projected to increase by up to 16 percent because of the war in Ukraine and the pandemic, which made ingredients, packaging and supply chains more costly, according to UNICEF.

displaced by the drought this year. As many as three million Somalis have also been displaced by tribal and political conflicts and the ever-growing threat from the terrorist group Al Shabab.

cyclones, rising temperatures, a locust infestation that destroyed crops, and, now, four consecutive failed rainy seasons.

spend 60 to 80 percent of their income on food. The loss of wheat from Ukraine, supply-chain delays and soaring inflation have led to sharp rises in the prices of cooking oil and staples like rice and sorghum.

At a market in the border town of Doolow, more than two dozen tables were abandoned because vendors could no longer afford to stock produce from local farms. The remaining retailers sold paltry supplies of cherry tomatoes, dried lemons and unripe bananas to the few customers trickling in.

perished since mid-2021, according to monitoring agencies.

The drought is also straining the social support systems that Somalis depend on during crises.

As thousands of hungry and homeless people flooded the capital, the women at the Hiil-Haween Cooperative sought ways to support them. But faced with their own soaring bills, many of the women said they had little to share. They collected clothes and food for about 70 displaced people.

“We had to reach deep into our community to find anything,” said Hadiya Hassan, who leads the cooperative.

likely fail, pushing the drought into 2023. The predictions are worrying analysts, who say the deteriorating conditions and the delayed scale-up in funding could mirror the severe 2011 drought that killed about 260,000 Somalis.

Famine in Somalia.”

For now, the merciless drought is forcing some families to make hard choices.

Back at the Benadir hospital in Mogadishu, Amina Abdullahi gazed at her severely malnourished 3-month-old daughter, Fatuma Yusuf. Clenching her fists and gasping for air, the baby let out a feeble cry, drawing smiles from the doctors who were happy to hear her make any noise at all.

“She was as still as the dead when we brought her here,” Ms. Abdullahi said. But even though the baby had gained more than a pound in the hospital, she was still less than five pounds in all — not even half what she should be. Doctors said it would be a while before she was discharged.

This pained Ms. Abdullahi. She had left six other children behind in Beledweyne, about 200 miles away, on a small, desiccated farm with her goats dying.

“The suffering back home is indescribable,” she said. “I want to go back to my children.”

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Afghanistan’s Health Care System Is Collapsing Under Stress

KABUL, Afghanistan — Amena, 7 months old, lay silently in her hospital crib amid the mewling of desperately ill infants in the malnutrition ward.

Her mother, Balqisa, had brought the child to Indira Gandhi Children’s Hospital in Kabul, Afghanistan’s capital, the night before. “Her body was so hot,” she said, stroking her daughter’s emaciated leg.

The baby had a high fever, convulsions and sepsis, said Dr. Mohammad Iqbal Sadiq, a pediatrician, glancing at her chart.

“Her chances are not good,” the doctor said. “We got her too late.”

At the Indira Gandhi hospital, and in faltering hospitals across Afghanistan, famished children arrive by car and taxi and ambulance every day and night. Acute malnutrition is just one of a cascade of maladies that threaten to topple the country’s fragile health system.

acute poverty, with 4.7 million Afghans likely to suffer severe malnutrition this year, according to the United Nations. Last month, the organization made its biggest appeal ever for a single country, asking international donors to give more than $5 billion to fend off a humanitarian disaster.

doubled since August, with 40 children dying in December on their way to receive medical care.

Jonas Gahr Store, the prime minister of Norway, whose country hosted meetings between Taliban representatives and Afghan civil society groups last week, spoke to the Security Council about the urgency to expedite aid.

“We need new agreements and commitments in place to be able to assist and help an extremely vulnerable civil population, and most vulnerable among them, the children who face hunger and suffering,” he said.

Before the U.S.-backed Afghan government disintegrated in August as the Taliban overran the country, the health system relied on international aid to survive. But much of that funding has been frozen to comply with sanctions imposed on the Taliban.

As a result, the International Rescue Committee recently predicted that 90 percent of Afghanistan’s health clinics were likely to shut down in the coming months. The World Health Organization has said that outbreaks of diarrhea, measles, dengue fever, malaria and Covid-19 threaten to overwhelm overburdened hospitals.

including $308 million in relief authorized by the United States, they have not been enough to cover 1,200 health facilities and 11,000 health workers.

Though the drastic decline in war-related casualties has relieved the burden of such patients on many hospitals, the suspension of operations by private facilities and the ability to safely travel Afghanistan’s roads has left other hospitals overrun with people.

On a recent morning, the corridors of Indira Gandhi hospital were crammed with beds as patients’ family members squatted on floors amid parcels of food bought at the local bazaar.

Patients’ meals consist of an egg, two apples, a milk packet, rice and juice, so many families supplement them with outside food. Some buy medicine at local pharmacies because the hospital can provide only about 70 percent of required medication, Dr. Sadiq said.

has now claimed more than 900,000 lives across the country, and the Covid death rates remain alarmingly high. The number of new infections, however, has fallen by more than half since mid-January, and hospitalizations are also declining.

Few Afghans wear masks — even at the Ministry of Public Health in Kabul. There, officials clustered in groups on a recent weekday, greeting visitors with hugs and kisses, and ignoring faded signs saying masks were required throughout the building.

At the Afghan-Japan Communicable Disease Hospital in Kabul, the only remaining Covid-19 facility in the capital, few staff members or patients complied with worn stickers on the floors that proclaimed: “Let’s Beat Coronavirus — Please keep at least 2 meters from people around you.”

“When I try to talk to people about Covid-19, they say we have no food, no water, no electricity — why should we care about this virus?” said Dr. Tariq Ahmad Akbari, the hospital’s medical director.

Dr. Akbari suspected that the Omicron variant had entered the country, but the hospital lacked the medical equipment to test for variants. He and his staff had not been paid for five months, he said, and the hospital was critically low on oxygen supplies and health care workers.

Seven of the hospital’s eight female doctors fled after the Taliban takeover in August, part of a hollowing out that reduced the staff from 350 to 190 the past five months. Four of the five staff microbiologists quit. And only five of the country’s 34 Covid-19 centers were still operating, Dr. Akbari said.

Several staff members lived in the hospital in Kabul because, without salaries, they cannot afford rent, he said.

The hospital was recently buoyed by a two-month stopgap grant of $800,000 from an affiliate of Johns Hopkins Hospital, Dr. Akbari said. And Afghanistan’s relative isolation following the Taliban takeover had likely helped contain the spread of Covid-19, he said.

Up to 20 patients died per day during the previous wave, but just one or two a day now. And the hospital tests about 150 patients a day now, down from 600 to 700 daily tests during the second wave, Dr. Akbari said.

He speculated that Afghans are so overwhelmed by other survival issues that they are less likely to seek treatment for Covid-19.

Before the Taliban takeover, the Ministry of Public Health published detailed daily charts showing the number of coronavirus cases, hospitalizations and deaths — and the positivity rate for testing. But now the poorly funded ministry struggles to keep tabs on the pandemic.

Of the more than 856,000 tests conducted since the first wave of Covid-19 in early 2020 — of an estimated population of nearly 40 million — roughly 163,000 were positive, a health ministry spokesman said. More than 7,400 Covid-19 deaths had been confirmed since 2020, he said.

But because testing is extremely limited and the cause of death is not recorded in many instances, particularly in rural areas of Afghanistan, no one knows the pandemic’s true scale.

Dr. Akbari shook his head in frustration as he described how little was known about the virus in Afghanistan.

Looking defeated, he said, “If we have a surge like we had during the second and third wave, we would not be equipped to handle it.”

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Winter Heating Bills Loom as the Next Inflation Threat

Last week, the Biden administration released 90 percent of the $3.75 billion in funds dedicated to the Low Income Home Energy Assistance Program, which provided an average of $439 to more than five million families the year before the pandemic. It received $4.5 billion in additional emergency grants this year. Usually, funding for the program isn’t released until all budget items for the fiscal year are approved, but Congress recently made an exception as cold months approached and sparring over spending bills continued.

Mr. Wolfe’s group has urged Congress to include $5 billion more for the program in the social safety net package being negotiated in Washington.

The increase in home heating costs is sure to hover over economic debates in Washington about inflation. White House allies, fighting to push through the president’s sweeping agenda, assert that the current surge in consumer prices mostly reflects pandemic disruptions that will dissipate next year. Federal Reserve officials, who have been trying to put in place a policy framework less keenly sensitive to inflation, will be pushed to gauge whether that contention is well founded.

The latest outlook from the National Oceanic and Atmospheric Administration suggests a decent chance of a milder-than-average winter. But according to projections by the U.S. Energy Information Administration, if winter is somewhat colder than usual, energy bills could rise 15 percent for households heated by electricity, 50 percent for those depending on natural gas and 59 percent for those that mostly use heating oil. Propane users would be in for the biggest blow — a 94 percent increase, or potentially hundreds of dollars over the six-month heating season.

As with other price shocks stemming from the pandemic, the pain will be particularly acute for those of limited means. Twenty-nine percent of those surveyed by the Census Bureau have reported reducing or forgoing household expenses to pay an energy bill in the last year.

Before the pandemic, Jamillia Grayson, 43, of Buffalo, had a successful event-planning business. Her work dried up, and even with unemployment insurance, she couldn’t meet household expenses while supporting her 8-year-old daughter, who has sickle cell anemia, as well as an older aunt, who depends on a home oxygen tank and lives with them.

Electricity and gas bills piled up throughout this year, and by the end of the summer, she owed $3,000, she said.

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Singapore Struggles to Reopen After Vaccinations

The country’s experience has become a sobering case study for other nations pursuing reopening strategies without first having had to deal with large outbreaks in the pandemic. For the Singapore residents who believed the city-state would reopen once the vaccination rate reached a certain level, there was a feeling of whiplash and nagging questions about what it would take to reopen if vaccines were not enough.

“In a way, we are a victim of our own success, because we’ve achieved as close to zero Covid as we can get and a very, very low death rate,” said Dr. Paul Tambyah, an infectious diseases specialist at National University Hospital. “So we want to keep the position at the top of the class, and it’s very hard to do.”

vaccinated people are already gathering at concerts, festivals and other large events. But unlike Singapore, both of those places had to manage substantial outbreaks early in the pandemic.

Lawrence Wong, Singapore’s finance minister and a chair of the country’s Covid-19 task force, said the lesson for “Covid-naive societies” like Singapore, New Zealand and Australia is to be ready for large waves of infections, “regardless of the vaccine coverage.”

up against the Delta variant, Mr. Wong said.

“In Singapore, we think that you cannot just rely on vaccines alone during this intermediate phase,” he said. “And that’s why we do not plan an approach where we reopen in a big bang manner, and just declare freedom.”

highest since 2012, a trend that some mental health experts have attributed to the pandemic. People have called on the government to consider the mental health concerns caused by the restrictions.

“It’s just economically, sociologically, emotionally and mentally unsustainable,” said Devadas Krishnadas, chief executive at Future-Moves Group, a consultancy in Singapore. Mr. Krishnadas said the decision to reintroduce restrictions after reaching such a high vaccination rate made the country a global outlier.

granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for mandates in both the public and private sectors. Such mandates are legally allowed and have been upheld in court challenges.

  • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
  • Schools. California became the first state to issue a vaccine mandate for all educators and to announce plans to add the Covid-19 vaccine as a requirement to attend school, which could start as early as next fall. Los Angeles already has a vaccine mandate for public school students 12 and older that begins Nov. 21. New York City’s mandate for teachers and staff, which went into effect Oct. 4 after delays due to legal challenges, appears to have prompted thousands of last-minute shots.
  • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get vaccinated. Mandates for health care workers in California and New York State appear to have compelled thousands of holdouts to receive shots.
  • Indoor activities. New York City requires workers and customers to show proof of at least one dose of the Covid-19 for indoor dining, gyms, entertainment and performances. Starting Nov. 4, Los Angeles will require most people to provide proof of full vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.
  • At the federal level. On Sept. 9, President Biden announced a vaccine mandate for the vast majority of federal workers. This mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services.
  • In the private sector. Mr. Biden has mandated that all companies with more than 100 workers require vaccination or weekly testing, helping propel new corporate vaccination policies. Some companies, like United Airlines and Tyson Foods, had mandates in place before Mr. Biden’s announcement.
  • “I think a lot of times we are so focused on wanting to get good results that we just have tunnel vision,” she said.

    Ms. Ng lives across from a testing center. Almost daily, she watched a constant stream of people go in for tests, a strategy that many public health experts say is a waste of resources in such a highly vaccinated country.

    “Freedom Day — as our ministers have said — is not the Singapore style,” said Jeremy Lim, an associate professor at the National University of Singapore and an expert on health policy, referring to England’s reopening in the summer. But moving too cautiously over the potential disadvantages of restrictions is a “bad public health” strategy, he said.

    The government should not wait for perfect conditions to reopen, “because the world will never be perfect. It’s so frustrating that the politicians are almost like waiting for better circumstances,” Dr. Lim said.

    Sarah Chan, a deputy director at Singapore’s Agency for Science, Technology and Research, said she had a fleeting taste of what normal life was like when she arrived in Italy last month to visit her husband’s family.

    No masks were required outdoors, vaccinated people could gather in groups, and Dr. Chan and her son could bop their heads to music in restaurants. In Singapore, music inside restaurants has been banned based on the notion that it could encourage the spread of the virus.

    Dr. Chan said she was so moved by her time in Italy that she cried.

    “It’s almost normal. You forget what that’s like,” she said. “I really miss that.”

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    How Asia, Once a Vaccination Laggard, Is Revving Up Inoculations

    Then came the Delta variant. Despite keeping their countries largely sealed off, the virus found its way in. And when it did, it spread quickly. In the summer, South Korea battled its worst wave of infections; hospitals in Indonesia ran out of oxygen and beds; and in Thailand, health care workers had to turn away patients.

    With cases surging, countries quickly shifted their vaccination approach.

    Sydney, Australia, announced a lockdown in June after an unvaccinated limousine driver caught the Delta variant from an American aircrew. Then, Prime Minister Scott Morrison, who had previously said vaccination “was not a race,” called in July on Australians to “go for gold” in the country’s inoculation drive.

    He moved to overcome a supply shortage, compounded by the slow regulatory approval. In August, Australia bought one million Pfizer doses from Poland; this month, Mr. Morrison announced a purchase of a million Moderna shots from Europe.

    When the Delta outbreak emerged, fewer than 25 percent of Australians over the age of 16 had received a single shot. In the state of New South Wales, which includes Sydney, 86 percent of the adult population has now received a first dose, and 62 percent of adults are fully vaccinated. The country expects to fully inoculate 80 percent of its population over the age of 16 by early November.

    “There was great community leadership — there were people from across the political divide who came out to support vaccination,” said Greg Dore, an infectious-disease expert at the University of New South Wales. “It really helped us turn around a level of hesitancy that was there.”

    Many governments have used incentives to encourage inoculations.

    In South Korea, the authorities eased restrictions in August on private gatherings for fully vaccinated people, allowing them to meet in larger groups while maintaining stricter curbs for others. Singapore, which has fully vaccinated 82 percent of its population, previously announced similar measures.

    Researchers there have also analyzed the pockets of people who refuse to be inoculated and are trying to persuade them.

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    Hurricane Ida News: Storm Could Be Among the Strongest to Hit Louisiana since the 1850s, Governor Warns

    saying local officials expected “the possibility of flooding and even spinoff tornadoes in portions of Alabama.” In Mississippi, Gov. Tate Reeves also issued a state of emergency on Saturday, allowing for the use of state resources for response and recovery.

    Research over the past decade has found that, on average, such rapid intensification of hurricanes is increasing, in part because the oceans, which provide the energy for hurricanes, are getting warmer as a result of human-caused emissions of greenhouse gases. But Ida will also strengthen quickly because the Gulf, as is usual at the end of the summer, is very warm.

    The hurricane center defines rapid intensification as at least a 35-m.p.h. increase in sustained winds over 24 hours. In the extremely active 2020 season, Hurricane Laura intensified by 45 m.p.h. in the 24 hours before making landfall in Louisiana as a Category 4 storm in late August.

    The National Hurricane Center said Ida was likely to produce heavy rainfall late Sunday into Monday from southeast Louisiana to coastal Mississippi and Alabama. Tropical storm force winds will arrive along the coast as early as Saturday night, according to the National Weather Service, before the storm makes landfall on Sunday afternoon or evening. After moving inland, the storm could contribute to flooding in Tennessee, where flash flooding killed 20 people last weekend.

    “Based upon current track and strength of Ida, this storm will test our hurricane protection systems in a way they haven’t been tested before,” Chip Kline, executive assistant to the governor of Louisiana for coastal activities, said on Twitter. “It’s times like these that remind us of the importance of continuing to protect south Louisiana.”

    Correction: 

    Because of an editing error, an earlier version of this article misidentified the location of Tropical Storm Ida. It was in the Caribbean Sea early Friday, not the Gulf of Mexico.

    Bella Witherspoon, left, and Sara Marriott prepare their boat ahead of the arrival of Hurricane Ida in Ocean Springs, on the Mississippi coast.
    Credit…Hannah Ruhoff/The Sun Herald, via Associated Press

    Hurricane Ida will produce “life-threatening” weather conditions in Louisiana and batter parts of Mississippi, the National Weather Service said, urging people to evacuate inland.

    Here is a breakdown of how various parts of the region could be affected when the hurricane makes landfall on Sunday afternoon or evening , according to the Weather Service.

    Baton Rouge, La.

    River Parishes and Northshore in Louisiana

    New Orleans

    Coastal Louisiana

    Southwest Mississippi

    Coastal Mississippi

    Jawan Williams shoveled sand for a sandbag held by his son Jayden Williams, before landfall of Hurricane Ida at the Frederick Sigur Civic Center in Chalmette, La., on Saturday.
    Credit…Matthew Hinton/Associated Press

    Hurricane Ida is expected to make landfall Sunday, threatening to bring dangerous wind, storm surge and rain to the Gulf Coast exactly 16 years after the arrival of Hurricane Katrina, one of the most costly natural disasters in American history, which left more than 1,800 dead and produced more than $100 billion in damages.

    The overall impact of storm surge from Ida is predicted to be less severe than during Katrina. Because that storm began as a Category 5 hurricane in the Gulf of Mexico before weakening as it approached landfall, it generated enormous storm surge, which brought over 20 feet of water to parts of the Mississippi coast. Current projections put the storm surge of Ida at 10 to 15 feet.

    “Fifteen-foot sure can do a lot of damage,” said Barry Keim, a professor at Louisiana State University and Louisiana State Climatologist. “But it’s going to be nothing in comparison with Katrina’s surge.”

    Improvements to the levee system following Katrina have better prepared the New Orleans metro area for the storm surge.

    However, the areas likely to receive the most severe surge from Ida may be less equipped to handle it than the area hit by Katrina, said Dr. Keim.

    Ida is expected to make landfall to the west of where Katrina struck, bringing the most severe storm surge impacts to the Louisiana coast west of the Mississippi River rather than east of the river along coastal Mississippi, as Katrina did.

    “We are testing a different part of the flood protection in and around southeast Louisiana than we did in Katrina,” said Dr. Keim. “Some of the weak links in this area maybe haven’t been quite as exposed.”

    While the impacts of Ida’s storm surge are expected to be less severe than Katrina’s, Ida’s winds and rain are predicted to exceed those that pummeled the Gulf Coast in 2005.

    Ida is expected to make landfall on the Gulf Coast as a Category 4 storm with peak winds of 130 mph, while Katrina made landfall as a Category 3 with peak winds of 125 mph.

    “It could be quite devastating — especially some of those high rise buildings are just not rated to sustain that wind load,” said Jamie Rhome, acting deputy director of the National Hurricane Center.

    The severe damage from Hurricane Laura, which struck southwest Louisiana last year as a Category 4 storm, was caused primarily by high winds peaking at 150 mph. The storm caused 42 deaths and damage costing more than $19 billion.

    Ida’s rainfall also threatens to exceed Katrina’s highs.

    The National Hurricane Center estimates that Ida will drench the Gulf Coast with 8 to 16 inches of rain and perhaps as much as 20 inches in some places. Katrina brought 5-10 inches of rain with more than 12 inches in the most impacted areas.

    “That is a lot of rainfall,” said Mr. Rhome. “Absolutely the flash flood potential in this case is high, very high.” Especially combined with storm surge, he said, such intense levels of rainfall could have a “huge and devastating impact to those local communities.”

    A wedding party marches by boarded-up buildings in the French Quarter in New Orleans on Saturday.
    Credit…Dan Anderson/EPA, via Shutterstock

    NEW ORLEANS — When a hurricane comes roaring toward New Orleans out of the Gulf of Mexico, there is a discernible mood shift on Bourbon Street, the city’s famed strip of iniquity and conspicuous alcohol consumption.

    It goes from tawdry to tawdry with a hint of apocalypse. On Friday afternoon, the street was half alive. Daiquiri bars were open and daiquiri bars were boarded up. The doors to Larry Flynt’s Hustler Club were locked. Nearby, a man lay on his back on the sidewalk, a plastic bag at his side, yelling the name “Laura.” Or maybe “Lord.”

    Six happy women from New York ambled toward Canal Street in matching black T-shirts that said, “Birthday, beignets and booze.” The birthday girl declined to give her name. They went past the club called The Famous Door, where a listless bar band played “Fat Bottomed Girls.”

    The riffs poured out into the street. A member of the birthday team raised a glass of something alcoholic and sugary and shouted out the chorus.

    Another of the New York women, Jessika Edouard of Long Island, said that most of her group had been trying to get out of town before the storm’s arrival, to no avail. It was all cancellations and unresponsive airline customer service. “The flights are terrible,” she said.

    What choice did they have but to keep the party going? Ms Edouard thought she and some of the others might be able to leave on Monday, after Ida hit.

    In the meantime, she said, they had bought a ton of booze in the French Quarter. In the morning they had beignets. They had just met a crew from the Weather Channel. They seemed more excited than scared.

    Ms. Edouard even had words for the storm, which she delivered like a threat from one pro wrestler to another.

    “If Hurricane Ida thinks she is going to ruin my friend’s 30th birthday, then Ida has another thing coming,” she said.

    New Orleans residents prepared to leave after the mayor asked for voluntary evacuations in anticipation of Hurricane Ida.
    Credit…Max Becherer/NOLA.com, via The Advocate, via Associated Press

    NEW ORLEANS — With Hurricane Ida likely to bring powerful winds and heavy rain to their city, residents of New Orleans faced a familiar choice: flee or hunker down for the duration.

    The storm was expected to make landfall by Sunday afternoon or evening and officials urged people who intended to evacuate to do so by Saturday. Residents came to a variety of decisions on the matter.

    Lacy Duhe, 39, and Jeremy Housely, 42, opted to hunker down in their second-story apartment on Deslonde Street in New Orlean’s Lower Ninth Ward. If they evacuated and ended up in a shelter, they said, they worried about the risk of their unvaccinated children contracting Covid-19. They also had just paid their monthly bills and could not afford to go anywhere.

    “It feels serious,” said the couple’s 11-year-old daughter, Ja-nyi. “I wasn’t born during Katrina time. But I know it knocked down a lot of places.”

    Mary Picot, 71, walked out the door on Saturday afternoon carrying bags of snacks and medicine. She wasn’t worried about flooding and believed the levees would hold. It was the threat of power outages that convinced her to leave.

    “My husband is diabetic,” she said. “We have to keep his medicine cold.”

    Donald Lyons, 38, was packing up a silver Nissan sedan Saturday afternoon under a cloud-filled sky in Hollygrove, one of the traditionally Black working class neighborhoods that flooded badly when Katrina hit. The car, carrying his wife, three children and mother-in-law, was full of bags and bedding. They were heading to Sugar Land, Texas, 27 miles southwest of Houston, where they had family that had left after Katrina, 16 years ago, and never come back.

    “I’m just trying to get somewhere safe,” Mr. Lyons said.

    Down the block, Barbara Butler, 65, a housekeeper, said she thought the city was safer now with all of the new flood protection. She intended to ride out the storm at home.

    “It gave us some relief,” she said. “It’s better than no relief.”

    She was sitting on the porch with her husband, Curtis Duck, 63, and her brother, Ray Thomas, in a house that Ms. Butler said was flooded with eight feet of water after Katrina.

    Mr. Duck said he was sick of evacuating time and again.

    “We listen to the news,” he said. “People telling us to go, go, go.”

    Victor Pizarro, a health advocate, and his husband decided to ride out the storm in their home in the Gentilly Terrace neighborhood, although they said they would leave town if they lost power for an extended period.

    “It’s definitely triggering to even have to think about this and make these decisions,” Mr. Pizarro said in a telephone interview while he drove across town in search of a spare part for his generator. “It’s exhausting to be a New Orleanian and a Louisianian at this point.”

    Andy Horowitz and his family decided to vacate their home in the Algiers Point neighborhood, which sits directly across the Mississippi River from the French Quarter. Mr. Horowitz is the author of “Katrina: A History, 1915-2015,” and he is among those scholars and Louisiana residents who fear that the city’s new flood protection system, as massive as it is, may prove to be inadequate for a sinking city in the likely path of more frequent and powerful storms in the age of climate change.

    “Every summer, New Orleans plays a game of Russian roulette, and every summer we pull the trigger,” Mr. Horowitz said.

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    New Orleans Mayor Urges Evacuations Ahead of Hurricane Ida

    Hurricane Ida is expected to make landfall as a Category 4 storm on Sunday, which is also the 16th anniversary of Hurricane Katrina. Mayor LaToya Cantrell warned residents to either evacuate immediately or bunker down in a safe place ahead of the hurricane.

    What we know is today, right now, everyone has to make a decision to leave voluntarily, which I’m recommending, do that, prepare yourselves. If you’re going to leave, you need to do that now. We need to make sure that you are in a safe place, everyone, whether you’re going to leave voluntarily or stay onsite, hunkered down. Wherever that is, hopefully that’s your home, in our city, but in a safe space. Prepare for damaging wind, power outages, heavy rain, tornadoes. What I am told is that this storm in no way will be weakening. There will be and there are no signs, again, that this storm will weaken, and there’s always an opportunity for the storm to strengthen. This continues to remain a very fluid situation. And we know, again, that time is not on our side. It’s just, it’s rapidly, it’s growing, it’s intensifying.

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    Hurricane Ida is expected to make landfall as a Category 4 storm on Sunday, which is also the 16th anniversary of Hurricane Katrina. Mayor LaToya Cantrell warned residents to either evacuate immediately or bunker down in a safe place ahead of the hurricane.CreditCredit…Matthew Hinton, via Associated Press

    NEW ORLEANS — With tracking maps for Hurricane Ida consistently showing an expected pathway toward southeast Louisiana, Mayor LaToya Cantrell of New Orleans issued a stern warning on Saturday that city residents who intend to leave should do so immediately.

    “In no way will this storm be weakening, and there’s always an opportunity for the storm to strengthen,” Ms. Cantrell said at a news briefing. “Time is not on our side. It’s rapidly growing, it’s intensifying.”

    City officials are asking that residents who plan to stay in the city prepare for extended power outages, limited emergency services and several days of high temperatures after the storm passes.

    “The first 72 is on you,” said Collin Arnold, director of the New Orleans Office of Homeland Security and Emergency Preparedness. “The first three days of this will be difficult for responders to get to you.”

    Forecasters are predicting that Hurricane Ida will be a Category 4 storm upon landfall on Sunday, the 16th anniversary of Hurricane Katrina, which left more than 1,800 dead.

    “What we learned during Hurricane Katrina is we are all first-responders,” Ms. Cantrell said. “It’s about taking care of one another.”

    Delery Street in the Ninth Ward of New Orleans was flooded after Hurricane Katrina in 2005.
    Credit…Nicole Bengiveno/ New York Times

    NEW ORLEANS — On Saturday afternoon, the Rev. Willie L. Calhoun Jr., a 71-year-old resident of the Lower Ninth Ward, was in his Lincoln Continental on the brink of getting out of town. He was not quite sure where. Somewhere in Alabama, he figured.

    Rev. Calhoun remembers his father smashing a hole in the roof of his family’s home in the Lower Ninth in 1965, when Hurricane Betsy put 10 feet of water in his house. When Katrina came, he and his family made sure to get out of the neighborhood before the storm destroyed their homes — unlike many of his neighbors, some of whom perished when the levees failed.

    The pain from Katrina was now an indelible fact of life in the neighborhood. He had hoped to take part in a 16th anniversary commemoration on Sunday, with a high school marching band and a theme, he said, of “healing, unifying and strengthening our communities.”

    “The trauma, and the hurt that’s there,” he said. “I have one friend who lost his mother and his granddaughter in Katrina. For that trauma to be revisited every year is a tough thing.”

    But his perspective on the neighborhood 16 years on was somewhat nuanced. He felt confident that the improvements to the city’s storm protection system — with its mammoth flood walls and new gates and levees — would keep the Ninth Ward safe. His worry, he said, was the damage from the wind that comes with a Category 4 hurricane.

    And yet it was difficult not to be disappointed. The jobs for Black men seemed to have dried up in the city. A revamped post-Katrina educational system, heavily reliant on charter schools, did not seem, in Rev. Calhoun’s opinion, to have done much good. The neighborhood was in need of economic stimulus. Still full of empty lots, and ghostly foundations of homes, many of them owned by Black families, long washed away.

    After $20 billion in infrastructure improvements, it felt, at best, like partial progress, and like survival with an asterisk.

    Credit…Adrees Latif/Reuters

    LAKE CHARLES, La. — Not again. That was the widespread sentiment among residents of Lake Charles, a city of about 76,000 residents some 200 miles from New Orleans, on Saturday.

    A year after Hurricane Laura left many here without power — and some without homes — for long periods of time, residents were preparing for perhaps yet another weather catastrophe.

    When Laura, a powerful Category 4 storm, barreled through Lake Charles last August, it shattered the windows of the home that Juan Jose Galdames, 55, a construction worker, shared with his five children. On Saturday, he was at Home Depot, buying plywood to protect the windows and other vulnerable parts of his house ahead of the storm.

    “Yes, I am a little afraid,” Mr. Galdames said. “I don’t want a repeat of that day. It was scary. I want my children to feel safe. I’m trying to get everything ready before nightfall.”

    Water and bread were in short supply at an area Target store, and traffic stretched for miles as residents sought safety elsewhere.

    Tracy Guillory, 57, a carpenter, tried to prepare by stocking up on supplies and staying on top of weather reports. She said she and her family were weary after a long year of weather crises that included Hurricane Delta and a winter storm that caused pipes to burst and knocked out water systems throughout the region.

    Ms. Guillory said her neighborhood was still recovering from flooding in May, which left her SUV beyond repair. She plans to hunker down with her 83-year-old father and 21-year-old daughter.

    Josue Espinal, 34, who also works in construction, was trying to reassure his 4-year-old son, Anderson, that everything would be all right. The boy sat on top of a generator box as his father loaded a cart with bottles of water at a Home Depot. Truth was, Mr. Espinal admitted, he too was worried. He and his family live in a mobile home near a lake, and he was looking for a better option to spend the next two nights.

    A medical worker monitored a Covid-19 patient in the intensive care unit at Lake Charles Memorial Hospital in Louisiana earlier this month.
    Credit…Mario Tama/Getty Images

    In Louisiana, where daily deaths from Covid reached their highest levels this week, stretched hospitals are having to modify the intense preparations they would normally make ahead of an expected strike from Hurricane Ida.

    Louisiana’s medical director, Dr. Joseph Kanter, asked residents on Friday to avoid unnecessary emergency room visits to preserve the state’s hospital capacity, which has been vastly diminished by its most severe Covid surge of the pandemic.

    And while plans exist to transfer patients away from coastal areas to inland hospitals ahead of a hurricane, this time “evacuations are just not possible,” Gov. John Bel Edwards said at a news conference.

    “The hospitals don’t have room,” he said. “We don’t have any place to bring those patients — not in state, not out of state.”

    The governor said officials had asked hospitals to check generators and stockpile more water, oxygen and personal protective supplies than usual for a storm. The implications of a strike from a Category 4 hurricane while hospitals were full were “beyond what our normal plans are,” he added.

    Mr. Edwards said he had told President Biden and Deanne Criswell, the administrator of the Federal Emergency Management Agency, to expect Covid-related emergency requests, including oxygen.

    The state’s recent wave of Covid hospitalizations has exceeded its previous three peaks, and staffing shortages have necessitated support from federal and military medical teams. On Friday, 2,684 Covid patients were hospitalized in the state. This week Louisiana reported its highest ever single-day death toll from Covid — 139 people.

    Oschner Health, one of the largest local medical systems, informed the state that it had limited capacity to accept storm-related transfers, especially from nursing homes, the group’s chief executive, Warner L. Thomas, said. Many of Oschner’s hospitals, which were caring for 836 Covid patients on Friday, had invested in backup power and water systems to reduce the need to evacuate, he said.

    The pandemic also complicated efforts to discharge more patients than usual before the storm hits. For many Covid patients who require oxygen, “going home isn’t really an option,” said Stephanie Manson, chief operating officer of Our Lady of the Lake Regional Medical Center in Baton Rouge, which had 190 Covid inpatients on Friday, 79 of them in intensive care units.

    The governor said he feared that the movement of tens or hundreds of thousands of evacuees in the state could cause it to lose gains made in recent days as the number of new coronavirus cases began to drop. Dr. Kanter urged residents who were on the move to wear masks and observe social distancing. Many of the state’s testing and vaccination sites were slated to close temporarily.

    The Inner Harbor Navigation Canal Surge Barrier was constructed after Hurricane Katrina to prevent tidal surges from hurricanes from reaching New Orleans.
    Credit…Gerald Herbert/Associated Press

    NEW ORLEANS — As Hurricane Ida heads toward a possible Sunday landfall on Louisiana’s coastline, the National Weather Service’s storm surge forecast has local officials warning about the potential for water to overtop some of the levees that protect parts of New Orleans.

    Mayor LaToya Cantrell of New Orleans noted at a news briefing on Friday evening that water overtopping the levees “is as it was structured to do.” That reflects the updates to the local system of earthen and reinforced levees that protects much of southeast Louisiana in the years after Hurricane Katrina stretched it to a breaking point.

    The system, officials said, was rebuilt to defend against a so-called “100-year-storm,” or a storm that has a 1 percent chance in happening every year, but to remain reinforced up to a 500-year-event. It includes armoring, splash pads — concrete areas designed to keep the ground behind an overtopped wall from being washed away — and pumps with backup generators, officials said.

    Heath Jones, an emergency operation manager with the Army Corps of Engineers, said that some levees protecting New Orleans on the western side of the Mississippi River were at risk of overtopping in line with the Weather Service’s forecast calling for between 10 and 15 feet of storm surge. A federal levee database shows sections of levee there as low as 10 feet.

    Levees in this part of the state have rarely been challenged since they were shored up in the years after Hurricane Katrina in 2005.

    “The previous big tests were (hurricanes) Isaac and Gustav,” said Matt Roe, a public affairs specialist with the Army Corps of Engineers, which occurred in 2012 and 2008, “but it’s important to note that each storm is different.”

    Ida’s strength, according to Chip Cline, chairman of the Coastal Protection and Restoration Authority, “will test our hurricane protection system in a way they haven’t been tested before.”

    Homes in Lake Charles, La., were covered with blue tarps after being hit by Hurricane Laura. Then Hurricane Delta swept through, knocking down trees and scattering debris from the previous storm.
    Credit…William Widmer for The New York Times

    Hurricane Ida threatens to be the first major storm to strike the Gulf Coast during the 2021 season, hitting a region in many ways still grappling with the physical and emotional toll of a punishing run of hurricanes last year.

    The Atlantic hurricane season of 2020 was the busiest on record, with 30 named storms, 13 of which reached hurricane strength. There were so many storms that forecasters ran through the alphabet and had to take the rare step of calling storms by Greek letters.

    Louisiana was dealt the harshest blow, barraged repeatedly by storms, including Hurricane Laura, which was one of the most powerful to hit the state, trailed six weeks later by Delta, which was weaker than Laura but followed a nearly identical path, inflicting considerable pain on communities still gripped by the devastation from the earlier storm.

    The state is still struggling to claw its way back. Gov. John Bel Edwards of Louisiana said the state had $3 billion in unmet recovery needs. In Lake Charles, which was ravaged by direct hits from both hurricanes followed by a deadly winter storm and flooding in May, local officials recently renewed a plea for federal aid as the city has failed to regain its footing; much of it has yet to recover and many residents, unable to find adequate or affordable housing, have fled.

    The looming impact of Ida underscores the persisting danger imperiling coastal communities as a changing climate stands to intensify the destructive force of the storms that have always been a seasonal part of life.

    President Biden cited the growing danger in May when he announced a significant increase in funding to build and bolster infrastructure in communities most likely to face the wrath of extreme weather.

    A fallen tree and electricity pole were cleared as Hurricane Nora approaches Manzanillo, Mexico, on Sunday.
    Credit…Reuters

    Hurricane Nora formed in the eastern Pacific on Saturday morning, threatening much of Mexico’s western coastline as the storm strengthens and barrels its way toward Puerto Vallarta, Jalisco and the tip of the Baja California Peninsula, forecasters said.

    As of 10 a.m. on Saturday, Nora was about 425 miles from Cabo San Lucas, Mexico, and had maximum sustained winds of 80 miles per hour as it moved north, according to the National Hurricane Center.

    A hurricane warning was in effect for parts of western Mexico.

    Forecasters said the storm was expected to cause flooding, mudslides and perilous surf along much of Mexico’s central and northern Pacific Coast.

    The remnants of the storm are expected to produce heavy rainfall in parts of the southwestern U.S. and central Rockies toward the middle of next week, forecasters said.

    A forecast track from the National Hurricane Center showed Nora skirting close to Mexico’s coastline by Sunday morning before moving toward the Gulf of California a day later.

    “Some additional strengthening is forecast through tonight if Nora’s center does not make landfall,” the National Hurricane Center said in an update. “Some gradual weakening is expected to begin by Sunday night or Monday, but Nora is forecast to remain as a hurricane through Tuesday.”

    Nora is expected to produce rainfall totals of up to 12 inches this weekend along Mexico’s western coast.

    It has been a dizzying few weeks for meteorologists who are monitoring Hurricane Ida this weekend after having monitored three named storms that formed in quick succession in the Atlantic, bringing stormy weather, flooding and damaging winds to different parts of the United States and the Caribbean.

    The links between hurricanes and climate change are becoming more apparent. A warming planet can expect to see stronger hurricanes over time, and a higher incidence of the most powerful storms — though the overall number of storms could drop because factors like stronger wind shear could keep weaker storms from forming.

    Hurricanes are also becoming wetter because of more water vapor in the warmer atmosphere; scientists have suggested that storms like Hurricane Harvey in 2017 produced far more rain than they would have without the human effects on climate. Also, rising sea levels are contributing to higher storm surges — the most destructive element of tropical cyclones.

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    Covid Vaccines Produced in Africa Are Being Exported to Europe

    Johnson & Johnson’s Covid vaccine was supposed to be one of Africa’s most important weapons against the coronavirus.

    The New Jersey-based company agreed to sell enough of its inexpensive single-shot vaccine to eventually inoculate a third of the continent’s residents. And the vaccine would be produced in part by a South African manufacturer, raising hopes that those doses would quickly go to Africans.

    That has not happened.

    South Africa is still waiting to receive the overwhelming majority of the 31 million vaccine doses it ordered from Johnson & Johnson. It has administered only about two million Johnson & Johnson shots. That is a key reason that fewer than 7 percent of South Africans are fully vaccinated — and that the country was devastated by the Delta variant.

    At the same time, Johnson & Johnson has been exporting millions of doses that were bottled and packaged in South Africa for distribution in Europe, according to executives at Johnson & Johnson and the South African manufacturer, Aspen Pharmacare, as well as South African government export records reviewed by The New York Times.

    donated by the United States. But about four million of the country’s 60 million residents are fully vaccinated.

    That left the population vulnerable when a third wave of cases crested over the country. At times in recent months, scores of Covid-19 patients at Helen Joseph Hospital in Johannesburg were waiting in the emergency department for a bed, and the hospital’s infrastructure struggled to sustain the huge volumes of oxygen being piped into patients’ lungs, said Dr. Jeremy Nel, an infectious-disease doctor there.

    “The third wave, in terms of the amount of death we saw, was the most heartbreaking, because it was the most avoidable,” Dr. Nel said. “You see people by the dozens dying, all of whom are eligible for a vaccine and would’ve been among the first to get it.”

    a United Nations-backed clearinghouse for vaccines that has fallen behind on deliveries. South Africa was slow to enter negotiations with manufacturers for its own doses. In January, a group of vaccine experts warned that the government’s “lack of foresight” could cause “the greatest man-made failure to protect the population since the AIDS pandemic.”

    announced in November. Aspen’s facility in Gqeberha, on South Africa’s southern coast, was the first site in Africa to produce Covid vaccines. (Other companies subsequently announced plans to produce vaccines on the continent.)

    South African officials hailed Aspen’s involvement as indispensable.

    Aspen “belongs to us as South Africans, and it is making lifesaving vaccines,” South Africa’s president, Cyril Ramaphosa, said during a visit to Aspen’s plant in March. He said he had pushed Johnson & Johnson to prioritize the doses made there for Africans.

    “I want them now,” Mr. Ramaphosa added. “I’ve come to fetch our vaccines.”

    results of a clinical trial suggested that the vaccine from AstraZeneca offered little protection from mild or moderate infections caused by the Beta variant that was circulating in South Africa.

    Weeks later, Johnson & Johnson and the government signed a contract for 11 million doses. South Africa ordered another 20 million doses in April. That would be enough to vaccinate about half the country.

    South Africa agreed to pay $10 per dose for the 11 million shots, according to the contract. That was the same price that the United Statespaid and slightly more than the $8.50 that the European Commission agreed to pay. The South African contract prohibited the government from banning exports of the vaccine, citing the need for doses to “move freely across national borders.”

    introduced export controls this year to conserve scarce supplies. India halted exports produced by the Serum Institute, which was supposed to be a major vaccine supplier to poor countries. In the United States, officials said they didn’t ban exports, but they didn’t need to. The combination of the extensive vaccine production on American soil and the high prices the U.S. government was willing to pay meant that companies made the delivery of shots for Americans a priority.

    Other benefits for Johnson & Johnson were embedded in the South African contract.

    While such contracts typically protect companies from lawsuits brought by individuals, this one shielded Johnson & Johnson from suits by a wider range of parties, including the government. It also imposed an unusually high burden on potential litigants to show that any injuries caused by the vaccine were the direct result of company representatives engaging in deliberate misconduct or failing to follow manufacturing best practices.

    “The upshot is that you have moved almost all of the risk of something being wrong with the vaccine to the government,” said Sam Halabi, a health law expert at Georgetown University who reviewed sections of the South African contract at the request of The Times.

    Mr. Halabi said the contract’s terms appeared more favorable to the pharmaceutical company than other Covid vaccine contracts he had seen. South African officials have said Pfizer, too, sought aggressive legal protections.

    The contract said Johnson & Johnson would aim to deliver 2.8 million doses to South Africa by the end of June, another 4.1 million doses by the end of September and another 4.1 million doses by the end of December. (The government expects the 20 million additional doses to be delivered by the end of this year, Mr. Maja said.)

    The company has so far fallen far short of those goals. As of the end of June, South Africa had received only about 1.5 million of the doses from its order. The small number of doses that have been delivered to the African Union were on schedule.

    The difficulties in procuring doses have revealed the limits of fill-and-finish sites, which leave countries dependent on vaccines from places like the European Union or the United States, said Dr. Salim Abdool Karim, who until March was co-chairman of South Africa’s ministerial advisory committee on Covid.

    “Ultimately,” he said, “the solution to our problem has to be in making our own vaccines.”

    Lynsey Chutel and Choe Sang-Hun contributed reporting.

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    Why Tunisia’s Promise of Democracy Struggles to Bear Fruit

    GAZIANTEP, Turkey — In the 10 years since its popular uprising set off the Arab Spring, Tunisia has often been praised as the one success story to emerge from that era of turbulence. It rejected extremism and open warfare, it averted a counterrevolution, and its civic leaders even won a Nobel Peace Prize for consensus building.

    Yet for all the praise, Tunisia, a small North African country of 11 million, never fixed the serious economic problems that led to the uprising in the first place.

    It also never received the full-throated support of Western backers, something that might have helped it make a real transition from the inequity of dictatorship to prosperous democracy, analysts and activists say. Instead, at critical points in Tunisia’s efforts to remake itself, many of its needs were overlooked by the West, for which the fight against Islamist terrorism overshadowed all other priorities.

    Now, as Tunisians grapple with their latest upheaval, which began when President Kais Saied dismissed the prime minister and suspended Parliament over the weekend, many seem divided on whether to condemn his actions — or embrace them.

    terrorism and the pandemic, Mr. Kaboub said.

    overthrew the country’s authoritarian president of 23 years, Zine el-Abidine Ben Ali.

    But Western officials were obsessively focused on the Islamists — namely the Ennahda, or Renaissance, party that swept early elections — and where they were going and what they represented.

    “In conversations, those sorts of questions ate up almost all the oxygen in the room,” Ms. Marks said. “It was almost impossible to get anybody to ask another question.”

    awarded the Nobel Peace Prize in 2015 — to the point that it became a “fetish,” she said.

    After the 2011 revolution, Al Qaeda and other extremists were quick to mobilize networks of recruits.

    Terrorism burst into the open in 2012 when the U.S. Embassy in Tunis came under attack from a mob. Over the years that followed, extremist cells carried out a string of political assassinations and suicide attacks that shattered Tunisians’ optimism and nearly derailed the democratic transition.

    training and assisting Tunisian security forces, and supplying them with military equipment, but so discreetly that the American forces themselves were virtually invisible.

    By 2019, some 150 Americans were training and advising their Tunisian counterparts in one of the largest missions of its kind on the African continent, according to American officials. The value of American military supplies delivered to the country increased to $119 million in 2017 from $12 million in 2012, government data show.

    The assistance helped Tunisia defeat the broader threat of terrorism, but government ministers noted that the cost of combating terrorism, while unavoidable, burned a larger hole in the national budget.

    But it is the structure of the economy that remains the root of the problem, Mr. Kaboub said. All of Tunisia’s political parties have identical economic plans, based on World Bank and International Monetary Fund guidelines. It was the same development platform used by the ousted president, Mr. Ben Ali, Mr. Kaboub said.

    “Right now,” he said, “everybody in Tunisia is begging for an I.M.F. loan, and it is going to be seen as the solution to the crisis. But it is really a trap. It’s a Band-Aid — the infection is still there.”

    Lilia Blaise contributed reporting from Tunis.

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    More Power Lines or Rooftop Solar Panels: The Fight Over Energy’s Future

    The nation is facing once in a generation choices about how energy ought to be delivered to homes, businesses and electric cars — decisions that could shape the course of climate change and determine how the United States copes with wildfires, heat waves and other extreme weather linked to global warming.

    On one side, large electric utilities and President Biden want to build thousands of miles of power lines to move electricity created by distant wind turbines and solar farms to cities and suburbs. On the other, some environmental organizations and community groups are pushing for greater investment in rooftop solar panels, batteries and local wind turbines.

    There is an intense policy struggle taking place in Washington and state capitals about the choices that lawmakers, energy businesses and individuals make in the next few years, which could lock in an energy system that lasts for decades. The divide between those who want more power lines and those calling for a more decentralized energy system has split the renewable energy industry and the environmental movement. And it has created partnerships of convenience between fossil fuel companies and local groups fighting power lines.

    At issue is how quickly the country can move to cleaner energy and how much electricity rates will increase.

    senators from both parties agreed to in June. That deal includes the creation of a Grid Development Authority to speed up approvals for transmission lines.

    Most energy experts agree that the United States must improve its aging electric grids, especially after millions of Texans spent days freezing this winter when the state’s electricity system faltered.

    “The choices we make today will set us on a path that, if history is a barometer, could last for 50 to 100 years,” said Amy Myers Jaffe, managing director of the Climate Policy Lab at Tufts University. “At stake is literally the health and economic well-being of every American.”

    The option supported by Mr. Biden and some large energy companies would replace coal and natural gas power plants with large wind and solar farms hundreds of miles from cities, requiring lots of new power lines. Such integration would strengthen the control that the utility industry and Wall Street have over the grid.

    batteries installed at homes, businesses and municipal buildings.

    Those batteries kicked in up to 6 percent of the state grid’s power supply during the crisis, helping to make up for idled natural gas and nuclear power plants. Rooftop solar panels generated an additional 4 percent of the state’s electricity.

    become more common in recent years.

    Some environmentalists argue that greater use of rooftop solar and batteries is becoming more essential because of climate change.

    After its gear ignited several large wildfires, Pacific Gas & Electric began shutting off power on hot and windy days to prevent fires. The company emerged from bankruptcy last year after amassing $30 billion in liabilities for wildfires caused by its equipment, including transmission lines.

    Elizabeth Ellenburg, an 87-year-old cancer survivor in Napa, Calif., bought solar panels and a battery from Sunrun in 2019 to keep her refrigerator, oxygen equipment and appliances running during PG&E’s power shut-offs, a plan that she said has worked well.

    “Usually, when PG&E goes out it’s not 24 hours — it’s days,” said Ms. Ellenburg, a retired nurse. “I need to have the ability to use medical equipment. To live in my own home, I needed power other than the power company.”

    working to improve its equipment. “Our focus is to make both our distribution and transmission system more resilient and fireproof,” said Sumeet Singh, PG&E’s chief risk officer.

    But spending on fire prevention by California utilities has raised electricity rates, and consumer groups say building more power lines will drive them even higher.

    Average residential electricity rates nationally have increased by about 14 percent over the last decade even though average household energy use rose just over 1 percent.

    2019 report by the National Renewable Energy Laboratory, a research arm of the Energy Department, found that greater use of rooftop solar can reduce the need for new transmission lines, displace expensive power plants and save the energy that is lost when electricity is moved long distances. The study also found that rooftop systems can put pressure on utilities to improve or expand neighborhood wires and equipment.

    Texas was paralyzed for more than four days by a deep freeze that shut down power plants and disabled natural gas pipelines. People used cars and grills and even burned furniture to keep warm; at least 150 died.

    One reason for the failure was that the state has kept the grid managed by the Electric Reliability Council of Texas largely disconnected from the rest of the country to avoid federal oversight. That prevented the state from importing power and makes Texas a case for the interconnected power system that Mr. Biden wants.

    Consider Marfa, an artsy town in the Chihuahuan Desert. Residents struggled to stay warm as the ground was blanketed with snow and freezing rain. Yet 75 miles to the west, the lights were on in Van Horn, Texas. That town is served by El Paso Electric, a utility attached to the Western Electricity Coordinating Council, a grid that ties together 14 states, two Canadian provinces and a Mexican state.

    $1.4 million, compared with about $1 million to Donald J. Trump, according to the Center for Responsive Politics.

    In Washington, developers of large solar and wind projects are pushing for a more connected grid while utilities want more federal funding for new transmission lines. Advocates for rooftop solar panels and batteries are lobbying Congress for more federal incentives.

    Separately, there are pitched battles going on in state capitals over how much utilities must pay homeowners for the electricity generated by rooftop solar panels. Utilities in California, Florida and elsewhere want lawmakers to reduce those rates. Homeowners with solar panels and renewable energy groups are fighting those efforts.

    Despite Mr. Biden’s support, the utility industry could struggle to add power lines.

    Many Americans resist transmission lines for aesthetic and environmental reasons. Powerful economic interests are also at play. In Maine, for instance, a campaign is underway to stop a 145-mile line that will bring hydroelectric power from Quebec to Massachusetts.

    New England has phased out coal but still uses natural gas. Lawmakers are hoping to change that with the help of the $1 billion line, called the New England Clean Energy Connect.

    This spring, workmen cleared trees and installed steel poles in the forests of western Maine. First proposed a decade ago, the project was supposed to cut through New Hampshire until the state rejected it. Federal and state regulators have signed off on the Maine route, which is sponsored by Central Maine Power and HydroQuebec.

    But the project is mired in lawsuits, and Maine residents could block it through a November ballot measure.

    set a record in May, and some scientists believe recent heat waves were made worse by climate change.

    “Transmission projects take upward of 10 years from conception to completion,” said Douglas D. Giuffre, a power expert at IHS Markit. “So if we’re looking at decarbonization of the power sector by 2035, then this all needs to happen very rapidly.”

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    Coronavirus Surges in Kisumu, Kenya

    KISUMU, Kenya — Before Kenya’s president and other leaders arrived in late May to mark a major public holiday, health officials in Kisumu on Lake Victoria saw disaster brewing. Coronavirus infections were spiking, hospital isolation units were filling up and the highly contagious Delta variant had been found in Kenya for the first time — in Kisumu County.

    Dr. Boaz Otieno Nyunya, the county executive for health and sanitation, said he and other health specialists argued and pleaded for the politicians to hold a virtual celebration and skip the mass, in-person events that can supercharge an outbreak. Just weeks earlier, huge political rallies had helped fuel the catastrophic Covid-19 wave in India, where the Delta variant first emerged and became dominant.

    Their objections were waved away, the health officials said. President Uhuru Kenyatta, Deputy President William Ruto, the former prime minister Raila Odinga and others descended on Kisumu, drawing large and mostly unmasked crowds who thronged the streets to watch their slow-moving motorcades through the city and gathered to hear them at marketplaces and parking lots.

    turning away patients for lack of beds or oxygen, health officials say they fear a wave like the one that ripped through India in April and May could be looming over Kisumu.

    “The India example is not lost to us,” Dr. Nyunya said.

    Though data on infections and deaths is spotty, more than 23 percent of the people tested for the virus in Kisumu last week were positive — more than double the national rate. Kenya’s overall positivity rate is similar to that of the United States when the pandemic peaked there in January. But the Delta variant was still rare then, the American health system is far more robust than Kenya’s and the U.S. government was ramping up vaccination on a grand scale.

    All of Africa is vulnerable, as the latest wave of the pandemic sweeps the continent, driven in part by more transmissible variants. Fewer than 1 percent of Africa’s people have been even partially vaccinated, by far the lowest rate for any continent.

    “I think the greatest risk in Africa is to look at what happened in Italy earlier on and what happened in India and start thinking we are safe — to say it’s very far away from us and that we may not go the same way,” said Dr. Mark Nanyingi, an infectious disease epidemiologist at the University of Liverpool in Britain. He called the surge in western Kenya a “storm on the horizon.”

    said. But experts say the true scale of the pandemic far exceeds reported figures in Africa, where testing and tracing remain a challenge for many countries, and many nations do not collect mortality data.

    To forestall the ongoing crisis, Kenya’s Ministry of Health last week imposed a restriction on gatherings and extended a dusk-to-dawn curfew in Kisumu and more than a dozen surrounding counties. But the measures were too late for Dr. Nyunya, who said that thinking back on the deliberations — which involved the county governor Peter Anyang’ Nyong’o, a former national health minister — over the celebrations last month, “It makes you feel impotent.”

    record cases and deaths, President Yoweri Museveni has imposed a strict 42-day lockdown. Just weeks ago, Rwanda hosted the Basketball Africa League and other big sporting events, raising the possibility for a full reopening. But after a spike in cases, the government introduced new lockdown measures on Monday.

    The Democratic Republic of Congo — where the virus has claimed the lives of more than 5 percent of lawmakers ­— is grappling with a third wave as it falters in rolling out vaccines. South Africa, the continent’s worst-hit nation, has reported new infections doubling in just two weeks’ time, with the sharpest increases in major urban centers. Tunisia, where hospitals are full and oxygen supplies are low, is enduring a fourth wave.

    “New, higher transmitting variants create a precarious situation in many countries that have weak health systems,” said Dr. Ngozi Erondu, a senior health scholar at the O’Neill Institute at Georgetown University.

    The W.H.O. attributes the surge in Africa to lack of vaccination, insufficient adherence to precautionary measures like mask wearing and social distancing and the Delta and other variants.

    lament a lack of protective gear and health insurance.

    “We are buying our own gloves and masks,” said Dr. Onyango Ndong’a, chairman of the local chapter of the Kenya Medical Practitioners, Pharmacists and Dentists Union. “We are covering for government inadequacies. We are tired now. We are stretched.”

    For now, families who have lost loved ones are adjusting to a new reality.

    Edward Onditi, 33, lost both his brother and his mother to Covid-19 this month. He said he left Nairobi to come and assist his family after his brother, Herbert, whom he regarded as a best friend and mentor, fell ill.

    For weeks, the family transported Herbert, 43, between three hospitals in two counties — a distance of 70 miles in total — so that he could get high-flow oxygen. On the day before Herbert died, Edward had fish, his brother’s favorite meal, delivered to his isolation ward and promised to take him on a holiday once he was out.

    “I’m so touched,” his brother said in a text message sent on June 2.

    Barely 12 hours later, he was gone.

    A few days later, their mother, Naomi, who had been ailing, succumbed to complications from Covid-19, too.

    “It’s one of the toughest moments of my life,” Mr. Onditi said on a recent afternoon, his eyes welling with tears. “Things are just not working. They are not adding up.”

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