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Drug Overdose Deaths Have Surged During the Pandemic, C.D.C. Says

On Tuesday, several dozen organizations that work on addiction and other health issues asked Mr. Biden’s health and human services secretary, Xavier Becerra, to “act with urgency” and eliminate the rule that doctors go through a day of training before getting federal permission to prescribe buprenorphine. Many addiction experts are also calling for abolishing rules that had already been relaxed during the pandemic so that patients don’t have to come to clinics or doctors’ offices for addiction medications.

Although many programs offering treatment, naloxone and other services for drug users have reopened at least partly as the pandemic has dragged on, many others remain closed or severely curtailed, particularly if they operated on a shoestring budget to begin with.

Sara Glick, an assistant professor of medicine at the University of Washington, said a survey of about 30 syringe exchange programs that she conducted last spring found that many closed temporarily early in the pandemic. After reopening, she said, many programs cut back services or the number of people they could help.

“With health departments spending so much on Covid, some programs have really had to cut their budgets,” she said. “That can mean seeing fewer participants, or pausing their H.I.V. and hepatitis C testing.”

At the same time, increases in H.I.V. cases have been reported in several areas of the country with heavy injection drug use, including two cities in West Virginia, Charleston and Huntington, and Boston. West Virginia’s legislature passed a law last week placing new restrictions on syringe exchange programs, which advocates of the programs said would force many to close.

Mr. Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, as well as $30 million in funding for local services that benefit people with addiction, including syringe exchange programs. The latter is significant because while federal funds still largely cannot be spent on syringes for people who use drugs, the restriction does not apply to money from the stimulus package, according to the Office of Drug Control Policy. Last week, the administration announced that federal funding could now be used to buy rapid fentanyl test strips, which can be used to check whether drugs have been mixed or cut with fentanyl.

Fentanyl or its analogues have increasingly been detected in counterfeit pills being sold illegally as prescription opioids or benzodiazepines — sedatives like Xanax that are used as anti-anxiety medications — and particularly in meth.

Northeastern states that had been hit hardest by opioid deaths in recent years saw some of the smallest increases in deaths in the first half of the pandemic year, with the exception of Maine. The hardest-hit states included West Virginia and Kentucky, which have long ranked at the top in overdose deaths, but also western states like California and Arizona and southern ones like Louisiana, South Carolina and Tennessee.

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Expert Panel to CDC to Vote on Johnson & Johnson Vaccine Pause

An advisory committee for the Centers for Disease Control and Prevention will meet on Wednesday afternoon to discuss whether the Johnson & Johnson Covid-19 vaccine should remain paused while a possible link to rare blood clots is investigated.

The emergency meeting follows the Food and Drug Administration’s announcement on Tuesday that it was studying six cases of rare and severe blood clots in women aged 18 to 48, one of whom died. All of the women had received the Johnson & Johnson vaccine before developing the clots, though it is unclear whether the vaccine is responsible. As of Tuesday, more than seven million people in the United States have received the shot, and another 10 million doses have been shipped out to the states, according to C.D.C. data.

Following the call from federal health agencies, all 50 states, Washington, D.C., and Puerto Rico on Tuesday quickly paused or recommended that providers pause the administration of the vaccine. The U.S. military, federally run vaccination sites, and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix also paused the injections.

The Advisory Committee on Immunization Practices, or ACIP, is a panel of independent experts who advise the C.D.C. on its vaccine policies. At the meeting, the experts will be reviewing and debating the data from the six cases, and listening to comments from the public, before taking a vote on how to proceed. They could vote to recommend that the pause continues, for example, or to specify that it should apply only to a certain age or sex.

reiterated on Wednesday that the pause in Johnson & Johnson vaccinations gives public health officials a chance to investigate the cases and discuss with health care professionals. He added that pauses are common when new vaccines and drugs are rolled out.

“We’re just doing the due diligence we need to do to make sure everything is safe so we can continue with our vaccination efforts,” Dr. Murthy said on “CBS This Morning.”

was not worth the trade-off of slowing the vaccination campaign and potentially eroding the public’s trust of vaccines in general.

Madeleine Ngo contributed reporting.

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Why Coinbase’s IPO Is a Cryptocurrency Coming-Out Party

SAN FRANCISCO — Digital currency, once mocked as a tool for criminals and reckless speculators, is sliding into the mainstream.

Traditional banks are helping investors put their money into cryptocurrency funds. Companies like Tesla and Square are hoarding Bitcoin. And celebrities are leading the way in a digital-art spending spree using a technology called an NFT.

On Wednesday, digital or cryptocurrencies will take their biggest step yet toward wider acceptance when Coinbase, a start-up that allows people to buy and sell cryptocurrencies, goes public on Nasdaq. Coinbase shares received a reference price of $250 each on Tuesday evening, which would value the company at $65 billion based on all its outstanding shares.

Call it crypto’s coming-out party. Coinbase, founded in San Francisco, is the first major cryptocurrency start-up to go public on a U.S. stock market. It is doing so at a valuation that tops that of Capital One Financial Corporation or Moody’s, the ratings agency.

plan to “create an open financial system for the world” and “increase economic freedom.”

But so far, cryptocurrency is mostly a vehicle for financial speculation and trading. Few people want to use Bitcoin for everyday purchases like coffee because its price is so volatile. Many early buyers have become wildly rich by simply holding their crypto or “buying the dip” when prices fall. Others ruefully relay tales of the sushi dinner they bought with Bitcoin years ago that would be worth $200,000 today or the million-dollar pizza.

Coinbase eases that trading by acting as a central exchange. Before it and similar services were created, people had to set up their own digital wallets and wire money.

“Can it be anything more than an asset class?” Mr. Tusk asked. “That’s still very much up in the air.”

Silk Road, a marketplace for buying and selling drugs and weapons with Bitcoin until the federal authorities shut it down, and Mt. Gox, a crypto exchange that collapsed under accusations of theft and embezzlement, further tarnished the young industry.

Coinbase tried to change that. The company joined Y Combinator, a prestigious start-up program, and raised money from top venture capital firms including Union Square Ventures and Andreessen Horowitz.

Mr. Armstrong was one of the few people in the industry who seemed prepared to comply with inevitable regulations, rather than cut corners to avoid them, said Nick Tomaino, who dropped out of business school to join Coinbase in 2013.

Coinbase also persuaded well-known retailers to accept Bitcoin. “It was good for credibility when people saw you could actually use a Bitcoin to buy a mattress at Overstock,” Mr. Tomaino, who left in 2016, said. Coinbase earned money on transaction fees.

But Bitcoin’s wildly volatile price and a slow computer network that managed it made transactions difficult, and people began to see the currency as an investment. In 2015, Ethereum, a cryptocurrency network with more tech abilities, was introduced, enticing enthusiasts to build companies and funds around the technology.

Soon after, a flood of “initial coin offerings,” where companies sold tokens on the promise of the technology they planned to build, created a new boom in cryptocurrency trading. But it quickly deflated after many projects were found to be frauds and U.S. regulators deemed the offerings to be securities, requiring that they comply with financial rules.

Tesla to buy $1.5 billion worth of Bitcoin and the payments company Square to spend $170 million. In March, Morgan Stanley began offering its wealthy clients access to three Bitcoin funds, and Goldman announced that it would soon offer similar access. The mayor of Miami has proposed that the city accept tax payments in Bitcoin and invest city funds in the asset.

The stock trading app Robinhood announced that 9.5 million of its customers had traded cryptocurrency in the first three months of the year — up more than fivefold from the previous three months. Venture funding for crypto-related start-ups surged to its highest-ever level in the first quarter to $3 billion, according to PitchBook.

PayPal recently added a crypto trading and shopping feature for its customers in the United States. The company was motivated by consumer interest and advances in the technology that made transactions faster. It plans to quickly expand the offering to customers around the world.

“It feels like the time is right,” said Jose Fernandez da Ponte, head of PayPal’s blockchain, crypto and digital currencies group. “We think this has the potential to revolutionize payments and financial systems in general.”

Still, the so-called revolution faces some challenges. Coinbase has sometimes struggled to keep up with demand, with some customers who lost access to their accounts complaining that the company has been unresponsive. It has also received criticism for its treatment of female and Black employees.

Treasury Secretary Janet L. Yellen has threatened harsher regulation of the currencies, including limiting their use.

And a big drop in prices could again send speculators fleeing. In its financial prospectus, Coinbase warned that its business results would fluctuate with the volatility of crypto assets, “many of which are unpredictable and in certain instances are outside of our control.”

The industry’s biggest issue — fulfilling the promise that the technology is more than just a place to park money — could take another decade to play out.

“There’s no doubt we’re in the latest boom, and I don’t know if that’s going to turn tomorrow or two years from now,” Mr. Tomaino said. “But the busts and booms are always higher than the last.”

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F.D.A. Will Allow Abortion Pills by Mail During the Pandemic

The Biden administration has decided to allow women to receive abortion pills by mail for the duration of the coronavirus pandemic, the latest development in an issue that has increasingly taken center stage in the American abortion debate.

In a letter sent Monday to two leading organizations representing reproductive health physicians, the acting commissioner of the Food and Drug Administration said that the agency would temporarily stop enforcing its requirement that the first of two drugs needed to terminate an early pregnancy be dispensed in a medical clinic.

The new policy counters a Supreme Court decision in January that sided with the Trump administration, which had appealed a federal judge’s decision last July to suspend the requirement. The judge had argued that the requirement put women at risk during the pandemic because they would need to visit clinics in person and often travel significant distances to do so.

Abortion through medication, first approved by the F.D.A. in 2000, is increasingly becoming women’s preferred method for terminating a pregnancy. As of 2017, research estimated that about 60 percent of abortion patients early enough in pregnancy to be eligible — 10 weeks pregnant or less — chose medication abortion over suction or surgery.

dispensed in clinics or hospitals by specially certified doctors or other medical providers. For years, reproductive health experts have urged that the requirement be lifted on the grounds that there are no significant safety reasons for in-person dispensing of a pill that women are then legally allowed to take on their own in any location, and that the restriction places the greatest burden on low-income women and those in areas with limited access to abortion providers.

For several years, with the F.D.A.’s permission, researchers have been conducting a study that provides telemedicine consultations to women seeking abortions and mails them the pills. Their research has found the approach to be safe and effective.

Additional data was collected in recent months from the experiences of women during the pandemic who received abortion pills by mail after the judge lifted the restriction and before the Supreme Court reinstated it.

Dr. Janet Woodcock, the acting F.D.A. commissioner, wrote in her letter to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine that studies of the pandemic experience “do not appear to show increases in serious safety concerns,” like bleeding, ectopic pregnancy or the need for surgical interventions “occurring with medical abortion as a result of modifying the in-person dispensing requirement during the Covid-19 pandemic.”

Groups that oppose abortion objected to the decision. Jeanne Mancini, president of March for Life, said in a statement that allowing appointments for medication abortion via telemedicine posed “grave danger” to women’s safety, adding “chemical abortions should have more medical oversight not less.”

letter in March to President Biden and Vice President Kamala Harris asking for the F.D.A. to lift the restrictions during the pandemic, welcomed the decision.

“Mifepristone itself has demonstrated, through both clinical study and decades of use, to be a safe, effective medication,” the president and chief executive of the American College of Obstetricians and Gynecologists said in a statement. “Requiring the medicine to be dispensed in person, then taken elsewhere at the patients’ discretion, is arbitrary and does nothing to bolster the safety of an already-safe medicine.”

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How Worried Should You Be About the J&J Vaccine and Blood Clots?

On Tuesday morning, U.S. federal health regulators recommended a pause in the use of Johnson & Johnson’s Covid-19 vaccine while they investigated six reports of blood clots in women ages 18 to 48. One has died, and a second is hospitalized in critical condition.

As of Monday, 6.8 million people in the United States had received the vaccine without any other serious adverse reactions reported.

Experts have yet to determine to what extent, if any, the vaccine is responsible for the clots. But the investigation follows actions by European regulators who concluded that a vaccine made by AstraZeneca may also be the cause of a similar, extremely rare clotting disorder.

U.S. and European public health experts have emphasized that for most people, the benefits of the Covid vaccines far outweigh the risks.

recommends that people who have received the Johnson & Johnson vaccine within the past three weeks should contact their doctors if they experience severe headaches, abdominal pain, leg pain or shortness of breath. People should not be concerned about mild headaches and flu-like symptoms in the first few days after vaccination. Those are common, harmless side effects brought on by the immune system’s production of a defense against the coronavirus.

During clinical trials and after vaccines go into wide use, experts keep track of any medical problems experienced by people who receive them. If an unusually large cluster of cases turns up, regulators may decide to pause a trial or stop the use of a vaccine to investigate further.

Pauses are common, and typically the investigations reveal that the medical problems were a matter of coincidence. If the investigation reveals that a vaccine does pose a risk, regulators may write new guidance about who should or should not receive it.

regulators have said, roughly one in 1,000 people are affected by a blood clot in a vein every year.

But the clotting disorder of concern in the vaccine recipients is much rarer and different from typical blood clots. In addition to clotting in the brain — called cerebral venous sinus thrombosis, or CVST for short — the patients all had a notably low level of platelets, which left them prone to abnormal bleeding.

said the company was aware of an extremely rare disorder involving people with blood clots in combination with low platelets in a small number of individuals who have received our COVID-19 vaccine. “In addition, we have been reviewing these cases with European health authorities,” the company said in its statement. “We have made the decision to proactively delay the rollout of our vaccine in Europe.”

At the news conference on Tuesday, Dr. Marks of the F.D.A. said the cases were “very, very similar.”

a number of possible symptoms, including swelling in the leg, persistent abdominal pain, severe and persistent headaches or blurred vision, and tiny blood spots under the skin beyond the area where the injection was given.

But that set of symptoms was so vague that almost immediately, British emergency rooms experienced a surge in patients who were worried that they fit the description.

Nonetheless, German researchers say that such symptoms in vaccine recipients must be followed up. Blood tests can detect the antibodies.

Doctors in Germany and Norway have treated patients with blood-thinning drugs to try to stop the growth of the clots, and with intravenous immune globulin, which can help eliminate the misguided antibodies that are causing the problem.

AstraZeneca vaccines. One recipient, a physician in Florida, died from a brain hemorrhage when his platelet levels could not be restored, and others have been hospitalized. U.S. health officials have said that the cases are being investigated, but they have not reported the findings of those reviews and have yet to indicate that there is any link to the vaccines.

Benjamin Mueller contributed reporting.

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Covid-19 Live Updates: Regeneron’s Antibody Drug Can Help Prevent Infections, Study Says

clinical trial results announced on Monday. The drug, if authorized, could offer another line of defense against the disease for people who are not protected by vaccination.

The findings are the latest evidence that such lab-made drugs not only prevent the worst outcomes of the disease when given early enough, but also help prevent people from getting sick in the first place.

Using the cumbersome drugs preventively on a large scale won’t be necessary: Vaccines are sufficient for the vast majority of people and are increasingly available.

Still, antibody drugs like Regeneron’s could give doctors a new way to protect high-risk people who haven’t been inoculated or who may not respond well to vaccination, such as those taking drugs that weaken their immune system. That could be an important tool as rising coronavirus cases and dangerous virus variants threaten to outpace vaccinations.

Regeneron said in a news release that it would ask the Food and Drug Administration to expand the drug’s emergency authorization — currently for high-risk people who already have Covid but are not hospitalized — to allow it to be given for preventive purposes in “appropriate populations.”

There’s “a very substantial number of people” in the United States and globally who could be a good fit to receive these drugs for preventive purposes, said Dr. Myron Cohen, a University of North Carolina researcher who leads monoclonal antibody efforts for the Covid Prevention Network, a National Institutes of Health-sponsored initiative that helped to oversee the trial.

“Not everyone’s going to take a vaccine, no matter what we do, and not everyone’s going to respond to a vaccine,” Dr. Cohen said.

Regeneron’s new data come from a clinical trial that enrolled more than 1,500 people who lived in the same household as someone who had tested positive for the virus within four days. Those who got an injection of Regeneron’s drug were 81 percent less likely to get sick with Covid compared to volunteers who got a placebo.

Dr. Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital who was not involved in the study, said the data were “promising” for people who have not yet been vaccinated. But he said that the study did not enroll the type of patients that would be needed to assess whether the drug should be used preventively for immunocompromised patients. “I would say we don’t yet know that,” Dr. Gandhi said.

Regeneron’s cocktail, a combination of two drugs designed to mimic the antibodies generated naturally when the immune system fends off the virus, got a publicity boost last fall when it was given to President Donald J. Trump after he got sick with Covid.

The treatment received emergency authorization in November. Doctors are using it, as well as another antibody cocktail from Eli Lilly, for high-risk Covid patients.

But use of the antibody drugs has been slowed not by a shortage of doses, but by other challenges, though access has improved in recent months. Many patients don’t know to ask for the drugs or where to find them.

Many hospitals and clinics have not made the treatments a priority because they have been time-consuming and difficult to administer, in large part because they must be given via intravenous infusion. Regeneron plans to ask the F.D.A. to allow its drug to be given via an injection, as it was administered in the results of the study announced on Monday, which would allow it to be given more quickly and easily.

Decorating the exterior of an Italian restaurant in London on Sunday. Pubs and restaurants were permitted to reopen outdoor spaces on Monday.
Credit…Andrew Testa for The New York Times

Britain reopened large parts of its economy on Monday, allowing people in England back in shops, hair salons and outdoor areas of pubs and restaurants, a long-awaited milestone after three months of lockdown, and a day after the country recorded its lowest daily coronavirus death toll since September.

Under the second stage of the government’s gradual reopening, libraries, community centers and some outdoor attractions like zoos will also return, though outdoor gatherings remain limited to six people or two households.

For many in England, the return was a hopeful — if not definitive — sign that the worst of the pandemic was behind them, after a new variant of the virus detected last year in the country’s southeast spun out of control around Christmas, overwhelming hospitals and causing tens of thousands of deaths.

At its winter peak, Britain reported as many as 60,000 daily cases a day and 1,820 daily deaths, according to a New York Times database. But after months of restrictions and an aggressive vaccination program that has offered a dose to about half of Britain’s population, those figures declined to 1,730 daily cases and seven deaths reported on Sunday.

Prime Minister Boris Johnson has so far gone ahead with the gradual easing of measures that he had announced, reopening schools on March 8, reducing restrictions on outdoor gatherings on March 29, and allowing large parts of the economy to reopen on Monday.

Mr. Johnson said on Monday that the reopening was “a major step forward in our road map to freedom.” Still, he urged caution.

“I urge everyone to continue to behave responsibly and remember ‘hands, face, space and fresh air’ to suppress Covid,” he said.

Scotland, Wales and Northern Ireland, where devolved governments are responsible for coronavirus restrictions, have laid out similar plans to reopen their economies.

The apparent success represents a turnaround for Mr. Johnson’s government, which struggled to stem cases earlier in the pandemic and at one point reported the greatest rate of excess deaths in Europe.

But now E.U. countries — hampered by a vaccine rollout slower than Britain’s and a scare over a possible links between the AstraZeneca vaccine and blood clots — are facing a third wave of coronavirus infections. France, Italy and other countries have recently imposed new lockdown measures.

In England, business owners reopened on Monday with hope — and some anxiety that the numbers of infections could go up again. Still, “we’re looking confident we won’t be seeing anything like that again,” said Nicholas Hair, the owner of The Kentish Belle, a London pub that opened its doors to patrons one minute after midnight.

Global Roundup

A train station in Mumbai, on Monday.
Credit…Niharika Kulkarni/Reuters

Even as India hit a record for daily coronavirus infections, and its total caseload rose to second in the world behind the United States, the images that dominated Indian news media on Monday were of a crowded religious festival along the banks of the Ganges River.

The dissonance was a clear manifestation of the confusing messages sent by the authorities just as India’s coronavirus epidemic is spiraling, with a daily high of 168,000 cases and 900 deaths reported on Monday.

Yet millions of devotees have thronged the holy city of Haridwar for the monthlong Kumbh Mela, or pitcher festival, when Hindu pilgrims seek absolution by bathing in the Ganges. Officials have said that about one million people will participate every day, and as many as five million during the most auspicious days, all crowded into a narrow stretch along the river and searching for the holiest spot to take a dip.

Already, fears are running high that one of the most sacred pilgrimages in Hinduism could turn into a superspreading event.

Dr. S. K. Jha, a local health officer, said that an average of about 250 new cases had been registered each day recently. Experts have warned that many more infections are going unrecorded, and that devotees could unwittingly carry the virus with them as they return to their homes across the country.

India is in the grip of the world’s fastest growing outbreak, with more and more jurisdictions going back into varying stages of lockdown. Infections are spreading particularly fast in Mumbai, the country’s financial hub, and the surrounding state of Maharashtra, where the government has announced a partial weekday lockdown and near-total closure over the weekends.

The situation is also worsening in the capital, New Delhi, which reported more than 10,000 new cases on Sunday, surpassing the previous daily high of nearly 8,500. The state government has imposed a curfew and ordered restaurants and public transport systems to run at half capacity. Arvind Kejriwal, Delhi’s top official, has said more restrictions may follow.

Hospitals in several states are reporting shortages of oxygen, ventilators and coronavirus testing kits, and some are also running low on remdesivir, a drug used in serious Covid-19 cases. India has halted the export of remdesivir until the situation improves.

India is also trying to ramp up its vaccination drive, with about three million people being inoculated daily and 104 million doses administered so far. But with many vaccination centers nationwide expressing concern over possible shortages, India’s large pharmaceutical industry has sharply reduced its exports of the AstraZeneca vaccine in order to keep more doses at home, creating serious challenges for other countries that had been relying on those shipments.

On Monday, Indian experts recommended the use of Russia’s Sputnik-V coronavirus vaccine, which would become the third available in the country if approved by the authorities.

After months of lower-than-expected infections and deaths from the virus, critics say Indian officials have sent dissonant messages about the seriousness of the crisis. Police officers are enforcing curfew and mask rules, sometimes resorting to beatings captured on videos shared across social media. But senior political leaders, including the prime minister, Narendra Modi, have been holding large rallies for local elections.

Mr. Modi’s Hindu nationalist government has also allowed the religious festival to proceed — in contrast to what happened last spring, at the start of the pandemic, when India’s health ministry blamed an Islamic seminary for fanning a far smaller outbreak. Critics say rhetoric from members of Mr. Modi’s party contributed to a spate of attacks against Muslims, a minority of about 200 million people in a Hindu-dominated country of 1.3 billion.

In other news around the world:

Anna Schaverien, Constant Méheut and Niki Kitsantonis contributed reporting.

A vaccination center at the Royal Exhibition Building in Melbourne, Australia, last month.
Credit…James Ross/EPA, via Shutterstock

Australia has given up on the goal of vaccinating its entire population against Covid-19 by the end of the year, following updated advice from health officials that younger people should not receive the AstraZeneca vaccine, as well as delays in the delivery of doses.

The Australian government said last week that it had accepted a recommendation by a panel of health experts that people under 50 receive the Pfizer-BioNTech vaccine instead of the one developed by AstraZeneca, which had been the centerpiece of Australia’s vaccination program. The change in guidance came after European regulators found links between the AstraZeneca vaccine and rare blood clots, prompting several countries to restrict use of the shot.

Prime Minister Scott Morrison said Friday that the government had ordered another 20 million doses of the Pfizer vaccine, doubling what it had already purchased. But they are not expected to be available until the fourth quarter of this year, dealing a blow to the government’s previously stated goal of inoculating all of its 25 million people by then.

Mr. Morrison appeared to acknowledge the change in timeline in a Facebook post on Sunday.

“The government has also not set, nor has any plans to set any new targets for completing first doses,” Mr. Morrison said. “While we would like to see these doses completed before the end of the year, it is not possible to set such targets given the many uncertainties involved.”

Public health experts have criticized Mr. Morrison’s government for relying too heavily on the AstraZeneca vaccine, a relatively cheap and easy-to-use shot but one whose troubles have jeopardized inoculation efforts in multiple countries. They said the setback to Australia’s vaccination program risked undermining the country’s success in containing the spread of the coronavirus since recording its first case in January 2020.

“We’re in a position a year later where that hard-won success is jeopardized by a completely incompetent approach to a vaccine rollout,” said Bill Bowtell, a public health policy expert and adjunct professor at the University of New South Wales in Sydney.

Australia has made four separate agreements for the supply of Covid-19 vaccines that would give it a total of 170 million doses, enough to inoculate its population more than three times over. Plans to manufacture almost all of its 54 million AstraZeneca doses domestically were approved last month.

But the Australian government has been under fire for weeks over the sluggish pace of its vaccination rollout, which began in late February. By the end of March, when the government had aimed to vaccinate four million people, only about 600,000 had actually been inoculated. As of Sunday, Australia had administered fewer than 1.2 million doses.

Australian officials have attributed the slow rollout to delays in the delivery of millions of vaccine doses manufactured in the European Union, which has curbed exports amid its own supply shortages. The export restrictions mainly affect the AstraZeneca vaccine.

After enduring strict lockdowns for much of the past year, Australians are now enjoying relatively normal life in a country that has all but stamped out the virus. But public health experts warn that until more of the population is vaccinated, those freedoms are precarious.

“Having eliminated Covid, they thought a mass vaccination campaign would lock that in,” Mr. Bowtell said of the Australian public. “Now they are being deeply disillusioned.”

Covid-19 vaccinations at a monastery in Bangkok this month.
Credit…Adam Dean for The New York Times

Thailand is facing its worst coronavirus outbreak just as millions of people head to their home provinces during the country’s biggest travel holiday.

The latest wave of infections, which has sent at least eight cabinet members into isolation, is centered in a Bangkok nightlife district said to be popular with government officials and wealthy partygoers. The country, which until now has largely kept the virus under control, set a record Monday for new daily cases with 985.

One top health official warned that Thailand could soon face as many as 28,000 new cases a day in the worst-case scenario. The government announced it would set up field hospitals as Covid-19 wards at existing facilities begin to fill up.

Officials ordered the closure of hundreds of bars and nightclubs, but critics say the government has been inconsistent in its efforts to bring the outbreak under control. The prime minister, Prayuth Chan-ocha, stopped short of banning travel between provinces for the Songkran holiday, which begins on Tuesday and marks the beginning of the Thai New Year.

“Whatever will be, will be,” he said last week in explaining his decision. “The reason is it’s a matter that involves a huge number of people. The government will have to try to cope with that later.”

Dozens of provinces have imposed their own restrictions on travelers coming from Bangkok and other affected areas, prompting many Thais to cancel their trips. But many others set off over the weekend.

During earlier outbreaks, the government often acted quickly to require face masks, ban foreign tourists, impose quarantine restrictions and lock down hard-hit areas. It has reported fewer than 34,000 cases — mostly from a January surge traced to a seafood market near Bangkok — and just 97 deaths.

But it has been lax in testing and slow to vaccinate. So far, it has procured about 2.2 million doses and given at least one to about 500,000 people. Thailand’s population is 70 million.

Vaccine production is not expected to begin in earnest until June, when a manufacturer in Thailand is scheduled to begin producing 10 million doses a month of the AstraZeneca vaccine.

Health officials were alarmed by the recent discovery of dozens of cases of the highly infectious coronavirus variant first identified in Britain. The finding highlighted the inadequacy of Thailand’s virus testing and suggested that its quarantine procedures have not been as effective as officials believed.

Tourism operators have been especially angered by the government’s lackadaisical approach to obtaining vaccine supplies. The tourism industry, which normally accounts for about 20 percent of the nation’s economy, is highly dependent on foreign visitors and has been calling for widespread vaccinations to speed its recovery.

The outbreak in Bangkok has also prompted questions about the activities of some top officials and their aides.

The transportation minister, Saksayam Chidchob, who was hospitalized with Covid-19, was criticized for not being forthcoming about his whereabouts during times when he may have been exposed to the virus. He denied visiting the gentlemen’s club at the center of the outbreak and said he believed he had contracted the virus from an aide.

Eyan Gallegos, 11, a middle schooler in Washington, completing his homework in his room.
Credit…Gabriella Demczuk for The New York Times

Parents with school-age children have struggled to combine their usual work and family responsibilities this past year with at least some degree of home-schooling.

But mothers and fathers of middle-schoolers — the parenting cohort long known to researchers as the most angst-ridden and unhappy — are connecting now in a specific sort of common misery: the pressing fear that their children, at a vital point in their academic and social lives, have tripped over some key developmental milestones and may never quite find their footing.

Experts say some of their worries are justified — up to a point. The pandemic has taken a major toll on many adolescents’ emotional well-being.

Yet as the nation begins to pivot from trauma to recovery, many mental-health experts and educators are trying to spread the message that parents, too, need a reset. If adults want to guide their children toward resilience, these experts say, then they need to get their own minds out of crisis mode.

Early adolescence is considered a critical period, a time of brain changes so rapid and far-reaching that they rival the plasticity and growth that take place in the newborn to 3-year-old phase.

These changes make children more capable of higher-level thinking and reasoning. They also make them crave social contact, attention and approval.

Remote learning and social distancing are in many ways the opposite of what children in this age group want and need.

It’s been hardest on middle schoolers,” said Phyllis Fagell, a therapist and school counselor who wrote the 2019 book “Middle School Matters.” “It is their job to pull away from parents, to use these years to really focus on figuring out where they are in the pecking order. And all of that hard work that has to happen in these years was just put on hold.”

Yet Ms. Fagell and many other experts in adolescent development were adamant that parents should not panic — and that the spread of the “lost year” narrative needed to stop.

Getting a full picture of what’s going on with middle schoolers, they agreed, requires holding two seemingly contradictory ideas simultaneously in mind: The past year has been terrible. And most middle schoolers will be fine.

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Blood Clots Linked to AZ Vaccine Stem From Rare Antibody Reaction

Two reports published on Friday in a leading medical journal help to explain how AstraZeneca’s Covid vaccine can, in rare cases, cause serious and sometimes fatal blood clots.

Scientific teams from Germany and Norway found that people who developed the clots after vaccination had produced antibodies that activated their platelets, a blood component involved in clotting. The new reports add extensive details to what the researchers have already stated publicly about the blood disorder.

Why the rare reaction occurred is not known. Younger people appear more susceptible than older ones, but researchers say no pre-existing health conditions are known to predispose people to the problem, so there is no way to tell if an individual is at high risk.

Reports of the clots have already led a number of countries to limit AstraZeneca’s vaccine to older people, or to stop using it entirely. The cases have dealt a crushing blow to global efforts to halt the pandemic, because the AstraZeneca shot — easy to store and relatively cheap — has been a mainstay of vaccination programs in more than 100 countries.

statement on its website, AstraZeneca said it was “actively collaborating with the regulators to implement these changes to the product information and is already working to understand the individual cases, epidemiology and possible mechanisms that could explain these extremely rare events.”

The two new reports were published by The New England Journal of Medicine. One from Germany describes 11 patients, including nine women ages 22 to 49. Five to 16 days after vaccination, they were found to have one or more clots. Nine had cerebral venous thrombosis, a clot blocking a vein that drains blood from the brain. Some had clots in their lungs, abdomen or other areas. Six of the 11 died, one from a brain hemorrhage.

One patient had pre-existing conditions that affected clotting, but during a news briefing on Friday, Dr. Andreas Greinacher, an author of the report, said those conditions most likely played only a minor role in the disorder that occurred after vaccination.

second report, from Norway, described five patients, one male and four female health care workers ages 32 to 54, who had clots and bleeding from seven to 10 days after receiving the AstraZeneca vaccine. Four had severe clots in the brain, and three died. Severe headaches were among their early symptoms. Like the German patients, all had high levels of antibodies that could activate platelets.

The team from Norway also recommended treatment with intravenous immune globulin. The researchers said the disorder was rare, but “a new phenomenon with devastating effects for otherwise healthy young adults,” and they suggested that it may be more common than previous studies of the AstraZeneca vaccine had indicated.

On Friday, European regulators also said they were reviewing reports of a few blood clot cases that occurred in people who had received the Johnson and Johnson vaccine. In the United States, federal agencies are investigating reports of a different type of unusual blood disorder involving a precipitous drop in platelets that emerged in a few people who had received either the Pfizer-BioNTech or Moderna vaccines.

Benjamin Mueller and Melissa Eddy contributed.

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Are Your Illegal Drugs Pure? New Zealand Will Check Them for You.

According to the most recent data from the Ministry of Health, around 9 percent of New Zealanders have used an illicit drug in the past year, with cannabis the most popular. Synthetic cannabis is a common problem, with more than 40 deaths associated with the drug reported in 2018. (The country narrowly voted against legalizing marijuana in a referendum last year.) Drugs are the third most common reason young people are kicked out of school.

While New Zealand has long struggled with methamphetamine abuse, party drugs are increasingly common. In 2019, the New Zealand police seized more than two million Ecstasy tablets and their equivalents, up 560 percent from 2018.

It is these party drugs in particular that have resulted in injury or death, sometimes as a result of people taking mislabeled or contaminated drugs. This year, KnowYourStuff received almost 1,000 messages from festivalgoers who reported atypical reactions to drugs sold to them as MDMA, including paranoia, seizures, severe nausea and days of insomnia. The drugs are believed to have been contaminated with synthetic cathinones.

Speaking in Parliament last year, Andrew Little, the minister of health, emphasized that the current New Zealand government saw drug policy as a health matter rather than a criminal one.

A prosecution-led approach has not worked, he said, adding: “It’s not changing. If we want to change behaviors, then we’ve got to take a different approach.”

The data is spotty, but promising.

A survey from Victoria University found that 68 percent of surveyed festivalgoers who used the testing services changed their behavior, with some reducing the amount they took while others disposed of their drugs altogether.

A similar study held at a festival in Canberra, Australia, in 2019 found that “all those who had a very dangerous substance detected disposed of that drug in the amnesty bin.”

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Kati Kariko Helped Shield the World From the Coronavirus

She grew up in Hungary, daughter of a butcher. She decided she wanted to be a scientist, although she had never met one. She moved to the United States in her 20s, but for decades never found a permanent position, instead clinging to the fringes of academia.

Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna.

For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines.

But for many years her career at the University of Pennsylvania was fragile. She migrated from lab to lab, relying on one senior scientist after another to take her in. She never made more than $60,000 a year.

was published, in Immunity, it got little attention.

Dr. Weissman and Dr. Kariko then showed they could induce an animal — a monkey — to make a protein they had selected. In this case, they injected monkeys with mRNA for erythropoietin, a protein that stimulates the body to make red blood cells. The animals’ red blood cell counts soared.

25 years of work by multiple scientists, including Pieter Cullis of the University of British Columbia.

Scientists also needed to isolate the virus’s spike protein from the bounty of genetic data provided by Chinese researchers. Dr. Barney Graham, of the National Institutes of Health, and Jason McClellan, of the University of Texas at Austin, solved that problem in short order.

Testing the quickly designed vaccines required a monumental effort by companies and the National Institutes of Health. But Dr. Kariko had no doubts.

On Nov. 8, the first results of the Pfizer-BioNTech study came in, showing that the mRNA vaccine offered powerful immunity to the new virus. Dr. Kariko turned to her husband. “Oh, it works,” she said. “I thought so.”

To celebrate, she ate an entire box of Goobers chocolate-covered peanuts. By herself.

Dr. Weissman celebrated with his family, ordering takeout dinner from an Italian restaurant, “with wine,” he said. Deep down, he was awed.

“My dream was always that we develop something in the lab that helps people,” Dr. Weissman said. “I’ve satisfied my life’s dream.”

Dr. Kariko and Dr. Weissman were vaccinated on Dec. 18 at the University of Pennsylvania. Their inoculations turned into a press event, and as the cameras flashed, she began to feel uncharacteristically overwhelmed.

A senior administrator told the doctors and nurses rolling up their sleeves for shots that the scientists whose research made the vaccine possible were present, and they all clapped. Dr. Kariko wept.

Things could have gone so differently, for the scientists and for the world, Dr. Langer said. “There are probably many people like her who failed,” he said.

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