NAIROBI, Kenya — The rapidly escalating coronavirus crisis in India is not only forcing hospitals to ration oxygen and sending families scrambling to find open beds for infected loved ones. It is also wreaking havoc on the global vaccination effort.
Nowhere is that more evident than in Africa.
Most nations were relying on vaccines produced by the Serum Institute factory in India. But the Indian government’s decision to restrict exports of doses as it deals with its own outbreak means that Africa’s already slow vaccination campaign could soon come to a near standstill.
Before India suspended exports, more than 70 nations received vaccines it manufactured, totaling more than 60 million doses. Many went to low- and middle-income countries through the Covax program, the global initiative aimed at ensuring equitable access to vaccines.
So far, Covax has delivered 43.4 million doses to 119 countries, but this represents only about 2 percent of the two billion doses it hopes to deliver this year, according to Andrea Taylor, an assistant director at the Duke Global Health Innovation Center.
“The export controls from India are the primary constraint on Covax current supply,” she wrote in an email.
Even before India’s halt in shipments, Africa was experiencing the slowest vaccine rollout of any continent. As of April 21, African nations, with a total population of 1.3 billion, had acquired more than 36 million vaccine doses but administered only about 15 million, according to the Africa Centers for Disease Control and Prevention.
Just six million doses have been administered in all of sub-Saharan Africa — fewer than in many individual U.S. states. The prospect of reduced supplies further complicates what was, for many African nations, an already daunting logistical challenge.
Many African governments prioritized administering first doses to more of their populations in the expectation that more doses would soon arrive. Now they are struggling with what to do if there are not enough vaccine supplies to give the full two-dose regimen that offers maximum prevention.
Countries like Rwanda and Ghana, which were among the first to receive doses from Covax, are about to exhaust their initial supplies. In Botswana, inoculations were temporarily halted in some areas this month after the allotted doses were finished. And Kenya, which has almost run out of its initial one million doses, said this week that it would seek to acquire Johnson & Johnson and Pfizer vaccines to continue its inoculation campaign. On Saturday, because of the delays, the country lengthened the timing between the administration of the first and second dose to 12 weeks from eight.
In total, the 10 African countries that have carried out the most vaccinations have run through more than two-thirds of their supplies, said Dr. Matshidiso Moeti, the World Health Organization’s regional director for Africa.
The African Union’s vaccination task force has secured funding to purchase up to 400 million Johnson & Johnson vaccines for member states — but those doses won’t start arriving until fall.
“More than one billion Africans remain on the margins of this historic march to end this pandemic,” Dr. Moeti said.
A spokesman for Gavi, which helps lead the Covax program, said in an email that it was in close contact with the Indian government about restarting vaccine shipments, but that “in terms of timing of next deliveries, we’re not able to confirm at this stage.”
Even as the United States sits on tens of millions of doses of the AstraZeneca vaccine — the most affordable vaccine in widespread use — African nations are turning to Russia and China for doses made in those countries, despite concerns about lack of clinical data on their efficacy and safety.
Amid the delays, some African countries are facing new and possibly deadlier waves of the pandemic. The Africa Centers for Disease Control and Prevention reported 2,155 deaths from the virus in the past week, up from 1,866 the week before.
In Nairobi, the capital of Kenya and home to one of the continent’s better health care systems, officials have warned of a scarcity of intensive-care beds and oxygen supplies. Last month, the Kenyan government ordered a new lockdown that has prompted anger over the restrictions’ economic impact.
NEW DELHI — Twenty patients in critical condition at a Covid-19 hospital in New Delhi died overnight when oxygen supplies ran low, doctors said on Saturday — the third hospital tragedy this week in a country that is reeling from an enormous second wave of infections.
Deep Kumar Baluja, the medical director of the facility, Jaipur Golden Hospital in New Delhi, said that a scheduled delivery of oxygen supplies was seven hours late on Friday. That left the hospital’s reserves nearly depleted and led to lowered pressure in the oxygen lines that were keeping patients alive.
Around midnight, Dr. Baluja said, the patients began to succumb.
“A little after that, the patients died. Almost at midnight,” he said in a telephone interview. “One after the other.”
Despite numerous calls to Delhi government officials late Friday, the hospital had received only half of the oxygen it needed. Hospitals across India are desperately short of oxygen as new coronavirus patients flood in, prompting many big hospitals to appeal on social media for emergency supplies — or to announce that they cannot take new patients.
The Indian government reported more than 344,000 new infections on Saturday, setting a new global record for the third consecutive day, and more than 2,600 deaths from the virus. Yet experts say that those numbers, however staggering, are just a fraction of the real toll.
Millions refuse to even step outside for fear of catching the virus. Accounts from around the country tell of the sick being left to gasp for air as they wait at chaotic hospitals that seem to be buckling under the stress. On Wednesday, at least 22 coronavirus patients died at a hospital in Maharashtra State when a leak cut off their oxygen supply. Two days later, a fire at another hospital in the state left at least 13 Covid-19 patients dead.
The sudden coronavirus surge in India in recent weeks, with an insidious newer variant possibly playing a role, is casting increasing doubt on the country’s official Covid-19 death toll of nearly 200,000.
Interviews from cremation grounds across the country, where the fires never stop, portray an extensive pattern of deaths far exceeding the official figures. Nervous politicians and hospital administrators may be undercounting or overlooking large numbers of dead, analysts say. And grieving families may be hiding Covid connections, adding to the confusion in the enormous nation of 1.4 billion.
“It’s a complete massacre of data,” said Bhramar Mukherjee, an epidemiologist at the University of Michigan who has been following India closely. “From all the modeling we’ve done, we believe the true number of deaths is two to five times what is being reported.”
Months ago, India seemed to be doing remarkably well with the pandemic. After a harsh initial lockdown early last year was eased, the country continued to avoid the frightening case and death counts that sent other big countries into crisis mode, and officials began talking expansively about its success.
Now, countless Indians are turning to social media to send out heartbreaking S.O.S. messages for hospital beds, medicine and oxygen.
At the same time, India’s vaccination campaign is struggling. Less than 10 percent of the population has received even one dose, despite India’s status as the world’s leading vaccine manufacturer.
The situation will have ripple effects across the world, especially for poorer countries: India had planned to ship out millions of doses, but now, given the country’s stark shortfall, exports have essentially been shut down.
For weeks, Illinois, like much of the Upper Midwest, has been troubled by a stubbornly high daily load of reported coronavirus cases, leading to climbing numbers of hospitalizations and deaths. But new data is signaling that the virus might be on the verge of retreating.
Illinois is reporting an average of about 2,840 new cases a day, down nearly 16 percent from April 17. Central Illinois, which saw major growth in cases earlier this month, is now improving, according to a New York Times database — especially in Peoria, one of the metropolitan areas where the virus had been spreading the fastest.
“It is great we have seen some abatement in local hot spots,” said Dr. Emily Landon, the chief epidemiologist at the University of Chicago, who has been advising Gov. J.B. Pritzker, a Democrat, on the state’s pandemic response. Dr. Landon cautioned, though, that other pockets of the state, especially those with low vaccination rates, remained ripe for “a fiery outbreak.”
“I wouldn’t say everybody is out of the woods,” she said.
Indeed, hospitalizations remain high in Illinois and other Great Lakes states like Michigan and Minnesota, putting mounting pressure on health care systems. Hospitalizations in Illinois are up by about 25 percent over the past two weeks, as are hospitalizations in Michigan and Minnesota. In the past two weeks, deaths have risen by 20 percent in Illinois and 48 percent in Michigan.
The surge grew particularly worrisome in Michigan, which continues to lead the nation in daily cases per person but has recorded a 27 percent decline over the past two weeks.
Minnesota has recorded an 8 percent drop in daily new cases in the past two weeks, but a 25 percent increase in hospitalizations.
The case counts surged as variants were starting to spread widely, and states have been racing to vaccinate as many people as possible. More than a quarter of Illinois’s population is now fully vaccinated, and 44 percent of people have received at least one shot. Officials said the recent surge might be burning itself out in part because of the growing number of people who are protected.
“We have seen a beginning of, maybe, a lessening of the rise of cases,” Mr. Pritzker said last week. “I don’t want to predict anything, because this virus is unpredictable. But I think at least in the short term, that seems to be good news.”
Officials in Illinois said that when vaccinations first became widely available, people started taking fewer precautions, even though highly contagious variants were spreading.
“It led to the perfect storm,” said Monica Hendrickson, public health administrator for the Peoria City/County Health Department, who noted that recent cases had been highest among young people, the last to become eligible for the vaccine.
In Michigan, where 40 percent of adults have received at least one vaccine dose, Gov. Gretchen Whitmer, a Democrat, has asked the Biden administration for extra doses, but the administration has so far held to its policy of distributing doses by population and not demand.
The director of the Centers for Disease Control and Prevention, Dr. Rochelle P. Walensky, said at a White House news conference last week that securing extra doses was not the most immediate or practical solution. She said that Michigan — whose metro areas include 15 of the 17 worst outbreaks in the nation — needed to enact shutdown measures to quickly slow the virus’s spread.
The situation in Illinois remains dire. Dr. Michael Cruz, chief operating officer at OSF HealthCare, said on Thursday that about a half-dozen of the hospital system’s medical centers in Illinois were at more than 90 percent of capacity. He said it was too early to say whether the recent decline in new case reports was a “true inflection point.” In Michigan, 24 hospitals hit 90 percent of capacity last week.
“The virus does what the virus does,” Dr. Cruz said. “Let it hang around long enough, it will start mutating.”
Cambodia closed all markets in the capital, Phnom Penh, on Saturday to contain a surge in coronavirus infections, and thousands of families pleaded to the government for food as a two-week lockdown continued.
Cambodia also reported a daily record of 10 new coronavirus deaths on Saturday, its health ministry said, as infections spike following an outbreak first detected in late February.
The latest figures take the country’s overall number of cases to 9,359. Cambodia until recently had one of the world’s lowest numbers of infections. It has reported 71 deaths, all in the past two months.
Phnom Penh went into lockdown on April 15 and has declared some districts “red zones,” banning people from leaving their homes except for medical reasons.
In a new order issued on late Friday, Phnom Penh City Hall said all markets were to be closed from Saturday until May 7, adding that they have seen rising infections in markets and urging vendors and guards to get tested for the coronavirus.
City officials have given thousands of families who can’t leave their homes more than 50 pounds of rice, a box of soy sauce, a bag of fish sauce and a bag of canned fish, according to the City Hall’s Facebook page.
A government Telegram group set up recently for people seeking emergency food aid has received thousands of requests.
It was a similar story last year at Norwegian Cruise Line, which lost $4 billion and furloughed 20 percent of its staff while its chief executive’s pay doubled — and at Hilton, where nearly a quarter of the corporate staff was fired while the company’s top executive received compensation worth $55.9 million.
The divergent fortunes of chief executives and everyday workers in the United States during the pandemic illustrates the sharp divides in a nation on the precipice of an economic boom but still racked by steep inequality.
“We’ve created this class of centimillionaires and billionaires who have not been good for this country,” said Nell Minow, vice chair of ValueEdge Advisors, an investment consulting firm. “They may build a wing on a museum. But it’s not infrastructure — it’s not the middle class.”
In Manhattan’s Federal District Court, witnesses now testify from Plexiglas booths. New handsets let defendants communicate with lawyers confidentially, but at a distance. Jurors are sit spaced apart on elevated platforms, and deliberate and eat lunch in a separate courtroom. As New York reopens, the sprawling federal and state court systems have transformed the way they operate in order to bring people back into buildings safely and clear case backlogs. Nowhere have the changes been more visible than in jury trials.
The court spent $1 million reconfiguring 11 courtrooms and stocking courthouses with sanitizer, gloves, masks and antimicrobial pens. To get the system moving again, the court decided that criminal trials generally would be given precedence. And since trials had begun again, the court was having no difficulty attracting juries — since, for some, jury duty was preferable to staying at home.
Most adults who test positive for the coronavirus don’t require hospitalization but tend to seek medical care in subsequent months, and two-thirds of those who do are told they have a health condition they did not have before..
These are the findings of a study conducted by investigators from the Centers for Disease Control and Prevention and Kaiser Permanente, which included some 3,171 members of the Kaiser Permanente Georgia integrated health care system. More than half were Black.
The message for patients is that even for those who have had only mild Covid-19, “it’s possible you may experience new or persistent symptoms months after the initial diagnosis,” said Dr. Alfonso C. Hernandez-Romieu, an infectious disease specialist with the C.D.C., and the study’s lead author. “And it’s important for people to make sure they’re going to their clinicians,” he said, to express their concerns.
“It’s equally important,” he added, “for clinicians to acknowledge that there may be these long-term effects and to really make sure they’re validating patients, treating them with empathy and trying to help them in the best way possible.”
Clinicians need to monitor patients for Covid-19-related complications that are potentially very serious, like blood clots, he said.
The study did not compare patients who tested positive for the coronavirus to patients who did not, so the authors were unable to say whether people who had recovered from mild Covid-19 cases made more doctors’ visits than those who never had the virus.
But two-thirds of the patients who had mild disease sought medical care one to six months after their Covid-19 diagnoses, and about two-thirds of those who sought care were found to have an entirely new condition. The new diagnoses included cough, shortness of breath, heart rate abnormalities, chest or throat pain, and fatigue, “which likely represent ongoing Covid-19 symptoms,” the study said.
Among those more likely to seek medical care were adults 50 and older, women and those with underlying health conditions. Black adults were also slightly more likely than others to seek care. But over all, the authors noted, the number of visits declined over time.
The potential for long-term complications, even after a mild course of disease, underscores the need for prevention measures and vaccination, Dr. Hernandez-Romieu said.
“There is a lot we don’t know about post-Covid conditions,” he said. “Even though a majority of people don’t end up with severe Covid, or end up in the hospital, the potential for long-term health effects is really important.”
After a year in which many people have learned to dutifully wear masks and look askance at anyone who does not, it’s understandable that people remain fearful when they cross paths with the unmasked. So how to decide about when to wear a mask outside?
Many experts in viruses and public health say the guidance hasn’t changed: Spending time with others outside during the pandemic has always been safer than indoors. But whether a mask is needed outdoors depends on the circumstances, including local public health rules and whether people are vaccinated.
On Thursday, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said on the “Today” show that the agency is considering revising its mask guidance for outdoor activities as more and more people get vaccinated against the coronavirus.
She added that if “we can get our caseloads down, then we’ll be in really good shape in the country.”
While new cases, hospitalizations and new deaths have declined from their peaks in January, they have stayed at a relatively stagnant level in recent weeks, according to a New York Times database. The average of new cases is more than 61,000 a day, as of Thursday, with high concentrations in Michigan and the Northeast. And new deaths remain near an average of more than 715 a day.
Currently, the C.D.C. says masks “may not be necessary” when you are outside by yourself away from others, or with people in your household, but it does not explicitly say there is no longer a need to mask up while outdoors.
Brief encounters with an unmasked person on a sidewalk or a hiking trail are very low risk, said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech who is one of the world’s leading experts on viral transmission.
Even if a person coughs or sneezes outside, the odds of someone nearby getting a large enough dose of virus to become infected remain low, she said.
Dr. Marr uses a two-out-of-three rule for deciding when to wear a mask in public spaces or when she doesn’t know others’ vaccination status. In these situations, she makes sure to meet two out of three conditions: outdoors, distanced and masked.
“If you’re outdoors, you either need to be distanced or masked,” she said. “If you’re not outdoors, you need to be distanced and masked. This is how I’ve been living for the past year.”
in case you missed it
The Food and Drug Administration announced on Friday that Johnson & Johnson vaccinations would resume within days after federal regulators suspended use of the vaccine to investigate a rare blood-clotting disorder.
The one-shot vaccine will now come with a warning label about the disorder, which has occurred among young women. Health officials said information about the disorder would also be provided at vaccination sites.
“After recommending a pause out of an abundance of caution, we join our federal partners in encouraging everyone to get vaccinated against Covid-19 with the vaccine available to you,” Dr. Cara Christ, director of the Arizona Department of Health Services, said in a statement on Friday. “Arizonans can be confident that all Covid-19 vaccines approved for emergency use, including the Johnson & Johnson vaccine, have undergone a thorough review for safety and efficacy.”
At an advisory panel meeting on Friday, the Centers for Disease Control and Prevention reported that it had identified a total of 15 cases of the blood-clotting disorder, including three deaths. Regulators had suspended use of the vaccine 10 days earlier after learning that six women had developed the disorder within about two weeks of receiving the shot, and one had died.
The clotting disorder is exceedingly rare, and regulators decided that not using it would lead to more deaths from Covid-19 than the disorder might cause. Nearly eight million people in the United States have received the Johnson & Johnson shot.
Here’s what else you may have missed this week:
New York City health officials estimate that nearly a quarter of adult New Yorkers were infected with the coronavirus during the catastrophic wave of last spring, and that the toll was even higher among Black and Hispanic residents. The estimates, based on antibody test results, suggest that Black and Hispanic New Yorkers were twice as likely as white New Yorkers to have contracted the coronavirus.
Researchers at the C.D.C. have found no evidence that the Pfizer-BioNTech or Moderna vaccines pose serious risks during pregnancy, according to an early analysis of coronavirus vaccine safety data. Though the results are preliminary, the study is the largest yet on the safety of Covid-19 vaccines in pregnant people.
The Smithsonian announced on Friday that it would reopen eight of its Washington-area institutions, including the National Zoo, in May.
The reopenings will be phased. The National Air and Space Museum’s Steven F. Udvar-Hazy Center in Chantilly, Va., will kick things off on May 5. Next the National Portrait Gallery, the National Museum of African American History and Culture and the Smithsonian American Art Museum and its Renwick Gallery will open on May 14. The final wave will include the National Museum of American History, the National Museum of the American Indian and the National Zoo on May 21.
Visitors will need to reserve free timed-entry passes online for each location, which will be available beginning a week before an institution’s scheduled reopening. A Smithsonian spokeswoman said capacity would vary, but that it would start around 25 percent and then increase when the Smithsonian believes it can safely accommodate more visitors.
The museums and zoo will also require facial coverings for everyone ages 2 and older, some sites will reduce their hours and museum cafes will remain closed.
The Smithsonian had reopened the same eight institutions in phases between July and October of last year, only to close them again in November when nationwide coronavirus cases increased. Apart from those eight, all Smithsonian museums have been closed since March 2020 because of the pandemic.
Perth, Australia’s fourth largest city, began a three-day lockdown on Saturday after a coronavirus case was discovered outside quarantine.
Health officials believe that the virus passed from a man who left a two-week hotel quarantine on April 17 to a woman he later stayed with in Perth. The man tested positive on Friday after flying to Melbourne, officials said.
The lockdown bars the city’s two million residents from leaving their homes except to buy groceries, exercise, work or seek medical care. It has also forced the cancellation of public events in Perth on Sunday for Anzac Day, which celebrates military veterans of Australia and New Zealand.
New Zealand, which days ago opened a long-awaited travel bubble with Australia, said it had paused flights to and from Western Australia State, of which Perth is the capital. New Zealand’s government said in a statement that the pause was “an example of the type of scenario both countries have planned for.”
Australia has all but eliminated local transmission of the virus, in part by imposing swift, short-term lockdowns anytime new infections are found. In February, when one coronavirus case was detected outside quarantine for the first time in 10 months, Perth was locked down for five days.
The premier of Western Australia, Mark McGowan, said that more than 2,500 people underwent coronavirus tests at public clinics on Friday, and that more than 300 people who are believed to have come into contact with the infected man had been placed into quarantine and were being tested.
No additional infections have been found, Mr. McGowan said, but he urged residents to get tested if they believe they could be at risk.
“We need many more tests to be done,” Mr. McGowan told a news conference on Saturday. “This is crucial to get us the data and certainty to look beyond this lockdown.”