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Fungal Infections in Covid Patients in India Push Government to Get Grip on Spread

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India’s federal health ministry raised an alarm on Thursday, asking state governments to immediately report all cases of a potentially deadly fungal infection that appears to be spreading quickly among Covid-19 patients.

The rare condition, mucormycosis, commonly known as black fungus, was present in India before the pandemic, but it is affecting those with Covid or those who have recently recovered.

Many health experts blame the spread on a central coronavirus treatment, steroids. These drugs can limit inflammation of the lungs, but they also dull the response of the immune system, which can allow infections like the black fungus to take hold.

More broadly, Covid patients with weakened immune systems and underlying conditions, particularly diabetes, are especially vulnerable to black fungus, which has a high mortality rate.

Video of a woman saying she would jump off the roof of a hospital if it failed to arrange injections of the medication for her husband spread widely on social media early this week.

The woman, in the central Indian state of Madhya Pradesh, said, “If I don’t get the injection today, then I will jump off the roof of the hospital and commit suicide. I have no other option left.” She added that the hospital had none of the medication and said of her husband, “Where should I take him in this condition?”

amid a virulent second wave.

Of the medication for the disease she said: “It is not one of the common over-the-counter medications. This is a toxic medication by itself. It can’t be given by all and sundry. It is not something which you can take at home. It needs strict monitoring of body parameters because it is a toxic drug.”

The federal government directive requiring state governments to immediately disclose cases follows those of many Indian states that had already required hospitals to report cases of mucormycosis.

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Virus Deaths Likely Higher Than Official Toll, W.H.O. Says

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GENEVA — Deaths from Covid-19 and Covid-related causes are likely to be two to three times the number that countries have recorded in their official data, the World Health Organization said on Friday.

Some six to eight million people may have now died from Covid-19 or its effects since the start of the pandemic, compared with 3.4 million deaths recorded in countries’ official reporting, Dr. Samira Asma, assistant director of the W.H.O.’s data division, told reporters.

The W.H.O. also estimates that at least three million people may have died from Covid-19 in 2020, compared with 1.8 million recorded in official data, the W.H.O. reported in annual statistics released on Friday.

The W.H.O. based its assessment on a statistical model that estimates the excess deaths attributable to Covid-19. The technique involves taking the total number of officially recorded deaths and then subtracting the number of deaths that would have been expected on the basis of previous mortality trends if the pandemic had not occurred.

On that basis, the W.H.O. said it estimated that 1.1 million to 1.3 million people in 53 European countries died from Covid-19 in 2020, roughly double the number recorded in official data. The organization also calculates that, over the same period, 1.3 million to 1.5 million people died in 35 countries in the Americas, compared with the 900,000 deaths officially recorded.

The huge discrepancy between the W.H.O.’s estimates and official data underscores the limited capacity of many countries to test their populations for the coronavirus and other weaknesses in official health data. For example, some Covid victims had died before being tested and their deaths did not appear in official reporting, William Msemburi, a W.H.O. data analyst said.

The W.H.O. will present its statistics to the annual meeting of its policymaking assembly in Geneva next week. The numbers will help make the case for countries to invest urgently in bolstering data systems and their capacity to monitor and report health developments.

“We can only be better prepared with better data,” Dr. Asma said.

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Preferential testing in N.Y. leads to a federal investigation into Cuomo, the latest in a slew of inquiries.

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On April 3, the day before Easter, one of Mr. Cuomo’s daughters, Mariah Kennedy Cuomo, and her boyfriend, Tellef Lundevall, were tested at a state-run site in Albany, N.Y., and the samples were labeled a priority — “specials,” as they were known inside the Health Department — before being rushed for processing at the state’s Wadsworth Center laboratory nearby.

The samples were processed within hours, according to two people familiar with the events. Their reason for getting priority was personal: They were going to see the governor for the holiday.

The couple’s preferential treatment underscored how a system meant to ensure fast test results for high-priority cases — such as those involving possible outbreaks — had been repeatedly used for Mr. Cuomo’s immediate family and other influential people.

Officials are barred by state law from using their position to obtain “privileges or exemptions” for themselves or others, or even trying to do so. An impeachment inquiry into Mr. Cuomo, run by the State Assembly, has also begun considering the access the governor’s family received to testing.

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Japan Approves Moderna and AstraZeneca Vaccines

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Japan on Friday approved the Moderna and AstraZeneca coronavirus vaccines for use in adults, giving the country much-needed new options as it tries to speed up an inoculation campaign that has been one of the slowest in the developed world.

Previously, only the Pfizer vaccine had been authorized for use in Japan, where just 4.1 percent of the population has received a first shot. Vaccinations have been held up by strict rules that allow only doctors and nurses to administer shots, and by a requirement that vaccines be tested on people in Japan before they are approved for use.

Japan is in the midst of a fourth wave of Covid-19 infections, just two months before the Summer Olympics in Tokyo are set to begin. Tokyo and eight other prefectures are under a state of emergency that will last at least until the end of this month, and Okinawa is expected to be added to that list. Japan has been reporting about 5,500 cases a day, compared to 1,000 in early March.

A health ministry panel recommended on Thursday night that the government approve the Moderna and AstraZeneca vaccines. The health minister, Norihisa Tamura, said the Moderna shots would be used at mass inoculation sites scheduled to open on Monday in Tokyo and Osaka, which will be staffed mainly by military doctors and nurses.

very rare cases of blood clotting.

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The global vaccination effort, already in dire shape, faces more setbacks.

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As inoculations help a sense of normalcy return in the lives of many Americans, much of the world remains gripped by the pandemic, with little hope that a significant number of vaccine doses will be made available soon.

The effort to vaccinate enough of the world’s population to get the virus under control — already a huge struggle, experts said — was set back again this week after the Serum Institute of India, the world’s largest vaccine producer, signaled that it would not be able to export doses until the end of the year.

The Serum Institute’s manufacturing capacity is at the heart of Covax, a global effort to vaccinate the populations of low- and middle-income countries. The program is already more than 140 million doses behind schedule, and the Serum Institute announcement suggested that its goal of two billion doses by the end of the year would be all but impossible to meet.

Dr. Arthur Reingold, chief of the epidemiology division at the University of California, Berkeley, said that the delay was “not surprising, given the drastic situation” in India, which has been pummeled by the virus in recent weeks.

devastating second wave of coronavirus infections, the institute has diverted all its manufacturing powers to domestic needs, falling behind on commitments to the Covax partnership as well as on bilateral commercial deals with many countries.

“It simply means that poor countries of the world, the low- and middle-income countries of the world,” Dr. Reingold said, “are going to have to wait longer to come anywhere close to the kind of vaccination coverage that we’ve achieved in some of the wealthier countries.”

About 48 percent of people in the United States have received at least one dose of a Covid-19 vaccine, according to federal data on Wednesday. In the United Kingdom, the figure is 54 percent, and in Germany, nearly 38 percent, according to the Our World in Data project at Oxford University.

But only 10 percent of people in India have received a dose of the vaccine. Just over 1 percent of people in Honduras have received a shot, and less than 1 percent have been at least partially vaccinated in Somalia.

100 million doses of Johnson & Johnson’s vaccine were now on hold as regulators checked them for possible contamination.

The Johnson & Johnson vaccine has been viewed by public health officials as an important tool to vaccinate populations that are more difficult to reach, because it requires only one dose and does not need the special low-temperature storage required by the Moderna and Pfizer-BioNTech vaccines.

The rate of vaccinations in the United States has slowed considerably in recent weeks, though about 1.8 million doses are being administered to Americans each day on average, according to a New York Times database.

President Biden announced on Monday that the United States would send 20 million doses of the three vaccines abroad. The 100 million Johnson & Johnson doses under inspection could pad the American stockpile, or be sent to help meet the dire need abroad.

Still, Dr. Reingold said that it was “time well spent” to “very carefully look at those doses and ensure that they’re safe and effective.”

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Cuomo will likely make over $5 million for his pandemic book, which is at the center of an investigation.

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Gov. Andrew M. Cuomo was expected to earn more than $5 million from his book about leading New York during the coronavirus pandemic, according to figures released by his office on Monday, as investigators continued to look into his use of state resources to write and promote the book.

The governor received the bulk of the money, $3.12 million, last year, state officials said. Under the contract, he is set to be paid another $2 million in installments over the next two years.

The windfall book deal, which dwarfed the governor’s salary of $225,000, was reached last year after Mr. Cuomo rose to national prominence for televised news briefings during the pandemic’s uncertain early phase, when New York was the nation’s center.

But the disclosure of the details on Monday arrived as Mr. Cuomo and his administration found themselves in a very different place: mired in multiple overlapping investigations into accusations of sexual harassment by the governor, his handling of nursing home death data and his use of government resources for work on the book.

Across the publishing world, the revelation of Mr. Cuomo’s payment elicited shock: The amount appeared to be a staggering sum to pay to a politician who already had a meager sales record for his previous book, a memoir that sold just a few thousand print copies.

While former presidents have garnered multimillion-dollar advances — Bill Clinton sold his autobiography to Knopf for about $15 million, while Barack and Michelle Obama received some $65 million from Penguin Random House for their books — Mr. Cuomo’s book deal appeared far larger than those for other well-known elected officials.

The book, “American Crisis: Leadership Lessons From the Covid-19 Pandemic,” proved a lucrative endeavor for the governor, but since its publication in October, it has become a minefield for him and his publisher, Crown.

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W.H.O. Notes Steep Drop in New Cases in Europe Over Past Month

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Europe has recorded a 60 percent drop in new coronavirus infections over the past month, the World Health Organization said Thursday, encouraging news that comes as the continent plans to reopen its borders. Still, “this progress is fragile,” a top agency official cautioned.

On Wednesday, the 27 member states of the European Union agreed that the bloc would reopen its borders to nonessential travelers who have been fully vaccinated against the coronavirus with an approved shot, as well as to those coming from a list of countries where the coronavirus is relatively under control.

The rules are set to become formal policy next week, and could be implemented immediately. Under the E.U. plan, the bloc would accept visitors who have completed their immunization at least two weeks before their arrival, using one of the shots approved by the union’s own regulator or by the W.H.O. That covers the vaccines from AstraZeneca, Johnson & Johnson, Moderna, Pfizer-BioNTech and Sinopharm, according to a draft of the rules seen by The New York Times.

Most countries are likely to introduce changes slowly and conservatively, but some of them, like Greece, have already removed quarantine requirements for vaccinated travelers or those who have a negative PCR test from no more than 72 hours ago. England, France, Spain, Poland, Italy and other countries in the bloc have already started easing restrictions.

worrisome variants that appeared to be spreading within the bloc remained a cause for concern.

“This progress is fragile, we have been here before,” Dr. Kluge told reporters at a news conference, advising vigilance over outbreaks “that could quickly evolve into dangerous resurgences.”

The B.1.617 variant, which was first identified in India and has been deemed a variant of concern by the W.H.O., has now spread to 26 of the 53 countries the W.H.O. includes in its European region. Dr. Kluge said that although most cases of the variant were connected to international travel, transmission of the variant was occurring within Europe.

“We are heading in the right direction, but need to keep a watchful eye on a virus that has claimed the lives of nearly 1.2 million people in this region,” Dr. Kluge said.

Dr. Kluge added that the vaccines had so far been effective against variants, but that the slow vaccine rollout in Europe had only reached a small percentage of the population, and that precautions like social distancing and wearing masks were still necessary.

“Vaccines may be a light at the end of the tunnel, but we cannot be blinded by that light,” he said.

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The death of a pair of twins in India punctures country’s numbing statistics.

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NEW DELHI — Joefred and Ralfred Gregory moved through life as one.

They went to the same college. They studied the same thing. They wore matching clothes. They trimmed their beards the exact same way.

Identical twins, they were two handsome young men in northern India who above all else really loved each other. And when they both were struck by Covid-19 last month and hospitalized, it was like they shared one sick body.

Hours after Joefred died, Ralfred’s mother told him that his brother was still alive, to keep his spirits up.

But Ralfred sensed his brother was no more and said, from his hospital bed, “Mummy, you’re lying.”

The next day, on May 14, Ralfred died too.

has suffered so much and keeps suffering. Though India’s overall case numbers have dropped this past week, the deaths keep going up.

On Wednesday, India broke a world record for the most reported Covid deaths in a single day: 4,529. However alarming that number is — three Indians dying every minute because of the coronavirus — experts say that it is just a small fraction of the true toll and that the real numbers are far higher.

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Mongolia has plenty of vaccines as countries scramble for doses.

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At a time when most countries are scrambling for coronavirus vaccines, Mongolia already has enough to fully vaccinate more than half its citizens, in large part thanks to deals with both China and Russia.

Officials are so confident about the nation’s vaccine riches that they are promising citizens a “Covid-free summer.”

Mongolia’s success in procuring so many doses within months is a big victory for a low-income, developing nation. Many poor countries have been waiting in line for shots, hoping for the best. But Mongolia, using its status as a small geopolitical player between Russia and China, was able to snap up doses at a clip similar to that of much wealthier countries.

Mongolia has a population not much bigger than Chicago’s. The small democratic nation is used to living in the shadows of Russia and China, which often treat it as a geopolitical pawn.

during a pandemic, being a small nation sandwiched between two vaccine makers with global ambitions can have advantages.

“It speaks to the Mongolian ability to play to the two great powers and maximize their benefits even while they are on this tightrope between these two countries,” said Theresa Fallon, director of the Center for Russia Europe Asia Studies in Brussels.

It is also a win for China and Russia, which have extensive resource interests in Mongolia and ambitions to appear to play a role in ending the pandemic, even when much of the world has expressed deep skepticism over their homegrown vaccines.

has extended the period of time the Pfizer-BionNTech vaccine can be refrigerated. The agency now says undiluted and thawed vaccines can be stored for up to 30 days, rather than up to five, as before. The European Medicines Agency announced a similar recommendation earlier in the week.

  • Prince William, the second in line to the throne of Britain, said on Thursday that he had received his first dose of a Covid-19 vaccine. He shared a photo on social media of the injection at the Science Museum in London on Tuesday, thanking everyone involved in the country’s vaccination program. The prince is 38, part of an age group that became eligible to book inoculations last week. Queen Elizabeth II, his grandmother, was vaccinated in January and his father, Prince Charles, received a first dose in February.

  • The European Commission, the executive arm of the European Union, signed a contract for an additional 1.8 billion doses of BioNTech-Pfizer vaccine to be delivered between December 2021 and 2023, the commission’s president, Ursula von der Leyen, announced Thursday. The deal will allow member countries to buy 900 million doses, including booster shots to prolong immunity, as well as possible new vaccines targeting emerging variants of the coronavirus, with an option to purchase additional 900 million in coming years.

    • Anna Schaverien, Monika Pronczuk and Kaly Soto contributed reporting.

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    Oregon to Require Businesses Verify Vaccination Status

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    Oregon has lifted its mask mandate for people who have been fully vaccinated against Covid-19, but is requiring businesses, workplaces and houses of worship to verify the vaccination status of individuals before they enter buildings without a mask.

    This statewide mandate, one of the first of its kind in the country, raised concerns that the procedure of verifying vaccinations could be too cumbersome for workers.

    Many states have lifted mask requirements without requiring confirmation that individuals have been vaccinated. New York lifted its mask mandate on Tuesday for vaccinated people, though businesses will be allowed to enforce stricter rules. Some Republican governors, like Gov. Greg Abbott of Texas, have instead not only lifted mask rules but banned local governments from enforcing their own. Gov. Ron DeSantis of Florida, also a Republican, issued an executive order last month prohibiting businesses from requiring vaccine documentation.

    The notion of relying on the honor system, which some states and businesses have adopted, has raised its own questions. And business groups in Oregon expressed concerns that a mandate to check vaccination status could become — like mask enforcement — a difficult and potentially dangerous proposition for workers.

    “We have serious concerns about the practicality of requiring business owners and workers to be the enforcer,” said Nathaniel Brown, a spokesman for Oregon Business and Industry, which represents companies like Nike, as well as small businesses. “We are hearing from retailers and small businesses who are concerned about putting their frontline workers in a potentially untenable position when dealing with customers.”

    The Oregon Health Authority said in new guidance on Tuesday that effective immediately, businesses would be required to continue to enforce mask requirements unless they had established a policy to confirm proof of vaccination using a card or photo of one before individuals can enter the building without a mask.

    Gov. Kate Brown, a Democrat, said last week that Oregonians who were fully vaccinated no longer needed to wear masks in most public settings, except in places like schools, public transit and health care settings.

    But she quickly noted that businesses would have “the option” of lifting mask requirements only if they instituted verification procedures. “Some businesses may prefer to simply continue operating under the current guidance for now rather than worrying about vaccination status, and that’s fine,” she said.

    A spokesman for Fred Meyer, a grocery store chain in the Pacific Northwest owned by Kroger, said that it would continue to require customers and employees to wear masks in its stores.

    New York has created the Excelsior Pass, a digital proof of Covid-19 vaccination, which will be used at some sites like Madison Square Garden and Radio City Music Hall. Jen Psaki, President Biden’s press secretary, reiterated on Monday that the federal government would not be issuing “vaccine passports,” the development of which she said should be left up to the private sector.

    Charles Boyle, a spokesman for Gov. Brown, said that “businesses that do not want to implement vaccine verification can keep current health and safety measures in place, which includes masks and physical distancing for all individuals.”

    Asked if businesses would face penalties for allowing customers to go maskless without checking their vaccination status, Mr. Boyle said that “in the past year state agencies have issued fines for businesses that are out of compliance with health and safety guidance.”

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