Covid-19 Updates: U.S. to Send Brazil 3 Million Doses of J&J’s Vaccine

The White House plans to send 3 million doses of Johnson & Johnson’s vaccine to Brazil on Thursday.

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A health care worker loading up protected vials of Covid vaccine bound for hard-hit riverside areas in the Amazon rainforest in northwestern Brazil.Credit...Mauricio Lima for The New York Times

The White House said on Wednesday that the United States would send three million doses of Johnson & Johnson’s vaccine to Brazil on Thursday. The country’s virus cases and fatalities are surging again, with a death toll above 500,000.

Less than a third of the country’s population has had at least one shot, and an average of 74,490 new cases per day were reported in the country in the last week — an increase of 26 percent from the average two weeks ago.

The vaccines, which are set to arrive in Campinas, near São Paulo, are part of President Biden’s pledge to dispatch 80 million doses overseas by the end of the month, a White House official said. The official added that “scientific teams and legal and regulatory authorities” from the United States and Brazil had worked to secure the arrangement.

The shipment to Brazil follows one to Taiwan last weekend: 2.5 million doses of Moderna’s vaccine. Mr. Biden, who has been under intense pressure to increase his vaccine commitments abroad, announced this month that his administration would buy 500 million doses of the Pfizer-BioNTech vaccine and distribute them among about 100 countries over the next year.

Asked last week at a pandemic news conference whether the administration would send vaccines to Brazil, Jeffrey D. Zients, the White House Covid-19 response coordinator, said that the United States was working with other countries on complicated logistical issues, including securing needles, syringes and alcohol pads that would accompany the medicine.

The Johnson & Johnson vaccine, which confers a high level of protection against virus cases, hospitalizations and deaths, has faced sagging demand in the United States. The Centers for Disease Control and Prevention and the Food and Drug Administration in April recommended a pause in its use after reports of a rare blood-clotting disorder in a small number of people who had received the vaccine, a decision that state officials said had derailed interest in the shot.

And with manufacturing problems at a Baltimore plant operated by a subcontractor, Emergent BioSolutions, Johnson & Johnson has been able to deliver fewer than half of the 100 million doses it promised the federal government by the end of this month. A little more than half the Johnson & Johnson doses delivered to states so far have been administered, according to C.D.C. data.

Roughly two-thirds of the doses the U.S. is sending to Brazil are from a federal pool that holds vaccines that states choose not to order, the White House said. Around a third of them were produced at Emergent and recently cleared by the F.D.A. in a special review of the facility and the doses produced there.

Earlier this month, the F.D.A. cleared around 10 million doses for use in the United States or for export, with a proviso that regulators could not guarantee that Emergent had adhered to manufacturing standards.

Last week, the agency released another 15 million doses from Emergent. It is still reviewing other batches of the vaccine to determine if they are safe. A decision is expected soon.

C.D.C. researchers identify 1,200 cases of post-vaccination heart problems, noting they remain very rare.

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A teenager receiving a Covid-19 vaccine in Philadelphia last month. Currently, the C.D.C. strongly recommends the shots for Americans ages 12 and older. Credit...Hannah Beier/Reuters

The coronavirus vaccines made by Pfizer-BioNTech and Moderna may have caused heart problems in more than 1,200 Americans, including about 500 who were younger than age 30, according to data reported on Wednesday by researchers at the Centers for Disease Control and Prevention.

Still, the benefits of immunization greatly outweigh the risks, advisers to the C.D.C. said. They strongly recommended vaccination for all Americans 12 and older.

The heart problems are myocarditis, inflammation of the heart muscle; and pericarditis, inflammation of the lining around the heart. The risk is higher after the second dose of an mRNA vaccine than the first, and much higher in men than in women. Researchers do not know why.

But the side effect is very uncommon, just 12.6 cases per million second doses administered.

C.D.C. researchers estimated that every million second doses given to boys ages 12 to 17 might cause a maximum of 70 myocarditis cases, but would prevent 5,700 infections, 215 hospitalizations and two deaths.

Agency researchers presented the data to members of the Advisory Committee on Immunization Practices, which makes recommendations on vaccine use in the United States. (The scientists grouped together pericarditis and myocarditis for reporting purposes.)

Most cases were mild, with symptoms like fatigue, chest pain and disturbances in heart rhythm that quickly cleared up, the researchers reported. Of the 484 cases reported in Americans under age 30, the C.D.C. has definitively linked 323 cases to vaccination. The rest remain under investigation.

“These events are really very rare, extremely rare,” said Dr. Brian Feingold, an expert on heart inflammation in children at the UPMC Children’s Hospital of Pittsburgh. “That needs to be taken in context with illness and morbidity and mortality related to Covid.”

Separately, more than a dozen federal and professional medical organizations said in a joint statement on Wednesday that myocarditis “is an extremely rare side effect, and only an exceedingly small number of people will experience it after vaccination.”

The C.D.C. advisers met as the Biden administration publicly acknowledged that it expected to fall short of its goal of getting 70 percent of Americans partly vaccinated by July 4. The shortfall, officials said on Tuesday, resulted in part from reluctance among younger Americans to be immunized.

It’s unclear what causes myocarditis, or why it is more common in young men than in women. The first cases linked to coronavirus vaccines were reported in Israel, mostly among young men aged 16 to 19 years. Israel recorded 148 cases between December and May, 95 percent of them mild.

In the United States, too, myocarditis has been more common in men and boys: Up to 80 percent of cases after the second dose were in males. There has also been a clear age difference, with the side effect clustered in individuals in their late teens and early 20s.

The vast majority of patients with myocarditis recovery fully, noted Dr. James de Lemos, a cardiologist at the University of Texas Southwestern Medical Center in Dallas, who reported one of the first cases in January.

Covid-19 itself may cause heart problems in young people. A large study of collegiate athletes showed that 2.3 percent of those who had recovered from Covid-19 had heart abnormalities consistent with myocarditis.

“It’s going to be many-fold more common to get heart muscle inflammation from getting Covid than you would from getting a vaccine, even in young men,” Dr. de Lemos said.

Vaccination is becoming an even more urgent priority, given more contagious variants of the coronavirus now circulating in the United States, Dr. Paul Offit, a pediatrician at the Children’s Hospital of Philadelphia and a member of the Food and Drug Administration’s vaccine safety committee, said in an interview.

“We are not close to being near where we need to be” in terms of the percentage of the population that should be vaccinated, Dr. Offit said. “And you’re going to head into winter when you’re going to have a generally under vaccinated population.”

Tracking the Coronavirus ›

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Nearly 900 Secret Service employees were infected with the virus, a watchdog group finds.

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A Secret Service agent on duty while former President Trump held a campaign rally in Oshkosh, Wis., last August.Credit...Doug Mills/The New York Times

The rigors of protecting a president, a vice president and their families in an election year amid a pandemic placed a heavy burden on the Secret Service, with nearly 900 employees testing positive for the coronavirus, a watchdog group said this week.

The group, the Citizens for Responsibility and Ethics in Washington, faulted former President Donald J. Trump for continuing to hold large campaign rallies, which it said had contributed to the infections.

It obtained the Secret Service data from the federal government as part of a public records request under the Freedom of Information Act. The cases were recorded from March 2020 to March of this year, according to the group, but the data did not include details of the assignments of the agents who were infected. The government also did not disclose what percentage of the total number of Secret Service employees had contracted the virus.

The employees who tested positive included 477 special agents, 249 members of the uniformed division and 131 staff members working in administrative, professional and technical positions, according to the group. The Secret Service is the main federal law enforcement agency charged with protecting U.S. political leaders, including the president, and the families.

“Throughout the pandemic, then-President and Vice President Trump and Pence held large-scale rallies against public health guidelines, and Trump and his family made repeated protected trips to Trump-branded properties which the then-president was making millions of dollars a year from,” the group said on Tuesday in a post on its website. The group also blamed the former president for riding in a vehicle with Secret Service protection while he was under treatment for a coronavirus infection last October, “further putting agents in danger,” it said.

Representatives for Mr. Trump did not immediately respond to a request for comment on Wednesday night.

A spokeswoman for the Secret Service said in an emailed statement on Wednesday that the agency had distributed masks, gloves and other protective gear to employees and conducted a robust virus-testing program. She added that the agency’s mission “required significant public interaction during a public health crisis” and that it “was fully prepared and staffed to successfully meet these challenges.”

Last November, the Secret Service’s uniformed-officer division experienced a coronavirus outbreak, according to several people who were briefed on the matter at the time. The outbreak was at least the fourth to strike the agency since the pandemic began, with at least 30 uniformed Secret Service officers testing positive for the virus over several weeks. About 60 officers had been asked by the agency to go into quarantine.

In the final months of Mr. Trump’s presidency, the virus permeated the West Wing. Several of his top aides tested positive, including Hope Hicks, his adviser; Kayleigh McEnany, the White House press secretary; and two of Ms. McEnany’s deputies, Chad Gilmartin and Karoline Leavitt.

Mr. Trump, who had eschewed wearing masks for months, was sicker with Covid-19 last October than the White House publicly acknowledged at the time, according to several people familiar with his condition. At the time that he was hospitalized, his blood oxygen levels had plunged and officials feared he was on the verge of being placed on a ventilator.

San Francisco will require all city employees to be vaccinated.

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A drive-through vaccination center at the City College of San Francisco in March.Credit...Jeff Chiu/Associated Press

The city of San Francisco said on Wednesday that it would require all 35,000 of its employees to be vaccinated against Covid-19 or risk losing their jobs, making it one of the largest U.S. municipalities to impose a vaccine mandate for public workers.

The requirement will take effect once a Covid vaccine receives full authorization from the Food and Drug Administration. The vaccines are currently being used in the United States under emergency authorizations.

City officials said that the requirement would promote safety in municipal workplaces and among the general public, given that police officers, firefighters, building inspectors and other city workers come into regular contact with members of the community.

“With those two things in mind — the safety of our employees and the safety of the public we serve — we made this decision,” said Carol Isen, San Francisco’s director of human resources. “We believe this step is a simple one to take. It’s safe, it’s very effective, and it’s going to guarantee the safety of all.”

San Francisco has one of the highest vaccination rates of any major U.S. city, with 80 percent of residents 12 and older having received at least one dose and 70 percent fully vaccinated, Mayor London Breed said this month. Ms. Isen said that informal surveys of city workers — many of whom live in other municipalities where vaccination rates are lower — suggested that at least 60 percent were fully vaccinated.

Under the new policy, starting on Monday, city employees will be required to show proof of their vaccination status within 30 days. City officials said that they would redouble efforts to get shots to those who haven’t had them, while allowing workers to request exemptions on medical or religious grounds.

Both Pfizer and Moderna, the makers of the two most widely used Covid shots in the United States, have applied for full F.D.A. approval for their vaccines, but it is unclear when regulators will make a decision.

Elsewhere in the United States, vaccine mandates have been met with opposition. This week, more than 150 staff members at a Houston-area hospital resigned or were fired for not following a policy that requires employees to be vaccinated against Covid-19.

San Francisco officials said that employees who did not meet the vaccine requirement could lose their jobs but added that firings would be a last resort. A recent outbreak of the Delta variant among unvaccinated residents in nearby Marin County — where more than 80 percent of people are fully inoculated — shows the need for everyone to receive the shots, officials said.

“We see that Delta did make its way through a cluster of unvaccinated people, and so we just wanted to make this move quickly,” Ms. Isen said. “We hope our employees respond to this in the spirit in which it’s offered — not as a punishment, but as a safety measure.”

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The inquiry into Emergent and its troubled Maryland vaccine plant is expanded.

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Representative James Clyburn, Democrat of South Carolina, speaking during a hearing about Emergent in Washington in May.Credit...Pool photo by Susan Walsh

Congressional investigators are expanding their inquiry of Emergent BioSolutions, the operator of a troubled Maryland vaccine-making plant, to encompass the firm’s relationship with the two companies that hired it to produce their shots.

In letters dated Tuesday, two House panels asked the companies, AstraZeneca and Johnson & Johnson, to document their efforts to supervise production of their vaccines at Emergent’s factory and to produce all records related to their decisions to hire Emergent as a subcontractor.

The plant, in southeastern Baltimore, has been forced to throw out the equivalent of 75 million doses of Johnson & Johnson’s coronavirus vaccine because of suspected contamination. Deliveries of more than 100 million other doses of both vaccines have been delayed for weeks while regulators check them. The plant has been closed since mid-April while Emergent tries to meet the regulators’ demands to bring its manufacturing up to standard.

The congressional panels began a joint investigation of Emergent’s operations after The New York Times documented months of problems at the Baltimore plant, including a failure to properly disinfect equipment and to protect against viral and bacterial contamination. Among other matters, Democratic lawmakers are looking into whether the company leveraged its contacts with a top Trump administration official, Dr. Robert Kadlec, to win the business of vaccine production, and whether federal officials failed to oversee the firm’s work.

The investigation is being run by the Committee on Oversight and Reform, headed by Carolyn B. Maloney, a New York Democrat, and the Select Subcommittee on the Coronavirus Crisis, headed by James E. Clyburn, a Democrat from South Carolina.

“We are troubled by the impact Emergent’s manufacturing errors have had on the availability of coronavirus vaccine doses, as well as the potential effect on public perceptions regarding the safety and efficacy of these vaccines,” the lawmakers said in the nearly identical letters to the two vaccine developers. “We are also concerned about the circumstances that led AstraZeneca and Johnson & Johnson to sign contracts with Emergent,” they wrote.

At a congressional hearing last month, Emergent’s founder and executive chairman, Fuad El-Hibri, testified that the Trump administration had been well aware of the risks of relying on the Baltimore plant. “Everyone went into this with their eyes wide open, that this is a facility that had never manufactured a licensed product before,” he said.

Confidential audits obtained by The Times show that both Johnson & Johnson and AstraZeneca — as well as the division of the Department of Health and Human Services that oversees Emergent’s contract — all found deficiencies at the plant last summer. AstraZeneca’s audit said that the firm had not documented that it had mitigated “high risk” hazards of contamination. It also said that Emergent repeatedly loosened monitoring criteria so it appeared to meet them, but even then failed the tests.

Johnson & Johnson’s audit said that the firm’s “contamination control strategy is deficient” and that monitoring reports for bacteria or other contaminants were filed four to six months late. Emergent has said that it takes all such observations seriously and works expeditiously to address them.

The federal government agreed in May 2020 to pay Emergent $628 million, much of that to reserve production capacity at the Baltimore plant. It also signed billion-dollar contracts with Johnson & Johnson and AstraZeneca for the doses that Emergent was supposed to produce, and Emergent signed production contracts with the vaccine developers that were expanded in multiyear agreements in July 2020.

Federal officials have now stripped Emergent of its responsibility to manufacture AstraZeneca’s vaccine, lessening the firm’s payments by at least $18 million a month. The factory is expected to eventually reopen and resume manufacturing Johnson & Johnson’s vaccine.

The Delta variant is likely to make up 90 percent of E.U. cases by late August, officials warn.

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The main port area in Patmos, Greece in May.Credit...Byron Smith/Getty Images


Residents of the European Union should be fully vaccinated against the coronavirus as quickly as possible this summer, the European Center for Disease Prevention and Control warned on Wednesday, as concerns grew that the contagious Delta variant would sweep across the bloc.

Andrea Ammon, the agency’s director, said the variant was expected to account for 90 percent of all coronavirus cases in the European Union by the end of August. The variant has already spread to 23 European countries; in some it is linked to a limited share of cases, but it is responsible for more than 66 percent of new cases in Portugal, which has faced a recent surge of infections. In Moscow, 90 percent of new cases are reported to be the Delta variant, according to the local authorities.

“Unfortunately, preliminary data shows that it can also infect individuals that have received only one dose of the currently available vaccines,” Dr. Ammon said. “It is very likely that the Delta variant will circulate extensively during the summer, particularly among younger individuals that are not targeted for vaccination.”

The Delta variant is unlikely to pose much risk to people who have been fully vaccinated, experts said. According to one recent study, the Pfizer-BioNTech vaccine was 88 percent effective at protecting against symptomatic disease caused by Delta, nearly matching its 93 percent effectiveness against the Alpha variant. But a single dose of the vaccine was just 33 percent effective against Delta, the study found.

After a sluggish start, the distribution of vaccines in the European Union has sped up in recent months. Even so, around 30 percent of residents over 80 years old and around 40 percent of those over 60 have yet to be fully vaccinated, according to the center.

Most E.U. countries have not yet fully vaccinated one-third of their total populations: the average is about 27 percent.

Chancellor Angela Merkel of Germany said on Wednesday that her country’s entire population will have been offered at least one dose of a vaccine by Sept. 21 if vaccine deliveries arrive as planned.

Public health officials have said that Delta may be 50 percent more contagious than Alpha, though precise estimates of its infectiousness vary. The European Center for Disease Prevention and Control estimates that Delta is between 40 and 60 percent more transmissible.

The warning on Tuesday brought a feeling of déjà vu: Last summer, a rise of cases among younger populations in some European countries and the United States led to new lockdown measures and a surge of infections among older people. But vaccines are driving down coronavirus case numbers in most of the United States, and it’s unclear whether Delta will reverse that trend.

The Delta variant has been detected in at least 85 countries to date, and public health experts say a surge of new cases in Britain in recent weeks has been driven in part by the variant. Dr. Hans Kluge, the World Health Organization’s regional director for Europe, said this month that the variant was “poised to take hold” in Europe.

The European Union is set to launch a bloc-wide program for proof of vaccination — the so-called digital green certificate — on July 1. Its purpose is to allow residents to travel freely within the bloc if they have been fully vaccinated, have proof of a recent negative test, or have recovered from Covid-19, although individual countries can impose their own restrictions.

Under recommendations issued last week by the European Union, American visitors would be able to travel to countries of the bloc if they can show a proof of vaccination or a recent negative test.

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The Biden administration plans to extend the federal moratorium on evictions for another month.

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The Biden administration plans to extend the national moratorium on evictions through July, officials said. Activists in Brooklyn called in May for an extension of New York State’s eviction moratorium. Credit...Justin Lane/EPA, via Shutterstock

The Biden administration plans to extend the national moratorium on evictions, scheduled to expire on June 30, by one month to buy more time to distribute billions of dollars in federal pandemic housing aid, according to two officials with knowledge of the situation.

The moratorium, instituted by the Centers for Disease Control and Prevention last September to prevent a wave of evictions spurred by the economic downturn associated with the coronavirus pandemic, has significantly limited the economic damage to renters and sharply reduced eviction filings.

Congressional Democrats, local officials and tenant groups have been warning that the expiration of the moratorium at the end of the month, and the lapsing of similar state and local measures, might touch off a new — if somewhat less severe — eviction crisis.

President Biden’s team decided to extend the moratorium by a month after an internal debate at the White House over the weekend. The step is one of a series of actions that the administration plans to take in the next several weeks, involving several federal agencies, the officials said.

Other initiatives include a summit on housing affordability and evictions, to be held at the White House later this month; stepped-up coordination with local officials and legal aid organizations to minimize evictions after July 31; and new guidance from the Treasury Department meant to streamline the sluggish disbursement of the $21.5 billion in emergency aid included in the pandemic relief bill in the spring.

White House officials, requesting anonymity because they were not authorized to discuss the issue publicly, said that the one-month extension, while influenced by concerns over a new wave of evictions, was prompted by the lag in vaccination rates in some parts of the country and by other factors that have extended the coronavirus crisis.

Forty-four House Democrats wrote to Mr. Biden and the C.D.C. director, Dr. Rochelle P. Walensky, on Tuesday, urging them to put off allowing evictions to resume. “By extending the moratorium and incorporating these critical improvements to protect vulnerable renters, we can work to curtail the eviction crisis disproportionately impacting our communities of color,” the lawmakers wrote.

A spokesman for the C.D.C. did not immediately reply to a request for comment.

Many local officials have also pressed to extend the freeze as long as possible, and are bracing for a rise in evictions when the federal moratorium and similar state and city orders expire over the summer.

Gov. Gavin Newsom of California announced on Monday that his state had set aside $5.2 billion from federal aid packages to pay off the back rent of tenants who fell behind during the pandemic, an extraordinary move intended to wipe the slate clean for millions of renters.

Still, groups representing private landlords maintain that the health crisis that justified the freeze has ended, and that continuing the freeze even for an extra four weeks would be an unwarranted government intrusion in the housing market.

“The mounting housing affordability crisis is quickly becoming a housing affordability disaster fueled by flawed eviction moratoriums, which leave renters with insurmountable debt and housing providers holding the bag,” said Bob Pinnegar, president of the National Apartment Association, a trade group representing owners of large residential buildings.

Guam invites travelers to come and get vaccinated on the Pacific island.

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Tumon Bay, near Hagatna, Guam. Tourists who want to visit the island and get their coronavirus shots will need to book a package from a participating government-approved hotel.Credit...Tassanee Vejpongsa/Associated Press

The U.S. territory of Guam has begun offering Covid vaccinations to travelers from any country in a bid to lift tourism to the island.

On Tuesday, the authorities in Guam announced that a program called Air V&V, which previously allowed U.S. citizens to visit and get vaccinated, would now be open to international tourists age 12 and over.

The program aims mostly at countries in the Asia-Pacific region, where the rollout of vaccines has been relatively slow. The first three tourists will arrive from Taiwan on Wednesday evening, according to the Guam-based Pacific Daily News. Early next month, three more flights from Taiwan are set to bring about 500 passengers, another local news outlet, the Guam Daily Post, reported.

Carl Gutierrez, president of the island’s visitor bureau, said in a statement, “This program captures a unique demographic of travelers around the world that are tired of waiting to get vaccinated in this pandemic.”

Visitors will need to book a package from a participating government-approved hotel, which includes accommodation, meals, transportation to and from the airport, coronavirus tests, health monitoring and two doses of a vaccine. Participants can choose from the vaccines made by Pfizer and Moderna, which require two doses, or the “one and done” shots from Johnson & Johnson.

The travelers are required to present a negative coronavirus test result before departing their home country and must quarantine for seven days upon arrival in Guam. They will receive a first vaccine shot on their second day on the island.

But it is not a cheap vacation for visitors who opt for a vaccine that requires two doses and who remain on the island for three weeks to get both: Hotel rooms are about $150 to $350 a night, while the additional coronavirus measures cost a flat rate of $880 per person.

About 71 percent of Guam’s population of 169,000 has had at least one vaccine dose, while 63 percent are fully inoculated.

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Some mysteriously deleted early virus sequences haven been recovered by Seattle researcher.

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A medical staff member holding samples from patients infected by Covid-19 in Wuhan, China, in March 2020.Credit...Agence France-Presse — Getty Images

About a year ago, genetic sequences from more than 200 virus samples from early cases of Covid-19 in China mysteriously disappeared from an online scientific database.

Now, by rooting through files stored on Google Cloud, a researcher in Seattle reports that he has recovered 13 of those original sequences — intriguing new information for discerning when and how the virus may have spilled over from a bat or another animal into humans.

The new analysis, released on Tuesday, bolsters earlier suggestions that a variety of coronaviruses may have been circulating in Wuhan before the initial human outbreaks linked to animal and seafood markets in December 2019.

As the Biden administration investigates the contested origins of the virus, known as SARS-CoV-2, the new study neither strengthens nor discounts the hypothesis that the pathogen leaked out of a famous Wuhan lab. But it does raise questions about why original sequences were deleted from the open database, which is run by the National Institutes of Health, and suggests that there may be more revelations to recover from the far corners of the internet.

Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center who wrote the new report, called the deletion of these sequences suspicious. It “seems likely that the sequences were deleted to obscure their existence,” he wrote in the paper, which has not yet been peer-reviewed or published in a scientific journal.

Dr. Bloom belongs to an outspoken group of scientists who have called for more research into how the pandemic began. In a letter published in May, they complained that there wasn’t enough information to determine whether it was more likely that a lab leak had spread the coronavirus, or that it had leapt to humans from contact with an infected animal outside of a lab.

The genetic sequences of viral samples hold crucial clues about how SARS-CoV-2 shifted to our species from another animal, most likely a bat. Most precious of all are sequences from early in the pandemic, because they take scientists closer to the original spillover event.

Some scientists are skeptical that there is anything sinister behind the removal of the sequences. Dr. Bloom acknowledged that the reasoning is unknown, but he also noted that the Chinese government ordered the destruction of a number of early samples of the virus and barred the publication of papers on the coronavirus without its approval.

Global Roundup

Angela Merkel gets ‘mix and match’ vaccine doses, and other news from around the world.

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Chancellor Angela Merkel of Germany at a cabinet meeting in Berlin on Wednesday. Unlike other world leaders, she has refrained from widely publicizing her vaccinations with a selfie or public event. Credit...Pool photo by Henning Schacht

When Chancellor Angela Merkel of Germany received her second coronavirus vaccination recently, she was given a Moderna shot to follow the AstraZeneca one she received in mid-April, a spokesman confirmed on Tuesday.

Germany has permitted “mix and match” vaccinations for those who received one AstraZeneca dose before the authorities introduced age-specific recommendations for that vaccine at the end of March. Since then, the combination of one AstraZeneca shot followed by either the Pfizer-BioNTech or Moderna vaccine has become standard in Germany for people under 60.

It was not clear why Ms. Merkel, who will turn 67 next month, chose the mixed approach.

Initial studies suggest the combination of the two types of vaccines is effective, but a report published in May in The Lancet, a medical journal, also found that side effects were more common than with uniform first and second shots.

AstraZeneca shots make up only about 17 percent of the doses administered in Germany, while Moderna vaccines account for just 9 percent. The Pfizer-BioNTech vaccine is the most widely used, with nearly 71 percent of doses administered so far (unsurprising, perhaps, as BioNTech is a German company). A relatively small number of Johnson & Johnson vaccine doses have also been administered.

Unlike other world leaders, Ms. Merkel refrained from widely publicizing her vaccinations with a selfie photograph or public event. After her first dose in April, her spokesman merely tweeted a picture of her W.H.O.-issued vaccination booklet. It is not clear exactly when Ms. Merkel received the second dose, but a spokesman confirmed on Tuesday that it had been within the last few days.

Currently, 52 percent of the German population has received at least one dose of a vaccine. Ms. Merkel joined the 32 percent of Germans who are fully vaccinated.

In other news from around the world.

  • The government of New Zealand announced on Wednesday that it would impose social-distancing and mask-wearing requirements until Sunday in the city of Wellington, after a tourist visiting the capital from Sydney, Australia, over the weekend tested positive for the coronavirus. New Zealand began a 72-hour pause on Tuesday for quarantine-free travel from the Australian state of New South Wales, which includes Sydney, after more than 20 cases were reported in the eastern suburbs of the city.

  • The Red Cross has urged residents of the South Pacific island nation of Fiji to get vaccinated after a surge in new coronavirus infections there reached record highs. The health and humanitarian organization said that new infections were doubling every 10 days as the country grappled with the more transmissible Delta variant, adding that “misinformation and rumors” on social media were stoking fear and undermining immunization efforts.

  • The health authorities in Greece announced on Wednesday that face masks will no longer be mandatory in uncrowded outdoor areas starting Thursday. The decision comes amid a significant drop in the rate of daily infections and follows the country‘s official opening to international tourists last month. Masks will continue to be obligatory in all indoor public areas and in outdoor spaces with crowds, officials told a news conference. The officials also announced the revocation, as of next Monday, of a public curfew first imposed last November, which has been gradually shortened in recent weeks.

  • Despite concerns about the dangerous Delta variant of the coronavirus, Switzerland will terminate most remaining restrictions this weekend, including those limiting entry to the country, the government announced Wednesday. As of Saturday, the Swiss Ministry of Health said, rules requiring that masks be worn outdoors will end, shops will be permitted to open at full capacity, and limits on patrons in restaurants will be lifted. In a statement posted on its website, the health ministry attributed the relaxation of safety measures to “the positive development of the epidemic situation and the progress made with vaccination.”

  • In a new sign of worry over the Delta variant, the Tourism Ministry of Israel said Wednesday that it had postponed, by at least one month, the granting of individual tourist visas. Despite the country’s high rate of vaccinations, the ministry said its plan to resume issuing those visas as of July 1 would now be delayed until Aug. 1. The new caution came as the Israeli news media reported that more than 100 new cases had been registered in the country for the third consecutive day. Just three weeks ago, with new cases having dropped below 20 a day, Israel lifted many restrictions.

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The pandemic affected mental health and college plans for U.S. high schoolers.

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Brighton High School seniors during their graduation ceremony at Fenway Park in Boston last week.Credit...Brian Snyder/Reuters

Nearly 80 percent of American high school juniors and seniors say the coronavirus pandemic has affected their plans after graduation, and 72 percent of 13- to 19-year-olds have struggled with their mental health, a new survey shows.

The survey, conducted by America’s Promise Alliance, a nonprofit group, found that 58 percent of teenagers reported learning entirely or mostly online in the 2020-21 school year, and 22 percent said that they had learned about half online and half in person. Nineteen percent said they had learned mostly through in-person instruction.

The results are from a nationally representative survey of 2,400 high school students conducted in March and April.

Among those who said the pandemic had affected their plans after high school, one-third said they would attend college closer to home; one-quarter said they would attend a two-year college instead of a four-year institution; 17 percent said they would attend college remotely rather than in person; and 16 percent said they would put off attending college. Seven percent said they were no longer planning to attend college.

Nearly half the respondents who changed their plans said they were doing so because of financial pressure, suggesting that the pandemic will probably widen educational inequalities among young adults.

Given the extraordinary swell of racial-justice activism over the past year, the survey also asked students about how their schools had handled race issues. Two-thirds reported that “the history of racism” had been taught at their schools. But Asian, Black, Latino and multiracial students were less likely than white students to say that the curriculum represented their own “racial and ethnic background.”

New York’s state of emergency will end Thursday. Takeout alcohol will end along with it.

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Most of New York’s remaining pandemic restrictions were relaxed last week.Credit...Calla Kessler for The New York Times

New York’s state of emergency will end on Thursday, Gov. Andrew M. Cuomo said on Wednesday. And with it will depart the freedom restaurants and bars have had to deliver and sell alcoholic beverages to go.

The official end of the state of emergency comes just over a week after Mr. Cuomo relaxed most of the state’s remaining restrictions, a welcome sign of the state’s steady march back toward normalcy after more than 53,000 deaths linked to the virus. The sudden halt to the freer sale of alcohol may be a boon to liquor stores while surprising the bars and restaurants that came to rely on the business they generated to weather the pandemic.

“The Legislature failed to codify the ability of restaurants to offer alcohol to-go,” New York State’s Liquor Authority said in an emailed statement, referring to legislation to extend the takeout alcohol that state lawmakers did not act on before their session ended this month. “With the state’s declaration of emergency expiring on Thursday, all temporary pandemic-related suspensions and directives, including privileges allowing bars, restaurants, and manufacturers to sell drinks to go, will end after June 24th.”

(Bill Crowley, a spokesman for the authority, noted that bars and restaurants could still deliver and sell beer to go, as they could before the pandemic.)

The Distilled Spirits Council, a trade association that has lobbied to keep to-go alcohol sales, said that 15 states had passed bills to make them permanent and that 12 had extended the period for such sales.

Lisa Hawkins, an official with the council, expressed dismay that New York was ending the practice. “It’s shocking and extremely disappointing that this important revenue stream will soon dry up for New York’s hospitality businesses,” she said in an email.

Andrew Rigie, the executive director of the New York City Hospitality Alliance, an association representing restaurants, bars and nightclubs, said that many proprietors had thought takeout alcohol would be allowed at least through July 5, when the latest in a series of extensions of the authorization for freer sales was set to expire.

Customers who have grown accustomed to the convenience of takeout tequila, delivery daiquiris and walkaway wine could also be taken aback, Mr. Rigie said in an interview. “It’s a shame the state legislature failed to continue to support local restaurants and to continue to deliver a very popular policy to New Yorkers,” he said.

But with restaurants and bars once again open to full capacity and more than 70 percent of adults in the state having received at least one dose of a vaccine, some New York City restaurateurs welcomed the change, which they hope will further motivate customers to spend time and money on premises.

“I want people to now come in, order food and enjoy the venue,” said Michael Trenk, managing partner of the Baylander Steel Beach bar and restaurant, located on a decommissioned aircraft carrier docked at the West Harlem Piers. “I don’t want you to just come in, buy a drink and leave.”

Mr. Cuomo declared the state of emergency on March 7, 2020, as New York City became one of the world’s hardest-hit places. In mid-March, when he limited restaurants and bars to takeout and delivery, the New York State Liquor Authority granted “new off-premises privileges,” meaning drinks to go.

Virus numbers declined in the city by the fall, but the state experienced a new surge in cases around the holidays and until relatively recently was still reporting new cases at a high rate. Buffalo and other cities also struggled to tamp down outbreaks. Vaccinations have helped radically improve the state’s caseload trajectory.

At a news conference on Wednesday, Mr. Cuomo said: “The emergency is over. It’s a new chapter.”

He said that federal guidance advising people to go on wearing masks in many situations if they are unvaccinated, and on public transportation and in settings like homeless shelters even if they are vaccinated, would remain in effect and that state and local health departments would be able to ensure that precautions were adhered to. He asked New Yorkers to remain “wary and vigilant” about the virus and noted that many still needed to be vaccinated, especially young people.

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Alcohol will be banned at the Tokyo Olympics.

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In Tokyo last week. The Olympic organizing committee had said that it was considering sales of alcohol during the Games, which are scheduled to begin in the Japanese capital on July 23. Credit...Charly Triballeau/Agence France-Presse — Getty Images

Organizers of the Tokyo Olympics said on Wednesday that they would ban alcohol at the Games, bowing to an outcry from a Japanese public that is deeply skeptical of hosting the event and weary of months of pandemic restrictions.

Two days earlier, the organizing committee said that it was considering sales of alcohol during the Games, which are scheduled to begin in Tokyo on July 23. That prompted outrage from many Japanese, with Tokyo and several other areas just emerging from a prolonged state of emergency during which restaurants were prohibited from selling alcohol as a virus control measure.

On Wednesday, the president of Tokyo 2020, Seiko Hashimoto, said that the committee had consulted with experts and decided to ban the sale and consumption of alcohol at Olympic venues “to prevent expansion of infection.”

Asahi Breweries, an official partner and one of the largest beer and spirits producers in Japan, endorsed the ban. “We totally understand the decision by the committee,” said Takayuki Tanaka, a company spokesman. “We will keep supporting the Games’ success.”

The alcohol ban is the latest sign that the Tokyo Games, postponed from 2020 because of the pandemic, will be unlike any other. This week, organizers said that crowds would be limited to 50 percent of a venue’s capacity, up to 10,000 people. Only spectators who live in Japan will be permitted to attend, with the organizers having decided back in March not to allow fans to travel to the Games from overseas.

Organizers are still determining what the crowd guidelines will be for some outdoor events such as marathons and whether viewing events that could attract large groups should be allowed in certain parts of the country.

After a sharp spike in May, coronavirus cases in Japan are receding, with daily totals of new cases nationwide having fallen by 38 percent over the past two weeks. A sluggish vaccination drive is starting to pick up pace, but with only 8 percent of the country fully vaccinated, according to New York Times data, the Olympic events are set to take place in front of crowds that are mostly not immunized.

Here’s what to know about the Delta variant in the U.S.

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Medical personnel remove the body of a Covid-19 victim from the coronavirus ward at the Honorio Delgado Hospital in Arequipa, Peru, last week, following an outbreak of cases of the Delta strain in the city.Credit...Diego Ramos/Agence France-Presse — Getty Images

The super-contagious Delta variant of the coronavirus is now responsible for about one in every five Covid-19 cases in the United States, and its prevalence has doubled in the last two weeks, health officials said on Tuesday.

First identified in India, Delta is one of several “variants of concern,” as designated by the Centers for Disease Control and Prevention and the World Health Organization. It has spread rapidly through India and Britain.

Its appearance in the United States is not surprising. And with vaccinations ticking up and Covid-19 case numbers falling, it’s unclear how much of a problem Delta will cause here. Still, its swift rise has prompted concerns that it might jeopardize the nation’s progress in beating back the pandemic.

“The Delta variant is currently the greatest threat in the U.S. to our attempt to eliminate Covid-19,” Dr. Anthony S. Fauci, the nation’s leading infectious disease expert, said at the briefing. The good news, he said, is that the vaccines authorized in the United States work against the variant. “We have the tools,” he said. “So let’s use them, and crush the outbreak.”

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Orchestras can perform more safely if they’re open to a bit of musical chairs, a new study shows.

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Comparison of aerosol concentrations, both instantaneous and averaged, for the baseline scenario and for the proposed mitigation strategy.CreditCredit...Hedworth et al

If musical instruments were people, trumpets would be super spreaders. When a trumpeter blows into the mouthpiece, tiny respiratory droplets, known as aerosols, travel out of the musician’s mouth, whiz through the brass tubing and spray into the air.

During a deadly pandemic, when a musician might unwittingly be exhaling an infectious virus, wind instruments like the trumpet pose a potential health hazard for orchestras.

A simple but radical change — rearranging the musicians — could significantly reduce the aerosol buildup on stage, according to a new study, which was published in Science Advances on Wednesday.

Researchers at the University of Utah started studying the problem last summer, when the Utah Symphony began to wonder whether, and how, they could return to performing safely. By creating simulations based on detailed computer models of air flow and ventilation, and mapping the positions of musicians, they found that trumpets posed a particular problem.

But rearranging instruments around the stage, with some moved closer to air vents or open doors, reduced the average aerosol concentration in the musicians’ breathing zones a hundredfold, the researchers calculated.

“You want the smoker to sit close to the window,” said Tony Saad, a chemical engineer and a co-author of the study. “That’s exactly what we did here.”

The researchers knew the idea might be controversial; orchestras have generally been arranged the same way for decades, for reasons that include both acoustics and tradition. “We asked them when we started the project, ‘What constraints do we have to work with? Can we move people?’” said another of the study’s co-authors, James Sutherland. “And they said, ‘You do whatever you think you can to mitigate risk.’”

And when the Utah Symphony took the stage last fall, it did so with the stage doors open and the wind instruments at the rear.

It took a few weeks for the musicians to get comfortable with the new arrangement, and they plan to return to their traditional seating configuration this fall. But the simulations gave the musicians peace of mind and allowed them to get back onstage. “For us, it was life changing,” said Steven Brosvik, the president and chief executive of the Utah Symphony and Utah Opera.

British music festivals, a summer tradition, are in doubt for a second year.

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Festivalgoers at the Download Festival in Donington Park, England, last Friday. The three-day festival is a test event to examine how Covid-19 transmission takes place in crowds, with reduced capacity.Credit...Joe Giddens/Press Association, via Associated Press

CASTLE DONINGTON, England — At 5 p.m. on Friday, a metal band called Death Blooms walked onstage in a field in Derbyshire, England, and launched into a pummeling track to open Download Festival, Britain’s first large-scale music festival to take place since the pandemic began.

A second later, several hundred rain-soaked fans — including two men dressed as bananas — began careering into one another in front of the stage at Donington Park, arms and legs flailing, smiling ecstatically as they formed the first legal mosh pit in the country in 15 months.

Since the 1970s, music festivals have been a key part of the British summer: events where teenagers get a first taste of parent-free vacations, music fans find community and people generally get very muddy and carefree. But there is widespread concern that few events will go ahead this year despite nearly half of Britain’s population having been fully vaccinated against Covid-19. And organizers say they risk going bankrupt.

Several major festivals were canceled for the second year in a row after Prime Minister Boris Johnson said last week that social-distancing measures would continue in England until at least July 19.

Download, too, was initially canceled in March. Last weekend’s hastily arranged special edition was able to go ahead only because it was part of a government trial to see whether and how cultural life could return safely. Previous pilot events — two 3,000-person club nights and a 5,000-capacity rock concert in Liverpool — led to eight cases of potential coronavirus transmission, according to one of the scientists involved, Iain Buchan.

Download 2021 had a significantly reduced capacity of only 10,000 fans, and the lineup featured only British acts to avoid the risks of international travel and quarantines.

Attendees had to take a coronavirus test before going in, and agree to another one five days after the festival. But once inside in the grounds, masks weren’t required — though head banging, moshing and drunken conversations at the campsite were prevalent.

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As mass vaccination sites close in the U.S., the focus shifts to the ‘ground game.’

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Federico Ivan Cuadrado (left), Sahar Alfredo (center) and Laura Alfredo waited after receiving vaccinations during the last days of a mass Covid-19 vaccination site at the New Jersey Institute of Technology in Newark last week.Credit...Bryan Anselm for The New York Times

On Sunday, the last of 39 mass vaccination centers operated by the U.S. government closed in Newark, the end of an effort that administered millions of Covid-19 shots over five months in 27 states. Many state-run sites are also closed or soon will be.

The United States’ shift away from high-volume vaccination centers is an acknowledgment of the harder road ahead. Health officials are pivoting to the “ground game”: a highly targeted push, akin to a get-out-the-vote effort, to persuade the reluctant to get their shots.

President Biden will travel to Raleigh, N.C., on Thursday to spotlight this time-consuming work. It will not be easy — as Dr. Anthony S. Fauci, the president’s coronavirus response coordinator, discovered last weekend, when he went door-knocking in Anacostia, a majority-Black neighborhood in Washington, with Mayor Muriel E. Bowser.

In an interview on Tuesday, Dr. Fauci said he and the mayor spent 90 minutes talking to people on their front porches. He said he persuaded six to 10 people to get their shots, though he did encounter some flat refusals.

“We would say, ‘OK, come on, listen: Get out, walk down the street, a couple of blocks away. We have incentives, a $51 gift certificate, you can put yourself in a raffle, you could win a year’s supplies of groceries, you could win a Jeep,’” Dr. Fauci said. “And several of them said, ‘OK, I’m on my way and I’ll go.’”

Vaccines are a tough sell in the sparsely populated, skeptical Mountain West.

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A billboard in Salt Lake City promoting a state website about Covid-19 vaccines. Utah officials have tried to counter misinformation that may be a factor in many residents’ reluctance to be vaccinated. Credit...Ruth Fremson/The New York Times

The Mountain West has emerged as one of the most vaccine-hesitant regions of the United States. Along with the South, it is lagging far behind the national vaccination pace.

In both Idaho and Wyoming, fewer than 40 percent of people have received at least one dose so far, ranking those states among the bottom five in the nation, according to a New York Times database. Montana, Utah and Nevada are doing a bit better, but remain well below the national average of 54 percent. None of the five states is on track to meet President Biden’s goal of at least partly vaccinating 70 percent of adults by July 4, and the White House acknowledged this week that the president doesn’t expect the nation as a whole to meet that target.

Health officials in the region say that their efforts have been hampered by sparse populations in their wide-open areas and by the deep-rooted brand of political conservatism that is common among rural residents. But there is more to the story than that.

As in other parts of the country, the unvaccinated in the Mountain West can be divided largely into two camps, experts say.

“There are those who are kind of the wait-and-see folks, and then we have the absolutely, definitely not,” said Greg Holzman, who was Montana’s state medical officer until April. Rampant misinformation makes it difficult to change minds, he said, and so does the logistical difficulty of providing convenient access in small, widely scattered communities.

There are crosscurrents beneath the statewide trends. For example, Native Americans in Montana, after some initial hesitancy, have embraced the vaccines while white residents in rural areas have been less accepting.

Garfield County, in eastern Montana, illustrates some of what health officials are up against. The county was the scene of a lengthy standoff in 1996 between the F.B.I. and an anti-government militia called the Montana Freemen. These days, “the life philosophy is pretty much the same, and that’s no government intervention, no way, no how,” said Dr. Randall Rauh, medical director of the Garfield County Health Center, a critical access facility and nursing home.

Just 21 percent of eligible county residents have been fully vaccinated, the lowest rate in Montana, according to state figures.

Dr. Rauh said that after the center vaccinated all of its nursing home residents, he was accused by an employee of experimenting on old people, and the facility received little support from local officials. The county health department will administer vaccine doses only when 10 or more people show up to get them, Dr. Rauh said, so “it’s very difficult for people unless they can make the trip to a surrounding county to get vaccinated.”

In Utah, home to the Church of Jesus Christ of Latter-day Saints, the church’s leadership has voiced strong support for vaccination. Even so, a recent survey found that about half of Mormon respondents were hesitant or unwilling to get vaccinated.

Misinformation appears to be a factor among Mormon women, in a state with one of the nation’s highest birthrates, said Dr. Emily Spivak, an infectious diseases specialist at the University of Utah Hospital in Salt Lake City. “I’ve had a lot of questions about fertility” and whether the vaccines affect menstruation, she said. There is no current evidence that the vaccines impact fertility.

Idaho tends to have lower immunization rates in general, according to Maggie Mann, the district director for Southeastern Idaho Public Health. Many people have told her that their schedules are too busy to fit in the appointment.

The eight counties Ms. Mann oversees are dotted with communities that have not been severely hit by the pandemic, she said, and “it’s hard for people when they haven’t been personally affected to be highly motivated to get that vaccine.”

Only one county in Nevada has fully vaccinated more than half of its residents 12 and older, according to the Times database. Experts say many people in the state’s rural areas simply do not see the need.

Matthew Walker, chief executive of William Bee Ririe Critical Access Hospital and Rural Health Clinics in Ely, Nev., said that health care workers try to win over skeptics by appealing to their sense of self-reliance.

“We try to really push that if you get sick, regardless whether it’s the flu or Covid, and you have to be laid up in bed for a few days, or worse, what’s going to happen?” he said. “You can’t take care of yourself, you’re an hour or two away from a medical facility, you’ve got kids or family — who’s going to take care of your ranch? And oftentimes, that will get people.”

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