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China Poses Biggest Threat to U.S., Intelligence Report Says

This year’s report offers a far more robust discussion of the national security implications of climate change, whose threats, for the most part, are long term, but can also have short-term consequences, the report said.

“This year, we will see increasing potential for surges in migration by Central American populations, which are reeling from the economic fallout of the Covid-19 pandemic and extreme weather, including multiple hurricanes in 2020 and several years of recurring droughts and storms,” the report said.

It adds that the economic and political implications of the coronavirus would reverberate for years, predicting that the economic damage would worsen instability in a few countries, though it does not name them.

Combined with extreme weather caused by climate change, the report says the number of people worldwide experiencing acute hunger will rise to 330 million this year from 135 million. The report says that the pandemic has disrupted other health services, including polio vaccinations and H.I.V. treatments in Africa.

Typically, the director of national intelligence delivers the threat assessment to Congress and releases a written report alongside it. But no declassified assessment was issued last year, as the Trump administration’s intelligence agencies sought to avoid angering the White House.

In 2019, Dan Coats, then the director of national intelligence, delivered an analysis of threats from Iran, North Korea and the Islamic State that was at odds with President Donald J. Trump’s views. The testimony prompted Mr. Trump to lash out on Twitter, admonishing his intelligence chiefs to “go back to school.”

Avril D. Haines, the director of national intelligence; William J. Burns, the C.I.A. director; and other top intelligence officials will testify about the report on Wednesday and Thursday.

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Some Children With Covid-Related Syndrome Develop Neurological Symptoms

Reports about the mysterious Covid-related inflammatory syndrome that afflicts some children and teenagers have mostly focused on physical symptoms: rash, abdominal pain, red eyes and, most seriously, heart problems like low blood pressure, shock and difficulty pumping.

Now, a new report shows that a significant number of young people with the syndrome also develop neurological symptoms, including hallucinations, confusion, speech impairments and problems with balance and coordination. The study of 46 children treated at one hospital in London found that just over half — 24 — experienced such neurological symptoms, which they had never had before.

Those patients were about twice as likely as those without neurological symptoms to need ventilators because they were “very unwell with systemic shock as part of their hyperinflammatory state,” said an author of the study, Dr. Omar Abdel-Mannan, a clinical research fellow at University College London’s Institute of Neurology. Patients with neurological symptoms were also about twice as likely to require medication to improve the heart’s ability to squeeze, he said.

The condition, called Multisystem Inflammatory Syndrome in Children (MIS-C), typically emerges two to six weeks after a Covid infection, often one that produces only mild symptoms or none at all. The syndrome is rare, but can be very serious. The latest data from the Centers for Disease Control and Prevention reports 3,165 cases in 48 states, Puerto Rico and the District of Columbia, including 36 deaths.

study published last month in JAMA Neurology, 126 of 616 young people with the syndrome admitted to 61 U.S. hospitals last year had neurological issues, including 20 with what the researchers described as “life-threatening” problems like strokes or “severe encephalopathy.”

The new report, presented as preliminary research on Tuesday as part of an annual conference of the American Academy of Neurology, evaluated children under 18 who were admitted to Great Ormond Street Hospital (GOSH) between April and September of last year with the syndrome (it has a different name and acronym, PIMS-TS, in Britain). The data is also included in a preprint of a larger study that has not yet been peer-reviewed.

As was the case with other studies of the syndrome, including in the United States, the researchers said a majority of those afflicted were “nonwhite,” a pattern that public health experts believe reflects the disproportionate way the pandemic has affected communities of color. Nearly two-thirds of the patients were male, and the median age was 10.

All 24 of the patients with neurological symptoms had headaches and 14 had encephalopathy, a general term that can involve confusion, problems with memory or attention and other types of altered mental function. Six of the children were experiencing hallucinations, including “describing people in the room that were not there or seeing cartoons or animals moving on the walls,” Dr. Abdel-Mannan said. He said some experienced auditory hallucinations involving “hearing voices of people not present.”

Six of the children had weakness or difficulty controlling muscles used in speech. Four had balance or coordination problems. One child had seizures and three children had peripheral nerve abnormalities including weakness in facial or shoulder muscles. One patient’s peripheral nerve damage led to a foot-drop problem that required the use of crutches and a recommendation for a nerve transplant, said Dr. Abdel-Mannan, who is also a senior resident in pediatric neurology at GOSH.

Some of the patients underwent brain scans, nerve conduction tests or electroencephalograms (EEGs), including 14 who showed slower electrical activity in their brains, the study reported.

Thirteen of the 24 with neurological symptoms needed to be placed on ventilators and 15 needed medication to improve their heart contractions, Dr. Abdel-Mannan said. By contrast, only three of the 22 children without neurological issues needed ventilators and seven needed such heart medication, he said. None of the children with hallucinations needed psychotropic medications.

Three children had to be hospitalized again after their initial stay, one for another episode of encephalopathy and two for infectious complications, Dr. Abdel-Mannan said, but he added that there were no deaths and “almost all children made a complete functional recovery.”

Dr. Abdel-Mannan said a team led by the study’s senior author, Dr. Yael Hacohen, will be following patients who had the syndrome — both those who had neurological symptoms and those who did not. They will conduct brain scans and cognitive assessments to see if the children experience any long-term cognitive or psychological effects.

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N.F.L. to Bar Unvaccinated Coaches From Working With Players

The N.F.L. on Tuesday sent a memo to all 32 teams effectively mandating that support personnel including coaches and trainers be vaccinated against Covid-19, with an exception made for staff who have “bona fide medical or religious ground” for not doing so.

According to the statement, the unvaccinated will not be allowed to work in proximity to players, who are strongly encouraged, but not yet required, to take the vaccine.

In the most direct address of vaccination protocols so far, the league said it expected employees classified as Tier 1 and Tier 2 — including coaches, trainers, front office personnel, videographers and others — to receive the vaccine. Those tiers were created last summer to stratify and limit access to team facilities as the N.F.L. prepared to open training camps in preparation for the 2020 season, and have been used continually since.

“N.F.L. team facilities proved to be among the safest places in the world in 2020 thanks to N.F.L.-N.F.L.P.A. comprehensive protocols that were developed in conjunction with public health officials,” an N.F.L. spokesman said in a statement emailed to The New York Times. “Having team personnel vaccinated will benefit these individuals and their families, will make the facilities even safer and also provide another step toward returning to normalcy.”

The league will require teams to report how many employees are vaccinated on a weekly basis and, based on those numbers, are expected to relax certain restrictions, such as locker room access, the use of cafeterias and close-contact quarantine, for vaccinated individuals. The memo also encouraged N.F.L. teams to host informational sessions on the vaccine with players, staff members and their families, and to use team stadiums and training facilities as vaccination sites.

The N.F.L.’s mandate follows similar messaging from the N.B.A. and M.L.B., to leagues currently in season, who have incentivized players and personnel with relaxed coronavirus restrictions once they are vaccinated.

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New York Times tech workers form a union.

Tech workers at The New York Times announced on Tuesday that they had formed a union and would ask the company to recognize it.

The group, a majority of which signed cards in support of the effort, of more than 650 employees includes software engineers, designers, data analysts and product managers. It will be represented by the NewsGuild of New York. NewsGuild membership already includes more than 1,300 newsroom workers and business staff members at The Times, as well as workers at other media outlets.

As part of the Times Tech Guild, the tech workers would be in a separate bargaining unit from other Times employees represented by the NewsGuild.

In recent years, The Times has ramped up its hiring of tech workers as part of its strategy to reach 10 million paid digital subscribers by 2025. In 2020, digital-only subscriptions neared seven million and became the company’s largest revenue stream.

formed a union, a rarity in Silicon Valley. An organizing drive at an Amazon warehouse in Alabama was voted down last week.

Media companies have had a surge in such efforts. Workers at publications like BuzzFeed News, Vice, The New Yorker, Slate and Vox Media have all formed unions in recent years.

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A Ramadan Closer to Normal for 2021

CAIRO — Compared with Ramadan 2020, when mosques around the world were closed for prayer during the holiest month of the year for Muslims, and curfews prevented friends and family from gathering to break the fast, the religious holiday this year offered the promise of something much closer to normal.

“Last year, I felt depressed and I didn’t know how long the pandemic would last,” said Riyad Deis, a co-owner of a spice and dried-fruit shop in Jerusalem’s Old City. On Tuesday, the first day of the Muslim fasting month, its narrow alleys were alive with shoppers browsing Ramadan sweets and worshipers heading to the Al-Aqsa Mosque.

Mr. Deis, 51, who was selling whole pieces of turmeric and Medjool dates to a customer, recalled how empty and subdued the Old City had felt last year as virus cases surged and the authorities closed Al-Aqsa to the public. “Now, I’m relaxed, I have enough money to provide for my family and people are purchasing goods from my shop,” he said. “It’s a totally different reality.”

rising coronavirus infections across many countries.

In Kenya, the authorities have introduced longer curfews, closed bars and schools, restricted gatherings at spaces of worship, and limited travel in and out of five counties including Nairobi, the capital.

For Nairobi residents like Ahmed Asmali, this means a prolonged inability to break the fast with loved ones or attend prayers with larger congregations.

“It’s the second year now that we are in a lockdown,” said Mr. Asmali, a 41-year-old public relations worker. The experience, he said “feels weird. Feels out of place.”

Lebanon Crisis Observatory, a project by the American University in Beirut.

The pandemic still shadows much of the festivities. Shop owners in Jerusalem’s Old City said they were worried that Israel would not allow large numbers of Palestinians from the West Bank, where few have been vaccinated, to visit the Old City this Ramadan, depriving the area of their holiday spending.

Prepandemic, Israel usually allowed tens of thousands of Palestinians from the West Bank to visit Jerusalem on Fridays during the fasting month. The arm of the Israeli government that liaises with the Palestinian Authority said on Tuesday that Israel would allow 10,000 vaccinated Palestinians from the West Bank to pray at the Aqsa on Friday. It also said authorities would permit 5,000 vaccinated Palestinians from the West Bank to make family visits in Israel between Sunday and Thursday next week.

Omar Kiswani, the director of the Aqsa Mosque, said he was overjoyed that the compound was open to worshipers — an estimated 11,000 attended the taraweeh prayers at the compound Monday evening — but he emphasized that people would still need to be careful. He said masks and two meters’ distance between worshipers are required at the mosque, and the indoor and outdoor spaces will be sterilized daily.

“These are times of great happiness,” Mr. Kiswani said. “We hope the blessed Aqsa Mosque will return to its prepandemic glory. But these are also times of caution, because the virus is still out there.”

Vivian Yee reported from Cairo, and Adam Rasgon from Jerusalem. Asmaa al-Omar contributed reporting form Istanbul and Abdi Latif Dahir from Nairobi.

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Toronto Police Hindered by Anti-Gay Bias in Bruce McArthur Serial Killer Case

OTTAWA — A two-and-half-year investigation of the Toronto police found that “systemic discrimination” within the force enabled a serial killer to murder eight gay men, mostly of Middle Eastern or South Asian descent, over a span of seven years.

Several times the police interviewed the killer, Bruce McArthur, who was convicted in 2019, but did not link him to the deaths and released him — allowing him to continue his killing spree.

“There was institutional resistance to the notion that these cases night be linked and that a serial killer might be preying on” Toronto’s L.G.B.T.Q community, Gloria Epstein, a retired justice of the Ontario Court of Appeal, wrote in a report released on Tuesday. “This systemic failure is perhaps the most troubling.”

The investigation found that the police force repeatedly failed to enter evidence linking the killings to Mr. McArthur into case-tracking software.

The report makes 151 recommendations, among them proposals to allow civilians within the Toronto police force to coordinate missing persons investigations; to centralize those inquiries under one police unit; and to conduct them in concert with public health, social service and not-for-profit community groups.

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Several States Pausing Use of Johnson & Johnson Vaccine After CDC, FDA Advisory

“Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given,” the statement said.

Like many states, New York had already prepared for a significant drop in its supply of the Johnson & Johnson vaccine after federal officials said that supplies would be limited because of a production issue at a Baltimore manufacturing plant. On Friday, Gov. Andrew M. Cuomo said that New York expected to receive 34,900 Johnson & Johnson shots, a decrease of 88 percent from the previous week.

Dr. Zucker, New York’s health commissioner, said that the state would honor appointments made at state-run mass vaccination sites for the Johnson & Johnson vaccine by giving people the Pfizer-BioNTech vaccine instead. That vaccine requires two doses, and it was not immediately clear how the state would handle the additional strain on its supply.

New Jersey health officials said the state would work with its vaccination sites to help people get appointments for the Pfizer or Moderna vaccine instead. Mayor Bill de Blasio of New York City said that the city would do the same, rescheduling appointments at city-run vaccine sites.

“Every site has been told this morning to stop giving the J&J shots,” he said at a news conference.

The city’s health commissioner, Dr. Dave Chokshi, said that around 234,000 residents have received the Johnson & Johnson vaccine and none had reported any blood clots so far. The city had been relying on the vaccine to inoculate hard-to-reach New Yorkers, including people who are homebound.

Both Mr. Cuomo and Mr. de Blasio received the Johnson & Johnson vaccine at separate appearances last month, which they framed as an effort to boost confidence in that vaccine’s efficacy rate and to address vaccine hesitancy.

Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That vaccine has not been authorized for emergency use in the United States.

Rebecca Robbins contributed reporting.

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Worry Over 2 Covid Vaccines Deals Fresh Blow to Europe’s Inoculation Push

BRUSSELS — First it was AstraZeneca. Now Johnson & Johnson.

Last week, British regulators and the European Union’s medical agency said they had established a possible link between AstraZeneca’s Covid-19 vaccine and very rare, though sometimes fatal, blood clots.

On Tuesday, Johnson & Johnson said it would pause the rollout of its vaccine in Europe and the United States over similar concerns, further compounding the continent’s one-step-forward-two-steps-back efforts to quickly get people immunized against the coronavirus.

European officials had been confident that they had secured enough alternative vaccine doses to take up the slack of the AstraZeneca problems and achieve their goal of fully inoculating 70 percent of the European Union’s adult population — about 255 million people — by the end of the summer.

On Tuesday, European officials did not immediately say whether they believed the milestone would also survive the Johnson & Johnson suspension. But the European commissioner for health, Stella Kyriakides, wrote on Twitter that “Today’s developments with the J&J vaccine in the US are under close monitoring” by the bloc’s medicines regulator.

months of short supplies and logistical problems.

There is mounting evidence that the concerns are eroding Europeans’ willingness to get the AstraZeneca vaccine in particular, and threatening to elevate already high levels of vaccine hesitancy generally.

YouGov poll published last month, 61 percent of the French, 55 percent of Germans and 52 percent of Spaniards consider the AstraZeneca vaccine “unsafe.” That is in stark contrast to the findings of a similar poll from February, when more people in those countries, with the exception of France, believed that the shot was more safe than unsafe.

Regulators have asked vaccine recipients and doctors to be on the lookout for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.

In Poland, where the vaccination campaign relies to a large extent on AstraZeneca and where its use has not been restricted, a recent poll showed that given a choice, fewer than 5 percent of Poles would choose the AstraZeneca shot.

Almost everywhere across the European Union, it seems, many are eager for alternatives, as the new types of vaccines that include the Moderna and Pfizer, which utilize science known as “mRNA,” have not been associated with similar side effects.

Data from the 27 E.U. member states by the European Center for Disease Prevention and Control shows that over all, 80 percent of vaccine doses distributed to the bloc have already been administered. That share drops to 65 percent for AstraZeneca, however, suggesting that many of its doses are sitting unused.

Yet it is hard to predict how serious a blow the latest twist in the AstraZeneca saga — and the new Johnson & Johnson concerns — will be to E.U. vaccination efforts, as officials in Brussels have made big if belated efforts to turbocharge the second-quarter supply of doses.

The European Union is poised to receive at least 300 million doses of various vaccines, three times what it got in the first quarter. Two hundred million are slated to come from Pfizer/BioNTech. Moderna is expected to deliver 35 million doses. Another 55 million doses are due of the Johnson & Johnson jab, and 70 million from AstraZeneca.

In the rosiest scenario, the European Union could get up to 360 million doses by June.

On Thursday, after Spain’s government changed the age threshold for the AstraZeneca shot, two-thirds of people called up for vaccination in Madrid did not show up, Antonio Zapatero, the regional health minister, told a news conference on Friday.

He attributed the no-show by 18,200 people to “confusion” generated by Spain’s central government, which said on Wednesday that the AstraZeneca vaccine should be given only to people over 60. Before this change, Mr. Zapatero said, the rate of abstention was 2 percent.

In Belgium, where the use of the AstraZeneca vaccine has also been limited, the authorities said they did not expect major delays in the overall rollout, but they are still concerned about the confusion that the rare blood clotting issue is causing.

Yves Van Laethem, a top epidemiologist who is the country’s Covid task force spokesman, said he expected a two-week delay that would mostly affect younger age groups in late summer. He said the E.U. regulator guidance had only partly helped in clarifying the situation.

The European Medicines Agency’s opinion “wasn’t very clear, and it is also part of the problem,” Dr. Van Laethem said in an interview. “When you say, ‘We don’t apply limitations, but we just say there are serious side effects,’ there is part science and part diplomacy in that.”

He said the limited effect that the new AstraZeneca issues would have on Belgian’s rollout was in large part because the country had ordered big shares of other vaccines.

Although all E.U. countries have been offered a chunk of each vaccine approved in the bloc so far — AstraZeneca, Johnson & Johnson, Moderna and Pfizer — many opted to forgo parts of their share of more expensive or cumbersome vaccines like Pfizer and Moderna early on, instead favoring the AstraZeneca jab.

“In Britain or Eastern Europe, a big part of the campaigns are based on AstraZeneca,” Dr. Van Laethem said.

Wealthier bloc members like Denmark, France, Germany and the Netherlands can better compensate for the loss of confidence in AstraZeneca, because they acquired extra doses of other vaccines — especially Pfizer — through a secondary market after poorer E.U. nations gave theirs up.

Those countries — including Bulgaria, Croatia, Latvia and Slovakia — are likely to be less able to quickly offer alternatives.

Dr. Van Laethem, the Belgian immunologist, said that the national and European authorities needed to better communicate the costs and benefits of taking the AstraZeneca dose versus and the other authorized vaccines.

Experts worry that even limited concerns over one vaccine’s unlikely side effects can affect people’s overall willingness to be immunized.

“The main thing is to make people understand that the problem is the virus,” he said. “We have to vaccinate people — the risk linked to the virus is higher than those rare side effects.”

Raphael Minder contributed reporting from Madrid and Constant Méheut from Paris.

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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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