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.

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The C.D.C. and N.I.H. launch a rapid, at-home testing initiative in Tennessee and North Carolina.

The Centers for Disease Control and Prevention and the National Institutes of Health announced a new initiative on Wednesday to help determine whether frequent, widespread use of rapid coronavirus tests slows the spread of the virus.

The program will make rapid at-home antigen tests freely available to every resident of two communities, Pitt County, N.C., and Hamilton County, Tenn., enough for a total of 160,000 people to test themselves for the coronavirus three times a week for a month.

“This effort is precisely what I and others have been calling for nearly a year — widespread, accessible rapid tests to help curb transmission,” said Michael Mina, an epidemiologist at Harvard University who has been a vocal proponent of rapid, at-home testing programs.

He added, “Taking 30 seconds out of your day three times a week to perform the test is something any person can do.”

testing remains essential, public health experts say.

“We have all hypothesized that testing at home, at scale could stop the chain of transmission of the virus and allow communities to discover many more cases,” said Bruce Tromberg, who directs the National Institute of Biomedical Imaging and Bioengineering and leads its rapid acceleration of diagnostics program, which is supplying the tests for the initiative. “All the mathematical models predict that. But this is a real world, real life example.”

Residents who decide to participate in the program can have the tests delivered to their homes or pick them up at local distribution sites. An online tool will guide participants through the testing process and help them interpret their results. Residents can also volunteer to complete surveys that will assess whether frequent testing has changed their behavior, knowledge about Covid-19, or opinions on vaccination.

Researchers at the University of North Carolina and Duke University will compare the test positivity, case and hospitalization rates in these two communities to those in other similar communities that are not participating in the program.

A. David Paltiel, a professor of health policy and management at Yale School of Public Health, called the launching of a real-world study of the effectiveness of rapid, at-home screening “just great news.” But he cautioned that the results will need to be interpreted carefully, especially if the residents who choose to participate in the initiative are not representative of the community at large.

“We know that self-selection tends to bring out the worried well and a disproportionate number of people who are already Covid-conscious or Covid-conscientious,” he said.

“It’ll be great to see how it works when in the hands of people who really care,” he added. But, he said, the results may not be widely generally applicable to screening programs in which participation is mandatory, as may be the case with some workplace and school programs.

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Covid-19 Live Updates: U.S. Health Officials Question AstraZeneca Vaccine Trial Results

may have been based on outdated and incomplete information about the vaccine’s effectiveness, an extraordinary blow to the credibility of an already embattled vaccine.

In a statement released shortly after midnight, the National Institute of Allergy and Infectious Diseases said that an independent panel of medical experts that has been helping to oversee AstraZeneca’s U.S. trial had “expressed concern that AstraZeneca may have included outdated information from that trial, which may have provided an incomplete view of the efficacy data.”

The public airing of a conflict between a pharmaceutical company and a board overseeing a clinical trial is highly unusual. It is almost certain to trigger extra scrutiny of the vaccine by the Food and Drug Administration and other regulators if AstraZeneca seeks emergency authorization of its vaccine in the United States

“This is really what you call an unforced error,” Dr. Anthony S. Fauci, the nation’s leading infectious-disease expert, said on “Good Morning America” on Tuesday morning. “Because the fact is: This is very likely a very good vaccine, and this kind of thing does, as you say, do nothing but really cast some doubt about the vaccines and maybe contributes to the hesitancy.”

The friction with the independent monitoring board revolved around how AstraZeneca was determining whether participants in the clinical trial had possible or actual cases of Covid-19, according to a person familiar with the situation. The independent monitoring board twice pushed AstraZeneca to take a more rigorous approach, telling the company it had sufficient information to determine how many trial participants had the disease. That had the potential to reduce the vaccine’s apparent effectiveness.

But AstraZeneca unveiled its interim results on Monday without conducting the full analysis the board requested, possibly casting its vaccine in an overly favorable light.

AstraZeneca defended the data it released on Monday, which it said showed the vaccine was 79 percent effective at preventing Covid-19. The company said on Tuesday that the interim results appeared to be “consistent” with more recent data collected during the trial. AstraZeneca said it would immediately share its latest efficacy data with the monitoring board. The company said it would reissue fuller results within 48 hours.

The results that AstraZeneca announced on Monday were a badly needed dose of good news, especially because they came at a moment when concerns about the vaccine’s safety had led more than a dozen countries, mostly in Europe, to temporarily suspend the shot’s use over concerns about possible rare side effects. The results not only affirmed the vaccine’s safety, but also made the vaccine look more effective than it appeared in earlier trials.

But members of the independent monitoring board were surprised by the company’s announcement. “They got concerned and wrote a rather harsh note to them and with a copy to me, saying that in fact they felt that the data that was in the press release were somewhat outdated and might in fact be misleading a bit and wanted them to straighten it out,” said Dr. Fauci, who runs the National Institute of Allergy and Infectious Diseases.

That prompted the overnight statement from the infectious-disease institute, which is part of the National Institutes of Health.

Companies sponsoring drug or vaccine trials typically wait for the monitoring board to review analyses and conclude that the study has yielded an answer before they announce trial results.

Company executives do not see the results of the study until the monitoring board reports their study data back to the company. The monitoring board ultimately conveyed the results of the study to AstraZeneca in a meeting over the weekend, leading to the company’s announcement Monday morning.

The monitoring board’s slow progress fueled concerns among federal officials that AstraZeneca may have been sitting on the data or that the monitoring board had concerns about the way the data it was reviewing had been presented.

An AstraZeneca spokeswoman, whom the company declined to name, said on Friday that it was “completely incorrect” that the trial data had formatting problems or had not been submitted to the monitoring board in a clean fashion.

“As is often the case,” the spokeswoman said, monitoring boards “can request new or clarifying analyses of data from the trial. This would enable them to ensure the robustness of their determinations.”

The national institute’s statement, issued shortly after midnight, stunned experts. Dr. Eric Topol, a clinical trials expert at Scripps Research in San Diego, said it was “highly irregular” to see such a public display of friction between a monitoring board and a study sponsor, which are typically in close concordance.

“I’ve never seen anything like this,” he said. “It’s so, so troubling.”

AstraZeneca’s relationship with the U.S. authorities has been fraught since last year, when senior health officials believed the company was not being forthright about the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies grew suspicious about why AstraZeneca had not announced data from its U.S. study..

Munich last week. The number of coronavirus cases in Germany is rising, prompting the government to extend lockdown measures.
Credit…Laetitia Vancon for The New York Times

Chancellor Angela Merkel of Germany, warning on Tuesday that her country is facing a significantly more deadly wave of the coronavirus, announced a five-day lockdown over Easter and the extension of existing restrictions until mid-April in an effort to break a spike in coronavirus cases.

Starting April 1, and until the following Monday, Germany will effectively shut down for an extended Easter break, with private meetings limited to no more than two groups of up to five adults and almost all stores ordered shuttered (supermarkets can open on the Saturday). Churches are asked to hold services online, and people are being asked to stay home and not travel.

“We are in a very, very serious situation,” Ms. Merkel told a news conference, after hours of deliberations with the leaders of the country’s 16 states over the Easter lockdown and extension of existing restrictions through April 18.

“After we were able to sharply bring down the number of new infections in January, we are now experiencing, through the spread of the more contagious British variant, a more dangerous variation — the numbers are going up and the intensive care beds are filling up,” she said.

Germany is the latest country in Europe to tighten restrictions as more contagious virus variants spread and the continent struggles to vaccinate its citizens. Poland, Italy and parts of France have ordered that residents stay home, and many businesses have shut before the holiday.

A resurgent virus and lagging vaccinations have forced governments to renege on promises that they would slowly reopen businesses and society as spring approached. That has spurred protests across Europe.

Europe’s vaccine campaign slowed after a small number of cases of blood clots and abnormal bleeding were reported in patients who received the AstraZeneca vaccine, dampening confidence in its safety. While the European drug regulator, the European Medicines Agency, cleared the vaccine for use last week and said it was “safe and effective,” the scare further complicated vaccination efforts.

Just three weeks ago, Ms. Merkel and state officials hammered out a road map to reopening that relied on a decline in case rates. But the number of new daily cases in Germany has increased by 69 percent in the past two weeks, to levels last seen in January.

Regeneron’s monoclonal antibody treatment sharply cuts the risk of hospitalization and death among high-risk Covid-19 patients, a study found.
Credit…Regeneron, via Associated Press

A monoclonal antibody treatment developed by the drug maker Regeneron sharply cut the risk of hospitalization and death when given to high-risk Covid-19 patients in a large clinical trial, the company announced on Tuesday.

The results are the latest in a growing flurry of evidence that the infused drugs, meant to mimic the antibodies that the immune system generates naturally in fighting the coronavirus, can help infected patients avoid the worst outcomes if given early.

Regeneron’s treatment, a cocktail of two antibody drugs, was given last fall to President Donald J. Trump shortly after he got sick with Covid-19 and is now one of three such therapies available in the United States.

The new results come from a Phase 3 trial that enrolled more than 4,500 patients beginning in late September, around the time virus cases began to climb dangerously in the United States. The study found that patients who got the infused treatment within 10 days of developing symptoms or testing positive had a roughly 70 percent reduced risk of being hospitalized or dying compared with patients who were infused with a placebo.

“I think these are exciting data,” said Dr. Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital who was not involved in the study.

Even as vaccinations speed up, antibody treatments are expected to be helpful for high-risk people who still get sick for many months at least, and longer still if the virus can’t be wiped out. While there are signs that emerging virus variants may in some cases make antibodies less potent, Regeneron’s cocktail has not shown such vulnerability in laboratory tests.

In the new findings, Regeneron’s treatment worked equally well when given at half the dosing at which it was authorized. Regeneron said that it planned to request that the Food and Drug Administration allow the treatment to be given at that reduced strength.

Such a change would bring several advantages: While the cocktail is safe, getting it at a lower dose reduces the odds of side effects, such as an infusion reaction.

It would also allow Regeneron to increase the supply it can provide the United States. The company said that it had expected to supply the country with about 750,000 doses at the originally authorized higher strength by the end of June. If the lower strength is authorized, the company expects to provide about 1.25 million doses by then.

The antibody treatments from Regeneron and the drug maker Eli Lilly, which makes the other two such drugs authorized in the United States, were expected to be in high demand and to serve as a bridge in fighting the pandemic before vaccinations ramped up. Instead, they ended up sitting on refrigerator shelves in many places even during recent surges.

Many patients and their doctors did not know to ask for them or where to find them. Overwhelmed hospitals lacked the bandwidth to prioritize giving out the treatments. And some doctors were unconvinced by the relatively weak evidence available last fall supporting their use.

That picture is gradually shifting, thanks to improved logistics and more awareness. And more solid evidence, like the new data from Regeneron, also appears to be helping the drugs get used more widely. “As the data get stronger and stronger, I would expect that use will increase,” Dr. Gandhi said.

People enjoying a Friday evening as businesses and restaurants begin to reopen at Fisherman’s Wharf in San Francisco this month.
Credit…Jim Wilson/The New York Times

Positive trends in pandemic statistics in the United States are easy to distrust. After all, the country went through two false dawns last year, in the late spring and then again in the late summer, when declines in case reports prefaced even darker days. Each time, the apparent good news prompted relaxations and reopenings that helped bring on the next wave.

So it is no surprise that public health experts are wary about the latest flattening in the curve of the pandemic, from the steep decline in cases seen in late January and February to something like a plateau or slight decline more recently. With more contagious virus variants becoming prevalent, they fear the good news could be ending and a fourth wave might be building.

On Monday, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, again warned Americans about the spread of the coronavirus, saying that with increased travel, looser pandemic restrictions and worrisome variants bearing down on the United States, another surge could erupt if Americans did not take protection efforts seriously “for just a little bit longer.”

“We are at a critical point in this pandemic, a fork in the road, where we as a country must decide which path we are going to take. We must act now,” said Dr. Walensky, who has been one of many federal officials in recent weeks to warn governors against lifting mask mandates too soon. “And I am worried that if we don’t take the right actions now, we will have another avoidable surge, just as we are seeing in Europe right now and just as we are so aggressively scaling up vaccination.”

That said, there are positive signs:

  • Daily death reports, which stayed stubbornly high long after the post-holidays surge, have finally come down sharply, to levels not seen since mid-November. As of Monday, the nation had averaged 1,051 newly reported virus deaths a day over the past week; the average had hovered around 3,000 for weeks over the winter.

  • Some recent hot spots have made major progress — notably Los Angeles, whose mayor, Eric Garcetti, said on CBS on Sunday that he had “not felt this optimism in 12 months.” The city and surrounding county, where cases in some areas leapt 450 percent over the holidays and hospitals became so swamped that some turned away ambulances, now has a test positivity rate of about 1.9 percent, and in an important shift, new case reports have fallen among people experiencing homelessness.

  • Vaccinations are becoming more accessible by the week, as states receive more doses and open up eligibility, in some cases to include all adult residents. The number of doses administered nationwide each day is rising, and the country surpassed President Biden’s initial goal to have administered 100 million shots on March 19, almost six weeks ahead of schedule.

The question now is which will prevail: the positive effects of trends like these or the negative effects of looser behavior and the evolution of the virus into more dangerous forms?

It’s still “a race between vaccinations and variants,” Dr. Ashish Jha, dean of the Brown University School of Public Health, said on Twitter. Like other experts, he cautioned: “Opening up too fast helps the variants.”

Noah Weiland contributed reporting.

Samar Khan expected to recover fully from a mild case of Covid-19, but before long her symptoms multiplied, including a “really intense brain fog.”
Credit…Taylor Glascock for The New York Times

In the fall, after Samar Khan came down with a mild case of Covid-19, she expected to recover and return to her previous energetic life in Chicago. She was 25 and healthy.

But weeks later, she said, “this weird constellation of symptoms began to set in.”

She had blurred vision encircled with halos. She had ringing in her ears, and everything began to smell like cigarettes or Lysol. One leg started to tingle, and her hands would tremble while she was putting on eyeliner.

She also developed “really intense brain fog,” she said. Trying to concentrate on a call for her job in financial services, she felt as if she had come out of anesthesia.

By the end of the year, Ms. Khan was referred to a special clinic for Covid-related neurological symptoms at Northwestern Memorial Hospital in Chicago, which has been evaluating and counseling hundreds of people with similar problems.

Now, the clinic has published the first study focused on long-term neurological symptoms in people who were never physically sick enough from Covid-19 to need hospitalization, including Ms. Khan.

The study of 100 patients from 21 states, published on Tuesday in The Annals of Clinical and Translational Neurology, found that 85 percent of them experienced four or more neurological issues like brain fog, headaches, tingling, muscle pain and dizziness.

“We are seeing people who are really highly, highly functional individuals, used to multitasking all the time and being on top of their game, but, all of a sudden, it’s really a struggle for them,” said Dr. Igor J. Koralnik, the chief of neuro-infectious diseases and global neurology at Northwestern Medicine, who oversees the clinic and is the senior author of the study.

City Hall Park and Tweed Courthouse in Downtown Manhattan.
Credit…Jose A. Alvarado Jr. for The New York Times

With virus cases seeming to stabilize in New York City and vaccinations becoming more widespread, city officials intend to send a message that New York is close to returning to normal: On May 3, the city will compelits municipal office employees to begin to report to work in person, according to planning documents shared with The New York Times. Workers will return in phases over several weeks.

Mayor Bill de Blasio’s decision to bring the nation’s largest municipal work force back to the office signals a remarkable turnabout in the fortunes of a city that was the national epicenter of the pandemic, coming to symbolize the perils of living in densely packed global capitals.

The move is meant to broadcast that New York City will soon be open for business, and to encourage private companies to follow suit.

The new policy is expected to affect about 80,000 employees who have been working remotely, including caseworkers, computer specialists and clerical associates. The rest of the city’s roughly 300,000-person work force, many of them uniformed personnel including police officers, firefighters and sanitation workers, have already been reporting to work sites.

“Above all else, this is a major momentum builder,” said Reggie Thomas, a senior vice president with the Real Estate Board of New York.

Yet the move has spurred concern among some workers and union leaders who fear it is premature. New York City still has among the highest coronavirus case rates in the nation. Many workers will have to commute an hour or more on mass transit.

Facial masks will be strongly encouraged but not required: A March 18 presentation from the city’s Department of Citywide Administrative Services said agency leaders should “encourage face coverings to be worn at all times even if six-feet distancing can be maintained.” The provision allows workers to remove face coverings if they are more than six feet apart.

Vaccination will not be mandatory for those returning to the office because of legal concerns, though city officials are strongly encouraging their workers to get vaccinated and are trying to facilitate that process.

At Heathrow Airport, near London, last month. England’s new rules would exclude those traveling for some work, elite sporting competitions or education.
Credit…Henry Nicholls/Reuters

Residents of England who travel abroad without a valid reason will be fined 5,000 pounds, or $6,900, under coronavirus regulations that are scheduled to come into force on Monday if lawmakers approve.

Daily coronavirus deaths in Britain have dropped to their lowest level since fall, thanks in part to a vaccination program that has already reached more than half the adult population, and the country is preparing to slowly reopen its economy after months of national lockdown. A stay-at-home order is to be lifted on Monday, though many shops and other businesses will be closed until mid-April or later.

Travel abroad for leisure is banned until May 17 at the earliest, and the new regulations signal a potentially longer wait for vacationers.

If the new regulations are approved, travelers would have to provide a valid excuse for leaving the country, which would include some essential work, elite sports competitions and education. But opposition lawmakers have criticized an exemption that would allow travel “in connection with the purchase, sale, letting or rental of a residential property,” arguing that it would privilege those wealthy enough to own a second residence. Travel without an essential reason is also banned in Scotland, Wales and Northern Ireland.

The legislation, which is set to be reviewed on April 12 and expire at the end of June, would also renew a ban on indoor gatherings and limit outdoor gatherings to six people. Lawmakers on Thursday will also vote on extending a coronavirus act that gave the government emergency powers during the pandemic, which has caused friction among some members of the governing Conservative Party who have called the laws extreme.

It comes as the country marks the one year since Prime Minister Boris Johnson announced the first national lockdown. Britain has reported at least 4.3 million cases and over 126,000 deaths according to a New York Times database.

The Regal Cinemas theater in Times Square. The theater chain’s parent company, Cineworld.
Credit…Nathan Bajar for The New York Times

Cineworld, the parent company of the U.S. movie theater chain Regal Cinemas, announced on Tuesday that it would reopen its cinemas in the United States in April and in Britain in May as those countries ease lockdown restrictions.

“We have long-awaited this moment,” said Mooky Greidinger, the chief executive of Cineworld, which is based in London. “With capacity restrictions expanding to 50 percent or more across most U.S. states, we will be able to operate profitably in our biggest markets.”

Regal Cinemas is the second largest theater chain in the United States, after AMC Theaters. The announcement by Cineworld comes six months after the movie theater chains were forced to shut down across the United States and Britain last October in an effort to curb the spread of the coronavirus. The decision affected a total of 45,000 employees in both countries and forced studios to postpone film releases.

Cineworld also announced a multiyear agreement with Warner Bros. starting in 2022 that will allow the theater chain to show the studios’ films for 45 days in the United States and 31 days in Britain. The deal shortens the typical window that theaters have to show movies before they are released to on-demand streaming services.

The reopening plans in the United States will coincide with the release of two movies from Warner Bros. Pictures, “Godzilla vs. Kong” on April 2 and “Mortal Kombat” on April 16.

“We are very happy for the agreement with Warner Bros.,” Mr. Greidinger said. “This agreement shows the studio’s commitment to the theatrical business.”

Last week, AMC Theaters announced the reopening of nearly all of its U.S. theaters.

The moves come at a time of concern that looser restrictions will lead to rise in coronavirus cases. On Monday, the director of the Centers for Disease Control and Prevention warned that relaxed pandemic restrictions could lead to another spike. “If we don’t take the right actions now,” said Dr. Rochelle Walensky, “we will have another avoidable surge.”

In September, Cineworld reported a pretax loss of $1.6 billion for the first half of 2020. In 2019, 90 percent of the company’s revenue was generated in the United States and Britain.

A rally of parents and schoolchildren to re-open the public schools in Scotch Plains-Fanwood at the Board of Education office in Scotch Plains.
Credit…James Estrin/The New York Times

Most school districts in New Jersey have partly reopened, but one in four children still live in a district where public schools are closed. No state in the Northeast had more districts relying on all-virtual teaching in early March than New Jersey, according to Return to Learn, a database created by a conservative think tank, the American Enterprise Institute, and Davidson College. Nationwide, only seven states had a greater proportion of all-remote instruction.

As the distribution of vaccines has accelerated and President Biden has signaled a push for broader reopenings, frustration among parents has grown, particularly in New Jersey’s affluent suburbs, where schools with stellar reputations are a key reason families are willing to pay some of the nation’s highest taxes.

These parents have filed federal lawsuits, held protests, created online petitions and shown up at virtual board of education meetings to demand expanded in-person instruction.

The pressure to open schools more fully comes as the infection rate in New Jersey, which is small and densely populated, remains stubbornly high: With a weekly average of 45 cases for every 100,000 residents, the state leads the nation in new infections per capita, according to a New York Times database.

The drumbeat intensified after the Centers for Disease Control and Prevention announced a major policy shift on Friday, reducing its distancing recommendations to three feet from six feet for all elementary schools and for middle and high schools in areas where the virus infection rate is not high.

Anger at the pace of reopening has led some families who can afford it to enroll their children in private schools, start home-schooling them or move. If enough children leave a district in New Jersey, it could lead to cuts in state aid, scaled-back programming or potentially layoffs.

Several New Jersey cities and counties have held educator-only vaccine distribution events. But the virus’s hold on the state has left teachers and their powerful unions wary of expanded reopening.

Testing for Covid-19 at a local market in Mumbai, India, on Tuesday. 
Credit…Divyakant Solanki/EPA, via Shutterstock

Mumbai, India’s financial hub, has begun random testing for the coronavirus in malls, railway stations and other crowded places as officials attempt to tamp down on a worrying surge in cases.

Rapid antigen tests will be taken without individuals’ consent, the Municipal Corporation of Greater Mumbai said in a statement on Monday. Anyone who resists will be in violation of India’s colonial-era epidemic act, which gives the government the power to fine or imprison people who violate rules to contain an outbreak.

“We are trying to implement the existing protocol to the strictest possible level: use of face mask, regulating the number of people in one event, use of hand sanitizer, and now tests,” Suresh Kakani, a senior municipal official in Mumbai, told The New York Times.

Active Covid-19 cases in Mumbai have risen by more than 140 percent since March 1. With variants circulating and commercial activity almost back to prepandemic levels, the number of infections has also shot up in the surrounding state of Maharashtra. An entire district was forced back into lockdown last week.

Mr. Kakani said officials are determined to avert another lockdown in Mumbai, the city of 20 million that is home to Bollywood, India’s film industry, as well as the country’s largest stock exchange.

Another lockdown would be economically disastrous for India, which is just starting to recover from a lockdown last year that triggered a humanitarian crisis, as millions of migrant workers fled cities for their home villages, and a recession.

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U.S. health officials question results from AstraZeneca’s vaccine trial, less than a day after they’re released.

Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.

In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.

The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”

AstraZeneca did not immediately return a request for comment early Tuesday.

In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, a higher figure than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects. After conducting a review, Europe’s top drug regulator said last week that the shot was “safe and effective.”

more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.

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U.S. Health Officials Question AstraZeneca Vaccine Trial Results

Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.

In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.

The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”

AstraZeneca did not immediately return a request for comment early Tuesday.

In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, higher than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects.

the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies grew suspicious about why AstraZeneca had not announced data from its U.S. study.

That U.S. trial, which involved more than 32,000 participants, was the largest test of its kind for the shot. The results AstraZeneca released on Monday were from an interim look at the data after 141 Covid-19 cases had turned up among volunteers.

The company did not disclose how up-to-date the data are. If the analysis was conducted on data from a month or two ago, it is possible that a more current look would present a different picture of the vaccine’s effectiveness and safety. The company has said it will provide the Food and Drug Administration with a more comprehensive, recent set of data than what it disclosed on Monday. Although no clinical trial is large enough to rule out extremely rare side effects, AstraZeneca reported that its study turned up no serious safety issues.

The fresh data may have arrived too late to make much difference in the United States, where the vaccine is not yet authorized and is unlikely to become available before May. By then, federal officials predict, there will be enough vaccine doses for all of the nation’s adults from the three vaccines that have already been authorized: Pfizer-BioNTech, Moderna and Johnson & Johnson.

Even so, the better-than-expected results were seen as a heartening turn for AstraZeneca’s shot, whose low cost and simple storage requirements have made it a vital piece of the drive to vaccinate the world.

said last week that the shot was “safe and effective,” having conducted a review 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 sign of such problems, although some safety issues can only be detected in the real world, once a drug or vaccine has been widely used.

Many millions of people have received the AstraZeneca shot worldwide, including more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.

AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply in the coming weeks for emergency authorization in the United States. The vaccine has already been approved in more than 70 countries, but clearance from American regulators would bolster its global reputation.

The statement from the infectious disease institute comes after a series of miscues and communication blunders by AstraZeneca dating to last year that have eroded American officials’ trust in the company.

Last summer, at least some top F.D.A. officials learned only from news reports that AstraZeneca had paused its Phase ⅔ vaccine trial in Britain after a participant developed neurological symptoms. Then in September, after another participant in the British study fell ill with similar symptoms, AstraZeneca halted its trials globally but failed to promptly notify the U.S. authorities.

The U.S. study was ultimately paused for seven weeks last fall, in part because AstraZeneca was slow to provide the F.D.A. with evidence that the vaccine had not caused the neurological symptoms. Investigators ultimately concluded that the illnesses could not be linked to the vaccine. Still, the delay was a key reason that AstraZeneca fell so far behind the three other manufacturers whose vaccines have been granted emergency authorization in the United States.

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U.S. health officials question results from AstraZeneca’s vaccine trial, less than a day after they came out.

Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.

In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.

The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”

AstraZeneca did not immediately return a request for comment early Tuesday.

In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, higher than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects.

the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies grew suspicious about why AstraZeneca had not announced data from its U.S. study.

That U.S. trial, which involved more than 32,000 participants, was the largest test of its kind for the shot. The results AstraZeneca released on Monday were from an interim look at the data after 141 Covid-19 cases had turned up among volunteers.

The company did not disclose how up-to-date the data are. If the analysis was conducted on data from a month or two ago, it is possible that a more current look would present a different picture of the vaccine’s effectiveness and safety. The company has said it will provide the Food and Drug Administration with a more comprehensive, recent set of data than what it disclosed on Monday. Although no clinical trial is large enough to rule out extremely rare side effects, AstraZeneca reported that its study had turned up no serious safety issues.

The data may have arrived too late to make much difference in the United States, where the vaccine is not yet authorized and is unlikely to become available before May. By then, federal officials predict, there will be enough vaccine doses for all of the nation’s adults from the three vaccines that have already been authorized: Pfizer-BioNTech, Moderna and Johnson & Johnson.

Even so, the better-than-expected results were seen as a heartening turn for AstraZeneca’s shot, whose low cost and simple storage requirements have made it a vital piece of the drive to vaccinate the world.

said last week that the shot was “safe and effective,” having conducted a review 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 sign of such problems, although some safety issues can only be detected in the real world, once a drug or vaccine has been widely used.

Many millions of people have received the AstraZeneca shot worldwide, including more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.

AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply in the coming weeks for emergency authorization in the United States. The vaccine has already been approved in more than 70 countries, but clearance from American regulators would bolster its global reputation.

The statement from the infectious disease institute comes after a series of miscues and communication blunders by AstraZeneca dating to last year that have eroded American officials’ trust in the company.

Last summer, at least some top F.D.A. officials learned only from news reports that AstraZeneca had paused its Phase 2/3 vaccine trial in Britain after a participant developed neurological symptoms. Then in September, after another participant in the British study fell ill with similar symptoms, AstraZeneca halted its trials globally but failed to promptly notify the U.S. authorities.

The U.S. study was ultimately paused for seven weeks last fall, in part because AstraZeneca was slow to provide the F.D.A. with evidence that the vaccine had not caused the neurological symptoms. Investigators ultimately concluded that the illnesses could not be linked to the vaccine. Still, the delay was a key reason that AstraZeneca fell so far behind the three other manufacturers whose vaccines have been granted emergency authorization in the United States.

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Covid-19 Live Updates: AstraZeneca Vaccine Is 79% Effective in U.S. Study

provided strong protection against Covid-19 in a large clinical trial in the United States, completely preventing the worst outcomes from the disease while causing no serious side effects, according to results announced on Monday.

The findings, announced in a news release from AstraZeneca, may help shore up global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the use of the shot over concerns about possible rare side effects.

The trial, involving more than 32,000 participants, was the largest test of its kind for the shot. The vaccine was 79 percent effective overall in preventing symptomatic infections, higher than observed in previous clinical trials. The trial also showed that the vaccine offered strong protection for older people, who had not been as well-represented in earlier studies.

But the fresh data may not make much difference in the United States, where the vaccine is not yet authorized and may not be needed.

If AstraZeneca wins authorization for emergency use in the United States based on the new results, the vaccine is unlikely to become available before May, when federal officials predict that three manufacturers that already have authorization will be producing enough doses for all the nation’s adults.

AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply “in the coming weeks” for emergency authorization from the Food and Drug Administration. It already has approval in more than 70 countries, but clearance from American regulators, if the company can secure it, would bolster the vaccine’s reputation globally.

The interim results announced on Monday were based on 141 Covid-19 cases that had turned up in volunteers. Two-thirds of participants were given the vaccine, with doses spaced four weeks apart, and the rest received a saline placebo. Volunteers were recruited from Chile and Peru as well as the United States.

None of the volunteers who got the vaccine developed severe symptoms or had to be hospitalized, a major selling point for the shot. Five participants who were given the placebo developed severe Covid-19, Ruud Dobber, an executive vice president at AstraZeneca, told CNBC on Monday.

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Police Break Up Spring Break Crowds in Miami Beach

The police fired pepper balls to disperse crowds after an 8 p.m. curfew went into effect on Saturday. Local Miami officials said people had flocked to the city because of its relatively few coronavirus restrictions.

[yelling; sirens]

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The police fired pepper balls to disperse crowds after an 8 p.m. curfew went into effect on Saturday. Local Miami officials said people had flocked to the city because of its relatively few coronavirus restrictions.CreditCredit…Cristobal Herrera-Ulashkevich/EPA, via Shutterstock

One day after the spring break oasis of South Beach descended into chaos, with the police struggling to control overwhelming crowds and making scores of arrests, officials in Miami Beach decided on Sunday to extend an emergency curfew for up to three weeks.

Officials went so far as to approve closing the famed Ocean Drive for four nights a week until April 12, including to pedestrians, during the 8 p.m. to 6 a.m. curfew. Residents, hotel guests and employees of local businesses are exempt.

The strip, frequented by celebrities and tourists alike, was the scene of a much-criticized skirmish on Saturday night in which police officers used pepper balls to disperse a large crowd of sometimes unruly and mostly unmasked revelers just hours after the curfew had been introduced.

The restrictions were a stunning concession to the city’s inability to control unwieldy crowds. The city and the state of Florida have aggressively courted visitors.



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“I believe it’s a lot of pent-up demand from the pandemic and people wanting to get out,” David Richardson, a member of the Miami Beach City Commission, said on Sunday. “And our state has been publicly advertised as being open, so that’s contributing to the issue.”

In an emergency meeting, the commission approved maintaining the curfew in the city’s South Beach entertainment district from Thursday through Sunday for three more weeks, which is when spring break typically ends. Bridges along several causeways that connect Miami Beach with the mainland will also continue to be shut during the curfew.

Law enforcement officials said many people had been drawn to the city for spring break this year because it has relatively few virus restrictions, mirroring the state at large. And hotel rooms and flights have been deeply discounted, to make up for the months of lost time.

Miami-Dade County, which includes Miami Beach, has recently endured one of the nation’s worst outbreaks, and more than 32,000 Floridians have died from the virus, an unthinkable cost that the state’s leaders rarely acknowledge. The state is also thought to have the highest concentration of B.1.1.7, the more contagious and possibly more lethal virus variant first identified in Britain.

GLOBAL ROUNDUP

A crowded market in Mumbai, India, on Friday. The surrounding state of Maharashtra is at the center of a new coronavirus outbreak.
Credit…Francis Mascarenhas/Reuters

The coronavirus, once seemingly in retreat in India, is again rippling across the country. On Monday, the government reported almost 47,000 new cases, the highest number in more than four months. It also reported 212 new deaths from the virus, the most since early January.

The outbreak is centered in the state of Maharashtra, home to Mumbai, the country’s financial hub. Entire districts of the state have gone back into lockdown. Scientists are investigating whether a new strain found there is more virulent, like variants found in Britain, South Africa and Brazil.

Officials are under pressure to aggressively ramp up testing and vaccination, especially in Mumbai, to avoid disruptions like the dramatic nationwide lockdown last year, which resulted in a recession.

But less than 3 percent of India’s population of 1.3 billion has received a jab, including about half of health care workers.

The campaign has also been plagued by public skepticism. The government approved a domestically developed vaccine, called Covaxin, before its safety and efficacy trials were even over, though preliminary findings since then have suggested it works.

The other jab available in India is the Oxford-AstraZeneca vaccine, which was suspended in some countries after a number of patients reported blood clots and strokes, though most have since reversed course and scientists haven’t found a link between the shots and the patients’ conditions.

In other developments around the world:

The stimulus package signed by President Biden includes billions to ramp up coronavirus vaccinations.
Credit…Al Drago for The New York Times

The Biden administration, with hundreds of billions of dollars to spend to end the Covid-19 crisis, has set aggressive benchmarks to determine whether the economy has fully recovered, including returning to historically low unemployment and helping more than one million Black and Hispanic women return to work within a year.

But restoring economic activity, which was central to President Biden’s pitch for his $1.9 trillion stimulus package, faces logistical and epidemiological challenges unlike any previous recovery. New variants of the virus are spreading. Strained supply chains are holding up the distribution of rapid coronavirus tests, which could be critical to safely reopen schools, workplaces, restaurants, theaters and concert venues.

Then there are questions of whether the money can reach schools and child care providers quickly enough to make a difference for parents who were forced to quit their jobs to care for their children.

Economic optimism is rising as the pace of vaccinations steadily increases. Unemployment has already fallen from its pandemic peak of 14.8 percent last April to 6.2 percent in February. Federal Reserve officials now expect the unemployment rate to slip below 4 percent by next year and for the economy to grow faster this year than in any year since the Reagan administration.

But risks remain. For the economy to fully bounce back, Americans need to feel confident in returning to shopping, traveling, entertainment and work. No matter how much cash the administration pumps into the economy, recovery could be stalled by the emergence of new variants, the reluctance of some Americans to get vaccinated and, in the coming weeks, spotty compliance with social distancing guidelines and other public health measures.

At the Union Turnpike station in Queens. Ridership on the New York subway is at about one third of its pre-pandemic levels.
Credit…Jonah Markowitz for The New York Times

A year ago the pandemic drained the New York City subway of nearly all its riders, sickened thousands of transit workers and plunged North America’s largest public transit agency into its worst financial emergency ever.

Today ridership on the subway has crept back up to about one third of its usual levels, from an all-time low of 7 percent last spring. An infusion of billions of dollars in federal aid has kept the Metropolitan Transportation Authority afloat. And the agency, which operates the subway, buses and two commuter rail lines, was further lifted by another $6 billion in President Biden’s rescue plan.

But the M.T.A.’s long-term survival depends on the return of its largest funding source: riders. Fares provide early 40 percent of the agency’s operating revenue, a higher percentage than almost any other major American transit system.

Now, as more people are vaccinated and urban life slowly rebounds, public transit officials are confronting a sobering reality: a growing consensus that ridership may never return entirely to its prepandemic levels.

Though public health experts generally agree that riding trains and buses is not a major risk factor for exposure to the virus, transit experts say some commuters with the means to do so are still likely to stay with the alternatives — like using cars or bikes — that they turned to during the pandemic.

Prime Minister Benjamin Netanyahu of Israel takes personal credit for the country’s vaccination campaign, which has fully vaccinated about half the population of nine million.
Credit…Menahem Kahana/Agence France-Presse — Getty Images

JERUSALEM — Vaccinated Israelis are working out in gyms and dining in restaurants. They’re partying at nightclubs and cheering at soccer matches by the thousands.

Prime Minister Benjamin Netanyahu is taking credit for bringing Israel “back to life,” as he calls it, and banking on the country’s giddy, post-pandemic mood of liberation to put him over the top in a close election on Tuesday.

But nothing is quite that simple in Israeli politics.

Even as most Israelis appreciate the government’s world-leading vaccination campaign, many worry that the grand social and economic reopening may prove premature and suspect that the timing is political.

Instead of a transparent reopening process led by public health professionals, “decisions are made at the last minute, at night, by the cabinet,” said Hagai Levine, an epidemiologist at the Hebrew University-Hadassah Braun School of Public Health in Jerusalem. “The timing, right before the election, is intended to declare mission accomplished.”

The parliamentary election on Tuesday will be the country’s fourth in two years. Mr. Netanyahu is on trial on corruption charges and analysts say his best chance of avoiding conviction lies in heading a new right-wing government. He has staked everything on his handling of the coronavirus crisis.

He takes personal credit for the country’s inoculation campaign, which has fully vaccinated about half the population of nine million — outpacing the rest of the world — and he has declared victory over the virus.

“Israel is the world champion in vaccinations, the first country in the world to exit from the health corona and the economic corona,” he said at a pre-election conference last week.

The vaccination campaign has been powered by early delivery of several million doses from Pfizer, and Mr. Netanyahu has presented himself as the only candidate who could have pulled off that deal, boasting of his personal appeals to Pfizer’s chief executive, Albert Bourla, who, as a son of Holocaust survivors, has great affinity for Israel.

Mr. Netanyahu even posted a clip from “South Park,” the American animated sitcom, acknowledging Israel’s vaccination supremacy.

But experts said his claim that the virus was in the rearview mirror was overly optimistic.

A seating area in the main atrium of a remodeled Microsoft office in Redmond, Washington in 2017.
Credit…Stuart Isett for The New York Times

Microsoft announced Monday that it would begin allowing more workers back into its headquarters in Redmond, Wash., starting on March 29.

In this stage of reopening, which Microsoft described as Step 4 in a six-step “dial,” the Redmond campus will give nonessential on-site employees the choice to work from the office, home or a combination of both. Microsoft will also continue to require employees to wear masks and maintain social distancing.

Microsoft plans to open its office without restrictions only once the virus acts “more like an endemic virus such as the seasonal flu,” wrote Kurt DelBene, an executive vice president at the tech giant. But even then, office life for Microsoft’s 160,000 employees is not likely to look like what it did before the pandemic.

“Once we reach a point where Covid-19 no longer presents a significant burden on our communities, and as our sites move to the open stage of the dial, we view working from home part of the time (less than 50 percent) as standard for most roles,” Mr. DelBene wrote on the company blog.

Microsoft also released on Monday the results of a survey of that it says shows the work force has changed after a year of working remotely. In the survey of more than 30,000 full-time and self-employed workers, 73 percent said they wanted flexible remote work options to continue, and 46 percent said they were planning to move this year now that they could work remotely.

“There are some companies that think we’re just going to go back to how it was,” Jared Spataro, the corporate vice president for Microsoft 365, said in an interview. “However, the data does seem to indicate that they don’t understand what has happened over the last 12 months.”

People receiving the Sinopharm Covid-19 vaccine in Dubai last month.
Credit…Kamran Jebreili/Associated Press

The distributor of China’s Sinopharm vaccine in the United Arab Emirates says it has started offering a “very small number” of people a third shot after these recipients reported insufficient levels of antibodies following a two-dose regimen.

The distributor, G42 Healthcare, has found that some people were “not really responsive” to the Sinopharm vaccine, Walid Zaher, the company’s chief researcher, told Dubai Eye Radio on Sunday.

Dr. Zaher’s disclosure could add to questions about the overall efficacy of the Sinopharm vaccine, which has been rolled out to at least six countries. The state-owned company has not reported detailed Phase 3 clinical data for scientists to independently assess the strength of its vaccines. Sinopharm did not respond to a request for comment.

It is unclear which of Sinopharm’s two vaccines Dr. Zaher was referring to. One was developed in conjunction with the Beijing Institute of Biological Products, and the other with the Wuhan Institute of Biological Products. In December, the Emirates became the first government to approve the vaccine that was made with the Beijing Institute.

Dr. Zaher said that G42 Healthcare had approached people to be part of a study in which they were given a third shot.

“No one vaccine will be working for everyone,” he said.

Pfizer and BioNTech said last month that they planned to test a third booster shot in response to concerns over coronavirus variants. Similarly, Moderna said it had shipped doses of a newly adjusted vaccine to the National Institutes of Health for testing that would address the variant first detected in South Africa, known as B.1.351.

Dr. Farida al-Hosani, a spokeswoman for the Emirates’ health sector, has also said that residents and Emiratis inoculated with the Sinopharm vaccine can get a third dose if they do not develop sufficient antibodies, telling the National newspaper this month that only a small number of people would be affected.

Dr. Zaher said he did not know the exact number of people who would require a third shot “because obviously we did not measure everyone, but it’s a very small number.” He said anyone who was concerned about their antibody levels after receiving the Sinopharm vaccine could approach their doctor about getting a third shot.

Sinopharm has said the vaccine made with the Beijing Institute has an efficacy rate of 79 percent, while the one made with the Wuhan Institute of Biological Products has an efficacy rate of 72.5 percent. Both are above the 50 percent threshold that the World Health Organization has said would make a vaccine effective for general use.

In addition to Sinopharm, the Emirates, which is inoculating its population faster than any country except Israel and the Seychelles, is also using the Pfizer-BioNTech, Oxford-AstraZeneca and Sputnik V vaccines. The government is donating some of the Sinopharm doses it purchased to countries where it has strategic or commercial interests, including the Seychelles and Egypt.

But some doctors in Egypt have been reluctant to receive the shots, citing a lack of trust in the data released by Sinopharm and the Emirates, where some of the trials were held. Malaysia, one of the Emirates’ biggest trading partners, also declined an offer of 500,000 doses, saying that regulators would have to independently approve the Sinopharm vaccine.

Kent Taylor, the founder and chief executive of the Texas Roadhouse restaurant chain, died on Thursday.
Credit…Ron Bath/Texas Roadhouse

Kent Taylor, the founder and chief executive of the Texas Roadhouse restaurant chain, died by suicide on Thursday after suffering from post-Covid-19 symptoms, the company and his family said in a statement. He was 65.

“After a battle with post-Covid-related symptoms, including severe tinnitus, Kent Taylor took his own life this week,” the statement said.

His body was found in a field on his property near Louisville, Ky., the Kentucky State Police told The Louisville Courier Journal. The State Police and the Oldham County coroner did not immediately respond to requests for comment on Sunday.

Mr. Taylor, who was also the chairman of the company’s board of directors, founded Texas Roadhouse in 1993. He sought to create an “affordable, Texas-style” restaurant but was turned down more than 80 times as he tried to find investors, according to a biography provided by the company.

Eventually, he raised $300,000 from three doctors from Elizabethtown, Ky., and sketched out the design for the first Texas Roadhouse on a cocktail napkin for the investors.

The first Texas Roadhouse opened in Clarksville, Ind., in 1993. Three of the chain’s first five restaurants failed, but it went on to open 611 locations in 49 states, and 28 international locations in 10 countries.

Until his death, Mr. Taylor had been active in Texas Roadhouse’s operations, the company said. He oversaw decisions about the menu, selected the murals for the restaurants and picked songs for the jukeboxes.

Greg Moore, the lead director of the company’s board, said in a statement that Mr. Taylor gave up his compensation package during the coronavirus pandemic to support frontline workers in the company.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

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The U.A.E. offers a third dose of Chinese vaccine to some with low immune response.

The distributor of China’s Sinopharm vaccine in the United Arab Emirates says it has started offering a “very small number” of people a third shot after these recipients reported insufficient levels of antibodies following a two-dose regimen.

The distributor, G42 Healthcare, has found that some people were “not really responsive” to the Sinopharm vaccine, Walid Zaher, the company’s chief researcher, told Dubai Eye Radio on Sunday.

Dr. Zaher’s disclosure could add to questions about the overall efficacy of the Sinopharm vaccine, which has been rolled out to at least six countries. The state-owned company has not reported detailed Phase 3 clinical data for scientists to independently assess the strength of its vaccines. Sinopharm did not respond to a request for comment.

It is unclear which of Sinopharm’s two vaccines Dr. Zaher was referring to. One was developed in conjunction with the Beijing Institute of Biological Products, and the other with the Wuhan Institute of Biological Products. In December, the Emirates became the first government to approve the vaccine that was made with the Beijing Institute.

test a third booster shot in response to concerns over coronavirus variants. Similarly, Moderna said it had shipped doses of a newly adjusted vaccine to the National Institutes of Health for testing that would address the variant first detected in South Africa, known as B.1.351.

Dr. Farida al-Hosani, a spokeswoman for the Emirates’ health sector, has also said that residents and Emiratis inoculated with the Sinopharm vaccine can get a third dose if they do not develop sufficient antibodies, telling the National newspaper this month that only a small number of people would be affected.

Dr. Zaher said he did not know the exact number of people who would require a third shot “because obviously we did not measure everyone, but it’s a very small number.” He said anyone who was concerned about their antibody levels after receiving the Sinopharm vaccine could approach their doctor about getting a third shot.

Sinopharm has said the vaccine made with the Beijing Institute has an efficacy rate of 79 percent, while the one made with the Wuhan Institute of Biological Products has an efficacy rate of 72.5 percent. Both are above the 50 percent threshold that the World Health Organization has said would make a vaccine effective for general use.

inoculating its population faster than any country except Israel and the Seychelles, is also using the Pfizer-BioNTech, Oxford-AstraZeneca and Sputnik V vaccines. The government is donating some of the Sinopharm doses it purchased to countries where it has strategic or commercial interests, including the Seychelles and Egypt.

But some doctors in Egypt have been reluctant to receive the shots, citing a lack of trust in the data released by Sinopharm and the Emirates, where some of the trials were held. Malaysia, one of the Emirates’ biggest trading partners, also declined an offer of 500,000 doses, saying that regulators would have to independently approve the Sinopharm vaccine.

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The AstraZeneca vaccine protects fully against Covid-19’s worst outcomes, new study shows.

largest known coronavirus outbreaks early in the pandemic, are now eligible for vaccines in at least 26 states, a New York Times survey found.

The expansion of vaccines to food processing workers comes amid rapid widening of eligibility, especially for essential workers at greater risk of contracting the virus. Almost every state is vaccinating some subset of frontline workers, but the list of eligible professions varies widely. In at least six states, food processing workers are eligible in certain counties but not in others.

Meat and poultry processing facilities have largely remained open even as large outbreaks infected thousands of workers and killed dozens in the first months of the pandemic. The virus started to spread rapidly in meatpacking facilities as assembly-line workers stood side by side in tight quarters.

A JBS USA pork production plant in Worthington, Minn., with more than 700 recorded coronavirus cases held a mass vaccination event on Friday. JBS USA, a subsidiary of JBS S.A., a Brazilian company that is the world’s largest meat-processing firm, has offered employees who receive the vaccine $100 incentives.

“There was a lot of skepticism among members, for a lot of different reasons,” said Matt Utecht, who represents the Worthington workers as president of the United Food and Commercial Workers Local 663 union. He said union representatives went to the facility repeatedly in recent months to share information about the vaccine, and signed up about 1,500 of the union’s roughly 1,850 members.

“It’s been a daily grind of educating, talking, communicating,” he said.

The production and distribution of vaccines has been steadily ramping up in the United States. The Centers for Disease Control and Prevention said on Saturday that about 79.4 million people had received at least one dose of a Covid-19 vaccine, including about 43 million people who have been fully vaccinated. About 2.25 million doses are given each day on average, up from less than a million two months ago.

With demand for vaccines still outpacing supply, states have faced competing interests in deciding which groups to prioritize. Eligibility opened to many food processing workers in early March across much of the Midwest, where meatpacking and food production are a major part of the economy and often a source of employment for recent immigrants.

In Kansas, where food processing workers are now eligible for the vaccine, nearly 4,000 reported cases have been tied to outbreaks in meatpacking plants, more than in any other setting except long-term care centers and correctional facilities.

“This is a livelihood that supports a number of immigrant populations,” said Marci Nielsen, the Kansas governor’s chief adviser on Covid-19. “And it was very important for the governor to send out a signal that she wants to keep those families safe and to keep these industries open.”

Bonnie G. Wong and

The AstraZeneca vaccine at a hospital in Milan last week.
Credit…Alessandro Grassani for The New York Times

The coronavirus vaccine developed by AstraZeneca and the University of Oxford provided strong protection against Covid-19 in a large clinical trial in the United States, completely preventing the worst outcomes from the disease while causing no serious side effects, according to results announced on Monday.

The findings, announced in a news release from AstraZeneca, may help shore up global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the use of the shot over concerns about possible rare side effects.

The trial, involving more than 32,000 participants, was the largest test of its kind for the shot. The vaccine was 79 percent effective overall in preventing symptomatic infections, higher than observed in previous clinical trials. The trial also showed that the vaccine offered strong protection for older people, who had not been as well-represented in earlier studies.

But the fresh data may not make much difference in the United States, where the vaccine is not yet authorized and may not be needed.

If AstraZeneca wins authorization for emergency use in the United States based on the new results, the vaccine is unlikely to become available before May, when federal officials predict that three manufacturers that already have authorization will be producing enough doses for all the nation’s adults.

AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply “in the coming weeks” for emergency authorization from the Food and Drug Administration. It already has approval in more than 70 countries, but clearance from American regulators, if the company can secure it, would bolster the vaccine’s reputation globally.

The interim results announced on Monday were based on 141 Covid-19 cases that had turned up in volunteers. Two-thirds of participants were given the vaccine, with doses spaced four weeks apart, and the rest received a saline placebo. Volunteers were recruited from Chile and Peru as well as the United States.

None of the volunteers who got the vaccine developed severe symptoms or had to be hospitalized, a major selling point for the shot. However, AstraZeneca did not disclose how many volunteers had developed severe Covid-19 or had to be hospitalized after receiving the placebo, making it difficult to know how statistically powerful those findings are.

A prayer service at the Islamic Center in Sandy, Utah, last year. At least one American mosque is having a popup vaccination event to give members the chance to get two shots before Ramadan begins.
Credit…Francisco Kjolseth/The Salt Lake Tribune, via Associated Press

With Ramadan less than a month away, some Muslim organizations in the United States have begun addressing a critical question: whether the dawn-to-dusk Ramadan fast prohibits Muslims from receiving vaccine injections during daylight hours.

The executive director of the Islamic Society of North America, Basharat Saleem, said that numerous scholars of Islamic law had been consulted on the matter.

“The answer is no,” he said. “It does not break the fast.”

The group joined with dozens of others last year in organizing a National Muslim Task Force on Covid-19, which has taken advisement from Muslim jurists. They were in general agreement, Mr. Saleem said, that getting a Covid-19 vaccine was acceptable during Ramadan or at any other time. A shot “will not invalidate the fast because it has no nutritional value and it is injected into the muscle,” the task force announced, a ruling that in the past has covered flu shots and other vaccinations.

Whether vaccinations are permitted during Ramadan is not only a concern among Muslims, and perhaps not even the chief one; there have been questions around the world as well about the presence of forbidden ingredients, such as pork products, in the vaccines. Some have also expressed misgivings about the Johnson & Johnson vaccine similar to those of some Catholic leaders, given that cells used in its development and production had a remote connection to abortion.

Muslim health care workers, even those who have been publicly urging people to get vaccinated, have acknowledged the ethical difficulties.

“These decisions are a matter of personal conscience,” said Dr. Hasan Shanawani, the president of American Muslim Health Professionals and a practicing pulmonologist in Michigan. But the preservation of life is one of the highest principles in Islam, he said, and given the current scarcity of vaccines in many places, the ethics, to him, were straightforward.

Declining a vaccine means “potentially putting all of us at risk,” said Dr. Shanawani, who has treated hundreds of Covid-19 patients over the past year. “Take the vaccine that’s available to you. God is the most forgiving.” When the present emergency has passed, he added, then a person can be more discriminating about which vaccine to take.

Haaris Ahmad, the president of a large and diverse mosque in the Detroit suburbs, said he had heard all of these concerns. He has assured members of the mosque that scholars are in broad agreement that a vaccination would not break the Ramadan fast, and he has also told people that if the Johnson & Johnson vaccine is the only readily available option, they should take it.

But he also acknowledged that people would rather not have to think about these things, especially during the holiest month of the Muslim calendar. So his mosque is hosting a vaccine clinic next Monday night, which would allow people to get in two doses of the Pfizer-BioNTech vaccine just before Ramadan begins in mid-April. And while the event was initially advertised with general language about vaccines, Mr. Ahmad said, the latest flier includes more explicit guidance about what will not be on offer at the clinic: “NOTE,” it reads, “Not J&J.”

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Police Break Up Spring Break Crowds in Miami Beach

The police fired pepper balls to disperse crowds after an 8 p.m. curfew went into effect on Saturday. Local Miami officials said people had flocked to the city because of its relatively few coronavirus restrictions.

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The police fired pepper balls to disperse crowds after an 8 p.m. curfew went into effect on Saturday. Local Miami officials said people had flocked to the city because of its relatively few coronavirus restrictions.CreditCredit…Cristobal Herrera-Ulashkevich/EPA, via Shutterstock

One day after the spring break oasis of South Beach descended into chaos, with the police struggling to control overwhelming crowds and making scores of arrests, officials in Miami Beach decided on Sunday to extend an emergency curfew for up to three weeks.

Officials went so far as to approve closing the famed Ocean Drive for four nights a week until April 12, including to pedestrians, during the 8 p.m. to 6 a.m. curfew. Residents, hotel guests and employees of local businesses are exempt.

The strip, frequented by celebrities and tourists alike, was the scene of a much-criticized skirmish on Saturday night in which police officers used pepper balls to disperse a large crowd of sometimes unruly and mostly unmasked revelers just hours after the curfew had been introduced.

The restrictions were a stunning concession to the city’s inability to control unwieldy crowds. The city and the state of Florida have aggressively courted visitors.

“I believe it’s a lot of pent-up demand from the pandemic and people wanting to get out,” David Richardson, a member of the Miami Beach City Commission, said on Sunday. “And our state has been publicly advertised as being open, so that’s contributing to the issue.”

In an emergency meeting, the commission approved maintaining the curfew in the city’s South Beach entertainment district from Thursday through Sunday for three more weeks, which is when spring break typically ends. Bridges along several causeways that connect Miami Beach with the mainland will also continue to be shut during the curfew.

Law enforcement officials said many people had been drawn to the city for spring break this year because it has relatively few virus restrictions, mirroring the state at large. And hotel rooms and flights have been deeply discounted, to make up for the months of lost time.

Miami-Dade County, which includes Miami Beach, has recently endured one of the nation’s worst outbreaks, and more than 32,000 Floridians have died from the virus, an unthinkable cost that the state’s leaders rarely acknowledge. The state is also thought to have the highest concentration of B.1.1.7, the more contagious and possibly more lethal virus variant first identified in Britain.

Prime Minister Benjamin Netanyahu of Israel takes personal credit for the country’s vaccination campaign, which has fully vaccinated about half the population of nine million.
Credit…Menahem Kahana/Agence France-Presse — Getty Images

JERUSALEM — Vaccinated Israelis are working out in gyms and dining in restaurants. They’re partying at nightclubs and cheering at soccer matches by the thousands.

Prime Minister Benjamin Netanyahu is taking credit for bringing Israel “back to life,” as he calls it, and banking on the country’s giddy, post-pandemic mood of liberation to put him over the top in a close election on Tuesday.

But nothing is quite that simple in Israeli politics.

Even as most Israelis appreciate the government’s world-leading vaccination campaign, many worry that the grand social and economic reopening may prove premature and suspect that the timing is political.

Instead of a transparent reopening process led by public health professionals, “decisions are made at the last minute, at night, by the cabinet,” said Hagai Levine, an epidemiologist at the Hebrew University-Hadassah Braun School of Public Health in Jerusalem. “The timing, right before the election, is intended to declare mission accomplished.”

The parliamentary election on Tuesday will be the country’s fourth in two years. Mr. Netanyahu is on trial on corruption charges and analysts say his best chance of avoiding conviction lies in heading a new right-wing government. He has staked everything on his handling of the coronavirus crisis.

He takes personal credit for the country’s inoculation campaign, which has fully vaccinated about half the population of nine million — outpacing the rest of the world — and he has declared victory over the virus.

“Israel is the world champion in vaccinations, the first country in the world to exit from the health corona and the economic corona,” he said at a pre-election conference last week.

The vaccination campaign has been powered by early delivery of several million doses from Pfizer, and Mr. Netanyahu has presented himself as the only candidate who could have pulled off that deal, boasting of his personal appeals to Pfizer’s chief executive, Albert Bourla, who, as a son of Holocaust survivors, has great affinity for Israel.

Mr. Netanyahu even posted a clip from “South Park,” the American animated sitcom, acknowledging Israel’s vaccination supremacy.

But experts said his claim that the virus was in the rearview mirror was overly optimistic.

A pharmacist preparing a Covid-19 vaccine at the Cherokee Nation Outpatient Health Center in Tahlequah, Okla., this month.
Credit…Shane Brown for The New York Times

The rapid development of Covid-19 vaccines, achieved at record speed and financed by massive public funding in the United States, the European Union and Britain, represents a great triumph of the pandemic. Governments partnered with drugmakers, pouring in billions of dollars to procure raw materials, finance clinical trials and retrofit factories. Billions more were committed to buy the finished product.

But this Western success has created stark inequity. Residents of wealthy and middle-income countries have received about 90 percent of the nearly 400 million vaccines delivered so far. Under current projections, many of the rest will have to wait years.

A growing chorus of health officials and advocacy groups worldwide are calling for Western governments to use aggressive powers — most of them rarely or never used before — to force companies to publish vaccine recipes, share their know-how and ramp up manufacturing.

The prospect of billions of people waiting years to be vaccinated poses a health threat to even the richest countries. One example: In Britain, where the vaccine rollout has been strong, health officials are tracking a virus variant that emerged in South Africa, where vaccine coverage is weak. That variant may be able to blunt the effect of vaccines, meaning even vaccinated people might get sick.

But on March 30, a U.S. patent is expected to be issued on a five-year-old invention in a National Institutes of Health lab that swaps a pair of amino acids in the coronavirus spike protein. This feat of molecular engineering is at the heart of at least five major Covid-19 vaccines, and the United States government will control that patent.

The new patent presents an opportunity — and some argue the last best chance — to exact leverage over the drug companies producing the vaccines and pressure them to expand access to less affluent countries.

Pierluigi Marchionne, a veteran police officer in Rome, directing the light traffic last week in the ordinarily jammed Piazza Venezia.
Credit…Nadia Shira Cohen for The New York Times

ROME — If, as it’s said, all roads lead to Rome, then they intersect at Piazza Venezia, the downtown hub of the Italian capital, watched over by a traffic officer on a pedestal who choreographs streamlined circulation out of automotive chaos.

For many Romans and tourists alike, those traffic controllers are as much a symbol of the Eternal City as are the Colosseum or the Pantheon.

That may explain the media frenzy last week over the return of the pedestal (plus its traffic cop) after a yearlong hiatus while the piazza was being repaved — even though there was not much traffic to direct, because of the widespread lockdown that began last week in hopes of containing a surge in coronavirus cases.

“In this difficult period, I think that it was seen as a sign of something returning to normal,” said Fabio Grillo, 53, who, with 16 years under his belt, is the senior member of the team of four or five municipal police officers who direct traffic from the Piazza Venezia pedestal.

In rain or sleet, or sweltering through Rome’s sultry summers, officers have directed traffic from the Piazza Venezia pedestal near the mouth of the Via del Corso, one of Rome’s main streets, for as long as anyone can remember. And the gestures they make with their white-gloved hands are things that all Italian motorists dutifully memorize for their driver’s tests. (Important note: Two hands straight out with the palms facing motorists is equivalent to a red light.)

“It’s been compared to conducting an orchestra,” Mr. Grillo said.

Apart from regular traffic, Piazza Venezia is also a crossroads that leads to City Hall, the Parliament, Italy’s presidential palace and a national monument where visiting heads of state routinely pay homage — which all contributes to the tangle at the hub.

GLOBAL ROUNDUP

A crowded market in Mumbai, India, on Friday. The surrounding state of Maharashtra is at the center of a new coronavirus outbreak.
Credit…Francis Mascarenhas/Reuters

The coronavirus, once seemingly in retreat in India, is again rippling across the country. On Monday, the government reported almost 47,000 new cases, the highest number in more than four months. It also reported 212 new deaths from the virus, the most since early January.

The outbreak is centered in the state of Maharashtra, home to Mumbai, the country’s financial hub. Entire districts of the state have gone back into lockdown. Scientists are investigating whether a new strain found there is more virulent, like variants found in Britain, South Africa and Brazil.

Officials are under pressure to aggressively ramp up testing and vaccination, especially in Mumbai, to avoid disruptions like the dramatic nationwide lockdown last year, which resulted in a recession.

But less than 3 percent of India’s population of 1.3 billion has received a jab, including about half of health care workers.

The campaign has also been plagued by public skepticism. The government approved a domestically developed vaccine, called Covaxin, before its safety and efficacy trials were even over, though preliminary findings since then have suggested it works.

The other jab available in India is the Oxford-AstraZeneca vaccine, which was suspended in some countries after a number of patients reported blood clots and strokes, though most have since reversed course and scientists haven’t found a link between the shots and the patients’ conditions.

In other developments around the world:

A vaccination clinic in Mississauga, Ontario, this month. The United States has said it will send millions of doses of AstraZeneca’s Covid-19 vaccine, which it has not yet approved for use, to Canada and Mexico.
Credit…Nathan Denette/The Canadian Press, via Associated Press

To many Canadians, it seemed decidedly unneighborly. Canada’s initial coronavirus vaccination program moved at a stately pace over the winter, while inoculations in the United States raced ahead. But Washington was unwilling to share any of its stockpile of tens of millions of doses of a vaccine it had yet to approve for use by Americans.

Last week, that shifted. After weeks of suggesting that any vaccine diplomacy was well into the future, Jen Psaki, the White House press secretary, said Thursday that the United States was planning to share 1.5 million doses of the AstraZeneca vaccine with Canada and 2.5 million doses with Mexico.

The White House announcement seemed to catch Ottawa officials off guard. Hours passed before Anita Anand, the cabinet minister responsible for buying vaccines, issued a statement that read more like an insurance policy than a note of thanks.

“After numerous discussions with the Biden administration, Canada is in the process of finalizing an exchange agreement,” it read in part.

Ms. Anand and Prime Minister Justin Trudeau had little more to add on Friday afternoon, saying only that the talks were still underway and that the details would come later.

From Ms. Psaki’s remarks, it appears that the United States will officially just be lending Canada and Mexico the vaccines. It is unclear whether they will ultimately have to be replaced in kind or if the loan will be of the forgivable nature. She also said that the United States might soon share surpluses of other vaccines.

Pharmacy technicians filling syringes with vaccine in Portland, Maine, this month.
Credit…Robert F. Bukaty/Associated Press

Melanie Allen, a high school English teacher, was in a bind. She works in one state and lives in another. And both denied her a Covid-19 vaccine.

Ms. Allen, who lives in Chatham, N.H., but works in Maine, said she was told that she was not eligible for a vaccine by officials in both states. Although teachers are now eligible for vaccination in every state, her New Hampshire residency blocked her from receiving the vaccine in Maine, she said.

And in New Hampshire, she was told she is not eligible because she does not teach in the state and, at 45, does not meet the age requirement.

And so, she waited.

On Friday, Ms. Allen finally got her first shot after a health center in Maine decided to vaccinate teachers no matter where they lived.

“Even though the states haven’t officially changed their tune,” she said, “it was heartening to see that the local community was stepping in to make sure the right thing happened.”

About half of the states have residency requirements for vaccinations, though most allow out-of-state workers to receive a shot if they meet other eligibility conditions, said Jennifer Kates, senior vice president of the Kaiser Family Foundation, a nonprofit focused on national health issues.

Connecticut, for example, allows workers who live in other states to receive the vaccine if they can prove that they work in an approved industry.

States including Florida and New Hampshire limited the rollout of Covid-19 vaccines to residents in hopes of stemming complaints of “vaccine tourism,” where a person could drive across a state line for a shot that they would not be eligible for back home.

Although most states allow nonresident workers to be inoculated, Ms. Kates said people living in one state and working in another might run into snags as they navigate the scheduling process.

“When you have such a patchwork of requirements,” Ms. Kates said, “it’s like a puzzle, and people who really want to get vaccinated are trying to figure how they can get that last piece of the puzzle.”

Kent Taylor, the founder and chief executive of the Texas Roadhouse restaurant chain, died on Thursday.
Credit…Ron Bath/Texas Roadhouse

Kent Taylor, the founder and chief executive of the Texas Roadhouse restaurant chain, died by suicide on Thursday after suffering from post-Covid-19 symptoms, the company and his family said in a statement. He was 65.

“After a battle with post-Covid-related symptoms, including severe tinnitus, Kent Taylor took his own life this week,” the statement said.

His body was found in a field on his property near Louisville, Ky., the Kentucky State Police told The Louisville Courier Journal. The State Police and the Oldham County coroner did not immediately respond to requests for comment on Sunday.

Mr. Taylor, who was also the chairman of the company’s board of directors, founded Texas Roadhouse in 1993. He sought to create an “affordable, Texas-style” restaurant but was turned down more than 80 times as he tried to find investors, according to a biography provided by the company.

Eventually, he raised $300,000 from three doctors from Elizabethtown, Ky., and sketched out the design for the first Texas Roadhouse on a cocktail napkin for the investors.

The first Texas Roadhouse opened in Clarksville, Ind., in 1993. Three of the chain’s first five restaurants failed, but it went on to open 611 locations in 49 states, and 28 international locations in 10 countries.

Until his death, Mr. Taylor had been active in Texas Roadhouse’s operations, the company said. He oversaw decisions about the menu, selected the murals for the restaurants and picked songs for the jukeboxes.

Greg Moore, the lead director of the company’s board, said in a statement that Mr. Taylor gave up his compensation package during the coronavirus pandemic to support frontline workers in the company.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Restaurants transformed their outdoor dining spaces into areas where people could gather to connect amid isolation.
Credit…Sasha Arutyunova for The New York Times

In the year since the pandemic began, people learned to be together while apart and navigated the pain of feeling apart while together. Screens — small and large — became crucial links to the rest of the world.

Activities and routines that commanded crowds — visiting museums, attending concerts, working out, learning, traveling, partying — ceased or found a new life online. Holidays usually celebrated by family gatherings became fraught with consequences.

Memories of a prepandemic world, where people could stand shoulder to shoulder with faces bare, began to feel like dreams — as did moments of unexpected connection.

Couples in quarantine learned a lot about their significant others. In some instances, these revelations were not happy ones: Lawyers and mediators saw an increase in clients looking to divorce as soon as courts reopened.

In other cases, being confined together made couples stronger. Engagements and pregnancy announcements seemed to pop up constantly on social media. And there were plenty of weddings.

For many of those who were single, dating felt impossible in the early months of the pandemic. Sex toy sales increased. Eventually, emotional and physical needs began to weigh heavy, and people across the country found ways to meet and hook up within the confines of their comfort.

In search of safety, stability and support, adult children moved in with parents and parental figures, sometimes without a fixed departure date. In doing so, they rediscovered one another, and experienced the joys of bonding and the suffocation of constant proximity.

Though some Americans were able to hole up at home, their kitchen tables and couches converted into makeshift offices, others continued to work in public spaces. Delivery drivers dealt with health risks, theft and assault. Airline workers who weren’t furloughed had to confront passengers who refused to wear masks.

But things have opened up, slowly, over the past few months, as cases have fallen and people have become inoculated. Last week, President Biden promised that there would be enough vaccine doses for every American adult by May, and the Centers for Disease Control and Prevention announced that vaccinated people can begin gathering indoors again — a sign that people will soon be finding their way back to one another.

Brittany Marsh, who owns a pharmacy in Little Rock, Ark., administering a Covid-19 vaccine this month. She said the Dr. B service made it easier to distribute leftover doses.
Credit…Rory Doyle for The New York Times

In the hustle to score an elusive vaccine appointment, the leftover dose has become the stuff of pandemic lore.

Extra shots — which must be used within hours once taken out of cold storage — have been doled out to drugstore customers buying midnight snacks, people who are friends with nurses and those who show up at closing time at certain grocery stores and pharmacies. At some larger vaccination sites, the race to use every dose sets off a flurry of end-of-the-day phone calls.

In every case, if the leftover dose does not find an available arm, it must go into the trash.

Now, a New York-based start-up is aiming to add some order to the hunt for leftover doses. Dr. B, as the company is known, is matching vaccine providers who find themselves with extra vaccines to people who are willing to get one at a moment’s notice.

Since the service began last month, more than 500,000 people have submitted a host of personal information to sign up for the service, which is free to join and is also free to providers. Two vaccine sites have begun testing the program, and the company said about 200 other providers had applied to participate.

Dr. B is just one attempt at coordinating the chaotic patchwork of public and private websites that allow eligible people to find vaccine appointments. And while it does not solve the broader structural issues around vaccine distribution, if it scales up the way some hope that it will, it could serve as a model for a better, more equitable way of scheduling vaccinations.

“Ultimately, patients need this vaccine, and there’s providers who need help getting it to the people of priority,” Cyrus Massoumi, a tech entrepreneur and founder of Dr. B, said in an interview. “That’s my motivation.”

Mr. Massoumi said he was financing the project out of his own pocket and had no plans to collect revenue. The company is named after his grandfather, who was nicknamed Dr. Bubba and became a doctor during the 1918 influenza pandemic.

The service suffers, however, from some of the same barriers that have marred vaccination efforts so far. Although signing up is simple, doing so requires an internet connection as well as ready access to a cellphone. Because of the last-minute nature of leftover doses, participants must have flexible schedules and access to transportation.

“It’s still heavily internet dependent, so it will depend on who hears about it,” said Arthur Caplan, a medical ethicist at New York University’s Grossman School of Medicine. “It seems he’s trying to solve a problem and do some good, but I’m sad that governments — counties, cities, national organizations — didn’t prepare for this and then didn’t react more quickly to give advice and guidance.”

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Rich Countries Signed Away a Chance to Vaccinate the World

In the coming days, a patent will finally be issued on a five-year-old invention, a feat of molecular engineering that is at the heart of at least five major Covid-19 vaccines. And the United States government will control that patent.

The new patent presents an opportunity — and some argue the last best chance — to exact leverage over the drug companies producing the vaccines and pressure them to expand access to less affluent countries.

The question is whether the government will do anything at all.

The rapid development of Covid-19 vaccines, achieved at record speed and financed by massive public funding in the United States, the European Union and Britain, represents a great triumph of the pandemic. Governments partnered with drugmakers, pouring in billions of dollars to procure raw materials, finance clinical trials and retrofit factories. Billions more were committed to buy the finished product.

But this Western success has created stark inequity. Residents of wealthy and middle-income countries have received about 90 percent of the nearly 400 million vaccines delivered so far. Under current projections, many of the rest will have to wait years.

to help an Indian company produce about 1 billion doses by the end of 2022 and his administration has donated doses to Mexico and Canada. But he has made it clear that his focus is at home.

“We’re going to start off making sure Americans are taken care of first,” Mr. Biden said recently. “But we’re then going to try and help the rest of the world.”

Pressuring companies to share patents could be seen as undermining innovation, sabotaging drugmakers or picking drawn-out and expensive fights with the very companies digging a way out of the pandemic.

As rich countries fight to keep things as they are, others like South Africa and India have taken the battle to the World Trade Organization, seeking a waiver on patent restrictions for Covid-19 vaccines.

as part of their vaccine diplomacy. The Gamaleya Institute in Moscow, for example, has entered into partnerships with producers from Kazakhstan to South Korea, according to data from Airfinity, a science analytics company, and UNICEF. Chinese vaccine makers have reached similar deals in the United Arab Emirates, Brazil and Indonesia.

Canada to Bangladesh say they can make vaccines — they just lack patent licensing deals. When the price is right, companies have shared secrets with new manufacturers in just months, ramping up production and retrofitting factories.

pressured Johnson & Johnson to accept the help and is using wartime procurement powers to secure supplies for the company. It will also pay to retrofit Merck’s production line, with an eye toward making vaccines available to every adult in the United States by May.

Despite the hefty government funding, drug companies control nearly all of the intellectual property and stand to make fortunes off the vaccines. A critical exception is the patent expected to be approved soon — a government-led discovery for manipulating a key coronavirus protein.

This breakthrough, at the center of the 2020 race for a vaccine, actually came years earlier in a National Institutes of Health lab, where an American scientist named Dr. Barney Graham was in pursuit of a medical moonshot.

For years, Dr. Graham specialized in the kind of long, expensive research that only governments bankroll. He searched for a key to unlock universal vaccines — genetic blueprints to be used against any of the roughly two dozen viral families that infect humans. When a new virus emerged, scientists could simply tweak the code and quickly make a vaccine.

In 2016, while working on Middle East Respiratory Syndrome, another coronavirus known as MERS, he and his colleagues developed a way to swap a pair of amino acids in the coronavirus spike protein. That bit of molecular engineering, they realized, could be used to develop effective vaccines against any coronavirus. The government, along with its partners at Dartmouth College and the Scripps Research Institute, filed for a patent, which will be issued this month.

another virus when the outbreak in China inspired his team to change focus. “We just flipped it to coronavirus and said, ‘How fast can we go?’” Dr. Graham recalled.

filed such a lawsuit in 2019 against the drugmaker Gilead over H.I.V. medication.

being lured to the United States.

“We funded the research, on both sides of the Atlantic,” said Udo Bullmann, a German member of the European Parliament. “You could have agreed on a paragraph that says ‘You are obliged to give it to poor countries in a way that they can afford it.’ Of course you could have.”

In May, the leaders of Pakistan, Ghana, South Africa and others called for governments to support a “people’s vaccine” that could be quickly manufactured and given for free.

They urged the governing body of the World Health Organization to treat vaccines as “global public goods.”

Though such a declaration would have had no teeth, the Trump administration moved swiftly to block it. Intent on protecting intellectual property, the government said calls for equitable access to vaccines and treatments sent “the wrong message to innovators.”

World leaders ultimately approved a watered-down declaration that recognized extensive immunization — not the vaccines themselves — as a global public good.

grant language requiring equitable access to vaccines. As leverage, the organization retains some right to the intellectual property.

Dr. Slaoui, who came to Warp Speed after leading research and development at GlaxoSmithKline, is sympathetic to this idea. But it would have been impractical to demand patent concessions and still deliver on the program’s primary goals of speed and volume, he said.

“I can guarantee you that the agreements with the companies would have been much more complex and taken a much longer time,” he said. The European Union, for example, haggled over price and liability provisions, which delayed the rollout.

In some ways, this was a trip down a trodden path. When the H1N1 “swine flu” pandemic broke out in 2009, the wealthiest countries cornered the global vaccine market and all but locked out the rest of the world.

Experts said at the time that this was a chance to rethink the approach. But the swine flu pandemic fizzled and governments ended up destroying the vaccines they had hoarded. They then forgot to prepare for the future.

For months, the United States and European Union have blocked a proposal at the World Trade Organization that would waive intellectual property rights for Covid-19 vaccines and treatments. The application, put forward by South Africa and India with support from most developing nations, has been bogged down in procedural hearings.

“Every minute we are deadlocked in the negotiating room, people are dying,” said Mustaqeem De Gama, a South African diplomat who is involved in the talks.

But in Brussels and Washington, leaders are still worried about undermining innovation.

During the presidential campaign, Mr. Biden’s team gathered top intellectual property lawyers to discuss ways to increase vaccine production.

“They were planning on taking the international view on things,” said Ana Santos Rutschman, a Saint Louis University law professor who participated in the sessions.

Most of the options were politically thorny. Among them was the use of a federal law allowing the government to seize a company’s patent and give it to another in order to increase supply. Former campaign advisers say the Biden camp was lukewarm to this proposal and others that called for a broader exercise of its powers.

The administration has instead promised to give $4 billion to Covax, the global vaccine alliance. The European Union has given nearly $1 billion so far. But Covax aims to vaccinate only 20 percent of people in the world’s poorest countries this year, and faces a $2 billion shortfall even to accomplish that.

Dr. Graham, the N.I.H. scientist whose team cracked the coronavirus vaccine code for Moderna, said that pandemic preparedness and vaccine development should be international collaborations, not competitions.

“A lot of this would not have happened unless there was a big infusion of government money,” he said.

But governments cannot afford to sabotage companies that need profit to survive.

Dr. Graham has largely moved on from studying the coronavirus. He is searching for a universal flu vaccine, a silver bullet that could prevent all strains of the disease without an annual tweak.

Though he was vaccinated through work, he spent the early part of the year trying to get his wife and grown children onto waiting lists — an ordeal that even one of the key inventors had to endure. “You can imagine how aggravating that is,” he said.

Matina Stevis-Gridneff and Monika Pronczuk contributed reporting.

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