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To Speed Vaccination, Some Call for Delaying Second Shots

The prospect of a fourth wave of the coronavirus, with new cases climbing sharply in the Upper Midwest, has reignited a debate among vaccine experts over how long to wait between the first and second doses. Extending that period would swiftly increase the number of people with the partial protection of a single shot, but some experts fear it could also give rise to dangerous new variants.

In the United States, two-dose vaccines are spaced three to four weeks apart, matching what was tested in clinical trials. But in Britain, health authorities have delayed doses by up to 12 weeks in order to reach more people more quickly. And in Canada, which has precious few vaccines to go around, a government advisory committee recommended on Wednesday that second doses be delayed even longer, up to four months.

Some health experts think the United States should follow suit. Dr. Ezekiel J. Emanuel, a co-director of the Healthcare Transformation Institute at the University of Pennsylvania, has proposed that for the next few weeks, all U.S. vaccines should go to people receiving their first dose.

“That should be enough to quell the fourth surge, especially in places like Michigan, like Minnesota,” he said in an interview. Dr. Emanuel and his colleagues published the proposal in an op-ed on Thursday in USA Today.

10 days after the first dose, researchers could see that the volunteers were getting sick less often than those who got the placebo.

In the same month, Britain experienced a surge of cases caused by a new, highly transmissible variant called B.1.1.7. Once the British government authorized two vaccines — from Pfizer-BioNTech and AstraZeneca — it decided to fight the variant by delaying the second doses of both formulations by 12 weeks.

said on Jan. 31 on NBC’s “Meet the Press.”

But the government stayed the course, arguing that it would be unwise to veer off into the unknown in the middle of a pandemic. Although the clinical trials did show some early protection from the first dose, no one knew how well that partial protection would last.

“When you’re talking about doing something that may have real harm, you need empirical data to back that,” said Dr. Céline R. Gounder, an infectious-disease specialist at Bellevue Hospital Center and a member of Mr. Biden’s coronavirus advisory board. “I don’t think you can logic your way out of this.”

But in recent weeks, proponents of delaying doses have been able to point to mounting evidence suggesting that a first dose can provide potent protection that lasts for a number of weeks.

The Centers for Disease Control and Prevention reported that two weeks after a single dose of either the Moderna or the Pfizer-BioNTech vaccine, a person’s risk of coronavirus infection dropped by 80 percent. And researchers in Britain have found that first-dose protection is persistent for at least 12 weeks.

Dr. Emanuel argued that Britain’s campaign to get first doses into more people had played a role in the 95 percent drop in cases since their peak in January. “It’s been pretty stunning,” Dr. Emanuel said.

studies that show that a single dose of Moderna or Pfizer-BioNTech does not work as well against certain variants, such as B.1.351, which was first found in South Africa.

“Relying on one dose of Moderna or Pfizer to stop variants like B.1.351 is like using a BB gun to stop a charging rhino,” said John P. Moore, a virologist at Weill Cornell Medicine.

Dr. Moore said he also worried that delaying doses could promote the spread of new variants that can better resist vaccines. As coronaviruses replicate inside the bodies of some vaccinated people, they may acquire mutations that allow them to evade the antibodies generated by the vaccine.

But Dr. Cobey, who studies the evolution of viruses, said she wasn’t worried about delayed doses breeding more variants. “I would put my money on it having the opposite effect,” she said.

Last week, she and her colleagues published a commentary in Nature Reviews Immunology in defense of delaying doses. Getting more people vaccinated — even with moderately less protection — could translate into a bigger brake on the spread of the virus in a community than if fewer people had stronger protection, they said. And that decline wouldn’t just mean more lives were saved. Variants would also have a lower chance of emerging and spreading.

“There are fewer infected people in which variants can arise,” she said.

Dr. Adam S. Lauring, a virologist at the University of Michigan who was not involved in the commentary, said he felt that Dr. Cobey and her colleagues had made a compelling case. “The arguments in that piece really resonate with me,” he said.

Although it seems unlikely that the United States will shift course, its neighbor to the north has embraced a delayed strategy to cope with a booming pandemic and a short supply of vaccines.

Dr. Catherine Hankins, a public health specialist at McGill University in Montreal and a member of Canada’s Covid-19 Immunity Task Force, endorsed that decision, based on the emerging evidence about single doses. And she said she thought that other countries facing even worse shortfalls should consider it as well.

“I will be advocating at the global level that countries take a close look at Canada’s strategy and think seriously about it,” Dr. Haskins said.

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AstraZeneca Vaccine Faces New Setbacks in U.K. and European Union

LONDON — Britain said on Wednesday that it would curb the use of AstraZeneca’s vaccine in adults under 30 because of the risk of rare blood clots, a blow to the efforts of scores of countries reliant on the vaccine to stamp out the coronavirus pandemic amid a global surge in cases.

Adding to the unease, the European Medicines Agency outlined a “possible link” between the vaccine and rare clots, even as it said that Covid-19 remained the far greater threat, leaving decisions about how to use the vaccine in the hands of the 27 member states of the European Union.

Taken together, the decisions represented a considerable setback for the AstraZeneca shot, which has been seen as the principal weapon in the battle to reduce deaths in the vaccine-starved global south.

The world’s most widely administered coronavirus vaccine, it is far less expensive and easier to store than some of the alternatives, spurring its use in at least 111 countries, rich and poor. AstraZeneca, based in Britain, has promised to deliver three billion doses this year, enough to inoculate nearly one in five people worldwide.

Cameroon and the Democratic Republic of Congo have already delayed injections of AstraZeneca’s vaccine amid mounting concerns in Europe. Any further hesitation, scientists said, could cost lives.

“In developing countries, the dynamic is to either use the vaccine you have, or you have nothing,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London. “In which case, carnage ensues.”

For the vast majority of people, British and European regulators said on Wednesday, the benefits of AstraZeneca’s shot far outweigh the risks. The clotting problems were appearing at a rate of roughly one in 100,000 recipients across Europe. Meanwhile, in Britain, the vaccine has driven down hospitalizations from Covid-19 — which can, itself, cause serious clotting problems — and saved thousands of lives, regulators said.

most people doubted the vaccine’s safety.

Over all, use of the shot has suffered: Across Europe, 64 percent of delivered doses of AstraZeneca’s vaccine have been injected into people’s arms, markedly lower than the rates for other shots.

“One hoped there would have been collaboration, and more discussion, between regulators, instead of lots of different countries going off in all sorts of directions,” Professor Ward said. “That aspect has really been the most unhelpful.”

watch for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.

As of March 22, regulators had carried out detailed review of 86 cases, 18 of which were fatal, they said.

Concerns about the shot became acute enough in Britain this week that the University of Oxford, which developed the vaccine with AstraZeneca, stopped giving doses as part of a two-month-old trial in children.

“Safety has been our priority throughout the development of the vaccine,” Andrew Pollard, the Oxford researcher in charge of the trials, said on Wednesday. The identification of the clots, he added, “shows that the safety system works.”

In the United States, AstraZeneca is preparing to apply for emergency use authorization from the Food and Drug Administration. If and when they take up the application, that agency’s regulators are expected to scrutinize the clotting cases.

The United States, flush with vaccines from three other makers, may not ultimately need AstraZeneca’s shot. But any ruling by the F.D.A. is expected to hold considerable weight in some of the poorer nations that are relying on the shot.

The World Health Organization said a vaccine safety subcommittee had met on Wednesday and noted that “rare adverse events following immunizations should be assessed against the risk of deaths from Covid-19 disease and the potential of the vaccines to prevent infections.” It said that a link with the clotting problems, while “plausible,” had not been confirmed.

For Britain, the AstraZeneca vaccine has become a huge source of national pride, and the backbone of the country’s speedy inoculation program.

Even if younger people are at lower risk from severe Covid-19, scientists have said, inoculating them remains essential to creating enough protection in the population to end the pandemic.

Emma Bubola, Monika Pronczuk and Rebecca Robbins contributed reporting.

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AstraZeneca Vaccine Faces Setbacks in U.K. and European Union

LONDON — Britain said on Wednesday that it would curb the use of AstraZeneca’s vaccine in adults under 30 because of the risk of rare blood clots, a blow to the efforts of scores of countries reliant on the vaccine to stamp out the coronavirus pandemic amid a global surge in cases.

Adding to the unease, the European Medicines Agency outlined a “possible link” between the vaccine and rare clots, even as it said that Covid-19 remained the far greater threat, leaving decisions about how to use the vaccine in the hands of the 27 member states of the European Union.

Taken together, the decisions represented a considerable setback for the AstraZeneca shot, which has been seen as the principal weapon in the battle to reduce deaths in the vaccine-starved global south.

The world’s most widely administered coronavirus vaccine, it is far less expensive and easier to store than some of the alternatives, spurring its use in at least 111 countries, rich and poor. AstraZeneca, based in Britain, has promised to deliver three billion doses this year, enough to inoculate nearly one in five people worldwide.

Cameroon and the Democratic Republic of Congo have already delayed injections of AstraZeneca’s vaccine amid mounting concerns in Europe. Any further hesitation, scientists said, could cost lives.

“In developing countries, the dynamic is to either use the vaccine you have, or you have nothing,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London. “In which case, carnage ensues.”

For the vast majority of people, British and European regulators said on Wednesday, the benefits of AstraZeneca’s shot far outweigh the risks. The clotting problems were appearing at a rate of roughly one in 100,000 recipients across Europe. Meanwhile, in Britain, the vaccine has driven down hospitalizations from Covid-19 — which can, itself, cause serious clotting problems — and saved thousands of lives, regulators said.

most people doubted the vaccine’s safety.

Over all, use of the shot has suffered: Across Europe, 64 percent of delivered doses of AstraZeneca’s vaccine have been injected into people’s arms, markedly lower than the rates for other shots.

“One hoped there would have been collaboration, and more discussion, between regulators, instead of lots of different countries going off in all sorts of directions,” Professor Ward said. “That aspect has really been the most unhelpful.”

watch for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.

As of March 22, regulators had carried out detailed review of 86 cases, 18 of which were fatal, they said.

Concerns about the shot became acute enough in Britain this week that the University of Oxford, which developed the vaccine with AstraZeneca, stopped giving doses as part of a two-month-old trial in children.

“Safety has been our priority throughout the development of the vaccine,” Andrew Pollard, the Oxford researcher in charge of the trials, said on Wednesday. The identification of the clots, he added, “shows that the safety system works.”

In the United States, AstraZeneca is preparing to apply for emergency use authorization from the Food and Drug Administration. If and when they take up the application, that agency’s regulators are expected to scrutinize the clotting cases.

The United States, flush with vaccines from three other makers, may not ultimately need AstraZeneca’s shot. But any ruling by the F.D.A. is expected to hold considerable weight in some of the poorer nations that are relying on the shot.

The World Health Organization said a vaccine safety subcommittee had met on Wednesday and noted that “rare adverse events following immunizations should be assessed against the risk of deaths from Covid-19 disease and the potential of the vaccines to prevent infections.” It said that a link with the clotting problems, while “plausible,” had not been confirmed.

For Britain, the AstraZeneca vaccine has become a huge source of national pride, and the backbone of the country’s speedy inoculation program.

Even if younger people are at lower risk from severe Covid-19, scientists have said, inoculating them remains essential to creating enough protection in the population to end the pandemic.

Emma Bubola, Monika Pronczuk and Rebecca Robbins contributed reporting.

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Covid-19 Live Updates: U.K. to Offer Alternatives to AstraZeneza Vaccine to Adults Under 30

finally over rare, but sometimes fatal, blood clots reported in some recipients.

Those concerns led several European countries to first restrict the use of AstraZeneca in older age groups, then suspend it over reports of blood clots, only to roll it out again last month after the European Medicines Agency issued a preliminary opinion that the benefits of the vaccine outweighed the risks.

As doctors reported a higher incidence of serious blood clots in younger people, some countries decided to stop administering the shot to anyone younger than 55.

Europe’s concerns over the vaccine’s side effects are also likely to threaten global inoculation efforts, with much of the developing world depending on the AstraZeneca vaccine to tackle the pandemic. The shot is the cornerstone of Covax, a program designed to make vaccine access more equitable worldwide.

The vaccine appeared to be causing an immune reaction in which antibodies bind to platelets, activating them, German doctors and the European Medicines Agency have said. Those platelets, in turn, were causing the formation of dangerous clots in certain parts of the body, including in veins that drain blood from the brain, leading in some cases to a rare type of stroke.

Why the antibodies develop in these people is not known, doctors have said. Some component of the vaccine, or excessive immune reaction — or both — could be the cause, they said.

No pre-existing conditions are known to make patients more vulnerable to this clotting disorder after a vaccination, European regulators said.

A mass vaccination event for teachers in Carteret, N.J., this month. About eight million school employees had received at least one vaccine dose by the end of March.
Credit…Bryan Anselm for The New York Times

Nearly 80 percent of school staff and child care workers in the United States have received at least one dose of the coronavirus vaccine, the Centers for Disease Control and Prevention said on Tuesday.

The announcement comes as the Biden administration has made an ambitious push to reopen schools and return to in-person instruction by the president’s 100th day in office. That goal has been tempered by dangerous virus variants, protests from teachers’ unions, and the fears and frustrations of students and parents.

The push to reopen schools has gathered momentum as evidence mounted that proper safety measures limited virus transmission in schools and coronavirus cases fell sharply from their January peak. Education officials and experts have cited the urgency of getting students back in classrooms before the academic year ends.

About eight million teachers, school staff and child care workers received their first vaccine dose by the end of March, according to the C.D.C., with about two million receiving their shot through the Federal Retail Pharmacy Program.

President Biden announced the program in March, urging nationwide access to vaccines for school employees and child care workers. But a hodgepodge of eligibility guidelines followed, as some states chose not to deviate from their rollout plans. By the end of March, however, K-12 educators in all states had become eligible to receive the vaccine.

While the acceleration of vaccinations among educators and staff has reduced the resistance from teachers’ unions to reopening classrooms, school systems with powerful unions, especially on the West Coast, have been slower to revert to in-person instruction.

Union resistance has led a bipartisan group of governors in several states to prod, and sometimes force, school districts to open. The result has been a major increase in the number of students who now have the option of attending school in-person, or will soon.

According to a school reopening tracker created by the American Enterprise Institute, 7 percent of the more than 8,000 districts being tracked were fully remote on March 22, the lowest percentage since the tracker was started in November. Forty-one percent of districts were offering full-time in-person instruction, the highest percentage in that time. Those findings have been echoed by other surveys.

In February, the C.D.C. issued guidelines that said K-12 schools could reopen safely as long as they followed basic health protocols like masking or distancing.

More recently, it said that elementary students and some middle and high schoolers could be spaced three feet apart in classrooms, instead of six feet, as long as everyone was wearing a mask. Unions had used the six-foot guidance to oppose bringing children back for normal schedules.

“Our push to ensure that teachers, school staff, and child care workers were vaccinated during March has paid off and paved the way for safer in-person learning,” Dr. Rochelle Walensky, the center’s director, said in a statement released on Tuesday.

Mr. Biden touted the C.D.C.’s newly released benchmark while visiting a vaccination site in Alexandra, Va., on Tuesday.

“That is great progress protecting our educators and our essential workers,” Mr. Biden said of the new estimate. “And because our vaccine program is in overdrive, we are making it easier to get a vaccination shot.”

The American Federation of Teachers, the nation’s second-largest teacher’s union, on Tuesday released a survey that reported over 80 percent of association members had been vaccinated or had made a vaccine appointment. About 85 percent of members said their school was “operating on at least a part-time basis,” according to the survey.

Randi Weingarten, the federation’s president, said in a statement on Tuesday that “A.F.T. members have embraced vaccines as vital to getting back in the classroom.”

“They want to return, the road map to reopening is robust, and if we instill trust and meet fear with facts we can finally end this national nightmare,” Ms. Weingarten said.

A guest showed her “Excelsior Pass,” with proof of vaccination, on a phone outside the The Shed, a performing and visual arts venue in New York.
Credit…Angela Weiss/Agence France-Presse — Getty Images

Around the United States, businesses, schools and politicians are considering “vaccine passports” — digital proof of vaccination against the coronavirus — as a path to reviving the economy and getting Americans back to work and play.

New York has rolled out “Excelsior Pass,” billed by the state as “a free, fast and secure way to present digital proof of Covid-19 vaccination” in case reopening sports and entertainment venues require proof of attendees’ status.

Walmart is offering electronic verification apps to patients vaccinated in its stores so they “can easily access their vaccine status as needed,” the company said.

But the idea is raising charged legal and ethical questions: Can businesses require employees or customers to provide proof of vaccination against the coronavirus when the vaccine is ostensibly voluntary?

Can schools require that students prove they have been injected with what is still officially an experimental prophylaxis the same way they require long-approved vaccines for measles and polio? And finally, can governments mandate vaccinations — or stand in the way of businesses or educational institutions that demand proof?

Legal experts say the answer to all of these questions is generally yes, though in a society so divided, politicians are girding for a fight. Government entities like school boards and the Army can require vaccinations for entry, service and travel — practices that flow from a 1905 Supreme Court ruling that said states could require residents to be vaccinated against smallpox or pay a fine.

Backers of digital vaccination cards are pressing the Biden administration to become involved, at least by setting standards for privacy and for verifying the accuracy of the records.

The White House is clearly skittish.

“The government is not now nor will we be supporting a system that requires Americans to carry a credential,” Jen Psaki, the White House press secretary, said on Tuesday.

Republican critics say vaccine passports raise the specter of centralized databases of vaccinated people, which they view as a government intrusion on privacy.

“A vaccine passport — a unified, centralized system for providing or denying access to everyday activities like shopping and dining — would be a nightmare for civil liberties and privacy,” Justin Amash, a former Republican congressman who is now a libertarian, wrote on Twitter last week.

But, in fact, every state already has a database, or an “immunization registry.” And under “data use agreements,” the states are required to share their registries with the C.D.C., though the agency de-identifies the information and not all states have agreed to provide it.

global roundup

A vaccination center in Kathmandu, Nepal, last month.
Credit…Niranjan Shrestha/Associated Press

Three weeks after suspending its vaccination campaign, Nepal has started administering shots again thanks to a gift of doses from China.

Nepal, a poor Himalayan nation, had been depending on vaccines manufactured in neighboring India, but last month India began cutting vaccine exports as the country experienced a surge in coronavirus cases. Nepal’s vaccination effort ground to a halt, even as infections began to rise again.

Last week, Nepal’s other giant neighbor, China, stepped in with a donation of 800,000 doses of the vaccine developed by Sinopharm, a state-owned company.

The vaccines will be administered to essential workers, Nepali students preparing to travel to China to study and those living in districts along the Nepal-China border, health officials said. Taranath Pokhrel, a senior official in Nepal’s health department, said that the Chinese government asked Nepal to give priority to the students and to people involved in cross-border trade, presumably to reduce the risk of infected people crossing into China.

Thousands of Nepali students study at Chinese universities under Chinese government scholarships. China, to increase the appeal of its vaccines, has said that foreigners who are inoculated with Chinese-made vaccines may face fewer bureaucratic hurdles entering the country.

Nepal, a nation of 30 million people, has vaccinated more than 1.7 million and slowly begun reopening to visitors, including to a few hundred climbers attempting to scale Mount Everest. The country reported very few infections in January, but new cases have surpassed 300 in recent days, part of a worrying resurgence in new cases across South Asia. India, which shares a porous border with Nepal, recorded more than 115,000 new infections on Wednesday, by far its highest daily total since the pandemic began.

The future of Nepal’s vaccination campaign remains uncertain because the Chinese donation falls short of the two million vaccine doses Nepal was due to receive under an agreement with the Indian manufacturer, the Serum Institute of India. Nepal officials said that they had paid the company 80 percent of the contract price but received only half of the doses. Serum’s chief executive said this week that he hoped to restart exports by June if new infections in India subsided.

“Our entire diplomatic channels are mobilized to get vaccines, but none has assured us of providing vaccines when we tried to procure them,” Dr. Pokhrel said.

In other news from around the world:

With only months left in office, Chancellor Angela Merkel of Germany has struggled to rally support for a national lockdown.
Credit…Hannibal Hanschke/Agence France-Presse — Getty Images

Chancellor Angela Merkel of Germany has called for a short and strict nationwide lockdown to bring down the number of new coronavirus infections in the country, according to her spokeswoman, but will meet with local officials next week to discuss potential regulations.

A year after the first lockdown was successful in tamping down cases, the country’s 16 governors are finding it harder than ever to agree on a unified plan to stem new infections. And with only months left in office, Ms. Merkel has found it increasingly difficult to rally support for a national lockdown as fatigue from prolonged restrictions looms large even as cases rise.

The governors and Ms. Merkel are scheduled to meet on Monday to hammer out new regulations.

While Armin Laschet, the governor of the country’s most populous state and a potential successor to Ms. Merkel, has made similar calls for a two- to three-week hard lockdown to bring down infections, other governors are pushing back. The governor of one small state even began a pilot program on Tuesday to reopen theaters, gyms and restaurant patios.

“A common nationwide approach would also be important here,” Ulrike Demmer, the deputy government spokeswoman, said during a daily news conference, referring to the confusing and often contradictory rules set by state governors. Ms. Demmer also pointed to the rising number of coronavirus patients in intensive care wards as a cause for concern.

According to Ms. Demmer, the goal is to get the infection rate below 100 new cases per 100,000 before the authorities should consider easing restrictions.

On Tuesday, the German health authorities recorded an average of 110 infections per 100,000 people over the previous 7 days, but warned that because fewer people were tested over the Easter holiday weekend, the number was likely to be much higher.

According to a New York Times database, Germany is averaging 15,562 new infections daily and since the pandemic began. More than 77,000 have died with the disease in the country since the pandemic began.

People accused of breaking coronavirus rules were made to exercise as punishment in Manila last month.
Credit…Lisa Marie David/Reuters

A 28-year-old man has died in the Philippines after the police forced him to do 300 squats as punishment after he was caught violating coronavirus lockdown rules.

The man, Darren Manaog Peñaredondo, was detained on Thursday in General Trias city, a Manila suburb, over a curfew violation. Officials have struggled to contain infections in the southeast Asian nation and have increasingly resorted to harsh tactics to enforce restrictions, rights groups say.

He was released the following day, but first was forced to complete 300 squats, his relatives said.

It is not the first time that the authorities have been accused of using aggressive tactics against civilians during the pandemic. President Rodrigo Duterte told the police last year not to be afraid to shoot anyone who “causes commotion,” after 20 people protesting restrictions were arrested. Last year, a former soldier suffering from mental health issues was gunned down by the police as he tried to cross a coronavirus checkpoint.

Mr. Peñaredondo’s partner, Reichelyn Balce, said that when he returned home on Friday after being detained, he had shown signs of fatigue.

“He told me that he fell when doing the exercises,” she said. “He struggled to walk when he got home. When he went to relieve himself, he turned blue and convulsed.”

She said that Mr. Peñaredondo was revived but he later died.

Two police officers who imposed the harsh punishment have been suspended pending the results of an investigation into their actions, said Brig. Gen. Ildebrandi Usana, a national police spokesman.

The local police had initially denied the events, but two men who were detained with Mr. Peñaredondo signed a sworn statement about the ordeal.

Cristina Palabay, who leads a local rights group called Karapatan, said that the police punishment amounted to “a form of torture that is cruel and inhuman” and signaled that the local police had adopted a “strongman approach.”

Ms. Palabay’s group aids families of the thousands of citizens killed in the president’s aggressive war on drugs.

The country’s Commission on Human Rights was critical of what it called an “overreach of the enforcement of quarantine rules and regulations,” according to the body’s spokeswoman, Jacqueline Ann de Guia.

Ms. de Guia said that curfew violations called for community service or a fine, rather than harsh physical punishment.

Near Cora, Wyo., in March. In the throes of a pandemic that has made the indoors inherently dangerous, tens of thousands more Americans than usual have flocked outdoors.
Credit…Max Whittaker for The New York Times

Kenna Tanner and her team can list the cases from memory: There was the woman who got tired and did not feel like finishing her hike; the campers, in shorts during a blizzard; the base jumper, misjudging his leap from a treacherous granite cliff face; the ill-equipped snowmobiler, buried up to his neck in an avalanche.

All of them were pulled by Ms. Tanner and the Tip Top Search and Rescue crew from the rugged Wind River mountain range — the Winds, as the range is known locally — in the past year in a sprawling, remote pocket of western Wyoming. And all of them, their rescuers said, were wildly unprepared for the brutal backcountry in which they were traveling.

“It is super frustrating,” said Ms. Tanner, Tip Top’s director. “We just wish that people respected the risk.”

In the throes of a pandemic that has made the indoors inherently dangerous, tens of thousands more Americans than usual have flocked outdoors, fleeing crowded cities for national parks and the public lands around them. But as these hordes of inexperienced adventurers explore the treacherous terrain of the backcountry, many inevitably call for help. It has strained the patchwork, volunteer-based search-and-rescue system in America’s West.

Where places like Canada or Switzerland have professional, full-time teams that manage everything from lost tourists to fatal mountaineering accidents, most operations in the United States are handled by a loose network of volunteer organizations like Tip Top, which are overseen by local sheriffs.

For much of the country’s history, this patchwork system met demand. But that trend has shifted in the past decade — and rapidly, over the past year — as less experienced recreationalists push further into treacherous places.

No one expects the eventual end of the pandemic to stem the flood of newcomers to the Winds, which people grudgingly admit have been discovered. Property values continue to soar in Sublette County, and even this winter, locals say out-of-state plates were more common than Wyoming plates in trailhead parking lots.

“You can’t stop it,” said Chris Hayes, who works at an outdoor retailer in Pinedale and also runs a fishing guide service. “There’s no secret place anymore. They’re all gone.”

Credit…Moritz Wienert

Before the pandemic, I found comfort in the routine of my life and the rhythms of my family — what Nora Ephron once called the “peanut-butter-and-jellyness” of days with children. I liked the morning thunderdome of getting the children dressed and fed, dropping them at school and taking the 20-minute walk to the subway.

At this point my commute is the five feet from my bed to my desk, and I am somehow both tired and agitated when I start work each day. My kids never leave the house, except when we go to the same three parks in our neighborhood. Sometimes when I go running outside, I fantasize about just … not stopping, my eyes thirsty for some new horizon.

In other words, I’m so freaking bored.

Here’s how one boredom researcher — yes, there are boredom researchers — has defined the emotion. “‘Feeling unchallenged’ and perceiving one’s ‘activities as meaningless’ is central to boredom,” concluded a study by Wijnand Van Tilburg, an experimental social psychologist at the University of Essex in England.

Even in normal times, boredom is a very common emotion — a study of almost 4,000 American adults found that 63 percent felt bored at least once in a 10-day sampling period. The causes of boredom are multifaceted, but a lack of control over your situation is a common one. He added, “There’s research that shows when you’re limited in your control over the situation — that intensifies boredom.”

Knowing that many of us may not be able to have much control over our movements for at least the next few months, how do we try to alleviate our boredom? First, the researchers I spoke to said it’s important to acknowledge there’s no easy fix for our doldrums — so much of what is happening right now is beyond our control, and the vaccines are just beginning to be tested in children under 12, so we may not be able to make big moves just yet.

This weekend, we saw relatives I adore for an outdoor Easter egg hunt. Just 90 minutes of warm interaction with these beloved adults made me feel so happy and alive that I was smiling for the rest of the day.

As the weather gets warmer and more of my peers are inoculated, I am planning more get-togethers. Whenever I drop back into the doldrums, I will think about all the walks and dinners and hugs on the horizon.

Kate Whelley McCabe, a co-founder of Vermont Evaporator Company, which saw customer demand double during the pandemic, tapping trees in a neighbor’s yard near Montpelier, Vt.
Credit…Jay Ericson

Stress-baking and panic shopping. Vegetable regrowing and crafting. Now we can add another hobby to a year of quarantine trends: backyard maple sugaring.

Among the many indicators that it’s on the rise: a run on at-home evaporators and other syrup-making accouterments. A surge in traffic and subscriptions to syrup-making websites and trade publications. And, of course, lots of documentation on social media. (The Facebook group Backyard Maple Syrup Makers added some 5,000 members, almost doubling the its community, in the past year.)

Tapping maple trees and boiling the sap into syrup — known as sugaring — isn’t a new hobby. What’s unique about this year is the influx of suburban and urban backyard adventurers fueling these maple sugaring highs.

Claire and Thomas Gallagher, for example, tapped a tree behind their home in New Rochelle, N.Y., for the first time three weeks ago.

“It’s such a fun thing to do with the kids, it gets us outside, it’s educational,” Ms. Gallagher, 37, said. And with everyone at home all winter and probably the spring as well, the Gallaghers decided there would never be a better year to try it.

Because sugaring is a sticky business — and boiling sap indoors can mean resin all over the walls — many backyard amateurs turn to small-scale, hobby-size evaporators like the ones sold by Vermont Evaporator Company in Montpelier, Vt.

“When we started our company five years ago, our customers used to look just like us: rural homeowners with five to 10 acres of land,” said Kate Whelley McCabe, the chief executive. “Now we sell to people all over the country and to a growing number of suburban and urban customers.”

The governor of New Hampshire, Chris Sununu, is a dedicated sugarer. His 8-year old son, Leo, is his tree tapping assistant, and his two teenagers, Edie and Calvin, “do the heavy lifting.”

Governor Sununu said that when the tree sap begins to flow, it’s the official signal that spring has arrived. “It’s been a long winter and a long year. The sun is coming up, the days are getting warmer, and when the sap ran this year, we knew we were really coming out of winter with a lot of optimism,” he said in an interview.

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U.K. says AstraZeneca alternative should be offered for under 30s, and E.U. finds a ‘possible link’ to rare clots.

Britain said on Wednesday that it would offer alternatives to the AstraZeneca vaccine for adults under 30 as European regulators described a “possible link” with rare blood clots, a setback for the world’s most widely used vaccine and a blow to the more than 100 countries relying on it to save lives amid a global surge in coronavirus cases.

The European regulator, the European Medicines Agency, stopped short of advising that use of the vaccine be curbed in the 27 European Union countries, saying that it was up to the national authorities to decide who should receive which vaccine.

Until the announcement, Britain had never wavered in its use of the vaccine, making it a holdout in Europe even as many countries detected unusual, sometimes fatal, blood clots in some recipients. But evidence has mounted that very small numbers of Britons had also been afflicted, forcing the country to reduce the use in younger people of a vaccine that is the backbone of its world-beating inoculation program.

The concern over the blood clots has threatened the pace of vaccinations far beyond Europe. At least 111 countries of varying income levels have administered doses of AstraZeneca’s shot, making it international aid groups’ most potent weapon in the battle to reduce deaths in the vaccine-starved global south.

finally over rare, but sometimes fatal, blood clots reported in some recipients.

Those concerns led several European countries to first restrict the use of AstraZeneca in older age groups, then suspend it over reports of blood clots, only to roll it out again last month after the European Medicines Agency issued a preliminary opinion that the benefits of the vaccine outweighed the risks.

As doctors reported a higher incidence of serious blood clots in younger people, some countries decided to stop administering the shot to anyone younger than 55.

Europe’s concerns over the vaccine’s side effects are also likely to threaten global inoculation efforts, with much of the developing world depending on the AstraZeneca vaccine to tackle the pandemic. The shot is the cornerstone of Covax, a program designed to make vaccine access more equitable worldwide.

The vaccine appeared to be causing an immune reaction in which antibodies bind to platelets, activating them, German doctors and the European Medicines Agency have said. Those platelets, in turn, were causing the formation of dangerous clots in certain parts of the body, including in veins that drain blood from the brain, leading in some cases to a rare type of stroke.

Why the antibodies develop in these people is not known, doctors have said. Some component of the vaccine, or excessive immune reaction — or both — could be the cause, they said.

No pre-existing conditions are known to make patients more vulnerable to this clotting disorder after a vaccination, European regulators said.

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Possible Side Effects of AstraZeneca Vaccine Come Into Sharper Focus

LONDON — For months, European countries have seesawed between craving and rebuffing AstraZeneca’s vaccine, with the shot’s fortunes rising and falling on spats over supply and on questions over the efficacy of the vaccine itself.

But few concerns have proved as disruptive to the rollout of the world’s workhorse vaccine in Europe as reports of very rare blood clots in some recipients. Many countries responded by halting the shot’s use, only to start giving it again after an all-clear from regulators at the European Medicines Agency, and then stopped inoculations a second time in certain age groups after doctors became more concerned about the clots.

On Tuesday, those concerns were reinforced yet again when a top vaccines official at the European Medicines Agency said that the vaccine was linked to extremely rare, though sometimes fatal, blood clots in a small number of recipients. It was the first indication from an international regulatory body that the clots may be a real, if very unusual, side effect of the shot.

Regulators now appear to be considering issuing their first formal warnings about the potential side effects — not only in continental Europe, which has long been wary of the shot for political and scientific reasons, but also in Britain, the birthplace of the AstraZeneca vaccine and long its biggest champion, where new data have sown concerns as well.

speedy inoculation program, have also insisted that the vaccine’s benefits far outweighed the risks. They and the company cited a lack of evidence in Britain that the clotting events were any more common than would be expected among people who had never been given AstraZeneca’s vaccine.

But the evidence changed last week when Britain reported 30 cases of the rare blood clots, 25 more than previously. This week, a prominent scientific adviser to the British government said there was “increasing evidence” of the clots being associated with the vaccine.

regulators reported 30 cases of the rare blood clots combined with low platelets among 18 million people given the AstraZeneca vaccine. That translated to roughly one case in 600,000 recipients of the vaccine.

European countries’ divergent approaches to the vaccine stem from a number of factors, including the supply of vaccines and severity of the pandemic. Marco Cavaleri, the official at the European Medicines Agency who spoke about the link between the vaccine and blood clots, said on Tuesday that those factors would likely continue to dictate how countries used the shot.

Beyond those factors, countries also took very different approaches to managing risk, scientists said. Countries that have continued using the shot were more focused on securing the overall health of their citizens. Others were more preoccupied with minimizing the risk to any single person.

“The attitude here is more, ‘Get me out of the pandemic,’” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London, referring to the British approach. In continental Europe, she said, “There seems to be a much higher emphasis on individual safety in the population.”

Adriano Mannino, a philosopher at the University of Munich and director of the Solon Center for Policy Innovation in Germany, said that the collective benefits of the vaccine dominated thinking in Britain, while Germans were more concerned with the risk of an injection going wrong in individual cases. That reflected, partly, Germany’s history with the Nazis, who conducted lethal experiments on people.

“In many areas where law has to regulate ethically delicate and potentially dangerous things,” he said, “the German state has tended to go for tough restrictions.”

Nevertheless, Germans over 60 — the age group still being given AstraZeneca’s vaccine — flooded hotlines to book appointments and stood in line for hours in recent days as eligibility restrictions for their age group were relaxed.

In the northeastern city of Wismar, several hundred people waited for up to five hours on Tuesday in a driving wind and mix of rain and snow to receive the shot.

“I wish there had been better weather,” Kerstin Weiss, the head of the district authority in the northeastern region, told public broadcaster NDR. “But honestly, this is a sign that people are willing to be vaccinated with AstraZeneca.”

Benjamin Mueller reported from London and Melissa Eddy from Berlin. Monika Pronczuk and Emma Bubola contributed reporting.

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Researchers Are Hatching a Low-Cost Covid-19 Vaccine

A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NVD-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.

Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in factories around the world.

If NVD-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NVD-HXP-S for themselves or acquire it at low cost from neighbors.

“That’s staggering — it would be a game-changer,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.

Vaccines work by acquainting the immune system with a virus well enough to prompt a defense against it. Some vaccines contain entire viruses that have been killed; others contain just a single protein from the virus. Still others contain genetic instructions that our cells can use to make the viral protein.

Once exposed to a virus, or part of it, the immune system can learn to make antibodies that attack it. Immune cells can also learn to recognize infected cells and destroy them.

spike, latches onto cells and then allows the virus to fuse to them.

But simply injecting coronavirus spike proteins into people is not the best way to vaccinate them. That’s because spike proteins sometimes assume the wrong shape, and prompt the immune system to make the wrong antibodies.

The researchers injected the 2P spikes into mice and found that the animals could easily fight off infections of the MERS coronavirus.

The team filed a patent for its modified spike, but the world took little notice of the invention. MERS, although deadly, is not very contagious and proved to be a relatively minor threat; fewer than 1,000 people have died of MERS since it first emerged in humans.

But in late 2019 a new coronavirus, SARS-CoV-2, emerged and began ravaging the world. Dr. McLellan and his colleagues swung into action, designing a 2P spike unique to SARS-CoV-2. In a matter of days, Moderna used that information to design a vaccine for Covid-19; it contained a genetic molecule called RNA with the instructions for making the 2P spike.

Other companies soon followed suit, adopting 2P spikes for their own vaccine designs and starting clinical trials. All three of the vaccines that have been authorized so far in the United States — from Johnson & Johnson, Moderna and Pfizer-BioNTech — use the 2P spike.

Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.

Dr. McLellan’s ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. “This guy is a genius,” said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. “He should be proud of this huge thing he’s done for humanity.”

But once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.

HexaPro, in honor of its total of six prolines.

The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.

Dr. McLellan also hoped that HexaPro-based vaccines would reach more of the world — especially low- and middle-income countries, which so far have received only a fraction of the total distribution of first-wave vaccines.

“The share of the vaccines they’ve received so far is terrible,” Dr. McLellan said.

To that end, the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.

Meanwhile, Dr. Innes and his colleagues at PATH were looking for a way to increase the production of Covid-19 vaccines. They wanted a vaccine that less wealthy nations could make on their own.

experimenting with Newcastle disease virus to create vaccines for a range of diseases. To develop an Ebola vaccine, for example, researchers added an Ebola gene to the Newcastle disease virus’s own set of genes.

The scientists then inserted the engineered virus into chicken eggs. Because it is a bird virus, it multiplied quickly in the eggs. The researchers ended up with Newcastle disease viruses coated with Ebola proteins.

At Mount Sinai, the researchers set out to do the same thing, using coronavirus spike proteins instead of Ebola proteins. When they learned about Dr. McLellan’s new HexaPro version, they added that to the Newcastle disease viruses. The viruses bristled with spike proteins, many of which had the desired prefusion shape. In a nod to both the Newcastle disease virus and the HexaPro spike, they called it NDV-HXP-S.

announced the start of a clinical trial of NDV-HXP-S. A week later, Thailand’s Government Pharmaceutical Organization followed suit. On March 26, Brazil’s Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.

Meanwhile, the Mount Sinai team has also licensed the vaccine to the Mexican vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.

To the nations involved, the prospect of making the vaccines entirely on their own was appealing. “This vaccine production is produced by Thai people for Thai people,” Thailand’s health minister, Anutin Charnvirakul, said at the announcement in Bangkok.

In Brazil, the Butantan Institute trumpeted its version of NDV-HXP-S as “the Brazilian vaccine,” one that would be “produced entirely in Brazil, without depending on imports.”

Ms. Taylor, of the Duke Global Health Innovation Center, was sympathetic. “I could understand why that would really be such an attractive prospect,” she said. “They’ve been at the mercy of global supply chains.”

Madhavi Sunder, an expert on intellectual property at Georgetown Law School, cautioned that NDV-HXP-S would not immediately help countries like Brazil as they grappled with the current wave of Covid-19 infections. “We’re not talking 16 billion doses in 2020,” she said.

Instead, the strategy will be important for long-term vaccine production — not just for Covid-19 but for other pandemics that may come in the future. “It sounds super promising,” she said.

In the meantime, Dr. McLellan has returned to the molecular drawing board to try to make a third version of their spike that is even better than HexaPro.

“There’s really no end to this process,” he said. “The number of permutations is almost infinite. At some point, you’d have to say, ‘This is the next generation.’”

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Researchers Are Hatching a Low-Cost Coronavirus Vaccine

A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NVD-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.

Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs — the same eggs that produce billions of influenza vaccines every year in factories around the world.

If NVD-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NVD-HXP-S for themselves or acquire it at low cost from neighbors.

“That’s staggering — it would be a game-changer,” said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.

Vaccines work by acquainting the immune system with a virus well enough to prompt a defense against it. Some vaccines contain entire viruses that have been killed; others contain just a single protein from the virus. Still others contain genetic instructions that our cells can use to make the viral protein.

Once exposed to a virus, or part of it, the immune system can learn to make antibodies that attack it. Immune cells can also learn to recognize infected cells and destroy them.

spike, latches onto cells and then allows the virus to fuse to them.

But simply injecting coronavirus spike proteins into people is not the best way to vaccinate them. That’s because spike proteins sometimes assume the wrong shape, and prompt the immune system to make the wrong antibodies.

The researchers injected the 2P spikes into mice and found that the animals could easily fight off infections of the MERS coronavirus.

The team filed a patent for its modified spike, but the world took little notice of the invention. MERS, although deadly, is not very contagious and proved to be a relatively minor threat; fewer than 1,000 people have died of MERS since it first emerged in humans.

But in late 2019 a new coronavirus, SARS-CoV-2, emerged and began ravaging the world. Dr. McLellan and his colleagues swung into action, designing a 2P spike unique to SARS-CoV-2. In a matter of days, Moderna used that information to design a vaccine for Covid-19; it contained a genetic molecule called RNA with the instructions for making the 2P spike.

Other companies soon followed suit, adopting 2P spikes for their own vaccine designs and starting clinical trials. All three of the vaccines that have been authorized so far in the United States — from Johnson & Johnson, Moderna and Pfizer-BioNTech — use the 2P spike.

Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.

Dr. McLellan’s ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. “This guy is a genius,” said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. “He should be proud of this huge thing he’s done for humanity.”

But once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.

HexaPro, in honor of its total of six prolines.

The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.

Dr. McLellan also hoped that HexaPro-based vaccines would reach more of the world — especially low- and middle-income countries, which so far have received only a fraction of the total distribution of first-wave vaccines.

“The share of the vaccines they’ve received so far is terrible,” Dr. McLellan said.

To that end, the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.

Meanwhile, Dr. Innes and his colleagues at PATH were looking for a way to increase the production of Covid-19 vaccines. They wanted a vaccine that less wealthy nations could make on their own.

experimenting with Newcastle disease virus to create vaccines for a range of diseases. To develop an Ebola vaccine, for example, researchers added an Ebola gene to the Newcastle disease virus’s own set of genes.

The scientists then inserted the engineered virus into chicken eggs. Because it is a bird virus, it multiplied quickly in the eggs. The researchers ended up with Newcastle disease viruses coated with Ebola proteins.

At Mount Sinai, the researchers set out to do the same thing, using coronavirus spike proteins instead of Ebola proteins. When they learned about Dr. McLellan’s new HexaPro version, they added that to the Newcastle disease viruses. The viruses bristled with spike proteins, many of which had the desired prefusion shape. In a nod to both the Newcastle disease virus and the HexaPro spike, they called it NDV-HXP-S.

announced the start of a clinical trial of NDV-HXP-S. A week later, Thailand’s Government Pharmaceutical Organization followed suit. On March 26, Brazil’s Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.

Meanwhile, the Mount Sinai team has also licensed the vaccine to the Mexican vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.

To the nations involved, the prospect of making the vaccines entirely on their own was appealing. “This vaccine production is produced by Thai people for Thai people,” Thailand’s health minister, Anutin Charnvirakul, said at the announcement in Bangkok.

In Brazil, the Butantan Institute trumpeted its version of NDV-HXP-S as “the Brazilian vaccine,” one that would be “produced entirely in Brazil, without depending on imports.”

Ms. Taylor, of the Duke Global Health Innovation Center, was sympathetic. “I could understand why that would really be such an attractive prospect,” she said. “They’ve been at the mercy of global supply chains.”

Madhavi Sunder, an expert on intellectual property at Georgetown Law School, cautioned that NDV-HXP-S would not immediately help countries like Brazil as they grappled with the current wave of Covid-19 infections. “We’re not talking 16 billion doses in 2020,” she said.

Instead, the strategy will be important for long-term vaccine production — not just for Covid-19 but for other pandemics that may come in the future. “It sounds super promising,” she said.

In the meantime, Dr. McLellan has returned to the molecular drawing board to try to make a third version of their spike that is even better than HexaPro.

“There’s really no end to this process,” he said. “The number of permutations is almost infinite. At some point, you’d have to say, ‘This is the next generation.’”

View Source