The Food and Drug Administration on Wednesday offered the first public look at Pfizer’s application for a booster coronavirus shot, two days before an outside advisory committee of experts is scheduled to meet to recommend whether or not the agency should approve the company’s request.
It also comes amid significant disagreement about the need for boosters between career scientists at the agency and top Biden health officials, who have already started planning a broad booster campaign for this fall.
In a 23-page document reviewing the company’s application, regulators examined safety and immune response data on roughly 300 adults who received a booster shot of Pfizer-BioNTech’s vaccine six months after their second dose, finding an increased immune response in study participants, even as they said that coronavirus vaccines were holding up powerfully against severe forms of Covid-19. There were no serious safety concerns associated with the booster injection, the regulators reported.
Pfizer said in a separate filing that one month after a third injection, levels of neutralizing antibodies against the Delta variant in a subgroup of trial volunteers were between five and seven times higher, roughly, than they were a month after the second dose. The company also reiterated its findings that the effectiveness of its vaccine against symptomatic disease fell from about 96 percent to about 84 percent by six months after the second shot, although it held steady against severe disease.
Pfizer argued in its filing that ebbing of the vaccine’s potency was the dominant reason for breakthrough infections among vaccinated people in Israel, which has relied almost exclusively on the Pfizer vaccine and has vaccinated its population faster than the United States.
But the F.D.A. regulators wrote that while waning immunity is one potential factor in breakthrough infections, other variables, including the Delta variant, may also have contributed to the cases.
In an interview, Pfizer officials acknowledged that the company’s booster study was quite small. But they said that the data they have delivered meets the F.D.A.’s criteria for justifying third shots for people 16 and up. Pfizer has another, much bigger booster study underway, with results expected this fall.
The F.D.A.’s analysis noted that Pfizer provided data on immune response against the Delta variant, by far the dominant variant in the U.S., in only two dozen people. Understanding the effectiveness of boosters against variants would likely be critical to the F.D.A.’s review, the document suggested. “Available data should support the effectiveness of the booster dose, particularly against currently circulating” variants, regulators wrote.
The analysis also suggested that regulators are cautiously weighing studies from Israel, which top Biden administration officials have said were key to their decision to recommend starting a booster campaign this month. Israel is already providing booster shots to most of its population.
“While observational studies can enable understanding of real-world effectiveness, there are known and unknown biases that can affect their reliability,” the regulators wrote. Studies in the United States “may most accurately represent vaccine effectiveness in the U.S. population,” they added.
As a coronavirus vaccination mandate for health workers went into effect in France on Wednesday, government officials said that some were still holding out against the obligation.
Under a law passed this summer, nearly 3 million people who work in health care or other essential fields — including hospital workers, retirement home employees and firefighters — must get at least a first shot or face job suspensions without pay. Those who have already received their first dose have until Oct. 15 to get a second one.
Gabriel Attal, the French government spokesman, said at a news conference on Wednesday that more than 90 percent of health workers had received at least a first dose, compared with 64 percent in early July, when President Emmanuel Macron first announced the mandate.
“A vast majority of health workers have made the choice of responsibility,” Mr. Attal said, adding that the measure aimed to “protect hospitals, protect our health workers, protect vulnerable patients.”
Mr. Macron had announced the mandate and a broader health pass policy in July to counter slumping vaccination rates. The health pass — which shows proof of vaccination, a recent negative coronavirus test or recovery from Covid-19 — is now mandatory to eat at restaurants, go to the movies and attend other public venues.
Protesters angered by the policy marched through cities around France over the summer, calling the pass an infringement on their freedom. But the demonstrations have dwindled in size over the past weeks. The policy is now broadly accepted, and France has seen an uptick in vaccination rates.
Still, several hundred health care workers demonstrated in font of the health ministry in Paris over the weekend, voicing their discontent.
Some union leaders, who favor vaccination but say the government should convince health workers instead of forcing them, have warned that France’s health care system could come under strain if even a small number of unvaccinated workers were suspended.
But most officials were reassuring.
“It won’t destabilize hospitals,” Frédéric Valletoux, the head of France’s hospital federation, told RTL radio on Wednesday, adding that “it might disturb the functioning of a department here or there, but hospital workers will step up, reorganize, and life will go on.”
The attitude of health workers who refuse to get vaccinated is “very individualistic, very selfish,” Mr. Valletoux added.
While the spread of new coronavirus cases is steady or slowing in many parts of the world, it is accelerating in the Western Hemisphere, where new case reports rose by 20 percent in the past week, the World Health Organization warned on Wednesday.
North America, where new case reports are up by one-third, is the chief driver of the trend.
New cases doubled in the Canadian province of Alberta, “where hospitals are experiencing a critical staffing shortage,” Dr. Carissa F. Etienne, the director of the Pan American Health Organization, a division of the W.H.O., said at a news conference. And with new cases in the United States reaching levels not seen since January, Dr. Etienne said, “hospital capacity in many Southern U.S. states remains worryingly low.”
Several Central American countries are also experiencing infection surges, including Costa Rica, Guatemala and Belize. The spread of the virus has slowed somewhat in the Caribbean, but there are exceptions, including Jamaica, where new case reports are at their highest of the pandemic.
By contrast, in most of South America, which was very hard hit earlier in the year, reports of new infections and Covid-19 deaths are declining. The organization’s experts are not sure why, though they dismissed speculation that a decline in testing might be responsible.
“It’s important to note that this drop in South America is not an effect of laboratory testing,” said Dr. Sylvain Aldighieri, P.A.H.O.’s incident manager for Covid-19. “Laboratory vigilance has been maintained.”
Dr. Aldighieri said a number of factors could be at work in South America, including strict social distancing measures and reduced mobility in some countries. The change of season may also play a role, he added, noting that “the epidemiological curves for influenza between 2014 and 2019 in South America have a similar behavior to Covid-19 between 2020 and 2021.”
Although the highly infectious Delta variant is becoming predominant in the Caribbean, it has yet to make significant inroads in South America, Dr. Aldighieri said.
W.H.O. officials called on national governments to pay more attention to how the pandemic affects children, both directly and indirectly.
“At the beginning of the pandemic, the virus was having a disproportionate impact on our elderly,” Dr. Etienne said, “and as a result, too many children and young people still don’t think they’re at risk. We must change that.”
The strains that the pandemic has placed on health services also mean that many young people are not getting annual checkups, routine vaccinations and other services, including reproductive health services. That is helping to “fuel one of the largest jumps in teenage pregnancy that we’ve seen in more than a decade,” Dr. Etienne said.
And the closing of schools because of the pandemic “has triggered the worst educational crisis we have ever seen in this region,” she added.
President Biden met on Wednesday with top executives from Microsoft, the Walt Disney Company, Kaiser Permanente and other companies that have endorsed vaccine mandates, days after he announced a federal effort to require employees of large companies to be vaccinated against the coronavirus or be tested regularly.
The administration sought to use the meeting to show that vaccine mandates are good for the economy while spotlighting employers that have mandates for workers or have praised Mr. Biden’s order. The meeting was meant to rally more business support for mandates.
“It’s about saving lives — that’s what this is all about,” said Mr. Biden, who was flanked by Treasury Secretary Janet Yellen and Jeffrey D. Zients, the White House pandemic coordinator.
“Vaccinations mean fewer infections, hospitalizations and deaths, and in turn it means a stronger economy,” he added.
One of the invitees to the meeting, Tim Boyle, the chief executive of Columbia Sportswear, said in an interview on Wednesday that his company had drafted a policy mandating vaccines months ago. But it had held off carrying it out until Mr. Biden announced last week that he was directing the Labor Department to issue an emergency safety declaration that would effectively function as a vaccine mandate for tens of millions of workers. Columbia Sportswear told its workers that it will put a vaccine requirement in place next week.
Mr. Boyle said Columbia was concerned that by acting alone it would risk losing as many as half of its workers in distribution centers and retail stores. Mr. Biden’s order, he said, reduced the risk that workers who don’t want to get vaccinated would quit to work elsewhere.
“There’s much less opportunity for people to go somewhere they don’t need to be vaccinated,” he said.
Mr. Boyle said vaccinations had divided Columbia’s work force. Managers in its Portland, Ore., headquarters have largely embraced the shots, he said, but retail and warehouse workers throughout the country have been more reluctant. He said that hesitancy had hurt the company, with infections and the threat of infection forcing closures and cleanings of locations.
“Those operations are predicated on people working together closely,” he said. Having unvaccinated workers is “highly disruptive.”
Several of the business leaders who met with Mr. Biden have installed mandates already, for at least part of their work force, including Disney, Walgreens and Children’s Hospital of Philadelphia.
Beginning Oct. 1, new immigrants to the United States must be fully vaccinated against Covid-19, the U.S. Citizenship and Immigration Services said in a news release on Tuesday.
People seeking to become “lawful permanent residents” — or green card holders — have permission to live in the United States and eventually seek citizenship. Applicants for permanent residency must undergo a medical examination.
The Covid vaccine joins a list of others that applicants must have, including inoculations against measles, mumps, rubella, polio, and hepatitis A and B, according to the Centers for Disease Control and Prevention. Some people may be exempt from the new rules, including those who are too young to be vaccinated and those who have medical conditions that make the shots dangerous for them.
About 54 percent of the U.S. population is fully vaccinated against Covid-19, and some people have begun to get booster shots.
The new requirement for those seeking permanent U.S. residency is in line with President Biden’s new vaccine mandates for federal workers and contractors. The Pentagon has announced that active-duty military personnel also must be vaccinated.
Mr. Biden has rolled back several Trump-era immigration rules, including a ban on legal immigration that Donald J. Trump implemented at the beginning of the pandemic.
The European Union announced on Wednesday the creation of a new biomedical authority designed to better respond to future pandemics, as it seeks to avoid repeating the mistakes that plagued its early response to the coronavirus.
Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, also pledged to donate 200 million extra coronavirus vaccine doses to middle- and low-income countries by mid-2022, in addition to 250 million already promised by the end of the year.
In her annual speech on the state of the union, Ms. von der Leyen described vaccination discrepancies as one of the greatest geopolitical issues facing nations.
“The scale of injustice and the level of urgency are obvious,” Ms. von der Leyen told lawmakers at the European Parliament in Strasbourg, in eastern France, acknowledging that the bloc and other rich nations had fallen short on their promises.
But the bloc’s pledges on vaccine donations have so far rung hollow: E.U. member countries had only donated 18 million doses as of early September, a fraction of the 200 million promised. Covax, the global vaccine-sharing program, of which the European Union is a part, last week slashed its forecast for doses available this year, in part because rich countries continued to hold most of the world’s doses.
Still, Ms. von der Leyen’s speech served as a reset for the European Commission after early missteps in vaccine procurement that took a more positive turn in recent months.
While most developing countries have yet to administer a single dose of a coronavirus vaccine, including in the European Union’s immediate neighborhood, more than 70 percent of adults across the bloc have been fully vaccinated.
“We delivered,” she said, although she conceded that the bloc faced wide discrepancies domestically, as several Eastern European countries have been lagging behind.
Ms. von der Leyen’s confident tone on Wednesday came in great contrast with her speech last year, when new Covid-19 cases were picking up across the bloc and coronavirus vaccines were months away.
“When I stood here in front of you a year ago, I didn’t know when and if we could have a safe and effective vaccine against the pandemic,” she said.
The European Commission, which negotiated for vaccines on behalf of member countries, was heavily criticized for the sluggish beginning of its vaccination program. The commission signed its first deal on behalf of member nations months after the United States, hampering vaccine deliveries and, later, inoculation campaigns.
Yet the rollout gained speed in recent months, and many E.U. countries have now overtaken other rich nations like the Britain, Israel and the United States. Some have started administering booster shots to millions of older and vulnerable residents, even though the World Health Organization has called on the richest nations to delay boosters until the end of the year, to allow more doses to go to poorer countries.
To help the bloc be better prepared for future health crises, Ms. von der Leyen said that the new agency — known as the Health Emergency Preparedness and Response Authority, or HERA — would aim to “make sure that no virus will ever turn a local epidemic again into a global pandemic.”
It is set to receive 50 billion euros (about $59 billion) in funding by 2027 and will function alongside the E.U.’s existing health agencies, the European Center for Disease Control and the European Medicines Agency.
But its exact role remains unclear, as E.U. members each run their own health policies. The pandemic brought to light the limits of the European Center for Disease Control, which is in charge of coordinating individual nations’ pandemic response plans but has had limited powers in enforcing or modifying states’ actions.
Still, many welcomed the creation of the new agency, highlighting a need for more coordination at an E.U. level. Véronique Trillet-Lenoir, an oncologist and a lawmaker in the European Parliament, said the agency could reinforce solidarity among the bloc’s member countries, something it lacked in the early stages of the pandemic.
“What the coronavirus pandemic has shown is that the 27 member states have fared much better all together,” Ms. Trillet-Lenoir said, “and that no European country would have done better on its own.”
The coronavirus pandemic helped propel the recall attempt of Gov. Gavin Newsom to the ballot in California, and on Tuesday, his handling of the pandemic was an overriding issue as about two-thirds of voters decided he should stay in office.
Across the nation’s most populous state, voters surveyed by New York Times reporters outside polling places cited Mr. Newsom’s pandemic restrictions and support for vaccine mandates as key factors in whether they voted to oust or keep him. The recall served as a preview of next year’s midterm elections nationally, with voters sharply divided along partisan lines over issues such as masks, lockdowns and mandatory vaccinations.
In San Francisco, Jose Orbeta said he voted to keep Mr. Newsom, a Democrat, in office, calling the recall a “waste of time.”
“It’s a power grab by the G.O.P.,” said Mr. Orbeta, a 50-year-old employee of the Department of Public Health. He said Mr. Newsom had done a “decent job” leading California through the pandemic despite his “lapse of judgment” in dining at the French Laundry during the height of the outbreak.
In Yorba Linda, a conservative suburb in Orange County, Jose Zenon, a Republican who runs an event-planning business with his wife, said he was infuriated by Mr. Newsom’s pandemic restrictions and support for vaccine mandates. He pointed to examples of his friends leaving for other states, such as Arizona, Nevada and Texas.
“That train out of here is really long, and we might be getting on it, too,” Mr. Zenon said, just after voting for Larry Elder, the Republican talk-radio host who led the field of challengers hoping to take Mr. Newsom’s job.
“The rules this governor made put a lot of businesses in an impossible position — we were without income for 10 months. Here we live in a condo, we want to have a home, but it’s just impossible. Something’s got to change.”
Some voters in an increasingly politically active constituency of Chinese Americans supported the recall. They blamed Mr. Newsom for a rise in marijuana dispensaries, homeless people and crime that they said are ruining the cluster of cities east of Los Angeles where Chinese immigrants, many of them now American citizens, have thrived for years.
“We really don’t like the situation in California,” said Fenglan Liu, 53, who immigrated to the United States from mainland China 21 years ago and helped mobilize volunteers in the San Gabriel Valley.
“No place is safe; crime is terrible. Newsom needs to go. This is failed management, not the pandemic.”
In the wealthy Orange County suburb of Ladera Ranch, Candice Carvalho, 42, cast her ballot against the recall because, she said, “I thought it was important to show that Orange County isn’t just Republicans.”
She expressed frustration that the recall was taking so much attention at a critical moment in the pandemic.
“It was a waste of money and completely unnecessary,” she said. “And I’m a little shocked we’re focusing on this now.” While she acknowledged knowing little about the specifics of state election laws, she said it seemed “slightly too easy” to get the recall attempt on the ballot.
The last 18 months have been exceptionally difficult for Public School 5 in the South Bronx, which serves low-income Black and Latino elementary- and middle-school students in a neighborhood that has been ravaged by the coronavirus.
Last year, about 80 percent of the school’s roughly 600 students chose to learn remotely.
But Danielle Keane, the school’s principal, believed her students needed to be back in classrooms this fall. And she knew she couldn’t just hope that her families would suddenly feel comfortable sending their children back.
So over the summer, she set out to make P.S. 5 a place that people wanted to be. There were comedy nights for families, along with literacy classes for parents still learning English, an outdoor movie night in the park adjacent to the school and a carnival that was wildly successful.
On Monday, nearly 90 percent of students on Ms. Keane’s register returned to classrooms, a higher percentage than the citywide average of just over 82 percent.
The school felt as vibrant as Ms. Keane hoped it would. “What a beautiful day,” she said.
But it’s only a first step toward achieving something like a normal school year.
Ms. Keane’s work is being put to the test this week, as New York’s school system, the nation’s largest, fully reopens for the first time since March 2020 — with no remote learning option.
There’s so much the school’s teachers don’t know about what the hundreds of children who were remote last year have been through. The academic and mental health challenges that will reveal themselves in the coming days and weeks may be enormous.
Throughout the coronavirus pandemic, a lack of centralized, national data on schooling has made it difficult for parents, educators, policymakers and researchers to make decisions and analyze trends.
On Wednesday, a team at Brown University led by Emily Oster, an economist and author, is launching the Covid-19 School Data Hub, a site that includes data from about 56,000 schools across 31 states. It is one of the most comprehensive efforts yet to document how schools operated during the pandemic, and, eventually, the researchers hope, measure the impact on children and the education system itself.
The site’s data will show when school buildings were open, closed or operating in hybrid mode. In 11 states, the hub can tally the number of students who participated in each mode of learning. It also includes counts of coronavirus cases discovered in schools in 30 states.
In the coming months, Professor Oster said, her team hopes to add data on student achievement and school enrollment to the site, tracking whether students who left local schools last year returned. In the future, researchers may be able to answer if and how school closures affected high school graduation rates, crime, obesity and mental health needs, she noted.
Professor Oster emerged early in the pandemic as a well-known voice in favor of in-person learning. In addition to her scholarly research on economics and public health, she is the author of a series of popular parenting books.
In an initial analysis using the new data hub, posted Wednesday, Professor Oster demonstrated that third- through eighth-grade test scores in Virginia declined the most at schools that operated predominantly online last year, and that the impact was greater in math than in reading.
Those findings fit within a broader, emerging body of research showing that millions of students experienced academic setbacks during the pandemic, with Black and Latino students, as well as students from low-income families, affected most heavily. Those groups also had the least access to open classrooms.
The data hub will fill an important information gap. There is no federal database of coronavirus cases discovered inside school buildings or during extracurricular activities such as sports.
The federal government has conducted a limited survey on when various schools operated in-person or online, and how many students participated in each setting. But the survey focuses only on fourth grade and eighth grade in 4,000 schools.
The hub is funded by several high-profile philanthropies: The Chan Zuckerberg Initiative, founded by Facebook’s Mark Zuckerberg and his wife, Priscilla Chan; Emergent Ventures, a program at George Mason University supported by Peter Thiel, the technology venture capitalist; and Arnold Ventures, founded by hedge fund billionaire John D. Arnold and his wife, Laura.
While the effort is broad, some pressing questions may be hard to answer, Professor Oster said. States are not collecting data on school quarantining policies or virus-related closures this academic year, for example. And there is not yet much concrete information on how individual schools plan to help students recover academically from the pandemic.
“When kids are far behind, how do you get them caught up?” Professor Oster asked. “That’s not just a pandemic problem.”
When Prime Minister Boris Johnson fumbled his initial response to the coronavirus pandemic, his political fortunes faltered. Then when Britain’s vaccine rollout proved surprisingly effective, his standing rebounded.
Now, with his popularity waning again — this time over tax policy — Mr. Johnson is hoping that the shots will turn things around for him a second time.
He is placing his faith in a redoubled vaccine campaign, including initial shots for children 12 to 15 and boosters for anyone over 50, to protect Britain’s health service from being overwhelmed by a winter surge, and to spare him from having to order lockdowns that would depress the economy and infuriate a noisy caucus of his own lawmakers.
If a major winter surge does develop, Mr. Johnson could reinstitute a mask mandate, introduce “vaccine passports,” and urge workers to stay home if possible, under what the government calls its Plan B. Full lockdowns would be a last resort.
“We’re now in a situation where so many of the population have some degree of immunity, smaller changes in the way we’re asking people to behave can have a bigger impact,” Mr. Johnson said at a news conference on Tuesday.
For a leader who often seems to defy political gravity, the risks are high. Poll ratings are slipping for Mr. Johnson’s Conservative Party, and some of the new voters he attracted in the 2019 election might be drifting away. “His premiership currently doesn’t seem to have delivered on the things that these voters want,” said Matthew Goodwin, professor of politics at Kent University.
“The vaccine bounce helped him the first time around, Mr. Goodwin said, “and if the booster plan — which will be a massive story in British politics — goes well and he’s able to say the rollout is going to plan, that will potentially help him.”
Like other Republican governors around the country, Tate Reeves of Mississippi reacted angrily to the coronavirus vaccine mandates President Biden imposed on private businesses. Declaring the move “terrifying,” he wrote on Twitter: “This is still America, and we still believe in freedom from tyrants.”
There is a deep inconsistency in that argument. Mississippi has some of the strictest vaccine mandates in the nation, which have not drawn opposition from most of its elected officials.
Not only does it require children to be vaccinated against measles, mumps and seven other diseases to attend school, but it goes a step further than most states by barring parents from claiming “religious, philosophical or conscientious” exemptions.
Resistance to vaccine mandates was once a fringe position in both parties, more the realm of misinformed celebrities than mainstream political thought. But the fury over Mr. Biden’s mandates shows how a once-extreme stance has moved to the center of the Republican Party.
Mr. Biden also imposed vaccine mandates on federal workers and many health care workers. But Republican outrage is really boiling over his plan to require all private-sector businesses with more than 100 employees to mandate vaccines or weekly testing for their work forces.
Gov. Greg Abbott of Texas called the president’s move “a power grab.” Gov. Henry McMaster of South Carolina promised to fight Mr. Biden in court, to “the gates of hell.” Gov. Greg Gianforte of Montana called it “unlawful and un-American.” Gov. Kay Ivey of Alabama called the move “outrageous” and “overreaching.”
But each of these states — like every state in the country — already mandates certain vaccinations for children, and sometimes for adults, including health care workers and patients in certain facilities.
Republican suspicion of vaccines was building before the pandemic; when Donald J. Trump was running for president in 2016, he rejected established science by raising the debunked claims that vaccines cause autism.
Now, some of the governors argue that given the country’s outsize divisions, and widespread suspicion of Washington, federal intervention would be counterproductive. It would be best, they say, to let state officials continue making the case that the vaccines are safe and effective, and to allow people to decide themselves.
Three-quarters of American adults have had at least one Covid-19 shot, which suggests growing acceptance of the vaccine. Mr. Biden’s move is aimed at the roughly 80 million Americans who are eligible but remain unvaccinated.
Alaska’s largest hospital announced Tuesday that a relentless coronavirus outbreak driven by the highly contagious Delta virus variant has left emergency room patients waiting hours in their vehicles and forced medical teams to ration care.
At Providence Alaska Medical Center in Anchorage, the hospital said it was now operating under “crisis standards of care” — procedures put in place to prioritize resources in a way that may leave some patients with substandard care.
Alaska, where 60 percent of adults are fully vaccinated, is just one state among many where the Delta variant has run rampant, straining hospitals to their breaking points. Last week, Idaho announced that medical centers in the northern part of its state would move to crisis standards of care. In Alabama, all I.C.U. beds are occupied, as hospitals in Southern states run dangerously low on space in intensive care units.
In Mississippi, where 51 percent of adults are fully vaccinated, state officials tried to outsource “I.C.U.-level-care patients” to Kentucky. And in North Dakota, an executive at the state’s largest health care system said it could use as many as 300 additional nurses to help treat Covid-19 patients.
In Anchorage, Dr. Kristen Solana Walkinshaw, a senior leader at the Providence hospital, wrote in a message to the community that the hospital did not have the necessary staff, space or beds to keep pace with demand.
“Due to this scarcity, we are unable to provide lifesaving care to everyone who needs it,” Dr. Solana Walkinshaw wrote.
The hospital said that with an emergency room overflowing, patients have to wait in their cars for hours to see a physician for emergency care. Elective surgeries continue to be postponed. Dr. Solana Walkinshaw said rationing care may include dialysis and “specialized ventilatory support.”
Providence Alaska Medical Center is a critical hub for patients from all over the state, serving as the destination for many people who need a higher level of care that can’t be provided in their home communities. Dr. Solana Walkinshaw said the hospital has been unable to accept patients from other facilities.
Alaska has been reporting record hospitalization numbers in recent days. New daily case numbers have also been on the rise, but Gov. Mike Dunleavy has resisted implementing mitigation measures — such as mask mandates — that other states have embraced.
On Tuesday, Dr. Solana Walkinshaw pleaded with members of the public to wear masks, even those who are vaccinated, and encouraged more vaccinations. She also encouraged people to avoid potentially dangerous activities because people who get seriously injured may not get access to a bed at the hospital’s trauma center.
Dr. Solana Walkinshaw said the hospital expects an escalation in Covid hospitalizations in the coming weeks.
“What is already a stressful situation could rapidly progress to a catastrophe,” Dr. Solana Walkinshaw wrote.