Vaccination rates are falling in the United States, despite the spread of highly contagious virus variants that are fueling the country’s alarmingly high caseload.
More than 50,000 new U.S. cases were reported on Saturday, and case rates are similar to those of the second wave last summer. But the average number of vaccine doses being administered each day, which rose for months and peaked at 3.38 million, has now fallen to 2.86 million, its lowest level since March 31, according to data from the Centers for Disease Control and Prevention.
The vaccination rate stopped climbing on April 13, when federal health officials recommended pausing the use of Johnson & Johnson’s vaccine to allow researchers to examine a rare blood-clotting disorder that emerged in six recipients. The Food and Drug Administration lifted the pause on Friday, opting to add a warning about the risk to vaccine labeling.
Experts aren’t sure why vaccination rates have begun falling, or whether vaccine hesitancy, an issue before the Johnson & Johnson pause, is entirely to blame. They suggest the issue is more complicated. Many Americans who were eager and able to be vaccinated have now been inoculated, experts believe, and among the unvaccinated, some are totally opposed while others would get a vaccine if it were more accessible to them.
Whatever the reason for the slowdown in vaccinations, it could delay the arrival of herd immunity, the point at which the coronavirus cannot spread easily because it cannot find enough vulnerable people to infect. The longer that takes, the more time there is for dangerous variants to arise and possibly evade vaccines.
Elected leaders and public health officials are left struggling to tailor their messages, and their tactics, to persuade not only the vaccine hesitant but also the indifferent. As mass vaccination sites begin to close, more patients could get vaccinated by their own doctors, with whom people are most at ease — a shift that would require the Biden administration to distribute the vaccines in much smaller shipments to many more providers.
Resuming use of the single-shot Johnson & Johnson vaccine should help with hard-to-reach populations like Americans in remote communities, migrants and older people who may have difficulty leaving their homes.
White House and state health officials are calling the next phase of the vaccination campaign “the ground game,” and are likening it to a get-out-the-vote effort.
“We’re entering a new phase” in the country’s vaccination effort, said Dr. Mark McClellan, former commissioner of the Food and Drug Administration and director of the Duke-Margolis Center for Health Policy at Duke University. “In most parts of the country now, there are unfilled vaccination appointments available.”
People who were clamoring for a vaccine have been inoculated, including those who were willing to schedule appointments and wait in long lines at mass vaccination sites, he said.
“Now, it’s more about bringing vaccines to the people who want them but haven’t been able to easily reach the existing sites,” Dr. McClellan said. Walk-in availability, which New York City allowed at city-run sites starting on Friday, could also help vaccinate more people, he said.
Dr. Ashish Jha, the dean of the Brown University School of Public Health, cautioned that it would be “hugely problematic” to broadly denounce those who had yet to get a vaccine — because of indifference or inconvenience — as “resisters.” He said on National Public Radio last week that “there are lots of people who are perfectly happy to get a vaccine but aren’t desperate for it — aren’t convinced that they need it badly.”
Rupali J. Limaye, a professor who studies vaccine behavior at Johns Hopkins Bloomberg School of Public Health, said as vaccinations continued, some might think: “If these other people are vaccinated, why do I need to get it?” but added, “We still need those people to get it to reach herd immunity.”
With temperatures getting warmer, many states have already eased social-distancing measures, and some have even appeared to return to normal activity, alarming officials. Dr. Anthony S. Fauci, the nation’s top infectious disease expert, has said that restrictions should remain in place until there are fewer than 10,000 new cases a day — a number that the United States will not reach by Aug. 1, according to projections from the Institute for Health Metrics and Evaluation at the University of Washington.
“It will feel over in the summer,” said Ali H. Mokdad, a professor of health metrics sciences at the institute. “But somebody like me who works in public health will feel like swimming upstream, telling people in the summer we are not out of danger.”
Hospitals in Michigan, the state with the worst current coronavirus outbreak in the country, are admitting about twice as many young adults with coronavirus now as they did during the fall peak, according to the Michigan Health & Hospital Association.
“I am putting more patients in their 20s and 30s and 40s on oxygen and on life support than at any other time in this pandemic,” said Dr. Erin Brennan, an emergency room physician in Detroit.
Public health experts say the outbreak — driven by the B.1.1.7 variant of the virus, which is more contagious and more severe — is spreading rapidly in younger age groups in the state.
Public health experts point to a number of factors contributing to the changing demographics. As pandemic restrictions have been loosened, younger people are out and about, socializing and in the work force, at a time when just one-third of American adults are fully vaccinated, most of them over 65.
“The restrictions were our pause button,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health. “As soon as you press play, you are going to see the virus race back as quickly as it can.”
Some health experts said it was conceivable that more younger people were being hospitalized now because the hospitals are not overflowing and have room for borderline cases who might have been sent home during the holiday surge.
But at the Beaumont Hospital in Royal Oak, Mich., near Detroit, doctors said they had not lowered the bar for admission: The younger people in their care may often have fewer chronic health problems than older patients do, but they nonetheless exhibited serious symptoms that required immediate intervention.
Children going to camp this summer can be within three feet of peers in the same-group settings, but they must wear masks at all times, federal health officials say. The only times children should remove their masks is when they are swimming, napping, eating or drinking; they should be spaced far apart for these activities, positioned head to toe for naps and seated at least six feet apart for meals, snacks and water breaks.
The Centers for Disease Control and Prevention issued the anticipated updated guidance for summer camp operators on Sunday morning, just weeks before many camps resume operations in mid-May. Many parents have been eager to find camps for their children, who had spent months indoors in remote learning classes during the pandemic.
A theme that runs throughout the updated guidance is the emphasis on conducting as many activities as possible outdoors, where the risk of infection in considered much lower than indoors. When activities must be brought indoors, spaces should be well-ventilated and windows should be kept open (windows should also be open on camp buses and vans), the C.D.C. said.
The guidance urges children not to share toys, books or games. Each camper should have a labeled cubby for their belongings, and nap mats should be assigned to individual children, and sanitized before and after use.
Some activities should still be avoided altogether, including close-contact or indoor sports, and large gatherings or assemblies. Singing, chanting, shouting or playing instruments are recommended for outdoors.
Wearing a mask is a critical piece of the prevention effort, even as federal health officials are weighing whether to lessen that restriction for the outdoors especially among people who are fully vaccinated.
“All people in camp facilities should wear masks at all times, with exceptions for certain people, or for certain settings or activities, such as while eating and drinking or swimming,” the guidance states in the only sentence emphasized in bold font in the 14-page advisory.
Federal health officials also issued rules for overnight camps, saying eligible staff, volunteers, campers and family members should be fully vaccinated two weeks before traveling to camps, while those who are not vaccinated should self-quarantine for two weeks before arriving at camp. Those who are not fully vaccinated should also provide proof of a negative test for the virus, taken one to three days before arriving at the camp.
Campers and staff members should be screened for Covid symptoms upon arrival at camps, and screening tests should be conducted if there is substantial community transmission in the area. Daily symptom checks should also be carried out to monitor for possible illness, the advice says.
Anyone working at a camp who is 16 or older is “strongly encouraged” to get vaccinated “as soon as the opportunity is available,” health officials said.
But immunized individuals must still wear masks around children, who are not eligible for vaccination yet, and stay six feet away from them. Children should also stay six feet away from children in other groups.
More than five million Americans, or nearly 8 percent of those who got a first shot of the Pfizer or Moderna vaccines, have missed their second doses, according to the most recent data from the Centers for Disease Control and Prevention. That is more than double the rate among people who got inoculated in the first several weeks of the nationwide vaccination campaign.
Even as the country wrestles with the problem of millions of people who are wary about getting vaccinated at all, local health officials are confronting a new challenge of ensuring that those who do get inoculated are doing so fully.
The reasons vary for why people are missing their second shots. In interviews, some said they feared the side effects, including flulike symptoms, which were more common and stronger after the second dose. Others said they felt that they were sufficiently protected with a single shot.
Those attitudes were expected, but another hurdle has been surprisingly prevalent. A number of vaccine providers have canceled second-dose appointments because they ran out of supply or didn’t have the right brand in stock.
Walgreens, one of the biggest vaccine providers, sent some people who got a first shot of the Pfizer or Moderna vaccine to get their second doses at pharmacies that had only the other vaccine on hand.
Several Walgreens customers said in interviews that they scrambled, in some cases with help from pharmacy staff members, to find somewhere to get the correct second dose. Others, presumably, simply gave up.
Ambulance crews that serve much of rural America have run out of money and volunteers and are in danger of disappearing, a crisis worsened by the demands of the pandemic and a neglected, patchwork 911 system.
The situation is particularly acute in Wyoming, where a least 10 localities are in danger of losing ambulance service, some imminently, according to an analysis reviewed by The New York Times. Some are staffed by volunteers; others are run by for-profit chains that say they are losing money in the community, or by local contractors hired by municipalities that can no longer afford to pay them. Thousands of Wyoming residents could soon have no one nearby to answer a call for help.
“Nobody can figure out a solution,” said Andy Gienapp, the recent administrator for emergency medical services at the Wyoming Department of Health. “Communities are faced with confronting the very real crisis of, ‘We don’t know how we’re going to do this tomorrow, because nobody’s doing it for free.’”
There is a misconception, fueled by stories of astronomical bills, that ambulance service is a sustainable, or even lucrative, business. The truth, medical professionals say, is that ambulance bills are rarely paid in full by Medicare, private insurance or patients. And if an emergency call doesn’t result in a patient being taken to a hospital, it might not yield any payment at all.
Unreliable revenue streams have long put the country’s emergency medical systems in danger of collapse, experts say, but the pandemic has made a threatened crisis real.
The United States currently has the largest immigration detention system in the world. On any given day, Immigration and Customs Enforcement, or ICE, holds tens of thousands of people in about 200 facilities across the country. And throughout the pandemic, these facilities have become some of the most dangerous places in the United States when it comes to Covid-19 outbreaks.
The New York Times compared estimated infection rates in ICE detention centers with infection rates in prisons and in the general population. As Covid cases rose last June, ICE detention facilities had an average infection rate five times that of prisons and 20 times that of the general population.
To understand the risks the ICE facilities posed, we talked to former detainees, data scientists, lawyers, county officials and the family of a former ICE contractor about the spread of Covid inside and outside ICE detention centers. We also reviewed court documents, medical records of detainees and government inspection reports from June 2020 to March. This video shows what we found.
NEW DELHI — With a devastating second wave of Covid-19 sweeping across India and lifesaving supplemental oxygen in short supply, India’s government on Sunday said it ordered Facebook, Instagram and Twitter to take down dozens of social media posts critical of its handling of the pandemic.
The order was aimed at roughly 100 posts that included critiques from opposition politicians and calls for Narendra Modi, India’s prime minister, to resign. The government said that the posts could incite panic, used images out of context and could hinder its response to the pandemic.
The companies complied with the requests for now, in part by making the posts invisible to those using the sites inside India. In the past, the companies have reposted some content after determining that it didn’t break the law.
The takedown orders come as India’s public health crisis spirals into a political one, and set the stage for a widening struggle between American social media platforms and Mr. Modi’s government over who decides what can be said online.
On Sunday, the country reported more than 349,691 new infections and 2,767 deaths, marking the fourth consecutive day it set a world record in daily infection statistics, though experts warn that the true numbers are probably much higher. The country now accounts for almost half of all new cases globally. Its health system appears to be teetering. Hospitals across the country have scrambled to get enough oxygen for patients.
In New Delhi, the capital, hospitals this weekend turned away patients after running out of oxygen and beds. Last week, at least 22 patients were killed in a hospital in the city of Nashik, after a leak cut off their oxygen supplies.
Online photos of bodies on plywood hospital beds and the countless fires of overworked crematories have gone viral. Desperate patients and their families have pleaded online for help from the government, horrifying an international audience.
Mr. Modi has been under attack for ignoring the advice of experts about the risks of loosening restrictions, after he held large political rallies with little regard for social distancing. Some of the content now offline in India highlighted that contradiction, using lurid images to contrast Mr. Modi’s rallies with the flames of funeral pyres.
It was a similar story last year at Norwegian Cruise Line, which lost $4 billion and furloughed 20 percent of its staff while its chief executive’s pay doubled — and at Hilton, where nearly a quarter of the corporate staff was fired while the company’s top executive received compensation worth $55.9 million.
The divergent fortunes of chief executives and everyday workers in the United States during the pandemic illustrate the sharp divides in a nation on the precipice of an economic boom but still racked by steep inequality.
“We’ve created this class of centimillionaires and billionaires who have not been good for this country,” said Nell Minow, vice chair of ValueEdge Advisors, an investment consulting firm. “They may build a wing on a museum. But it’s not infrastructure — it’s not the middle class.”
A fire sparked by an exploding oxygen cylinder killed at least 82 people, many of them Covid-19 patients, at a Baghdad hospital late Saturday, the latest example of the pandemic’s devastating impact on a country riddled with corruption, mismanagement and a legacy of decrepit infrastructure.
The hospital, a facility dedicated to Covid-19 patients in one of Baghdad’s poorer neighborhoods, had no smoke detectors, sprinkler system or fire hoses, said Maj. Gen. Khadhim Bohan, the head of Iraq’s civil defense forces. The fire spread quickly because of flammable material used in false ceilings in the intensive care ward, he said.
“If there had been smoke detectors, the situation would have been totally different,” General Bohan said.
Some of the victims were older patients on ventilators who could not move from their beds when the fire started, officials said. At least 110 people were injured.
Prime Minister Mustafa al-Khadimi called the fire a crime and ordered an investigation within 24 hours into possible negligence at the hospital, the Ibn al-Khatib.
Iraq last week surpassed one million reported Covid cases since the pandemic began, and the country of 39 million is in the midst of a ferocious second wave of infections. New daily cases recently hit a record of more than 8,000.
AUCKLAND, New Zealand — More than 50,000 fans packed into Eden Park stadium, New Zealand’s largest, on Saturday night for what is believed to be the largest live in-person concert since the pandemic began.
Through a combination of swift lockdowns and border closures, New Zealand has all but eliminated the coronavirus, with 2,600 cases and 26 deaths reported since the start of the pandemic, according to a New York Times database.
Masks are rarely worn, and there are no social-distancing requirements in place. Instead, people are encouraged to scan in on the country’s tracking and tracing system, and hand sanitizer is widely available.
“Next time they tell you it’s impossible, show them this,” Six60, the New Zealand band headlining the concert, wrote in a comment on an aerial photograph of the crowd, posted to its Instagram account.
The event sold out in a matter of weeks. Featuring pyrotechnics and a Maori kapa haka group, it was the first time a musical act had been permitted to headline an event at Eden Park.
While hard-hit countries like Spain, which last month held an experimental indoor concert for 5,000 fans, test out safe ways to resurrect live music in a post-Covid environment, venues in New Zealand have been operating much as they did before the pandemic.
Less than 3 percent of New Zealand’s population has received a dose of a vaccine, according to a New York Times database, and audience members are not required to present proof of inoculation or a negative virus test.
Large live music events are also being organized in other places that have been able to curb the spread of the virus. In Taiwan, the singer-songwriter Eric Chou played sold-out events last year at Taipei Arena, with tickets capped at 10,000 people. In China, over 4,000 live concerts were held during the first week of October for the country’s National Day celebrations.
Perhaps the greatest change for New Zealand is the lack of international performers. With the border closed to almost everyone but citizens and some essential workers, performing artists have had to apply for special permission to enter the country, then spend two weeks quarantining in hotels. The Australian children’s entertainment group The Wiggles and a tribute act to the band Queen have been among those granted special entry visas for entry.
New Zealanders have instead embraced local acts. A national tour by the singer-songwriter Marlon Williams sold out in New Zealand’s largest cities. The singer Benee, who gained fame from TikTok and hails from Auckland, headlined the annual music festival Rhythm and Vines near the city of Gisborne, which attracted 23,000 attendees.
A new trans-Tasman travel corridor, which permits quarantine-free travel between Australia and New Zealand, began last week, opening the way for the Australian singer-songwriter Courtney Barnett to announce a 10-date tour in July.
The National Police in Spain said on Saturday that they had arrested a man who went to his workplace and a gym while showing Covid-19 symptoms, spreading the virus to 22 people.
The 40-year-old man was arrested on charges of a “crime of injury” in Manacor, a city on the island of Majorca, after an investigation that started in late January after an outbreak in the city.
Though the man showed symptoms at his workplace — “a well-known establishment in Manacor” — he did not want to go home, which concerned his co-workers, the police said in a statement. After his workday ended, the man got a coronavirus test.
He was notified of his positive test result at the end of the next day, the police said, after he had gone to a gym and again to work, where he had a fever of 104 degrees Fahrenheit and coughed while lowering his mask, saying, “I am going to infect you all with the coronavirus.”
The man infected eight people directly: five at his workplace and three at his gym, the police said. Those people infected another 14 people, including three children, among them a 1-year-old, the police said. None of the people involved in the outbreak has been hospitalized.
[An earlier version of this briefing misstated the day the police spoke. It was Saturday, not Monday.]
BANGKOK — The Thai authorities are stepping up travel restrictions and other measures to combat a rapidly spreading third wave of coronavirus infections driven by the highly transmissible and more lethal B.1.1.7 variant.
The country, which succeeded in limiting the spread of the virus last year, has recorded over 24,000 cases and 46 deaths in just 25 days, a huge proportion of its pandemic totals of 55,460 infections and 140 deaths. On Sunday, there were 2,438 new coronavirus cases and, in a second record in two days, 11 new deaths.
A spokesman for the government’s Covid task force said that Thailand would slow the issuance of travel documents for foreign nationals from India to try to ward off a coronavirus variant, called B.1.617, that is at least partly fueling India’s crushing surge in infections.
“For foreigners from India entering Thailand, right now we will slow this down,” he said but added that 131 Thai nationals in India already registered to travel in May will still be allowed into the country.
Quarantine for all arrivals has also been extended to 14 days from 10 days until the situation improves, a health ministry official said.
The B.1.617 variant is sometimes referred to as a “double mutant.” It contains genetic mutations found in two other difficult-to-control versions of the coronavirus. One is present in the highly contagious variant that ripped through California earlier this year. The other mutation is similar to one found in the variant first identified in South Africa and believed to make the virus more resistant to vaccines.
Other measures Thailand announced this weekend include the closure of venues in Bangkok like parks, gyms, cinemas and day-care centers from April 26 through May 9. Bangkok also introduced a fine of up to $635 for people who fail to wear face masks in public.
Shopping malls remain open but the Thai Retailers Association has restricted opening hours in Bangkok and 17 other provinces.
Prime Minister Prayut Chan-o-cha also said on his Facebook page on Saturday that provincial governors could close public venues and impose curfews if necessary to stop the virus spreading.
The surge in cases has prompted concern over the number of hospital beds, particularly as government policy is to admit anyone testing positive for the novel coronavirus, even those without symptoms.
Health officials have said there are still over 20,000 available beds nationwide.