California, Besieged by Virus for Months, Has Most Deaths in U.S. – The New York Times

In Los Angeles, Kristin Michealsen, a chaplain, held the hand of a Covid-19 victim while talking to the patient’s family by phone.
Credit…Jae C. Hong/Associated Press

Dozens of times a day in Covid-19 wards across California, a scene like this plays out: A hospital chaplain watches as a death is announced by machine.

Kristin Michealsen, a hospital chaplain in Los Angeles, stood at a man’s bedside, holding his hand. His relatives gathered at their home just minutes from the hospital — they were not allowed into the hospital ward. The patient’s heart had just stopped. Ms. Michealsen, an ordained minister, had watched a computer monitor as she accompanied the man to the edge of his life. Eighty beats per minute. Sixty. Forty.

California has averaged 433 daily deaths over the past week. On Tuesday, it became the state with the largest total toll, surpassing New York.

In the depersonalized math of the pandemic, there are two ways to view the ravages of the virus in California. As America’s most populous state, it has by far the most cases in the country — more than 3.4 million — and now the most deaths. But when adjusted for its large population, California has a lower death rate than 31 states and Washington, D.C.

With about 114 deaths per 100,000 people, the state has about half the rate of New York, New Jersey, Massachusetts or Mississippi. The disparity between New York and California could be even greater when taking into account the likelihood that New York undercounted deaths in the pandemic’s frenetic early stages because virus testing was so limited.

Yet these mitigating statistics mean little to the families of the more than 44,900 people killed by the virus in California. Nor do the numbers mean much to chaplains like Ms. Michealsen, who on that day in January when the picture was taken by an Associated Press photographer had already watched two other patients die. Often, she is the only other person in the room when death comes. Sometimes, a nurse holds the other hand of the dying patient.

“When we come into this world, we are immediately surrounded by people — we have human touch,” Ms. Michealsen said last week from the Providence Holy Cross Medical Center in Los Angeles. “I just think that when we leave this world, we should have the same.”

The pandemic has taken an uneven toll in California, with people in the south and agricultural Central Valley much harder hit than those in the north.

In San Francisco, where almost 350 people have died from the virus, the cruelty of the pandemic — the inability of families to surround their dying relatives, the interruption of age-old rituals of mourning — is wearing.

“I’ve never in 15 years experienced the multiple layers of loss that we are experiencing now,” said Naomi Tzril Saks, a chaplain at the University of California, San Francisco medical center. Like chaplains across the country, Ms. Saks and her colleagues have done what they can to remedy the cruel isolation of the disease.

“We’ve Zoomed in bands and people playing the violin,” Ms. Saks said. “We Zoomed in a person’s son who was incarcerated, and she hadn’t seen him for years before she died.”

Chaplains have gone on virtual retreats to avoid emotional burnout, Ms. Saks said. Some have joined national support groups.

“There are stories and experiences from this pandemic that will stay in my body for a very long time,” Ms. Saks said.

People waited to get their injections in a parking lot at Golden Gate Fields, a horse racing track, in Berkeley, Calif., last week.
Credit…Jim Wilson/The New York Times

The United States is on the verge of administering 1.5 million doses of the coronavirus vaccine a day, nearing a goal President Biden set shortly after taking office last month.

According to the Centers for Disease Control and Prevention, 1.49 million shots, on average, have been administered each day over the last week, up from an average of about 900,000 doses when Mr. Biden took office.

The president has vowed to get “100 million Covid-19 shots in the arms of the American people” by his 100th day in office, a goal that some criticized as not ambitious enough since vaccinations had already been increasing during the final weeks of Donald J. Trump’s presidency. Since the vaccines were approved in December, about 32.9 million people in the United States have received at least one dose, including about 9.8 million who have been fully vaccinated with two shots.

But even as the rollout picks up speed, state leaders have complained that the limited supply of vaccines has slowed their ambitions.

“Right now, we don’t have enough doses for everyone who wants one,” said Lt. Gov. Peggy Flanagan of Minnesota. “Until the federal government steps up and provides them, our providers need to quickly use the precious supply we have on hand.”

Public health departments are also under pressure to head off racial disparities in the distribution of the vaccines and to make sure people who are eligible for shots are able to get to appointments.

In Detroit, officials are offering $2 roundtrip bus fare to a vaccination site downtown, as well as new neighborhood vaccine clinics at churches. In North Carolina, the health department is setting aside some doses for events in underserved communities.

“Speed is critical, but we are also emphasizing equity,” Gov. Roy Cooper said. “Communities of color have been disproportionately impacted by this devastating pandemic, and the state is working to reduce the high rates of sickness this population is experiencing.”

Eli Lilly’s bamlanivimab in production in Latina, Italy, in December.
Credit…Riccardo Antimiani/EPA, via Shutterstock

The U.S. Food and Drug Administration on Tuesday granted emergency use authorization to a Covid-19 therapy that combines two monoclonal antibody drugs.

The approval of the treatment, which is manufactured by the drug maker Eli Lilly, gives doctors another option for patients with Covid-19 who are not sick enough to be hospitalized but are at high risk of becoming seriously ill. Such therapies received a publicity boost under President Donald Trump when he and several other politicians took them while sick with Covid-19, but the drugs have not been widely used in many places, even as hospitalizations soared through the fall and into the winter.

Researchers are hopeful about suggestions in preliminary data that the new combination therapy may be better able to fight virus variants compared with a similar treatment already in use.

The therapy combines the company’s drug known as bamlanivimab — which was authorized in November and is being used for high-risk Covid-19 patients — with a second drug known as etesevimab. Both consist of artificially synthesized copies of the antibodies generated naturally when an immune system fights off infection.

Another monoclonal antibody combination therapy, made by Regeneron, is also authorized in the United States.

In clinical trial results announced last month, high-risk patients with Covid-19 who were given Eli Lilly’s combination therapy were significantly less likely to end up hospitalized than those who received a placebo. No patients who were given the combination therapy died.

The combination therapy must be given via an intravenous infusion. On Tuesday, the F.D.A. said that bamlanivimab alone could now be infused for a period as short as 16 minutes, down from an hour when the therapy was first authorized.

That long infusion time is one reason that monoclonal antibody drugs have not been more widely used in some places. Patients and their families have also struggled to gain access to the therapies. Some hospitals have been too overwhelmed to prioritize the drugs. And some doctors have been hesitant to embrace them, saying that they want to see more evidence from clinical trials supporting the drug’s use.

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White House Announces Plan for Vaccine Equity

The White House said on Tuesday that it would begin sending coronavirus vaccines to federally funded clinics in underserved areas starting next week to ensure a more equitable distribution of doses.

“Today, we are announcing another step in this effort focused on some of our hardest- hit populations. Starting next week, we will begin a new program with federally qualified health centers, or as many people know them, community health centers.” “Under this new program, we will begin directly sending vaccine supplies to community health centers, enabling them to vaccinate the people they serve. Community health centers are an important part of our broader strategy to ensure we are reaching everyone with our response.” “Equity is our North Star here. This effort that focuses on direct allocation to the community health centers really is about connecting with those hard-to-reach populations across the country.” “And as always, we plan to be very inclusive across jurisdictions. So in this initial phase, we will include at least one community health center in each state and territory. As the program further scales, vaccines will become available to all 1,400 community health centers across states and territories should they want to participate.”

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The White House said on Tuesday that it would begin sending coronavirus vaccines to federally funded clinics in underserved areas starting next week to ensure a more equitable distribution of doses.CreditCredit…Gerry Broome/Associated Press

The Biden administration will begin delivering Covid-19 vaccines directly to a network of federally funded clinics in underserved areas next week, officials said Tuesday, part of its effort to bring racial equity to a vaccination campaign aimed at eradicating a pandemic that has taken a disproportionate toll on communities of color.

The program, though, will be relatively small at first; the administration is allocating one million doses for 250 so-called “federally qualified health centers,” said Dr. Marcella Nunez-Smith, a Yale University professor who has been appointed by President Biden to lead a Covid-19 Equity Task Force. She said it would ramp up as supply expands.

“Equity is our North Star here,” Dr. Nunez-Smith said during a White House virus team briefing. “This effort that focuses on allocation for community health centers really is about connecting with those hard-to-reach populations across the country.”

Just as the pandemic has laid bare racial disparities in health care, it has exposed disparities in who is getting vaccinated. In cities like Washington, D.C., wealthy white residents are lining up to be vaccinated in low-income communities of color.

Experts say there are several reasons. People in underserved neighborhoods face a variety of obstacles, including registration phone lines and websites that can take hours to navigate, and lack of transportation or time off from jobs to get to appointments. And people of color, particularly Black people, are more likely to be hesitant about getting vaccinated, in light of the history of unethical medical research in the United States.

At the same time, the Biden administration is having trouble collecting data on the race and ethnicity of those vaccinated, a critical component of the racial equity effort. The Centers for Disease Control and Prevention reported last week that it has such data for just 52 percent of vaccine recipients.

“These data are just critical for us to have,” Dr. Nunez-Smith said in a recent interview. “It’s just at the core of the work that we need to do.”

The pace of vaccinations is increasing, amid expected — albeit slow — growth in supply, which continues to be a limiting factor. As of Tuesday, the seven-day average of vaccine doses administered across the United States was reported by the Centers for Disease Control and Prevention to be about 1.49 million doses a day.

Gov. Andrew M. Cuomo of New York, speaking to reporters after a call between governors and Jeffrey D. Zients, Mr. Biden’s coronavirus response coordinator, said he did not expect supply to substantially increase unless or until the Food and Drug Administration grants emergency approval to the vaccine made by Johnson & Johnson, which is expected in the coming weeks.

So far, just two vaccines, one by Moderna and the other by Pfizer-BioNTech, have emergency authorization from the F.D.A.

“You now have about 10 million New Yorkers waiting on 300,000 doses,” Mr. Cuomo said. “A big question on the call with the White House coordinator, by the governors, is ‘Supply, supply, supply — when will the supply increase?’”

When Mr. Biden became president, the federal government was shipping 8.6 million doses of vaccine to states each week. That number is about to go up to 11 million — an increase of 28 percent, Mr. Zients said. That tracks with expected increases in manufacturing.

The one million doses to the community clinics will be in addition to the supply being sent to the states. Separately, the White House announced last week that on Thursday, the administration will begin shipping an additional one million doses to 6,500 pharmacies.

A team of World Health Organization scientists spoke during a news conference in Wuhan, China, on Tuesday.
Credit…Ng Han Guan/Associated Press

For months, China resisted allowing World Health Organization experts into the country to trace the origins of the global pandemic, concerned that such an inquiry could draw attention to the government’s early missteps in handling the outbreak.

After a global uproar, the Chinese government finally relented, allowing a team of 14 scientists to visit laboratories, disease-control centers and live-animal markets over the past 12 days in the city of Wuhan.

But instead of scorn, the W.H.O. experts on Tuesday delivered praise for Chinese officials and endorsed critical parts of their narrative, including some that have been contentious.

The W.H.O. team opened the door to a theory embraced by Chinese officials, saying it was possible the virus might have spread to humans through shipments of frozen food, an idea that has gained little traction with scientists outside China. And the experts pledged to investigate reports that the virus might have been present outside China months before the outbreak in Wuhan in late 2019, a longstanding demand of Chinese officials.

“We should really go and search for evidence of earlier circulation wherever that is,” Marion Koopmans, a Dutch virologist on the W.H.O. team, said at a three-hour news conference in Wuhan, where the experts presented their preliminary findings alongside Chinese scientists.

Some scientists worry that shifting attention to other countries could cause the investigation to lose its focus. Determining what happened in the early days of the outbreak in China is considered critical to avoiding another pandemic.

The team also played down the idea that the virus might have leaked accidentally from a Chinese-run laboratory, a notion that even some skeptical scientists say is worth exploring. This theory is different than a widely discredited one pushed by some Republicans in the United States, which claimed that a lab in China manufactured the virus for use as a bio-weapon.

The W.H.O., by design, is beholden to its member countries and has long struck a diplomatic tone in dealing with the Chinese government, which is notoriously resistant to outside scrutiny. The inquiry is still in its earliest stages — it could take years — and W.H.O. officials have promised a rigorous and transparent examination of data and research by China and other countries.

Still, the findings announced Tuesday gave Beijing a public relations win as it comes under attack from officials in the United States and elsewhere for its initial efforts to conceal the outbreak.

“This is the most authoritative support that China has received in terms of its official narrative,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.

Mr. Huang said the W.H.O. should continue to press China for data and access.

“One visit is not enough time to do a thorough investigation,” he said. “They’re doing all the work within the parameters set by the Chinese government.”

The team did not report major breakthroughs but said it had found important clues. The virus was circulating in Wuhan several weeks before it appeared at the Huanan Seafood Wholesale Market, where some of the earliest clusters were initially reported, the experts said. It most likely emerged in bats and spread to humans through another small mammal, though the experts said they have not been able to identify the species.

Lynda Hartman with her husband, Len, who has dementia, in a “hug tent” outside his assisted-living center in Louisville, Colo., this month.
Credit…Thomas Peipert/Associated Press

People with dementia have significantly greater risk of contracting the coronavirus, and are much more likely to be hospitalized and die from it, than people without dementia do, a new study of millions of medical records in the United States has found.

Their risk could not be entirely explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home, and having conditions like obesity, asthma, diabetes and cardiovascular disease. After researchers adjusted for those factors, Americans with dementia were still twice as likely to have gotten Covid-19 as of late last summer.

“It’s pretty convincing in suggesting that there’s something about dementia that makes you more vulnerable,” said Dr. Kristine Yaffe, a professor of neurology and psychiatry at the University of California, San Francisco, who was not involved in the study.

The study found that Black people with dementia were nearly three times as likely as white people with dementia to become infected with the virus, a finding that experts said probably reflects the fact that people of color generally have been disproportionately harmed during the pandemic.

“This study highlights the need to protect patients with dementia, especially those who are Black,” the authors wrote.

The study was led by researchers at Case Western Reserve University in Cleveland who analyzed electronic health records of 61.9 million people age 18 and older in the United States from Feb. 1 through Aug. 21, 2020. The data, collected by IBM Watson Health Explorys, came from 360 hospitals and 317,000 health care providers across all 50 states and represented a fifth of the American population, the authors said.

The researchers found that out of 15,770 patients with Covid-19, 810 of them also had dementia. When the researchers adjusted for general demographic factors — age, sex and race — they found that people with dementia had more than three times the risk of getting Covid-19. When they adjusted for Covid-specific risk factors like nursing home residency and underlying physical conditions, the gap closed somewhat, but people with dementia were still twice as likely to become infected.

Experts and the study authors said the reasons for this vulnerability might include cognitive and physiological factors.

“Folks with dementia are more dependent on those around them to do the safety stuff, to remember to wear a mask, to keep people away through social distancing,” said Dr. Kenneth Langa, a professor of medicine at the University of Michigan who was not involved in the study. “There is the cognitive impairment and the fact that they are more socially at risk.”

People waiting in line before sunset to fill oxygen tanks last week at a government certified private provider in Mexico City.
Credit…Luis Antonio Rojas for The New York Times

MEXICO CITY — When a second wave of the coronavirus slammed into Mexico this winter, demand for oxygen exploded, spawning a national shortage of devices that deliver the lifesaving resource.

Prices spiked. A black market metastasized. Organized criminal groups began hijacking trucks filled with oxygen tanks, or stealing them at gunpoint from hospitals, according to media reports. And for a growing number of Mexicans, the odds of survival were suddenly in the hands of amateur oxygen sellers like Juan Carlos Hernández.

“We are in the death market,” Mr. Hernández said. “If you don’t have money, you could lose your family member.”

The resurgence of the pandemic in Mexico left more people infected than ever — among them the country’s president, Andrés Manuel López Obrador. In January alone, Mexico recorded more than 30,000 deaths, its highest monthly toll to date.

“Oxygen right now is like water,” said Alejandro Castillo, a doctor who works at a public hospital in Mexico City. “It’s vital.”

To survive at home, the sickest patients need to get purified oxygen pumped into their lungs 24 hours a day, sending friends and family members scrambling, often in vain, to find tanks and refill them multiple times a day.

David Menéndez Martínez had no idea how oxygen therapy worked until his mother became ill with Covid-19 in December. Now he knows that the smallest tank in Mexico can cost more than $800, up to 10 times more than in countries like the United States. The oxygen to fill it up costs about $10 — and can last as little as six hours.

Mr. Menéndez had a few tanks on loan from friends, but still spent hours waiting to refill them in lines that stretch across city blocks and have become a fixture in certain Mexico City neighborhoods.

“You see people arrive with their tanks and they want to get in front of the line and they end up crying,” he said. “They’re desperate.”

For people stuck navigating the chaotic market, finding someone with oxygen is a relief. In the time he spent scouring the city for oxygen, the only happiness Mr. Menéndez remembers was when he got to the front of the line and left with a full tank.

When he found a seller who would rent him a concentrator for $100 a week, he felt a spark of hope. “It was a blessing,” Mr. Menéndez said.

The machine kept his mother alive — for a while, until her lungs gave out. She was intubated on Christmas Eve, and died before the New Year.

Baseball season will start on April 1 with a traditional 162-game schedule and a 108-page manual that regulates coronavirus protocols.
Credit…Jamie Squire/Getty Images

As Major League Baseball players gear up for spring training, the league and the players’ union agreed late Monday to new health and safety obligations built on some of the regulations and pandemic lessons from 2020’s baseball season.

The operations manual governing the 2021 Major League Baseball season is 108 pages and regulates coronavirus protocols. It includes a five-day quarantine before reporting to spring training; shorter spring training games; no indoor dining; mandatory wearable contact-tracing devices; and discipline for violations, including for failure to wear a mask correctly, or at all, while at the stadium.

Before the delayed and abbreviated 60-game 2020 season began, M.L.B. and the union agreed to a similarly lengthy operations manual. But back then they were entering uncharted waters. Now, they have the benefit of their own experience and the knowledge of what worked for other sports.

The rules may still evolve as they did last season. Initial delays with the every-other-day testing were ironed out. And after two early outbreaks on the St. Louis Cardinals and the Miami Marlins threatened the season’s viability, M.L.B. tightened its protocols and became more aggressive in postponing games after a positive test, while players and key workers became more vigilant.

In the end, all but two teams — the Detroit Tigers and the Cardinals — played the full 60 games in the regular season. There wasn’t a positive test among players for nearly two months. The creation of bubblelike conditions allowed the postseason to go off without a hitch — until the final day, when Justin Turner returned to the field to celebrate the Los Angeles Dodgers’ World Series title despite having been pulled from the game after a positive test.

“I’m cautiously optimistic,” Dr. Michael Saag, an infectious diseases expert at the University of Alabama at Birmingham who is not affiliated with M.L.B. or the union, said about 2021’s protocols in a telephone interview on Tuesday. “I think the mitigation rules that they’ve created now have evidence that it worked for the most part, with a few exceptions.”

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New York City’s First Lady Gets Vaccinated

Chirlane McCray received a Covid-19 vaccine at Kings County Hospital in Brooklyn as health officials tried to address the racial disparity in the vaccine rollout.

It was so easy. Kings County Hospital staff are so warm and welcoming. And it’s so easy for us to do this. Fill out our application, get our card, our follow-up appointment and here we are. And it was just a pinch. All of us said the same thing. We barely felt it.

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Chirlane McCray received a Covid-19 vaccine at Kings County Hospital in Brooklyn as health officials tried to address the racial disparity in the vaccine rollout.CreditCredit…Mayoral Photography Office

New York City’s first lady, Chirlane McCray, received a Covid-19 vaccine on Tuesday afternoon at Kings County Hospital in Brooklyn, as New York City health officials try to address a stark racial disparity in its vaccine rollout.

Ms. McCray, who is 66, meets the state’s current age requirement that allows New Yorkers older than 65 years of age to get the vaccine. Her husband, Mayor Bill de Blasio, who is 59, does not.

So far, Black and Latino residents have received far fewer doses of a vaccine than white residents, even though communities of color have been hit hardest by the virus. The city’s demographic data is incomplete but the most recent data available shows that of nearly 375,000 city residents who received one dose of a vaccine and whose race was recorded, about 46 percent were white, 16 percent were Latino, 16 percent were Asian and 12 percent were Black.

Latino and Black residents were particularly underrepresented: The city’s population is roughly 29 percent Latino and 24 percent Black.

The city’s health department has pushed to encourage Black and Latino New Yorkers to get vaccinated, hoping to address vaccine hesitancy, in light of the history of unethical medical research in the United States. But Mr. de Blasio said last week that he and his wife, who is Black, would not receive the vaccine until they met state eligibility criteria, citing a desire to reassure New Yorkers that the process was fair and equitable.

“People need to see that folks they know, folks they trust and respect are getting the vaccine,” Mr. de Blasio said at a news conference. “They also need to know that the priorities are being respected and those who need it most are getting it first.”

After receiving her shot, a dose of the Pfizer-BioNTech vaccine, Ms. McCray encouraged eligible New Yorker to sign up for vaccine appointments — though access to those appointments, which are listed on dozens of disparate websites, has been one of the barriers to the equitable distribution of the vaccine.

“There really is nothing to be afraid of,” Ms. McCray said of being vaccinated. “We want to do this for our families, we want to do this for our loved ones, and of course we want to do it for our city.”

As of Tuesday, New York City had administered more than a million doses of vaccine. Mr. de Blasio had hoped to provide that many doses in January alone but has blamed a lack of supply for the slower pace.

Workers loading South Africa’s first Covid-19 vaccine doses as they arrive in Johannesburg this month.
Credit…Elmond Jiyane for Gcis, via Reuters

A million doses of the AstraZeneca-Oxford vaccine had been shipped recently to South Africa from India. The first injections were set for Wednesday. After weeks of rich countries vaccinating doctors and nurses against the coronavirus, a respite from the anxiety and the trauma seemed to be nearing in South Africa, too.

Then, all of a sudden, the plans were shelved. The country’s leaders on Sunday ordered the rollout of the vaccine halted after a clinical trial failed to show that it could prevent people from getting mild or moderate cases of Covid-19 caused by the coronavirus variant that has overrun the country.

The new findings from South Africa were far from conclusive: They came from a small clinical trial that enrolled fewer than 2,000 people. And they did not preclude what some scientists say is the likelihood that the vaccine protects against severe disease from the variant — a key indicator of whether the virus will overwhelm hospitals and kill people.

But even if the vaccine is shown to prevent severe disease, scientists say, what happened in South Africa is a warning to the world. As quickly as scientists developed vaccines, the virus has seemed to evolve even more quickly. Instead of eradicating the virus, scientists now foresee months, if not years, of vaccine makers continually having to update their booster shots to protect against new variants.

And if the variant first seen in South Africa, now present in 32 countries, becomes the dominant form of the virus elsewhere, those countries could face a far slower crawl out of the pandemic.

The news was not all bad. Other vaccines offer some protection against the variant from South Africa, though less than against earlier versions of the virus. Among them is Johnson & Johnson’s vaccine, which prevented hospitalizations and deaths in clinical trials in the country. Despite not yet being authorized there, it could be rolled out to some health workers by mid-February as part of what officials vaguely described as “a research project.”

AstraZeneca is working to produce a version of its vaccine that can protect against the variant from South Africa by the fall.

Still, the findings rattled scientists, undercutting the notion that vaccines alone will stop the spread of the virus anytime soon. And they led to new, and more urgent, demands that richer countries donate doses to poorer countries that could become breeding grounds for mutations if the virus spreads unchecked.

A number of coronavirus variants are raising worries that they may draw out the pandemic or make vaccines less effective. Here are four that have been in the news lately and what we know about them.

  • First emerged in Britain.

  • Thought to be about 50 percent more infectious than earlier versions.

  • Preliminary evidence suggests that it is about 35 percent more deadly.

  • Current vaccines appear to work well against it.

This variant has been detected in more than 70 countries, including the United States, where it is doubling roughly every 10 days. Experts predict that it could become the country’s dominant source of infection by March. Learn more about B.1.1.7.

South Africa halted its use of the AstraZeneca-Oxford vaccine on Sunday after evidence emerged that the vaccine did not protect against mild or moderate illness caused by B.1.351. The variant has spread to at least 24 countries, including the United States, where it has been detected in Maryland, South Carolina and Virginia.

A close relative of B.1.351, this variant has spread to several countries, including the United States, where it has been detected in Minnesota and Oklahoma.

This variant was found in more than half of the coronavirus test samples that were screened in Los Angeles.

For more information and the latest news on these variants, check our tracker.

Representative Richard E. Neal, Democrat of Massachusetts, unveiled the bill on Monday ahead of a week of legislative work to solidify the details of President Biden’s stimulus proposal.
Credit…Anna Moneymaker for The New York Times

House Democrats on Monday unveiled a main plank of President Biden’s stimulus plan, proposing legislation to send direct payments of $1,400 to Americans earning up to $75,000 and households with incomes up to $150,000.

The plan, drafted the day before key committees are scheduled to begin meeting to consider it, is at odds with proposals from some Republicans and moderate Democrats who want to curtail eligibility for direct payments, targeting it to lower-income people. Mr. Biden has said he is open to such modifications.

For now, the measure would allow individuals paid up to $100,000 and households up to $200,000 to be eligible for some payment, though the size of the checks would phase out gradually for those with incomes above $75,000, or $150,000 for a family.

The bill, unveiled by Representative Richard E. Neal, Democrat of Massachusetts and the chairman of the Ways and Means Committee, was one of a series that Democrats presented on Monday ahead of a week of legislative work to solidify the details of Mr. Biden’s stimulus proposal.

The decision to keep the income cap at the same level as the last round of stimulus payments comes after days of debate among the House Democratic caucus over the size of the checks. Some moderates pushed to restrict the full amount to those who make $50,000 or less and households making up to $100,000.

The legislation also includes significant changes to the tax code and an increase in an extension of weekly federal unemployment benefits. It would raise the $300-a-week payment to $400 a week and continue the program — currently slated to begin lapsing in March — through the end of August.

The $1.9 trillion plan would also provide for billions of dollars for schools, colleges, small businesses, and a provision that would increase the federal minimum wage to $15 by 2025, a progressive priority.

Global Roundup

Moving a coffin of a suspected coronavirus victim at a cemetery in Cochabamba, Bolivia, last year. The country has suffered one of the world’s worst epidemics.
Credit…Dico Soliz/Associated Press

In Bolivia, bodies are piling up at homes and on the streets again, echoing the horrific images of last year, when a deadly surge in coronavirus infections overwhelmed the country’s fragile medical system. The Bolivian police say that in January they recovered 170 bodies of people thought to have died from Covid-19, and health officials say intensive-care units are full.

“When 10 or 20 patients die, their beds are full again in a few hours,” said Carlos Hurtado, a public health epidemiologist in Santa Cruz, Bolivia’s largest city.

The resurgence of the virus in Bolivia is part of a larger second wave throughout Latin America, where some of the world’s strictest quarantine measures are giving way to pandemic fatigue and concerns about the economy.

The International Monetary Fund said on Monday that it was revising its 2021 growth forecast for Latin America and the Caribbean to 4.1 percent from 3.6 percent. Warning that the surge in cases could threaten an economic recovery that is already expected to take longer than in other parts of the world, the fund predicted that regional output will not return to pre-pandemic levels until 2023.

While the number of new cases is falling, deaths remain at near-record highs in many parts of the region, just as some governments begin vaccination efforts.

Brazil and Mexico have each been averaging over 1,000 daily Covid-19 deaths for weeks; their total pandemic death toll is now surpassed only by that of the United States. Deaths in Brazil have matched their midyear peak, while in Mexico they are far higher than any earlier peak, though they have begun falling in recent days.

In Bolivia in the middle of last year, mortality figures reviewed by The New York Times suggested that the country’s real death toll was nearly five times the official tally, indicating that Bolivia had suffered one of the world’s worst epidemics. About 20,000 more people died from June through August than in past years, according to a Times analysis — a vast number in a country of about 11 million people.

Bolivia is now reporting an average of 60 coronavirus deaths per day, approaching the numbers from last year’s peak. Experts believe the higher mortality rate is caused by the more contagious virus variants originating in neighboring Brazil and elsewhere, but they lack the instruments to analyze the virus’s genetic code.

Despite the rising death rate, the Bolivian authorities have not implemented the quarantine measures used to help curb the virus’s first wave a year ago. Officials in Bolivia and other Latin American nations are touting their nascent vaccination programs as a reason to avoid lockdowns, even though few countries in the region beyond Brazil have procured a meaningful number of doses.

Only 20,000 vaccine doses have arrived in Bolivia, although the government says it plans to vaccinate eight million people by September.

In other global developments:

  • More cases linked to a quarantine hotel in Victoria, Australia, were reported on Tuesday as an employee and returned traveler both tested positive for the virus. The traveler had completed her quarantine period, making her the second person this week to test positive after leaving a facility.

  • Starting next week, travelers who return to Britain from countries where variants of the virus are widespread will have to pay 1,750 pounds ($2,410) for a 10-day hotel quarantine, the authorities said on Tuesday. Those who lie about where they have been could face prison terms of up to 10 years, Britain’s health secretary, Matt Hancock, said. The list of affected countries include Portugal, as well as most of South America and southern Africa.

  • A “very small number” of British soldiers in Kenya have tested positive in an outbreak at a training camp, the British Defense Ministry said. The camp, about 120 miles north of the capital, Nairobi, has about 100 permanent employees and about 280 who rotate in and out, according to the British military. The base closed last year but reopened last month.

  • Greece is closing the schools in Athens again, and tightening other restrictions, because of a surge in new cases in the capital, Prime Minister Kyriakos Mitsotakis announced on Tuesday. Mr. Mitsotakis appealed to Greeks to “stay united” despite their frustration with a lockdown, the country’s second, that was imposed in early November. The Athens schools had reopened last month. Most retail stores in the country will remain closed, and a curfew in the capital and other major cities was extended last week.

  • Spain’s regional lockdowns are being challenged in court. On Tuesday, the highest court in the Basque region annulled an order by the authorities to shut down the region’s bars and restaurants, following legal action by an industry association. In its decision, the regional Supreme Court said that as long as social distancing limits were in place, being inside an establishment “does not appear at this moment like an element of grave and certain risk for public health.” On Tuesday, Spain reached 3 million registered coronavirus cases and its highest daily death toll since the first wave of the pandemic, with 766 deaths reported overnight by the health ministry.

A Covid-19 vaccination site at a church in Harlem.
Credit…Simbarashe Cha for The New York Times

A small number of people who have received a Covid-19 vaccine have developed immune thrombocytopenia — a lack of platelets, a blood component essential for clotting.

It is not known whether the blood disorder is related to the Covid vaccines. More than 31 million people in the United States have received at least one dose, and 36 similar cases had been reported to the government’s Vaccine Adverse Event Reporting System by the end of January. The cases involved either the Pfizer-BioNTech or Moderna vaccine, the only two authorized so far for emergency use in the United States.

The reporting system shows only problems described by health care providers or patients after vaccination, and does not indicate whether the shots caused the problems.

Officials with the Food and Drug Administration and the Centers for Disease Control and Prevention said that they were looking into the reports, but that rates of the condition in vaccinated people did not appear to be higher than the rates usually found in the U.S. population, so the cases could be coincidental. Over all, the vaccines are considered safe. A small number of severe allergic reactions have been reported, but they are treatable, and the rates are in line with those reported for other vaccines, regulators say.

In a statement, Pfizer said: “We take reports of adverse events very seriously,” and added that it was aware of thrombocytopenia cases in vaccine recipients.

A statement from Moderna did not address the platelet disorder but said the company “continuously monitors the safety of the Moderna Covid-19 vaccine using all sources of data” and routinely shares safety information with regulators.

Hematologists with expertise in treating immune thrombocytopenia said they suspected that the vaccine did play a role. But they said cases after vaccination were likely to be exceedingly rare, possibly the result of an unknown predisposition in some people to react to the vaccine by developing an immune response that destroys their platelets.

The disorder has occurred, rarely, in people who received other vaccines, particularly the measles-mumps-rubella inoculation.

Four skiers died on Saturday in an avalanche in Millcreek Canyon in Utah.
Credit…Wasatch Backcountry Rescue/Uacwasatch, via Reuters

At least 14 people died in seven avalanches in the United States during the first week of February. It was the country’s highest number of recreation-related fatalities in avalanches in at least a century, according to experts, who also said that the pandemic might be a contributing factor.

“The snowpack is the first-order reason — people are dying because it is very dangerous,” said Simon Trautman, an avalanche specialist for the U.S. Forest Service’s National Avalanche Center. “The question is the second-order or third-order effect. I don’t know, but what I do know is that there are more people out there this year because of Covid. There’s just no doubt about it.”

Avalanche experts say this season would be dangerous even without a pandemic. Early snow followed by a dry period across much of the West created a weak first layer of snow. Recent storms have dumped huge, heavy loads atop that weak layer — snow that entices people outdoors but also threatens to shatter the support below it, sending it all downhill in a battle of physics between gravity and friction.

But experts are also searching for answers beyond the scientific danger of this winter’s snowpack.

“It’s hard to drive a direct connection to Covid, but I think we can drive an indirect connection,” said Karl Birkeland, the director of the U.S. Forest Service’s National Avalanche Center.

“Across the country, we’ve seen a continuation of what we saw this summer, which is more and more people going out onto our public lands,” he said. “This winter we’ve seen more and more people going into the backcountry, whether on skis, snowshoes or snowmobiles. And with more people, you have a larger potential for people to get involved with avalanches.”

A hospital worker put a warning label on a body bag holding a deceased patient at Providence Holy Cross Medical Center in Los Angeles last month.
Credit…Jae C. Hong/Associated Press

Coronavirus-related deaths, which rose sharply in the United States beginning in November and remain high, appear to be in a steady decline, following in the tracks of new virus cases and hospitalizations, which began to drop last month.

The country has reported about 2,800 deaths a day recently, an average that excludes one anomalous day last week when Indiana announced a large number of backlogged death reports. That national average remains far above the level of early November, before the country’s recent surge, when roughly 825 deaths were being reported daily. But it is down significantly from the peak just a few weeks ago, when the average was more than 3,300 a day.

New coronavirus cases are a leading indicator for deaths, and that statistic has been improving markedly for a month. On Tuesday, the country reported 96,400 new cases, the third day in a row of having fewer than 100,000 new recorded cases, a level not seen since early November.

The seven-day average of new cases, a more reliable indicator of the pandemic’s direction, has fallen more than 50 percent since it peaked on Jan. 8.

Whether that will continue remains in doubt. Researchers warn that a more contagious virus variant first found in Britain is doubling roughly every 10 days in the United States. The Centers for Disease Control and Prevention cautioned last month that it could become the dominant variant in the nation by March.

Deaths tend to lag behind new cases by several weeks, and the day-to-day statistics can be prone to reporting vagaries. For a while, it was hard to discern clear signs that deaths had begun to decline. But the national trend now is unmistakable: The daily average has dropped about 18 percent since Jan. 12.

Although deaths are still rising in some states, including Alabama and South Carolina, far more are reporting sustained declines. Over the past two weeks, reports of virus deaths have dropped more than 40 percent in New Mexico and more than 30 percent in Arkansas, Colorado and Connecticut.

The declines are heartening but are not a reason for people to let down their guard, said Bill Hanage, an epidemiologist and associate professor at Harvard.

Dr. Hanage said the surges in new cases and deaths in December and early January had probably stemmed from the increase in gatherings over the holidays and from the onset of winter. Influenza and most kinds of coronavirus infections peak during winter, and there is little reason to think that Covid-19 is any different. (Influenza is not a coronavirus infection, as an earlier post suggested.)

The more infectious nature of the Covid-19 virus, and the appearance of variants that may spread even more easily, remain a significant cause for caution, he said.

“If in response to these dropping numbers people relax, then it is entirely possible and expected that we will see that decline start to bottom out and even start to increase again,” he said.

A New York Times analysis found that about half of the country’s roughly 465,000 Covid-19 deaths have occurred since the brutal surge began in November.

A nurse preparing the Pfizer-BioNTech Covid-19 vaccine at the East Alabama Medical Center Education Center in Montgomery.
Credit…Jake Crandall/The Montgomery Advertiser, via Associated Press

An expansion of Alabama’s lagging Covid-19 vaccination program drew large crowds of people on Monday as the state opened the last of eight new sites for inoculations.

The centers are a huge expansion of a vaccination program that has struggled to gain traction. Only 7.7 percent of eligible Alabamians have gotten at least one vaccine dose, according to a New York Times database, placing the state last among the 50 states and the District of Columbia.

Long lines of cars formed outside a downtown stadium in Selma, a hospital parking deck in Dothan and the site of a former shopping mall in Montgomery, where teams of workers delivered vaccinations through car windows. Shots were available to anyone over 65 and to select groups that included educators, farm workers, grocery employees and state legislators.

Before the centers opened, only about 700,000 medical workers, emergency medical workers, nursing home residents and people 75 and over were eligible to be vaccinated. The opening of the eight centers coincided with an expansion of eligibility for vaccination that raised that total to about 1.5 million.

Each of the eight centers is equipped to give 5,000 vaccinations by week’s end. By comparison, workers at Southeast Health medical center in Dothan had vaccinated fewer than 4,700 people since vaccines first became available in late December, the hospital spokesman, Mark Stewart, said in an interview.

Mr. Stewart said thousands of applicants had already sought appointments in the Dothan area. About 900 vaccinations were to be given out by day’s end, he said.

Sorgente articolo:
California, Besieged by Virus for Months, Has Most Deaths in U.S. – The New York Times

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