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Tasked to Fight Climate Change, a Secretive U.N. Agency Does the Opposite

LONDON — During a contentious meeting over proposed climate regulations last fall, a Saudi diplomat to the obscure but powerful International Maritime Organization switched on his microphone to make an angry complaint: One of his colleagues was revealing the proceedings on Twitter as they happened.

It was a breach of the secrecy at the heart of the I.M.O., a clubby United Nations agency on the banks of the Thames that regulates international shipping and is charged with reducing emissions in an industry that burns an oil so thick it might otherwise be turned into asphalt. Shipping produces as much carbon dioxide as all of America’s coal plants combined.

Internal documents, recordings and dozens of interviews reveal what has gone on for years behind closed doors: The organization has repeatedly delayed and watered down climate regulations, even as emissions from commercial shipping continue to rise, a trend that threatens to undermine the goals of the 2016 Paris climate accord.

One reason for the lack of progress is that the I.M.O. is a regulatory body that is run in concert with the industry it regulates. Shipbuilders, oil companies, miners, chemical manufacturers and others with huge financial stakes in commercial shipping are among the delegates appointed by many member nations. They sometimes even speak on behalf of governments, knowing that public records are sparse, and that even when the organization allows journalists into its meetings, it typically prohibits them from quoting people by name.

Homes are washing away. Much of the nation could become unlivable in the coming decade.

was almost denied a seat. International Registries, which represented the Marshall Islands on the I.M.O., initially refused to yield to the foreign minister, Mr. Woodroofe recalled.

United Nations climate meetings, countries are typically represented by senior politicians and delegations of government officials. At the maritime organization’s environmental committee, however, one in four delegates comes from industry, according to separate analyses by The New York Times and the nonprofit group Influence Map.

Representatives of the Brazilian mining company Vale, one of the industry’s heaviest carbon polluters and a major sea-based exporter, sit as government advisers. So does the French oil giant Total, along with many shipowner associations. These arrangements allow companies to influence policy and speak on behalf of governments.

Connections can be hard to spot. Luiz Gylvan Meira Filho sat on the Brazilian delegation in 2017 and 2018 as a University of Sao Paulo scientist. But he also worked at a Vale-funded research organization and, during his second year, was a paid Vale consultant. In an interview, he described his role as mutually beneficial: Brazilian officials relied on his expertise, and Vale covered his costs.

“Sometimes you cannot tell the difference. Is this actually the position of a nation or the position of the industry?” said David Paul, a Marshallese senator who attended an I.M.O. meeting in 2018.

Hundreds of other industry representatives are accredited observers and can speak at meetings. Their numbers far exceed those of the approved environmental groups. The agency rejected an accreditation request by the Environmental Defense Fund in 2018.

Industry officials and the maritime organization say such arrangements give a voice to the experts. “If you don’t involve the people who are actually going to have to deliver, then you’re going to get a poor outcome,” said Guy Platten, secretary general of the International Chamber of Shipping.

openly opposed strict emissions regulation as a hindrance to economic growth. And an informal bloc of countries and industry groups helped drag out the goal-setting process for three years.

Documents show that China, Brazil and India, in particular, threw up repeated roadblocks: In 2015, it was too soon to consider a strategy. In 2016, it was premature to discuss setting targets. In 2017, they lacked the data to discuss long-term goals.

a Cook Islands diplomat.

The I.M.O. almost never puts environmental policies to a vote, favoring instead an informal consensus-building. That effectively gives vocal opponents blocking power, and even some of the agency’s defenders acknowledge that it favors minimally acceptable steps over decisive action.

So, when delegates finally set goals in 2018, Mr. de Brum’s ambition had been whittled away.

The Marshall Islands suggested a target of zero emissions “by the second half of the century” — meaning by 2050. Industry representatives offered a slightly different goal: Decarbonization should occur “within” the second half of the century, a one-word difference that amounted to a 50-year extension.

Soon, though, the delegates agreed, without a vote, to eliminate zero-emissions targets entirely.

What remained were two key goals:

First, the industry would try to improve fuel efficiency by at least 40 percent. This was largely a mirage. The target was set so low that, by some calculations, it was reached nearly the moment it was announced.

Second, the agency aimed to cut emissions at least in half by 2050. But even this watered-down goal is proving unreachable. The agency’s own data say emissions may rise by 30 percent.

When delegates met last October — five years after Mr. de Brum’s speech — the organization had not taken any action. Proposals like speed limits had been debated and rejected.

What remained was what several delegates called the “refrigerator rating” — a score that, like those on American appliances, identified the clean and dirty ships.

European delegates insisted that, for the system to work, low-scoring ships must eventually be prohibited from sailing.

China and its allies wanted no such consequence.

So Sveinung Oftedal of Norway, the group’s chairman, told France and China to meet separately and compromise.

Delegates worked across time zones, meeting over teleconferences because of the Covid-19 pandemic. Shipping industry officials said they weighed in through the night.

The Marshallese were locked out.

“We’re always being told ‘We hear you,’” Mr. Ishoda said. “But when it comes to the details of the conversation, we’re told ‘We don’t need you to contribute.’”

Ultimately, France ceded to nearly all of China’s requests, records show. The dirtiest ships would not be grounded. Shipowners would file plans saying they intended to improve, would not be required to actually improve.

German delegates were so upset that they threatened to oppose the deal, likely triggering a cascade of defections, according to three people involved in the talks. But European Union officials rallied countries behind the compromise, arguing that Europe could not be seen as standing in the way of even limited progress.

“At I.M.O., that is as always the choice,” said Damien Chevallier, the French negotiator. “We have the choice to have nothing, or just to have a first step.”

All of this happened in secret. The I.M.O.’s summary of the meeting called it a “major step forward.” Natasha Brown, a spokeswoman, said it would empower customers and advocacy groups. “We know from consumer goods that the rating system works,” she said.

But the regulation includes another caveat: The I.M.O. will not publish the scores, letting shipping companies decide whether to say how dirty their ships are.

Ms. Kabua, the Marshallese minister, is under no illusions that reclaiming the diplomatic seat will lead to a climate breakthrough.

But if it works, she said, it might inspire other countries with private registries to do the same. Countries could speak for themselves rather than through a corporate filter.

Regardless of the outcome, the political winds are shifting. The European Union is moving to include shipping in its emissions-trading system. The United States, after years of being minor players at the agency, is re-engaging under President Biden and recently suggested it may tackle shipping emissions itself.

Both would be huge blows to the I.M.O., which has long insisted that it alone regulate shipping.

Suddenly, industry officials say they are eager to consider things like fuel taxes or carbon.

“There’s much more of a sense of momentum and crisis,” said Mr. Platten, the industry representative. “You can argue about, ‘Are we late to it,’ and all the rest. But it is palpable.”

Behind closed doors, though, resistance remains. At a climate meeting last winter, recordings show that the mere suggestion that shipping should become sustainable sparked an angry response.

“Such statements show a lack of respect for the industry,” said Kostas G. Gkonis, the director of the trade group Intercargo.

And just last week, delegates met in secret to debate what should constitute a passing grade under the new rating system. Under pressure from China, Brazil and others, the delegates set the bar so low that emissions can continue to rise — at roughly the same pace as if there had been no regulation at all.

Delegates agreed to revisit the issue in five years.

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Global Shortages During Coronavirus Reveal Failings of Just in Time Manufacturing

In the story of how the modern world was constructed, Toyota stands out as the mastermind of a monumental advance in industrial efficiency. The Japanese automaker pioneered so-called Just In Time manufacturing, in which parts are delivered to factories right as they are required, minimizing the need to stockpile them.

Over the last half-century, this approach has captivated global business in industries far beyond autos. From fashion to food processing to pharmaceuticals, companies have embraced Just In Time to stay nimble, allowing them to adapt to changing market demands, while cutting costs.

But the tumultuous events of the past year have challenged the merits of paring inventories, while reinvigorating concerns that some industries have gone too far, leaving them vulnerable to disruption. As the pandemic has hampered factory operations and sown chaos in global shipping, many economies around the world have been bedeviled by shortages of a vast range of goods — from electronics to lumber to clothing.

In a time of extraordinary upheaval in the global economy, Just In Time is running late.

“It’s sort of like supply chain run amok,” said Willy C. Shih, an international trade expert at Harvard Business School. “In a race to get to the lowest cost, I have concentrated my risk. We are at the logical conclusion of all that.”

shortage of computer chips — vital car components produced mostly in Asia. Without enough chips on hand, auto factories from India to the United States to Brazil have been forced to halt assembly lines.

But the breadth and persistence of the shortages reveal the extent to which the Just In Time idea has come to dominate commercial life. This helps explain why Nike and other apparel brands struggle to stock retail outlets with their wares. It’s one of the reasons construction companies are having trouble purchasing paints and sealants. It was a principal contributor to the tragic shortages of personal protective equipment early in the pandemic, which left frontline medical workers without adequate gear.

a shortage of lumber that has stymied home building in the United States.

Suez Canal this year, closing the primary channel linking Europe and Asia.

“People adopted that kind of lean mentality, and then they applied it to supply chains with the assumption that they would have low-cost and reliable shipping,” said Mr. Shih, the Harvard Business School trade expert. “Then, you have some shocks to the system.”

presentation for the pharmaceutical industry. It promised savings of up to 50 percent on warehousing if clients embraced its “lean and mean” approach to supply chains.

Such claims have panned out. Still, one of the authors of that presentation, Knut Alicke, a McKinsey partner based in Germany, now says the corporate world exceeded prudence.

“We went way too far,” Mr. Alicke said in an interview. “The way that inventory is evaluated will change after the crisis.”

Many companies acted as if manufacturing and shipping were devoid of mishaps, Mr. Alicke added, while failing to account for trouble in their business plans.

“There’s no kind of disruption risk term in there,” he said.

Experts say that omission represents a logical response from management to the incentives at play. Investors reward companies that produce growth in their return on assets. Limiting goods in warehouses improves that ratio.

study. These savings helped finance another shareholder-enriching trend — the growth of share buybacks.

In the decade leading up to the pandemic, American companies spent more than $6 trillion to buy their own shares, roughly tripling their purchases, according to a study by the Bank for International Settlements. Companies in Japan, Britain, France, Canada and China increased their buybacks fourfold, though their purchases were a fraction of their American counterparts.

Repurchasing stock reduces the number of shares in circulation, lifting their value. But the benefits for investors and executives, whose pay packages include hefty allocations of stock, have come at the expense of whatever the company might have otherwise done with its money — investing to expand capacity, or stockpiling parts.

These costs became conspicuous during the first wave of the pandemic, when major economies including the United States discovered that they lacked capacity to quickly make ventilators.

“When you need a ventilator, you need a ventilator,” Mr. Sodhi said. “You can’t say, ‘Well, my stock price is high.’”

When the pandemic began, car manufacturers slashed orders for chips on the expectation that demand for cars would plunge. By the time they realized that demand was reviving, it was too late: Ramping up production of computer chips requires months.

stock analysts on April 28. The company said the shortages would probably derail half of its production through June.

The automaker least affected by the shortage is Toyota. From the inception of Just In Time, Toyota relied on suppliers clustered close to its base in Japan, making the company less susceptible to events far away.

In Conshohocken, Pa., Mr. Romano is literally waiting for his ship to come in.

He is vice president of sales at Van Horn, Metz & Company, which buys chemicals from suppliers around the world and sells them to factories that make paint, ink and other industrial products.

In normal times, the company is behind in filling perhaps 1 percent of its customers’ orders. On a recent morning, it could not complete a tenth of its orders because it was waiting for supplies to arrive.

The company could not secure enough of a specialized resin that it sells to manufacturers that make construction materials. The American supplier of the resin was itself lacking one element that it purchases from a petrochemical plant in China.

One of Mr. Romano’s regular customers, a paint manufacturer, was holding off on ordering chemicals because it could not locate enough of the metal cans it uses to ship its finished product.

“It all cascades,” Mr. Romano said. “It’s just a mess.”

No pandemic was required to reveal the risks of overreliance on Just In Time combined with global supply chains. Experts have warned about the consequences for decades.

In 1999, an earthquake shook Taiwan, shutting down computer chip manufacturing. The earthquake and tsunami that shattered Japan in 2011 shut down factories and impeded shipping, generating shortages of auto parts and computer chips. Floods in Thailand the same year decimated production of computer hard drives.

Each disaster prompted talk that companies needed to bolster their inventories and diversify their suppliers.

Each time, multinational companies carried on.

The same consultants who promoted the virtues of lean inventories now evangelize about supply chain resilience — the buzzword of the moment.

Simply expanding warehouses may not provide the fix, said Richard Lebovitz, president of LeanDNA, a supply chain consultant based in Austin, Texas. Product lines are increasingly customized.

“The ability to predict what inventory you should keep is harder and harder,” he said.

Ultimately, business is likely to further its embrace of lean for the simple reason that it has yielded profits.

“The real question is, ‘Are we going to stop chasing low cost as the sole criteria for business judgment?’” said Mr. Shih, from Harvard Business School. “I’m skeptical of that. Consumers won’t pay for resilience when they are not in crisis.”

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Brazil’s Bid to Outsource Amazon Conservation Finds Few Takers

This article was produced in partnership with the Pulitzer Center’s Rainforest Investigations Network.

RIO DE JANEIRO — Facing strong international condemnation over the destruction of the Amazon, President Jair Bolsonaro’s government came up with a strategy: It offered companies the chance to “adopt” a patch of rainforest.

But the plan — which invites companies to contribute money to help preserve the forest — has been marred by disorganization and met with skepticism by critics, who see it as an effort to “green wash” the Bolsonaro administration’s poor record on the environment.

It also hasn’t found many takers.

The program was announced in February, as the Biden administration made clear that it expected Brazil to reverse some of the forest loss and dismantling of environmental protections that marked Mr. Bolsonaro’s first two years in office.

the Adopt-a-Park program would accomplish two of the Bolsonaro administration’s goals: redeem Brazil’s tarnished environmental image, which industry leaders have feared could shut them out of international markets, and outsource the costs of conservation at a time of tightening budgets.

“Many of these companies, investment funds that signed letters demonstrating their concern about the Amazon,” said Ricardo Salles, the minister of the environment, “now have in Adopt a Park a concrete, very simple and efficient possibility of transforming their statements into action.”

The government offered 132 federal reserves in the Amazon for sponsorship. So far, only three foreign companies — the grocery chain Carrefour, Coca-Cola and Heineken — and five Brazilian corporations have enrolled. Their donations total just over $1 million — a tiny fraction of the $600 million that Mr. Salles aspires to raise.

Protected Areas of the Amazon program has raised tens of millions of dollars from governments and companies for protected areas in the Amazon.

Through the Adopt-a-Park program, sponsoring companies pay at least $9.5 per hectare of the reserve’s area per year. To sponsor the biggest park costs almost $35 million annually, while the smallest go for $23,000 a year.

Once sponsorship deals are finalized, companies donate goods and services — which could include vehicles or a fire brigade — to the Chico Mendes Institute office in each reserve.

July to share responsibility for protecting the Amazon with nongovernment actors. As protests over fires in the Amazon rainforest intensified, he challenged the actor Leonardo DiCaprio, one of the government’s most prominent critics, to sponsor a reserve.

“Are you going to put your money where your mouth is?” Mr. Salles wrote on Twitter in September.

Beyond proposing the park-adoption program before the climate change summit convened by the Biden administration last month, Brazil’s government seems to have done little to improve its environmental policies.

At the summit, Mr. Bolsonaro vowed to allocate more money to environmental protection agencies. But the very next day the government did the opposite, signing into law a budget that further slashed funding for the agencies.

And federal lawmakers are considering a bill that would make it easier for companies to get environmental permits for new farming, mining and infrastructure ventures.

“Is receiving donations as they are proposing going to compensate for all that?” asked Natalie Unterstell, a climate policy expert who has been tracking the program. “No. It’s a palliative measure.”

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A Super Blood Moon Dazzles Earthlings

Australians were among those lucky enough to see it on Wednesday evening, a rare astronomical event marked by a dazzling array of sunset colors like red and burnt orange: a “super blood moon.”

From Brazil to Alaska, California to Indonesia, people with the right view of the celestial phenomenon marveled as their moon, usually a predictable, pale, Swiss-cheese-like round in the sky, was transformed into a fierce, red giant. As one Twitter user, words failing, put it: “Man I’m in love with this urghhh.”

The striking display was the result of two simultaneous phenomena: a supermoon (when the moon lines up closer than normal to our planet and appears to be bigger than usual), combined with a total lunar eclipse, or blood moon (when the moon sits directly in the Earth’s shadow and is struck by light filtered through the Earth’s atmosphere).

“A little bit of sunlight skims the Earth’s atmosphere,” said Brad Tucker, an astrophysicist and cosmologist based at the Australian National University in Canberra, the country’s capital. He said this creates the effect of “sunrise and sunset being projected onto the moon.”

on a special flight to see the supermoon. It left Sydney about 7:45 p.m. and was to return later that evening. Vanessa Moss, an astronomer with Australia’s national science agency, CSIRO, and the guest expert on the flight, said this kind of phenomenon was exciting because it was accessible.

“You don’t need a telescope; you don’t need binoculars,” she said, adding that it was a good chance to “look up at the sky and think about our place in the universe.”

studied humanity’s relationship with space, wrote in an email.

“We wonder whether the red moon is a sign of the end of disruption and suffering, or another beginning,” he said, adding that the moon provides one of the constants in our lives. “When that’s disrupted, we temporarily lose our moorings, and for a moment we’re jostled from the world we take for granted.”

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As Israel’s Dependence on U.S. Shrinks, So Does U.S. Leverage

Israel, a small country surrounded by adversaries and locked in conflict with the Palestinians, depends absolutely on American diplomatic and military support. By giving it, the United States safeguards Israel and wields significant leverage over its actions.

That’s the conventional wisdom, anyway. For decades, it was true: Israeli leaders and voters alike treated Washington as essential to their country’s survival.

But that dependence may be ending. While Israel still benefits greatly from American assistance, security experts and political analysts say that the country has quietly cultivated, and may have achieved, effective autonomy from the United States.

“We’re seeing much more Israeli independence,” said Vipin Narang, a Massachusetts Institute of Technology political scientist who has studied Israeli strategy.

nearly $4 billion, it was closer to one percent.

Washington underscored its own declining relevance to the conflict last week, calling for a cease-fire only after an Egyptian-brokered agreement was nearing completion, and which Israeli leaders said they agreed to because they had completed their military objectives in a ten day conflict with Gaza. Secretary of State Anthony J. Blinken will visit the region this week, though he said he does not intend to restart formal Israeli-Palestinian peace talks.

Democrats and left-wing activists, outraged over Israel’s treatment of Palestinians and bombing of Gaza, are challenging Washington’s long-held consensus on Israel.

Yet significant, if shrinking, numbers of Americans express support for Israel, and Democratic politicians have resisted their voters’ growing support for the Palestinians.

The United States still has leverage, as it does with every country where it provides arms and diplomatic support. But that leverage may be declining past the point at which Israel is able and willing to do as it wishes, bipartisan consensus or not.

When Americans think of the Israeli-Palestinian conflict, many still picture the period known as the Second Intifada, when Israeli tanks crashed through Palestinian towns and Palestinian bombs detonated in Israeli cafes and buses.

But that was 15 years ago. Since then, Israel has re-engineered the conflict in ways that Israeli voters and leaders largely find bearable.

Violence against Israelis in the occupied West Bank is rarer and lower-level, rarer still in Israel proper. Though fighting has erupted several times between Israel and Gaza-based groups, Israeli forces have succeeded in pushing the burden overwhelmingly on Gazans. Conflict deaths, once three-to-one Palestinian-to-Israeli, are now closer to 20-to-one.

At the same time, Israeli disaffection with the peace process has left many feeling that periodic fighting is the least bad option. The occupation, though a crushing and ever-present force for Palestinians, is, on most days and for most Jewish Israelis, ignorable.

missile defense technology that is made and maintained largely at home — a feat that hints at the tenacity of Israel’s drive for self-sufficiency.

“If you had told me five years ago,” said Mr. Narang, the M.I.T. scholar, “that the Israelis would have a layered missile defense system against short-range rockets and short-range ballistic missiles, and it was going to be 90 percent effective, I would have said, ‘I would love what you’re smoking.’”

mixed, and tend starkly negative in Muslim-majority societies, Israel has cultivated ties in parts of Africa, Asia and Latin America.

Even nearby Arab states, such as Jordan and Egypt, once among its greatest enemies, now seek peace, while others have eased hostilities. Last year, the so-called Abraham Accords, brokered under President Trump, saw Israel normalize ties with Bahrain and the United Arab Emirates. Israel subsequently normalized ties with Morocco and reached a diplomatic agreement with Sudan.

“We used to talk about a diplomatic tsunami that was on its way. But it never materialized,” said Dahlia Scheindlin, an Israeli political analyst and pollster.

polls show, and growing numbers consider it a low priority, given a status quo that much of the Israeli public sees as tolerable.

“That changes the nature of the relationship to the U.S.,” Ms. Mizrahi-Arnaud said.

Because Israeli leaders no longer feel domestic pressure to engage in the peace process, which runs through Washington, they do not need to persuade the Americans that they are seeking peace in good faith.

If anything, leaders face declining pressure to please the Americans and rising demands to defy them with policies like expanding settlements in the West Bank, even annexing it outright.

Israel is hardly the first small state to seek independence from a great-power patron. But this case is unusual in one way: It was the Americans who built up Israel’s military and diplomatic independence, eroding their own influence.

Now, after nearly 50 years of not quite wielding that leverage to bring an end to the Israeli-Palestinian conflict, it may soon be gone for good, if it isn’t already.

“Israel feels that they can get away with more,” said Ms. Mizrahi-Arnaud, adding, to underscore her point, “When exactly is the last time that the United States pressured Israel?”

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Traveling to Europe? A Country-by-Country Reopening Guide

Infections and deaths in Turkey from the coronavirus have been declining steadily following a strict three-week national lockdown, which is expected to be lifted gradually through May.

Turkey so far has fully vaccinated about 13 percent of its population of 83 million people; about three million more have received their first dose, according to Our World in Data, an online compendium of data from global sources.

While the country is currently facing a vaccine shortage, forcing it to delay the administration of second doses, the health minister, Fahrettin Koca, said 30 million more doses of the Pfizer-BioNtech vaccine would arrive in June and 50 million doses of the Sputnik V vaccine are expected to arrive from Russia within six months.

Turkey has remained open to tourists, including Americans, throughout the pandemic. Most international arrivals are required to show proof of a negative PCR test taken within 72 hours of their arrival into the country.

Coronavirus tests are not required for passengers arriving from places that Turkey considers epidemiologically safe, which include Hong Kong, China, Taiwan, Vietnam, Australia, New Zealand, Singapore, Thailand, South Korea, Israel, Japan, Latvia, Luxembourg, Ukraine and Estonia.

Passengers arriving from Brazil, South Africa and India will be required to quarantine for 14 days in government-assigned accommodations and will be released if they test negative for the virus after day 10.

Turkey offers health insurance packages starting at as little as $15 that cover foreign visitors for Covid-19 treatment and hospitalization for up to 30 days. The country treats coronavirus patients in both public and private hospitals and opened 17 new hospitals last year to provide more intensive-care capacity for Covid treatment.

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Why is Covid Killing So Many Young Children in Brazil? Doctors Are Baffled

RIO DE JANEIRO — Fretting over a fever in her toddler that wouldn’t break, the mother took the young girl, Letícia, to a hospital. Doctors had worrisome news: It was Covid-19.

But they were reassuring, noting that children almost never develop serious symptoms, said the mother, Ariani Roque Marinheiro.

Less than two weeks later, on Feb. 27, Letícia died in the critical care unit of the hospital in Maringá, in southern Brazil, after days of labored breathing.

“It happened so quickly, and she was gone,” said Ms. Marinheiro, 33. “She was everything to me.”

Covid-19 is ravaging Brazil, and, in a disturbing new wrinkle that experts are working to understand, it appears to be killing babies and small children at an unusually high rate.

scientists say are leading to more severe cases of Covid in young, healthy adults and driving up death tolls in Brazil — on babies and children.

But experts say the variant appears to be leading to higher death rates among pregnant women. Some women with Covid are giving birth to stillborn or premature babies already infected with the virus, said Dr. André Ricardo Ribas Freitas, an epidemiologist at São Leopoldo Mandic College in Campinas, who led a recent study on the impact of the variant.

“We can already affirm that the P.1 variant is much more severe in pregnant women,” said Dr. Ribas Freitas. “And, oftentimes, if the pregnant woman has the virus, the baby might not survive or they might both die.”

Lack of timely and adequate access to health care for children once they fall ill is likely a factor in the death toll, experts said. In the United States and Europe, experts said, early treatment has been key to the recovery of children infected with the virus. In Brazil, overstretched doctors have often been late to confirm infections in children, Dr. Marinho said.

“Children are not being tested,” she said. “They get sent away, and it’s only when these children return in a really bad state that Covid-19 is suspected.”

study published in the Pediatric Infectious Disease Journal in January foundthat children in Brazil and four other countries in Latin America developed more severe forms of Covid-19 and more cases of multisystem inflammatory syndrome, a rare and extreme immune response to the virus, compared with data from China, Europe and North America.

Even before the pandemic began, millions of Brazilians living in poor areas had limited access to basic health care. In recent months, the system has been overwhelmed as a crush of patients have flooded into critical care units, resulting in a chronic shortage of beds.

“There’s a barrier to access for many,” said Dr. Ana Luisa Pacheco, a pediatric infectious diseases specialist at the Heitor Vieira Dourado Tropical Medicine Foundation in Manaus. “For some children, it takes three or four hours by boat to get to a hospital.”

The cases in children have shot up amid Brazil’s broader explosion in infections, which experts attribute to President Jair Bolsonaro’s cavalier response to the pandemic and his government’s refusal to take vigorous measures to promote social distancing. A lagging economy has also left millions without income or enough food, forcing many to risk infection as they search for work.

Some of the children who have died of the virus already had health issues that made them more vulnerable. Still, Dr. Marinho estimates that they represent just over a quarter of deaths among children under 10. That suggests that healthy children, too, seem to be at heightened risk from the virus in Brazil.

Letícia Marinheiro was one such child, her mother said. A healthy baby who had just started walking, she had never been sick before, Ms. Marinheiro said.

Ms. Marinheiro, who was infected along with her husband Diego, 39, believes Letícia might have lived if her illness had been treated with more urgency.

“I think they didn’t believe that she could be so sick, they didn’t believe it could happen to a child,” said Ms. Marinheiro.

She recalled pleading to have more tests done. Four days into the child’s hospitalization, she said, doctors had still not fully examined Letícia’s lungs.

Ms. Marinheiro is still unsure how her family got sick.

She had kept Letícia — a first child the couple had badly wanted for years — at home and away from everyone. Mr. Marinheiro, a supplier of hair salon products, had been cautious to avoid contact with clients, even as he kept working to keep the family financially afloat.

For Ms. Marinheiro, the sudden death of her daughter has left a gaping hole in her life. As the pandemic rages on, she says, she wishes other parents would quit underestimating the dangers of the virus that took Letícia away from her. In her city, she watches as families throw birthday parties for children and officials push to reopen schools.

“This virus is so inexplicable,” she said. “It’s like playing the lottery. And we never believe it will happen to us. It’s only when it takes someone from your family.”

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Uruguay and Coronavirus: The World’s Highest Death Toll Per Capita

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.

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.

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Uruguay Death Toll Soars as Virus Slams South America

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.

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 from 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.

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