This obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.
For nearly four decades, William R. Harris devoted his career to safeguarding his fellow citizens.
As an international lawyer and a sought-after consultant, he drafted treaties to prevent the proliferation of nuclear weapons and reduce the risk of accidental war. He modeled a framework for the government to continue functioning during a national catastrophe. He helped extend Daylight Saving Time to conserve fuel and focused officials on protecting the electrical grid from digital sabotage.
He practiced what he preached, too, making sure to get his first vaccination for the coronavirus in early February, as soon as he was eligible and the vaccine was available. He completed the regimen by the end of the month.
In late March, though, his family said, he received a jarring diagnosis: Covid-19. Mr. Harris also had chronic lymphocytic leukemia, and family members said that a few weeks after learning that he had Covid, he read an article in a scientific journal suggesting that the vaccine might not be fully effective for people with that type of leukemia.
The New York Times last month.
No vaccine is 100 percent effective, and some so-called breakthrough infections can be expected, even in healthy people who have been fully vaccinated. But those cases are rare. As of April 26, the Centers for Disease Control and Prevention reported 9,245 breakthrough cases, out of 95 million fully vaccinated Americans; 132 people died.
In a eulogy on Facebook, Mr. Harris’s daughter Darcy R. Harris described him this way: “As an international lawyer and policy wonk, his work spanned arms control treaties and verification, energy policy, space law. He was a consummate researcher, an early adopter, an innovator. On top of that, he was always working for free and helping others out.”
Dr. William A. Horwitz and Dr. Henriette Klein, both of whom were professors of clinical psychiatry at Columbia University.
He attended the Dalton School in Manhattan and, after graduating from the Choate School, now Choate Rosemary Hall, in Wallingford, Conn., earned a bachelor’s degree in history from Harvard College in 1962 and a law degree from Harvard Law School in 1966.
In 1968, he married Elizabeth Jones. Along with his wife and their daughter Darcy, he is survived by another daughter, Rebecca Harris Deane; a son, William Proctor Harris; four grandchildren; and his sister, Susan Harris Molnar.
When Fan Jianhua had her third daughter last April, she was afraid that she would be fined for violating China’s birth limits.
Ms. Fan was already heavily in debt paying for treatment for her 6-year-old, who has leukemia. To her relief, when she registered her new baby with the police, she didn’t have to pay the $7,500 fine.
“I was really happy and could finally relax,” said Ms. Fan, 34, a stay-at-home mother in the central city of Danjiangkou, in Hubei Province.
Slowly, in fits and starts, China’s ruling Communist Party is loosening its long-held restrictions over childbirth and women’s bodies. Some local governments have tacitly allowed couples to have more than two children. Beijing has said civil servants will no longer be fired for such infringements. Party leaders have pledged to make population policies more inclusive, a signal that some have taken to mean the rules will be eased further.
decline in birthrates. A once-a-decade population census, released on Tuesday, showed that the number of births last year fell to the lowest since the Mao era. Low fertility translates to fewer workers and weaker demand, which could stunt growth in the world’s second-largest economy.
But the party is wary of giving up control and has resisted scrapping birth restrictions wholesale. Instead, Beijing has been taking a piecemeal approach by slowly dismantling the once-powerful family-planning bureaucracy and carving out exemptions. In many places, police officers, employers and city officials are deciding how strictly, or loosely, to enforce the rules.
That can mean more freedom for some, like Ms. Fan, to have more children. But it also creates uncertainty about the risks, adding to a reluctance about having more children.
The strategy could also founder amid broad cultural changes. Anxiety over the rising cost of education, housing and health care is now deeply ingrained in society. Many Chinese simply prefer smaller families, and the government’s efforts to boost the birthrate, including introducing a two-child policy in 2016, have largely fizzled.
“If the restrictions on family planning are not lifted, and they are encouraging births at the same time, this is self-contradictory,” said Huang Wenzheng, a demography expert with the Center for China and Globalization, a Beijing-based research center. He said that removing all birth limits would convey an important message. “I think such a step has to be taken.”
official murmurs about a reconsideration of the one-child policy surfaced but were quickly dismissed. It took years before the government moved to allow all couples to have two children.
Now, the population is aging more rapidly than those of many developed countries, including the United States, and some argue that the government cannot afford to keep any restrictions on procreation.
“We have to take advantage of the fact that a certain number of residents now are willing to give birth but aren’t allowed to,” China’s central bank said in a working paper it published on April 14. “If we wait to lift it when no one wants to give birth, it will be useless.”
harshly enforced family-planning rules in what Beijing has depicted as a fight against religious extremism. The campaign has led in recent years to a rise in sterilizations and contraceptive procedures — forcibly imposed in some cases — in the region’s Muslim-dominated areas.
China’s family-planning policy has long given local officials a powerful weapon of control — one that may be hard, or costly, to wrest back. Before they were unwound, family-planning agencies hired around eight million people, down to the village level, who corralled women to be fitted with intrauterine devices or coerced them into abortions.
The officials also collected large fines from couples who broke the rules. One senior researcher at the Central Party School estimated in 2015 that the fees amounted to between $3 billion and $5 billion annually.
In recent years, the government has been reassigning family-planning employees to roles including in population research and tackling Covid-19. But local governments retain the power to enforce birth limits as they see fit, which has led to inconsistencies.
The central government said in May last year that civil servants did not have to lose their jobs for violating birth limits, yet months later, a village committee in the eastern city of Hangzhou fired a woman after she had a third child — prompting a public outcry.
Ultimately, the fate of China’s family-planning policies may change little. A generation of highly educated women are putting off marriage and childbirth for other reasons, including a rejection of traditional attitudes that dictate women should bear most of the responsibility of raising children and doing housework.
Liu Qing, a 38-year-old editor of children’s books in Beijing, said getting married and having children were never in her future because they would come at too great a personal cost.
“All the things that you want — your ideals and your ambitions — have to be sacrificed,” Ms. Liu said.
Ms. Liu said Chinese society imposed a motherhood penalty on women, pointing to the discrimination that mothers often faced in hiring.
“I’m furious about this environment,” she said. “I’m not the kind of person who would accept this reality and compromise. I just won’t.”
For other Chinese, having fewer children is a matter of necessity when holes in the country’s social safety net mean that a major illness can lead to financial ruin.
Ms. Fan, the woman in Hubei who was spared a fine, said that she and her husband, a laborer, were getting increasingly desperate. Public health insurance had covered half the cost of her daughter’s treatment for leukemia, but they were on the hook for $76,000.
She had a third child only because she heard that a sibling’s cord blood could help in the treatment of leukemia. But she later learned that such treatment would cost more than $100,000.
“I don’t dare think about the future,” Ms. Fan said. She added that if her daughter’s condition deteriorated or they went broke, they would have to give up treatment.
“We can only leave it up to her fate,” she said.
Research was contributed by Claire Fu, Liu Yi, Albee Zhang and Elsie Chen.
For more than a year, Dr. Andrew Wollowitz has mostly been cloistered inside his home in Mamaroneck, N.Y.
As chief of emergency medicine at Montefiore Medical Center in the Bronx, Dr. Wollowitz, 63, was eager to help treat patients when the coronavirus began raging through the city last spring. But a cancer treatment in 2019 had obliterated his immune cells, leaving him defenseless against the virus, so he instead arranged to manage his staff via Zoom.
A year later, people in Dr. Wollowitz’s life are returning to some semblance of normalcy. His wife, a dancer and choreographer, is preparing to travel for work at Austria’s National Ballet Company. His vaccinated friends are getting together, but he sees them only when the weather is nice enough to sit in his backyard. “I spend very little time in public areas,” he said.
Like his friends, Dr. Wollowitz was vaccinated in January. But he did not produce any antibodies in response — nor did he expect to. He is one of millions of Americans who are immunocompromised, whose bodies cannot learn to deploy immune fighters against the virus.
as high as 55 percent.
Most people who have lived with immune deficiencies for a long time are likely to be aware of their vulnerability. But others have no idea that medications may have put them at risk.
“They’ll be walking around outside thinking they’re protected — but maybe they’re not,” said Dr. Lee Greenberger, chief scientific officer of the Leukemia and Lymphoma Society, which funds research on blood cancers.
The only recourse for these patients — apart from sheltering in place until the virus has retreated — may be to receive regular infusions of monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have recovered from Covid-19. The Food and Drug Administration has authorized several monoclonal antibody treatments for Covid-19, but now some are also being tested to prevent infections.
Convalescent plasma or gamma globulin — antibodies distilled from the blood of healthy donors — may also help immunocompromised people, although a version of the latter that includes antibodies to the coronavirus is still months from availability.
compassionate use program. (Regeneron released trial results this week showing that the cocktail reduces symptomatic infections by 81 percent in people with normal immune systems.)
It’s unclear how many immunocompromised people don’t respond to coronavirus vaccines. But the list seems at least to include survivors of blood cancers, organ transplant recipients, and anyone who takes the widely used drug Rituxan, or the cancer drugs Gazyva or Imbruvica — all of which kill or block B cells, the immune cells that churn out antibodies — or Remicade, a popular drug for treating inflammatory bowel disease. It may also include some people over age 80 whose immune responses have faltered with age.
“We’re extremely concerned and interested in trying to see how we might be able to help those particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.
As the pandemic spread, doctors who specialize in treating blood cancers or who care for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at Icahn School of Medicine at Mount Sinai in New York, has about 600 patients who are almost entirely dependent on getting regular doses of gamma globulin to stay safe from pathogens.
Even so, 44 of her patients became infected with the coronavirus; four died, and another four or five had long-term illnesses. (Chronic infections may offer opportunities for the virus to evolve into dangerous variants.)
registry to provide information and antibody tests to people with blood cancers. And several studies are assessing the response to coronavirus vaccines in people with cancer, autoimmune conditions like lupus or rheumatoid arthritis, or who take drugs that mute the immune response.
What You Need to Know About the Johnson & Johnson Vaccine Pause in the U.S.
On April 13, 2021, U.S. health agencies called for an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.
All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
In one such study, British researchers followed nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals in the country. They found that less than half of patients who took Remicade mounted an immune response following coronavirus infection.
were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In Britain, the current practice is to delay second doses to stretch vaccine availability.)
Likewise, another study published last month indicated that fewer than 15 percent of patients with cancers of blood or the immune system, and fewer than 40 percent of those with solid tumors, produced antibodies after receiving a single dose of the Pfizer-BioNTech vaccine.
And a study published last month in the journal JAMA reported that only 17 percent of 436 transplant recipients who got one dose of the Pfizer-BioNTech or Moderna vaccine had detectable antibodies three weeks later.
Despite the low odds, immunocompromised people should still get the vaccines because they may produce some immune cells that are protective, even antibodies in a subset of patients.
“These patients should probably be prioritized for optimally timed two doses,” said Dr. Tariq Ahmad, a gastroenterologist at the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.
He suggested that clinicians routinely measure antibody responses in immunocompromised people even after two vaccine doses, so as to identify those who also may need monoclonal antibodies to prevent infection or a third dose of the vaccines.
Wendy Halperin, 54, was diagnosed at age 28 with a condition called common variable immunodeficiency. She was hospitalized with Covid-19 in January and remained there for 15 days. But the coronavirus induced unusual symptoms.
“I was having trouble walking,” she recalled. “I just lost control of my limbs, like I couldn’t walk down the street.”
Because she was treated for Covid-19 with convalescent plasma, Ms. Halperin has had to wait three months to be immunized and has made an appointment for April 26. But despite her condition, her body did manage to produce some antibodies to the initial infection.
“The take home message is that everybody should try and get the vaccine,” said Dr. Amit Verma, an oncologist at Montefiore Medical Center.
The gamble did not pay off in Dr. Wollowitz’s case. Without antibodies in his system to protect him, he is still working from home — a privilege he is grateful for. He was an avid mountain biker and advanced skier, both of which carry risk of injury, but with the coronavirus, he is playing it safe.
In anticipation of returning to his normal lifestyle, Dr. Wollowitz is tuning his bicycles. But he said he foresaw himself living this way till enough other people are vaccinated and the number of infections in the city drops.
“I’m not exactly sure what that date is,” he said. “I’m really waiting to get back out.”
Just a few weeks after a promising gene therapy for sickle cell disease seemed to have hit a roadblock, prospects for the treatment now look better. Preliminary data suggesting that it might cause cancer have not held up.
In the gene therapy, scientists insert a normal gene into patients’ DNA to help correct sickle cell disease, which is caused by a devastating mutation. The cutting-edge treatment may prove to be a cure, and a company that is testing the treatment, Bluebird Bio, had been on track to apply to the Food and Drug Administration for approval next year.
But on Feb. 16, Bluebird Bio announced that a sickle cell patient treated five years ago in a clinical trial had developed acute myeloid leukemia. Another patient got acute myelodysplastic syndrome, a form of cancer that is often a precursor to leukemia.
The company shut down its trials for sickle cell patients and those with another blood disorder, beta thalassemia, while its researchers sought to understand if the gene therapy was at fault.
On Wednesday, Bluebird Bio reported that it had not found evidence that the gene therapy caused the sickle cell patient’s leukemia.
The gene inserted in the patient’s DNA did not disrupt the functioning of other genes, the company said. And the gene was not inserted near any others in the genome known to be involved in leukemia.
Bluebird Bio is still investigating whether its treatment may be linked to acute myelodysplastic syndrome, but officials have asked the Food and Drug Administration to allow its clinical trials to continue.
A separate sickle cell trial, at Boston Children’s Hospital, was also shut down when Bluebird Bio announced the two cancers at the request of the National Institutes of Health, which is paying for the trial.
Dr. David Williams, a hematologist at Boston Children’s and a principal investigator of the trial, said the researchers are asking the N.I.H. for permission to resume their work.
Like Bluebird Bio’s investigators, Dr. Williams and his colleagues are using a disabled lentivirus to deliver a gene to sickle cell patients. Lentiviruses are thought to be safe — hundreds of patients in other gene therapy trials have been treated with them, and no blood cancers were reported. The possibility that lentiviruses might not be safe was of grave concern.
The leukemia patient in the Bluebird Bio trial carried genetic abnormalities associated with leukemia, which could explain why it developed.
Philip Gregory, chief scientific officer at the company, said it is not yet clear if the patient diagnosed with myelodysplastic syndrome actually has it. So far, Bluebird Bio has not been able to find any cancer cells in his bone marrow.
“He may have been prematurely diagnosed,” Dr. Gregory said. If cancer cells are found in the patient’s marrow, Dr. Gregory added, the company will proceed with the same detailed molecular analysis it did for the leukemia patient.
Dr. John Tisdale, chief of the cellular and molecular therapeutics branch at the National Heart, Lung and Blood Institute, was cautiously optimistic.
“These data indeed point away from the vector as causative,” he wrote in an email. But, he added, researchers still need to better understand the illnesses in the trial participants before they can breathe a final sigh of relief.