“a skeleton walking.” He is insisting that he be allowed to be seen by doctors of his choosing.

killed by another Black model, George Koh.

From prison, Koh still sounds bewildered by what he has done. “I kind of thought, OK, let me just show Harry that I’m a big man — and that’s how it escalated.”

Here’s an excerpt from our climate team’s definitive answers to big questions about our warming world — and how we know what we know.

How bad are the effects of climate change going to be?

It depends on how aggressively we act to address climate change. If we continue with business as usual, by the end of the century, it will be too hot to go outside during heat waves in the Middle East and South Asia. Droughts will grip Central America, the Mediterranean and southern Africa. And many island nations and low-lying areas, from Texas to Bangladesh, will be overtaken by rising seas.

Conversely, climate change could bring welcome warming and extended growing seasons to the upper Midwest, Canada, the Nordic countries and Russia. Farther north, however, the loss of snow, ice and permafrost will upend the traditions of Indigenous peoples and threaten infrastructure.

kill jobs and cripple the economy. But that implies that there’s an alternative in which we pay nothing for climate change. And unfortunately, there isn’t.

In reality, not tackling climate change will cost a lot and will cause enormous human suffering and ecological damage, while transitioning to a greener economy would benefit many people and ecosystems around the world.

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New coronavirus cases around the world reached a new weekly record, according to the W.H.O.

More new coronavirus cases were reported around the world last week than in any seven-day period since the beginning of the pandemic, according to new data published on Tuesday by the World Health Organization.

Last week’s figure — 5.24 million new cases — broke the previous record set at the beginning of 2021, when 5.04 million new cases were reported in the week ended Jan. 4.

The latest surge is being driven largely by an outbreak in India, where the authorities reported nearly 300,000 new cases on Wednesday alone. The country’s health care system is showing signs of buckling under the country’s second major wave of coronavirus infections, and an accident this week at a Covid-19 hospital in India killed more than 20 people.

India accounts for almost one-third of all new cases worldwide, according to the W.H.O. data. New cases are rising in all regions tracked by the organization except Europe, where they declined by 3 percent last week.

The rate at which new coronavirus-related deaths are being reported is also accelerating, according to the W.H.O. More than 83,000 deaths were reported last week, compared with 76,000 the week before.

By the organization’s reckoning, the overall death toll for the pandemic surpassed 3 million last week. A spokeswoman for the W.H.O., Margaret Harris, noted that it took nine months for the world to reach 1 million pandemic deaths, then four months to pass 2 million, and now three months to reach 3 million.

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A New Bird Flu Jumps to Humans. So Far, It’s Not a Problem

To Dr. Lucey, no one else seemed to be taking the infection of humans with H5N8 as “of any concern.” He added, “I think it’s of concern.”

Other scientists said they were not as worried.

Dr. Florian Krammer, a flu researcher at the Icahn School of Medicine at Mt. Sinai, said he was more concerned about other avian flu viruses like H5N1 that have already shown themselves to be dangerous to people. Another avian influenza virus, H7N9, infected people for the first time in 2013. There have been more than 1,500 confirmed cases and more than 600 deaths since then. Since 2017 there have been only three confirmed cases and the virus does not jump easily from person to person.

It is always possible that any virus can evolve human-to-human transmission, as well as become more dangerous. But H5N8 would have both hurdles to jump. Compared to other viral threats, Dr. Krammer said, “I’m not worried.”

Dr. Richard J. Webby, a flu specialist at the St. Jude Graduate School of Biomedical Sciences and director of the W.H.O.’s Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds, said that all of the H5 viruses are of concern because some of them have infected and killed people. But, he said, “They all have the same sort of binding capacity to human cells, which is limited,” he said. Flu viruses use a slightly different way to attach to cells in birds than to cells in humans and being good at one usually means not being good at the other.

Dr. Webby also said that while seven infections would certainly be of concern, only one infection has been confirmed. The tests of the other six involved nasal swabs and blood antibody tests. In people with no symptoms, he said, nasal swabs can simply indicate that they had breathed in virus. That would not mean it had infected them.

Blood antibody tests also have a potential for error, he said, and may not be able to distinguish exposure to one flu virus from another.

Nor did he see any scientific basis for suggesting that H5N8 is more likely than any other bird flu to evolve human-to-human transmission. But any virus could evolve that ability.

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Pregnant British Women to Get Covid Vaccines

Pregnant women in Britain are now eligible to receive a Covid-19 vaccine, British health authorities announced on Friday, citing data from the Centers for Disease Control and Prevention that showed that about 90,000 pregnant women had been vaccinated in the United States without any health issues.

The new guidance states that women in Britain who are trying to get pregnant, recently gave birth or are breastfeeding could be vaccinated with any available vaccine, but that the Pfizer-BioNTech or Moderna doses are preferred because “there is more real-world safety data from the U.S.”

Early in the pandemic, Britain had recommended against vaccines for pregnant women, citing a lack of research on side effects, but the country expanded access late last year to women at high risk of serious complications from Covid-19.

Last month, the C.D.C. and the World Health Organization recommended that pregnant women could get vaccinated, but should still consult their doctors. The W.H.O. limits its recommendations to pregnant women at high risk of contracting the coronavirus, including health care workers or those with underlying conditions.

pregnant women have experienced complications or delivered stillborn, according to an analysis of 40 studies in 17 countries published in the journal Lancet Global Health last month.

Vaccines are generally considered to be safe, and pregnant women have been urged to be immunized for influenza and other diseases since the 1960s, even in the absence of rigorous clinical trials to test them.

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Covid-19 Live Updates: U.S. Calls for Pause on Johnson & Johnson Vaccine, Complicating Rollout

Johnson & Johnson’s single-dose coronavirus vaccine after six recipients in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

All six recipients were women between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.

Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention.

“We are recommending a pause in the use of this vaccine out of an abundance of caution,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement. “Right now, these adverse events appear to be extremely rare.”

On a media call later on Tuesday morning, Dr. Marks said that “on an individual basis, a provider and patient can make a determination whether or not to receive the vaccine” manufactured by Johnson & Johnson.

While the move was framed as a recommendation to health practitioners in the states, the federal government is expected to pause administration of the vaccine at all federally run vaccination sites. Federal officials expect that state health officials will take that as a strong signal to do the same. Within two hours of the announcement, Gov. Mike DeWine of Ohio, a Republican, advised all health providers in his state to temporarily stop giving Johnson & Johnson shots. In New York, the health commissioner, Dr. Howard Zucker, said the state would halt the use of the vaccine statewide while federal officials evaluate the safety risks. Appointments for Johnson & Johnson’s shot on Tuesday at state mass sites would be honored with Pfizer doses, Dr. Zucker said.

The authorities in New Jersey, Connecticut, Massachusetts, Maryland, Nebraska, Georgia, Indiana, Texas and Virginia also said that they would follow the call from federal health agencies.

Scientists with the F.D.A. and C.D.C. will jointly examine possible links between the vaccine and the disorder and determine whether the F.D.A. should continue to authorize use of the vaccine for all adults or limit the authorization.

In the media call, federal health officials tried to reassure recipients of Johnson & Johnson’s vaccine while at the same time describing symptoms that they should watch out if they received a shot within the past month.

Dr. Schuchat said that the risk of dangerous blood clots is “very low” for people who received the vaccine more than a month ago.

“For people who recently got the vaccine within the last couple of weeks, they should be aware, to look for any symptoms. If you receive the vaccine and develop severe headaches, abdominal pain, leg pain or shortness of breath, you should contact your health care provider and seek medical treatment,” she said. She emphasized that an emergency meeting of the C.D.C.’s outside advisory committee, which has been scheduled for Wednesday, to discuss how to handle the vaccine in the future is made up of independent experts.

Dr. Janet Woodcock, acting commissioner of the Food and Drug Administration, said she expects the pause in distributing and administrating the vaccine will last for “a matter of days” while officials investigate the cases. Officials also stressed that no serious safety problems have emerged with either of the other two federally authorized vaccines, developed by Pfizer-BioNTech and Moderna.

The move could substantially complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy. Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That concern has driven up some resistance to all vaccines, even though the AstraZeneca version has not been authorized for emergency use in the United States.

The vast majority of the nation’s vaccine supply comes from two other manufacturers, Pfizer-BioNTech and Moderna, which together deliver more than 23 million doses a week of their two-shot vaccines. There have been no significant safety concerns about either of those vaccines.

But while shipments of the Johnson & Johnson vaccine have been much more limited, the Biden administration had still been counting on using hundreds of thousands of doses every week. In addition to requiring only a single dose, the vaccine is easier to ship and store than the other two, which must be stored at extremely low temperatures.

Jeffrey D. Zients, the White House Covid-19 response coordinator, said Tuesday the pause “will not have a significant impact” the Biden administration’s plans to deliver enough vaccine to be able to inoculate all 260 million adults in the United States by the end of May. With the Johnson & Johnson setback, federal officials expect there will only be enough to cover fewer than 230 million adults. But a certain percentage of the population is expected to refuse shots, so the supply may cover all the demand.

Mr. Zients said the administration will still “reach every adult who wants to be vaccinated” by the May 31 target.

Federal officials are concerned that doctors may not be trained to look for the rare disorder if recipients of the vaccine develop symptoms of it. The federal health agencies said Tuesday morning that “treatment of this specific type of blood clot is different from the treatment that might typically be administered” for blood clots.

“Usually, an anticoagulant drug called heparin is used to treat blood clots. In this setting, administration of heparin may be dangerous, and alternative treatments need to be given,” the statement said.

In a news release, Johnson & Johnson said: “We are aware that thromboembolic events including those with thrombocytopenia have been reported with Covid-19 vaccines. At present, no clear causal relationship has been established between these rare events and the Janssen Covid-19 vaccine.” Janssen is the name of Johnson & Johnson’s division that developed the vaccine.

In the United States alone, 300,000 to 600,000 people a year develop blood clots, according to C.D.C. data. But the particular blood clotting disorder that the vaccine recipients developed, known as cerebral venous sinus thrombosis, is extremely rare.

All of the women developed the condition within about two weeks of vaccination, and government experts are concerned that an immune system response triggered by the vaccine was the cause. Federal officials said there was broad agreement about the need to pause use of the vaccine while the cases are investigated.

The decision is a fresh blow to Johnson & Johnson. Late last month, the company discovered that workers at a Baltimore plant run by its subcontractor had accidentally contaminated a batch of vaccine, forcing the firm to throw out the equivalent of 13 million to 15 million doses. That plant was supposed to take over supply of the vaccine to the United States from Johnson & Johnson’s Dutch plants, which were certified by federal regulators earlier this year.

The Baltimore plant’s certification by the F.D.A. has now been delayed while inspectors investigate quality control issues, sharply reducing the supply of Johnson & Johnson vaccine. The sudden drop in available doses led to widespread complaints from governors and state health officials who had been expecting much bigger shipments of Johnson & Johnson’s vaccine this week than they got.

A Kent State University student getting his Johnson & Johnson vaccination in Kent, Ohio, last week.
Credit…Phil Long/Associated Press

The authorities in Ohio, New York, New Jersey, Connecticut, Massachusetts, Maryland, Nebraska, Georgia, Indiana, Texas and Virginia said on Tuesday that they would follow the call from federal health agencies to pause the administration of Johnson & Johnson’s vaccine after six women in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

CVS, the nation’s largest retail pharmacy chain, also said that it would immediately stop its use of Johnson & Johnson vaccinations and was emailing customers whose appointments would be canceled. A spokesman said that CVS would reschedule appointments “as soon as possible.”

Gov. Mike DeWine of Ohio and the state’s chief health official said they were advising all state vaccine providers to temporarily halt use of the single-dose vaccine. New York’s health commissioner, Dr. Howard Zucker, said the state would stop using the Johnson & Johnson vaccine, while the Food and Drug Administration and the Centers for Disease Control and Prevention evaluate the safety risks.

Connecticut health officials said they told vaccine providers to delay planned appointments and give an alternative option if they had the supply.

The C.D.C.’s outside advisory committee has scheduled an emergency meeting for Wednesday.

Jeff Zients, the White House Covid coordinator, said on Tuesday that the pause will not have a significant impact on the country’s vaccination campaign, which has accelerated in recent weeks as a rise in new virus cases threatens a fourth possible surge. Many states have already opened vaccination eligibility to all adults and others plan to by next week.

“Over the last few weeks, we have made available more than 25 million doses of Pfizer and Moderna each week, and in fact this week we will make available 28 million doses of these vaccines. This is more than enough supply to continue the current pace of vaccinations of 3 million shots per day,” Mr. Zients said in a statement.

Even though the reaction to the Johnson & Johnson shot is rare, any questions about the safety of the shots could bolster vaccine hesitancy.

Nearly seven million people in the United States have received Johnson & Johnson shots so far, and roughly nine million more doses have been shipped out to the states, according to data from the Centers for Disease Control and Prevention. The six women who developed blood clots were between the ages of 18 and 48. One woman died and a second woman in Nebraska has been hospitalized in critical condition.

“Right now, these adverse events appear to be extremely rare,” Dr. Peter Marks, director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, and Dr. Anne Schuchat, principal deputy director of the C.D.C., said in a joint statement on Tuesday. “People who have received the J&J vaccine who develop severe headache, abdominal pain, leg pain, or shortness of breath within three weeks after vaccination should contact their health care provider.”

Like many states, New York had already prepared for a significant drop in its supply of the Johnson & Johnson vaccine after federal officials said that supplies would be limited because of a production issue at a Baltimore manufacturing plant. On Friday, Gov. Andrew M. Cuomo said that New York expected to receive 34,900 Johnson & Johnson shots, a decrease of 88 percent from the previous week.

Dr. Zucker, New York’s health commissioner, said that the state would honor appointments made at state-run mass vaccination sites for the Johnson & Johnson vaccine by giving people the Pfizer-BioNTech vaccine instead. That vaccine requires two doses, and it was not immediately clear how the state would handle the additional strain on its supply.

Mayor Bill de Blasio of New York City said that the city would work to reschedule appointments at city-run vaccine sites, giving those people the Pfizer or Moderna vaccines instead.

“Every site has been told this morning to stop giving the J&J shots,” he said at a news conference.

Mr. Cuomo received the Johnson & Johnson vaccine at a public appearance last month in Harlem, which he framed as an effort to boost confidence in that vaccine’s efficacy rate and to address vaccine hesitancy.

Regulators in Europe and elsewhere are concerned about a similar issue with another coronavirus vaccine, developed by AstraZeneca and Oxford University researchers. That vaccine has not been authorized for emergency use in the United States.

Students line up for vaccines at Oakland University on Friday in Rochester, Mich. Coronavirus cases in the state have continued to rise in recent weeks.
Credit…Emily Elconin for The New York Times

The virus is again surging in parts of the United States, but it’s a picture with dividing lines: ominous figures in the Northeast and Upper Midwest, but largely not in the South.

Experts are unsure what explains the split, which doesn’t correspond to vaccination levels. Some point to warmer weather in the Sun Belt, while others suspect that decreased testing is muddying the virus’s true footprint.

The contours of where the virus is resurgent can be drawn around one figure: states that are averaging about 15 new cases a day for every 100,000 people. The 23 states — including Alabama, Mississippi and Arkansas — that have averaged that or fewer over the past week seem to be keeping cases relatively low, according to a New York Times database. Nationally, the country is averaging 21 new cases per 100,000 people.

In the 27 states above that line, though, things have been trending for the worse. Michigan has the highest surge of all, reporting the most drastic increase in cases and hospitalizations in recent weeks. Illinois, Minnesota and others have also reported worrisome increases.

Nationally, reported cases in the United States are growing again after a steep fall from the post-holiday peak in January. In the past two weeks, new confirmed cases have jumped about 11 percent, even though vaccinations picked up considerably, with an average of 3.2 million doses given daily.

Some Southern states, like Alabama and Mississippi, are lagging in vaccinations. Only about 28 percent of people in each state have received at least one shot, according to a New York Times vaccine tracker. Still, case counts continue to drop in both states.

Health experts say cases are rising in the Northeast and Upper Midwest for several reasons, including pandemic fatigue, the reopening of schools and the resumption of youth sports.

Hospitalizations tend to follow the trend line in cases by a few weeks, and have been rising in some states, most notably in Michigan.

Officials are also concerned about the spread of more contagious virus variants, especially B.1.1.7, first identified in Britain. The variant is now the leading source of new coronavirus infections in the United States, the director of the Centers for Disease Control and Prevention said last week.

Just why those factors might affect some states more than others is hard to pinpoint, experts say.

Dr. David Rubin, the director of PolicyLab at the Children’s Hospital of Philadelphia, said warmer weather in Southern states and California was probably playing a role, because it allows people to gather outdoors, with less risk of transmission.

New case reports have fallen by about 11 percent in Georgia over the past two weeks. And in Alabama, new cases are down roughly 29 percent, with a 17 percent decline in hospitalizations.

Some experts say, though, that reduced testing in some states could be obscuring the true picture. Testing in Alabama, for instance, has started to dip, but the share of tests that come back positive has remained high, at 11.1 percent, compared with a nationwide average of 5.1 percent, according to data compiled by Johns Hopkins University.

“People who are symptomatic and go to their provider are going to get a test,” said Dr. Michael Saag, the associate dean for global health at the University of Alabama at Birmingham, but “the desire for people to go get tested just because they want to know what their status is has dropped off dramatically.”

Still, Dr. Saag said, there is probably not a hidden spike in cases in Alabama right now, since hospitalizations in the state remain low.

The first dawn prayers of Ramadan around the Kaaba at the Grand Mosque in Mecca, Saudi Arabia, on Tuesday.
Credit…Amr Nabil/Associated Press

Millions of Muslims on Tuesday began celebrating a second Ramadan in the middle of the pandemic, although in many countries the first day of the holy month offered the promise of a Ramadan with fewer restrictions than last year.

Mosques across the Middle East and other parts of the world were closed for prayer last year, and lockdowns prevented festive gatherings with friends and family. In Jerusalem, for instance, the Old City was largely empty and the Aqsa Mosque compound was closed to the public, as coronavirus cases were surging.

But a large degree of normalcy was back on Tuesday: The Old City’s narrow alleys were crowded, sweet shops were preparing Ramadan desserts, clothing stores were open and the Aqsa compound was welcoming worshipers.

“Last year, I felt depressed and I didn’t know how long the pandemic would last,” said Riyad Deis, a co-owner of a spice and dried fruit shop in the Old City, while selling whole pieces of turmeric and Medjool dates to a customer. “Now, I’m relaxed, I have enough money to provide for my family and people are purchasing goods from my shop — it’s a totally different reality.”

The enthusiasm of some didn’t mean the Ramadan would go as normal. Across several countries in the Middle East, the authorities imposed limitations on customs and festivities, requiring that mosques enforce social distancing and telling worshipers to bring their own prayer rugs and to wear face masks.

In Dubai, Saudi Arabia and Egypt, taraweeh, the optional extra prayers that worshipers can observe at night, were capped at half an hour. No one will also be allowed to spend the night in a mosque, as is common during the last 10 days of Ramadan.

Mosques around the region were also prohibited from serving the fast-breaking meal of iftar or the predawn meal of suhoor. Though Muslims could still gather for those meals with friends and family, the authorities asked them to limit those gatherings this year.

In Jerusalem, Omar Kiswani, the director of Al Aqsa Mosque, said he was overjoyed that the compound was open to worshipers, but still urged caution.

“These are times of great happiness — we hope the blessed Aqsa Mosque will return to its pre-pandemic glory — but these are also times of caution because the virus is still out there,” Mr. Kiswani said.

In Egypt, government officials and prominent television hosts linked to the authorities warned Egyptians of a third wave of infections as Ramadan approached, hinting that another curfew or other lockdown restrictions could be imposed if cases rose.

“If you want the houses of God to remain open,” Nouh Elesawy, an official who oversees mosques at the Egyptian Ministry of Endowments, said earlier this month, “adhere to the precautionary procedures and regulations.”

The Ramadan restrictions may hit the hardest in poor neighborhoods, where residents depend on iftar banquets usually sponsored by wealthy individuals or organizations. For those people, feasting and Ramadan gifts are likely to be rarer, with tourism still at a trickle and many small businesses still suffering from the economic effects of the pandemic.

In Lebanon and Syria, the pandemic has worsened economic crisis that will likely squeeze people’s ability to enjoy the holy month, more than the governments’ limited restrictions aimed at curbing the spread of the coronavirus.

In Syria, where experts say the official infection and death numbers for Covid-19 are far below the reality, the government has few restrictions in place. Worshipers will even be allowed to stand in line inside of mosques to pray together after breaking their fast, the Syrian Ministry of Religious Affairs said.

In Lebanon, which emerged recently from a strict lockdown, shops and restaurants can operate regularly during the day but must offer only delivery service during a nighttime curfew from 9:30 p.m. to 5 a.m.

Global Roundup

Administering a coronavirus vaccine to a frontline worker in New Delhi, last week.
Credit…Rebecca Conway for The New York Times

India said on Tuesday that it would fast-track the approval of vaccines in use in other countries, a move aimed at rapidly increasing the country’s vaccine supply as it battles what is currently the world’s biggest coronavirus outbreak.

The Indian government said that it would grant emergency authorization to any foreign-made vaccine that had been approved for use by regulators in the United States, the European Union, Britain or Japan, or by the World Health Organization. The move had been recommended by a panel of Indian scientists and eliminates a requirement for drug companies to conduct local clinical trials.

“The decision will facilitate quicker access to such foreign vaccines” and encourage imports of materials that would boost India’s vaccine manufacturing capacity, the government said in a statement.

Earlier on Tuesday, India’s top drug regulator granted emergency approval to Sputnik V, the Russian-made vaccine, adding a third vaccine to the country’s arsenal on the same day that health officials recorded 161,736 new coronavirus infections in 24 hours.

It was the seventh straight day that India has added more than 100,000 cases, according to a New York Times database. Only the United States has seen a faster rise in infections during the pandemic.

India has administered about 105 million domestically produced vaccine doses for a population of 1.3 billion, but it is widely believed that the country needs to scale up inoculations rapidly because other measures have failed to control the virus. Many states have reimposed partial lockdowns and weekend curfews. In the country’s financial hub, Mumbai, health officials are racing to erect field hospitals as facilities report shortages of oxygen, ventilators and coronavirus testing kits.

And there is the risk of a superspreading event with the gathering of millions of Hindu pilgrims for the annual Kumbh Mela festival on the banks of the Ganges River, where the authorities say they are powerless to enforce social distancing.

India’s outbreak is reverberating worldwide as its pharmaceutical industry — which was supposed to manufacture and export hundreds of millions of doses of the AstraZeneca vaccine — is keeping most supplies at home. The approval of the Sputnik vaccine, whose first doses are expected to be available for use in weeks, offers hope that India could speed up its inoculation drive.

But it is unclear at this stage whether India will be able to procure significant quantities of other vaccines, including the Pfizer, Moderna and Johnson & Johnson shots in use in the United States. Major Western nations have accumulated much of the global supply of those vaccines and manufacturers are struggling to meet the surging demand.

India will import millions of Sputnik doses from Russia and then begin manufacturing the vaccine domestically, officials said. More than 850 million doses will be made, with some intended for export, Kirill Dmitriev, chief executive of the Russian Direct Investment Fund, a sovereign wealth fund that has financed the vaccine’s development, said in an interview with India’s NDTV channel.

“India is a vaccine-manufacturing hub and our strategic partner for production of Sputnik V,” Mr. Dmitriev said.

India has more than 13.6 million confirmed coronavirus cases, the second most after the United States, and 171,058 deaths, the fourth highest toll.

In other news around the world:

Chancellor Angela Merkel, center, at a cabinet meeting in Berlin on Tuesday. Her government’s proposal on coronavirus restrictions would place half the country over the threshold for lockdown.
Credit…Pool photo by Andreas Gora

BERLIN — Chancellor Angela Merkel’s government moved a step closer on Tuesday to securing the right to force restrictions on areas where the coronavirus is spreading rapidly, overriding state leaders reluctant to take action.

Ms. Merkel and her ministers approved a legislative proposal that would make it easier for the national government to enforce lockdowns and other limits on movement in regions where infection levels pass a set threshold. At current levels, it could lock down more than half of the country.

Under Germany’s decentralized leadership structures, the 16 state leaders have been meeting regularly with the chancellor to agree on nationwide coronavirus response policies. But with different regions experiencing different rates of infection, some state leaders have been reluctant to enforce the agreed limitations, leading to confusion and frustration among many Germans.

“I believe this amendment is as important as it is an urgent decision about how to proceed in the coronavirus pandemic,” the chancellor told reporters after meeting with her ministers.

Parliament still has to debate and approve the proposal, which would take the form of an amendment to the Protection Against Infection Act, and that process is expected to begin this week.

“We are in a situation where an emergency mechanism is necessary,” Ralph Brinkhaus, the leader of the Christian Democratic Union in Parliament, told reporters, before a meeting of his party lawmakers to discuss the amendment.

Under the proposed amendment, the federal government could force stores and cultural institutions to close and enforce limits on the number of people allowed to meet up in any region where infections surpass 100 new cases per 100,000 residents over a period of seven days.

More controversially, the law would also allow Ms. Merkel’s government to order that schools and day care centers close if the number of new infections reaches more than 200 per 100,000 inhabitants. Schools fall under the jurisdiction of the states, and local leaders are reluctant to relinquish that control.

Germany has registered more than three million infections and more than 78,700 deaths from Covid-19 since the virus began moving through the country last spring. It recorded 10,810 new cases of infection on Tuesday, bringing the national rate of infection to more than 140 per 100,000.

The number of patients in intensive care is expected to hit a record this month, as the country struggles to vaccinate enough people to get ahead of the spread of the highly contagious B.1.1.7 variant.

Vaccinations at a mosque in London earlier this month. Britain’s program has reached over 32 million people, more than half the adult population.
Credit…Andrew Testa for The New York Times

Britain has now offered vaccinations to everyone in the country age 50 and older, the government announced late on Monday, and is extending its program to another age group, the latest sign that the national rollout is continuing at pace.

On Tuesday, the authorities opened vaccinations to anyone 45 or older, yet the announcement came with a small hiccup: The website for the country’s National Health Service crashed for a short time after the younger cohort was invited to book appointments online.

The new step in the country’s vaccine rollout comes as the authorities eased several restrictions in England on Monday after months of stringent lockdowns, with pubs and restaurants opened for drinks and dining outside, and nonessential shops once again opening their doors.

Prime Minister Boris Johnson called the moment a “hugely significant milestone” and in a statement thanked those involved with the vaccine rollout. Mr. Johnson said the country was on track to offer all adults a vaccination by the end of July. More than 32 million people across Britain have received their first dose of one of the vaccines, according to government data.

The government said it had also already offered vaccinations to every health or care worker, and to everyone with a high-risk medical condition.

England has also began rolling out the Moderna vaccine, which will be offered as an alternative alongside the Pfizer BioNTech vaccine for those under 30, instead of AstraZeneca’s, which has been the mainstay of Britain’s program so far.

There have been concerns about a possible link between the AstraZeneca vaccine and very rare blood clots, and last week British regulators said an alternative should be provided for younger people. Potential infection still poses much greater risks than any vaccine side effect for all those over 30, they said, and could do so for younger people if cases surged again.

“The Moderna rollout marks another milestone in the vaccination program,” Stephen Powis, the medical director of the National Health Service, said in a statement. “We now have a third jab in our armory.”

The vaccination program, he added, “is our hope at the end of a year like no other” as he encouraged people to book their appointments.

But despite the hopeful vaccine news and the return to public life, the country is still battling new cases of the virus, and a cluster in two London neighborhoods of a worrisome variant first discovered in South Africa has prompted mass testing. Health workers have gone door to door to urge residents to get tested, even if they are not showing symptoms, as dozens of cases have emerged. Similar measures were carried out elsewhere in the city earlier this month.

Studies have shown that the variant contains a mutation that diminishes the vaccines’ effectiveness against it. Dr. Susan Hopkins, the chief medical adviser for the country’s test and trace campaign, said the cluster of cases in parts of South London was “significant.”

“It’s really important people in the local area play their part in stopping any further spread within the local community,” she said in a statement.

Pacific Palace, a dim sum restaurant on a commercial strip in the Sunset Park section of Brooklyn, has seen revenue plunge.
Credit…Victor J. Blue for The New York Times

More than a year after the coronavirus first swept through New York, the streets of Sunset Park in southern Brooklyn reflect the pandemic’s deep and unhealed wounds intertwined with signs of a neighborhood trying to edge back to life.

The sidewalks are filling with shoppers and vendors. More businesses are welcoming customers. But owners still struggle to pay rent and keep their enterprises afloat, while many workers laid off after the city locked down last year remain without jobs.

And while the rate of vaccination in New York has increased significantly, the coronavirus still percolates through this densely packed neighborhood. The ZIP code that includes Sunset Park had the highest rate of positive cases in Brooklyn in early April, nearly double the citywide rate. Some residents have expressed skepticism about the vaccines, spooked by false information circulated over TikTok and other social media.

Adding to the stress is a spate of hate crimes and violence against people of Asian descent in New York and around the country, fed in some cases by racist claims that Asian-Americans are responsible for spreading the virus.

About a third of the residents in Sunset Park have received at least one dose of the vaccine, roughly the same level as the city overall, according to the city health data. But local leaders say they want to push that number much higher.

Kuan Neng, 49, the Buddhist monk who founded Xi Fang Temple on Eighth Avenue, said that people had come to him in recent weeks to express concerns over vaccines.

“Why do I need to do that?” is a common refrain, according to Mr. Kuan, followed by: “I’m healthy now. The hard times are over, more or less.”

“Many people want to delay and see,” Mr. Kuan said, himself included.

The owner of the Cinerama Dome in Hollywood and 15 other movie theaters said it would not reopen after the pandemic.
Credit…Kate Warren for The New York Times

ArcLight Cinemas, a beloved chain of movie theaters based in Los Angeles, including the Cinerama Dome in Hollywood, will permanently close all its locations, Pacific Theaters announced on Monday, after the pandemic decimated the cinema business.

ArcLight’s locations in and around Hollywood have played host to many a movie premiere, in addition to being favorite spots for moviegoers seeking out blockbusters and prestige titles. They are operated by Pacific Theaters, which also manages a handful of theaters under the Pacific name, and are owned by Decurion.

“After shutting our doors more than a year ago, today we must share the difficult and sad news that Pacific will not be reopening its ArcLight Cinemas and Pacific Theaters locations,” the company said in a statement.

“This was not the outcome anyone wanted,” it added, “but despite a huge effort that exhausted all potential options, the company does not have a viable way forward.”

Between the Pacific and ArcLight brands, the company owned 16 theaters and more than 300 screens.

The movie theater business has been hit particularly hard by the pandemic. But in recent weeks, the majority of the country’s largest theater chains, including AMC and Regal Cinemas, have reopened in anticipation of the slate of Hollywood films that have been put back on the calendar, many after repeated delays because of pandemic restrictions. A touch of optimism is even in the air as a result of the Warner Bros. movie “Godzilla vs. Kong,” which has generated some $70 million in box office receipts since opening over Easter weekend.

Still, the industry’s trade organization, the National Association of Theater Owners, has long warned that the punishing closures were most likely to affect smaller regional players like ArcLight and Pacific. In March, the Alamo Drafthouse Cinema chain, which operates about 40 locations across the country, announced that it had filed for Chapter 11 bankruptcy protection but would keep most of its locations operational while it restructured.

That does not seem to be the case for Pacific Theaters, which, according to two people with knowledge of the matter, fired its entire staff on Monday.

The reaction to ArcLight’s closing around Hollywood has been emotional, including an outpouring on Twitter.

Firefighters at the site of COVID-19 hospital Matei Bals, after a fire broke out in one of its buildings in Bucharest, Romania, in January.
Credit…Robert Ghement/EPA, via Shutterstock

Three people infected with the coronavirus died at a hospital in Bucharest on Monday evening after the oxygen supply stopped functioning, according to the authorities, the latest incident involving oxygen failure, which in many countries has driven up the virus death toll.

It was also another fatal setback for Romania’s ageing and overwhelmed health care system, which has suffered two fires in Covid-19 wards in recent months, killing at least 15 people.

Ventilators shut down at a mobile intensive care unit set up at the Victor Babes hospital in Bucharest after oxygen pressure reached too high a level, the country’s health authorities said in a statement, depriving patients of a vital supply. In addition to the three patients who died, five others were evacuated and moved to other facilities in the city.

Romania has recorded its highest rate of Covid-19 patients in intensive care units since the pandemic began, and on Sunday Prime Minister Florin Citu said that there were just six intensive care beds available across Romania, out of nearly 1,600.

Intensive care units in Hungary and Poland have also been at risk of being overwhelmed, as much of Eastern Europe has struggled to cope with a third wave of infections across the continent. Some Hungarian hospitals have sought medical students and volunteers to assist in Covid-19 wards, giving training to those without previous medical experience.

The mobile unit struck by the oxygen problem on Monday had only been in operation since Saturday, and it has epitomized long-running concerns over the country’s fragile health care system. In January, five patients died and a further 102 were evacuated from a different hospital in Bucharest after a fire broke out. In November, 10 patients hospitalized with the coronavirus died after a fire broke out in a hospital in the northeastern city of Piatra Neamt.

Romania’s spending on health care is among the lowest in the European Union, with just over five percent of gross domestic product allocated toward it, compared with 10 percent on average among other countries of the bloc.

More than 25,000 people who tested positive for the virus have died in Romania, and the authorities have closed schools and kindergartens throughout April as part of an extended Easter holiday.

The authorities have so far administered more than 3.5 million vaccine doses, in a population of about 19 million.

Alisa Stephens, a biostatistician at the University of Pennsylvania in Philadelphia, had to manage work and taking care of her children after the city went into lockdown last year.
Credit…Hannah Yoon for The New York Times

Studies have found that women in academia have published fewer papers, led fewer clinical trials and received less recognition for their expertise during the pandemic.

Add to that the emotional upheaval of the pandemic, the protests over structural racism, worry about children’s mental health and education, and the lack of time to think or work, and an already unsustainable situation becomes unbearable.

Michelle Cardel, an obesity researcher at the University of Florida, worries that this confluence of factors could push some women to leave the sciences.

“My big fear is that we are going to have a secondary epidemic of loss, particularly of early career women in STEM,” she said.

Female scientists were struggling even before the pandemic. It was not unusual for them to hear that women were not as smart as men, or that a woman who was successful must have received a handout along the way, said Daniela Witten, a biostatistician at the University of Washington in Seattle.

Women in academia often have little recourse when confronted with discrimination. Their institutions sometimes lack the human resources structures common in the business world.

Compounding the frustration are outdated notions about how to help women in science. But social media has allowed women to share some of those concerns and find allies to organize and call out injustice when they see it, said Jessica Hamerman, an immunologist at the Benaroya Research Institute in Seattle.

In November, for example, a study on female scientists was published in the influential journal Nature Communications suggesting that having female mentors would hinder the career of young scientists and recommending that young women seek out male help.

The response was intense and unforgiving: Nearly 7,600 scientists signed a petition calling on the journal to retract the paper — which it did on Dec. 21.

The study arrived at a time when many female scientists were already worried about the pandemic’s effect on their careers, and already on edge and angry with a system that offered them little support.

Alisa Stephens found working from home to be a series of wearying challenges. Dr. Stephens is a biostatistician at the University of Pennsylvania, and carving out the time and mental space for that work with two young children at home was impossible.

Things eased once the family could safely bring in a nanny, but there was still little time for the deep thought Dr. Stephens had relied on each morning for her work.

Over time, she has adjusted her expectations of herself. “Maybe I’m at 80 percent as opposed to 100 percent,” she said, “but I can get things done at 80 percent to some extent.”

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After months of near-total lockdown, Britain begins to reopen.

Scotland, Wales and Northern Ireland are following separate but similar timetables, under which some restrictions eased on Monday in England will remain in place a while longer.

Despite chilly weather with occasional snow flurries, the moment was greeted with an enthusiasm born of more than a year of deprivation — as the once unimaginable notion of conscripting to government decree has become a way of life.

Prime Minister Boris Johnson called it “a major step forward in our road map to freedom.”

In the first weeks of the global health crisis — when the World Health Organization was still debating whether to call the coronavirus outbreak a pandemic — a new word entered the popular lexicon.

Lockdown in English. Le confinement in French. El confinamiento in Spanish. But first came fengcheng in China, literally meaning to lock down a city.

At the time, as images from ghostly streets of Wuhan, China, started to grab the world’s attention and it became clear that the virus respected no national borders, there was a debate about whether Western democracies could — or should — resort to such extreme measures.

As hospitals struggled to deal with a flood of patients and death tolls soared, the debate was overtaken by the reality that traditional methods of infectious disease control, like testing and contact tracing, had failed.

Britain, which held out longer than many of its European neighbors, entered its first national lockdown on March 26, 2020.

Since then, lockdown has come to mean many things to many people — dictated as often by individual circumstance and risk assessment as government decree.

While no country matched China’s draconian measures, liberal democracies have been engaged in a yearlong effort to balance economic, political and public health concerns.

Last spring, that meant that much of the world looked alike, with about four billion people — half of humanity — living under some form of stay-at-home order.

A year later, national approaches to the virus vary wildly. And no region has relied on lockdowns to the extent Europe has.

Although it is difficult to compare lockdowns, since the use of the word differs in different places, researchers at Oxford University’s Blavatnik School of Government have developed a system ranking the rules’ stringency. They found that Britain has spent 175 days at its “maximum stringency level.”

“In this sense, we can say that the U.K. is globally unique in spending the longest period of time at a very high level of stringency,” said Thomas Hale, an associate professor of global public policy at Oxford.

Though there was still a winter chill in the air Monday morning, people in Britain flocked to stores and restaurants. After so many false dawns, there was a widespread hope that, this time, there would be no going back.

Treating a Covid-19 patient in an intensive care unit at Homerton University Hospital in London, in January.
Credit…Andrew Testa for The New York Times

The British lockdown that is being eased on Monday is the nation’s third. But it was first aimed at containing a variant of the coronavirus — offering an early warning to the world of the threat posed by the evolution of the virus and the difficulties in trying to control this particular form.

When the variant, known as B.1.1.7, was first discovered late last year in the southeastern English county of Kent, much about it was a mystery.

It appeared to be more contagious, but to what degree? Was it more deadly? How far had it spread?

The picture is becoming clearer. The most recent estimates suggest it is about 60 percent more contagious than the original form of the virus, and significantly more deadly.

That same variant is now spreading across continental Europe, prompting governments like those of France and Italy to impose new national lockdowns. The variant has also added urgency to the vaccination campaign in the United States — which is getting doses into millions of arms every day but still might not be fast enough to avoid yet another wave.

The vaccines being used in many countries have shown to be effective against it.

Britain’s vaccination campaign was launched with an urgency dictated by the moment, prioritizing first doses to spread a degree of protection as quickly and widely as possible.

Even after the lockdown was put in place, the variant propelled the country’s daily fatality rates to levels not seen since the peak of the pandemic’s first wave in April.

On Friday, the number of people with Covid-19 on their death certificate was just shy of 150,000.

But another statistic now offers hope. Nearly 32 million people have been given at least one dose of a vaccine — roughly half the adult population.

Officials are confident the combined effects of the lockdown and mass vaccination will provide a wall of protection. But, as England’s chief medical officer Chris Witty warned, it is a “leaky wall.”

A large majority of people under the age of 50 have yet to be offered a jab. And with supplies constrained around the world, eligibility is unlikely to be expanded for weeks or more.

A line outside an athletic wear shop in central London early Monday. 
Credit…Alberto Pezzali/Associated Press

The once-routine act of visiting a clothes store or shoe merchant took on a new meaning for the first shoppers who made an early-morning pilgrimage to Oxford Street, London’s busiest retail road that in recent months has been a desolate stretch of boarded up shops and empty stores.

Outside Niketown, JD Sports and Foot Locker, crowds were lining up by 7 a.m. as groups of mostly young men waited in line for a chance to get their hands on new sneakers.

Julian Randall, a dedicated collector who has spent the last 15 years amassing sneakers, left his London home at 2 a.m. to be there. He said he preferred to buy in store, rather than online, where it was harder to find specific shoes at a reasonable price.

“It’s virtually impossible to hop online and buy the shoes online — you don’t even have a chance,” he said. “In this day and age, we are in a recession, and I don’t want to be paying resell prices for shoes. I want to buy retail.”

The shops have remained mostly shuttered since the week of Christmas, when nonessential stores were forced to close across the region, but elsewhere in England, the closures have been in place even longer after coronavirus cases surged.

Retailers hope that there will be a splurge in spending by people who have amassed a record amount of savings — nearly $250 billion according to government estimates, roughly 10 percent of the Britain’s gross domestic product.

But for many stores, it is too late.

The flagship store of the British retailer Topshop on Oxford Circus, once a destination for fashion-hungry young adults, permanently shut its doors after its parent company, Arcadia Group, filed for bankruptcy last year.

Plywood boards cover the front of Debenhams, another retail chain that floundered during the pandemic, its extensive window displays now bare. The two companies crumbled within days of one another, as the country bounced from one lockdown to the next and the pandemic hastened the end of British high-street brands that were already teetering on the edge.

But the shuttered windows stood alongside some hopeful signs. Plastered in big letters on the shop front of John Lewis, a British department store, there was a clear message: “Come on in London, brighter days are coming.”

(Even that retailer has struggled, and it has explored converting parts of its Oxford Street store into office space.)

For those stores that did reopen, coronavirus precautions seemed to be front of mind, at least as the day began. Bokara Begum wanted to be as safe as she could during her shopping outing to Primark, so she arrived as doors swung open to beat the crowd.

“It’s just after 7 a.m., so I took advantage of that and came out here early,” she said, two brown paper bags in tow. “I was a bit panicky, really — I thought there would be a massive queue.”

Customers with their first pints of beer outside The Kentish Belle in London shortly after midnight on Monday.
Credit…Mary Turner for The New York Times

One man showed up in his robe. Another couple had made a two-hour trek from a neighboring county.

A little over a dozen patrons, shivering in the Arctic chill gripping England, stood at the ready as Nicholas Hair, owner of The Kentish Belle, counted the seconds until the clock ticked over to a minute past midnight.

“Ladies and gentlemen, take your seats!” he said to applause.

Then, for the first time in months, he poured and served a pint.

“I mean, I’ve not seen my friends like this together for so long,” said Ryan Osbourne, 22. “When we have an opportunity like today to bring my friends together, it’s incredible.”

Not all pubs will be allowed to reopen on Monday — only the estimated 15,000 with outdoor space, for outdoor service only. And most of those will open later in the day.

But Mr. Hair had secured a special license to open The Kentish Belle, a small pub specializing in artisanal beers in a quiet southeast London neighborhood, at the earliest possible opportunity.

Credit…Mary Turner for The New York Times

He was circled by news crews as he prepared to open.

The past year had been “dreadful,” he said, adding that he had not been able to access government funding for the past two months. “There are a lot of businesses like this that won’t survive.”

Uma Nunn, 43, traveled from Surrey to attend the night’s festivities. “We just wanted to show our support,” she said.

Her husband, Benjamin Nunn, a beer writer who spent the last open day for pubs at The Kentish Belle, said he thought it only fitting to return for the first. “This is one of the big things in my life, beer and music,” he said. “Now to be able to get that started up again, it’s energizing, it’s exciting.”

“It’s the middle of he night but hey, hopefully this will never happen again,” he added.

Decorating a restaurant before its reopening on April 12.
Credit…Andrew Testa for The New York Times

For the past year, the British economy has yo-yoed with the government’s pandemic restrictions. On Monday, as shops, outdoor dining, gyms and hairdressers reopened across England, the next bounce began.

The pandemic has left Britain with deep economic wounds that have shattered historical records: the worst recession in three centuries and record levels of government borrowing outside wartime.

Last March and April, there was an economic slump unlike anything ever seen before when schools, workplaces and businesses abruptly shut. Then a summertime boom, when restrictions eased and the government helped usher people out of their homes with a popular meal-discount initiative called “Eat Out to Help Out.”

Beginning in the fall, a second wave of the pandemic stalled the recovery, though the economic impact wasn’t as severe as it had been last spring. Still, the government has spent about 344 billion pounds, or $471 billion, on its pandemic response. To pay for it, the government has borrowed a record sum and is planning the first increase in corporate taxes since 1974 to help rebalance its budget.

By the end of the year, the size of Britain’s economy will be back where it was at the end of 2019, the Bank of England predicts. “The economy is poised like a coiled spring,” Andy Haldane, the central bank’s chief economist said in February. “As its energies are released, the recovery should be one to remember after a year to forget.”

Even though a lot of retail spending has shifted online, reopening shop doors will make a huge difference to many businesses.

Daunt Books, a small chain of independent bookstores, was busy preparing to reopen for the past week, including offering a click-and-collect service in all of its stores. Throughout the lockdown, a skeleton crew “worked harder than they’ve ever worked before, just to keep a trickle” of revenue coming in from online and telephone orders, said Brett Wolstencroft, the bookseller’s manager.

“The worst moment for us was December,” Mr. Wolstencroft said, when shops were shut in large parts of the country beginning on Dec. 20. “Realizing you’re losing your last bit of Christmas is exceptionally tough.”

He says he is looking forward to having customers return to browse the shelves and talk to the sellers. “We’d sort of turned ourselves into a warehouse” during the lockdown, he said, “but that doesn’t work for a good bookshop.”

With the likes of pubs, hairdressers, cinemas and hotels shut for months on end, Brits have built up more than £180 billion in excess savings, according to government estimates. That money, once people can get out more, is expected to be the engine of this recovery — even though economists are debating how much of this windfall will end up in the tills of these businesses.

Monday is just one phase of the reopening. Pubs can serve customers only in outdoor seating areas, and less than half, about 15,000, have such facilities. Hotels will also remain closed for at least another month alongside indoor dining, museums and theaters. The next reopening phase is scheduled for May 17.

Over all, two-fifths of hospitality businesses have outside space, said Kate Nicholls, the chief executive of U.K. Hospitality, a trade group.

“Monday is a really positive start,” she said. “It helps us to get businesses gradually back open, get staff gradually back off furlough and build up toward the real reopening of hospitality that will be May 17.”

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Blinken Calls for More Thorough Investigation of Covid Origins in China

Secretary of State Antony J. Blinken on Sunday criticized the Chinese government for a lack of transparency during the pandemic, particularly during “the early stages of Covid,” and he called for a more thorough investigation of the origins of the coronavirus.

A report of a joint inquiry by the World Health Organization and China published last month did not conclusively establish how or when the virus began spreading, and did little to allay Western concerns that the Chinese Communist Party bent the investigation to its advantage. Mr. Blinken, echoing those concerns, called on Beijing to make “a real commitment to transparency, to information sharing, to access for experts.”

“I think China knows that in the early stages of Covid, it didn’t do what it needed to do,” Mr. Blinken said in an appearance on NBC’s “Meet the Press.” “One result of that failure is that the virus got out of hand faster and with, I think, much more egregious results than it might otherwise.”

Mr. Blinken urged more investigation.

“We need to get to the bottom of this,” he said of the virus’ origins. “We need to do that precisely so we fully understand what happened, in order to have the best shot possible preventing it from happening again.”

sought to blame China for the spread of Covid-19 in the U.S., often fanning the flames of xenophobia in their public campaign to shirk responsibility for a poor response to the pandemic. Mr. Blinken’s comments, however, illustrated the Biden administration’s willingness to convey skepticism of the official narrative coming from Beijing.

Mr. Blinken’s predecessor, Mike Pompeo, had asserted with little evidence months into the pandemic the notion that the coronavirus originated in a research laboratory in Wuhan, China. He had pressed American spy agencies to hunt for evidence to support the unsubstantiated theory, but most agencies remain skeptical that conclusive evidence of a link to a lab can be found.

Days before the W.H.O. released their report, the former director of the Centers for Disease Control and Prevention during the Trump administration also speculated that the virus originated in a lab in China. The former official, Dr. Robert Redfield, offered no evidence and emphasized that it was his opinion.

The international W.H.O. team of experts who investigated the origins of the virus in China dismissed the lab theory in their report as “extremely unlikely.” But Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director-general, took the unexpected step of publicly raising doubts, saying that the theory required further investigation and that he was ready to deploy more experts to do so.

The Chinese foreign ministry and state media rejected criticism from the White House and others that Beijing had not been transparent during the W.H.O. inquiry.

said in a statement last month. “To politicize this issue will only severely hinder global cooperation in study of origins, jeopardize anti-pandemic cooperation, and cost more lives.”

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AstraZeneca Vaccine Faces New Setbacks in U.K. and European Union

LONDON — Britain said on Wednesday that it would curb the use of AstraZeneca’s vaccine in adults under 30 because of the risk of rare blood clots, a blow to the efforts of scores of countries reliant on the vaccine to stamp out the coronavirus pandemic amid a global surge in cases.

Adding to the unease, the European Medicines Agency outlined a “possible link” between the vaccine and rare clots, even as it said that Covid-19 remained the far greater threat, leaving decisions about how to use the vaccine in the hands of the 27 member states of the European Union.

Taken together, the decisions represented a considerable setback for the AstraZeneca shot, which has been seen as the principal weapon in the battle to reduce deaths in the vaccine-starved global south.

The world’s most widely administered coronavirus vaccine, it is far less expensive and easier to store than some of the alternatives, spurring its use in at least 111 countries, rich and poor. AstraZeneca, based in Britain, has promised to deliver three billion doses this year, enough to inoculate nearly one in five people worldwide.

Cameroon and the Democratic Republic of Congo have already delayed injections of AstraZeneca’s vaccine amid mounting concerns in Europe. Any further hesitation, scientists said, could cost lives.

“In developing countries, the dynamic is to either use the vaccine you have, or you have nothing,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London. “In which case, carnage ensues.”

For the vast majority of people, British and European regulators said on Wednesday, the benefits of AstraZeneca’s shot far outweigh the risks. The clotting problems were appearing at a rate of roughly one in 100,000 recipients across Europe. Meanwhile, in Britain, the vaccine has driven down hospitalizations from Covid-19 — which can, itself, cause serious clotting problems — and saved thousands of lives, regulators said.

most people doubted the vaccine’s safety.

Over all, use of the shot has suffered: Across Europe, 64 percent of delivered doses of AstraZeneca’s vaccine have been injected into people’s arms, markedly lower than the rates for other shots.

“One hoped there would have been collaboration, and more discussion, between regulators, instead of lots of different countries going off in all sorts of directions,” Professor Ward said. “That aspect has really been the most unhelpful.”

watch for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.

As of March 22, regulators had carried out detailed review of 86 cases, 18 of which were fatal, they said.

Concerns about the shot became acute enough in Britain this week that the University of Oxford, which developed the vaccine with AstraZeneca, stopped giving doses as part of a two-month-old trial in children.

“Safety has been our priority throughout the development of the vaccine,” Andrew Pollard, the Oxford researcher in charge of the trials, said on Wednesday. The identification of the clots, he added, “shows that the safety system works.”

In the United States, AstraZeneca is preparing to apply for emergency use authorization from the Food and Drug Administration. If and when they take up the application, that agency’s regulators are expected to scrutinize the clotting cases.

The United States, flush with vaccines from three other makers, may not ultimately need AstraZeneca’s shot. But any ruling by the F.D.A. is expected to hold considerable weight in some of the poorer nations that are relying on the shot.

The World Health Organization said a vaccine safety subcommittee had met on Wednesday and noted that “rare adverse events following immunizations should be assessed against the risk of deaths from Covid-19 disease and the potential of the vaccines to prevent infections.” It said that a link with the clotting problems, while “plausible,” had not been confirmed.

For Britain, the AstraZeneca vaccine has become a huge source of national pride, and the backbone of the country’s speedy inoculation program.

Even if younger people are at lower risk from severe Covid-19, scientists have said, inoculating them remains essential to creating enough protection in the population to end the pandemic.

Emma Bubola, Monika Pronczuk and Rebecca Robbins contributed reporting.

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AstraZeneca Vaccine Faces Setbacks in U.K. and European Union

LONDON — Britain said on Wednesday that it would curb the use of AstraZeneca’s vaccine in adults under 30 because of the risk of rare blood clots, a blow to the efforts of scores of countries reliant on the vaccine to stamp out the coronavirus pandemic amid a global surge in cases.

Adding to the unease, the European Medicines Agency outlined a “possible link” between the vaccine and rare clots, even as it said that Covid-19 remained the far greater threat, leaving decisions about how to use the vaccine in the hands of the 27 member states of the European Union.

Taken together, the decisions represented a considerable setback for the AstraZeneca shot, which has been seen as the principal weapon in the battle to reduce deaths in the vaccine-starved global south.

The world’s most widely administered coronavirus vaccine, it is far less expensive and easier to store than some of the alternatives, spurring its use in at least 111 countries, rich and poor. AstraZeneca, based in Britain, has promised to deliver three billion doses this year, enough to inoculate nearly one in five people worldwide.

Cameroon and the Democratic Republic of Congo have already delayed injections of AstraZeneca’s vaccine amid mounting concerns in Europe. Any further hesitation, scientists said, could cost lives.

“In developing countries, the dynamic is to either use the vaccine you have, or you have nothing,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London. “In which case, carnage ensues.”

For the vast majority of people, British and European regulators said on Wednesday, the benefits of AstraZeneca’s shot far outweigh the risks. The clotting problems were appearing at a rate of roughly one in 100,000 recipients across Europe. Meanwhile, in Britain, the vaccine has driven down hospitalizations from Covid-19 — which can, itself, cause serious clotting problems — and saved thousands of lives, regulators said.

most people doubted the vaccine’s safety.

Over all, use of the shot has suffered: Across Europe, 64 percent of delivered doses of AstraZeneca’s vaccine have been injected into people’s arms, markedly lower than the rates for other shots.

“One hoped there would have been collaboration, and more discussion, between regulators, instead of lots of different countries going off in all sorts of directions,” Professor Ward said. “That aspect has really been the most unhelpful.”

watch for certain symptoms, including severe and persistent headaches and tiny blood spots under the skin. Doctors’ groups have circulated guidance about how to treat the disorder.

As of March 22, regulators had carried out detailed review of 86 cases, 18 of which were fatal, they said.

Concerns about the shot became acute enough in Britain this week that the University of Oxford, which developed the vaccine with AstraZeneca, stopped giving doses as part of a two-month-old trial in children.

“Safety has been our priority throughout the development of the vaccine,” Andrew Pollard, the Oxford researcher in charge of the trials, said on Wednesday. The identification of the clots, he added, “shows that the safety system works.”

In the United States, AstraZeneca is preparing to apply for emergency use authorization from the Food and Drug Administration. If and when they take up the application, that agency’s regulators are expected to scrutinize the clotting cases.

The United States, flush with vaccines from three other makers, may not ultimately need AstraZeneca’s shot. But any ruling by the F.D.A. is expected to hold considerable weight in some of the poorer nations that are relying on the shot.

The World Health Organization said a vaccine safety subcommittee had met on Wednesday and noted that “rare adverse events following immunizations should be assessed against the risk of deaths from Covid-19 disease and the potential of the vaccines to prevent infections.” It said that a link with the clotting problems, while “plausible,” had not been confirmed.

For Britain, the AstraZeneca vaccine has become a huge source of national pride, and the backbone of the country’s speedy inoculation program.

Even if younger people are at lower risk from severe Covid-19, scientists have said, inoculating them remains essential to creating enough protection in the population to end the pandemic.

Emma Bubola, Monika Pronczuk and Rebecca Robbins contributed reporting.

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Possible Side Effects of AstraZeneca Vaccine Come Into Sharper Focus

LONDON — For months, European countries have seesawed between craving and rebuffing AstraZeneca’s vaccine, with the shot’s fortunes rising and falling on spats over supply and on questions over the efficacy of the vaccine itself.

But few concerns have proved as disruptive to the rollout of the world’s workhorse vaccine in Europe as reports of very rare blood clots in some recipients. Many countries responded by halting the shot’s use, only to start giving it again after an all-clear from regulators at the European Medicines Agency, and then stopped inoculations a second time in certain age groups after doctors became more concerned about the clots.

On Tuesday, those concerns were reinforced yet again when a top vaccines official at the European Medicines Agency said that the vaccine was linked to extremely rare, though sometimes fatal, blood clots in a small number of recipients. It was the first indication from an international regulatory body that the clots may be a real, if very unusual, side effect of the shot.

Regulators now appear to be considering issuing their first formal warnings about the potential side effects — not only in continental Europe, which has long been wary of the shot for political and scientific reasons, but also in Britain, the birthplace of the AstraZeneca vaccine and long its biggest champion, where new data have sown concerns as well.

speedy inoculation program, have also insisted that the vaccine’s benefits far outweighed the risks. They and the company cited a lack of evidence in Britain that the clotting events were any more common than would be expected among people who had never been given AstraZeneca’s vaccine.

But the evidence changed last week when Britain reported 30 cases of the rare blood clots, 25 more than previously. This week, a prominent scientific adviser to the British government said there was “increasing evidence” of the clots being associated with the vaccine.

regulators reported 30 cases of the rare blood clots combined with low platelets among 18 million people given the AstraZeneca vaccine. That translated to roughly one case in 600,000 recipients of the vaccine.

European countries’ divergent approaches to the vaccine stem from a number of factors, including the supply of vaccines and severity of the pandemic. Marco Cavaleri, the official at the European Medicines Agency who spoke about the link between the vaccine and blood clots, said on Tuesday that those factors would likely continue to dictate how countries used the shot.

Beyond those factors, countries also took very different approaches to managing risk, scientists said. Countries that have continued using the shot were more focused on securing the overall health of their citizens. Others were more preoccupied with minimizing the risk to any single person.

“The attitude here is more, ‘Get me out of the pandemic,’” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London, referring to the British approach. In continental Europe, she said, “There seems to be a much higher emphasis on individual safety in the population.”

Adriano Mannino, a philosopher at the University of Munich and director of the Solon Center for Policy Innovation in Germany, said that the collective benefits of the vaccine dominated thinking in Britain, while Germans were more concerned with the risk of an injection going wrong in individual cases. That reflected, partly, Germany’s history with the Nazis, who conducted lethal experiments on people.

“In many areas where law has to regulate ethically delicate and potentially dangerous things,” he said, “the German state has tended to go for tough restrictions.”

Nevertheless, Germans over 60 — the age group still being given AstraZeneca’s vaccine — flooded hotlines to book appointments and stood in line for hours in recent days as eligibility restrictions for their age group were relaxed.

In the northeastern city of Wismar, several hundred people waited for up to five hours on Tuesday in a driving wind and mix of rain and snow to receive the shot.

“I wish there had been better weather,” Kerstin Weiss, the head of the district authority in the northeastern region, told public broadcaster NDR. “But honestly, this is a sign that people are willing to be vaccinated with AstraZeneca.”

Benjamin Mueller reported from London and Melissa Eddy from Berlin. Monika Pronczuk and Emma Bubola contributed reporting.

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