Covid-19 Vaccines, Variants and Mask Mandate News: Live Updates – The New York Times

The influx has been even steeper in the largest high-risk area now on the national map, the hot spot that has spread across upstate New York and spilled into nearby states. According to the New York State, there were 2,119 patients hospitalized in the state with Covid on Tuesday, 47 percent more than the figure from two weeks before.

The figure is still well below the winter Omicron peak of January, when about 13,000 people were hospitalized statewide. But it has been increasing, propelled by rapidly spreading BA.2 subvariants, which were detected in Central New York and have become a growing share of new U.S. cases.

In the University of Rochester Medical Center system, which includes six hospitals in the Finger Lakes region and in western New York, coronavirus hospitalizations have quadrupled in recent weeks, rising to about 200 patients from a low of about 50 in early April, according to Chip Partner, a spokesman for the hospital system.

Most of those patients were in the hospital for other reasons, like surgery, but tested positive when they were admitted, Mr. Partner said, adding that relatively few Covid patients have needed intensive care recently.

At the same time, staffing shortages at hospitals in the region have been compounded by a recent increase in infections among their staffs. At F.F. Thompson Hospital in Canandaigua, N.Y., 45 of the hospital’s 1,750 workers were out with the virus recently, and there are 252 unfilled job openings.

“Covid is here, Covid is an issue, but the main challenge up here is the staffing,” said Michael Stapleton, the hospital’s chief executive.

Other hot spots are also putting pressure on health care systems. In Puerto Rico, 245 people on the island were in hospitals this week with the virus, more than five times the caseload from a month ago.

Though hospitalizations generally lag behind the trends in new cases, they remain among the most reliable kinds of data about the pandemic, experts agree — much more so than official reports of positive test results, which experts say significantly understate the true number of infections.

Hospitalizations are reported fairly rigorously. “For hospital data, even given that all the people were not admitted because of Covid, we can be sure that the numbers are pretty accurate,” said Dr. Eric S. Toner, a senior scholar at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. “So it’s the best data source we have now. The number of new Covid admissions is the number that I pay the most attention to.”

About 11 percent of people hospitalized with coronavirus infections in the United States were in intensive care, as of Wednesday, according to federal data.

The C.D.C. is also keeping a close eye on the nature of hospitalizations. “We’re seeing less oxygen use, less I.C.U. stays, and we haven’t fortunately seen any increase in death associated with them,” compared with earlier periods of the pandemic, Dr. Rochelle Walensky, the agency director, said last week.

While the criteria for declaring a county to be at high, medium or low risk have changed, the threat that the virus and its new variants pose has not. Most experts say that everyone should continue to be tested frequently if they are mixing in large groups, and that people who are vulnerable should consider continuing to wear masks in indoor public settings, even if they are not required.

This week the C.D.C. restated its recommendation that travelers wear masks in airplanes and airports, and on trains and buses, even though a judge struck down a federal mask mandate for public transportation last month.

“The only way to slow the surge is to test and isolate if positive,” said Mara Aspinall, an expert in biomedical diagnostics at Arizona State University. That would help stave off a looming problem for medical workers.

“Another surge of hospitalizations would be extraordinarily difficult,” Dr. Toner said.

Sarah Cahalan contributed reporting.

Reports that the vaccine can trigger a condition known as thrombosis with thrombocytopenia syndrome have bedeviled it from early on. In April 2021, not long after it was approved for emergency use, federal authorities paused distribution of the vaccine for a safety evaluation. Regulators lifted the pause 10 days later but added a warning to instructions for its use.

Then, in December, the C.D.C. recommended that adults seeking a booster shot choose Moderna or Pfizer instead of Johnson & Johnson, citing more benefits and lower risks. Coupled with a host of manufacturing troubles in the United States, some experts said, the agency’s judgment illustrated that the federal government had all but written off Johnson & Johnson’s vaccine.

According to the F.D.A. announcement on Thursday, federal authorities now have 60 reports of the blood-clotting disorder — or four times as many as were reported when last year’s pause in distribution was lifted. In the interim, the number of Johnson & Johnson doses administered has slightly more than doubled, while the number of Pfizer and Moderna recipients has skyrocketed.

The number of deaths attributed to the disorder triggered by the Johnson & Johnson’s vaccine does not appear to have risen much, if at all. But there have been far fewer, if any, suspected deaths due to side effects from the mRNA vaccines, federal health officials have said.

In its announcement, the F.D.A. cited more than six cases and close to one death attributed to the blood-clotting disorder for every two million shots of Johnson & Johnson vaccine administered in the United States.

About 17 million Americans have now gotten one dose of Johnson & Johnson’s vaccine, and another 1.5 million have gotten a booster dose, according to the C.D.C.’s data. By comparison, more than 200 million Americans have gotten at least two doses of either Moderna’s or Pfizer’s vaccine.

Trying to cast the tight new restrictions in a positive light, Johnson & Johnson said: “Data continue to support a favorable benefit-risk profile for the Johnson & Johnson COVID-19 vaccine in adults, when compared with no vaccine.”

Their calculations combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aimed to account for deaths that were missed.

Most of the excess deaths were victims of Covid itself, the experts said, but some died because the pandemic made it more difficult to get medical care for ailments such as heart attacks. The previous toll, based solely on death counts reported by countries, was six million.

Much of the loss of life from the pandemic was concentrated in 2021, when more contagious variants tore through even countries that had fended off earlier outbreaks. Overall deaths that year were roughly 18 percent higher — an extra 10 million people — than they would have been without the pandemic, the W.H.O.-assembled experts estimated.

Developing nations bore the brunt of the devastation, with nearly eight million more people than expected dying in lower-middle-income nations during the pandemic.

“It’s absolutely staggering what has happened with this pandemic, including our inability to accurately monitor it,” said Dr. Prabhat Jha, an epidemiologist at St. Michael’s Hospital and the University of Toronto, who was a member of the expert working group that made the calculations. “It shouldn’t happen in the 21st century.”

The figures had been ready since January, but their release was stalled by objections from India, which disputes the methodology for calculating how many of its citizens died.

Nearly a third of the excess deaths globally — 4.7 million — took place in India, according to the W.H.O. estimates. The Indian government’s own figure through the end of 2021 is 481,080 deaths.

But India was far from the only country where deaths were substantially underreported. Where excess deaths far outstripped the number of reported Covid fatalities, experts said the gap could reflect countries’ struggles to collect mortality data or their efforts to intentionally obscure the toll of the pandemic.

The Butovskoye cemetery in Moscow in July 2021, one of the burial grounds of Covid victims in Russia.Credit…Sergey Ponomarev for The New York Times

In some countries, flaws in government reports were widely known. Russia, for example, had reported roughly 310,000 Covid deaths by the end of 2021, but the W.H.O. experts indicated that the excess death toll was nearly 1.1 million. That mirrored earlier estimates from a Russian national statistics agency that is fairly independent of the government.

Aleksei Raksha, an independent demographer who quit the Russian state statistics service after complaining of the failure to count Covid deaths properly, said that informal orders had been given to local authorities to ensure that in many cases, Covid was not registered as the primary cause of death.

“Excess deaths have established the true picture,” Mr. Raksha said. “Russia demonstrated a dismal performance in fighting the pandemic.”

In other nations, W.H.O. experts used what limited data was available to arrive at estimates jarringly at odds with previous counts, though they cautioned that some of those calculations remained highly uncertain. In Indonesia, for example, the experts leaned heavily on monthly death data from Jakarta, the capital, to estimate that the country had experienced over a million more deaths than normal. That figure would be seven times as high as the reported Covid death toll.

Siti Nadia Tarmizi, a spokeswoman for the government’s Covid-19 vaccination program, acknowledged that Indonesia had suffered more deaths than the government had reported. She said the problem stemmed in part from people not reporting relatives’ deaths to avoid complying with government rules for Covid victims’ funerals. But she said that the W.H.O. estimates were far too high.

In Pakistan, Dr. Faisal Sultan, a former health minister, defended the government’s death reports, saying that studies of the number of graveyard burials in major cities did not reveal large numbers of uncounted victims of the pandemic.

For still other countries that suffered grievously during the pandemic, the W.H.O. estimates illuminated even more startling figures hiding inside already devastating death counts. In Peru, for instance, the expert estimate of 290,000 excess deaths by the end of 2021 was only 1.4 times as high as the reported Covid death toll. But the W.H.O. estimate of 437 excess deaths for every 100,000 Peruvians left the country with among the world’s highest per capita tolls.

“When a health care system isn’t prepared to receive patients who are seriously ill with pneumonia, when it can’t provide the oxygen they need to live, or even provide beds for them to lay in so they can have some peace, you get what you’ve gotten,” said Dr. Elmer Huerta, an oncologist and public health specialist who hosts a popular radio show in Peru.

In the United States, the W.H.O. estimated that roughly 930,000 more people than expected had died by the end of 2021, compared with the 820,000 Covid deaths that had been officially recorded over the same period.

In Mexico, the government has itself kept a tally of excess deaths during the pandemic that appears roughly in line with the W.H.O.’s. Those estimates — about double the country’s reported Covid death toll — reflected what analysts there described as difficulties counting the dead.

“We responded badly, we reacted slowly. But I think the most serious of all was to not communicate the urgency, the wanting to minimize, minimize,” said Xavier Tello, a public health analyst based in Mexico City. “Because Mexico wasn’t or isn’t testing for Covid, a lot of people died and we don’t know if they had Covid.”

The W.H.O.’s calculations include people who died directly from Covid, from medical conditions complicated by Covid, or because they had ailments other than Covid but could not get needed treatment because of the pandemic. The excess death estimates also take into account expected deaths that did not occur because of Covid restrictions, such as reductions in traffic accidents or isolation that prevented deaths from the flu and other infectious diseases.

Calculating excess deaths is complex, the W.H.O. experts said. About half of countries globally do not regularly report the number of deaths from all causes. Others supply only partial data. In the W.H.O.’s African region, the experts said that they had data from only six of 47 countries.

Scientists also noted that excess death rates were not necessarily indicative of a country’s pandemic response: Older and younger populations will fare differently in a pandemic, regardless of the response. And the W.H.O. experts said that they did not account for the effects of heat waves or conflicts.

Where death figures were missing, the statisticians had to rely on modeling. In those cases, they made predictions based on country-specific information like containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.

W.H.O. officials used the release of their calculations to plead for greater investment in death reporting.

“When we underestimate, we may underinvest,” said Dr. Samira Asma, the W.H.O.’s assistant director general for data, analytics and delivery for impact. “And when we undercount, we may miss targeting the interventions where they are needed most.”

In the U.S., the W.H.O. estimated that roughly 930,000 more people than normal had died by the end of 2021, compared with the 820,000 officially reported Covid deaths over the same period.Credit…Kirsten Luce for The New York Times

W.H.O. officials cited Britain as an example of a country that had accurately recorded Covid deaths: Their analysis found that about 149,000 more people than normal had died during the pandemic, nearly identical to the number of Covid deaths Britain reported.

The disagreement over India’s Covid deaths spilled into public this week when the Indian government on Tuesday abruptly released mortality data from 2020, reporting an 11 percent increase in registered deaths in 2020 compared with average annual deaths registered over the two prior years.

Analysts saw the release as an attempt to force the W.H.O. to reconsider its calculations on the eve of publication. Indian health officials said their figures showed that the country had lost fewer people to Covid than outside estimates suggested.

But scientists believe that most of the country’s excess mortality occurred in 2021, during a grievous wave caused by the Delta variant. And even India’s 2020 figures gave additional credence to the W.H.O. estimates, said Dr. Jha, who has also studied excess deaths in India.

“The Indian government wanted to deflect the news,” he said, “but they’re confirming, at least for 2020, the W.H.O. numbers.”

Other experts said that India’s refusal to cooperate with the W.H.O. analysis was rooted in the country’s history of ignoring how data can inform policymaking.

“It’s natural to miss some of the Covid deaths,” said Dr. Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with the W.H.O. to review the data. But, she added, “Nobody’s been this resistant.”

The Ministry of Health in New Delhi did not respond to requests for comment. W.H.O. officials said that India’s 2020 death figures were released too late to be incorporated into their calculations but that they would “carefully review” the data.

Nations that report Covid deaths more accurately have also been at the center of disputes over the reliability of excess death estimates. In Germany, for example, the W.H.O. experts estimated that 195,000 more people than normal had died during the pandemic, a significantly higher toll than the 112,000 Covid deaths recorded there.

But Giacomo De Nicola, a statistician at Ludwig Maximilian University of Munich, who has studied excess deaths in Germany, said that the country’s rapidly aging population meant that the W.H.O. analysis might have underestimated the number of people who would have been expected to die in a normal year. That, in turn, could have produced overestimates of excess deaths.

He said that the W.H.O.-assembled experts had accounted for trends in mortality, but not directly for changes in the age structure of the population. While Germany experienced excess deaths, he said, the W.H.O. estimate for the country “seems very high.”

Overall, the W.H.O. calculations were more conservative than separate analyses released earlier by The Economist and the Institute for Health Metrics and Evaluation.

Some experts said that the W.H.O. analysis benefited from relying more heavily than other estimates on actual data, even where it was incomplete, as opposed to statistical modeling.

Oscar Lopez, Karan Deep Singh, Sofia Villamil, Christopher F. Schuetze, Ivan Nechepurenko, Richard C. Paddock, Muktita Suhartono, Mitra Taj, Julie Turkewitz, Merna Thomas and Salman Masood contributed reporting.

In response, online censors have worked unceasingly to scrub dissent on the issue. Censored content included an essay by Liu Xiaobing, a professor at Shanghai University of Finance and Economics, and a member of China’s national legislature.

“The policy enforcers only worry about the trouble they could bring on themselves if they relax controls,” Mr. Liu wrote. “They never worry about being called to account from the harm caused by dead-handed restrictions.”

The episode has been the biggest test for the government since the coronavirus first emerged in Wuhan more than two years ago. Although cases have declined in recent days, much of Shanghai remains under strict lockdown.

On Friday, China reported 4,439 cases, including 4,088 in Shanghai. Recent outbreaks in Beijing, the country’s capital, and Zhengzhou, a city of 12 million, have led to lockdowns of many neighborhoods. Stringent lockdowns around the country have forced factories and businesses to close temporarily, leaving millions in China out of work and snarling supply chains worldwide.

Stocks in Asia fell on Friday after reports of China’s pledge to stick to its zero-Covid policy. Two major sporting events in China — the Asian Games and the World University Games — were also postponed. Another event, the Asian Youth Games, was canceled.

The statement reflects the party’s hardening line. Back in March, in the face of proliferating outbreaks, Mr. Xi had urged officials to reduce the impact of the country’s Covid response on people’s livelihoods.

In Thursday’s statement, the leadership again acknowledged that implementing the zero-Covid policy had suffered from problems like “insufficient preparation.” Officials were urged to “actively respond to social concerns,” increase vaccination uptake and act faster to bring small outbreaks under control.

But more emphasis was placed on adhering to the zero-Covid playbook, which relies on strict lockdowns, mass testing, rigorous contact tracing and tough border controls.

The party has pointed to the success of the policy as proof of the superiority of its top-down governance compared with liberal democracies. On Thursday, it warned that moving away from the zero-Covid approach would lead to mass sickness and deaths — something that Mr. Xi, who is set to take an unprecedented third term later this year, does not want to risk.

“Our prevention and control policies can stand the test of history,” the statement read.

Since January 2021, 7,200 unruly passenger incidents have been reported to the F. A.A., and 70 percent involved the enforcement of masking rules.

“Behaving dangerously on a plane will cost you; that’s a promise,” said Billy Nolen, the acting administrator of the F.A.A., in a statement last month. “Unsafe behavior simply does not fly and keeping our Zero Tolerance policy will help us continue making progress to prevent and punish this behavior.”

According to a recent survey by the Pew Research Center, about 77 percent of workers say their employers have not required vaccination, with 47 percent saying their employers have encouraged it.

Last year, President Biden called on every employer in America to follow the federal government’s lead and give employees paid time off to be vaccinated, a message he extended to booster shots this past December, when he announced a set of measures intended to help combat the highly transmissible Omicron variant of the virus. At the time, about one-third of workers reported not receiving paid time off for vaccinations.

In New York, employees are entitled to at least four hours of paid leave per injection, including boosters. Most California workers receive up to three workdays to attend each vaccination appointment and to recover, with some exceptions, under the state’s Covid sick leave policy.

Last July, Mr. Cooper instated a vaccine verification mandate for state workers in North Carolina, helping to spur an increase in inoculation: The governor’s office estimates that about 80 percent of state employees are now vaccinated, up from 65 percent in September.

Mr. Cooper also announced the suspension of a weekly testing scheme for unvaccinated employees, except for those working in health care or correctional facilities, citing high vaccination rates among workers and low infection rates.

Vaccine mandates have led to controversy around the country. Earlier this year, the Supreme Court struck down a federal mandate requiring a vaccine-or-testing scheme for large employers, which would have covered paid time off for vaccine appointments and recovery.

The first couple’s daughter, Ashley Biden, had planned to accompany Dr. Biden on the trip, but on Thursday night, the White House said she had been advised of a close contact with someone who tested positive for the coronavirus. Mark Gitenstein, a longtime Biden confidant who serves as U.S. ambassador to the European Union, will also join for part of the trip.

“Dr. Biden is inspired by the resilience and strength of the Ukrainian people and hopes to communicate that Americans are standing with them,” Michael LaRosa, her press secretary, wrote in an email detailing the particulars of the weekend trip. “On Mother’s Day, she will meet with Ukrainian mothers and children who have been forced to flee their home country because of Putin’s war.”

For first ladies dating back to Eleanor Roosevelt, visiting troops abroad — and showcasing soft diplomacy — has become something of an informal requirement.

As first ladies, Barbara Bush, Hillary Clinton, Laura Bush and Michelle Obama all traveled solo to military bases overseas to visit troops. (“I have a feeling I’m signing checkbooks,” Barbara Bush joked to one Marine as she tired of signing autographs during a 1990 visit to a base in Saudi Arabia.)

But Dr. Biden’s trip involves more diplomatic complexities than visiting American soldiers. The war in Ukraine has triggered a vast refugee crisis and presented President Biden with urgent foreign policy issues. In the last few weeks, he has shifted from a position of not wanting to create the appearance of a direct conflict between Washington and Moscow to one of heightened rhetoric and support for Ukraine.

It has been 10 weeks since Russia invaded Ukraine. More than a month ago, Mr. Biden declared in Poland that President Vladimir V. Putin of Russia “cannot remain in power,” a remark that administration officials were quick to say was not intended as a call for regime change. A week ago, Mr. Biden called for $33 billion more in military and humanitarian aid to Ukraine. Secretary of State Antony J. Blinken and Defense Secretary Lloyd J. Austin III have visited Kyiv. And this weekend, the first lady will tread even closer to the Ukrainian border than the president has, to showcase the administration’s support.