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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Why Asia, the Pandemic Champion, Remains Miles Away From the Finish Line

SYDNEY, Australia — All across the Asia-Pacific region, the countries that led the world in containing the coronavirus are now languishing in the race to put it behind them.

While the United States, which has suffered far more grievous outbreaks, is now filling stadiums with vaccinated fans and cramming airplanes with summer vacationers, the pandemic champions of the East are still stuck in a cycle of uncertainty, restrictions and isolation.

In southern China, the spread of the Delta variant led to a sudden lockdown in Guangzhou, a major industrial capital. Taiwan, Vietnam, Thailand and Australia have also clamped down after recent outbreaks, while Japan is dealing with its own weariness from a fourth round of infections, spiked with fears of viral disaster from the Olympics.

the new outbreak in southern China will affect busy port terminals there. Across Asia, faltering vaccine rollouts could also open the door to spiraling variant-fueled lockdowns that inflict new damage on economies, push out political leaders and alter power dynamics between nations.

The risks are rooted in decisions made months ago, before the pandemic had inflicted the worst of its carnage.

blocked the export of 250,000 doses of the AstraZeneca vaccine meant for Australia to control its own raging outbreak. Other shipments were delayed because of manufacturing issues.

“The supplies of purchased vaccine actually landing on docks — it’s fair to say they are not anywhere near the purchase commitments,” said Richard Maude, a senior fellow at the Asia Society Policy Institute in Australia.

with the United States and Europe.

In Asia, about 20 percent of people have received at least one dose of a vaccine, with Japan, for example, at just 14 percent. By contrast, the figure is nearly 45 percent in France, more than 50 percent in the United States and more than 60 percent in Britain.

Instagram, where Americans once scolded Hollywood stars for enjoying mask-free life in zero-Covid Australia, is now studded with images of grinning New Yorkers hugging just-vaccinated friends. While snapshots from Paris show smiling diners at cafes that are wooing summer tourists, in Seoul, people are obsessively refreshing apps that locate leftover doses, usually finding nothing.

“Does the leftover vaccine exist?” one Twitter user recently asked. “Or has it disappeared in 0.001 seconds because it is like a ticket for the front-row seat of a K-pop idol concert?”

keep its borders closed for another year. Japan is currently barring almost all nonresidents from entering the country, and intense scrutiny of overseas arrivals in China has left multinational businesses without key workers.

The immediate future for many places in Asia seems likely to be defined by frantic optimization.

China’s response to the outbreak in Guangzhou — testing millions of people in days, shutting down entire neighborhoods — is a rapid-fire reprise of how it has handled previous flare-ups. Few inside the country expect this approach to change anytime soon, especially as the Delta variant, which has devastated India, is now beginning to circulate.

has threatened residents with fines of around $450 for refusing vaccines. Vietnam has responded to its recent spike in infections by asking the public for donations to a Covid-19 vaccine fund. And in Hong Kong, officials and business leaders are offering a range of inducements to ease severe vaccine hesitancy.

Nonetheless, the prognosis for much of Asia this year is billboard obvious: The disease is not defeated, and won’t be anytime soon. Even those lucky enough to get a vaccine often leave with mixed emotions.

“This is the way out of the pandemic,” said Kate Tebbutt, 41, a lawyer who last week had just received her first shot of the Pfizer vaccine at the Royal Exhibition Building near Melbourne’s central business district. “I think we should be further ahead than where we are.”

Reporting was contributed by Raymond Zhong in Taipei, Taiwan, Ben Dooley in Tokyo, Sui-Lee Wee in Singapore, Youmi Kim in Seoul and Yan Zhuang in Melbourne, Australia.

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As Vaccines Turn Pandemic’s Tide, U.S. and Europe Diverge on Path Forward

LONDON — Over Memorial Day weekend, 135,000 people jammed the oval at the Indianapolis 500. Restaurants across the United States were thronged with customers as mask mandates were being discarded.

The formula, which gained the Biden administration’s blessing, was succinct: In essence, if you are fully vaccinated, you can do as you please.

But while the United States appears to be trying to close the curtain on the pandemic, across the ocean, in Britain and the European Union, it is quite a different story.

Despite plunging infection levels and a surging vaccine program, parts of Europe are maintaining limits on gatherings, reimposing curbs on travel and weighing local lockdowns.

Wellcome Sanger Institute, said of Delta. “It just means we have less certainty about what things will look like going forward.”

estimated on Friday that the Delta variant was roughly 60 percent more contagious than the earlier one from Britain. Health officials also warned that cases caused by the Delta variant might lead to a higher risk of hospitalization, though it was too early to say for certain.

The divergent strategies of European nations and the United States also reflect broader differences in how Western governments are thinking about their responsibility to unvaccinated people, scientists said.

in unvaccinated pockets of the United States, where the virus continues to sicken and kill people at elevated rates. The Biden administration is still searching for ways to overcome that vaccine hesitancy.

In Britain, even with more than 90 percent of people over 65 having been fully vaccinated, health officials have resisted as speedy a reopening as they seek to expand inoculation rates in lower-income and nonwhite areas.

“We know the virus predominantly hits poorer communities and people of color hardest,” said James Naismith, a structural biologist and the director of Britain’s Rosalind Franklin Institute, a medical research center. “The U.S. strategy perhaps reflects a more deep-rooted commitment to individualism. The U.K.’s vaccination campaign is highly managed and mirrors more a sense of being our brother’s keeper.”

Britain decided last year to delay second vaccine doses to give more people the partial protection of a single dose. That helped it weather the wintertime surge but also left it potentially exposed to the Delta variant. Health officials said this past week that there was strong evidence of “a reduction in vaccine effectiveness” for the new variant that was most pronounced after a single dose.

Health officials have since changed the guidance to speed up second doses, but many scientists are urging the government not to commit to reopening until the impact of the variant becomes clearer.

76 percent overall have gotten one shot. As a result, some scientists say, upticks in new infections are tolerable so long as the vast majority do not lead to serious illness or death.

“This variant is going to find it hard to spread, because it’s limited to younger people and limited to certain parts of the country,” Professor Spector said.

He said the government needed to help the neighborhoods where it was spreading and, beyond that, encourage people to keep working from home and socially distancing when possible. But delaying the easing of restrictions, he said, was not necessary.

“We need to get used to the idea there will be a few thousand cases every day and that this is a part of our life,” Professor Spector said. “Those cases will be milder.”

Germany, France and Austria all moved quickly to bar most visitors from Britain.

Like Britain, the bloc was chastened by a surge of the variant from Britain this winter that contributed to one of the world’s highest death tolls. Governments were hammered for failing to cement the gains of last summer, when lockdowns were lifted across most of Europe.

In the bloc, 47 percent of the adult population has received a first dose, according to the European Center for Disease Prevention and Control, but only 23 percent have full protection.

For those reasons, European leaders have said that vigilance is needed, even though infections have fallen about 80 percent since mid-April.

“This progress is fragile,” Hans Kluge, the World Health Organization’s director in Europe, warned last month. “We have been here before. Let us not make the same mistakes that were made this time last year.”

Still, now that supply bottlenecks have eased, European officials are confident that 70 percent of adults will be fully vaccinated by July.

The quandary that Europe faces over how to react to the Delta variant may recur as the virus continues to evolve, some scientists said. As long as it remains in wide circulation, even more transmissible variants could emerge, forcing countries to grapple with whether to hunker down yet again or risk the virus spreading through unprotected populations.

Poorer nations are facing far more difficult choices, though. If the same sort of lockdowns that controlled the variant from Britain prove insufficient against this new one, those countries could have to choose between even more draconian and economically damaging shutdowns or even more devastating outbreaks. The Delta variant has already taken a horrifying toll on South Asia.

“Globally, it’s a nightmare, because most of the world is still not vaccinated,” said Jeremy Kamil, a virologist at Louisiana State University Health Shreveport. “It raises the stakes.”

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The Dominic Cummings Chronicles: The Can’t-Miss Sequel

LONDON — A year ago this week, a brusque, defiant figure in shirt sleeves appeared in the sun-dappled garden behind 10 Downing Street to give one of the most extraordinary news conferences in recent British political history.

On Wednesday, that same man — Dominic Cummings, then the most powerful adviser to Prime Minister Boris Johnson; now arguably his most dangerous enemy — will testify before two Parliamentary committees on Britain’s handling of the coronavirus pandemic. It is being billed as a can’t-miss sequel in the Cummings Chronicles.

Mr. Cummings is expected to unload a trove of inside details about how Mr. Johnson bungled Britain’s initial response, necessitating what he claims were months of needless and ruinous lockdowns. His account, some of which he previewed in a dense, didactic Twitter thread over recent days, is likely to embarrass a leader who bounced back from that wobbly performance, largely on the strength of Britain’s swift rollout of vaccines.

“Dominic Cummings has long been known as a man who brings a bazooka to a knife fight,” said Matthew Goodwin, a professor of politics at the University of Kent. “I suspect he shall not walk quietly into the night.”

firing him in November. Last month, the aide turned publicly on his ex-boss, accusing him of unethical behavior in the costly decoration of his flat in Downing Street and of trying to shut down a leak investigation because he feared it would antagonize his fiancée, Carrie Symonds.

With its promise of further juicy details about an alliance gone bad, the testimony is likely to be political theater of a rare vintage. British papers have speculated that Mr. Cummings will say Mr. Johnson missed numerous early coronavirus meetings because he was busy working on his long-delayed book about Shakespeare.

127,700 deaths, the highest toll in Europe.

“If mass testing had been developed properly earlier in year as cd/shd have been, wd probably have avoided lockdowns 2&3 while awaiting vaccine,” Mr. Cummings said in a Twitter post. In another, he wrote, “One of the most fundamental & unarguable lessons of Feb-March is that secrecy contributed greatly to the catastrophe.”

The problem with Mr. Cummings’s message is the messenger. His decision to flout the rules — most notoriously in going on a family outing to Castle Barnard that he claimed he undertook to test his eyesight — arguably did more to damage the government’s credibility than any single incident during the pandemic.

“He is a tainted source,” said Tim Bale, professor of politics at Queen Mary University in London. “But just because he has an ax to grind and a credibility problem, doesn’t mean he’s not telling the truth.”

For Mr. Johnson, the saving grace may be that Mr. Cummings is testifying at a time when Britain’s vaccination campaign has driven down cases, hospitalizations and deaths. Though there are concerns about flare-ups of a variant first seen in India, the government remains on track to reopen the English economy fully on June 21.

Nor is it clear how much lawmakers will press Mr. Cummings on Mr. Johnson’s personal peccadilloes. On Tuesday, there was a fresh reminder of his checkered history, with the release of a report by the Conservative Party that concluded Mr. Johnson’s disparaging references to Muslims during his days as a newspaper columnist had fostered the impression that the party is “insensitive to Muslim communities.”

For all the static around Mr. Johnson, however, his party just scored impressive victories in regional elections in England.

“Cummings would be able to do severe damage to a prime minister and a government that was in trouble and was unpopular,” Mr. Bale said. “But this government is not in trouble and the prime minister is very popular.”

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Taiwan Was a Covid Haven for Performers. Then Cases Flared.

At many venues, attendees were required to provide their names and phone numbers to be used for tracing in case of an outbreak. Masks and temperature checks were required. Some concert halls barred the selling of food and drinks. Seats at some spaces were staggered to resemble flowers, in an arrangement that came to be known in Taiwan as “plum blossom seating.”

Despite the vigilance, there were occasional scares. More than a hundred people were forced to quarantine in March of last year after coming into contact with the Australian composer Brett Dean, who tested positive for the virus after performing in Taiwan. The incident was front-page news in Taiwan, with some people fuming that Dean — whose “Hamlet” is scheduled at the Metropolitan Opera in New York next season — had been allowed to perform even though he had a cough.

Lydia Kuo, the executive director of the National Symphony Orchestra, which collaborated with Dean, said the scare taught the orchestra the importance of maintaining strict health measures even when infections were near zero.

“We were facing an unknown enemy,” she said. “We were lucky to face this reality very early.”

Taiwan’s still-active cultural scene attracted talent from around the world over the past year when many artists were without stable work and confined at home. There were visits by the Chamber Music Society of Lincoln Center, the German organist Felix Hell, and Ma, the renowned cellist, who chartered a flight to the island for a tour in November.

Many musicians with roots in Taiwan have also returned, some for an extended visit. Ray Chen, a violinist, came back in August at the urging of his family and has taken part in about 20 live concerts, master classes and music education outreach events since then. He said he was struck by the care people showed toward one another and the widespread adherence to public health rules, even when Taiwan went months without any reported infections.

“Everyone is willing to play a part,” Chen said. “Everyone values life.”

Taiwan’s strict approach has not been popular in all corners of the artistic world. After the outbreak this month, some artists questioned the government’s decision to close performance venues, concerned that it would hurt performers’ income.

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What It’s Like to Be in India’s Covid-19 Crisis

Infections are soaring. So are deaths. Whole cities are under lockdown. And the government seems powerless to help.

India is in the grip of a coronavirus crisis. Experts agree that the spread is probably even worse than the official statistics suggest. In many parts of the country, hospital beds, supplemental oxygen and other vital supplies are running short.

As Western countries roll out mass vaccination campaigns, only about 3 percent of India’s population is fully inoculated. Though conditions are slowly improving in New Delhi and Mumbai, the virus appears to be spreading largely unchecked through the rest of the country.

The New York Times asked readers in India to describe their lives in the midst of the pandemic with words and photos. They wrote about fear and loss, anxiety and boredom. Some wrote about their anger at the stumbling response by India’s government under Prime Minister Narendra Modi. But they also wrote about family and friends who have helped them cope, and efforts they have made to help neighbors and strangers alike.

“A lot of people my age have been helping people find resources like hospital beds, oxygen cylinders, medication, etc., through social media by verifying whatever leads are floating around on the internet and sending them to whoever needs them. I’ve been working with one such group. I realize that it is a necessary job in these times, but it’s also incredibly draining. It is the sign of a completely broken system that teenagers have to band together and work themselves to exhaustion trying to answer all these desperate pleas all over Twitter. And it’s getting harder to do by the day as things worsen because resources get exhausted very quickly. Most of the time we just end up calling a lot of numbers and get no response, and when we do it’s usually people saying there’s nothing they can do for us. It’s heartbreaking when people around are just suffering and dying and there’s so little you can do to help. We’re all terrified and burnt out and this is a very unsustainable system of getting people access to health care. You can’t leave it to the citizens to bear the brunt of a health care system that’s crumbling.” — Arunima Tiwari, New Delhi

“I miss spontaneity. I hate that I now have to plan everything out and even when I do, the plans feel like they can just disappear. I’m trying not to focus on what could have been. Instead, I’m determined to stay focused on what I can do. I have reactivated my long-dormant social media accounts to amplify what I can, and I now volunteer at a response center that offers assistance to Covid-positive patients. I don’t have a choice but to help because elected authorities have made it loud and clear that they aren’t going to.” — Anindita Nayak, Bangalore

“Life in Delhi at the moment feels like you’re having an out-of-body experience. It’s hard to imagine this is actually real and happening. Every social media feed, every WhatsApp group is full of requests from people looking for oxygen, hospital beds, critical lifesaving medicines. The worst part: There’s almost nothing you can do to help anyone immediately. It takes hours of verifying, calling, begging for help to actually find some solutions, if that even happens. By that time, you feel almost too scared to call back and find out if help is still needed for fear of hearing the inevitable — that the person has died without getting adequate care. Indians are dying not because of Covid but because they’re not receiving treatment and care.” — Shweta Bahri, Delhi

“Both my parents got Covid. I lost my mother yesterday. Father is on ventilator support. The reason I lost my mother is because she didn’t get treatment. I live in Bangalore, and there is no way you can get a bed in any hospital. The help line numbers never work. If they do, then they just take details or transfer your call with no help. Being completely helpless, I took my mother to a hospital that I’m not sure is even legitimate. They just wanted money from me. They did not have trained staff. Oxygen was always in short supply. I felt helpless that I could not take her anywhere. I knew that if I kept her there she would not survive. I had to bring my father there, and his condition deteriorated due to lack of oxygen. I managed to take him to a different hospital, but it was too late. Now he is on a ventilator.” — Paresh Patil, Bangalore

Rahul Patil died on May 17, Paresh Patil said, after this submission was received.

“It has been challenging, but I maintain a mood log throughout the day and encourage my family to do the same. I also post a mood meter on social media so people can reply with how they are feeling using an emoji and we can talk about it. I also help my parents with their medicines, food, oximeter and temperature readings. Since both have different sets of medications, it’s really important we keep a record of the medicines along with a chart of the vitals. My extended family has been very helpful during this time. They remain connected through calls and texts and remind us not to lose faith.” — Rachita Ramya, Delhi

“Since I have been going to work every day, I have not really experienced the lockdown in terms of staying inside. But it has been a very stressful year when it comes to working. When the lockdown lifted last year, people immediately rushed into the bank where I work. It has been very difficult and almost impossible here, in a rural part of India, to make people understand the importance of masks and social distancing.”

“The government has done little to make people aware of the situation. Also, the lockdowns initially were more of a television ratings stunt rather than a precautionary measure. A lot of workers in banks have died on duty, and some have been denied leave even when they were sick. The precautionary measures on paper are nowhere close to reality. In the past few months, we played dumb to something which we clearly saw coming.” — Shweta Beniwal, Kolar

“As I type this out, four doors lay ajar or wide open in my home. Three of us have now developed Covid symptoms. My old dad has been taking care of cooking, cleaning, medicating and sanitizing all day. My dad sleeps in fits through the day and night, interrupted by calls for food, tea, hoarse coughing, and groans of pain and frustration. How do I cope? Each night, as a 21-year-old, lying wide-awake — the weather is unbearably hot, and my fever rarely subsides — I make up positive scenarios in my mind. Getting a job and earning enough to secure my family’s well-being in this cruel dog-eat-dog world. Being more bold, less hesitant, in fighting people who didn’t see the warning signs of a corrupt, inept distribution of resources. Slapping each of those complacent idiots who voted into power a ruthless demagogue who wins elections by stoking fear and resentment but is a dud when it comes to long-term policymaking, tough decision-making and leadership.” — Harmandeep Khera, Chandigarh

Since sending his submission, Mr. Khera said, he and his family have recovered.

“Many friends have been infected, and we call each other every day to share a joke and to stay positive and make plans to meet in the future. Still frightening, but we are coping. I also try to help people overcome disinformation and keep telling people that most of us who are infected will recover. I ask people to avoid panic buying and seeking unvalidated cures. Since last year I have exercised regularly and continue to do so even while infected and isolated. I am also a pistol shooter for my state of Maharashtra, so mental conditioning has been an important part of my training. I meditate for 10 minutes each day to stay positive.” — Raj Khalid, Mumbai

“It is very frightening. Half of the people I know have been tested positive or have been previously infected. We haven’t stepped out of the house for the past two weeks, and it has taken a greater toll on our physical and mental health. The only rule is to avoid contact. If you want to keep your close ones safe, then you need to keep them away for a while. My mother is an essential worker, and I have seen her doing grocery shopping for many needy people who are quarantined. It’s something I’m proud of. In times like these, we need to hold on to humanity and have faith in whatever you believe in. Being an atheist, I have faith in science and myself.” — Akash Helia, Mumbai

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How India’s Kerala Has Battled Coronavirus

When India’s second coronavirus wave slammed the country last month, leaving many cities without enough doctors, nurses, hospital beds or lifesaving oxygen to cope, Sajeev V.B. got the help he needed.

Local health workers quarantined Mr. Sajeev, a 52-year-old mechanic, at home and connected him with a doctor over the phone. When he grew sicker, they mustered an ambulance that took him to a public hospital with an available bed. Oxygen was plentiful. He left 12 days later and was not billed for his treatment.

“I have no clue how the system works,” Mr. Sajeev said. “All that I did was to inform my local health worker when I tested positive. They took over everything from that point.”

has failed, in many ways, to provide relief for victims of the world’s worst coronavirus outbreak.

online networks, charities and volunteers has emerged in India to fill the gaps left by the stumbling response of the central government and many states. Patients around India have died for lack of oxygen in hospitals where beds filled up quickly.

Deaths are rising. Workers face long hours and tough conditions. The situation could still worsen as the outbreak spreads.

On paper, Kerala’s death rate, at less than 0.4 percent, is one of India’s lowest. But even local officials acknowledge that the government’s data is lacking. Dr. Arun N.M., a physician who monitors the numbers, estimates that Kerala is catching only one in five deaths.

A relatively prosperous state of 35 million, Kerala presents particular challenges. Over 6 percent of its population works abroad, mostly in the Middle East. Extensive travel forces local officials to carefully track people’s whereabouts when a disease breaks out.

tackling a 2018 outbreak of the Nipah virus, a rare and dangerous disease.

As borders closed last year and migrant workers came home, the state’s disaster management team swung into action. Returning passengers were sent into home quarantine. If a person tested positive, local officials traced their contacts. Kerala’s testing rate has been consistently above India’s average, according to health data.

Experts say much of the credit for the system lies with K.K. Shailaja, a 64-year-old former schoolteacher who until this week was Kerala’s health minister. Her role in fighting the Nipah virus inspired a character in a 2019 movie.

drove India into recession. This year, Mr. Modi has resisted a nationwide lockdown, leaving local governments to take their own steps.

India’s states are also competing against each other for oxygen, medicine and vaccines.

“There has been a tendency to centralize decisions when things seemed under control and to deflect responsibility towards the states when things were not,” said Gilles Verniers, a professor of political science at Ashoka University.

has worsened the country’s outbreak, though they have been hindered by a lack of data. Kerala has used gene sequencing since November to track variants, helping to drive policy decisions, said Dr. Vinod Scaria, a scientist at the CSIR Institute of Genomics and Integrative Biology in New Delhi.

“It’s the only state that has not given up at any point in time,” Dr. Scaria said, adding that “they’re eager to use evidence to drive policies.”

A political shuffle has led some experts to wonder whether Kerala can keep its gains. This past week the Communist Party of India, which controls the state government, excluded Ms. Shailaja from its cabinet. The party said it wanted to give young leaders a chance, but observers wondered whether Ms. Shailaja had grown too popular. She didn’t respond to requests for comment.

“Even the best-performing governments,” Professor Verniers of Ashoka University said, “are not immune from shooting themselves in the foot due to misguided political calculations.”

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How India’s Kerala Has Battled Covid-19

When India’s second coronavirus wave slammed the country last month, leaving many cities without enough doctors, nurses, hospital beds or lifesaving oxygen to cope, Sajeev V.B. got the help he needed.

Local health workers quarantined Mr. Sajeev, a 52-year-old mechanic, at home and connected him with a doctor over the phone. When he grew sicker, they mustered an ambulance that took him to a public hospital with an available bed. Oxygen was plentiful. He left 12 days later and was not billed for his treatment.

“I have no clue how the system works,” Mr. Sajeev said. “All that I did was to inform my local health worker when I tested positive. They took over everything from that point.”

has failed, in many ways, to provide relief for victims of the world’s worst coronavirus outbreak.

online networks, charities and volunteers has emerged in India to fill the gaps left by the stumbling response of the central government and many states. Patients around India have died for lack of oxygen in hospitals where beds filled up quickly.

Deaths are rising. Workers face long hours and tough conditions. The situation could still worsen as the outbreak spreads.

On paper, Kerala’s death rate, at less than 0.4 percent, is one of India’s lowest. But even local officials acknowledge that the government’s data is lacking. Dr. Arun N.M., a physician who monitors the numbers, estimates that Kerala is catching only one in five deaths.

A relatively prosperous state of 35 million, Kerala presents particular challenges. Over 6 percent of its population works abroad, mostly in the Middle East. Extensive travel forces local officials to carefully track people’s whereabouts when a disease breaks out.

tackling a 2018 outbreak of the Nipah virus, a rare and dangerous disease.

As borders closed last year and migrant workers came home, the state’s disaster management team swung into action. Returning passengers were sent into home quarantine. If a person tested positive, local officials traced their contacts. Kerala’s testing rate has been consistently above India’s average, according to health data.

Experts say much of the credit for the system lies with K.K. Shailaja, a 64-year-old former schoolteacher who until this week was Kerala’s health minister. Her role in fighting the Nipah virus inspired a character in a 2019 movie.

drove India into recession. This year, Mr. Modi has resisted a nationwide lockdown, leaving local governments to take their own steps.

India’s states are also competing against each other for oxygen, medicine and vaccines.

“There has been a tendency to centralize decisions when things seemed under control and to deflect responsibility towards the states when things were not,” said Gilles Vernier, a professor of political science at Ashoka University.

has worsened the country’s outbreak, though they have been hindered by a lack of data. Kerala has used gene sequencing since November to track variants, helping to drive policy decisions, said Dr. Vinod Scaria, a scientist at the CSIR Institute of Genomics and Integrative Biology in New Delhi.

“It’s the only state that has not given up at any point in time,” Dr. Scaria said, adding that “they’re eager to use evidence to drive policies.”

A political shuffle has led some experts to wonder whether Kerala can keep its gains. Earlier this week, the Communist Party of India, which controls the state government, excluded Ms. Shailaja from its cabinet. The party said it wanted to give young leaders a chance, but observers wondered whether Ms. Shailaja had grown too popular. She didn’t respond to requests for comment.

“Even the best-performing governments,” Professor Vernier of Ashoka University said, “are not immune from shooting themselves in the foot due to misguided political calculations.”

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Italy’s Vaccine Drive Runs Up Against a Sacred Institution: Summer Vacation

ROME — As Dr. Mario Sorlini sits patients down in a vaccination center near the badly affected Italian town of Bergamo, he explains a potential complication of the coronavirus vaccine.

The second dose, he tells patients with terror-stricken faces, will fall on a date during the summer holidays.

“‘But I’ll be in Sardinia then,’” he said that some had responded with distress. Others moan about hotel rooms they’ve already booked. Some, he said, get up and leave.

For months, Italians have hungered for the vaccines that would give them safety, freedom from lockdown and a taste of normal life. After initial pitfalls and hurdles, the vaccination campaign is finally speeding up, but it is heading smack into the summer holidays that are sacred for many Italians and prompting fears among officials that a significant number would rather get away than get vaccinated.

recent vacation anthem. That could create a significant danger next autumn, Ms. Tosi wrote in an open letter to the region’s president.

“The Second Shot Blocks Vacation,” read a headline in Messaggero Veneto, a newspaper in northeastern Italy, echoing concerns in papers, websites and social media accounts across the country.

An estimated 20 million Italians — mostly 40- and 50-somethings — face the prospect of getting their second shots in the middle of July or worse, in the riptide that is the Italian August, which pulls people out of cities and into swelling seaside towns.

To avoid a potentially disastrous summer freeze in the vaccination campaign, and more economic pain, Italy’s regions are urging the government to meet vacationers where they are and offer shots on the beach.

led by Prime Minister Mario Draghi, prides itself on pragmatism and is desperate to get the tourism economy moving. Mr. Draghi recently announced that Italy would lift quarantines and restrictions on vaccinated international tourists and told them “it’s time to book your holidays in Italy.”

Island paradises like Capri, favored by many foreigners, have accelerated their vaccination campaigns and are now considered Covid free. But when it comes to Italians, who are themselves still in the process of getting vaccinated during the summer months, the government has sought to strike a balance between openness to innovative ideas and scolding Italians for their spring and summer fever.

“If we do flights of fancy and inventions, I’m not in,” Francesco Paolo Figliuolo, an army general who has been put in charge of Italy’s vaccination effort, said on Tuesday, seeking to throw cold water on plans floated by governors to inoculate vacationing Italians wherever they might go.

told reporters. “And that it is technically impossible.”

He suggested leaving vacations for a day and then heading back.

Bergamo, said that for now, most of his patients were accepting the summer date for follow-up shots but that many asked, “‘Can I do it at the beach?’”

He said he expected at least 10 people a day to give up on their August appointments for second shots, which means he will struggle to keep those doses from going to waste.

Ciro Mautone, 58, a security guard at Camponeschi, a cafe popular with the vacation set in Rome, said that he had selected the Johnson and Johnson vaccine, which does not require a second shot, in part not to interrupt a potential holiday.

But he said that after the brutal year, with his work hit by the closing of businesses, he was focused on making up lost income rather than fretting about cutting short a vacation.

“I wish I had that problem,” he said.

Emma Bubola and Gaia Pianigiani contributed reporting.

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Taiwan Faces a Surge in New Covid-19 Infections

TAIPEI, Taiwan — Closed schools and restaurants offering takeout only. Lines around the block at testing sites. Politicians on television urging the public to stay calm.

If the scenes around Taiwan this week have a distinctly early pandemic feel, it is because the coronavirus is only now washing up on the island’s shores in force. A crush of new infections has brought a swift end to the Covid-free normality that residents had been enjoying for more than a year.

By shutting its borders early and requiring two-week quarantines of nearly everyone who arrives from overseas, Taiwan had been managing to keep life on the island mostly unfettered. But all that changed after enough infections slipped past those high walls to cause community outbreaks.

For most of the past week, the government has ordered residents to stay home whenever possible and to wear masks outdoors, though it has not declared a total lockdown. Local authorities are ramping up rapid testing, though some health experts worry that too few tests are being done to stay ahead of the virus’s spread.

1,290 Covid-19 cases and 12 deaths during the entire pandemic.

Adding to the concern: Only around 1 percent of the island’s 23.5 million residents have been vaccinated against the virus so far.

happily shielded from its worst ravages.

Eight months passed last year without a single case of community transmission until an infection in December snapped the streak. Even after that, local infections cropped up only sporadically for months.

Then the tide shifted — gradually, then suddenly.

On April 14, the government began allowing crew members for Taiwanese airlines to quarantine at home for just three days after arriving on long-haul flights, down from the previous requirement of five days.

more pilots and their family members were testing positive, as were employees at a quarantine hotel.

On May 10, a pilot who had been in the United States tested positive after completing his three-day quarantine, but not before he had visited a pub and a restaurant in Taipei.

ordered into rolling 14-day home quarantines. But it was probably too late. A cluster of infections began to emerge among workers and patrons at so-called hostess bars in Taipei’s Wanhua District.

By the end of the week, daily case numbers had soared into the triple digits.

So far, the search for new infections has been concentrated in the populous cities of Taipei and New Taipei, where more than 1,600 people can receive rapid testing each day. Hospitals are also providing slower testing services.

Dr. Chiang Kuan-yu, 37, a physician at Taipei City Hospital, went to Wanhua District on Monday to help run a testing site there. He said there had been big crowds over the weekend, when the case numbers first started to rise. Some people had to wait an extra day to get tested.

“Now there are more resources for testing, so we can keep up better,” Dr. Chiang said.

Chen Shih-chung, Taiwan’s health minister and head of its Central Epidemic Command Center, has urged those with no Covid-19 symptoms and no history of contact to not even come to testing sites, lest they become infected there.

“This only will slow down our search for possible spreaders,” Mr. Chen said in a news briefing. “Don’t go there thinking, ‘Oh, maybe I’m infected, maybe it’s best that I get tested.’ You absolutely must not come.”

early March, and it has since been gradually immunizing health workers and other priority groups. Officials say doses of the Moderna vaccine will arrive soon. Several Taiwanese companies are also developing vaccines.

Taiwanese authorities began working with domestic vaccine producers in January 2020, after the coronavirus’s genetic sequence was made available and before the Chinese city of Wuhan went into lockdown.

“Taiwan got started extremely early,” said Dr. Ho Mei-shang, a research fellow at the Institute of Biomedical Sciences at Academia Sinica in Taipei who was involved with the government’s vaccine efforts. “We said at the time, ‘Whatever the vaccine ends up being, we want make it ourselves as quickly as possible.’”

But Taiwan’s insistence on developing and producing its own immunizations may have made officials less quick to snap up overseas vaccines when those started becoming available, Dr. Ho said.

“And then,” she said, “by the beginning of this year, when the pandemic was so severe in so many countries, we just said we’ll wait a little.”

Even after the AstraZeneca vaccine first became available in Taiwan, the low case count meant many people felt no urgent need to get immunized.

Still, Dr. Ho said she was heartened to see how quickly people in Taiwan were adjusting to the new restrictions on daily life, even after such a carefree past year.

Recently, she went for a run at 10 p.m. and forgot to wear her mask at first. But she noticed that even at that hour, everyone else who was out walking and exercising was masked up.

“This is a state of affairs,” she said, “that really sets Taiwan apart.”

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