according to the World Health Organization. Immunization levels in recent years have been above 95 percent.

But Bhutan’s health system is “hardly self-sustainable,” and patients who need expensive or sophisticated treatments are often sent to India or Thailand at the government’s expense, said Dr. Yot Teerawattananon, a Thai health economist at the National University of Singapore.

A government committee in Bhutan meets once a week to make decisions about which patients to send overseas for treatment, Dr. Yot said. He said the committee — which focuses on brain and heart surgery, kidney transplants and cancer treatment — was known informally as the “death panel.”

“I don’t think they could cope with the surge of severe Covid cases if that happened, so it is important for them to prioritize Covid vaccination,” he said, referring to Bhutan’s health authorities.

Bhutan has reported fewer than 1,000 coronavirus infections and only one death. Its borders, tight by global standards even before the pandemic, have been closed for a year with few exceptions, and anyone who enters the country must quarantine for 21 days.

received his first vaccine dose last month while in quarantine after a visit to Bangladesh. He has been supporting the vaccination effort in recent weeks on his official Facebook page.

“My days are dotted with virtual meetings on numerous areas that need attention, as I closely follow the vaccination campaign on the ground,” Dr. Tshering, a surgeon, wrote in early April. “So far, with your prayers and blessings, everything is going well.”

The economy in Lunana depends on animal husbandry and harvests of a so-called caterpillar fungus that is prized as an aphrodisiac in China. People speak Dzongkha, the national language, and a local dialect.

Last year, the drama “Lunana: A Yak in the Classroom” became the second film ever selected to represent Bhutan at the Academy Awards. It was filmed using solar batteries, and its cast included local villagers.

Lunana’s headman, Kaka, who goes by one name, said the most important part of the vaccination campaign was not on the ground, but in the sky.

“If there hadn’t been a chopper,” he said, “getting the vaccines would have been an issue, since there’s no access road.”

Chencho Dema reported from Thimphu, Bhutan, and Mike Ives from Hong Kong.

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Ontario Police’s Sweeping New Powers on Covid Draw Criticism

Ontario, Canada’s most populous province, has extended and expanded its stay-at-home orders and given the police sweeping new powers to enforce the mandates in an effort to curb rising case numbers and hospitalizations.

The police will now be able to stop and question people, including those in vehicles, to make sure that their trips outside home are essential. Residents, who are not permitted to gather with members outside their household with some exceptions, could face fines if they do not comply with the new orders. The Ontario government is also expected to restrict travel between Manitoba and Quebec, and the police will set up checkpoints at the provincial borders.

The new measures come amid a sluggish vaccine campaign in Canada and the latest virus wave there, driven largely in Ontario by the highly contagious B.1.1.7 variant first detected in Britain. The increasing case numbers have strained the capacity of intensive care units in many parts of the country.

Canada has inched ahead of the United States in new daily coronavirus cases per capita, and officials warned that worse is to come. By Friday, hospitalizations were up by 22 percent; I.C.U. admissions rose by 34 percent; and each day, 41 people died from Covid-19, a 38 percent increase from the previous week.

a variety of other measures.

The latest measures have been met with criticism, including from public health experts, the mayor of Toronto and several police departments, including the Toronto Police Service, which said on Twitter that it would “not be doing random stops of people or cars.” There were also concerns that asking the police to impose such measures could result in racial profiling.

“I know you are all sick and tired of Covid-19,” Prime Minister Justin Trudeau said on Friday as he urged Canadians to follow their provinces’ rules. “We all just want to be done with this.”

Emergency rooms, particularly in Ontario, are reaching their breaking points, as are intensive care units. In a bid to ease the strain, children’s hospitals in both Ottawa and Toronto opened their I.C.U. beds to adults.

Many factors are behind the increasing numbers. Among them is the arrival of more infectious variants of the virus. An outbreak of P.1, the variant first found in Brazil, spread throughout British Columbia and then into Alberta. Manitoba discovered its first case of the variant this week.

Moderna is delaying deliveries of its vaccine shipment to Canada and other countries, and the Johnson & Johnson vaccine, which has yet to arrive in Canada, has come under safety scrutiny.

Pfizer will sell Canada an additional eight million doses of the vaccine it has developed with BioNTech, half of which will arrive next month, and all of which will arrive by the end of July.

Many Canadians are frustrated as they see higher vaccination rates in Britain and the United States.

Canada’s vaccination strategy has been to delay second doses to allow more residents to gain the protection from at least one shot. About 2 percent of Canadians are fully vaccinated compared with 25 percent of Americans, and 19 percent have received at least one dose compared with 39 percent in the United States. Yet the scheduled increases in vaccine shipments — the Moderna slip up aside — should help Canada catch up over the next few weeks.

Farah Mohamed contributed reporting.

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Zimbabwe Releases Prisoners to Help Curb Coronavirus Spread

HARARE, Zimbabwe — Zimbabwe released at least 320 prisoners from its jails on Saturday to ease congestion in the country’s notoriously overcrowded jails as a second wave of the coronavirus devastates the country.

The move comes amid growing allegations that a government crackdown has sent dozens of activists, journalists and opposition leaders to prisons.

The prisoners were released under an amnesty program established by President Emmerson Mnangagwa in 2018, the year after he seized power, ending decades of the strongarm rule of Robert G. Mugabe. The amnesty does not include prisoners convicted of crimes that include murder, human trafficking, sexual offenses and treason.

Most of those released on Saturday had been convicted of nonviolent crimes, according to Zimbabwe’s Prison and Correctional Service, but were being held in the infamous Chikurubi Maximum Security Prison. That is the country’s largest correctional facility, and it is known for overcrowding and unsanitary conditions.

released 4,208 prisoners under the amnesty order.

The decision to release the latest round of prisoners comes after the variant first identified in South Africa, B.1.351, flooded into Zimbabwe at the start of the year, straining a system that already lacked enough drugs, equipment and medical staff. To date, Zimbabwe has recorded nearly 38,000 coronavirus infections, including 1,551 deaths, according to the Africa Centers for Disease Control and Prevention.

In February, the country launched a national vaccine campaign with 200,000 doses donated by the Chinese vaccine maker, Sinopharm. The country is set to receive an additional 1.1 million doses as part of Covax, a global sharing program which is distributing vaccines to poor and middle income countries.

Zimbabwean officials have portrayed the vaccine rollout as a major win in the government-led response to the pandemic. But in recent months, human rights organizations have accused leaders of using coronavirus restrictions as a pretext to arrest opposition leaders in a crackdown on dissent.

A U.S. State Department human rights report released last month accused Zimbabwe’s security forces of engaging in serious human rights violations last year — including arbitrary killing and torturing civilians. The report also noted harsh and life-threatening conditions for political prisoners and detainees inside the country’s prisons.

On Saturday, human rights investigators commended the latest release of some prisoners and called on the Zimbabwean government to expand upon the initiative immediately.

“The Zimbabwe authorities should also release those in pretrial detention for nonviolent and lesser offenses, many of whom are political activists whose continued detention is unnecessary and unjustified,” said Dewa Mavhinga, Southern Africa director of Human Rights Watch.

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Viewers React to Photo of Queen Elizabeth at Prince Philip’s Funeral

She was utterly alone.

With coronavirus restrictions firmly in place, some of Queen Elizabeth II’s relatives sat in small family groups with children and spouses to mourn Prince Philip, her husband. But she sat alone at the end of a pew, and for many watching the proceedings from home, the sight of the newly widowed queen, who will turn 95 next week, was perhaps the saddest image of the day.

“These pictures really bring home one of the horrible truths of the pandemic,” the British journalist Jane Merrick said on Twitter: “that there can be no tearful hugs with reunited family right at the time when you need it most.”

One Twitter user, referring to a widely shared photo of Elizabeth, said it was the first image from the funeral that made her tear up. “She looks so alone there, more a widow today than a queen.”

Many on social media remarked on the queen’s seeming frailty, saying she looked “little” or “more vulnerable.” And of those who lamented her having to grieve her husband in an era of social distancing, some took pains to note that their sympathy transcended any feelings about the monarchy.

one said. “Her beloved husband of 73 years, by her side every day; I can’t imagine. Her lonely image was heartbreaking.”

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As Variant Spreads, Covid-19 Cases Rise Sharply in Pennsylvania

Coronavirus cases and hospitalizations are surging in Pennsylvania, as state officials warn of trends seen across the country: increased travel levels, relaxing restrictions and the spread of more contagious virus variants.

Pennsylvania is reporting an average of 4,922 cases a day, up from roughly 2,515 a month ago, according to a New York Times database. Hospitalizations have also climbed about 16 percent in the past two weeks, and the state now has one of the highest per capita daily case counts in the country. Deaths, which tend to lag behind infections by weeks, have started to slightly increase again after plunging from the state’s high of an average of 222 in mid-January. Deaths now average about 37 a day.

State and national health officials are also worried about the spread of more contagious virus variants, particularly the B.1.1.7 variant first found in Britain. That variant is currently estimated to be about 60 percent more contagious and 67 percent more deadly than the original version.

B.1.1.7 is now the most common source of new coronavirus infections in the United States. Data from the Centers for Disease Control and Prevention show that 28 percent of Pennsylvania’s cases involve that variant, and it is spreading in a vast majority of two dozen other states with high caseloads. In Michigan, more than 57 percent of cases involve B.1.1.7; in Tennessee, the figure is over 60 percent.

opened up eligibility to all adults on Tuesday.

according to data from the C.D.C. Nationally, 38 percent of the population has received at least one shot, and 24 percent have been fully vaccinated.

But many health officials have warned about the lingering challenge of persuading all eligible people to get vaccinated. For instance, in one Pennsylvania county, a hospital set up a drive-through in a park stocked with roughly 1,000 vaccine doses. Only about 300 people showed up. In Iowa, a rural clinic called people who had volunteered to give shots to tell them not to come in because so few residents had signed up for appointments.

The New York Times examined survey and vaccine administration data for nearly every U.S. county and found that both willingness to receive a vaccine and actual vaccination rates to date were lower, on average, in counties where a majority of residents voted to re-elect President Donald J. Trump in 2020. The phenomenon has left some places with a shortage of supply and others with a glut.

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A Look at Who Attended Prince Philip’s Funeral

Amid coronavirus restrictions, Britain has had to adjust how it grieves over the past year. And with current rules allowing for just 30 people at funerals, the royal family scaled back plans for the service for Prince Philip.

A select handful of his closest family members were the only ones allowed in St. George’s Chapel. They were required to wear masks, follow social-distancing guidelines and refrain from singing, Buckingham Palace has said.

So who are those 30 people?

First, of course, there is Queen Elizabeth II. Like the rest of the family, she wore a face covering and had to sit at least six feet from other attendees.

Several family members took part in a procession behind Philip’s coffin before entering the chapel. The custom-built hearse was followed by his daughter, Anne, the Princess Royal; and by his son Charles, the Prince of Wales. Directly behind them were their younger brothers, Prince Edward, the Earl of Wessex; and Prince Andrew, the Duke of York.

killed by the Irish Republican Army in 1979.

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The Covid-19 Plasma Boom Is Over. What Did We Learn From It?

Scott Cohen was on a ventilator struggling for his life with Covid-19 last April when his brothers pleaded with Plainview Hospital on Long Island to infuse him with the blood plasma of a recovered patient.

The experimental treatment was hard to get but was gaining attention at a time when doctors had little else. After an online petition drew 18,000 signatures, the hospital gave Mr. Cohen, a retired Nassau County medic, an infusion of the pale yellow stuff that some called “liquid gold.”

In those terrifying early months of the pandemic, the idea that antibody-rich plasma could save lives took on a life of its own before there was evidence that it worked. The Trump administration, buoyed by proponents at elite medical institutions, seized on plasma as a good-news story at a time when there weren’t many others. It awarded more than $800 million to entities involved in its collection and administration, and put Dr. Anthony S. Fauci’s face on billboards promoting the treatment.

A coalition of companies and nonprofit groups, including the Mayo Clinic, Red Cross and Microsoft, mobilized to urge donations from people who had recovered from Covid-19, enlisting celebrities like Samuel L. Jackson and Dwayne Johnson, the actor known as the Rock. Volunteers, some dressed in superhero capes, showed up to blood banks in droves.

took a long time to measure its effectiveness. Eventually, studies did emerge to suggest that under the right conditions, plasma might help. But enough evidence has now accumulated to show that the country’s broad, costly plasma campaign had little effect, especially in people whose disease was advanced enough to land them in the hospital.

N.I.H. recently halted an outpatient trial of plasma because of a lack of benefit.

Doctors have used the antibodies of recovered patients as treatments for more than a century, for diseases including diphtheria, the 1918 flu and Ebola.

So when patients began falling ill with the new coronavirus last year, doctors around the world turned to the old standby.

In the United States, two hospitals — Mount Sinai in New York City and Houston Methodist in Texas — administered the first plasma units to Covid-19 patients within hours of each other on March 28.

Dr. Nicole M. Bouvier, an infectious-disease doctor who helped set up Mount Sinai’s plasma program, said the hospital had tried the experimental treatment because blood transfusions carry a relatively low risk of harm. With a new virus spreading quickly, and no approved treatments, “nature is a much better manufacturer than we are,” she said.

As Mount Sinai prepared to infuse patients with plasma, Diana Berrent, a photographer, was recovering from Covid-19 at her home in Port Washington, N.Y. Friends began sending her Mount Sinai’s call for donors.

thousands of Orthodox Jewish people were getting tested for coronavirus antibodies and showing up to donate. Coordinating it all was exhausting.

“April,” Mr. Lebovits recalled with a laugh, “was like 20 decades.”

Two developments that month further accelerated plasma’s use. With the help of $66 million in federal funding, the F.D.A. tapped the Mayo Clinic to run an expanded access program for hospitals across the country. And the government agreed to cover the administrative costs of collecting plasma, signing deals with the American Red Cross and America’s Blood Centers.

news releases announcing those deals got none of the flashy media attention that the billion-dollar contracts for Covid-19 vaccines did when they arrived later in the summer. And the government did not disclose how much it would be investing.

American Red Cross and America’s Blood Centers since last April.

“The convalescent plasma program was intended to meet an urgent need for a potential therapy early in the pandemic,” a health department spokeswoman said in a statement. “When these contracts began, treatments weren’t available for hospitalized Covid-19 patients.”

As spring turned to summer, the Trump administration seized on plasma — as it had with the unproven drug hydroxychloroquine — as a promising solution. In July, the administration announced an $8 million advertising campaign “imploring Americans to donate their plasma and help save lives.” The blitz included promotional radio spots and billboards featuring Dr. Fauci and Dr. Hahn, the F.D.A. commissioner.

provided access to its advertising agency, which created the look and feel for the Fight Is In Us campaign, which included video testimonials from celebrities.

although he later corrected his remarks following criticism from the scientific community.

the Infectious Diseases Society of America recommended that plasma not be used in hospitalized patients outside of a clinical trial. (On Wednesday, the society restricted its advice further, saying plasma should not be used at all in hospitalized patients.) In January, a highly anticipated trial in Britain was halted early because there was not strong evidence of a benefit in hospitalized patients.

narrowed the authorization for plasma so that it applied only to people who were early in the course of their disease or who couldn’t make their own antibodies.

Dr. Marks, the F.D.A. regulator, said that in retrospect, scientists had been too slow to adapt to those recommendations. They had known from previous disease outbreaks that plasma treatment is likely to work best when given early, and when it contained high levels of antibodies, he said.

“Somehow we didn’t really take that as seriously as perhaps we should have,” he said. “If there was a lesson in this, it’s that history actually can teach you something.”

pandemic exceptionalism” — had drained valuable time and attention from discovering other treatments.

“Pandemic exceptionalism is something we learned from prior emergencies that leads to serious unintended consequences,” she said, referring to the ways countries leaned on inadequate studies during the Ebola outbreak. With plasma, she said, “the agency forgot lessons from past emergencies.”

While scant evidence shows that plasma will help curb the pandemic, a dedicated clutch of researchers at prominent medical institutions continue to focus on the narrow circumstances in which it might work.

Dr. Arturo Casadevall, an immunologist at Johns Hopkins University, said many of the trials had not succeeded because they tested plasma on very sick patients. “If they’re treated early, the results of the trials are all consistent,” he said.

found that giving plasma early to older people reduced the progression of Covid-19. And an analysis of the Mayo Clinic program found that patients who were given plasma with a high concentration of antibodies fared better than those who did not receive the treatment. Still, in March, the N.I.H. halted a trial of plasma in people who were not yet severely ill with Covid-19 because the agency said it was unlikely to help.

With most of the medical community acknowledging plasma’s limited benefit, even the Fight Is In Us has begun to shift its focus. For months, a “clinical research” page about convalescent plasma was dominated by favorable studies and news releases, omitting major articles concluding that plasma showed little benefit.

the website has been redesigned to more broadly promote not only plasma, but also testing, vaccines and other treatments like monoclonal antibodies, which are synthesized in a lab and thought to be a more potent version of plasma. Its clinical research page also includes more negative studies about plasma.

Nevertheless, the Fight Is In Us is still running Facebook ads, paid for by the federal government, telling Covid-19 survivors that “There’s a hero inside you” and “Keep up the fight.” The ads urge them to donate their plasma, even though most blood banks have stopped collecting it.

Two of plasma’s early boosters, Mr. Lebovits and Ms. Berrent, have also turned their attention to monoclonal antibodies. As he had done with plasma last spring, Mr. Lebovits helped increase acceptance of monoclonals in the Orthodox Jewish community, setting up an informational hotline, running ads in Orthodox newspapers, and creating rapid testing sites that doubled as infusion centers. Coordinating with federal officials, Mr. Lebovits has since shared his strategies with leaders in the Hispanic community in El Paso and San Diego.

And Ms. Berrent has been working with a division of the insurer UnitedHealth to match the right patients — people with underlying health conditions or who are over 65 — to that treatment.

“I’m a believer in plasma for a lot of substantive reasons, but if word came back tomorrow that jelly beans worked better, we’d be promoting jelly beans,” she said. “We are here to save lives.”’

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Coronavirus Deaths Reach 3 Million Worldwide

Three million lives: That is roughly equivalent to losing the population of Berlin, Chicago or Taipei. The scale is so staggering that it sometimes begins to feel real only in places like graveyards.

More than 100,000 people have died of Covid-19 in France. The death rate is inching up in Michigan. Morgues in some Indian cities are overflowing with corpses.

The world’s Covid-19 death toll surpassed three million on Saturday, according to a New York Times database. And as the United States and other rich nations race to vaccinate their populations, new hot spots have emerged in parts of Asia, Eastern Europe and Latin America.

The global pace of deaths is accelerating, too. After the coronavirus emerged in the Chinese city of Wuhan, the pandemic claimed a million lives in nine months. It took another four months to kill its second million, and just three months to kill a million more.

according to a New York Times tracker.

At the same time, new outbreaks are still cropping up persistently in rich countries. That has shocked millions of people — from Madrid to Los Angeles — who once expected regular life to resume in tandem with vaccine rollouts.

France, which on Thursday became the third country in Western Europe to pass 100,000 deaths, is in the throes of a third national lockdown.

France on Thursday was the third European country to pass the tragic milestone of 100,000 coronavirus deaths, as it struggles to envision a clear way out of a third wave of infections.

A deep sense of fatigue and frustration has taken root in the country over a seemingly endless cycle of coronavirus restrictions and Paris has been shrouded in gloom for months. The country entered a third national lockdown two weeks ago that has limited outdoor activities, forced nonessential shops to close, banned travel between regions and shut schools for a month.

Michigan, the worst-hit state, is reporting an average of about 50 deaths a day, twice as many as two weeks ago, along with 7,800 or so new cases.

The United States and parts of Western Europe bore the brunt of deaths for the first year of the pandemic. Now, the hot spots for fatalities are in regions like Eastern Europe, South Asia and Latin America.

told The New York Times in Mexico City. “It just never crossed your mind that there would be so many dead in so little time.”

One reason for all the carnage is that richer countries have essentially hoarded vaccines, leaving poorer ones to scramble desperately for doses.

Safety worries about the AstraZeneca and Johnson & Johnson vaccines, based on a small number of people who developed problems with blood clotting, have also exacerbated vaccine hesitancy around the world — a trend that threatens to prolong the pandemic and subvert nascent vaccination drives.

undone decades of economic progress in India. Now, the country of 1.3 billion people is recording an average of about 1,000 deaths a day as a huge outbreak flares in the western state of Maharashtra, which is home to Mumbai.

India reported 1,341 deaths on Saturday alone, along with nearly a quarter of a million new cases.

Swapnil Gaikwad, 28, whose uncle died on Friday in the Osmanabad district of Maharashtra, said that it had taken seven hours to perform the traditional burial rites because the local crematory was so busy.

“There was absolutely no space, and more ambulances were arriving,” he said.

At one point, Mr. Gaikwad said, he became so angry that he complained to the staff.

One worker there began to cry. Mr. Gaikwad said some workers had told him that they were so busy at the crematory that they had not seen their own families for days.

Oscar Lopez and Monica Pronczuk contributed reporting.

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A vaccine scare ripples around the world: The week in Covid-19 news.

Safety worries about the AstraZeneca and Johnson & Johnson Covid-19 vaccines in the United States and Europe have reverberated around the world, undercutting faith in two sorely needed shots and threatening to prolong the coronavirus pandemic in poorer countries that cannot afford to be choosy about vaccines. With new infections surging on nearly every continent, signs that the vaccination drive is in peril are emerging, most disconcertingly in the continent of Africa.

In many African countries, vaccination campaigns have been hindered by factors like science skepticism, limited or no efforts to educate the public, inefficient distribution systems and concerns over the extremely rare but serious cases of blood clots being investigated among a small number of people who received the AstraZeneca and Johnson & Johnson vaccines. Those two vaccines, which require less stringent refrigeration, are crucial to efforts to immunize populations in poorer countries.

But in Malawi, some people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine because it was less effective against the dominant variant there.

Across the continent, public confusion over whether to get inoculated — and if so when and where to do so — has contributed to the expiration of doses. South Sudan saw 59,000 unused doses expire this month, and in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.

Pew Research Center — accounting for a majority of the 54 million who slipped out of the middle class worldwide. A second wave of Covid-19 is threatening the dreams of millions more looking for a better life.

  • Keeping the middle seats vacant during a flight could reduce passengers’ exposure to airborne coronavirus by 23 to 57 percent, researchers reported in a new study. This reduction in risk stemmed from increasing the distance between an infectious passenger and others as well as from reducing the total number of people in the cabin. But the study may have overestimated the benefits of empty middle seats because it did not take into account mask-wearing by passengers.

  • More exercise means less risk of developing severe Covid, according to a compelling new study of physical activity and coronavirus hospitalizations. The study found that those who had been the most active before falling ill were the least likely to be hospitalized or die as a result of their illness.

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    The global death toll from Covid-19 is nearing 3 million.

    The world’s Covid-19 death toll is approaching yet another once unthinkable number — nearly three million people have died from the virus since the first cases surfaced more than 14 months ago and upended life for people across the globe.

    The global death toll stands at 2,990,993, while the number of confirmed coronavirus cases has surged to nearly 140 million, according to a New York Times database, as countries race to provide enough vaccines to slow the relentless pace of infections.

    The pace of deaths has been accelerating. The world did not record one million deaths until Sept. 28, but had recorded two million less than four months later, by Jan. 15 (not Feb. 21, as an earlier version of this report said). And the latest million took just three months.

    The United States, Brazil and Mexico lead the world in Covid-19 deaths.

    In the United States, more than 564,800 virus-related deaths have been confirmed, about one in 567 people — the most of any other country.

    Brazil, where the spread of the virus has been fueled by a highly contagious variant, political infighting and distrust of science, more than 365,000 people have died. The virus is still pummeling the country, which is averaging over 2,900 deaths per day.

    The leaders of both countries, which are the region’s two largest nations, have largely dismissed the dangers and have resisted calls for a lockdown.

    India, the country with the fourth-highest number of total coronavirus deaths, has recorded more than 174,300 deaths. The virus is surging there once again, prompting more shutdowns and another mass migration away from big cities.

    Britain recently ended one of the longest and most stringent lockdowns in the world — more than 127,100 deaths have been recorded. And in Italy, once the nightmarish epicenter of the virus, there have been almost 116,000 confirmed deaths.

    Sweden, where officials have taken a more lax approach to combating the coronavirus, has experienced an increase in new cases and deaths recently, with more than 13,700 deaths.

    As dangerous virus variants spread, many developed countries are racing to vaccinate their populations as fast as possible. More than 841 million vaccine doses have been administered worldwide, though some countries have yet to report a single dose, according to a New York Times database that tracks the worldwide rollout of shots.

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