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U.S. Covid Vaccinations Fall, Even as Cases Remain High

“We’re entering a new phase” in the country’s vaccination effort, said Dr. Mark McClellan, former commissioner of the Food and Drug Administration and director of the Duke-Margolis Center for Health Policy at Duke University. “In most parts of the country now, there are unfilled vaccination appointments available.”

People who were clamoring for a vaccine have been inoculated, including those who were willing to schedule appointments and wait in long lines at mass vaccination sites, he said.

“Now, it’s more about bringing vaccines to the people who want them but haven’t been able to easily reach the existing sites,” Dr. McClellan said. Walk-in availability, which New York City allowed at city-run sites starting on Friday, could also help vaccinate more people, he said.

Dr. Ashish Jha, the dean of the Brown University School of Public Health, cautioned that it would be “hugely problematic” to broadly denounce those who had yet to get a vaccine — because of indifference or inconvenience — as “resisters.” He said on National Public Radio last week that “there are lots of people who are perfectly happy to get a vaccine but aren’t desperate for it — aren’t convinced that they need it badly.”

Rupali J. Limaye, a professor who studies vaccine behavior at Johns Hopkins Bloomberg School of Public Health, said as vaccinations continued, some might think: “If these other people are vaccinated, why do I need to get it?” but added, “We still need those people to get it to reach herd immunity.”

With temperatures getting warmer, many states have already eased social-distancing measures, and some have even appeared to return to normal activity, alarming officials. Dr. Anthony S. Fauci, the nation’s top infectious disease expert, has said that restrictions should remain in place until there are fewer than 10,000 new cases a day — a number that the United States will not reach by Aug. 1, according to projections from the Institute for Health Metrics and Evaluation at the University of Washington.

“It will feel over in the summer,” said Ali H. Mokdad, a professor of health metrics sciences at the institute. “But somebody like me who works in public health will feel like swimming upstream, telling people in the summer we are not out of danger.”

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Fauci Expects Decision on Using Johnson & Johnson Vaccine Friday

A decision about whether to resume administering the Johnson & Johnson coronavirus vaccine should come this Friday, when an expert panel that is advising the Centers for Disease Control and Prevention is scheduled to meet, according to Dr. Anthony S. Fauci, the nation’s leading infectious disease expert.

“I think by that time we’re going to have a decision,” Dr. Fauci said on Sunday on the CNN program “State of the Union.”

“I don’t want to get ahead of the C.D.C. and the F.D.A. and the advisory committee,” he added, but said he expected experts to recommend “some sort of either warning or restriction” on the use of the vaccine.

Federal health agencies recommended putting injections of the vaccine on pause on Tuesday while they investigated whether it was linked to a rare blood-clotting disorder. All 50 states, in addition to Washington, D.C., and Puerto Rico, have stopped administering the vaccine.

two more cases of the clotting disorder were identified, including one in a man who had received the vaccine in a clinical trial.

Of the 129.5 million people who have received at least one dose of a Covid-19 vaccine in the United States, more than seven million have received Johnson & Johnson’s. If there is a link between the vaccine and the clotting disorder, the risk remains extremely low, experts say.

“It’s an extraordinarily rare event,” Dr. Fauci said on the ABC program “This Week.” The pause was intended to give experts time to gather more information and to warn physicians about the clotting disorder so that they can make more informed treatment decisions, said Dr. Fauci, who appeared on four TV news programs on Sunday morning.

European regulators have been investigating similar cases of the unusual clotting disorder in people who have received the AstraZeneca vaccine. Some European countries have since stopped administering that vaccine altogether, while others have restricted its use in younger people.

Dr. Fauci also expressed frustration that “a disturbingly large proportion of Republicans,” who have been critical of many coronavirus restrictions, have expressed a reluctance to be vaccinated. “It’s almost paradoxical,” he said. “On the one hand they want to be relieved of the restrictions, but on the other hand, they don’t want to get vaccinated. It just almost doesn’t make any sense.”

Dr. Fauci said that he expected all high school students to become eligible for vaccination before school begins in the fall, with younger children eligible no later than the first quarter of 2022.

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Top health officials urge Americans to get vaccinated but barely address the J.&J. dose pause.

Three top federal health officials appeared on Capitol Hill on Thursday and implored Americans to get vaccinated against the coronavirus, but said little about the investigation into whether the Johnson & Johnson vaccine may be linked to a small number of cases of rare blood clots, or when that vaccine might be put back into use.

“Hopefully we’ll get a decision quite soon, as to whether or not we can get back on track with this very effective vaccine,” Dr. Anthony S. Fauci, President Biden’s top medical adviser for the coronavirus, told a House panel.

Dr. Fauci’s comments came as the future of the Johnson & Johnson one-shot vaccine hung in the balance. Earlier this week, the Food and Drug Administration and the Centers for Disease Control and Prevention called for a pause in the use of the vaccine in the wake of reports of a small number of rare blood clots in recipients. Though it is unclear whether the vaccine was responsible for the clots, injections came to a sudden halt across the country.

On Wednesday, a C.D.C. advisory panel suggested that it would be a week to 10 days before they had enough information to assess the vaccine’s risks and could make a decision about its future. In the meantime, the officials — Dr. Fauci; Dr. Rochelle Walensky, the C.D.C. director; and Dr. David Kessler, who runs the Biden administration’s vaccine effort — urged Americans to continue to get vaccinated.

an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.

  • All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use 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.
  • Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
  • The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
  • Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
  • The reports of blood clots were the second recent blow to the Johnson & Johnson vaccine. Earlier this month, an ingredient mix-up at a Baltimore manufacturing plant owned by Emergent BioSolutions ruined up to 15 million doses of the vaccine. The F.D.A. is now inspecting the plant to see whether any vaccine doses manufactured there can be released to the public.

    About 7.7 million Americans had received the Johnson & Johnson vaccine as of Wednesday, accounting for less than 4 percent of the more than 198 million doses administered across the country. The Pfizer and Moderna vaccines are in much greater supply.

    Officials note that the blood clots are extremely rare; the handful of cases represent less than one in one million recipients, although that incidence estimate could go up if more cases are reported.

    Biden administration officials say that the absence of the Johnson & Johnson vaccine might not have a major impact on the U.S. vaccination campaign. But if use of the vaccine is severely restricted worldwide, it could prove disastrous for the global vaccination effort.

    Health officials had hoped that the Johnson & Johnson vaccine, along with a similar vaccine developed by AstraZeneca, would help supply the world because they are less expensive and easier to store and handle than the Pfizer and Moderna vaccines.

    Denmark, where two recipients suffered severe blood clots, permanently suspended use of the AstraZeneca vaccine.

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    Trump’s former pandemic coordinator suggests restrained response may have cost hundreds of thousands of lives.

    In interviews broadcast on CNN Sunday night, former President Donald J. Trump’s pandemic officials confirmed in stark and no uncertain terms what was already an open secret in Washington: The administration’s pandemic response was riddled with dysfunction, and the discord, untruths and infighting most likely cost many lives.

    Dr. Deborah L. Birx, Mr. Trump’s coronavirus response coordinator, suggested that hundreds of thousands of Americans may have died needlessly, and Adm. Brett P. Giroir, the testing czar, said the administration lied to the public about the availability of testing.

    The comments were among a string of bombshells that emerged during a CNN special report that featured the doctors who led the government’s coronavirus response in 2020.

    Dr. Robert R. Redfield, the former director of the Centers for Disease Control and Prevention, accused Mr. Trump’s health secretary, Alex M. Azar, and the secretary’s leadership team of pressuring him to revise scientific reports. “Now he may deny that, but it’s true,” Dr. Redfield said in an interview with Dr. Sanjay Gupta, CNN’s chief medical correspondent. Mr. Azar, in a statement, denied it.

    “so attentive to the scientific literature” and for not publicly correcting the president as he made outlandish claims about unproven therapies, whose disclosures — in one of her first televised interviews since leaving the White House in January — may have been the most compelling.

    As of Sunday, more than 548,000 Americans have died from infection with the coronavirus. “I look at it this way,” she said. “The first time, we have an excuse. There were about 100,000 deaths that came from that original surge.”

    “All of the rest of them,” she said, referring to almost 450,000 deaths, “in my mind, could have been mitigated or decreased substantially” had the administration acted more aggressively.

    She also described a “very uncomfortable, very direct and very difficult” phone call with Mr. Trump after she spoke out about the dangers of the virus last summer. “Everybody in the White House was upset with that interview,” she said.

    After that, she decided to travel the country to talk to state and local leaders about masks and social distancing and other public health measures that the president didn’t want her to transmit to the American public from the White House podium.

    Dr. Gupta asked if she was being censored. “Clearly someone was blocking me from doing it,” she said. “My understanding was I could not be national because the president might see it.”

    Several of the officials, including Dr. Anthony S. Fauci — who unlike the others is a career scientist and is now advising President Biden — blamed China, where the virus was first detected, for not being open enough with the United States. And several, including Dr. Redfield and Dr. Giroir, said early stumbles with testing — and the attitude within the White House that testing made the president look bad by driving up the number of case reports — were a serious problem in the administration’s response.

    And the problems with testing went beyond simply Mr. Trump’s obsession with optics. Dr. Giroir said that the administration simply did not have as many tests as top officials claimed at the time.

    “When we said there were millions of tests — there weren’t, right?” he said. “There were components of the test available but not the full deal.”

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    Variants and Eased Restrictions Push US Coronavirus Cases Up Again

    After weeks of decline followed by a steady plateau, coronavirus cases are rising again in the United States. Deaths are still decreasing, but the country averaged 61,545 cases last week, 11 percent more than the average two weeks earlier.

    Scientists predicted weeks ago that the number of infections would curve upward again in late March, at least in part because of the rise of variants of the coronavirus across the country. The variant that walloped Britain, called B.1.1.7, has led to a new wave of cases across most of Europe. Some scientists warned that it may lead to a new wave in the United States.

    The rise in infections is also a result of state leaders pulling back on mitigation measures, and large social interactions, like spring break gatherings in Florida, Dr. Anthony S. Fauci, the Biden administration’s chief science adviser, said on the CBS program “Face the Nation” on Sunday.

    “The variants are playing a part, but it’s not completely the variants,” Dr. Fauci said. Most states have lifted restrictions, including on indoor dining, in response to the drop in numbers, actions that Dr. Fauci called “premature.”

    8,337 known cases of the B.1.1.7 variant in the country, but the actual number is probably much higher because labs in the country analyze only a very small proportion of the diagnosed cases. Still, the trend is clear: The variant — which is more transmissible and possibly more lethal — has been rising exponentially in the United States, its growth masked by the overall drop in infections.

    “It is remarkable how much this recalls the situation last year where we had introductions of virus to different places that scientists warned would be a problem,” said Bill Hanage, an epidemiologist at the Harvard T.H. School of Public Health, said in an interview on Sunday. “People waited for them to be a problem before they took action — and then too late, they took action.”

    Dr. Hanage said he was particularly worried about B.1.1.7 because it is at least 50 percent more transmissible than the original virus. The brisk pace of vaccinations will stem the tide somewhat, but the rising immunity in the population may be more than offset by the variant’s contagiousness, he added. “B.1.1.7 is really scary,” he said.

    The vaccines in use in the United States — made by Pfizer-BioNTech, Moderna, and Johnson & Johnson — are expected to prevent severe disease and death from any of the variants, although they are slightly less effective against a variant that was identified in South Africa. That variant, known as B.1.351, has not yet spread widely in the United States.

    Because many of the highest risk people have been inoculated, hospitalizations and deaths may not show a steep rise along with infections. But a surge in cases will still lead to some severe cases and deaths, Dr. Hanage said.

    “How large it will be we’ll need to wait and see,” he said. “But ideally we would not be waiting to see, ideally we’d be taking action.”

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    AstraZeneca’s Latest Stumble Again Clouds European Vaccinations

    LONDON — The announcement this week that the AstraZeneca shot, the workhorse of global vaccine rollouts, had achieved nearly 80 percent efficacy in a gold-standard American trial was met with relief by the many countries relying on it.

    “When you get the call, get the jab,” the British health secretary, Matt Hancock, urged, part of a campaign by European lawmakers to calm people’s nerves after a recent safety scare with the shot.

    But by Tuesday, that campaign had, once again, been thrown off course, at least for the moment. For AstraZeneca, it was seemingly another episode of public relations whiplash, part of a series of recent miscues and communication blunders by the company that scientists said had undercut the effort to sell one of the most potent and indispensable vaccines against the coronavirus.

    In a highly unusual move, American health officials said on Tuesday that the company’s account of its U.S. trial findings had not been entirely accurate, suggesting that AstraZeneca had used only the most favorable data to generate apparently spectacular efficacy results.

    developed unusual blood clots.

    In France, Germany, Italy and Spain, more people now believe that the vaccine is unsafe than that safe, polling has shown, a blow to a shot that remains the continent’s best hope for saving people’s lives during a mounting surge of new infections. Millions of doses are sitting unused in refrigerators across the continent, with doctors reporting some people canceling injections over fears about side effects.

    driving down hospitalizations and helping the country to emerge from a dreadful wintertime wave of infections.

    Nevertheless, AstraZeneca’s U.S. trial was hotly anticipated. The largest of its kind for the shot, it had been expected to provide the cleanest, most complete picture of the vaccine’s efficacy. American officials saw it as an incontrovertible test of the vaccine’s performance.

    And health officials around the world were looking to it as a crucial guide to their own rollouts: It would supply crucial data on older people, who had not been as well represented in earlier trials, and a more precise read on the vaccine’s overall efficacy, which had appeared from earlier trials to be lower than that of other leading shots.

    As soon as AstraZeneca announced its results on Monday, saying that the vaccine had 79 percent efficacy in preventing symptomatic Covid-19, lawmakers began citing it as part of their fledgling efforts to shore up public confidence in the vaccine.

    communications problems that have dogged the company since last year, delaying the regulatory process in some regions and creating hesitation among some recipients.

    So far, only 55 percent of the AstraZeneca doses delivered to the European Union have been put into people’s arms, according to the bloc’s figures, markedly lower than the usage rate for other vaccines. Some seven million doses are still sitting in refrigerators.

    public confusion about a vaccine that appears to be highly effective.

    In early September, the company quietly halted its global trials after a participant in Britain fell ill. But American regulators did not find out until the story broke publicly. Subsequently, the company’s slowness to provide the F.D.A. with evidence that its vaccine was not linked to any illnesses kept it grounded for nearly seven weeks. AstraZeneca has said it shared data in a timely manner.

    By late November, the company was again riding high: It released results from early clinical trials, including in Britain, showing that the vaccine was up to 90 percent effective.

    But those results, too, were quickly clouded by uncertainty. AstraZeneca later acknowledged that there had initially been confusion over the vaccine dosage received by some study participants, making it more difficult to interpret the findings.

    Britain, which has long championed the homegrown vaccine, authorized the shot in late December, relying on the earlier clinical trial results. The European Union’s medicine regulator did the same, but a month later.

    E.U. officials said that the delay had partly resulted from a back-and-forth between the regulators and AstraZeneca over the quality of the data.

    And even after the vaccine was authorized, a number of European countries initially restricted it to younger people, citing a lack of sufficient data about its efficacy in older people. That problem was supposed to be resolved by the American trial, in which older people were better represented.

    Neither European nor British regulators gave any indication on Tuesday that the problems with AstraZeneca’s American data would have any impact on rollouts there. Those agencies relied on a separate set of data from non-American trials to authorize the vaccine.

    “We are in contact with the company regarding this further information,” the European Medicines Agency said in a statement on Tuesday, “and E.M.A. will assess the data concerned as soon as the company submits it to us.”

    Matina Stevis-Gridneff contributed reporting from Brussels.

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    U.S. Risks a ‘Fourth Wave’ Fueled by Variants and Eased Restrictions, Fauci Warns

    The Centers for Disease Control and Prevention has been warning about it since January: A more contagious and possibly deadlier variant of the coronavirus, first found in Britain, is likely to become predominant in the United States, perhaps leading to a wrenching surge in cases and deaths.

    The first part of that warning seems to be coming true: The variant, known as B.1.1.7, is doubling its share of all new U.S. cases about every 10 days.

    But the second part is harder to make out, at least so far. The steep fall in new cases from the January peak halted in mid-February, but the trend since then has been roughly steady or only slightly downward, rather than a feared “fourth wave.”

    Experts are not sure why. The accelerating pace of vaccinations and the remaining virus-control measures in much of the country might be balancing out the spread of the more contagious variant, so that total cases neither rise nor fall very much. But it is difficult to know how long that equilibrium might last, or whether the next clear turn in the trend will be upward or downward.

    New York Times database. That is the lowest seven-day average since October and about 10 percent below the average on Feb. 21, when the steep decline slowed. Still, the figure is close to the peak level of the surge last summer. Death reports are also falling but remain high, regularly topping 2,000 a day.

    In an interview Sunday on the CBS program “Face the Nation,” Dr. Fauci said that over the past week and a half, the decline in cases had stalled. “We’re plateauing at quite a high level — 60 to 70,000 new infections per day is quite high,” he said.

    This trend is particularly worrisome, he said, because in the United States over the past year, when the daily level of new infections plateaued at a high level, surges in cases followed. And recently in Europe, infection levels were declining, then plateaued and “over the last week or so, they’ve had about a 9 percent increase in cases,” Dr. Fauci said.

    Experts say they need more data to understand why the United States has not yet seen a surge in cases as the fearsome B.1.1.7 variant has spread so rapidly, already accounting for more than one-fifth of new cases.

    William Hanage, a Harvard epidemiologist, said there could be several reasons B.1.1.7 has not started ravaging the United States the way it consumed Britain, including more widespread vaccination, improving weather and the patchwork of pandemic restrictions across the states.

    Florida, Mr. Hanage and other experts say, is an interesting example, because infections have not surged even though restrictions are looser than in other states and the variant makes up at least an estimated 30 percent of cases, the highest proportion in the nation.

    Dr. Fauci said on Sunday that a variant first identified in New York is “not widespread yet, but it seems to be spreading pretty efficiently through the New York City metropolitan area and beyond.”

    He said there is evidence that the variant may partly elude protection conferred by vaccines and monoclonal antibody treatments, although the variant does not evade vaccines and treatments as much as one first identified in South Africa.

    The best way to prevent further spread is to “get people vaccinated as quickly and as expeditiously as possible and, above all, maintain the public health measures that we talk about so often: the masking, the physical distancing, and the avoiding of congregate settings, particularly indoors.” Dr. Fauci said. “That’s what you can do to prevent the spread of a worrisome variant.”

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    Fauci Warns Coronavirus Cases Could Spike as States Ease Restrictions

    The B.1.1.7 variant, first identified in Britain, is spreading so rapidly in the United States that data analysis suggest that, as of this week, it has most likely grown to account for 20 percent of new U.S. cases. And scientists in Oregon have identified a single case of a homegrown variant with the same spine as B.1.1.7 that carries a mutation that could blunt the effectiveness of vaccines.

    Earlier this week, Texas and Mississippi, both Republican-led states, lifted mask mandates. President Biden denounced those moves as “a big mistake” that reflected “Neanderthal thinking,” saying it was critical for public officials to follow the guidance of doctors and public health leaders as the coronavirus vaccination campaign gains momentum.

    Other Republicans have been more cautious. Gov. Mike DeWine of Ohio said he would lift all public health measures aimed at curbing the virus crisis, but only once new cases there drop under a certain threshold. In Alabama, Gov. Kay Ivey said she would extend the state’s mask mandate through April 9.

    In Arizona, Gov. Doug Ducey has taken what he calls a “measured approach” requiring schools to offer in-person learning no later than March 15, barring local leaders from enacting measures that shut down businesses and allowing major league sports to restart if they receive approval from the state’s Department of Health Services.

    Among Democrats, Gov. Gretchen Whitmer of Michigan said on Tuesday that she was easing restrictions on businesses and would allow family members who had tested negative for the coronavirus to visit nursing home residents. In California, the state’s public health department also loosened some restrictions Friday, saying that amusement parks could reopen on a limited basis as soon as April 1.

    In New York City, limited indoor dining has returned. And on Thursday, Connecticut’s governor said the state would end capacity limits later this month on restaurants, gyms and offices. Masks remain required in both places.

    Dr. Rochelle P. Walensky, the director of the Centers for Disease and Prevention, has implored states not to relax their restrictions yet. A new report from the C.D.C. found that counties that allowed restaurants to open for in-person dining in the United States had a rise in daily infections weeks after. The study also said that counties that issued mask mandates reported a decrease in virus cases and deaths within weeks.

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