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:
Bangladesh has announced a weeklong lockdown, closing offices, factories and transport services starting Wednesday, and banning domestic and international flights. The country is facing its severest coronavirus outbreak so far, averaging nearly 7,000 daily new infections, according to a New York Times database, as the virus sweeps across South Asia.
In France, all people over 55 are eligible to receive the AstraZeneca and Johnson & Johnson vaccines starting Monday, as the authorities try to ramp up their vaccination campaign after a sluggish start. Health Minister Olivier Véran said on Sunday that France would also extend the period between the first and second shots of the Pfizer and Moderna vaccines to six weeks from four, echoing Britain’s strategy. Over 14 million people have received a first injection.
High schools reopened in Greece on Monday after five months closed. The reopening only applies to senior high-school classes, and pupils and teachers will have to take a virus test twice a week before returning to classrooms. Thousands did so at home on Sunday, with just 613 positives out of some 380,000, a rate of 0.16 percent, according to state television. Stores in the country reopened last week.
The world’s wealthy nations should commit $30 billion to a global mass vaccination campaign, Gordon Brown, a former prime minister of Britain, said on Monday. Lower-income countries’ inoculation efforts are trailing far behind richer nations’ and the divide has led to allegations of a “vaccine apartheid,” Mr. Brown warned in an op-ed for The Guardian. “The costs may still be in billions, but the benefit will be in trillions,” he wrote.
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.
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.
IDLIB, Syria — Among the millions of Syrians who fled as the government bombed their towns, destroyed their homes and killed their loved ones are 150 families squatting in a soccer stadium in the northwestern city of Idlib, sheltering in rickety tents under the stands or in the rocky courtyard.
Work is scarce and terror grips them whenever jets buzz overhead: New airstrikes could come at any time. But the fear of government retribution keeps them from returning home. More than 1,300 similar camps dot Syria’s last bastions under rebel control, eating up farmland, stretching along irrigation canals and filling lots next to apartment buildings where refugee families squat in damaged units with no windows.
“People will stay in these places with all the catastrophes before they go live under the regime of Bashar al-Assad,” said Okba al-Rahoum, the manager of the camp in the soccer stadium.
On a rare visit to Idlib Province, examples abounded of shocked and impoverished people trapped in a murky and often violent limbo. Stuck between a wall to prevent them from fleeing across the nearby border with Turkey and a hostile government that could attack at any moment, they struggle to secure basic needs in a territory controlled by a militant group formerly linked to Al Qaeda.
bused them here after conquering their towns. They drove in with trucks piled high with blankets, mattresses and children. Some arrived on foot, with few possession besides the clothes they wore.
Last year, an offensive by the Syrian government, backed by its Russia and Iran, pushed nearly a million more people into the area.
About 2.7 million of the 4.2 million people in the northwest, one of the last of two strips of territory held by a rebel movement that once controlled much of Syria, have fled from other parts of the country. That influx has transformed a pastoral strip of farming villages into a dense conglomeration of makeshift settlements with strained infrastructure and displaced families crammed into every available space.
SHINE, an education organization, urged a group of women at an event in Idlib to refuse polygamous marriages, which are permitted under Islamic law.
The next day, gunmen closed SHINE’s office and threatened to jail its manager, Ms. Kisar said.
a cease-fire between Russia and Turkey has stopped outright combat in Idlib, but on one day last month there were three attacks. A shell hit a refugee camp; an airstrike ignited a fuel depot on the Turkish border; and three artillery shells struck a village hospital in Al Atarib, killing seven patients, including an orphan boy who had gone for a vaccination, according to the Syrian American Medical Society, which supports the facility.
While the area’s displaced struggle to survive, others try to provide simple pleasures.
In the city of Idlib, the Disneyland restaurant entices visitors to dine on salads and grilled meat, and to forget their woes with video games, bumper cars, air hockey and stuffed animal claw machines.
The basement storeroom doubles as a shelter when the government shells nearby, and the terrace is enclosed with plastic sheeting instead of glass so it doesn’t shatter on diners if something explodes nearby.
The manager, Ahmed Abu Kheir, lost his job at a tourist restaurant that shut down when the war began, he said, so he opened a smaller place that was later destroyed by government shelling.
He opened another restaurant, but left it behind when the government seized the area last year and he fled to Idlib.
Like all of Idlib’s displaced, he longed to take his family home, but was glad to work in a place that spread a little joy in the meantime.
“We are convinced that normal life has to continue,” he said. “We want to live.”
IDLIB, Syria — Among the millions of Syrians who fled as the government bombed their towns, destroyed their homes and killed their loved ones are 150 families squatting in a soccer stadium in the northwestern city of Idlib, sheltering in rickety tents under the stands or in the rocky courtyard.
Work is scarce and terror grips them whenever jets buzz overhead: New airstrikes could come at any time. But the fear of government retribution keeps them from returning home. More than 1,300 similar camps dot Syria’s last bastions under rebel control, eating up farmland, stretching along irrigation canals and filling lots next to apartment buildings where refugee families squat in damaged units with no windows.
“People will stay in these places with all the catastrophes before they go live under the regime of Bashar al-Assad,” said Okba al-Rahoum, the manager of the camp in the soccer stadium.
On a rare visit to Idlib Province, examples abounded of shocked and impoverished people trapped in a murky and often violent limbo. Stuck between a wall to prevent them from fleeing across the nearby border with Turkey and a hostile government that could attack at any moment, they struggle to secure basic needs in a territory controlled by a militant group formerly linked to Al Qaeda.
bused them here after conquering their towns. They drove in with trucks piled high with blankets, mattresses and children. Some arrived on foot, with few possession besides the clothes they wore.
Last year, an offensive by the Syrian government, backed by its Russia and Iran, pushed nearly a million more people into the area.
About 2.7 million of the 4.2 million people in the northwest, one of the last of two strips of territory held by a rebel movement that once controlled much of Syria, have fled from other parts of the country. That influx has transformed a pastoral strip of farming villages into a dense conglomeration of makeshift settlements with strained infrastructure and displaced families crammed into every available space.
SHINE, an education organization, urged a group of women at an event in Idlib to refuse polygamous marriages, which are permitted under Islamic law.
The next day, gunmen closed SHINE’s office and threatened to jail its manager, Ms. Kisar said.
a cease-fire between Russia and Turkey has stopped outright combat in Idlib, but on one day last month there were three attacks. A shell hit a refugee camp; an airstrike ignited a fuel depot on the Turkish border; and three artillery shells struck a village hospital in Al Atarib, killing seven patients, including an orphan boy who had gone for a vaccination, according to the Syrian American Medical Society, which supports the facility.
While the area’s displaced struggle to survive, others try to provide simple pleasures.
In the city of Idlib, the Disneyland restaurant entices visitors to dine on salads and grilled meat, and to forget their woes with video games, bumper cars, air hockey and stuffed animal claw machines.
The basement storeroom doubles as a shelter when the government shells nearby, and the terrace is enclosed with plastic sheeting instead of glass so it doesn’t shatter on diners if something explodes nearby.
The manager, Ahmed Abu Kheir, lost his job at a tourist restaurant that shut down when the war began, he said, so he opened a smaller place that was later destroyed by government shelling.
He opened another restaurant, but left it behind when the government seized the area last year and he fled to Idlib.
Like all of Idlib’s displaced, he longed to take his family home, but was glad to work in a place that spread a little joy in the meantime.
“We are convinced that normal life has to continue,” he said. “We want to live.”
For weeks, the mood in much of the United States has been buoyant. Cases, hospitalizations and deaths from the coronavirus have fallen steeply from their highs, and millions of people are being newly vaccinated every day. Restaurants, shops and schools have reopened. Some states, like Texas and Florida, have abandoned precautions altogether.
In measurable ways, Americans are winning the war against the coronavirus. Powerful vaccines and an accelerating rollout all but guarantee an eventual return to normalcy — to backyard barbecues, summer camps and sleepovers.
But it is increasingly clear that the next few months will be painful. So-called variants are spreading, carrying mutations that make the coronavirus both more contagious and in some cases more deadly.
Even as vaccines were authorized late last year, illuminating a path to the pandemic’s end, variants were trouncing Britain, South Africa and Brazil. New variants have continued to pop up — in California one week, in New York and Oregon the next. As they take root, these new versions of the coronavirus threaten to postpone an end to the pandemic.
rising exponentially in the United States.
Limited genetic testing has turned up more than 12,500 cases, many in Florida and Michigan. As of March 13, the variant accounted for about 27 percent of new cases nationwide, up from just 1 percent in early February.
pledged a “down payment” of $200 million to ramp up surveillance, an infusion intended to make it possible to analyze 25,000 patient samples each week for virus variants. It’s an ambitious goal: The country was sequencing just a few hundred samples each week in December, then scaling up to about 9,000 per week as of March 27.
Until recently, B.1.1.7’s rise was camouflaged by falling rates of infection over all, lulling Americans into a false sense of security and leading to prematurely relaxed restrictions, researchers say.
“The best way to think about B.1.1.7 and other variants is to treat them as separate epidemics,” said Sebastian Funk, a professor of infectious disease dynamics at the London School of Hygiene and Tropical Medicine. “We’re really kind of obscuring the view by adding them all up to give an overall number of cases.”
Other variants identified in South Africa and Brazil, as well as some virus versions first seen in the United States, have been slower to spread. But they, too, are worrisome, because they contain a mutation that diminishes the vaccines’ effectiveness. Just this week, an outbreak of P.1, the variant that crushed Brazil, forced a shutdown of the Whistler Blackcomb ski resort in British Columbia.
as fast as possible.
Infections are rising again, driven to an uncertain degree by B.1.1.7 and other variants. Earlier this week, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, pleaded with Americans to continue to practice masking and social distancing, saying she felt a sense of “impending doom.”
60 percent more contagious and 67 percent more deadly than the original form of the virus, according to the most recent estimates.
The variant is no different from the original in how it spreads, but infected people seem to carry more of the virus and for longer, said Katrina Lythgoe, an evolutionary biologist at the University of Oxford. “You’re more infectious for more days,” she said.
So contagious is B.1.1.7 that Britain succeeded in driving down infections only after nearly three months of strict stay-at-home orders, plus an aggressive vaccination program. Even so, cases fell much more slowly than they did during a similar lockdown in March and April.
three-quarters of new infections, some hospitals have had to move coronavirus patients to Belgium to free up beds. Roughly as many people are dying each day from Covid-19 in Europe as were this time a year ago.
For too long, government officials disregarded the threat. “Case plateaus can hide the emergence of new variants,” said Carl Pearson, a research fellow at the London School of Hygiene and Tropical Medicine. “And the higher those plateaus are, the worse the problem is.”
In the United States, coronavirus infections began a rapid decline in January, soon prompting many state leaders to reopen businesses and ease restrictions. But scientists repeatedly warned that the drop would not last. After the rate bottomed out at about 55,000 cases and 1,500 deaths per day in mid-March, some states — notably Michigan — began seeing an uptick.
Since then, the national numbers have steadily risen. As of Saturday, the daily count was up to nearly 69,000, and the weekly average was 19 percent higher than the figure two weeks earlier.
Pfizer-BioNTech and Moderna vaccines seem to be slightly less effective against B.1.351, the variant identified in South Africa. That variant contains the Eek mutation, which seems to enable the virus to partly sidestep the body’s immune response. The vaccines made by Johnson & Johnson, AstraZeneca and Novavax were even less potent against B.1.351.
“I think for the next year or two, E484K will be the most concerning” mutation, said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.
The mutation slightly alters the so-called spike protein sitting on the surface of the coronavirus, making it just a bit harder for antibodies to latch on and destroy the invader.
The good news is that the virus seems to have just a few survival tricks in its bag, and that makes it easier for scientists to find and block those defenses. “I’m feeling pretty good about the fact that there aren’t that many choices,” said Michel Nussenzweig, an immunologist at Rockefeller University in New York.
The Eek mutation seems to be the virus’s primary defense against the immune system. Researchers in South Africa recently reported that a new vaccine directed against B.1.351 ought to fend off all other variants, as well.
Pfizer, BioNTech and Moderna already are testing newly designed booster shots against B.1.351 that should work against any variants known to blunt the immune response.
Instead of a new vaccine against variants, however, it may be just as effective for Americans to receive a third dose of the Pfizer-BioNtech or Moderna vaccines in six months to a year, said Dr. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases.
That would keep antibody levels high in each recipient, overwhelming any variant — a more practical strategy than making a specialized vaccine for each new variant that emerges, he said.
“My only concern about chasing all the variants is that you’d almost be playing Whac-A-Mole, you know, because they’ll keep coming up and keep coming up,” Dr. Fauci said.
In one form or another, the new coronavirus is here to stay, many scientists believe. Multiple variants may be circulating in the country at the same time, as is the case for common cold coronaviruses and influenza. Keeping them at bay may require an annual shot, like the flu vaccine.
The best way to deter the emergence of dangerous variants is to keep cases down now and to immunize the vast majority of the world — not just the United States — as quickly as possible. If significant pockets of the globe remain unprotected, the virus will continue to evolve in dangerous new ways.
“This might be something that we have to deal with for a long time,” said Rosalind Eggo, an epidemiologist at London School of Hygiene and Tropical Medicine.
Still, she added, “Even if it changes again, which it is very likely to do, we are in a better, much stronger position than a year ago to deal with it.”
Bats, humans, monkeys, minks, big cats and big apes — the coronavirus can make a home in many different animals. But now the list of potential hosts has expanded to include mice, according to an unnerving new study.
Infected rodents pose no immediate risk to people, even in cities like London and New York, where they are ubiquitous and unwelcome occupants of subway stations, basements and backyards.
Still, the finding is worrying. Along with previous work, it suggests that new mutations are giving the virus the ability to replicate in a wider array of animal species, experts said.
“The virus is changing, and unfortunately it’s changing pretty fast,” said Timothy Sheahan, a virologist at the University of North Carolina at Chapel Hill, who was not involved in the new study.
only animals known to be able to catch the coronavirus from humans and pass it back. In early November, Denmark culled 17 million farmed mink to prevent the virus from evolving into dangerous new variants in the animals.
More recently, researchers found that B.1.1.7 infections in domesticated cats and dogs can cause the pets to develop heart problems similar to those seen in people with Covid-19.
To establish a successful infection, the coronavirus must bind to a protein on the surface of animal cells, gain entry into the cells, and exploit their machinery to make copies of itself. The virus must also evade the immune system’s early attempts at thwarting the infection.
Given all those requirements, it is “quite extraordinary” that the coronavirus can infect so many species, said Vincent Munster, a virologist at the National Institute of Allergy and Infectious Diseases. “Typically, viruses have a more curtailed host range.”
Mice are a known reservoir for hantavirus, which causes a rare and deadly disease in people. Even though the coronavirus variants don’t seem to be able to jump from mice to people, there is potential for them to spread among rodents, evolve into new variants, and then infect people again, Dr. Munster said.
black-footed ferrets. “This virus seems to be able to surprise us more than anything else, or any other previous virus,” Dr. Munster said. “We have to err on the side of caution.”
Dr. Sheahan said he was more concerned about transmission to people from farm animals and pets than from mice.
“You’re not catching wild mice in your house and snuggling — getting all up in their face and sharing the same airspace, like maybe with your cat or your dog,” he said. “I’d be more worried about wild or domestic animals with which we have a more intimate relationship.”
But he and other experts said the results emphasized the need to closely monitor the rapid changes in the virus.
“It’s like a moving target — it’s crazy,” he added. “There’s nothing we can do about it, other than try and get people vaccinated really fast.”
In January, Britain made a change to its vaccine guidelines that shocked many health experts: If the second dose of one vaccine wasn’t available, patients could be given a different one.
The new rule was based on sheer guesswork; there was no scientific data at the time demonstrating that mixing two coronavirus vaccines was safe and effective. But that may change soon.
In February, researchers at the University of Oxford began a trial in which volunteers received a dose of the Pfizer-BioNTech vaccine followed by a dose of AstraZeneca’s formulation, or vice versa. This month, the researchers will start analyzing the blood of the subjects to see how well the mix-and-match approach works.
As growing numbers of vaccines are being authorized, researchers are testing other combinations. A few are in clinical trials, while others are being tested in animals for now.
created an Ebola vaccine whose first dose contained a virus called an adenovirus. The second shot used another virus, called vesicular stomatitis virus.
When the Covid-19 pandemic began last year, the Gamaleya researchers used a similar strategy to create vaccines against the new coronavirus. The first dose used the same adenovirus as in their Ebola vaccine, called Ad5. The second dose contained a different human adenovirus, Ad26. The researches inserted a gene into both viruses for the protein on the surface of the coronavirus, called spike.
Studies revealed that the vaccine, now known as Sputnik V, provided a strong defense against Covid-19. In clinical trials, the researchers found that it had an efficacy of 91.6 percent. Sputnik V is now in use in Russia and 56 other countries.
Recently, the Gamaleya institute joined forces with AstraZeneca, which makes its own Covid-19 vaccine. AstraZeneca’s consists of two doses of a chimpanzee adenovirus called ChAdOx1. Last week, the company reported that its vaccine had an efficacy of 76 percent.
found that the mixture worked better than two doses of the spike or of the R.B.D.
The researchers suspect that the first dose produces a broad range of antibodies that can stick to spots along the length of the spike protein, and that the second dose delivers a big supply of particularly potent antibodies to the tip of the spike. Together, the assortment of antibodies does a better job of stopping the coronavirus.
held back exports of vaccines to other countries as it grappled with a surge of Covid-19. For countries that were counting on those vaccines, a safe alternative for second doses could save lives.
After Britain was criticized in January for suggesting that vaccines could be mixed, researchers at the University of Oxford set out to put the idea to a formal test. In a trial called Com-Cov, they recruited 830 volunteers to test the two vaccines authorized by the British government: AstraZeneca’s adenovirus-based vaccine and the vaccine by Pfizer-BioNTech.
Pfizer-BioNTech’s vaccine uses a fundamentally different technology to produce spike proteins in the body. It contains tiny bubbles with genetic molecules called RNA. Once the bubbles fuse to cells, the cells use the RNA to make spike proteins.
stronger immune responses than mice that received the same vaccine for both doses.
Whether scientists carry out more experiments on other vaccines will depend on the willingness of the vaccine manufacturers. “You’re requiring quite large pharmaceutical companies to play nice together,” Dr. Wheatley said.
Dr. Bernard Moss, a virologist at the National Institute of Allergy and Infectious Diseases, suspects that a number of companies will be willing to let their vaccines be tested in combinations. “It’s always better to be a part of something that is going to be used,” he said, “than to wholly own something that isn’t.”
The former director of the Centers for Disease Control and Prevention said in a CNN clip on Friday that he favored a theory, decried by many scientists and rejected as “extremely unlikely” by at least one World Health Organization international expert, that the coronavirus escaped from a lab in Wuhan. The former official, Dr. Robert Redfield, offered no evidence and emphasized that it was his opinion.
“I am of the point of view that I still think the most likely etiology of this pathogen in Wuhan was from a laboratory, escaped. The other people don’t believe that. That’s fine. Science will eventually figure it out,” Dr. Redfield told Dr. Sanjay Gupta in the video clip, referring to the origin of the virus. A formal report from the W.H.O. team and the Chinese scientists it worked with, on the origins of the pandemic and on the coronavirus in humans, is expected next week.
Despite Dr. Redfield’s comments, officials briefed on the intelligence say there is no new evidence that would cause American spy agencies to reassess their views. There is no new information that bolsters the so-called lab theory, according to officials briefed on the intelligence.
During the Trump administration, then-Secretary of State Mike Pompeo, and to a lesser extent the president himself, pushed the theory that the coronavirus had escaped from a lab.
the Director of National Intelligence in the Trump administration concurred “with the wide scientific consensus that the Covid-19 virus was not man-made or genetically modified.”
Although that statement was diplomatically worded, the message from the intelligence agencies was clear that, despite pressure from the Trump administration, they had no evidence that the coronavirus had escaped from the lab. And many intelligence officials remained far more skeptical than Mr. Pompeo, telling colleagues there was simply not enough information to say where the coronavirus came from, and certainly not enough to challenge the scientific consensus that was skeptical of the lab theory.
The C.I.A. and other intelligence agencies have been skeptical that China was sharing all that it knew about the virus, although that was at least in part because of local officials withholding critical information from Beijing at key moments at the beginning of the outbreak.
wrote an open letter in early March when the W.H.O. team report was first anticipated demanding a thorough investigation of Chinese labs. Virologists who have studied the evolution of coronaviruses and the way they have jumped to humans in the past causing SARS and MERS continue to argue that the evidence for a natural origin apart from a lab leak is overwhelming.
The Chinese government, prominent Chinese scientists and many virologists, who study the evolution of viruses and the appearance of infectious diseases, have said the lab leak theory was very unlikely, citing genetic evidence and the many opportunities for natural infection in human interactions with animals like bats, where the virus is believed to have originated.
When Dr. Anthony S. Fauci, the United States’ top infectious disease expert, was asked at a White House news conference on the pandemic on Friday about Dr. Redfield’s comments, he noted that the remarks were only an opinion. Dr. Fauci said that there are different ways viruses could become adapted to humans.
“You know one of them is in the lab and one of them, which is the more likely, which most public health officials agree with, is that it likely was below the radar screen, spreading in the community in China for several weeks if not a month or more, which allowed it, when it first got recognized clinically to be pretty well adapted,” Dr. Fauci said.
At the same news conference on Friday, Dr. Rochelle Walensky, the current director of the C.D.C., said she was looking forward to reviewing the upcoming joint report from the W.H.O. experts and Chinese scientists.
“I don’t have any indication for or against either of the hypotheses that Dr. Fauci just outlined,” she said.
Zachary Montague and Isabella Grullón Paz contributed reporting.
AstraZeneca reiterated on Wednesday that its Covid-19 vaccine was very effective at preventing the disease, based on more recent data than was included when the company announced the interim results of its U.S. clinical trial on Monday.
The company said in a news release that its vaccine was 76 percent effective at preventing Covid-19. That is slightly lower than the number that the company announced earlier this week.
The new results strengthen the scientific case for the embattled vaccine. But they may not repair the damage to AstraZeneca’s credibility after U.S. health officials and independent monitors issued an extraordinary rebuke of the company for not counting some Covid-19 cases when it announced its initial findings this week.
In a news release on Wednesday, the company said complete results from its 32,000-person study showed that its vaccine was 76 percent effective. On Monday, the company had said the vaccine appeared to be 79 percent effective, based on an interim look at 141 Covid-19 cases that had turned up among volunteers before Feb. 17. The latest finding was based on 190 trial participants who had gotten sick with Covid-19.
public statement.
said last week that a review had found the shot to be safe after a small number of people who had recently been inoculated developed blood clots and abnormal bleeding. The U.S. trial did not turn up any signs of such safety problems.
“They’re our family. They’re our friends. They’re our neighbors. They’re our partners,” Scott Morrison, Australia’s prime minister, said last week. “This is in Australia’s interests, and it is in our region’s interests,” he added.
Covax, a global health initiative designed to make access to inoculations more equal, began rolling out doses of vaccines to developing nations last month, and it has said it will deliver 588,000 to Papua New Guinea by June.
But in some cases, wealthier nations have failed to honor contracts, reducing the number of doses the initiative can buy, Dr. Tedros Adhanom Ghebreyesus, the director of the World Health Organization, said in a statement last month. He warned that the pandemic would not end until everyone was vaccinated.
“This is not a matter of charity,” he said. “It’s a matter of epidemiology.”
Until then, officials in Papua New Guinea will be left to combat not only the virus itself but also a tide of misinformation about the pathogen and the vaccines, carried largely through social media channels.
“Even for the educated health worker, it’s causing a lot of doubt,” said Dr. Nou, the Port Moresby-based physician, who has conducted a survey of health care workers’ views about the pandemic.
Some public health experts said they worried that the redirection of resources to fight the coronavirus could come at a lethal cost to those with other severe health conditions, such malaria or tuberculosis. Papua New Guinea has some of the highest rates of tuberculosis in the world.
“It’s not good enough to just respond to Covid and then have someone die of another cause,” said Dr. Suman Majumdar, an infectious diseases specialist at the Burnet Institute, an Australian medical research facility. “We have feared the worst,” he added, “and this is happening.”
