The world surpassed a total of 100 million known coronavirus cases on Tuesday, according to a New York Times database, a staggering milestone for a global health crisis that is entering a phase of both hope and deep concern.
Experts say that 100 million most likely underestimates the true number of cases, given the lack of adequate testing and contact tracing in many countries, including the United States. Likewise, the number of deaths — more than two million people worldwide, including more than 420,000 in the United States — is probably much higher than officially reported.
Despite lockdowns, social distancing and other measures, the increase in cases has only accelerated in recent months. Global coronavirus cases topped 25 million at the end of August, more than eight months after the virus was first detected in Wuhan, China. By mid-November they had doubled to 50 million. It took less than three months for them to double again.
In one positive sign, the number of daily new cases in the United States, which has the worst outbreak in the world, has been on the decline in recent weeks. U.S. deaths, though, remain high, numbering more than 3,000 deaths per day on average in recent days and more than 420,000 in total. But the U.S. decrease in cases has contributed to a recent decline in the number of daily new cases reported worldwide. Yet more than 500,000 new cases are being reported around the globe each day on average.
Health experts also worry that new variants of the virus could bring a resurgence in U.S. numbers as they have in Britain, Ireland and South Africa. Those fears have prompted new lockdowns and travel restrictions around the world.
Weariness over the pandemic and the associated economic pain remains palpable, even as experts warn that preventive measures remain necessary in many areas. A United Nations official said Monday that the pandemic had precipitated the greatest global labor crisis since the Great Depression.
Some of the strongest stirrings of hope came in December, when large-scale rollouts of coronavirus vaccines began in earnest. But the global supply of the new vaccines has thus far been insufficient to meet the demands of the most vulnerable.
“There is not enough vaccine right now to even serve those who are most at risk,” Dr. Michael Ryan, head of the emergencies program at the World Health Organization, said Monday.
In an increasingly interconnected world, the economic fallout from a flawed vaccine distribution plan could prove difficult to contain, much like the virus itself. According to a report released Monday, inequitable vaccine distribution could cost the global economy more than $9 trillion. Wealthy nations, which in some cases have secured enough doses to vaccinate their populations several times over, would absorb about half of those costs, the report found.
Under pressure to speed up the U.S. pace of coronavirus vaccination, President Biden said on Monday that he was now aiming for the nation to administer 1.5 million vaccine doses a day — a goal that is 50 percent higher than his initial target but one that the nation already appears on track to meet.
The federal government’s weekly allocations of coronavirus vaccines will increase by about 1.5 million doses next week — a jump that White House officials plan to tell governors about on a call Tuesday afternoon, according to a federal official familiar with the government’s planning.
The increase, to around 10 million doses a week, will come from the federal government’s plans to release more of the vaccine made by Moderna, the Massachusetts biotech company whose vaccine was authorized for emergency use in December. Although governors will probably welcome the news, it does not reflect any increase in the overall amount that Moderna will deliver to the federal government in the first three months of this year, according to people familiar with the company’s production.
The increase was first reported by The Washington Post.
Moderna and the pharmaceutical giant Pfizer, which produces another vaccine with emergency authorization, have been stepping up production and are on track to deliver a total of 12 million to 18 million doses a week by the end of March, the federal official said.
As of Tuesday, Moderna had delivered to a federal government distributor 30.4 million doses out of the 100 million doses it has pledged to ship by the end of March. The company has said it expects to fulfill that promise.
Also on Tuesday, Pfizer’s chief executive, Dr. Albert Bourla, said the company would now provide 120 million doses to the United States by the end of March, instead of 100 million, an increase that he attributed to a change that allows each vial to yield six doses instead of five.
Vaccination sites were already extracting six doses from each vial in many cases, but starting this week, the new method will be formalized, and allocations of Pfizer doses to the states will be based on the assumption that each vial contains six doses, meaning that states could receive fewer vials. Some pharmacists have said that six doses cannot always reliably be extracted from a vial, even with the special syringes that the federal government is now providing.
Some states and localities have been clamoring for more vaccine doses, while many others are struggling to use their existing supply. Overall, according to data collected by the Centers for Disease Control and Prevention, only 53 percent of the doses already distributed have been administered.
Although that percentage has been rising as states become more efficient, Biden administration officials have cited an urgent need for more vaccinators and vaccination centers. Mr. Biden has already directed the Federal Emergency Management Agency to begin establishing federally supported community vaccination centers, aiming to have 100 centers in operation in the next month. And he intends to set up mobile vaccination units to reach underserved urban and rural populations.
Open schools. Close indoor dining.
When to keep schools open, and how to do so, has been an issue plaguing the response by the United States to the pandemic since its beginning. President Biden vowed to “teach our children in safe schools” in his inaugural address.
On Tuesday, federal health officials weighed in with a call for returning children to the nation’s classrooms as soon as possible, saying the “preponderance of available evidence” indicates that in-person instruction can be carried out safely as long as mask-wearing and social distancing are maintained.
But local officials also must be willing to impose limits on other settings — like indoor dining, bars or poorly ventilated gyms — in order to keep infection rates low in the community at large, researchers at the Centers for Disease Control and Prevention wrote in the journal JAMA.
School administrators must limit risky activities such as indoor sports, they added. “It’s not going to be safe to have a pizza party with a group of students,” Margaret Honein, a member of the C.D.C.’s Covid-19 emergency response team and the first author of article, said in an interview. “But outdoor cross-country, where distance can be maintained, might be fine to continue.”
Federal officials cited the many benefits of in-person schooling for children, and argued for prioritizing their educational, developmental and emotional and mental health needs. “Schools are an important source not just of education, but health and social services for children,” Dr. Honein said.
Even though the pandemic is rapidly changing, and contagious new variants are spreading, Dr. Honein and other C.D.C. officials argued there is little evidence that schools spark the kind of outbreaks seen in nursing homes and meatpacking plants, or contribute to increased transmission in communities.
“Back in August and September, we did not have a lot of data on whether or not we would see the same sort of rapid spread in schools that we had seen in other high-density work sites or residential sites,” Dr. Honein said. “But there is accumulating data now that with high face mask compliance, and distancing and cohorting of students to minimize the total number of contacts, we can minimize the amount of transmission in schools.”
The call by Dr. Honein and other officials reflects a consensus among some leading educators and public health experts that schools should be the last to close and the first to open when shutdowns are necessary.
Last year, all kindergarten to grade 12 public schools closed for in-person instruction by March 25, shortly after the World Health Organization declared that the new coronavirus outbreak was a pandemic. Many schools subsequently switched to online teaching models for the rest of the school year.
During the fall term, about one-quarter of school districts were completely online, about half were using a hybrid model, and fewer than one-quarter were fully open for in-person teaching. Yet more than half of school districts had students participating in sports programs.
In an opinion column in USA Today earlier this week, Randi Weingarten, the president of the American Federation of Teachers, and Dr. Rajiv Shah, president of the Rockefeller Foundation, called for widespread testing to keep schools safe and get children back into the classroom, not only for educational reasons, but to restore free school meals, give children a social outlet, and provide myriad school-based services that are vital to low-income children.
The Covid-19 School Response Dashboard, a collaboration that tracks infections in school districts willing to share data, has reported that infection case rates among staff in October and November were similar to case rates in the surrounding communities. More recently, however, staff case rates in New York increased at a faster rate than community case rates.
The causes are not clear. The increases may reflect a more frequent testing of schoolteachers. Case rates increased among teachers engaged in in-person teaching and among those teaching remotely, suggesting in-person instruction was not the sole factor.
Emily Oster, a professor of economics and public policy at Brown University who created the dashboard, said that low case rates in the community make it possible to keep schools running safely.
“Prioritizing schools is going to mean limiting some of those other activities, and deciding that we want to undertake some of those sacrifices to keep schools open, because we’ve decided as a society that schools are important relative to other things,” Dr. Oster said.
“The frustration for many people is that you can go to an indoor restaurant. In Massachusetts, I could go to an indoor water park like Great Wolf Lodge — I can take my kids to Great Wolf Lodge. But in a lot of places in Massachusetts, there has been no school.”
The C.D.C. also published two related studies on Tuesday. One was an investigation of a high school wrestling tournament in Florida in December that became a super-spreader event, leading to at least 79 infections and one death.
The tournament brought together 10 schools and 130 athletes and coaches, and 30 percent of participants were infected with the coronavirus. Thirty-eight individuals went on to transmit the virus to at least 41 others, including family members. (The full number is not yet known, because fewer than half the participants were tested.)
The researchers calculated that 1,700 in-person school days were lost to quarantines and isolation of patients and their contacts. The number would have been higher if not for the December holiday break.
C.D.C. researchers also took a look at 17 elementary and secondary schools in rural Wisconsin where mask-wearing was routine. The incidence of infection was lower in schools than in the community at large, the scientists found. During 13 weeks in the fall of 2020, there were 191 infections among staff and students; only seven resulted from in-school transmission, according to the study.
The drug maker Regeneron said on Tuesday that its Covid-19 antibody cocktail prevented illness in the family members of people who had tested positive for the virus, according to an early analysis of a clinical trial that has not yet been published in a scientific journal.
The antibody cocktail was authorized last fall to treat people who have already tested positive and are at high risk for complications from Covid-19, but this study looked at whether an injection of the cocktail — what they called a “passive vaccine” — could prevent infections.
The company said an early analysis of 400 trial participants found that the treatment completely prevented symptomatic infections, and also reduced the rate of asymptomatic infections. Among the 186 volunteers who received the treatment, 10 were infected with the virus but did not get sick. In contrast, of the 223 people who got a placebo, 23 tested positive for the virus and eight became ill with symptoms.
Regeneron is one of two companies — Eli Lilly is the other — that developed specially engineered antibodies to combat the virus soon after people are infected. Last fall, both companies received emergency authorization from the Food and Drug Administration to administer the drugs to people who are already infected with the virus.
Last week, Eli Lilly also released results from a trial showing that its antibody treatment prevented infections in nursing homes where an outbreak had occurred.
Despite the treatments’ early promise, the drugs have been sitting unused in many hospitals, even as the country has experienced a record wave of cases, hospitalizations and deaths. Doctors and hospital administrators have cited a range of reasons for not using the treatments more frequently, including challenges identifying the right patients, questions over whether they work, and logistical hurdles in administering the cocktails, which must be given as infusions in a clinic. (Regeneron’s preventive trial gave the antibodies as an injection instead.)
Regeneron has received more than $3 billion in federal funding to develop the antibody treatments and provide them to Americans.
In a statement on Tuesday, Regeneron’s president and chief scientific officer, Dr. George D. Yancopoulos, suggested that the treatment could be used to “break the chain” of transmission even as vaccines are slowly being rolled out. “Even with the emerging availability of active vaccines, we continue to see hundreds of thousands of people infected daily, actively spreading the virus to their close contacts,” he said.
Around the world, borders were being tightened this week as rising cases and the threat of more contagious virus variants taking hold prompted travel policy changes from the United States to Europe to Australia.
Even as the United States moved to impose travel restrictions, citing the danger of the fast-moving variants, a case of the variant spreading in Brazil was identified in Minnesota.
In Europe, France is moving to impose strict border measures, Britain is considering a mandatory hotel quarantine for some travelers, and the European Union is urging more coordinated action among member states to limit travel.
Germany’s interior minister, Horst Seehofer, said on Tuesday that his country was considering “the reduction of air traffic to Germany to almost zero” to head off the spread of the variants. “The people who accept tough restrictions in Germany expect us to protect them as best we can from an explosion in infection numbers,” he told the Bild newspaper.
Already, a hospital in Berlin and another in the state of Bavaria have stopped taking any new patients and have sent much of their staff into quarantine after the B.1.1.7 variant was detected, raising fears that the country’s current safety measures were not stringent enough to meet the new threat.
Prime Minister Jacinda Ardern of New Zealand said on Tuesday that the country’s borders would remain closed until New Zealanders had been “vaccinated and protected.” Australia has suspended its travel bubble with New Zealand for 72 hours from Monday, after New Zealand confirmed a case outside its quarantine system of the variant found in South Africa.
As of Tuesday, the United States will begin requiring a negative virus test from all arriving international air travelers. The Biden administration has announced that it is extending a ban on travel by noncitizens into the United States from Brazil, Britain and 27 other European countries, and adding South Africa to the list. The State Department also urged Americans not to travel abroad for nonessential reasons, warning that if they tested positive or were unable to present proof of a negative test, assistance from the U.S. government “is likely to be limited.”
The Brazil-based variant, known as B.22.214.171.124 or P.1, was identified Monday in a Minnesota resident who had recently traveled to Brazil, the state health authorities said, which could suggest that the variant might not yet be widely circulating.
Dr. Anthony S. Fauci, an adviser to President Biden, said it was only a matter of time before the Brazil-based variant was detected in the United States. “With the world travel that you have, and the degree of transmissibility efficiency, it’s not surprising,” he said.
The variants have arrived just as there are signs of progress. Hospitalizations, after peaking in early January, are at their lowest level nationally since Dec. 13, according to the Covid Tracking Project. The average daily caseload in the United States is down by about one-third compared with two weeks ago, according to a New York Times database.
And after a slow start, the pace of vaccinations is picking up, and the United States already seems to be vaccinating well over a million people per day, according to a New York Times analysis of data from the Centers for Disease Control and Prevention. Mr. Biden said Monday that he is now aiming for the United States to administer 1.5 million doses a day, a 50 percent increase from his initial target.
But scientists fear much of the country’s momentum could be quickly halted if the variants continue to spread unchecked. They are especially anxious about the variants spreading in Brazil and South Africa, which share many mutations, because they may be able to blunt the effectiveness of vaccines.
The United States is flying blind, scientists have warned, as the country navigates the spread of the new variants without a large-scale, nationwide system for checking virus genomes for new mutations. Instead, the work of discovering the variants has fallen to a patchwork of academic, state and commercial laboratories.
Scientists say that a national surveillance program would be able to determine just how widespread the new variant is and help contain emerging hot spots, extending the crucial window of time in which vulnerable people across the country could get vaccinated.
Beginning Tuesday, travelers flying into the United States from any other country must present proof of a negative test for the coronavirus. The State Department is also urging Americans to avoid traveling abroad for nonessential reasons, warning that those who test positive or cannot access a test could get stuck abroad for an extended period of time — and that for them, assistance from the U.S. government will be limited.
“The Department of State is committed to helping U.S. citizens overseas who find themselves in dire situations, but that assistance is likely to be limited,” said the Bureau of Consular Affairs Acting Assistant Secretary Ian Brownlee. “Our goal is to help people avoid those dire straits in the first place.”
The directive was in line with the new tone from the Biden administration which has tightened rules around international travel. Many other countries have been requiring negative test results for months.
While travel globally will be affected, especially in light of the Biden administration’s decision to bar travelers — excluding American citizens — from Brazil, Britain, Ireland, South Africa and 26 countries in Europe that allow travel across open borders, the biggest impact of the testing rule will be for destinations in the Caribbean and Mexico, which have continued to attract American leisure travelers who cannot go to other parts of the world.
“We keep getting curveballs thrown at us in our whole industry,” said Jason Kycek, senior vice president of sales and marketing at Casa de Campo, a golf-and-beach resort in the Dominican Republic that is expanding its existing on-site testing facilities. “The finish line keeps moving, but we are staying on top of things and making sure our guests have what they need and can travel safely.”
Mexico and countries in the Caribbean have remained popular destinations for American travelers even as other destinations closed their borders, in part because of their proximity to the United States, making them relatively easy and affordable to reach. In the fall, several U.S. airlines added flights to the Caribbean islands and to Mexico at a time when routes elsewhere were being cut. In November, nearly 500,000 Americans flew to Mexico alone, according to official figures.
Under the new requirement, travelers seeking to enter the United States will need to get tested no more than three days before their scheduled flight, showing a negative result to their airline before boarding. Those who have already had the virus will need to show documentation of recovery in the form of a recent positive viral test and a letter from a health care provider or a public health official stating they were cleared to travel.
Americans who test positive or cannot access a test could be stuck abroad for several weeks and should be prepared to pay for their medical care and lodging, Mr. Brownlee said.
“All travelers should have a plan B,” he said. He added that before traveling, Americans should ask themselves the following questions about what they would do if they were stuck in another country longer than intended: “Where would you stay? How would you pay for that extended stay? What would happen at home if you could get back to work, couldn’t get back to take care of your children or any of your other responsibilities?”
The United States will accept results from rapid antigen tests, while other countries have been asking for what are known as polymerase chain reaction tests, or P.C.R. tests. Antigen tests have been found to be less reliable than P.C.R. tests. U.S. embassies in other countries will not offer tests.
For an industry already decimated by the pandemic, the new testing requirement may cut into any business rebound. Last week, United Airlines told reporters on its fourth-quarter earnings call that Mexican destinations were among the most affected by the new testing requirement.
When New York announced new vaccine eligibility guidelines two weeks ago covering millions of additional state residents, one particularly hard-hit group remained unmentioned: the nearly 50,000 people incarcerated in the state’s prisons and jails.
Now, with state supplies dwindling and no clear plan for vaccinating incarcerated people, the virus is roaring back behind bars. At least 5,100 people living and working in New York’s prisons have tested positive and 12 have died in recent weeks, outpacing even the early days of the pandemic.
But how and when to vaccinate incarcerated people as millions around the state wait has raised legal, logistical and ethical questions.
Across the country, the arrival of a vaccine was hailed as a harbinger of the pandemic’s eventual end. But administering the limited supply has proved challenging, and correctional facilities — where more than half a million people have tested positive for the virus since the start of the pandemic — present additional complications.
Officials grappling with the same difficult questions have come to different conclusions, creating a patchwork of policies and timelines, according to an analysis by the Prison Policy Initiative, a research nonprofit devoted to reducing mass incarceration. But at least 27 states directly name inmates in their public plans, and about a dozen place them in the first phases of vaccine distribution, including Massachusetts, where tens of thousands of prisoners are to be vaccinated by the end of February.
Other states plan to vaccinate prison and jail workers before incarcerated people, breaking with guidance from the Centers for Disease Control and Prevention, which recommends vaccinating everyone at correctional facilities simultaneously. Some, like New York, do not address those behind bars at all.
Vaccinating incarcerated people in the early stages of distribution has proved politically fraught. In New York, state senators have questioned whether prioritizing people in prisons makes sense. In Colorado, a draft plan to offer the vaccine inside prisons was met with fierce opposition for, as one district attorney wrote in The Denver Post, prioritizing “the health of incarcerated murderers” ahead of “law-abiding Coloradans 65 and older.”
In New York City the discussion about when and how to vaccinate incarcerated people comes as supplies dwindle.
The city’s vaccine tracker showed less than 7,710 first doses and around 202,000 second doses on hand as of Tuesday morning, with 72,409 second doses yet to be scheduled. It also indicated that 99,831 second doses have been administered out of 650,546 total doses so far, several hundred thousand short of Mayor Bill de Blasio’s goal of one million vaccine doses administered in January.
Mr. de Blasio said at a news conference on Tuesday that he wanted to use the pool of vaccines saved for second doses as first doses, but that he was still determined to get people their second doses. He cited new C.D.C. guidelines, which have not been studied in large clinical trials, that allowed a second dose to be given up to six weeks after the first in situations when receiving the second dose in the recommended three to four weeks later, depending on the vaccine, was “not feasible.”
“Anyone who gets a first dose will get a second dose,” Mr. de Blasio said. “The question is timing.”
Mr. de Blasio said that he hoped the coming Johnson & Johnson vaccine, which only requires one dose, will speed up the vaccination process. He said that the city should soon have infrastructure in place to vaccinate half a million people each week, if there is sufficient vaccine to do so.
Dr. Dave A. Chokshi, the city’s health commissioner said on Tuesday that they expected about 107,000 doses from the federal government this week, without specifying whether they were intended for first or second doses, and that they would learn next week’s allocation in the next two days. Dr. Chokshi said the city had to postpone some first dose vaccination appointments and that he thought more notice about incoming supply would make it easier for the city to complete inoculations.
On Tuesday White House officials planned to announce that the federal government’s weekly allocations of coronavirus vaccine will increase by about 1.5 million doses to around 10 million in total. The increase will come from a release of more Moderna vaccine, though people familiar with Moderna’s production said that the newly distributed doses do not reflect an immediate increase in the overall amount of vaccine the company will deliver to the federal government in the first three months of this year.
At the state level, New York officials said they were preparing a plan for vaccinating incarcerated people. Public health experts broadly agree that they are at particularly high risk for contracting and spreading the virus; at least 8,800 people living or working in New York’s prison system have tested positive since the start of the pandemic.
And because guards, lawyers, workers and people entering and leaving custody move between the facilities and the community at large, the public health implications of outbreaks behind bars extend far beyond the prison walls.Officials said last fall that an outbreak at Greene Correctional Facility near Albany was linked to cases at an assisted-living facility and an elementary school.
Shopkeepers boarded up windows and sent employees home early in several cities across the Netherlands on Tuesday, as the country braced for a fourth night of protests against a 9 p.m. curfew that is meant to slow the spread of the coronavirus.
Hundreds of protesters have been arrested since the curfew went into effect nationwide on Saturday, the authorities said. Rioters have looted stores, burned a Covid-19 testing center, and thrown fireworks and rocks at the police in Amsterdam, Rotterdam and other cities.
“Officers have been injured, and residents felt unsafe in their own homes,” Hugo Hillenaar, the chief public prosecutor of Rotterdam, said on Tuesday, after police made dozens of arrests on Monday night. “As a society, we absolutely cannot tolerate this.”
Government officials have said the protests were no reason to change the strict lockdown measures, and on Tuesday, Prime Minister Mark Rutte of the Netherlands denounced the “criminal violence” that had erupted.
“The riots have nothing to do with protesting or fighting for freedom,” Mr. Rutte wrote on Twitter. “We must win the fight against the virus together, because only then can we regain our freedom.”
Though daily counts of new coronavirus cases have been declining in the Netherlands, Dutch authorities said last week that stricter restrictions were needed to control the spread of a more contagious variant that was first identified in Britain. Other European countries have also imposed curfews, including France, where people generally must be home by 6 p.m.The new variant, known as B.1.1.7., has been held responsible for record numbers of new cases in Britain and other European countries like Spain, which closed down its bars and restaurants last week, and Portugal, where hospitalizations have soared to record highs.
In the Netherlands, where bars and restaurants have been shut since October and schools and nonessential shops closed last month, the government has said it was “gravely concerned” about the new variant. “We don’t want to look back a few weeks from now and realize that we did not do enough,” the government said in a statement on Friday.
There have been protests against lockdown measures all through the pandemic, but none had turned as violent as the riots of the last four days. When the curfew and new travel restrictions took effect on Saturday, groups of youths set fires, attacked buildings and pelted police officers with stones.
The Dutch justice minister, Ferd Grapperhaus, said in a broadcast interview Tuesday that the protests were no reason to rethink the country’s strict lockdown measures. “We need the curfew,” he said.
The Netherlands has reported 13,686 deaths since the pandemic began, or 79 deaths for each 100,000 inhabitants — half the rate reported in countries like Britain, Belgium or Italy. The U.S. rate is about 127 per 100,000.
On Tuesday evening, soccer supporters in the cities of Den Bosch and Maastricht patrolling the streets said they were trying to prevent looting and clashes, according to a New York Times photographer and reports on social media.
Less than a week after the government of Ecuador began a pilot program for coronavirus inoculations, health care workers say that despite officially stated priorities, vaccine doses are being given to people who are not frontline responders.
A plane carrying 8,000 doses of the Pfizer-BioNTech vaccine landed to applause in Quito on Wednesday before flying to Guayaquil. Already, at least two people at a large public hospital in the capital — a medic and a press officer — were fired after receiving doses they were not supposed to receive.
Elsewhere at the largest public hospital in Cuenca, the country’s third largest city, frontline responders staged a brief protest on Monday after learning only 13 of the 100 workers who directly treated Covid-19 cases there had received a vaccine. The list of eligible people at the hospital, called Vicente Corral Moscoso, instead gave priority to staff members such as the general manager, ear and nose doctors, pediatricians, epidemiologists and even a plastic surgeon.
The country’s health minister has ordered an investigation into the hospital’s vaccine distribution. But the Health Minister himself, Juan Carlos Zevallos, was accused on Monday of sending vaccine doses from the pilot program to a nursing home of a wealthy private hospital, where some of his relatives live. The program’s plan had originally stated that doses were to be given only to frontline responders and the elderly residents and caretakers at public nursing homes.
In an interview with a local newspaper, Mr. Zevallos admitted sending the doses to the private facility. He said people working and living in private facilities also “had a right” to get the vaccine.
The country’s ombudsman, Freddy Carrión, sent a letter to President Lenín Moreno on Monday demanding that Mr. Zevallos be dismissed. Mr. Carrión said his office was concerned over “the irregularities and lack of transparency” in the first stage of the vaccine rollout, and voiced his concerns about the lack of public access to the vaccination plan and to information throughout the entire pandemic. As of Tuesday morning, the Health Ministry and Mr. Zevallos had not returned requests for comment.
The arrival of coronavirus vaccines in Ecuador — and specifically in Guayaquil, where the plane was received by Mr. Moreno, the health minister and local health care workers — was a hefty symbolic moment. The large port city was struck hardest by the pandemic after the first positive case was confirmed in Ecuador on February 29. The following months plunged the city into horror: thousands were dying, and hospitals and funeral parlors were so overwhelmed that corpses were left for days in housesand morgues and even on sidewalks, before they were picked up. Some have never found their loved ones’ bodies. Since the holidays and the discovery that a more contagious variant had entered the country as early as mid-December, cases have again surged.
Israel, which leads the world in vaccinating its population against the coronavirus, has produced some encouraging news: Early results show a significant drop in infection after just one shot of a two-dose vaccine, and better than expected results after both doses.
Public health experts caution that the data, based on the Pfizer-BioNTech vaccine, is preliminary and has not been subjected to clinical trials. Even so, Dr. Anat Ekka Zohar, the vice president of Maccabi Health Services, one of the Israeli health maintenance organizations that released the data, called it “very encouraging.”
In the first early report, Clalit, Israel’s largest health fund, compared 200,000 people aged 60 or over who received a first dose of the vaccine to a matched group of 200,000 who had not been vaccinated yet. It said that 14 to 18 days after their shots, the partly vaccinated patients were 33 percent less likely to be infected.
At about the same time, Maccabi’s research arm said it had found an even larger drop in infections after just one dose: a decrease of about 60 percent, 13 to 21 days after the first shot, in the first 430,000 people to receive it.
Maccabi did not specify an age group or whether it had compared the data with a matched, non-vaccinated cohort.
The Israeli Health Ministry and Maccabi released on Monday new data on people who had received both doses of the vaccine, showing extremely high rates of effectiveness.
The ministry found that of 428,000 Israelis who had received their second doses, only 63, or 0.014 percent, had contracted the virus a week later. Similarly, the Maccabi data showed that more than a week after having received the second dose, only 20 of roughly 128,600 people, about 0.01 percent, had contracted the virus.
In clinical trials, the Pfizer vaccine proved 95 percent effective after two doses in preventing coronavirus infection in people without evidence of previous infection. The Israeli results, if they hold up, suggest the efficacy could be even higher, though rigorous comparisons to unvaccinated people have not yet been published.
Both Clalit and Maccabi warned that their findings were preliminary and said they would soon be followed by more in-depth statistical analysis in peer-reviewed scientific publications.
Israel, where more than 40 percent of the population has already received one dose of the vaccine, has become something of an international test case for vaccination efficacy.
Prime Minister Boris Johnson of Britain promised on Tuesday to “learn lessons” from the coronavirus pandemic, as he acknowledged that the country had surpassed 100,000 total deaths.
“Its hard to compute the sorrow contained in that grim statistic — the years of life lost, the family gatherings not attended, and for so many relatives, the missed chance even to say goodbye,” Mr. Johnson said.
He called for the country to remember the lives lost and the efforts of the country’s health care workers as they struggle to help the afflicted and to contain the spread of the virus.
“I am deeply sorry for every life that has been lost, and as prime minister, I take full responsibility for everything that the government has done,” Mr. Johnson said, adding that the government would do everything in its power “to minimize, loss of life and to minimize suffering.”
The British government is preparing to announce tighter restrictions to combat a surge in new fast-spreading variants of the virus, which could include a mandatory hotel quarantine for travelers arriving from abroad. Mr. Johnson did not elaborate on those plans during his news conference.
Nadhim Zahawi, the British vaccine minister, told Sky News that an announcement on the travel rules would come later on Tuesday, but he declined to give details.
New data released by the Office for National Statistics earlier in the day put the total number of registered deaths in England, Northern Ireland, Scotland and Wales at 103,602 through Jan. 15.
The country has had some success in getting vaccinations going quickly. Simon Stevens, the chief executive of the National Health Service, said on Tuesday that so far, one in eight adults in the country had received the first of the two required vaccine doses. But he cautioned that there were still difficult times ahead.
“This is not a year that anybody is going to want to remember,” Mr. Stevens said.
Germany’s Health Ministry has denied widely criticized and thinly sourced reports in local news outlets that AstraZeneca’s coronavirus vaccine is barely effective in protecting older people, stressing that the data was still being reviewed as European Union regulators consider approving the vaccine.
“The German Ministry of Health cannot confirm recent reports of reduced efficacy of the AstraZeneca vaccine,” the ministry said in a statement on Tuesday, after two leading German newspapers reported that the vaccine had proved effective in just 8 percent of people over 65.
“At first glance, it appears that two things have been confused in the reports: About 8 percent of the subjects in the AstraZeneca efficacy trial were between 56 and 69 years of age, and only 3 to 4 percent were over 70 years of age,” the ministry said. “However, this does not imply an efficacy of only 8 percent in seniors.”
The German health minister, Jens Spahn, called the reports “speculation” early Tuesday and pointed out that the available data had not yet been fully assessed.
“It has long been clear — there was a discussion in the fall — that there is less data for older people,” Mr. Spahn said.
AstraZeneca refuted the initial reports in the German media on the effectiveness of the vaccine, calling them “completely incorrect.” AstraZeneca and Oxford, which developed the vaccine, have not released figures on how effective the vaccine is for different age groups.
The AstraZeneca vaccine has been approved for emergency use in several countries, including Britain, India and Mexico, but not yet in the European Union. The company applied for authorization on Jan. 12, and the European Medicines Agency, the bloc’s drug regulator, is expected to announce its decision on Friday.
The reports come amid growing concern in Germany over the sluggish start to the country’s mass vaccination program, after AstraZeneca informed Brussels on Friday that it would not be able to deliver the anticipated number of doses to the European Union, because of slow production at a manufacturing site within the bloc.
Chancellor Angela Merkel and Mr. Spahn have pledged to make vaccines available by Sept. 21 to all adults in Germany who want the shot. That promise is dependent on the country receiving the 56.2 million does of the AstraZeneca vaccine, based on its original delivery pledge.
For nearly a year, the president of Mexico, Andrés Manuel López Obrador, had minimized the pandemic, claiming that religious amulets protected him, refusing to wear a mask and even drinking from the same clay pot as supporters. It was only a matter of time until he got sick himself, some Mexicans said.
With the president now infected, what most aggrieved many Mexicans was not only that he had flouted basic safety precautions, but also that he may go back to playing down the threat that the surging pandemic poses after his own illness.
They noted that with top-notch medical care delivered at his living quarters, the president may well recover. Their loved ones, on the other hand, will struggle to get the most basic care.
A devastated Mexico is struggling to rein in the pandemic. Last Thursday, the authorities announced more than 1,800 coronavirus deaths, breaking the record of single-day deaths set just days earlier.
In Mexico City, hospitals are at 89 percent capacity, according to the most recent health ministry figures, while nationwide, the figure is 60 percent. Across the country, more than half of all hospital beds with ventilators are full.
So far, more than 1.7 million people have contracted the virus in Mexico and more than 150,000 people have died. That is the fourth-highest death toll in the world.
Amid widespread mistrust of hospitals, many infected people choose to stay home — and often die there. The cause of death may not be listed as Covid-19. That, combined with the country’s low levels of testing, means the pandemic’s true toll is most likely far worse than the official one.
On Monday, the day after the president disclosed his infection, Carlos Slim, a telecommunications tycoon who is the richest man in Mexico, was also reported to have contracted the virus. His son said on Twitter that Mr. Slim, who turns 81 this week, had mild symptoms and was doing “very well.”
While Mr. López Obrador also said that his symptoms were mild and that he “remained positive,” doctors warned that the 67-year-old heart attack survivor was in a high-risk category.
And it remains to be seen if his own bout with the virus will change his attitude toward it.
Mr. López Obrador is not the first world leader to fall ill with coronavirus.
Early last year, Prime Minister Boris Johnson of Britain famously persisted in shaking hands with Covid-19 patients and later was admitted to a hospital himself after contracting the illness.
Mr. Johnson emerged sounding chastened, and with a new, intimate awareness of the virus’s danger. He went on to embrace mask wearing and lockdowns and other measures designed to help stem transmission.
But in Mexico, some public health experts fear their leader will go more the way of former President Donald J. Trump, who beat the virus last year and then continued to play down the pandemic and undermine health officials’ recommendations.
Indonesia officially passed one million coronavirus cases on Tuesday, with many hospitals near capacity even as vaccinations are underway. As in many countries, however, the true number of infections is likely to be much higher.
Indonesia, which has the world’s fourth-largest population at more than 270 million, never succeeded in containing its first wave of infections, and the daily numbers of new cases and deaths have surged to their highest levels in the past 10 days.
On Tuesday, officials reported 13,094 new cases and 336 deaths for a total of 1,012,350 cases, the highest in Southeast Asia. Indonesia is the 19th country to surpass one million cases, and among Asian nations it trails only India in the number of cases.
Dicky Budiman, an epidemiologist who studies pandemics and global health security at Griffith University in Australia, has been saying for months that Indonesia is undercounting its case numbers by a third or more.
He estimates that the country has at least 60,000 new infections each day, more than four times what the government is reporting.
“The response they give to the pandemic is not equal to the problem,” said Dr. Dicky, a former Indonesian health official.
Though Indonesia began its vaccination program almost two weeks ago, it is likely to be some time before there is a significant effect on new infections. A government spokesman said that as of Tuesday, 162,000 people had received the first of two doses of the vaccine made by Sinovac, a private Chinese company. With a population spread across thousands of islands, experts say vaccinating enough Indonesians to reach herd immunity could take a year or more.
Here’s what else is happening around the world:
Violent protests erupted for the third night in cities across the Netherlands, with stores looted and rocks and fireworks thrown at police officers in response to a national 9 p.m. curfew that went into effect on Saturday. In total, the police arrested more than 150 people nationwide, the police chief told the Dutch broadcaster NOS.
Politicians echoed a similar sentiment. “What’s happening in the Dutch streets is unprecedented,” Wopke Hoekstra, the finance minister, told Dutch television on Tuesday. Ferd Grapperhaus, the justice minister, called the violence “outrageous” and indicated that the protests were no reason to rethink the strict lockdown measures. “We need the curfew,” Mr. Grapperhaus said.
France announced on Tuesday that it would not delay the second dose of the Pfizer-BioNTech vaccine to quickly maximize the number of people receiving a first shot, as some countries have done. The French health minister, Olivier Véran, said at a news conference that the debate on delaying the second dose was “legitimate” but that it was still unclear how efficient the vaccine would be if administered six weeks after the first shot, instead of the recommended three to four weeks. “I am choosing the security of confirmed data,” Mr. Véran said.
A World Health Organization panel of experts recommended on Tuesday that the Moderna Covid-19 vaccine be given in two doses spaced 28 days apart, which could be extended under exceptional circumstances to 42 days. The guidance was issued by the organization’s Strategic Advisory Group of Experts on Immunization several weeks after it issued similar guidance on the rival Pfizer shot, according to Reuters.
The European Union escalated a war of words with AstraZeneca on Monday over the company’s sudden announcement on Friday that it would have to drastically cut the number of vaccine doses delivered to the bloc and its 27 members.
The European health commissioner, Stella Kyriakides, said a call with the company’s leadership on Monday had not yielded sufficient answers as to why the company was breaking its contractual obligation and said another call would be held on Monday evening.
A spokesperson for AstraZeneca, said: “Our C.E.O. Pascal Soriot was pleased to speak with the Commission President Ursula von der Leyen earlier today. He stressed the importance of working in partnership and how AstraZeneca is doing everything it can to bring its vaccine to millions of Europeans as soon as possible.”
The AstraZeneca debacle delivers a serious blow to the bloc’s sluggish vaccination rollout, and comes days after Pfizer notified E.U. members and several other countries that it would slow down deliveries until mid-February as it upgraded its Belgium factory to increase production.
The twin disappointments have left several E.U. countries hamstrung, and have thwarted the bloc’s collective effort to vaccinate 70 percent of its population by this summer, as Britain and the United States are making better progress with their inoculation programs.
“The European Union has pre-financed the development of the vaccine and its production, and wants to see the return,” Ms. Kyriakides said, implying that the E.U. was concerned the company had sold the vaccines the bloc had funded to other countries.
“The European Union wants to know exactly which doses have been produced, where by AstraZeneca so far, and if, or to whom, they have been delivered,” she added.
Ms. Kyriakides also said that the European Commission, the executive branch of the E.U., was proposing its members approve a system in which pharmaceutical companies like AstraZeneca that produce vaccines in plants in E.U. territory would need to register any intention to export part of that production outside the bloc.
Vice President Kamala Harris on Tuesday afternoon received her second dose of the Moderna vaccine at the National Institute of Health’s Bethesda campus.
“When are ya gonna put it in?” she joked to the nurse administering the shot into her left arm, after it was already over. “It really was painless,” Ms. Harris said as the nurse put a Band-Aid on her arm, “relatively painless.”
Ms. Harris’ televised vaccination shot was part of the Biden administration’s ongoing attempt to instill confidence in the vaccine among skeptical Americans, and particularly among minority communities who are being infected with and dying of the coronavirus at higher rates.
In brief remarks after receiving her shot, Ms. Harris commended the staff at the N.I.H. for the research and dedication that resulted in what she called “something that will save your life.” Urging all Americans to take the vaccine when it becomes available to them, she reiterated: “It will save your life.”
During the Trump administration, scientists and scientific institutions were regularly undermined by the president and some of his top officials. In contrast, Ms. Harris noted that her mother worked at the N.I.H. and said that for scientists, “their whole reason for being is to see what can be, unburdened by what has been. Their whole reason for being is to pursue what is possible for the sake of improving human life and condition. It is such a noble pursuit.”
Ms. Harris sought to boost public trust in government and in science in particular, saying that for public health officials, “It’s not about profit, it’s about the people.”