India on Saturday reported a daily record of 145,384 new cases as the coronavirus raced out of control. Deaths, while still relatively low, are rising. Vaccinations, a mammoth task in such a large nation, are dangerously behind schedule. Hospital beds are running short.
Parts of the country are reinforcing lockdowns. Scientists are rushing to track new versions of the virus, including the more hazardous variants first discovered in Britain and South Africa, that may be hastening the spread. But the authorities have declared contact tracing in some places to be simply impossible.
Politicians in India, still stinging from the economic pain of the last national lockdown, have mostly avoided major restrictions and have even returned to holding big election rallies, sending mixed messages to the public. India’s vaccine rollout was late and riddled with setbacks, despite the country’s status as a major pharmaceutical manufacturer.
Now India, once a major exporter of the AstraZeneca vaccine, has curtailed shipments to focus on the country’s own needs, delaying vaccination campaigns in many other countries.
When the coronavirus first struck India last year, the country enforced one of the world’s strictest national lockdowns. Though damaging and ultimately flawed, the lockdown and other efforts seemed to be effective in slowing the spread of the virus. The number of infections fell and deaths from the virus remained low. Officials and the public dropped their guard. Experts warned fruitlessly that the government’s haphazard approach would bring a crisis when a new wave appeared.
Complacency and government missteps have since turned India from a seeming success story into one of the world’s worst-hit places, experts say. And epidemiologists warn that continuing failure in India would have global implications.
“India’s size is going to dominate the global numbers — how the world performs on Covid is going to be very dependent on how India performs on Covid,” said Dr. Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics and Policy, with headquarters in Washington and New Delhi. “If it is not over in India, it is not really over in the world.”
The government is keeping nearly all of the 2.4 million vaccine doses that the Serum Institute of India, a private company that is one of the world’s largest producers of the AstraZeneca vaccine, makes each day. Only 6.3 percent of India’s population has been at least partially vaccinated.
The World Health Organization said on Friday that Covax, a global initiative dedicated to distributing Covid-19 vaccines to low- and middle-income countries, has only delivered 38 million doses so far. That falls far short of the 100 million doses it had expected to distribute by now.
“Most countries do not have anywhere near enough vaccines to cover all health workers, or all at-risk groups, never mind the rest of their populations,” said Dr. Tedros Adhanom Ghebreyesus, the director general of the W.H.O. “There remains a shocking imbalance in the global distribution of vaccines.”
Scientists have warned that poorer nations could wait years for Covid-19 shots, threatening to prolong the pandemic as the virus continues to spread and possibly mutate across the world. About 83 percent of shots administered worldwide have gone to people in high- and upper-middle-income countries, while just 0.1 percent of doses have been administered in low-income countries, according to a New York Times vaccine tracker.
The AstraZeneca shot has also run into complications in Europe, a blow to the more than 100 countries relying on the shot to counter a growing surge in cases. The shot is far less expensive and easier to store than other available vaccines, making it the world’s most widely administered Covid-19 vaccine.
European regulators said there was a “possible link” between the vaccine and rare blood clots, which can be serious and sometimes fatal. Officials said the benefits of the shot far outweighed the risks for a vast majority of people, adding that the vaccine has led to a drop in hospitalizations in Britain and saved thousands of lives.
Still, countries like Cameroon and the Democratic Republic of Congo have already halted injections of the vaccine amid concerns in Europe.
The Supreme Court late Friday lifted California’s restrictions on religious gatherings in private homes, saying they could not be enforced to bar prayer meetings, Bible study classes and the like. The court’s brief, unsigned order came after earlier ones striking down limits on attendance at houses of worship.
The vote was 5 to 4, with Chief Justice John G. Roberts Jr. joining the court’s three liberal members in dissent.
The majority said California had violated the Constitution by disfavoring prayer meetings. “California treats some comparable secular activities more favorably than at-home religious exercise, permitting hair salons, retail stores, personal care services, movie theaters, private suites at sporting events and concerts and indoor restaurants,” the opinion said.
In dissent, Justice Elena Kagan, joined by Justices Stephen G. Breyer and Sonia Sotomayor, said the majority had compared in-home prayer meetings with the wrong kinds of activities.
“The First Amendment requires that a state treat religious conduct as well as the state treats comparable secular conduct,” Justice Kagan wrote. “Sometimes finding the right secular analogue may raise hard questions. But not today.
“California limits religious gatherings in homes to three households,” she went on. “If the state also limits all secular gatherings in homes to three households, it has complied with the First Amendment. And the state does exactly that: It has adopted a blanket restriction on at-home gatherings of all kinds, religious and secular alike.”
In most of the state, all indoor gatherings had been limited to members of three households. The Rev. Jeremy Wong and Karen Busch, residents of Santa Clara County who held religious services in their homes, challenged those limits, saying they interfered with their constitutional right to the free exercise of religion.
Last year, before the death of Justice Ruth Bader Ginsburg, the Supreme Court allowed the governors of California and Nevada to restrict attendance at religious services. In a pair of 5-to-4 orders, Chief Justice Roberts joined what was then the court’s four-member liberal wing to form majorities.
The court changed course after the arrival of Justice Amy Coney Barrett, in a case from New York.
New Hampshire and Oklahoma announced plans this week to open up vaccine eligibility to outside residents as supply grows and more states expand eligibility.
Gov. Chris Sununu, Republican of New Hampshire, said officials were confident that there would be enough shots to vaccinate outside residents by April 19, the same day that President Biden has called for every state to make all adults eligible for a shot. Mr. Sununu said New Hampshire was “well ahead” of that deadline after making all adults ages 16 or older in the state eligible for a vaccine on April 2.
“We’re going to have a lot of vaccine here,” he said at a news briefing on Thursday, “so we want to get it out to anyone who might actually be here in the state.”
The change came after Mr. Sununu faced criticism from students and Democratic lawmakers for not allowing out-of-state college students to get vaccinated in New Hampshire. He said last week that residents had to “come first” and that college students were at lower risk compared with other age groups.
About 47 percent of New Hampshire’s population of about 1.4 million has received at least one shot, the highest portion out of any state, according to a New York Times vaccine tracker. New Hampshire is behind some other states, though, in fully vaccinating residents, with about 22 percent completely inoculated.
Oklahoma began allowing outside residents to get vaccinated in the state on Thursday, nearly two weeks after the state made all adults ages 16 or older eligible.
“We have always known there would be a point at which supply and increasing capacity would allow us to welcome residents from neighboring states into Oklahoma to get vaccinated,” Keith Reed, a deputy commissioner at the Oklahoma State Department of Health, said in a statement. “We are now reaching that point.”
About 35 percent of Oklahoma’s population has received at least one shot, and 22 percent are fully vaccinated.
Indiana also ended its residency requirement late last month. Dr. Kristina Box, the state health commissioner, said officials made the change to comply with Federal Emergency Management Agency vaccination site rules. The state also wanted to accommodate college students and residents who live with multiple people but may not have proof of residency. More than half of the states and the District of Columbia have residency requirements for vaccination, although most allow exceptions for out-of-state workers, according to a vaccine tracker from the Kaiser Family Foundation, a nonprofit organization focused on national health issues.
The United States is administering on average about three million shots a day, an increase from roughly two million in early March. Although millions of Americans are getting vaccinated, the country is reporting a sharp rise in new cases, with an average of 67,923 new reported cases a day over the past week, according to a New York Times database.
Jennifer Kates, a senior vice president of the Kaiser Family Foundation, said more states are likely to follow New Hampshire and Oklahoma’s path as vaccine production ramps up.
“If a state does feel more secure in its supply and is not feeling a crunch,” Dr. Kates said, “then the ability to help the national effort to vaccinate more people and remove barriers becomes important.”
New research has identified unusual antibodies that appear to have caused, in rare cases, serious and sometimes fatal blood clots in people who received the Covid-19 vaccine made by AstraZeneca.
Exactly why the rare reactions to the vaccine have occurred is still a mystery.
Scientific teams from Germany and Norway found that people who developed the clots after vaccination had produced antibodies that activated their platelets, a blood component involved in clotting. The new reports add extensive details to what the researchers have already stated publicly about the blood disorder.
Younger people appear more susceptible than older ones, but researchers say no pre-existing health conditions are known to predispose people to the rare reaction. That is worrisome, they say, because there is no way to tell whether an individual is at high risk.
Reports of the clots have already led a number of countries to limit AstraZeneca’s vaccine to older people, or to stop using it entirely. These cases have dealt a crushing blow to global efforts to halt the pandemic, because the AstraZeneca shot — easy to store and relatively cheap — has been a mainstay of vaccination programs in more than 100 countries.
The European Medicines Agency, the regulator for the European Union, has emphasized repeatedly that the clotting disorder is rare, and that the vaccine’s benefits far outweigh its risks. But when a side effect has the potential to be devastating or fatal — like the blood clots in the brain linked to this vaccine — some regulators and segments of the public are finding that the risk is unacceptable, even if it is extremely rare.
As of Sunday, European regulators had received reports of 222 cases of the rare blood-clotting problem in Britain and the 30-nation European Economic Area, which includes members in the European Union as well as Iceland, Norway and Liechtenstein. They said that about 34 million people had received the AstraZeneca vaccine in those countries, and that the clotting problems were appearing at a rate of about one in 100,000 recipients.
At least 300,000 more people died last year during the coronavirus pandemic than the numbers that were reported in Russia’s most widely cited official statistics.
Not all of those deaths were necessarily caused by the virus. But they belie President Vladimir V. Putin’s contention that the country has managed the health crisis better than most. In reality, a New York Times analysis of mortality data shows, deaths in Russia last year were 28 percent higher than normal — an increase in mortality greater than in the United States and most countries in Europe.
“People didn’t know the objective situation,” said Olga Kagarlitskaya. “And if you don’t know the objective situation, you are not afraid.” Her father had been hospitalized weeks earlier in a coronavirus ward. Now, he is gone and the cause of death is listed as “viral pneumonia, unspecified.”
For much of the last year, Russia has appeared more focused on the public-relations and economic aspects of the pandemic than on fighting the virus itself. After a harsh, two-month lockdown last spring, the government largely lifted restrictions over the summer, a boon for public opinion and the economy, even as the virus continued to spread more rapidly.
In other virus developments around the world:
Iran, which is facing a fourth wave of the virus, began a 10-day lockdown across much of the country, state TV reported. The surge in cases comes after an uptick in travel over Nowruz, the Persian New Year. The country’s president said the presence of the variant first detected in Britain was a major factor in the increase, according to The Associated Press.
Cambodia’s prime minister threatened those who break quarantine rules with prison time and said that civil servants who did not get vaccinated could lose their jobs, according to AFP. The authorities have recently imposed stricter Covid-19 measures, including a nightly curfew in the capital and the closure of a popular tourist destination.
Libya began its vaccination campaign on Saturday with the prime minister receiving his shot on live TV, Reuters reports. The country, mired in political turmoil, has been slow on the vaccine front but recently received doses.
British authorities have asked those who are mourning Prince Philip’s death not to congregate because of the country’s coronavirus restrictions, but people from the U.K. and abroad are traveling to Buckingham Palace and Windsor Castle to offer their floral tributes and prayers in front of the royal residences.
Farah Mohamed contributed reporting.
WHAT WE LEARNED
A highly infectious and more lethal variant first identified in Britain is now the most common source of new infections in the United States, the director of the Centers for Disease Control and Prevention announced this week.
That variant, B.1.1.7, has been found to be most prevalent in Michigan, Florida, Colorado, California, Minnesota and Massachusetts, according to the C.D.C. Until recently, the variant’s rise was somewhat camouflaged by the drastic drop in reported cases over all, lulling Americans into a false sense of security and leading to a relaxing of restrictions that researchers have warned was premature.
The variant is about 60 percent more contagious and 67 percent more deadly than the original form of the virus, according to the most recent estimates. Infected people seem to carry more of the B.1.1.7 virus and for longer, said Katrina Lythgoe, an evolutionary biologist at the University of Oxford.
At the moment, most Covid-19 vaccines appear to be effective against the variants. But public health officials are deeply worried that future iterations of the virus may be more resistant, requiring Americans to line up for regular rounds of booster shots or even for new vaccines.
“We don’t have evolution on our side,” said Devi Sridhar, a professor of public health at the University of Edinburgh in Scotland. “This pathogen seems to always be changing in a way that makes it harder for us to suppress.”
Health officials see an urgent need to expand vaccinations, which reduce transmission and therefore the virus’s opportunities to mutate. The United States is administering an average of about three million doses a day, up from roughly two million a month ago.
President Biden said on Tuesday that he was moving up the deadline to April 19 for states to make all adults eligible for a vaccine. Puerto Rico and Washington, D.C. said this week that residents 16 or older would become eligible for vaccinations on Monday, meaning all 50 states, the capital and the largest U.S. territory have now said they would beat or meet Mr. Biden’s call to accelerate their eligibility timelines.
Here’s what else we learned this week:
On Tuesday, the American Federation of Teachers, the second-largest U.S. teachers’ union, released a survey reporting that over 80 percent of association members had been vaccinated or had made a vaccine appointment. About 85 percent of members said their school was “operating on at least a part-time basis,” according to the survey.
As the United States struggles to emerge from the worst public health crisis in a century, the arrival of digital vaccine verification apps — a modern version of the World Health Organization’s “yellow card” that provides international proof of yellow fever vaccination — has generated intense debate over whether proof of vaccination can be required at all.
In Mississippi on Thursday, there were more than 73,000 vaccine appointments available as the state struggles to find enough people to inoculate. Though access remains a problem in rural Mississippi, experts say that the state — one of the first to open eligibility to all adults three weeks ago — may be a harbinger of what much of the United States will confront in the coming weeks, as increasing supplies enable most Americans who want the vaccine to easily make appointments.
The pandemic has hit African-Americans and Latinos hardest on all fronts, with higher infection and death rates, more job losses and more business closures. And not since Lyndon B. Johnson’s momentous civil rights and anti-poverty legislation has an American president so pointedly put racial and economic equity at the center of his agenda.
President Biden’s multitrillion-dollar initiatives to rebuild infrastructure in neglected and segregated neighborhoods, increase wages for health care workers, expand the social safety net, and make early education and college more accessible are all shot through with attention to the particular economic disadvantages that people of color face. So were his sweeping pandemic relief bill and Inauguration Day executive orders.
Yet as ambitious as such efforts are, academic experts and some policymakers say that still more will be needed to repair one of the most stubborn and invidious inequalities: the gap in wealth between Black and white Americans.
Wealth — a person’s total assets — is the most meaningful measure of financial strength. Yet for every dollar a typical white household has, a Black one has 12 cents, a divide that has grown over the last half-century. Latinos have 21 cents for every dollar in white wealth.
Proposals that confront the wealth gap head on, however, are expensive and politically charged.
Vice President Kamala Harris and Senators Bernie Sanders of Vermont, Elizabeth Warren of Massachusetts and Cory Booker of New Jersey have tended to push for asset-building policies that have more popular support. They have offered programs to increase Black homeownership, reduce student debt, supplement retirement accounts and establish “baby bonds” with government contributions tied to family income.
With these accounts, recipients could build up money over time that could be used to cover college tuition, start a business or help in retirement.
“We have very clear evidence that if we create an account of birth for everyone and provide a little more resources to people at the bottom, then all these babies accumulate assets,” said Michael Sherraden, founding director of the Center for Social Development at Washington University in St. Louis. “Kids of color accumulate assets as fast as white kids.”
Without dedicated funds — the kind of programs that enabled white families to build assets — it won’t be possible for African-Americans to bridge the wealth gap, said Mehrsa Baradaran, a law professor at the University of California, Irvine, and the author of “The Color of Money: Black Banks and the Racial Wealth Gap.”
She paraphrased a 1968 presidential campaign slogan of Hubert Humphrey: “You can’t have Black capitalism without capital.”
Outbreaks are ripping through workplaces, restaurants, churches and family weddings. Hospitals are overwhelmed with patients. Officials are reporting more than 7,000 new infections each day, a sevenfold increase from late February. And Michigan is home to nine of the 10 metro areas with the country’s highest number of reported cases.
During previous surges in Michigan, a resolute Gov. Gretchen Whitmer shut down businesses and schools as she saw fit — over the din of both praise and protests. But this time, Ms. Whitmer has stopped far short of the sweeping shutdowns that made her a lightning rod.
“Policy change alone won’t change the tide,” Ms. Whitmer said on Friday, as she asked — but did not order — that the public take a two-week break from indoor dining, in-person high school and youth sports. “We need everyone to step up and to take personal responsibility here.”
It is a rare moment in the pandemic: a high-profile Democratic governor bucking the pleas of doctors and epidemiologists in her state and instead asking for voluntary actions from the public to control the virus’s spread. Restaurants and bars remain open at a reduced capacity, Detroit Tigers fans are back at the stadium and most schools have welcomed students into the classroom.
Ms. Whitmer’s new position reflects the shifting politics of the pandemic, shaped more by growing public impatience with restrictions and the hope offered by vaccines than by any reassessment among public health authorities of how best to contain the virus.
A Florida woman who was seen in a widely watched video intentionally coughing on a shopper at a Pier 1 home-goods store over the summer, as fears about the pandemic were raging, was sentenced on Thursday to 30 days in jail, court records show.
The woman, Debra Hunter, 53, had been charged with misdemeanor assault in June after she walked up and coughed on the shopper, Heather Sprague, who had been recording video of Ms. Hunter’s dispute with employees at the store, in Jacksonville.
Ms. Sprague said in court that she had started recording Ms. Hunter after watching her berate store employees for 15 minutes in an argument over an item that Ms. Hunter wanted to return.
Ms. Sprague said she had undergone surgery to remove a brain tumor 10 months earlier and was still undergoing treatment when Ms. Hunter saw that she was recording and made an obscene gesture.
“I think I’ll get real close to you and cough on you, then — how’s that?” Ms. Hunter is heard saying in the video footage as she approaches the camera lens and then coughs. Ms. Sprague, who said she was wearing a mask at the time, testified in court that Ms. Hunter had left spittle on her face.
The episode came during a period during the pandemic when the authorities were responding to heated confrontations across the country over mask mandates and other precautions, with some of those disputes leading to criminal charges for people who spat or coughed on ride-share drivers, store employees and police officers. Retail workers also reported being subjected to verbal abuse — and even threats involving guns — for enforcing mask rules at their workplaces.
In addition to 30 days in jail, Ms. Hunter was sentenced to six months of probation and ordered to pay a $500 fine. The judge in the sentencing hearing, James A. Ruth of Duval County Court, also ordered her to take an anger-management class and to undergo a mental-health evaluation and participate in follow-up treatment, if appropriate.