Covid-19: World’s Virus Death Toll Nears 3 Million

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A funeral procession at Jardim da Paz cemetery in Porto Alegre, Brazil, last month.
Credit…Mauricio Lima for The New York Times

The world’s Covid-19 death toll is approaching yet another once unthinkable number — nearly three million people have died from the virus since the first cases surfaced more than 14 months ago and upended life for people across the globe.

The global death toll stands at 2,990,993, while the number of confirmed coronavirus cases has surged to nearly 140 million, according to a New York Times database, as countries race to provide enough vaccines to slow the relentless pace of infections.

The pace of deaths has been accelerating. The world did not record one million deaths until Sept. 28, but had recorded two million by Feb. 21, less than five months later. And the latest million took under two months.

The United States, Brazil and Mexico lead the world in Covid-19 deaths.

In the United States, more than 564,800 virus-related deaths have been confirmed, about one in 567 people — the most of any other country.

In Latin America, Mexico, Brazil, Colombia, Peru, Argentina and others have been hit hard by the virus.

Mexico has recorded more than 211,000 deaths. By comparison, Japan, which has a similar sized population, has had just 9,507 deaths.

In Brazil, where the spread of the virus has been fueled by a highly contagious variant, political infighting and distrust of science, more than 365,000 people have died. The virus is still pummeling the country, which is averaging over 2,900 deaths per day.

The leaders of both countries, which are the region’s two largest nations, have largely dismissed the dangers and have resisted calls for a lockdown.

India, the country with the fourth-highest number of total coronavirus deaths, has recorded more than 174,300 deaths. The virus is surging there once again, prompting more shutdowns and another mass migration away from big cities.

In the United Kingdom — where Britain recently ended one of the longest and most stringent lockdowns in the world — more than 127,100 deaths have been recorded. And in Italy, once the nightmarish epicenter of the virus, there have been almost 116,000 confirmed deaths.

Sweden, where officials have taken a more lax approach to combating the coronavirus, has experienced an increase in new cases and deaths recently, with more than 13,700 deaths.

As dangerous virus variants spread, many developed countries are racing to vaccinate their populations as fast as possible. More than 841 million vaccine doses have been administered worldwide, though some countries have yet to report a single dose, according to a New York Times database that tracks the worldwide rollout of shots.

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transcript

White House Announces Nearly $2 Billion Plan to Track Variants

Andy Slavitt, a White House pandemic adviser, announced a $1.7 billion plan on Friday to bolster the nation’s ability to monitor coronavirus variants through genomic sequencing.

Even as we accelerate our efforts to get shots in arms, more dangerous variants are growing, causing increases in cases with people without immunity. This increases the urgency for you to get vaccinated, but it also requires us to intensify our efforts to quickly test for and find genetic sequence of the virus as it spreads. Today, we are announcing a $1.7 billion investment to bolster the ability of the C.D.C., and state and local public health departments to monitor, track and defeat emerging threats, whether it’s Covid-19 variants today or other viruses in the future, through a process known as genomic sequencing. This significant investment, which is made possible due to the American Rescue Plan President Biden signed into law last month, is critical in our fight against the new and potentially dangerous variants of Covid-19. Right now, these variants account for nearly half of all Covid-19 cases in the United States, and we need more capacity in our public health system to identify and track these mutations. State and local public health departments are on the front lines of beating back the pandemic, but they need more capacity to detect these variants early on before dangerous outbreaks. This funding will enable C.D.C. and states to do more genomic sequencing as we activate the nation’s great research capabilities to detect variants earlier and increase our visibility into emerging threats. This investment will give public health officials the chance to react more quickly to prevent and stop the spread.

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Andy Slavitt, a White House pandemic adviser, announced a $1.7 billion plan on Friday to bolster the nation’s ability to monitor coronavirus variants through genomic sequencing.CreditCredit…White House via YouTube

The White House on Friday announced an almost $2 billion plan for expanding and improving the nation’s ability to track coronavirus variants, an effort that public health experts have said is desperately needed to fight against variants that could drive another wave or potentially undermine the effectiveness of vaccines.

More than half of the funding, $1 billion, would go to the Centers for Disease Control and Prevention and states to monitor those variants by examining positive virus test samples. The tracking relies on genome sequencing, in which researchers read every genetic letter in a coronavirus’s genome to find out whether the virus belongs to a known lineage or is an entirely new variant with new mutations.

That money will be steered to the collection of samples and sequencing, then sharing the data with health officials and scientists, the White House said. The C.D.C. has so far leaned heavily on commercial laboratories to conduct that work.

The investment is the most significant effort by the federal government yet to speed up its ability to locate variants, which account for over half of the nation’s coronavirus infections and could, officials fear, prolong the pandemic in many parts of the country. One variant, a more contagious and more lethal variant known as B.1.1.7 and first identified in Britain, has become the dominant version in the United States, contributing to a surge in Michigan, the worst in the nation.

While new U.S. cases, hospitalizations and new deaths have declined from their peaks in January, new cases have begun increasing again after a weekslong plateau, reaching an average of more than 70,000 a day as of Thursday, according to a New York Times database.

“State and local public health departments are on the front lines of beating back the pandemic, but they need more capacity to detect these variants early on before dangerous outbreaks,” Andy Slavitt, a White House pandemic adviser, said at a news conference on Friday.

Carole Johnson, the Biden administration’s testing coordinator, said in an interview on Friday that the money, part of the recently passed American Rescue Plan, would arrive at the C.D.C. “quickly” and get to states by early May.

“We’re hoping that that gives a quick jolt to our response efforts,” she said.

The rest of the funding will go to two programs that appear to be aimed at organizing a more permanent architecture for sequencing samples. Four hundred million dollars will go to what the White House described as partnerships between state health departments and academic institutions. They could help develop new surveillance methods for tracking viruses.

And $300 million will go to creating a unified system that will allow scientists to store, share, and make sense of the vast amounts of new data. The goal is to quickly detect the spread of variants and enable prompt decisions about stopping them.

“This is about both doing the near term work of supporting sequencing but also really building out that infrastructure,” Ms. Johnson said.

In February, the Biden administration put forward $200 million as a “down payment” on a more robust surveillance program, with the goal of sequencing 29,000 samples weekly. Officials described it as an early step in building out the federal government’s capacity to sequence more samples.

Earlier this month, Dr. Rochelle Walensky, the C.D.C. director, said that the B.1.1.7 variant, which is currently estimated to be about 60 percent more contagious and 67 percent more deadly than the original version, had become the most common source of new infections in the United States. The C.D.C. has also been tracking the spread of other variants, such as B.1.351, first found in South Africa, and P.1, which was first identified in Brazil.

Ms. Johnson said that the funding would help health officials across the country respond to outbreaks in a more sophisticated way, including by surging testing in certain areas or considering new mitigation strategies.

When B.1.1.7 was first detected in the United States at the end of December, experts warned that the country was poorly prepared to track coronavirus variants, lacking a national plan for collecting samples and analyzing their mutations to determine the variants’ spread.

In January, the United States was sequencing samples from less than 1 percent of positive coronavirus tests. Researchers said that simply wasn’t enough information to know how common variants really were and how quickly they were spreading. By contrast, Britain, the world’s leader in genomic surveillance, was sequencing up to 10 percent of new positive tests.

Over the past three months, the C.D.C. has charted a steady rise in the number of coronavirus genomes sequenced weekly in the United States, recording a new high of 14,837 for the week ending April 10. The number represented about 3 percent of the country’s positive tests that week.

Michelle Melton, who was 35 weeks pregnant when this photo was taken, receives the Pfizer-BioNTech vaccine in February at Skippack Pharmacy in Schwenksville, Pa. 
Credit…Hannah Beier/Reuters

Pregnant women in Britain are now eligible to receive a Covid-19 vaccine, British health authorities announced on Friday, citing data from the Centers for Disease Control and Prevention that showed that about 90,000 pregnant women had been vaccinated in the United States without any health issues.

The new guidance states that women in Britain who are trying to get pregnant, recently gave birth or are breastfeeding could be vaccinated with any available vaccine, but that the Pfizer-BioNTech or Moderna doses are preferred because “there is more real-world safety data from the U.S.”

Early in the pandemic, Britain had recommended against vaccines for pregnant women, citing a lack of research on side effects, but the country expanded access late last year to women at high risk of serious complications from Covid-19.

Last month, the C.D.C. and the World Health Organization recommended that pregnant women could get vaccinated, but should still consult their doctors. The W.H.O. limits its recommendations to pregnant women at high risk of contracting the coronavirus, including health care workers or those with underlying conditions.

If infected, pregnant women face a heightened risk of severe illness and death. During the pandemic, more pregnant women have experienced complications or delivered stillborn, according to an analysis of 40 studies in 17 countries published in the journal Lancet Global Health last month.

Vaccines are generally considered to be safe, and pregnant women have been urged to be immunized for influenza and other diseases since the 1960s, even in the absence of rigorous clinical trials to test them.

A teacher gets a shot of the CoronaVac vaccine at the Salvador Sanfuentes public school during the start of the vaccination campaign for educators in Santiago, Chile, in February.
Credit…Esteban Felix/Associated Press

China’s CoronaVac vaccine provides robust protection against Covid-19, Chilean health authorities said Friday, citing the results of a study that monitored the health outcomes of millions of people who received the inoculant.

The two-dose vaccine, produced by the Beijing-based pharmaceutical company Sinovac Biotech, was 67 percent effective at preventing symptomatic Covid-19 cases and 80 percent effective at preventing death, according to Chile’s health ministry. The study also found the shot was 85 percent effective at preventing cases that required hospitalization.

The study in Chile, which has carried out one of the fastest Covid-19 vaccination campaigns in the world, provides a more positive assessment of the vaccine’s effectiveness than a clinical trial in Brazil that relied on medical professionals.

In January, scientists in Brazil said CoronaVac had an efficacy of just over 50 percent at preventing symptomatic cases, an underwhelming level compared to other Covid-19 vaccines. The study in Chile analyzed the health outcomes of more than 10 million people, including four million who received CoronaVac.

Officials in Chile called the results very promising for the country and the global effort to end the pandemic. CoronaVac is the most widely used vaccine in Latin America, where several countries, including Chile, have grappled with a rise of Covid-19 cases in recent months.

“This study is not only very important for Chile, but also for the world and the scientific community,” Chile’s deputy health secretary, Paula Daza, said in a statement. “It shows this vaccine is safe and that we must continue with the vaccination process.”

CoronaVac is being widely used in Brazil, where deaths have soared, and several other countries in the developing world. It is cheaper and easier to handle than the vaccines developed by Pfizer and Moderna.

“The effectiveness of the Sinovac vaccine reported by the Chilean Ministry of Health is encouraging news for low-income countries without access to Western vaccines,” said Denise Garrett, an epidemiologist at the Sabin Vaccine Institute in Washington, D.C.

A nurse preparing vaccine doses at a medical office in Los Angeles this month.
Credit…Allison Zaucha for The New York Times

Scientists have long said that giving people a single course of a Covid-19 vaccine might not be sufficient in the long term, and that booster shots and even annual vaccinations might prove necessary.

In recent days, that proposition has begun to sound less hypothetical.

Vaccine makers are getting a jump-start on possible new rounds of shots, although they sound more certain of the need for boosters than independent scientists have.

Pfizer’s chief executive Albert Bourla said on Thursday that a third dose of the company’s Covid-19 vaccine was “likely” to be needed within a year of the initial two-dose inoculation — followed by annual vaccinations.

Albert Bourla, the Pfizer chief, said in a conversation hosted by CVS Health, that people may need to get Covid vaccine shots annually, like flu shots. Some vaccines are only given once, while others need annual boosters, he said. (An earlier version of this post included a quoted comment in which he misstated the number of vaccine doses required for polio immunity — more than one dose is needed.)

Dr. David Kessler, who runs the Biden administration’s vaccine effort, told a House subcommittee on Thursday that the government was also looking ahead. One factor at play is the spread of coronavirus variants and whether further vaccination could better target mutant strains.

Mr. Bourla said that “a likely scenario” is “a third dose somewhere between six and 12 months, and from there it would be an annual re-vaccination.” Moderna said this week that it was at work on a booster for its vaccine, and Johnson & Johnson has said that its single-shot vaccine will probably need to be given annually.

Dr. Kessler emphasized the “strong efficacy” of the current vaccines, including against the variants, but said that the government was “taking steps to develop next generation of vaccines that are directed against these variants if in fact they can be more effective.”

He was one of a handful of top federal health officials at the House hearing who implored Americans to get vaccinated and sought to reassure the nation that all three federally authorized vaccines are safe. They said little about restarting Johnson & Johnson shots, which came to a halt after the Food and Drug Administration called for paused to examine a rare blood-clotting disorder. It is unclear whether the vaccine was responsible for the clots.

Late Thursday, the Centers for Disease Control and Prevention said it had scheduled a new emergency hearing for April 23. The agency’s independent vaccine advisory panel, known as the Advisory Committee on Immunization Practices, or ACIP, has been scheduled to meet then for a second time since shots were halted, to discuss safety data related to a small number of blood-clotting cases in Johnson & Johnson vaccine recipients.

“We recognize the critical importance of moving quickly. That’s why we will have two unscheduled ACIP meetings in a 10-day period,” Dr. Rochelle P. Walensky, the C.D.C. director, said at a White House news conference Friday.

She said that the C.D.C. had contacted over 10,000 providers “to ensure that they know what kinds of cases to look for.”

As of Thursday, more than 125 million people in the country had received at least one dose of a Covid-19 vaccine, including about 78 million who have been fully vaccinated by Johnson & Johnson’s single-dose vaccine or the two-dose series made by Pfizer-BioNTech and Moderna.

In February, Pfizer and its partner, BioNTech, said that they planned to test a third shot and to update their original vaccine. The F.D.A. has said that vaccine developers will not need to conduct lengthy trials for vaccines that have been adapted to protect against variants.

On Tuesday, Moderna said that its vaccine continued to provide strong protection in the United States against Covid-19 six months after it is given, and the company’s chief executive, Stéphane Bancel, told CNBC that he hoped to have booster shots ready by the fall.

Tents where patients with Covid-19 were administered bamlanivimab infusions are seen outside of Laredo Medical Center in Laredo, Texas, in January.
Credit…Verónica G. Cárdenas for The New York Times

The Food and Drug Administration on Friday revoked emergency authorization for the stand-alone use of a monoclonal antibody treatment for high-risk Covid-19 patients at the request of the drug’s manufacturer, the final step in a transition to using that treatment only in combination with a second antibody drug.

The medical community will not need to change course as a result of the agency’s move, because doctors have already only been able to order treatment in combination form for weeks.

The agency said the move was prompted by the rise of new, concerning coronavirus variants that appear to be resistant to the therapy, known as bamlanivimab, when it is used alone. That would elevate the risk that the drug would fail to help the people for which it is intended, Covid patients who are not hospitalized but at high risk of bad outcomes.

The therapy’s manufacturer, Eli Lilly, had announced earlier on Friday that it requested that the agency revoke its clearance for the stand-alone use of bamlanivimab, saying that its combination treatment can combat more of the emerging virus variants in the United States than bamlanivimab alone. The company in February won emergency authorization to use the drug in combination with another antibody treatment, known as etesevimab. The federal government has ordered 100,000 doses of the treatment in cocktail form.

The two forms of Eli Lilly’s treatment rely on lab-made antibodies to mimic the immune system’s natural response to fend off the virus. Last November, bamlanivimab became the first such treatment to win emergency use authorization. Regeneron makes another antibody cocktail that is also being used for high-risk patients.

The treatments have been shown in clinical trials to sharply cut hospitalizations, but they were not as widely used as hoped when they hit the market, though that has begun to change. The drugs are cumbersome to administer, because they must be given as an intravenous infusion, and many patients did not know to ask for them or where to find them.

The move away from stand-alone use of bamlanivimab has been in progress for weeks. The federal government in March halted stand-alone ordering of bamlanivimab in California, Arizona and Nevada, because of concern about a virus variant first seen in California. Not long after, the federal government moved to block physicians from ordering bamlanivimab as a stand-alone treatment nationwide.

global roundup

A vaccination center at the Catalonia Railway Museum in Vilanova, Spain.
Credit…David Ramos/Getty Images

The European Union is unlikely to buy new doses of the AstraZeneca and Johnson & Johnson Covid-19 vaccines, a French minister said on Friday, the first public comment from a government official indicating that the bloc will do without two vaccines it long counted on to move out of the pandemic.

France’s industry minister, Agnès Pannier-Runacher, told RMC radio that although no final decision had been made, “it is highly probable” that no further doses of the vaccines would be ordered.

Several European countries briefly suspended the administration of AstraZeneca vaccine last month before resuming it, recommending use in older age groups only.

“We have not started talks with Johnson & Johnson or with AstraZeneca for a new contract, but we have started talks with Pfizer/BioNTech and Moderna,” Ms. Pannier-Runacher said.

The comment came days after the European Commission, the bloc’s executive arm, said that it was negotiating a contract extension with Pfizer/BioNTech, pivoting away form AstraZeneca’s vaccine on which it had initially bet big.

“We need to focus on technologies that have proven their worth,” Ursula von der Leyen, the Commission’s president, said of the Pfizer/BioNTech vaccine.

On Wednesday, Denmark became the first country to permanently stop the use of AstraZeneca’s vaccine.

In other news around the world:

  • Four more prefectures in Japan will be placed under quasi-emergency restrictions next week as health officials recorded more than 4,570 new coronavirus cases on Friday. The measures will go into effect on Tuesday in three prefectures neighboring Tokyo, as well as the prefecture surrounding the city of Nagoya, joining six others where restrictions were put in place earlier this month. The rules allow local authorities to order bars and restaurants to curtail their hours, and issue fines to those that don’t comply. While Japan has controlled the coronavirus better than most nations, a fourth wave of infections has added to concerns over the Tokyo Olympics, which are due to begin in less than 100 days.

  • A company in South Korea said it would lead a consortium in manufacturing more than 100 million Sputnik-V vaccine doses per month beginning in August, reflecting growing interest globally in the Russian-made shot. The announcement, by Huons Global, came days after India’s government said it would begin production of the Sputnik vaccine for domestic use and export, joining about 60 countries that have approved use of the shot. The Russian sovereign wealth fund backing the Sputnik vaccine has a separate deal with another Korean manufacturer to produce 150 million doses per month.

Shashank Bengali and Hisako Ueno contributed reporting.

A policeman guarding a shipment of AstraZeneca vaccines at Kamuzu International Airport in Lilongwe, the capital of Malawi, in early March. 
Credit…Thoko Chikondi/Associated Press

With growing community transmission and high average mortality rates from the coronavirus in Malawi, there was widespread concern among the country’s health care advocates this week when the authorities announced that they would throw away 16,000 vaccine doses that had expired.

They were part of a total of 512,000 AstraZeneca vaccine doses that the landlocked southeast African nation had received from India, the African Union and Covax, the global initiative to procure and distribute vaccines. Health officials didn’t specify why the vaccines had expired, but said the doses went void on Tuesday “due to varying expiry dates of the received vaccine consignments.”

Health experts and campaigners warned that vaccine hesitancy, along with rumors that out-of-date jabs were being administered, might have contributed to the slow distribution of the vaccine doses and their eventual expiration.

In many African countries, vaccination campaigns have been hindered by factors like science skepticism, limited or no efforts to educate the public, inefficient distribution systems and concerns over the extremely rare but serious cases of blood clots being investigated among a small number of people who received the AstraZeneca and Johnson & Johnson vaccines. Those two vaccines, which require less stringent refrigeration, are crucial to efforts to immunize populations in poorer countries.

When the first vaccine doses arrived in Kenya in early March, there was widespread hesitancy to receive them, even among doctors, according to Dr. Chibanzi Mwachonda, the secretary-general of the Kenyan medical workers’ union. The government turned to administering the doses to nonessential workers to avoid wasting them. The Democratic Republic of Congo, which also received its first doses last month, delayed its vaccination campaign until April 19, a date it set after reporting that a task force had determined that the AstraZeneca vaccine doses in the country didn’t pose a risk to the population.

The apprehension over the vaccines also comes as the African Union stopped plans to secure the AstraZeneca vaccine — a decision one official said was made to avoid duplicating the efforts of Covax, which will still supply AstraZeneca to African nations. But even though the decision was not linked to concerns over blood clotting, experts said it could still magnify misinformation about the vaccine. And the African Union is shifting its focus to the Johnson & Johnson vaccine, which could add to the problem. Its use has been paused in the United States.

In African countries, public confusion over whether to get inoculated, and if so when and where to do so, has contributed to the expiration of doses. Like Malawi, South Sudan saw 59,000 unused doses expire this month.

The problem is not unique to African countries. Tens of thousands of jabs have also been thrown away in countries like France and the United States. But African countries face far more serious supply shortages. According to a New York Times database, Africa has the slowest vaccination rate of any continent, with many countries yet to start mass vaccination campaigns.

Countries like Ghana, which was the first African nation to receive doses from Covax, is about to run out of its initial supplies with no sense of when the next batch may come.

“This inequality negatively affects the entire world,” said Dr. Ngozi Erondu, an infectious disease specialist and a senior health scholar at the O’Neill Institute at Georgetown University. If “entire regions and countries remain insufficiently vaccinated,” she said, “it will continue to ravage populations with persistent morbidity and leave the larger global health community always vulnerable to the virus.”

A health care worker administers a vaccine at the Military Hospital of Milan last month. Italy’s national military police are investigating widespread reports of younger people cutting the line for vaccines.
Credit…Alessandro Grassani for The New York Times

Last year, in the worst days of the pandemic in Italy, old people died in record numbers. Now, as the country rolls out its vaccination campaign, national authorities have uncovered a rash of line-cutting by younger people and accused them of depriving the elderly and the most vulnerable of their shots.

The national military police, the Carabinieri, are fielding hundreds of reports of vaccine cheating, including by teenagers and people in their early 20s, and the prime minister has felt compelled to weigh in.

“Stop vaccinating people under 60. Stop vaccinating young people,” Prime Minister Mario Draghi said in a news conference last week.

“How can people in all conscience jump the line?” Mr. Draghi added. “Knowing that they leave exposed a person who is over 75 to a risk, a concrete risk of dying, or a fragile person?”

Italy’s strategy has been to inoculate health care workers first, and then its older population, before making the vaccine available to younger age groups. Vaccine shortages and discrepancies in distribution across different regions delayed the campaign. Italy has fully vaccinated less than seven percent of its population, according to the country’s health ministry, in line with the average in the European Union.

But the national military police on Thursday notified 15 doctors and nurses on the island of Sardinia that they were under investigation for embezzlement and abuse of office for administering 50 doses of the Pfizer-BioNTech vaccine to their relatives — in many cases, younger people.

An opened vial of vaccine has a short shelf life, but all the doses were administered in the early hours of the day, meaning they were not at risk of being thrown away, investigators said.

“Some of the children or relatives of these doctors pretended to be caregivers,” said Major Nadia Gioviale, the head of the public health unit of the police in the Sardinian city of Cagliari. “Others signed up as ‘volunteers,’ although they were not paramedics or workers who care for fragile people; others just didn’t bother filling up the forms.”

Only 30 percent of people over the age of 80 have been fully vaccinated in Sardinia, and the region is among those where infections rates are the highest in the country, despite its stringent lockdown restrictions.

The authorities said the examples of fraud were part of a more widespread problem that affects the entire country. In Italy, 4.9 million people over the age of 80 have received their first shot, but 3.7 million people have been vaccinated under the label “other,” which includes some people with comorbidities, but also lawyers, court workers and local politicians.

In Sardinia, Major Gioviale added that the officers had just begun to investigate. “I expect to see these numbers growing, not just here,” she said.

Sicily faces similar challenges: Only 37 percent of residents over the age of 80 have been fully vaccinated. But 431,000 people listed as “other” have received first doses.

Other countries, including the United States, have also reported cases of people sneaking ahead of those who are eligible. In Canada, a couple from Vancouver was fined for flying to a remote town in order to get vaccinated.

Visitors at the Stavros Niarchos Foundation Cultural Center in Athens last month. Greece is taking a gradual approach to reopening its borders to tourists.
Credit…Byron Smith for The New York Times

Greece will open its borders to travelers from the United States for the first time in over a year, starting on Monday, provided they show proof of vaccination or a negative coronavirus test, a Greek government spokesman said on Friday.

The move is part of a broader easing of restrictions for travelers from the European Union and five other countries: the United States, the United Kingdom, Serbia, Israel and the United Arab Emirates.

For U.S. residents, the white paper vaccine certificates issued by the Centers for Prevention and Disease Control will be accepted for entry.

Once approved to enter, visitors from those countries will not be required to quarantine. Until now, all foreigners arriving in Greece were required to test negative for the coronavirus 72 hours before their departure and to quarantine for seven days upon arrival.

“This is part of a phased approach to gradually open up Greece for the tourism season,” the government spokesman said. “At first there will be a limited number of direct flights from these countries, but gradually more will be added, especially toward the summer.”

The decision came even as the country faces a surge in coronavirus cases and deaths. More than 200,000 active coronavirus infections were reported by the Greek health ministry on Thursday, and 104 deaths — the highest daily death toll in the latest wave of the pandemic.

Incoming travelers must fly to one of a handful of destinations: Athens, Thessaloniki, Heraklion, Chania, Rhodes, Kos, Mykonos, Santorini or Corfu.

Greece had initially planned to fully open its borders to foreign visitors on May 14, but the government decided to accelerate those plans to avoid an influx of arrivals at the same time.

“It is safer to take a gradual approach,” the spokesman said.

“Vaccination is the key to overcoming this pandemic,” Chancellor Angela Merkel of Germany said on Friday.
Credit…Tobias Schwarz/Agence France-Presse — Getty Images

Chancellor Angela Merkel of Germany received a first dose of the AstraZeneca Covid-19 vaccine on Friday, a show of confidence for the vaccine after weeks of confusion over its use across the European Union.

“I am happy that today I received my first dose of the AstraZeneca vaccine,” Ms. Merkel said in a statement. On Twitter, the message included an image of her vaccination documents, though none of the chancellor rolling up her sleeve as other leaders have done.

Some have criticized Ms. Merkel for not being more public about her inoculation at a time when many Germans are wary of getting a shot, especially of AstraZeneca’s vaccine, which has been hampered by concerns over very rare blood clots and logistical bungling in the European Union.

The vaccine was initially given only to people under 60 in Germany, amid concerns that it had not been tested widely enough on older people. Then it was halted entirely after dozens of mostly young women developed an extremely rare clotting that proved fatal in at least seven cases. Since last week, the AstraZeneca vaccine has been available for Germans 60 and older.

“I thank everyone who has been active in the vaccination campaign — and everyone who gets vaccinated,” Ms. Merkel said. “Vaccination is the key to overcoming this pandemic.”

The chancellor was vaccinated hours after urging Parliament to tweak legislation that would allow her to enforce more stringent national restrictions as the coronavirus continues to spread throughout the country. Germany recorded 25,831 new cases on Friday, and the infection rate has risen to 160 per 100,000 people nationwide, well above the rate of 100 set by Ms. Merkel’s government as manageable.

A health care worker preparing a dose of the AstraZeneca vaccine at the Royal Exhibition Building in Melbourne last month.
Credit…James Ross/EPA, via Shutterstock

The Australian government said on Friday that the death of a 48-year-old woman who developed a rare blood-clotting disorder was likely linked to the AstraZeneca-Oxford vaccine.

The woman was vaccinated on April 8 in New South Wales and admitted to a hospital four days later, according to the Australian Department of Health. She was vaccinated hours before the Australian government announced that people under 50 years old should receive the Pfizer-BioNTech vaccine.

It was the country’s third case of “extensive thromboembolic event and thrombocytopenia” — meaning blood clots paired with low platelet counts that cause a tendency to bleed — following the vaccine.

The other cases involved two patients who have been hospitalized and are “recovering well,” according to Australian officials.

The woman who died had other underlying medical conditions, including diabetes. Australian officials said that an autopsy had been scheduled for the week of April 19.

Researchers in Europe studying a similar rare blood disorder among recipients of the AstraZeneca vaccine have said it appears to be caused by an intense reaction to the vaccine by the immune system, which generates antibodies that activate a person’s platelets, a blood component that creates normal clots to repair wounds.

But in the atypical Australian case, the woman tested negative for such antibodies, according to the Vaccine Safety Investigation Group, a group of independent medical and consumer experts who advise the Australian Department of Health’s drug regulation arm, the Therapeutic Goods Administration.

And unlike some other cases under review in various countries, the health authorities did not indicate that the woman developed any clots in the brain, or cerebral venous sinus thrombosis, one of the conditions that has emerged in recent weeks with the rare combination of low platelets in other patients who received the AstraZeneca vaccine.

Still, in the absence of another explanation for the disorder, the group said that it believed “a causative link to vaccination should be assumed at this time.”

Public health experts, who fear that publicity surrounding the rare vaccine-related reactions will fuel hesitancy, have continued to emphasize that the benefits of the AstraZeneca-Oxford vaccine far outweigh the risks.

In many nations, it is the only vaccine available.

The Therapeutic Goods Administration said that about 50 Australians experienced more common blood clots every day in cases unrelated to vaccinations, and that, with at least 885,000 doses of the AstraZeneca-Oxford vaccine administered in the country so far, the three cases involving the unusual pairing of clotting and bleeding “equates to a frequency of 1 in 295,000.”

Iceland is one destination allowing fully vaccinated travelers into the country.
Credit…Hazel Thompson for The New York Times

If 2020 was the summer of the pandemic-enforced road trip, many people seem to be hoping that 2021 will be the summer they can travel overseas.

But roadblocks abound. Among them are the rise of variant cases in popular destinations like Europe and confusion about the role that vaccine “passports” will play as people begin crossing borders.

Still, there is reason for optimism. The number of vaccine doses administered each day in the United States has tripled in the last few months, and President Biden has said the United States is on track to vaccinate every American adult who wants it by the end of May.

Some airlines have eyed May to expand international flights as vaccines become more available. Global hotel companies are preparing for more guests, and tour companies are ramping up. Trips that emphasize the outdoors and uncrowded places have become even more popular compared with last year.

“Hoteliers are chafing at the bit” to reopen and are able to do so quickly, said Robin Rossman, the managing director of the hospitality analytics company STR. The global hotel sector, though, will likely take up to two years to make a full return, he said.





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