But the vaccination campaign has slowed down since last month because of supply shortages and the need to start distributing second doses. The number of daily first doses on average last month was 113,000, far below the average of 350,000 daily doses administered in March.

Only those over 38-years-old are currently eligible for vaccination.

It remains unclear whether the country has the vaccine supplies on hand to move rapidly to surge more into communities around the country to speed up vaccinating younger age groups.

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U.K. May Change Vaccine Protocol to Tackle India Covid Variant

The British authorities said on Friday that they are considering changing vaccination protocols and reintroducing local lockdowns to stem the spread of a coronavirus variant first detected in India, a warning sign for countries that are easing restrictions even though their own vaccination campaigns are incomplete.

The numbers of cases involving the variant, known as B.1.617, rose from 520 last week to 1,313 cases this week in Britain, according to official statistics.

The extent to which the variant has spread globally is unclear, because most countries lack the genomic surveillance capabilities employed in England.

That surveillance capability has allowed health officials in Britain to spot the rise of concerning variants more quickly than other nations, offering an early warning system of sorts as a variant seen in one nation almost invariably pops up in others.

might not be quite as effective against B.1.617. The agency said, however, that vaccines were likely to remain potent enough to provide protection from serious illness and death.

British officials have said the variant appears to be more contagious than one detected last year in Kent, southeast of London, which swept across Britain in the winter, forcing the country into one of the world’s longest national lockdowns. The British variant has now been found in countries around the world.

The variant first detected in India has been found in virus sample from 44 countries, the W.H.O. said this week.

The U.N. agency has designated the B.1.617 variant as a variant of concern.

Christina Pagel, a member of a group of scientists advising the government, known as SAGE, said postponing next week’s reopening would avoid “risking more uncertainty, more damaging closures and longer recovery from a worse situation.”

“We need to learn from previous experience,” Dr. Pagel, the director of the Clinical Operational Research Unit at University College London, said on Twitter.

Britain briefly reopened its economy at the end of last year, only to abruptly impose new restrictions that remained in place for months as it fought a deadly wave of infections.

In an attempt to offer at least partial protection to as many people as quickly as possible, Britain spaced injections between doses for two-stage coronavirus vaccines up to 12 weeks after the first vaccines were approved in December. That was far longer than the three- or four-week interval employed by most other countries.

The speedy rollout saved at least 11,700 lives and prevented 33,000 people from becoming seriously ill in England, according to research released by Public Health England on Friday.

But the campaign has slowed down since last month because of supply shortages and the need to start distributing second doses. The number of daily first doses on average last month was 113,000, far below the average of 350,000 daily doses administered in March.

Only those over 38-years-old are currently eligible for vaccination.

Officials suggested Friday that the spread of the B1.617 variant may force a shift in strategy: In areas where the variant is spreading, they may move up the second doses in order to provide stronger protection and allow younger people — at the moment, only those who are at least 38-years-old are eligible to be vaccinated — in multigenerational households to be inoculated.

But it was unclear whether the country had the vaccine supplies on hand to move rapidly.

Mr. Zahawi, the vaccines minister, said Britain would “flex the vaccine program according to the clinical advice.” He also urged people to regularly use free P.C.R. tests that have been available since last month, and to “isolate, isolate, isolate” if they test positive for the coronavirus.

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What to Know About Gaza’s Rocket Arsenal

CAIRO — They smuggle the parts or make their own, aided with know-how from Iran. They repurpose plumbing pipes scavenged from abandoned Israeli settlements and components culled from dud Israeli bombs. They assemble the rockets underground or in dense neighborhoods that the Israelis are reluctant to strike.

Despite Israel’s vaunted surveillance capability and overwhelming military firepower next door, Palestinian militants in Gaza have managed to amass a large arsenal of rockets with enhanced range in the 16 years since Israel vacated the coastal enclave it had occupied after the 1967 war.

Hamas, the militant group that has run Gaza since 2007 and does not recognize Israel’s right to exist, has parlayed the arsenal into an increasingly lethal threat, as seen in the most recent upsurge of hostilities with the Israeli military. By Thursday, Israeli officials said, the militants had fired about 1,800 rockets.

The arsenal pales in comparison to the vast destructive powers of Israel’s air force. But to Israelis, the rockets are the tools of what their country and many others including the United States regard as a terrorist organization, embedded among the nearly two million Palestinian inhabitants of Gaza.

Michael Armstrong, an associate professor of operations research at Brock University in Canada, found a significant increase in the rate of fire. Using numbers from the Israel Defense Forces, Mr. Armstrong, who studies these weapons, cited 470 rockets fired from Gaza during the first 24 hours of the most recent escalation compared to a peak of 192 rockets per day in 2014 and 312 in 2012.

Hamas, he says, also launched more long-range attacks with 130 rockets fired at Tel Aviv late Tuesday, representing close to 17 percent of all fired until that point. In 2014 that rate was at eight percent and in 2012 at less than one percent.

“We still don’t know if Hamas has more long-range rockets, or if they are choosing to use their best stuff first,” Mr. Armstrong said.

Michael Herzog, an Israel-based international fellow at The Washington Institute for Near East Policy and a retired brigadier general in the Israel Defense Forces, said Israeli military and intelligence officials are now far more concerned about the abilities of the militants to produce rockets they once had to import.

“The focus of I.D.F. targeting now is on the production facilities so that when this round of fighting ends, there will not only be less rockets but also less production capabilities for making them,” Mr. Herzog said.

The Gaza militants have openly attributed their success to help supplied by Iran, which Israel regards as its most potent foreign adversary. Iranian officials, too, are not shy about their relationship with Hamas.

Speaking to a large gathering in May 2019, the leader of Hamas in Gaza, Yahya Sinwar, could not have been more explicit in acknowledging Iran’s critical role in assisting Hamas.

“If it wasn’t for Iran’s support,” he said, “we would not have had these capabilities.”

Along with providing smuggled weapons and equipment, Iran has been focused on training to help Hamas upgrade local production, extend the range of rockets and improve their accuracy, according to both Palestinian and Israeli officials and experts.

“It is a huge improvement going from firing one or two rockets at a time to launching 130 rockets in five minutes,” said Rami Abu Zubaydah, a Gaza-based military expert, referring to the frequency of fire seen in the past few days.

“Most weapons are now manufactured in Gaza, using technical expertise from Iran,” he said.

While still having to rely on smuggling parts and raw materials, Hamas leaders say the group has engineered creative workarounds to overcome tighter border controls and surveillance.

A 50-minute documentary broadcast by the Qatari-owned television channel Al Jazeera in September showed rare scenes of Hamas militants recovering dozens of Israeli missiles that had not detonated in previous strikes on Gaza.

They brought the remnants into what looked like a hidden manufacturing facility, carefully extracted the explosives packed inside and recycled some of the parts. The same documentary also showed militants digging up old water pipes from where Israeli settlements used to sit and repurposing the empty cylinders in the production of new rockets.

Referring to the repurposed plumbing pipes, while speaking in another gathering in 2019, Mr. Sinwar said, “There is enough there to manufacture rockets for the coming 10 years.”

Nada Rashwan, John Ismay and Rick Gladstone contributed reporting.

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As Trillions Flow Out the Door, Stimulus Oversight Faces Challenges

WASHINGTON — Lawmakers have unleashed more than $5 trillion in relief aid over the past year to help businesses and individuals through the pandemic downturn. But the scale of that effort is placing serious strain on a patchwork oversight network created to ferret out waste and fraud.

The Biden administration has taken steps to improve accountability and oversight safeguards spurned by the Trump administration, including more detailed and frequent reporting requirements for those receiving funds. But policing the money has been complicated by long-running turf battles; the lack of a centralized, fully functional system to track how funds are being spent; and the speed with which the government has tried to disburse aid.

The scope of oversight is vast, with the Biden administration policing the tail end of the relief money disbursed by the Trump administration last year in addition to the $1.9 trillion rescue package that Democrats approved in March. Much of that money is beginning to flow out the door, including $21.6 billion in rental assistance funds, $350 billion to state and local governments, $29 billion for restaurants and a $16 billion grant fund for live-event businesses like theaters and music clubs.

The funds are supposed to be tracked by a hodgepodge of overseers, including congressional panels, inspectors general and the White House budget office. But the system has been plagued by disagreements and, until recently, disarray.

released a scathing report accusing other Treasury officials of blocking him from conducting more extensive investigations.

Mr. Miller was selected to oversee relief programs managed by the Treasury Department, but the agency’s officials believed his role was to track only a $500 billion pot of money for the Federal Reserve’s emergency lending programs and funds for airlines and companies that are critical to national security. Mr. Miller said that Treasury officials were initially cooperative during the Trump administration, but that after the transition to the new administration started, his access to information dried up.

After Mr. Miller’s requests for program data were denied, he appealed to the Justice Department’s Office of Legal Counsel, which ruled against him last month. His team of 42 people has been left with little to do.

Economic Injury Disaster Loans. But federal oversight experts and watchdog groups say the exact scale of problems in the $2 trillion bipartisan stimulus relief bill in March 2020 is virtually impossible to determine because of insufficient oversight and accountability reporting.

Mr. Miller has been pursuing cases of business owners double dipping from various pots of relief money, such as airlines taking small-business loans and also receiving payroll support funds. The Small Business Administration’s inspector general said last year that the agency “lowered the guardrails” and that 15,000 economic disaster loans totaling $450 million were fraudulent.

The Government Accountability Office also placed the small-business lending programs on its “high risk” watch list in March, warning that a lack of information about the recipients of aid and inadequate safeguards could lead to many more problems than have been reported. The report identified “deficiencies within all components of internal control” in the Small Business Administration’s oversight and concluded that officials “must show stronger program integrity controls and better management.”

proposal to revamp many, but not all, of its procedures.

Oversight veterans and some lawmakers say they want to see a more cohesive approach and more transparency from the Biden administration.

“It is just staggering how little oversight there is,” said Neil M. Barofsky, who was the special inspector general for the Troubled Asset Relief Program from 2008 to 2011. “Not because of the fault of the people who are there, but because of the failure to empower them and give them the opportunity to do their jobs.”

Senator Elizabeth Warren, Democrat of Massachusetts, said she had pushed hard for more oversight last year because she believed that Trump administration officials had conflicts of interest. Despite improvements, she said, the Biden administration could be doing more.

“I kept pushing for more oversight — we got some of it, but not all of what we need,” Ms. Warren said. “We are talking hundreds of billions here.”

She added: “The Biden administration is definitely doing better, but there’s no substitute for transparency and oversight — and we can always do better.”

programs intended to speed $25 billion for emergency housing relief passed last year.

Watchdog groups are wary that speed could sacrifice accountability.

Under Mr. Trump, the Office of Management and Budget, which is responsible for setting policy in federal agencies, refused to comply with all the reporting requirements in the 2020 stimulus that called for it to collect and release data about businesses that borrowed money under the small-business lending programs.

To some observers, Mr. Biden’s budget office has not moved quickly enough to reverse the Trump-era policy. Instead, Mr. Sterling’s team is working on a complex set of benchmarks — tailored to individual programs included in the $1.9 trillion relief bill — which will be released one by one in the coming months.

stymied by disagreements about a program to prop up struggling state and local governments.

Its legally mandated report to Congress was delayed for weeks, and a member of the panel, Bharat Ramamurti, accused his Republican colleagues of stalling the group’s work. Mr. Ramamurti has since left to work for the Biden administration, and the five-person panel now has three commissioners and no chair. Its latest report was only 19 pages.

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Mystery Boxes With Mail-Order Pets Set Off a Backlash in China

HONG KONG — The mystery pet boxes are listed on e-commerce platforms in China as a bargain, priced at little more than a few dollars, and they often contain cuddly animals ready to be mailed straight to your doorstep.

The recipients of the pet “blind boxes.” typically don’t know exactly what’s inside — other than the fact that it’s a dog, a cat, a hamster or an unhatched turtle egg. Though the unauthorized transport of live animals across the country is illegal, that hasn’t stopped vendors from openly holding cheap sales and promising fast deliveries. The practice has become increasingly popular.

But many of the animals have ended up dead or suffering from infections or organ damage during the winding journey through China’s postal system after they have been dispatched by breeders.

dead animals among 13 packages at a depot in eastern China, headed to a village in Jiangsu Province, set off a furor. It was the second instance this month, after about 160 crates containing puppies and kittens were found by animal rescuers in a Chengdu shipping facility.

Video footage of the earlier episode posted by the rescuers of the malnourished animals piled into plastic-wrapped crates circulated widely online, casting harsh scrutiny on the industry and prompting internet users to denounce the maltreatment of the animals.

“We could hear them crying in discomfort,” the Chengdu Love Home Animal Rescue Center wrote on Weibo, the Chinese social media platform, last week after its volunteers worked to feed and revive the animals.

Last September, an animal rescue group said that 5,000 dogs, cats and rabbits were found abandoned in perforated cardboard boxes at a shipping warehouse in Henan Province. As volunteers rushed to rescue the surviving animals, they found that about 4,000 had already died.

Blind boxes promise the thrill of the unexpected and the chance to own a coveted collectible or particular breed of dog at a lower-than-market price. In the past few years, vendors on China’s e-commerce platforms have lured consumers with photos of figurines, comic books, clothes or makeup products. One of the largest manufacturers of blind-box figurines, Pop Mart, entered the Hong Kong stock market in 2020.

China banned the live transport of dogs and cats across provincial boundaries in 2011 without a health certificate signed by a government-approved vet at the animal’s place of origin.

Peter Li, a China policy specialist at the Humane Society International and an associate professor of East Asian politics at the University of Houston-Downtown, said that the mystery pet box phenomenon was not only a “gross inhumanity,” but also a public health risk.

“The fact that China’s surveillance system has failed to capture the illegal trade is because it looks like a normal business operation,” Dr. Li said in an email.

“Those involved in the mystery box ‘business’ are encouraging irresponsible pet ownership, irresponsible consumption habit and encouraging disrespectful behaviors toward nonhuman animals,” he said. “Shipping companies and delivery services have the duty not to handle shipment that is ethically questionable, legally liable and socially toxic.”

He added that while animal-protection groups in mainland China have been encouraging the adoption of rescue animals, the mystery-box model is a supply-driven trade, driven by breeders with too many animals who seek to lure younger customers with the promise of expensive breeds of pets at low prices.

Even among people who have bought mystery boxes of other items, but not pets, there was a recoiling at the idea of mailing animals.

Zhang Luyuan, a 33-year-old staff worker at a tourist attraction in the Chinese city of Fuzhou in Fujian Province, once indulged in blind-box purchases. “Those who buy blind boxes have a bit of wishful thinking and want to get what they want with less money,” he said by phone. But after spending $60 on a mystery box for what he thought were high-quality sport jerseys, he found subpar products inside.

“Since buying that blind box, I learned that meat pies won’t fall from the sky, and I have been buying the products the honest way,” he said, using an idiom similar to “there’s no free lunch.”

He said the delivery of living animals in mystery packages was tantamount to abuse, a lucrative way for breeders perhaps to get rid of those that are ill and unlikely to survive.

ZTO Express, the company behind both botched shipments of animals this month, could not be reached for comment. In a statement on May 4, it apologized for failing to enforce safety laws and said that it needed to “uphold correct life values.”

The company added that it would close the Chengdu delivery facility where the 160 crates were found, would cooperate with the police investigation and would enhance safety training. In another statement on Wednesday, ZTO said it had sought to regulate and reverse the delivery of live animals since May 5. The company added that the animals found in Suzhou were already being returned to their place of origin, but had been stranded at a shipment centers.

The police and postal authorities in Chengdu and Suzhou also could not immediately be reached for comment.

The backlash this month has prompted many breeders to remove their listings from popular e-commerce sites such as Pinduoduo and Taobao.

Li Ruoshui, a 19-year-old university student in Shanghai, said he had bought more than a dozen blind boxes of Harry Potter and anime figurines as gifts over the past two years.

“My sister really enjoys the surprise when opening the box, because you don’t know what you’re going to get,” he said in a phone interview. “I think that’s how blind boxes stand out from other products.”

But he said that the concept of blind boxes should never be extended to living animals, and questioned whether the customers who buy pet boxes actually want to take care of the animals inside or are doing it for the novelty.

“I will never buy pet boxes,” he said. “I like small animals, and transporting them in blind boxes is very unsafe and increases the chances of their abandonment.”

Liu Yi contributed research from Beijing.

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Covid Live Updates: Leaders of Biotech Firm That Ruined Vaccines Will Testify to Congress

opened a sprawling inquiry into Emergent’s manufacturing failures, and whether the company used its contacts with the Trump administration to land hundreds of millions of dollars in coronavirus vaccine contracts.

“Emergent’s actions wasted American taxpayer dollars and reduced the number of doses available for global vaccination efforts,” Representative Jim Clyburn, Democrat of South Carolina and the subcommittee’s chairman, said in a statement to The Times. He said that Congress “is looking for answers and they are long overdue.”

An investigation by The New York Times, published in March before the firm’s vaccine manufacturing troubles were known, examined Emergent’s aggressive lobbying tactics and lucrative relationship with the federal government.

The hearing will put an unwelcome spotlight on the company, which kept a low profile over the past two decades as it cornered the market on sales of anthrax vaccines and other bioterror-related products to the Strategic National Stockpile, the nation’s emergency medical reserve.

Emergent’s stock performed so well in 2020 that Mr. El-Hibri cashed in shares and options worth over $42 million, corporate filings show. Mr. Kramer, who has boasted to investors that “extensive relationships across multiple agencies within the federal government” helped build the company, took home a $1.2 million cash bonus and $2 million in stock awards.

Credit…Joe Andrucyk/Office of Governor Larry Hogan

In an interview with CNN on Wednesday morning, Mr. Clyburn indicated that the committee was also scrutinizing the executives’ market moves. “They all made millions in stock transactions while they seem to be hiding stuff from the public,” he said.

The Times reported last month that workers at Emergent’s Baltimore plant had accidentally conflated the ingredients of two coronavirus vaccines, one by Johnson & Johnson and the other by AstraZeneca. The error resulted in the loss of up to 15 million Johnson & Johnson doses, and a recent inspection by the Food and Drug Administration said that more doses may have been exposed to contamination.

In a statement on Wednesday, the company said that it had responded to the F.D.A.’s observations with a “comprehensive quality enhancement plan” and had “already started making improvements.”

On a recent call with investors, Mr. Kramer announced a management shake-up and took “full responsibility” for the manufacturing problems, acknowledging that the “loss of a batch for a viral contamination is extremely serious, and we treated it as such.” But he also said that Emergent had taken on a “herculean task” in a crisis.

In letters to the two Emergent executives last month, Mr. Clyburn and Representative Carolyn Maloney, Democrat of New York and chairwoman of the House Oversight and Reform Committee, demanded a slew of documents, including any correspondence between the company and Dr. Robert Kadlec, President Trump’s assistant secretary for preparedness and response, who previously consulted for the company. In interviews, Dr. Kadlec has said his consulting work, in 2013 and 2014, was limited and did not affect contracting decisions.

“Emergent has been in the news a lot lately, and that’s frankly not something we’re used to,” Mr. Kramer wrote in a commentary posted on the company’s website last month. “Until a year ago we were a little-known company that does our work behind the scenes.”

The company is trying to burnish its image with television and digital advertising, as part of a campaign it is calling “We Go.” The 30-second ads feature images of white-clad lab technicians and spotlight some of the company’s lesser-known work manufacturing cholera vaccines and medicine used to treat opioid overdoses, as well as its Covid-19 work.

Emergent’s plant in Baltimore is one of two federally designated Centers for Innovation in Advanced Development and Manufacturing, funded in part by taxpayers. In June 2020, the federal government awarded Emergent a $628 million contract, largely to reserve space for coronavirus vaccine manufacturing, despite staffing and quality concerns.

After The Biden administration responded to the potential contamination last month by putting Johnson & Johnson in charge of the Baltimore facility and moving out AstraZeneca. Doses made at the plant have not been cleared for use in the United States, and millions of shots made in Baltimore and sent overseas have also been put on hold.

Medical workers tending to a coronavirus patient in an emergency room in New Delhi last week.
Credit…Adnan Abidi/Reuters

A virus variant that has been spreading rapidly in India and designated a variant of concern by the World Health Organization might be more contagious than most versions of the coronavirus, the agency said in a report it published on Tuesday evening.

The W.H.O. emphasized in its report that it wasn’t yet clear how much the variant, known as B.1.617, had contributed to the devastating surge that has crushed India in recent weeks. It cautioned that India, like many countries, is only sequencing a tiny fraction of positive samples, and that with so little surveillance, it’s difficult to make firm conclusions about B.1.617.

The W.H.O. study comes amid growing condemnation of the Indian government’s response to its ferocious virus wave and calls for nationwide restrictions to try to limit the death toll, as hospitals are overrun and crematories burn nonstop.

India recorded more than 360,000 new cases on Wednesday and more than 4,200 deaths, the country’s highest daily death toll since the pandemic began. India has now reported more than 250,000 deaths from the virus, although experts believe that the true toll is far higher.

Experts also caution that it is not yet clear just how much of a factor B.1.617 has played in the explosion of cases in India. They point to a perfect storm of public health blunders, such as permitting enormous political rallies and religious festivals in recent months. It’s possible that the variant is being lifted up by the surge, rather than the other way around.

The W.H.O. speculated that another variant known as B.1.1.7, first identified in Britain and now dominant in the United States, might also be driving the swell in cases.

It’s not yet clear whether B.1.617 causes more severe Covid-19. Anecdotally, doctors in India are reporting higher numbers of young people and children testing positive for the virus and more patients with severe disease requiring oxygen support. But until more genetic sequencing is done, it’s impossible to know if the variant is to blame.

Stacia Wyman, a genomics scientist at the University of California, Berkeley, said that the W.H.O. had made the right decision. She pointed to the fact that the variant had already spread to at least 49 countries. “This appears to be posing the biggest threat right now in terms of transmissibility, with many countries reporting increasing trajectories of the B.1.617 variant,” she said.

B.1.617 is the fourth variant of concern recognized by the W.H.O. The others include B.1.1.7; B.1.351, which swept through South Africa; and P.1, which has devastated Brazil.

B.1.617 first came to light in October 2020. It had a number of mutations, some of which have been proved worrisome in other variants. Preliminary studies on the mutations suggest that some of them might give the coronavirus a tighter grip on cells, increasing their chances of a successful infection.

Other mutations could make it more difficult for antibodies produced by infections with other variants to stick to them. Studies on antibodies produced by vaccinated people also suggest that they work less successfully against B.1.617. Experts expect that most vaccines will remain effective against the variant.

W.H.O. researchers determined that B.1.617 is spreading fast in India, making up over 28 percent of samples from positive tests. The shift suggests that B.1.617 has a higher growth rate than other variants circulating in India, with the possible exception of B.1.1.7. And B.1.617 has been growing rapidly in Britain.

Gagandeep Kang, a pre-eminent Indian virologist, said there was not enough data to conclude whether either variant was contributing to India’s deadlier second wave.

“There is some conflicting data regarding the B.1.1.7 variant, which seems to indicate in some studies that it does cause more severe disease, in other studies not,” said Dr. Kang, the executive director of the Translational Health Science and Technology Institute in India.

Based on reports from hospitals, Dr. Kang said, it appeared that B.1.617 was causing more severe disease but that, again, there was insufficient data to draw conclusions. She said that real-time genetic information would be needed to determine whether B.1.617-infected people needed more oxygen.

Officials in India are trying to track how many fully vaccinated people have fallen ill. If an unusual number of these so-called breakthroughs are caused by a variant such as B.1.617, then that could point to the variant’s ability to evade a vaccine.

Pramod Sawant, chief minister of Goa, India, on the left and wearing personal protective gear, visited Covid-19 patients at a hospital in Panjim, a city in the state, on Tuesday.
Credit…Goa Chief Minister’s Office, via Agence France-Presse — Getty Images

NEW DELHI — Just a few months ago, the southwestern state of Goa was welcoming tourists from across the rest of India who were drawn to its picture-perfect beaches, an ideal source of relief from coronavirus rules in other regions.

Group celebrations, many without masks, were common. Life appeared to have gone back to normal.

But it did not last.

With India in the grip of a devastating coronavirus outbreak, 26 people died at the state-run Goa Medical College and Hospital on Tuesday morning, possibly because of an oxygen shortage, one official said.

“Due to interrupted supply of oxygen, we feel that between 2 a.m. and 6 a.m. many people are dying in G.M.C.,” the health minister for Goa, Vishwajit Rane, told The Times of India. He also called for a High Court inquiry to investigate the cause of the deaths.

Goa reported 75 deaths in total on Tuesday, its highest daily toll of the pandemic, and there were over 32,800 new daily infections in the state, which has a population of about 1.5 million. Officially, India has surpassed 250,000 total reported deaths from Covid.

Contradicting the health minister, Pramod Sawant, Goa’s chief minister, who visited the hospital, said that there was “no scarcity” and that the state had “abundant supplies of oxygen.” Mr. Rane said the chief minister might be “misguided.”

Goa has been reporting one of the highest infection rates in the country for at least a week.

Mr. Rane said in an interview with CNN last week, “Opening up of tourism without any restrictions in December has led to this situation.”

Goa has also created headlines for approving the use of ivermectin, an anti-parasite drug, in the treatment and prevention of Covid-19. The World Health Organization has said that there is not enough evidence to suggest that the drug reduces mortality in coronavirus patients.

On Monday, Mr. Rane announced on Twitter that the state government would make the drug available for everyone over 18 as a prophylactic.

Patients will be treated with ivermectin for a period of five days, Mr. Rane said, adding that the government would make the drug available at hospitals and primary health centers for people to “start the treatment immediately, irrespective of any symptoms.”

The W.H.O. has warned against the use of the drug, except in clinical trials.

“Safety and efficacy are important when using any drug for a new indication,” said Dr. Soumya Swaminathan, the W.H.O. chief scientist, in a post about ivermectin on Tuesday.

Marisol Gerardo, 9, is held by her mother as she gets a second dose of the Pfizer vaccine during a clinical trial for children at Duke Health in Durham, N.C., in April.
Credit…Shawn Rocco/Duke Health, via Reuters

On May 4, Dr. Hina Talib, who goes by the handle @teenhealthdoc on Instagram, asked the parents among her 33,000 followers if they were hesitant to get the coronavirus vaccine for their 12- to 15-year-olds, and if so, why. Dr. Talib, a physician in the adolescent medicine division at the Children’s Hospital at Montefiore in New York, got 600 messages in response.

More often than not, Dr. Talib said, the parents had already had the Covid-19 vaccine, and would preface their message with: “I’m not an anti-vaxxer or an anti-masker. I’m just worried.”

Although trials have shown no serious safety concerns for children thus far, some recent polls show that only about 30 percent of parents nationwide say they would get their children vaccinated right away. Parents of infants and preschoolers expressed even more anxiety about the vaccine than parents of teenagers.

These parents tend to be concerned about the vaccine affecting puberty and future fertility for their children, and its possible impact on allergies and side effects. Their fears are a key hurdle for U.S. efforts to expand vaccinations to younger teens.

Unloading an oxygen cylinder as a patient lay outside the emergency ward of a hospital in Kathmandu, Nepal, on Monday.
Credit…Niranjan Shrestha/Associated Press

As hospitals in Nepal strain to cope with one of the world’s fastest-growing coronavirus outbreaks, relief groups in the Himalayan nation are asking mountain climbers to hand over their used oxygen cylinders so that they can be refilled for Covid-19 patients.

The unusual appeal reflects the strange duality in Nepal: While hundreds of foreign climbers are attempting costly expeditions to the summits of Mount Everest and other peaks, the impoverished nation down below is facing urgent shortages of hospital beds, medical oxygen, coronavirus test kits and other supplies.

Expedition operators are preparing to airlift thousands of cylinders from the Himalayas as expeditions are completed this month, the culmination of the climbing season. Kul Bahadur Gurung, general secretary of the Nepal Mountaineering Association, estimated that tour companies would be able to provide at least 4,000 cylinders by the first week of June.

“We are asking them not to leave even a single oxygen cylinder in the mountains,” Mr. Gurung said.

Climbers attempting to reach the top of Everest, the world’s tallest peak, and other mountains carry oxygen to help them breathe in the thin air. Although Nepal prohibits leaving equipment behind in the mountains, canisters are sometimes left buried in the snow by exhausted climbers or stashed by expedition companies for later use.

Cylinders used in mountaineering are smaller to those typically found in intensive-care wards, but Mahabir Pun, a prominent Nepali scientist who is helping to lead the cylinder drive, said that they could be used by patients who cannot find a hospital bed or who are being treated at home.

“I.C.U. beds are already filled with critical Covid patients, so we want to distribute these portable expedition cylinders with regulators for those patients staying in home isolation,” Mr. Pun said.

Nepal’s outbreak has surged in recent weeks, most likely fueled by the virus’s catastrophic surge in India, with which it shares a long, porous border. On May 1, Nepal reported 26 deaths from the virus. On Tuesday, the official death toll was 225.

Doctors say that a shortage of medical oxygen is a factor in many of the deaths. Many hospitals have stopped admitting new Covid-19 patients, citing a lack of oxygen. Wealthy families are airlifting their loved ones by chartered helicopter to cities where they can find intensive-care beds. Other patients are being treated in makeshift emergency facilities set up in parking lots and other open spaces.

With almost half of Nepal’s coronavirus tests coming back positive, health experts warn that the worst is yet to come.

China has pledged to provide Nepal with 20,000 oxygen cylinders and 100 ventilators, the first batch of which arrived on Tuesday.

Expedition companies are stepping in with smaller donations. Mr. Gurung’s group said that he was sending five dozen cylinders, along with a few more from a local mountaineering museum, to hospitals treating coronavirus patients.

Mingma Sherpa, chairman of Seven Summit Treks, Nepal’s largest expeditions operator, said that he planned to ship as many as 500 cylinders used in expeditions to Everest and other peaks soon after climbers descended to base camps.

“My only condition is that those cylinders should be used for poor and helpless people rather than V.I.P.s,” he said, adding: “It’s our responsibility to help the government during these trying times. We will do it happily.”

Taking temperatures at a vaccination site in Bangkok on Tuesday.
Credit…Lillian Suwanrumpha/Agence France-Presse — Getty Images

As a resurgent coronavirus threatens countries across Southeast Asia, the health authorities in Thailand are working to contain an outbreak that is ripping through the tight-knit community of gemstone traders in the southeastern reaches of the country near the border with Cambodia.

The town of Chanthaburi — which has a long history as a center of the country’s business in rubies, sapphires and other stones — is at the heart of the outbreak, which has infected at least 166 in the community of traders from Africa who work in the country. At least 103 Thais in the town have also tested positive as a result of the latest outbreak, officials reported.

The cluster of cases comes as Thailand battles its worst outbreak since the pandemic began. For nearly three weeks, the country has averaged about 2,000 new cases a day — more than double its worst peak in January. The largest outbreak has been reported in Bangkok, which is under a partial lockdown.

On Wednesday, the government reported 34 deaths, a record, and 1,983 cases. One of those who died was from Finland.

Thailand was among the most effective countries last year in controlling the virus, but it has been slow to contain outbreaks this year and has lagged behind other countries in procuring vaccines.

Now, with the latest surge in cases, it is scrambling to obtain shots and to develop a mass inoculation program.

Some officials have declared that foreigners will not be vaccinated despite earlier outbreaks among migrant workers from Myanmar and now among the African gemstone traders. Other officials have said that Thailand will inoculate foreigners but have not provided specifics.

Thailand, which has a population of about 70 million, is home to more than two million foreigners who live in the country legally. More than two million more are believed to live in the country illegally.

Over the years, the gem business has attracted traders from several predominantly Muslim countries in Africa, including Gambia, Guinea and Mali. Many of them have settled in Thailand, married Thai wives and import gemstones from Africa.

Sankung Kongeh, a trader from Gambia, said members of the African community gathered daily at their offices and at the market, where they work, talk and eat together. During Ramadan, which began April 12, many also have prayed together, he said.

It is precisely that kind of close social contact that has fueled outbreaks around the world, but Mr. Kongeh discounted the group prayers as a significant risk.

“The possibility of the Covid spread has nothing to do with praying together,” said Mr. Kongeh, who recently tested negative. “It’s during the time hanging out at the office where we have the AC on, the door closed, and we chat with each other, drinking hot tea. There could be 10 or 12 of us sitting together. We don’t talk to each other during prayer.”

“Current institutions, public and private, failed to protect people from a devastating pandemic,” according to new reports delivered to the World Health Organization today. The Minneapolis-St. Paul International Airport in Minneapolis last November.
Credit…Tim Gruber for The New York Times

The next time the world faces an outbreak of a fast-spreading and deadly new pathogen, governments must act swiftly and be ready to restrict travel or mandate masks even before anyone knows the extent of the threat, according to a pair of new reports delivered to the World Health Organization.

The studies are intended to address missteps over the past year that led to more than 3.25 million deaths, some $10 trillion in economic losses and more than 100 million people pushed into extreme poverty.

“Current institutions, public and private, failed to protect people from a devastating pandemic,” concluded one of the reports, released on Wednesday, which called the Covid-19 pandemic “the 21st century’s Chernobyl moment.”

“Without change,” it said, these institutions “will not prevent a future one.”

The reviews, released in advance of this month’s meeting of the W.H.O.’s governing assembly, were written by appointees who donated countless hours in the midst of their own countries’ pandemic fights to interview hundreds of experts, comb through thousands of documents, gather data and seek counsel from public and private institutions around the world.

Pandemics, the authors concluded, are an existential threat on the order of a chemical or nuclear weapon, and preparing for them must be the responsibility of the highest levels of political leadership rather than only health departments, which are often among the least powerful of government agencies.

Aurora Duran, 86, is hugged by her granddaughter during a visit from her family at a long-term-care nursing community in Fort Stockton, Tex.. in April.
Credit…Tamir Kalifa for The New York Times

Epidemiologists in the United States are starting to hug again, running errands, gathering outdoors with friends and getting haircuts.

In a new informal survey this month by The New York Times, 723 epidemiologists responded to questions about how they were navigating this in-between phase of the pandemic, when vaccines have become widespread and cases are declining but herd immunity is not assured and Covid-19 remains a threat.

More than at any time in the past year, most are feeling hopeful that Covid-19 will eventually become just another risk in daily life, but not one that paralyzes us.

Nevertheless, their advice was to hold on to most precautions just a bit longer.

“There is a strong likelihood that we will experience unexpected problems due to moving about as if the Covid pandemic was no longer a threat,” said Jana Mossey, an epidemiologist who retired from Drexel University.

“It is not ‘one size fits all,’” said Alicia Riley, a sociologist and epidemiologist at the University of California, San Francisco, expressing a version of the profession’s unofficial motto: It depends. “How safe it is depends on the local levels of community transmission.”

Governor Henry McMaster of South Carolina signing a bill on April 22 requiring schools to provide in-person classes five days a week starting on April 26, in Columbia, S.C. 
Credit…Jeffrey Collins/Associated Press

Parents in South Carolina will be able to opt their children out of mask requirements in public schools, effectively ending mask mandates for schools throughout the state, according to an executive order signed by the governor that defies Centers for Disease Control and Protection guidance.

The order signed on Tuesday by Gov. Henry McMaster, a Republican, also prevented South Carolina’s local governments from using previously issued orders or states of emergency to enforce mask mandates and barred the use of “vaccine passports” in the state. South Carolina was one of several states that never had a statewide mask mandate, though several counties and cities imposed their own.

At least one school district said its legal counsel was reviewing the order. Doing away with masks in schools conflicts with C.D.C. guidance, which recommends universal masking combined with at least three feet of social distancing.

“Everybody knows what we need to do to stay safe — including wearing a mask if you’re at risk of exposing others — but we must move past the time of governments dictating when and where South Carolinians are required to wear a mask,” Mr. McMaster said in a statement, noting the availability of vaccines and falling coronavirus cases. “Maintaining the status quo ignores all of the great progress we’ve made.”

Mr. McHenry’s announcement comes as leaders in other states and cities have announced a rollback of restrictions and vaccines have become available to any adult. Mayor Muriel Bowser of Washington said on Monday that most of the city’s restrictions, including capacity limits, time restrictions and limits on types of activities would be lifted on May 21. Capacity limits on bars, nightclubs, and large sports and entertainment venues would be lifted June 11.

Mayor Jim Kenney of Philadelphia announced on Tuesday that all restrictions except the mask mandate would be lifted on June 11. The announcement came a week after Governor Tom Wolfe of Pennsylvania said that all restrictions related to gatherings, businesses and restaurants would be lifted on May 31 and that the statewide mask mandate would be lifted when 70 percent of adults in the state had been vaccinated. But the announcement came with the caveat that municipalities and school districts could continue or implement stricter mitigation efforts, despite the state’s easing restrictions.

The governor directed the Department of Health and Environmental Control and the Department of Education to develop a standardized form for opting out, the statement said.

Buying protective face masks following a small outbreak of coronavirus disease in Taipei, Taiwan, on Wednesday.
Credit…Ann Wang/Reuters

Growing concerns in Taiwan about a small but worsening coronavirus outbreak drove a sharp intraday plunge in its stock market on Wednesday, as investors worried about new government restrictions on businesses in a place that has largely escaped the pandemic.

On Wednesday morning, Taiwan’s health minister, Chen Shih-chung, said that the island’s new outbreak has reached a “very severe stage” and that restrictions could be upgraded in “the coming days.” He spoke after the government reported 16 new cases of local infection on Wednesday and seven on Tuesday.

The Taiwan Stock Exchange weighted index slumped as much as 8.6 percent intraday following the news, a nearly 13 percent loss from its April peak. The market regained some ground later in the day and finished down 4.1 percent.

Taiwan has been a rare success story in a pandemic-stricken world. The island democracy threw up its borders when the pandemic first began to spread from mainland China and has heavily limited travel. It has recorded only 1,210 total cases, according to a tally by The New York Times.

But the authorities haven’t been able to trace the handful of cases that have popped up in recent days, raising questions about whether the government will limit the number of people who can gather within restaurants or other businesses.

Taiwan instituted some Covid-related restrictions on Tuesday, the first in a long time. It suspended large events, limiting outdoor gatherings to 500 people and indoor gatherings to 100 people. On Wednesday morning, the health minister said that the restrictions might be stiffened within days.

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Hundreds Hurt in Clashes at Aqsa Mosque as Tension Rises in Jerusalem

JERUSALEM — Hundreds were injured as clashes between Israeli police and Palestinian protesters broke out Monday morning at the Aqsa mosque compound in Jerusalem, a site sacred to both Muslims and Jews, after a week of rising tension in the city. Police fired rubber-tipped bullets and stun grenades at stone-throwing Palestinians who had stockpiled stones at the site in expectation of a standoff with Jewish far-right groups.

By midmorning, more than 50 people had been transferred to the hospital, according to a representative of the Palestinian Red Crescent. One person was hit in the head by a bullet and was in a critical condition, the medical aid group said. Nine police officers were injured, a police spokesman said.

Videos posted on Twitter showed chaos both outside and inside the mosque, where some worshipers could be seen sheltering from explosions while others threw stones and set off fireworks. In another clip, police officers were seen striking a man being detained in part of the mosque compound.

Another video released by the police showed young men throwing stones from the perimeter of the mosque compound onto the land below. A separate clip, taken by a surveillance camera, appeared to show a Jewish man driving into a passer-by after stones hit his car.

Jerusalem Day is always fraught. But the atmosphere was especially febrile on Monday because the confrontations followed weeks of escalating tensions in the city, where restrictions on Palestinian access to the Old City during the holy month of Ramadan, a far-right march through the city center in April, and street assaults by both Jews and Arabs have all contributed to a feverish atmosphere.

the looming expulsion of several Palestinian families from their homes in Sheikh Jarrah, East Jerusalem. For Palestinians and their advocates, the case has become a stand-in for the wider campaign to force out Palestinians from parts of East Jerusalem and for their past displacement in the occupied territories and within Israel.

Tensions escalated again Friday night, as the police fired rubber-tipped bullets and stun grenades and Palestinians threw stones following prayers at the Aqsa compound. Video showed some grenades landing inside the mosque.

Militants in Gaza fired rockets into Israel overnight Sunday, after sending incendiary balloons into Israeli farmland for the past several days. Israel has returned fire, barred fishermen from the territory from accessing the sea and shut a key crossing between Gaza and Israel — but avoided a major escalation.

was postponed on Sunday, in part to diffuse these rising tensions. The Israeli police also made a last-minute decision Monday morning to block Jews from accessing the Aqsa compound, known to Jews as the Temple Mount and to Muslims as the Noble Sanctuary.

The Palestinian Authority recently canceled what would have been the first Palestinian elections in 15 years.

And after a fourth Israeli election in just two years, Israeli opposition parties are locked in negotiations to form a coalition government and replace Benjamin Netanyahu, the country’s prime minister. Mr. Netanyahu is serving in a caretaker capacity as he stands trial on corruption charges.

Myra Noveck contributed reporting from Jerusalem and Iyad Abuheweila from Gaza City.

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Online Cheating Charges Upend Dartmouth Medical School

HANOVER, N.H. — Sirey Zhang, a first-year student at Dartmouth’s Geisel School of Medicine, was on spring break in March when he received an email from administrators accusing him of cheating.

Dartmouth had reviewed Mr. Zhang’s online activity on Canvas, its learning management system, during three remote exams, the email said. The data indicated that he had looked up course material related to one question during each test, honor code violations that could lead to expulsion, the email said.

Mr. Zhang, 22, said he had not cheated. But when the school’s student affairs office suggested he would have a better outcome if he expressed remorse and pleaded guilty, he said he felt he had little choice but to agree. Now he faces suspension and a misconduct mark on his academic record that could derail his dream of becoming a pediatrician.

“What has happened to me in the last month, despite not cheating, has resulted in one of the most terrifying, isolating experiences of my life,” said Mr. Zhang, who has filed an appeal.

Dartmouth recently accused of cheating on remote tests while in-person exams were shut down because of the coronavirus. The allegations have prompted an on-campus protest, letters of concern to school administrators from more than two dozen faculty members and complaints of unfair treatment from the student government, turning the pastoral Ivy League campus into a national battleground over escalating school surveillance during the pandemic.

insecure, unfair and inaccurate.

cease using the exam-monitoring tools.

“These kinds of technical solutions to academic misconduct seem like a magic bullet,” said Shaanan Cohney, a cybersecurity lecturer at the University of Melbourne who researches remote learning software. But “universities which lack some of the structure or the expertise to understand these issues on a deeper level end up running into really significant trouble.”

At Dartmouth, the use of Canvas in the cheating investigation was unusual because the software was not designed as a forensic tool. Instead, professors post assignments on it and students submit their homework through it.

That has raised questions about Dartmouth’s methodology. While some students may have cheated, technology experts said, it would be difficult for a disciplinary committee to distinguish cheating from noncheating based on the data snapshots that Dartmouth provided to accused students. And in an analysis of the Canvas software code, The Times found instances in which the system automatically generated activity data even when no one was using a device.

“If other schools follow the precedent that Dartmouth is setting here, any student can be accused based on the flimsiest technical evidence,” said Cooper Quintin, senior staff technologist at the Electronic Frontier Foundation, a digital rights organization, who analyzed Dartmouth’s methodology.

Seven of the 17 accused students have had their cases dismissed. In at least one of those cases, administrators said, “automated Canvas processes are likely to have created the data that was seen rather than deliberate activity by the user,” according to a school email that students made public.

The 10 others have been expelled, suspended or received course failures and unprofessional-conduct marks on their records that could curtail their medical careers. Nine pleaded guilty, including Mr. Zhang, according to school documents; some have filed appeals.

Dr. Compton acknowledged that the investigation had caused distress on campus. But he said Geisel, founded in 1797 and one of the nation’s oldest medical schools, was obligated to hold its students accountable.

“We take academic integrity very seriously,” he said. “We wouldn’t want people to be able to be eligible for a medical license without really having the appropriate training.”

Instructure, the company that owns Canvas, did not return requests for comment.

In January, a faculty member reported possible cheating during remote exams, Dr. Compton said. Geisel opened an investigation.

To hinder online cheating, Geisel requires students to turn on ExamSoft — a separate tool that prevents them from looking up study materials during tests — on the laptop or tablet on which they take exams. The school also requires students to keep a backup device nearby. The faculty member’s report made administrators concerned that some students may have used their backup device to look at course material on Canvas while taking tests on their primary device.

administrators held a virtual forum and were barraged with questions about the investigation. The conduct review committee then issued decisions in 10 of the cases, telling several students that they would be expelled, suspending others and requiring some to retake courses or repeat a year of school at a cost of nearly $70,000.

Many on campus were outraged. On April 21, dozens of students in white lab coats gathered in the rain in front of Dr. Compton’s office to protest. Some held signs that said “BELIEVE YOUR STUDENTS” and “DUE PROCESS FOR ALL” in indigo letters, which dissolved in the rain into blue splotches.

Several students said they were now so afraid of being unfairly targeted in a data-mining dragnet that they had pushed the medical school to offer in-person exams with human proctors. Others said they had advised prospective medical students against coming to Dartmouth.

“Some students have built their whole lives around medical school and now they’re being thrown out like they’re worthless,” said Meredith Ryan, a fourth-year medical student not connected to the investigation.

That same day, more than two dozen members of Dartmouth’s faculty wrote a letter to Dr. Compton saying that the cheating inquiry had created “deep mistrust” on campus and that the school should “make amends with the students falsely accused.”

In an email to students and faculty a week later, Dr. Compton apologized that Geisel’s handling of the cases had “added to the already high levels of stress and alienation” of the pandemic and said the school was working to improve its procedures.

The medical school has already made one change that could reduce the risk of false cheating allegations. For remote exams, new guidelines said, students are now “expected to log out of Canvas on all devices prior to testing.”

Mr. Zhang, the first-year student, said the investigation had shaken his faith in an institution he loves. He had decided to become a doctor, he said, to address disparities in health care access after he won a fellowship as a Dartmouth undergraduate to study medicine in Tanzania.

Mr. Zhang said he felt compelled to speak publicly to help reform a process he found traumatizing.

“I’m terrified,” he said. “But if me speaking up means that there’s at least one student in the future who doesn’t have to feel the way that I did, then it’s all worthwhile.”

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The Separate Worlds of Bill and Melinda Gates

“It was a constant tension point of the foundation. It was Warren who limited it, but Bill’s appetite is always, ‘We should do this, we should do this.’ Teams end up with this massive to-do list,” the former executive said.

Mr. Buffett acknowledged in an interview with The Times last year that he opposed institutional bloat. “That’s the one piece of advice I don’t shut up on, ever, because it’s the natural tendency of every organization,” he said.

Employees at the foundation often have to wear multiple hats to keep up with the demands. For instance, one staff member, Anita Zaidi, serves in the highly technical role of director of vaccine development and surveillance but also serves as president for gender equality.

Mr. Gates famously gave a TED Talk in 2015 warning about the global threat posed by contagious respiratory viruses. The foundation was packed with top talent working on developing new vaccines. It did not, however, have a single person out of roughly 1,600 staff members devoted full time to pandemics before the Covid-19 outbreak began.

For all the workarounds with contract employees and consultants, there was only so much bandwidth, and the decision was made not to have a dedicated team working on the matter. Instead the foundation threw its weight behind the Coalition for Epidemic Preparedness Innovations, which helped develop vaccines to combat outbreaks.

When the pandemic struck, the foundation put its resources and expertise to work. It has dedicated $1.75 billion to combating the pandemic so far and played a key role in shaping the global response.

Even without the divorce, the foundation was in the midst of change. Mr. Buffett, the third trustee, turns 91 this summer. Mr. Gates’s father, Bill Gates Sr., who was co-chair and a guiding hand at the foundation, died this past September. Some observers have wondered if the couple’s three children could get involved soon. The elder two are already in college and medical school. Others have raised the possibility that this is the moment to loosen the family’s grip and install a board drawn from professionals outside the inner circle.

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Covid-19 Live Updates: Pfizer Seeks Full F.D.A. Approval for Its Vaccine

their Covid-19 vaccine for use in people 16 and older. The vaccine is currently being administered to adults in America under an emergency use authorization granted in December.

The approval process is likely to take months.

The companies said in a statement on Friday that they had submitted their clinical data, which includes six months of information on the vaccine’s safety and efficacy, to the F.D.A. They plan to submit additional material, including information about the manufacturing of the vaccine, in the coming weeks.

“We are proud of the tremendous progress we’ve made since December in delivering vaccines to millions of Americans, in collaboration with the U.S. government,” Dr. Albert Bourla, Pfizer’s chief executive, said in the statement. “We look forward to working with the F.D.A. to complete this rolling submission and support their review, with the goal of securing full regulatory approval of the vaccine in the coming months.”

As of Thursday, more than 134 million doses of the vaccine had been administered in the United States, according to the Centers for Disease Control and Prevention. Full approval would allow Pfizer and BioNTech to market the vaccine directly to customers.

It could also make it easier for companies, government agencies and schools to require vaccinations. The Equal Employment Opportunity Commission said in December that employers could mandate vaccination, and legal experts have generally agreed.

Many companies have been hesitant to require the vaccines, especially while they have only emergency authorization, which is designed to be temporary. Some institutions, like the University of California and California State University systems, have said that they would do so only after a vaccine has full approval.

Full approval could also prompt the U.S. military, which has had low uptake of Covid-19 vaccines, to mandate vaccinations for service members.

If the F.D.A. grants full approval, it could also help raise confidence in the vaccine. The pace of vaccination has slowed in the United States in recent weeks, and a recent national survey indicated that most people in the country who planned to get the shots had already done so.

The agency is also expected to issue an emergency authorization for use of the Pfizer-BioNTech vaccine in 12- to 15-year-olds next week. The companies have said that they plan to file for emergency authorization for 2- to 11-year-olds in September.

Moderna plans to apply for full approval for its Covid-19 vaccine this month, the company said during its quarterly earnings call on Thursday.

Director of the Center for the National Center for Immunization and Respiratory Diseases Dr. Nancy Messonnier spoke in Washington in January 2020.
Credit…Amanda Voisard/Reuters

Dr. Nancy Messonnier, who famously warned the nation early last year that the coronavirus would upend their lives, resigned from her position at the Centers for Disease Control and Protection on Friday.

Dr. Messonnier’s resignation is effective May 14. She is taking on a new role as an executive director at the Skoll Foundation, a philanthropical organization based in Palo Alto, Calif., she told staff in an email on Friday.

Her exit may augur more changes at the agency. Reports have circulated for weeks that the C.D.C.’s new director, Dr. Rochelle Walensky, planned to completely reorganize the division Dr. Messonnier led.

“My family and I have determined that now is the best time for me to transition to a new phase of my career,” Dr. Messonnier wrote in the email to staff.

Dr. Messonnier began her career in public health in 1995 with a stint in the prestigious Epidemic Intelligence Service. She has since held a number of leadership posts in the C.D.C. Since 2016, she has served as director of the National Center for Immunization and Respiratory Diseases, the C.D.C. division responsible for managing influenza and other respiratory threats.

In late 2019, she became the agency’s lead in responding to the coronavirus, and initially shared a stage with President Trump at briefings about the coronavirus.

She fell out of favor with President Trump and sent stocks tumbling after she sounded a dire alarm about the coronavirus, saying it would disrupt the lives of every American.

“It’s not a question of if this will happen but when this will happen and how many people in this country will have severe illnesses,” she said on Feb. 25, just as Mr. Trump was boarding Air Force One in New Delhi for his flight home.

Soon after that, she stopped appearing at briefings of the White House and of the C.D.C.

Patients with Covid-19 in the emergency ward at the Holy Family hospital in New Delhi on Thursday.
Credit…Rebecca Conway/Getty Images

India’s worsening coronavirus outbreak has spread far outside its cities to rural areas with poor health care infrastructure and limited testing capacities, doctors and experts say.

One factor behind the surge of cases, they believe, is a series of recent campaign rallies held without social distancing.

The state of West Bengal, where Prime Minister Narendra Modi’s party lost an election last week after more than a month of campaigning to vast crowds, is recording the highest rate of positive coronavirus tests in the country. More than 31 percent of tests in the state are now coming back positive.

“There is a clear pattern here: States that went through elections and where large rallies were held are witnessing a huge rise in cases,” said Dr. Thekkekara Jacob John, a senior virologist in the southern state of Tamil Nadu.

In Uttar Pradesh, India’s most populous state, 1,028 new coronavirus cases and four deaths were recorded on March 26. On April 29, after campaigns for local village council elections were held, there were 35,104 cases and 288 deaths. A teachers’ union in the state said that 577 teachers and support staff members who were on duty as election workers had died of Covid-19.

The country’s cases as a whole have been skyrocketing since late March, from a seven-day average of more than 62,000 on March 31 to more than 385,000, according to the Our World in Data project at the University of Oxford. On Friday, the country reported more than 410,000 new daily infections, a record, and more than 3,900 deaths.

As the outbreak reaches new heights, India’s vaccination campaign has slowed down, marred by supply shortages and competition among states.

The official daily death in the country has stayed over 3,000 over the past 10 days, and experts say the numbers are much higher,.

The true scope of the outbreak remains hard to measure. Nationwide, India conducted about 1.9 million coronavirus tests on Thursday, an increase from about 1.2 million daily tests last month, but hardly enough to keep up with a daily caseload that has almost quadrupled in that time.

West Bengal, a state of 90 million people that has poor health care infrastructure and is under a partial lockdown, has carried out fewer than 60,000 coronavirus tests a day. That is one of the lowest rates in the country, according to data compiled by researchers at the University of Michigan.

Dr. Abhijeet Barua, a physician in Kolkata, the state’s capital, said that cases had exploded in every corner of the city and that infections were spreading quickly in the state’s rural areas. At his 10-bed clinic, two people have died every day over the past 15 days, Dr. Barua said.

“What is making things worse in Kolkata is that over 70 percent of the population lives in close contact,” he said, adding that he was receiving dozens of calls a day from patients seeking help. “You can’t isolate yourself, because it is so congested here.”

Mr. Modi has repeatedly refrained from imposing a nationwide lockdown. Instead nearly a dozen of India’s 28 states have imposed restrictions, though they are less stringent than the nationwide lockdown put in place last year.

Protective masks are worn in March in Tokyo, the host of this summer’s Olympic Games.
Credit…Noriko Hayashi for The New York Times

TOKYO — Japan on Friday extended a state of emergency in Tokyo and other regions until the end of May to contain a surge of coronavirus cases, casting further doubt on the country’s ability to safely host the Summer Olympics, which are scheduled to begin in 11 weeks.

Prime Minister Yoshihide Suga made the announcement at a meeting of the government’s coronavirus task force, saying that the measures were necessary because infections remain at a “high level, mainly in large cities.”

The announcement extends emergency measures imposed last month to two more prefectures, covering a total of six prefectures, including Tokyo and Osaka, that are together home to over a third of Japan’s 126 million people. Another eight prefectures will be under slightly looser restrictions.

The existing state of emergency, which were imposed to curb travel during the just-ended Golden Week holiday period and had been set to expire next week, have not slowed Japan’s fourth wave of coronavirus infections. In early March, the country recorded about 1,000 daily new. It is now recording nearly 6,000, according to a New York Times database.

Health officials say that they are seeing a growing number of cases of coronavirus variants spreading in the population, including at least 26 cases of the strain first detected in India. The authorities in Tokyo say that in four out of five cases found in the city, the infected person neither traveled abroad nor had close contact with someone who had.

The outbreak is stretching health care systems even in Japan’s biggest cities. On Thursday, there were 370 people being treated for serious cases of Covid-19 in Osaka, a prefecture of nine million people, more than the number of hospital beds available for seriously ill patients.

Japan, which has recorded more than 620,000 infections and 10,000 deaths since the start of the pandemic, has controlled the virus better than many countries. But the government has faced criticism for the sluggish pace of vaccinations, and for pledging to go ahead with the Tokyo Olympics, scheduled to begin on July 23, despite widespread public opposition.

Toru Hashimoto, a lawyer and a former governor of Osaka prefecture, said on a television show on Friday that Olympic organizers were ignoring the severity of Japan’s outbreak, and that it was inappropriate to continue holding pre-Olympic “test events” during the state of emergency, even though they are taking place without spectators.

“If the government wants to reduce the number of people in the city, it’s not a time when test events can be held,” Mr. Hashimoto said.

The government has imposed two previous states of emergency during the pandemic, although they are looser than the total lockdowns seen in many nations. The measures allow the prefectures to ask businesses to close or to restrict their hours, and to fine those that do not.

Under the extended state of emergency, people are asked not to go out for nonessential matters, especially after 8 p.m., and to refrain from traveling outside their prefectures. Karaoke parlors are asked to close, and restaurants requested not to serve alcohol, with fines of up to 300,000 yen, or $2,750, for noncompliance.

A vaccination center in Johannesburg in March.
Credit…Joao Silva/The New York Times

A global debate is heating up over how to get Covid-19 vaccines to the nations most in need.

The United States is supporting an effort to suspend intellectual property protections on Covid-19 vaccines, and European countries say that richer nations should begin exporting more of their vaccine supply to poorer ones.

The European Union — whose approval is needed for any waiver of vaccine patents — said on Thursday that it would consider the Biden administration’s proposal. But Germany, the bloc’s largest economy, said that pushing pharmaceutical companies to share vaccine patents could have “significant implications” for the production of vaccines.

“The limiting factor in vaccine manufacturing is production capacity and high-quality standards, not patents,” a spokeswoman for Chancellor Angela Merkel of Germany said in a statement.

On Friday, Canada shared similar concerns. “Our government firmly believes in the importance of protecting intellectual property and recognizes the integral role that industry has played in innovating to develop and deliver lifesaving Covid-19 vaccines,” the minister of small businesses, Mary Ng, said in a statement.

She added many barriers to vaccine access, like supply shortages, were unrelated to intellectual property.

The European Commission president, Ursula von der Leyen, said the bloc was “ready to discuss any proposals that address the crisis in an effective and pragmatic manner.”

She also suggested, however, that the focus should be on getting more vaccines to countries that needed them by following the bloc’s example in allowing significant exports of doses. The United States has balked at that approach, keeping most doses produced domestically for use at home.

“We call upon all vaccine-producing countries to allow export and to avoid measures that disrupt the supply chains,” Ms. von der Leyen said.

The European statements emphasized the challenges of winning E.U. support for the waivers at the World Trade Organization, where the bloc wields significant influence, and where unanimous approval would be needed for any measure to suspend patents.

Many experts believe that the waivers are needed to expand the manufacturing of vaccines and get them to poorer parts of the world where inoculations have far lagged behind those of richer countries.

Until the Biden administration’s announcement this week, the United States had been a major holdout at the W.T.O. over a proposal by India and South Africa to suspend some intellectual property protections. The move could give drugmakers access to the trade secrets of how the vaccines are made.

The pharmaceutical industry has argued that suspending patent protections would undermine risk-taking and innovation.

“Who will make the vaccine next time?” Brent Saunders, the former chief executive of Allergan, which is now part of AbbVie, wrote on Twitter.

But Stephane Bancel, the chief executive of Moderna, told investors on Thursday, “We saw the news last night, and I didn’t lose a minute of sleep.”

Mr. Bancel said his company never planned to enforce the patent because few, if any, other drug makers can easily manufacture mRNA, the genetic script that carries DNA instructions to each cell’s protein-making machinery.

The debate arises amid a growing divide between wealthy nations that are slowly regaining normal life, and poorer countries that are confronting new and devastating outbreaks.

In India, which is suffering the world’s worst outbreak since the start of the pandemic, only 2.2 percent of the population is fully vaccinated, according to a New York Times database. South Africa has fully vaccinated less than 1 percent of its people. By contrast, vaccinations are slowing down in the United States — where one-third of people are fully inoculated — as they begin to pick up in Europe.

If the European Union agrees to support patent waivers, it would take months for developing nations to see the impact. Ngozi Okonjo-Iweala, the head of the W.T.O., told The Washington Post that she would press member countries to reach an agreement by Dec. 3.

Even if a waiver receives support from the trade body, it alone would not increase the world’s vaccine supply. Large drug manufacturers in India and elsewhere would need extensive technological and other support to produce doses, experts say.

Lifting intellectual property protections “is only one element,” said Anant Bhan, a health researcher at Melaka Manipal Medical College in southern India. Because of the additional steps required to begin making a vaccine on a huge scale, he said, “it is not going to mean increased access to vaccines in the near future.”

The American jobs engine slowed markedly last month, confounding rosy forecasts of the pace of the recovery and sharpening debates over how best to revive a labor market that was severely weakened by the coronavirus pandemic.

Employers added 266,000 jobs in April, the government reported Friday, far below the vigorous gains registered in March. The jobless rate rose slightly to 6.1 percent, as more people rejoined the labor force.

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“It turns out it’s easier to put an economy into a coma than wake it up,” Diane Swonk, chief economist for the accounting firm Grant Thornton, said of the disappointing report. “It’s understandable, it’s going to take some time, you’re not just going to snap your fingers and get everyone back to work,

Economists had forecast an addition of about a million jobs. The increase for March was revised down to 770,000 from 916,000.

The Alliance for American Manufacturing blamed supply chain problems for the loss of 18,000 jobs in that sector, noting in particular the impact that a shortage of semiconductors has had on the automotive industry.

And many offices are not yet ready to reopen fully. “I just think it takes a while for businesses to figure out how many people they need,” Ms. Swonk said, noting there is still a lot of skittishness on the part of employers and workers. “I don’t view this as terribly troubling or distressing.”

Ben Herzon, executive director of U.S. economics at the financial services company IHS Markit, agreed. “A single report with unexpected weakness in job gains is not a cause for concern,” he said. “Demand is picking up, activity is picking up.”

He noted that labor force participation had been on the upswing for two months in a row, rising to 61.7 percent last month from 61.4 percent in February.

More opportunities are bubbling up as coronavirus infections ebb, vaccinations spread, restrictions lift and businesses reopen. Job postings on the online job site Indeed are 24 percent higher than they were in February last year.

“There’s been a broad-based pickup in demand,” said Nick Bunker, who leads North American economic research at the Indeed Hiring Lab. The supercharged housing market is driving demand for construction workers. There is also an abundance of loading, stocking and other warehousing jobs — a side-effect of the boom in e-commerce.

The economy still has a lot of ground to regain before returning to prepandemic levels. Millions of jobs have vanished since February 2020, and the labor force has shrunk.

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As the economy fitfully recovers, there are divergent accounts of what’s going on in the labor market. Employers, particularly in the restaurant and hospitality industry, have reported scant response to help-wanted ads. Several have blamed what they call overly generous government jobless benefits, including a temporary $300-a-week federal stipend that was part of an emergency pandemic relief program.

But there are other forces constraining the return to work. Millions of Americans have said that health concerns and child care responsibilities — with many schools and day care centers not back to normal operations — have prevented them from returning to work. Millions of others who are not actively job hunting are considered on temporary layoff and expect to be hired back by their previous employers once more businesses reopen fully. At the same time, some baby boomers have retired or switched to working part time.

An 18-year-old student received a shot of a coronavirus vaccine in Los Angeles last month.
Credit…Etienne Laurent/EPA, via Shutterstock

A series of vaccine developments and the loosening of restrictions amid an improving virus trajectory may foreshadow a welcome return to normalcy for many young Americans, just as summer vacation nears.

By early next week, the Food and Drug Administration is expected to issue an emergency use authorization allowing the Pfizer-BioNTech coronavirus vaccine to be used in children 12 to 15 years old, a major step ahead in the United States’ efforts to tackle Covid-19. Pfizer also expects to seek federal clearance in September to administer the vaccine to children age 2 to 11, the company said on Tuesday.

Vaccinating children is key to raising the level of immunity in the population, experts say, and to bringing down the numbers of hospitalizations and deaths. It could also put school administrators, teachers and parents at ease if millions of adolescent students become eligible for vaccination before the next academic year begins.

The move would be a major leap forward, experts say, and comes as the director of the Centers for Disease Control and Prevention, Dr. Rochelle Walensky, said that vaccinated adolescents would be able to remove their masks outdoors at summer camps.

Yet the eagerness of parents to let their children be vaccinated is limited, according to a new national poll, which found that three in 10 parents surveyed said they would get their children vaccinated right away and 26 percent said they wanted to wait to see how the vaccine was working. About 23 percent said they would definitely not get their children vaccinated, and 18 percent said they would do so only if a child’s school required it. The survey also noted that only 9 percent of respondents said they had not yet gotten a shot but still intended to do so, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.

As health experts focus on the future of vaccinating children, a growing number of students have returned to in-person learning this school year. In March, 54 percent of K-8 schools were open for full-time in-person learning, and 88 percent were open for either full-time in-person and/or hybrid learning, according to data from a federal government survey released on Thursday. But Black, Hispanic and Asian students are enrolled in full-time in-person learning at much lower rates than white students.

The Biden administration has made an aggressive push for reopening schools in recent months, including an effort to prioritize vaccinations for teachers and employees.

Administering the AstraZeneca vaccine in Nottingham, England, last month.
Credit…Oli Scarff/Agence France-Presse — Getty Images

Britain’s vaccines regulator advised on Friday that all adults under 40 in the country should be offered alternatives to AstraZeneca’s Covid-19 vaccine. It factored in concerns over very rare blood clots, the dwindling risk of severe coronavirus infection in younger adults and the availability of alternatives.

The guidance extends earlier advice that people under 30 would be offered alternative doses.

The use of the AstraZeneca vaccine has been marred by uncertainty after reports of a possible link between the doses and very rare blood clots, but public health experts around the world say that the vaccine’s benefits far outweigh the risks for most people.

Britain’s Joint Committee on Vaccination and Immunization stressed that the chances of younger people becoming seriously ill with the coronavirus had grown smaller as infection rates decrease across the country. It said that this new reality paired with the availability of alternative vaccines had factored into the decision.

But the country is also closely monitoring new variants of the coronavirus, and on Friday public health officials in England noted that a variant first detected in India was now considered a “variant of concern” — meaning that it is at least as transmissible as the dominant variant in Britain. The cases identified in the country more than doubled from 202 to 520 in the week, but still account for just a fraction of the cases there.

While there is still not enough evidence to indicate whether any of the variants recently detected in India cause more severe illness or render vaccines any less effective, Britain is proceeding with caution. Most of the identified cases of the variant are in London and in the town of Bolton in the northwestern England.

Regarding the AstraZeneca vaccine, the regulator advised that where available, an alternative should be offered to healthy adults under 40, though it stressed that potentially severe side effects from the doses were “extremely rare.” It noted that “for the vast majority of people, the benefits of preventing serious illness and death far outweigh any risks.”

The vaccination committee advised that anyone who received a first dose of the AstraZeneca vaccine should still receive a second, except those who experienced clotting.

Britain’s medicines regulatory agency had received reports of 242 cases of blood clots accompanied by low platelet counts in people who received the AstraZeneca vaccine through April 28. As of that date, about 22.6 million AstraZeneca doses had been administered in Britain, including about 5.9 million second doses.

Over all, about 35 million people in the country have received at least one dose of a coronavirus vaccine.

An airplane landing at the airport in Frankfurt, Germany.
Credit…Michael Probst/Associated Press

One returning pilot lost control of an aircraft during landing and skidded off the runway into a ditch. Another just returning from furlough forgot to activate a critical anti-icing system designed to prevent hazards in cold weather. Several others flew at the wrong altitudes, which they attributed to distractions and lapses in communication.

In all of these incidents, which were recorded on NASA’s Aviation Safety Reporting System, a database of commercial aviation mistakes that are anonymously reported by pilots and other airline crew, the pilots involved blamed the same thing for their mistakes: a lack of practice flying during the pandemic.

In 2020, global air passenger traffic experienced the largest year-on-year decline in aviation history, falling 65.9 percent compared with 2019, according to the International Air Transport Association. Flights were grounded, schedules reduced and thousands of pilots were laid off or put on furlough for up to 12 months.

As vaccination programs pick up speed across some parts of the world and travel starts to rebound, airlines are beginning to reactivate their fleets and summoning pilots back as they prepare to expand their schedules for the summer. But returning pilots can’t just pick up where they left off.

“It’s not quite like riding a bike,” said Joe Townshend, a former pilot for Titan Airways, a British charter airline, who was laid off when the pandemic hit in March last year.

“You can probably go 10 years without flying a plane and still get it off the ground,” he said, “but what fades is the operational side of things.”

Marc Johnson, a virologist at the University of Missouri, examining samples of wastewater to track the coronavirus.
Credit…MichaelB Thomas for The New York Times

Although Covid-19 is primarily a respiratory disease, research conducted early in the pandemic revealed that people infected with the coronavirus often shed it in their stool. This finding, combined with the scale and urgency of the crisis, spurred immediate interest in tracking the virus by sampling wastewater.

In the past year, many scientists have been drawn into the once niche field of wastewater epidemiology. Researchers in 54 countries are tracking the coronavirus in sewage, according to the Covid19Poops Dashboard, a global directory of the projects.

These teams have found that the wastewater data seemed to accurately indicate what was happening in society. When the number of diagnosed Covid-19 cases in an area increased, more coronavirus appeared in the wastewater. Levels of the virus fell when areas instituted lockdowns and surged when they reopened.

Several teams have also confirmed that sewage can serve as an early warning system: Wastewater viral levels often peaked days before doctors saw a peak in official Covid-19 cases.

And wastewater analysis has allowed scientists to detect the arrival of certain variants in a region weeks before they are found in people — and to identify mutations that have not yet been detected in people anywhere.

The surveillance is not a replacement for clinical testing, experts said, but can be an efficient and cost-effective complement. The approach is likely to be especially valuable in low- and middle-income countries, where testing resources are more limited.

“Not every population gets tested, not everyone has access to health care,” said Dr. Marc Johnson, a virologist at the University of Missouri. “If there’s groups of people that are asymptomatic, they probably aren’t getting tested either. So you aren’t really getting the full big picture. Whereas for our testing, everyone poops.”

global roundup

Australian residents at the Sydney airport last year, returning from India.
Credit…Bianca De Marchi/EPA, via Shutterstock

Australia will resume repatriation flights for Australian nationals in India after May 15, Prime Minister Scott Morrison said on Friday.

The resumption will end a travel ban that made it a criminal offense for citizens and residents of Australia to enter the country from India. No other democratic nation has issued a similar ban on all arrivals.

Australians who test positive for the coronavirus will not be allowed to travel, officials said, and the government has introduced a pre-departure testing regime in India in an effort to catch infections before they reach Australia.

Critics of the travel ban have accused the government of racism and insensitivity, but officials have said that the restrictions are necessary to prevent transmission from the devastating outbreak in India.

Australian officials initially said that anyone trying to return from India faced up to five years in prison and nearly 60,000 Australian dollars ($46,300). But as the measure came under withering criticism this week, Mr. Morrison said it was “highly unlikely” that those seeking to return home would actually face jail.

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