,252 people had died from Covid-19, according to the Uruguayan Health Ministry, and the daily death toll has been about 50 during the past week.

Six out of the 11 countries with the highest death rates per capita are in South America, a region where the pandemic is leaving a brutal toll of growing joblessness, poverty and hunger. For the most part, countries in the region have failed to acquire sufficient vaccines to inoculate their populations quickly.

Contagion rates in Uruguay began inching up in November and soared in recent months, apparently fueled by a highly contagious variant first identified in Brazil last year.

“In Uruguay, it’s as if we had two pandemics, one until November 2020, when things were largely under control, and the other starting in November, with the arrival of the first wave to the country,” said José Luis Satdjian, the deputy secretary of the Health Ministry.

The country with the second-highest death rate per capita is nearby Paraguay, which also had relative success in containing the virus for much of last year but now finds itself in a worsening crisis.

Experts link the sharp rise in cases in Uruguay to the P.1 virus variant detected in Brazil.

“We have a new player in the system and it’s the Brazilian variant, which has penetrated our country so aggressively,” Mr. Satdjian said.

Uruguay closed its borders tightly at the beginning of the pandemic, but towns along the border with Brazil are effectively binational and have remained porous.

The outbreak has strained hospitals in Uruguay, which has a population of 3.5 million.

On March 1, Uruguay had 76 Covid-19 patients in intensive care units. This week, medical professionals were caring for more than 530, according to Dr. Julio Pontet, president of the Uruguayan Society of Intensive Care Medicine who heads the intensive care department at the Pasteur Hospital in Montevideo, the capital.

That number is slightly lower than the peak in early May, but experts have yet to see a steady decline that could indicate a trend.

“It is still too early to reach the conclusion that we’ve already started to improve, we’re in a high plateau of cases,” Dr. Pontet said.

Despite the continuing high number of cases, there is optimism that the country will be able to get the situation under control soon because it is one of the few in the region that has been able to make quick progress on its vaccination campaign. About a quarter of the population has been fully immunized.

“We expect the number of serious cases to begin decreasing at the end of May,” Dr. Pontet said.

A man in Los Angeles being vaccinated in March. The C.D.C. released a study on Friday providing more evidence that the vaccines are working well in real world settings.
A man in Los Angeles being vaccinated in March. The C.D.C. released a study on Friday providing more evidence that the vaccines are working well in real world settings.Credit…Allison Zaucha for The New York Times

The Pfizer-BioNTech and Moderna coronavirus vaccines are 94 percent effective at preventing symptomatic Covid-19 illness, according to a new study of more than 1,800 health care workers in the United States.

The research, which the Centers for Disease Control and Prevention released on Friday, provides yet more evidence that the vaccines are working well even outside controlled clinical trials.

“This report provided the most compelling information to date that Covid-19 vaccines were performing as expected in the real world,” Dr. Rochelle Walensky, the C.D.C. director, said in a statement on Friday.

“This study, added to the many studies that preceded it, was pivotal to C.D.C. changing its recommendations for those who are fully vaccinated against Covid-19.”

The findings are based on an ongoing study of health care workers in 25 states. This interim analysis included data on 1,843 health care workers who were routinely tested for infection with the coronavirus. More than 80 percent of participants were female.

Some 623 workers tested positive between January and mid-March. Those who were fully vaccinated were 94 percent less likely to develop symptomatic coronavirus infections than their unvaccinated peers, the researchers found. The figures are consistent with the efficacy estimates from the clinical trials.

The scientists also found that a single dose of the two-shot regimen was 82 percent effective at preventing symptomatic infection. That figure is higher than has been reported in other studies and may be a result of the relative youth of the study participants, who had a median age of 37 to 38. Fewer than 2 percent were 65 or older.

C.D.C. scientists had previously found that fully vaccinated health care, frontline and essential workers were 90 percent less likely to contract the coronavirus. Those findings helped allay fears that vaccinated people might still be likely to carry the virus, even asymptomatically, and spread it to others.

The concern was one of the main rationales for asking vaccinated Americans to continue to wear masks, a recommendation that the C.D.C. lifted on Thursday.

global roundup

Maj. Gen. Dany Fortin, right, with Prime Minister Justin Trudeau of Canada in Ottawa in December.
Maj. Gen. Dany Fortin, right, with Prime Minister Justin Trudeau of Canada in Ottawa in December.Credit…Sean Kilpatrick/The Canadian Press, via Associated Press

The senior military commander who was appointed by Prime Minister Justin Trudeau of Canada last fall to oversee the distribution of Covid-19 vaccines in the country has quit that post and is now the subject of a military investigation, officials said late Friday.

In a brief, joint statement, the Department of National Defense and the Canadian Armed Forces announced Maj. Gen. Dany Fortin’s resignation but offered no details about the nature of the investigation. The department declined to comment.

Before General Fortin became Canada’s vaccine coordinator, he led military missions to help workers in long-term care homes that were overwhelmed by Covid infections. He is a former commander of the NATO mission in Iraq.

General Fortin is now the third senior leader in the Canadian Armed Forces under scrutiny. Adm. Art McDonald stepped aside as chief of the defense staff, the country’s top military job, in February after the military police opened an investigation into unspecified accusations against him. The same month, the military police also began investigating the previous chief of the defense staff, Gen. Jonathan Vance, who held the post until his retirement from the army in January.

General Vance has been accused publicly of inappropriate behavior toward female subordinates. He has denied wrongdoing.

In other news, compiled with the help of wire services:

  • Japan said that as of Sunday, three more prefectures — Hokkaido, Okayama and Hiroshima — would be included in a state of emergency declaration that was already in force in Tokyo and five other prefectures, and which is scheduled to last until at least the end of May. The designation, under which people are asked to stay home except to run essential errands, was put in effect to control a fourth wave of coronavirus infections and has cast further doubt on Japan’s ability to safely host the Tokyo Summer Olympics in July.

  • China’s sports administration is putting an end to attempts to climb Mount Everest from its north face this spring, citing concern about the coronavirus, the official Xinhua news agency reported on Saturday. The agency said there was a need to “ensure absolutely no missteps,” apparently reflecting worries that climbers in Nepal, where infections are surging, could bring the virus to the top of the world’s highest mountain from the other side. The announcement came a few days after the authorities in Tibet, a region of China, said they would enforce a “zero contact strategy” to ensure there were no transmissions from climbers on the Nepal side of the mountain.

  • Indonesia halted the distribution of a batch of AstraZeneca vaccines on Sunday to test their safety and help investigate whether a dose contributed to the death of a 22-year-old Jakarta man. The batch of 448,000 doses was part of a shipment of more than 3.8 million doses that Indonesia received from Covax, an international vaccine-sharing program, in late April. The man died on May 6, a day after he was inoculated. He was reported to be feverish and weak after receiving the vaccine. The cause of death has not been determined, and health officials have said that further investigation was necessary to determine whether the vaccine was a contributing factor. The ministry said that it would take about two weeks to conduct safety tests and that halting distribution of the batch was “a form of caution by the government to ensure the safety of this vaccine.”

  • Portugal’s Interior Ministry said on Saturday that the country would allow tourist flights from European Union countries with low infection rates and from Britain, but passengers must present a negative virus test on arrival. A day earlier, the country also gave British tourists approval to enter Portugal beginning Monday.

  • Venezuela has approved the use of Russia’s single-dose Sputnik Light Covid vaccine, according to the Russian Direct Investment Fund after using the two-dose version successfully. Sputnik Light was authorized for emergency use in Russia, with an announced efficacy of 79.4 percent.

  • Restaurants, bars and pubs reopened for the first time in seven months in Poland, and masks are no longer required outside. The reopening is limited to outdoor consumption of food and drinks, but indoor dining is expected to be allowed by the end of the month.

Disinfecting seats at a Covid-19 testing site in Taipei on Saturday.
Disinfecting seats at a Covid-19 testing site in Taipei on Saturday.Credit…Ritchie B Tongo/EPA, via Shutterstock

Taiwan, which has had remarkable success in containing the coronavirus, raised restrictions for its main city to their highest level since the start of the pandemic on Saturday, after reporting a daily record of 180 new locally transmitted infections.

Taiwan’s current outbreak — its worst yet by far — began in late April with a cluster in airline workers. Saturday’s caseload represented more than half of the 344 locally transmitted cases that the self-governing island has recorded during the entire pandemic.

The Taiwanese premier, Su Tseng-chang, and other officials told reporters on Saturday that masks and other medical supplies to fight the outbreak were plentiful. Mr. Su urged Taiwanese to be “obedient, helpful and protect yourselves, your families, all of society and our country.”

The government raised the restrictions in the city of Taipei to Level 3 out of 4, still short of a full lockdown. Even so, the announcements sent a shiver of anxiety through Taipei, and some residents filed into supermarkets to stock up on food, toilet paper and other essentials.

“I felt a bit panicky in recent days because of the surge of cases,” said Chen Mei-ling, 58, a retired high school teacher who stood in a long line at a Taipei supermarket. “It seems that the pandemic will last for a while and we can’t expect a virus-free environment in the near future.”

The restrictions in Taipei and adjoining New Taipei City include a ban on indoor gatherings of more than five people and require the use of protective masks outdoors. Many public venues across the island will be closed, except for essential facilities like hospitals and police stations.

Taiwan has for decades been at loggerheads with China, which considers the island democracy to be a breakaway region that must accept eventual reunification. The Taiwanese government took swift measures to prevent the spread of the coronavirus from China early last year, even before the Chinese authorities confirmed that it was highly infectious.

Coronavirus test samples being readied for processing and eventual genomic sequencing at Duke University.
Coronavirus test samples being readied for processing and eventual genomic sequencing at Duke University.Credit…Pete Kiehart for The New York Times

On Dec. 29, a National Guardsman in Colorado became the first known case in the United States of a contagious new variant of the coronavirus.

The variant, called B.1.1.7, had roiled Britain, was beginning to surge in Europe and threatened to do the same in the United States. And although scientists didn’t know it yet, other mutants were also cropping up around the country. They included variants that had devastated South Africa and Brazil and that seemed to be able to sidestep the immune system, as well as others homegrown in California, Oregon and New York.

This mélange of variants could not have come at a worse time. The nation was at the start of a post-holiday surge of cases that would dwarf all previous waves. And the distribution of powerful vaccines made by Moderna and Pfizer-BioNTech was botched by chaos and miscommunication. Scientists warned that the variants — and B.1.1.7 in particular — might lead to a fourth wave, and that the already strained health care system might buckle.

That didn’t happen. B.1.1.7 did become the predominant version of the virus in the United States, now accounting for nearly three-quarters of all cases. But the surge experts had feared ended up a mere blip in most of the country. The nationwide total of daily new cases began falling in April and has now dropped more than 85 percent from the horrific highs of January.

Experts still see variants as a potential source of trouble in the months to come — particularly one that has battered Brazil and is growing rapidly in 17 U.S. states. But they are also taking stock of the past few months to better understand how the nation dodged the variant threat.

They point to a combination of factors — masks, social distancing and other restrictions, and perhaps a seasonal wane of infections — that bought crucial time for tens of millions of Americans to get vaccinated. They also credit a good dose of serendipity, as B.1.1.7, unlike some of its competitors, is powerless against the vaccines.

At a bookstore in San Francisco in March. Until the pandemic, there had seldom been a cultural push for mask wearing in the United States.
At a bookstore in San Francisco in March. Until the pandemic, there had seldom been a cultural push for mask wearing in the United States.Credit…Jim Wilson/The New York Times

Once Americans return to crowded offices, schools, buses and trains, so too will their sneezes and sniffles.

Having been introduced to the idea of wearing masks to protect themselves and others, some Americans are now considering a behavior scarcely seen in the United States but long a fixture in other cultures: routinely wearing a mask when displaying symptoms of a common cold or the flu, even in a future in which Covid-19 isn’t a primary concern.

Such routine use of masks has been common for decades in other countries, primarily in East Asia, as protection against allergies or pollution, or as a common courtesy to protect nearby people.

Leading American health officials have been divided over the benefits, partly because there is no tidy scientific consensus on the effect of masks on influenza virus transmission, according to experts who have studied it.

Nancy Leung, an epidemiologist at the University of Hong Kong, said that the science exploring possible links between masking and the emission or transmission of influenza viruses was nuanced — and that the nuances were often lost on the general public.

Changi Airport in Singapore this week. The airport outbreak began with an 88-year-old member of the airport cleaning crew who was fully vaccinated but who tested positive for the virus on May 5.
Changi Airport in Singapore this week. The airport outbreak began with an 88-year-old member of the airport cleaning crew who was fully vaccinated but who tested positive for the virus on May 5.Credit…Wallace Woon/EPA, via Shutterstock

SINGAPORE — Singapore said on Friday that it would ban dining in restaurants and gatherings of more than two people to try to stem a rise in coronavirus cases, becoming the latest Asian nation to reintroduce restrictions after keeping the illness mostly in check for months.

The new measures came after the city-state recorded 34 new cases on Thursday, a small number by global standards, but part of a rise in infections traced to vaccinated workers at Singapore Changi Airport.

The airport outbreak began with an 88-year-old member of the airport cleaning crew who was fully vaccinated but who tested positive for the virus on May 5. Co-workers who then became infected later visited an airport food court, where they transmitted the virus to other customers, officials said.

None of the cases linked to the airport outbreak are believed to have resulted in critical illness or death, according to officials.

In all, 46 cases have been traced to the airport, the largest of about 10 clusters of new infections in the country.

“Because we do not know how far the transmission has occurred into the community, we do have to take further, more stringent restrictions,” said Lawrence Wong, co-chair of Singapore’s coronavirus task force. The measures will be in effect for about one month beginning on Sunday.

According to preliminary testing, many of those infected were working in a zone of the airport that received flights from high-risk countries, including from South Asia. Several have tested positive for the B.1.617 variant first detected in India, which the World Health Organization has said might be more contagious than most versions of the coronavirus.

Singapore health officials said that of 28 airport workers who became infected, 19 were fully vaccinated with either the Pfizer or Moderna vaccines, the only two approved for use in Singapore.

“Unfortunately, this mutant virus, very virulent, broke through the layers of defense,” Transport Minister Ong Ye Kung told a virtual news conference on Friday.

Mr. Ong also said that the rise in cases “very likely” means that a long-delayed air travel bubble with Hong Kong would not begin as scheduled on May 26.

Singapore, a prosperous island hub of 5.7 million people, saw an explosion of infections among migrant workers living in dormitories, but a two-month lockdown and extensive testing and contact tracing contained the outbreak. Although Singapore has kept much of its economy open, its vaccination effort has not moved as quickly as many expected: less than one-quarter of the population has been fully inoculated.

Changi Airport, which served more than 68 million passengers in 2019, is operating at 3 percent of capacity as Singapore has paused nearly all incoming commercial traffic. Employees there work under strict controls, wearing protective gear and submitting to regular coronavirus tests.

Singapore joins Japan, Thailand and other Asian countries that have struggled to contain new outbreaks fueled in part by variants. But Paul Ananth Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that the rise in cases was not overly worrying.

“The reason for my optimism is that we now have effective vaccines, better diagnostics, proven treatments and even potential prophylactic agents,” he said. “If these are employed in a targeted approach, it is unlikely that we will end up with the same problems we had last year.”

Workers moved oxygen cylinders for transport at a factory in New Delhi on Sunday. The city has now received enough oxygen to share its supply.
Workers moved oxygen cylinders for transport at a factory in New Delhi on Sunday. The city has now received enough oxygen to share its supply.Credit…Atul Loke for The New York Times

After shortages in oxygen in New Delhi led to scores of people dying in hospitals, officials said there was now enough supply in the Indian capital to start sharing a surplus of the lifesaving gas to needier parts of the country.

For weeks, the New Delhi government appealed to Prime Minister Narendra Modi for a larger share of India’s oxygen reserves, with the battle for air ending up in the nation’s highest court.

On Thursday, just days after receiving the amount it had requested, New Delhi’s second-highest official, Manish Sisodia, said the city’s demand had fallen and its excess supply should be reallocated.

“The number of cases is coming down, hospital bed occupancy is coming down, and demand for oxygen, too, is down,” Mr. Sisodia told The New York Times.

It was an indication that the crisis in the capital might be reaching a peak.

The oxygen shortage in New Delhi began in April and has been linked to dozens of deaths, in and out of hospitals.

Health care facilities and crematories were overwhelmed, and medical professionals and residents were left scrambling for scarce resources.

Thousands of people in the city of 20 million stood in line at oxygen refilling stations, bringing cylinders into hospitals for friends and family or hoarding them at home in case the need arose.

The rise of new coronavirus infections in India has slowed. But, in pattern seen in nation after nation battered by the virus, death rates often plateau a few weeks later. And with the virus spreading in low-income rural areas, the overall crisis shows no sign of abating.

As of Wednesday, the official death toll surpassed 258,000, although experts suspect the true number to be much higher.

As the smoke from New Delhi crematories starts to clear, dozens of bodies have surfaced along the holy Ganges River in the states of Uttar Pradesh and Bihar.

Krishna Dutt Mishra, an ambulance driver in the Bihari village of Chausa, said that poor people were disposing of bodies in the river because the cost of cremations had become prohibitively expensive.

On Friday, the Indian news media showed bodies wrapped in cloth of the saffron color, considered auspicious in Hinduism, buried in shallow graves on the sandy banks of the Ganges River in the Unnao district of Uttar Pradesh.

Priyanka Gandhi, a leader of the opposition Indian National Congress party, called for a High Court investigation, saying that what was happening in Uttar Pradesh was “inhuman and criminal.”

A woman from the Guatemalan Maya community in Lake Worth, Fla., at a Covid vaccine center last month.
A woman from the Guatemalan Maya community in Lake Worth, Fla., at a Covid vaccine center last month.Credit…Saul Martinez for The New York Times

Latino adults in the United States have the lowest rates of Covid-19 vaccination, but among the unvaccinated they are the demographic group most willing to receive the Covid shots as soon as possible, a new survey shows.

The findings suggest that their depressed vaccination rate reflects in large measure misinformation about cost and access, as well as concerns about employment and immigration issues, according to the latest edition of the Kaiser Family Foundation Covid-19 Vaccine Monitor.

Earlier polls had suggested that skepticism about the vaccine was widespread among Latinos, but the latest survey showed that hesitation is declining.

Nearly 40 percent of all the unvaccinated Latinos responding to the survey said they feared they would need to produce government-issued identification to qualify. And about a third said they were afraid that getting the shot would jeopardize either their immigration status or that of a family member.

Their responses also pointed to the importance of community-based access. Nearly half said they would be more likely to be vaccinated if the shots were available at sites where they normally go for health care.

A protest in Utah last year. Some readers expressed hope that the rule change would prompt people to get vaccinated but others worried about “cheaters.”
A protest in Utah last year. Some readers expressed hope that the rule change would prompt people to get vaccinated but others worried about “cheaters.”Credit…Rick Bowmer/Associated Press

Throughout the pandemic, few topics have touched so raw a nerve in the United States as mask wearing. Confrontations have erupted from state capitols to supermarket checkout aisles, and debates raged over whether mask mandates violate First Amendment rights.

The Centers for Disease Control and Prevention provoked a flood of reaction with its announcement on Thursday that Americans who are fully vaccinated may stop wearing masks or maintaining social distance in most indoor and outdoor settings. Here’s a sampling, edited for length and clarity, of how Times readers reacted to the news on Facebook and on our website:

“I think this is a good incentive for the hesitators. Hopefully they’ll want to participate in activities (the ones that require proof of vaccination) maskless, so perhaps this will be an incentive, as they see others in the community enjoying life more.” writes Jerry B., on Facebook.

“Very, very few people have been wearing masks for the past 6 months. Covid is a real risk — I certainly don’t want it — but our cases have dropped precipitously, even with minimal masking. This announcement is welcome — the world will not end if people stop masking,” writes Stephen from Oklahoma City.

“I see the need for this policy change, but I fear that the cheaters — those who are not vaccinated but pretend to be — will be the ruin of us all,” writes Cary in Oregon.

“I have my doubts about the incentivization bit,” writes Andrew from Colorado Springs, Colo. “I figure it will simply mean that suddenly everyone’s been fully vaccinated, true or not. That said, as a double-shotted person, I figure my chances of being taken out by an anti-vaxxer are now less than my chances of being taken out by a texting driver. I’m down with that.”

“What’s to stop anti-masker/anti-vaxxer contrarians from mingling unmasked with the vaccinated population? I have little trust in this,” writes Mary Beth in Santa Fe, N.M.

“I am fully vaccinated and caught Covid anyway. I do think it made my symptoms more mild, but you can bet your bippy I’m going to be wearing my mask when I am out of quarantine.” — writes Jaime P., on Facebook.

What do you think about the guidance? Join the conversation.

Kevin Hayes contributed research.

People receiving oxygen in Delhi last month.
People receiving oxygen in Delhi last month.Credit…Atul Loke for The New York Times

India’s devastating Covid-19 surge has galvanized corporations, nonprofit organizations and individuals in the United States to raise millions of dollars and send medical supplies to assist the nation of 1.4 billion.

But a sweeping change to India’s law governing foreign donations is choking off aid just when the country needs it desperately. It is struggling through a second wave of coronavirus that, since beginning in mid-March, has more than doubled the country’s total confirmed infections to over 24 million and raised the known overall death toll to more than 266,000 — numbers that experts say are vast undercounts.

The amendment, abruptly passed by the government in September, limits international charities that donate to local nonprofits. Almost overnight, it gutted a reliable source of funding for tens of thousands of nongovernmental organizations, or NGOs, which help provide basic health services in India, picking up the slack in a country where government spending in that area totals just 1.2 percent of gross domestic product.

The amendment also prompted international charities to cut back giving that supported local efforts in fields such as health, education and gender.

Newly formed charities are rushing to find NGOs that can accept their donations without tripping legal wires. And nonprofits are being smothered in red tape: To receive foreign funds, charities must get affidavits and notary stamps and open accounts with the government-owned State Bank of India.

“Everyone was caught off-guard,” said Nishant Pandey, chief executive of the American India Foundation, which has raised $23 million for Covid-19 efforts. On May 5, his group wired $3 million to an Indian affiliate to build 2,500 hospital beds. A week later, Mr. Pandey said, the money still hadn’t cleared.

People over 65, who are much more likely than younger people to become seriously ill from Covid, have been a high priority since the U.S. vaccination campaign began. 
People over 65, who are much more likely than younger people to become seriously ill from Covid, have been a high priority since the U.S. vaccination campaign began. Credit…Christopher Capozziello for The New York Times

More than 70 percent of Americans who are 65 or older are fully vaccinated, and 84 percent have received at least one dose, a much higher proportion than for younger Americans, according to federal data. The numbers have surpassed President Biden’s goal of at least partly vaccinating 70 percent of the nation’s adults by July 4.

Some counties have blown far past that threshold, getting shots into more than 90 percent of residents 65 and older and offering an example for other areas where vaccine campaigns have lagged.

Two of the most populous 90-percent-plus counties are Jo Daviess County, Ill., across the Mississippi River from Dubuque, Iowa, and Dane County, Wis., which includes Madison, the state capital.

Elected and health officials in both counties suggested that some of the measures that they have adopted locally, such as expanding access and relying on trusted medical figures to share information about vaccines, were also reflected in the federal government’s strategy to reach those who have not received shots yet after the pace of vaccination has lagged in recent weeks.

President Biden has pushed for tens of thousands of pharmacies to allow people to walk in for their vaccinations, and ordered up pop-up and mobile clinics, especially in rural areas. The administration is also enlisting the help of family doctors and other trusted messengers to build up confidence in the vaccines.

On Thursday, Mr. Biden praised another incentive: The recommendation from the Centers for Disease Control and Prevention that people who have been fully vaccinated can go without masks in most situations.

In Dane County, Joe Parisi, the county executive, said this week that a number of efforts contributed to his county’s success in at least partly vaccinating most of the nearly 78,000 people 65 or over who live in the county. Over 90 percent of that group had been completely vaccinated as of Friday, according to local and federal data.

Officials strove to maximize access to the vaccine. They set up a mass vaccination site in December at the Alliant Energy Center, an arena and exhibition complex in Madison, and have distributed vaccines at health centers, pharmacies and mobile vaccination clinics, according to Morgan Finke, a spokeswoman for the county public health department.

Mr. Parisi said that the county worked with local hospital systems, health care providers, senior care centers and nursing homes to locate homebound people and help them get shots.

They did not encounter much hesitancy. “People wanted the vaccine,” Mr. Parisi said, “that certainly wasn’t the problem with that age group.”

Even so, he said, fostering trust and answering people’s questions are very important, especially now that the most eager recipients are already done. Mr. Parisi said the county partnered with trusted local doctors to spread the word about the vaccines through local news media outlets.

“We tried to share as much information as possible,” Mr. Parisi said, by “providing those voices that are nonjudgmental and can answer questions.”

In Jo Daviess County in the northwestern corner of Illinois, communication and community partnerships also played a major role, Lori Stangl, the county’s director of clinical services, wrote in an email.

Of the roughly 6,000 seniors in the county, 96.7 percent are fully vaccinated as of Friday, according to the C.D.C. Ms. Stangl credited extensive collaboration both within the county and with neighboring counties and states.

“Since Jo Daviess County borders Iowa and Wisconsin, many of our residents were able to receive vaccines there as well,” Ms. Stangl wrote, “especially early on, when our allocations were low.”

Though county leaders celebrate their success with seniors, she wrote, they are mindful that they still have many younger people left to reach. As of Friday, 54.9 percent of the county’s total population had been fully vaccinated, according to the C.D.C.

Times Square, where three people, including a toddler out toy shopping, were shot last Saturday.
Times Square, where three people, including a toddler out toy shopping, were shot last Saturday.Credit…Dakota Santiago for The New York Times

As of the second weekend in May, New York City had recorded 505 shooting victims, the most through that point of any year in the last decade.

The rise began in 2020, and experts say the economic and physical strain of the virus, which disproportionately took lives and jobs from neighborhoods already struggling with such violence, most likely drove the increase.

Those factors are not likely to subside soon, criminologists warn. Fears are growing that gun violence will slow the city’s ability to bounce back from its long lockdown.

Restaurants, stores, offices and theaters will be allowed to open fully May 19. But the cycles of violent retaliation fueled by individual shootings in recent months will be hard to break, said Jeffrey Butts, the director of the research and evaluation center at the John Jay College of Criminal Justice.

“This could be a generation that we have screwed up for some time,” Dr. Butts said.

Other large cities, including Los Angeles and Philadelphia, also reported jumps in gun violence during the pandemic. Chicago, with about a third of the population of New York City, saw 865 shootings by the first weekend of this month, compared with about 550 in 2019 and 650 in 2020.

Sanofi’s headquarters in Paris.
Sanofi’s headquarters in Paris.Credit…Benoit Tessier/Reuters

Sanofi, the French pharmaceutical company, said on Monday that it would move the experimental Covid-19 vaccine it is developing with GlaxoSmithKline into a late-stage trial after the shot produced strong immune responses in volunteers in a midstage study.

The findings are encouraging for a vaccine that has fallen behind in development and has so far disappointed those expecting that it would be crucial in combating the pandemic. If the vaccine can become available in the last three months of this year, as its developers hope, it could still play a central role as a booster shot as well as an initial inoculation in the developing world, where the pace of vaccination is lagging.

The vaccine hit a major setback in December, when its developers announced that it did not appear to work well in older adults and that they would have to delay plans to test it in a Phase 3 trial, the crucial test that will assess the vaccine’s effectiveness.

But the companies modified the vaccine and in February began testing it in a Phase 2 study that included more than 700 volunteers in the United States and Honduras between 18 and 95 years old. Sanofi said the vaccine did not raise any safety concerns and produced a strong immune response across age groups, a finding suggesting it has been successfully tweaked.

Sanofi announced the findings in a statement and said it plans to soon publish the results in a medical journal.

Sanofi and GSK are much more experienced in vaccine development than a number of their rivals that have already won authorization. The two companies used a more established approach than those deployed in other, more swiftly developed Covid vaccines. Their shot is based on viral proteins produced with engineered viruses that grow inside insect cells. GSK is supplying the Sanofi vaccine with an adjuvant, an ingredient used in many vaccines meant to boost the immune response.

Sanofi and GSK’s vaccine was one of six selected for funding from Operation Warp Speed, the Trump administration’s effort to accelerate vaccine development. Last summer, the federal government agreed to give the companies $2.1 billion to develop and manufacture the vaccine, in exchange for 100 million doses once the shot was ready.

Sanofi also has supply deals with the European Union and Canada. It has also agreed to supply 200 million doses to Covax, the program to deliver vaccines to middle- and lower-income countries that has been struggling with a shortfall in expected doses. Sanofi has also announced plans to help manufacture the authorized vaccines made by Pfizer-BioNTech, Moderna and Johnson & Johnson.

Sanofi said its Phase 3 trial of its vaccine would begin in the coming weeks and enroll more than 35,000 adult volunteers around the world. It will test two formulations of the vaccine, one aimed at preventing the original strain of the virus and the other aimed at the B.1.351 variant first seen in South Africa that some vaccines appear to be less effective against.

Su-Peing Ng, Sanofi’s global head of medical for vaccines, told journalists on Monday that the company expected it to be “operationally quite challenging” to enroll unvaccinated participants in the Phase 3 trial as vaccination coverage increases in many nations. Still, she said, vaccine doses were still scarce in many parts of the world, pointing to Latin America and Asia as places where the company may look to enroll volunteers.

The company said that soon after starting the Phase 3 trial it planned to assess whether its vaccine could boost immune responses in people who had been vaccinated months before with authorized vaccines. Those booster studies are expected to enroll volunteers in well-vaccinated parts of the world, including the United States and Europe.

Sanofi and GSK said last year they were preparing to be able to make 1 billion doses annually. Thomas Triomphe, Sanofi’s global head of vaccines, said on Monday that the company’s production this year, if its vaccine were shown to work, would depend on the world’s needs.

The vaccine, he said, has “potential to be a booster of choice for many nations and many different platforms.”

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