Covid-19: With Over 312,000 Cases in 24 Hours, India Sets a Record

India sets a global record for daily infections.

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A man who died of complications from the coronavirus was being cremated in Mumbai on Wednesday.Credit...Atul Loke for The New York Times

India’s rapidly worsening coronavirus outbreak is now expanding on a scale beyond any previously measured in more than a year of the pandemic: The health ministry reported more than 310,000 new infections on Thursday, the most recorded in any country on a single day.

India’s total eclipsed the previous one-day high of 300,669 recorded coronavirus cases, set in the United States on Jan. 8, according to a New York Times database, though differences in testing levels from country to country, and a widespread lack of tests early in the pandemic, make comparisons difficult.

Over the past two months, the outbreak in India has exploded, with reports of superspreader gatherings, oxygen shortages and ambulances lined up outside hospitals because there were no ventilators for new patients.

As cases worldwide reach weekly records, a substantial proportion of the new infections are coming in India, a sobering reminder that the pandemic is far from over, even as infections decline and vaccinations speed ahead in the United States and other wealthy parts of the world. India has surpassed 15.6 million total reported infections so far, second-most after the United States.

The death toll has also begun to climb precipitously.

On Thursday, the Indian government recorded 2,104 deaths, and an average of more than 1,600 people have died of the virus every day for the past week. That is less than the tolls at the worst points of the pandemic in the United States or Brazil, but it is a steep increase from just two months ago, when fewer than 100 people in India were dying daily.

There are signs that the country’s health system, patchy even before the pandemic, is collapsing under the strain. On Tuesday, at least 22 people died in an accident in the central city of Nashik when a leak in a hospital’s main oxygen tank cut the flow of oxygen to Covid-19 patients.

The picture is staggeringly different from early February, when India was recording an average of just 11,000 cases a day, and domestic drug companies were pumping out millions of vaccine doses. More than 132 million Indians have received at least one dose, but supplies are running low and experts warn that the country is unlikely to meet its goal of inoculating 300 million people by the summer.

Critics say Prime Minister Narendra Modi, who imposed a harsh nationwide lockdown in March 2020 in the early stages of the pandemic, failed to prepare for a second wave or to warn Indians to remain vigilant against the virus, especially as more infectious variants began to spread.

Mr. Modi’s Hindu nationalist government has also allowed a massive Hindu festival to take place, drawing millions of pilgrims to the banks of the Ganges River, and his party has held packed political rallies in several states.

“India’s rapid slide into this unprecedented crisis is a direct result of complacency and lack of preparation by the government,” Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics and Policy in Washington, wrote in The New York Times on Tuesday.

The hardest-hit region is Maharashtra, a populous western state that includes the financial hub of Mumbai. On Wednesday, the state’s top leader ordered government offices to operate at 15 percent capacity and imposed new restrictions on weddings and private transportation to slow the spread of the virus.

This week, Britain’s prime minister, Boris Johnson, and Japan’s prime minister, Yoshihide Suga, called off plans to visit India. On Thursday, the Australian prime minister, Scott Morrison, said that direct flights from India would be reduced by about 30 percent, and that Australians would be allowed to travel to India only in “very urgent circumstances.” Canada also suspended all direct flights from India and Pakistan starting Thursday night for 30 days.

No evidence that Pfizer or Moderna vaccines are unsafe during pregnancy, a preliminary study says.

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A pregnant woman receiving the Pfizer vaccine in Schwenksville, Pa., in February.Credit...Hannah Beier/Reuters

In an early analysis of coronavirus vaccine safety data, researchers at the Centers for Disease Control and Prevention have found no evidence that the Pfizer-BioNTech or Moderna vaccines pose serious risks during pregnancy.

The findings are preliminary and cover just the first 11 weeks of the U.S. vaccination program. But the study, which included self-reported data on more than 35,000 people who received one of the vaccines during or shortly before pregnancy, is the largest yet on the safety of the coronavirus vaccines in pregnant people.

During the clinical trials of the vaccines, pregnant women were excluded. That left patients, doctors and experts unsure whether the shots were safe to administer during pregnancy.

“There’s a lot of anxiety about whether it’s safe and whether it would work and what to expect as far as side effects,” said Dr. Stephanie Gaw, a maternal-fetal medicine specialist at the University of California, San Francisco.

The new data, Dr. Gaw said, demonstrate that “a lot of pregnant people are getting the vaccine, there isn’t a significant increase in adverse pregnancy effects at this point, and that side effect profiles are very similar to nonpregnant people.”

“I think that’s all very reassuring,” she said, “and I think it will really help providers and public health officials more strongly recommend getting the vaccine in pregnancy.”

Covid-19 poses serious risks during pregnancy. Pregnant women who develop symptoms of the disease are more likely to become seriously ill, and more likely to die, than nonpregnant women with symptoms.

Because of those risks, the C.D.C. has recommended that coronavirus vaccines be made available to pregnant women, though it also suggests that they consult with their doctors when making a decision about vaccination.

The new study, which was published on Wednesday in The New England Journal of Medicine, is based largely on self-reported data from V-safe, the C.D.C.’s coronavirus vaccine safety monitoring system. Participants in the program use a smartphone app to complete regular surveys about their health, and any side effects they might be experiencing, after receiving a Covid-19 vaccine.

The researchers analyzed the side effects reported by V-safe participants who received either the Pfizer or Moderna vaccine between Dec. 14, 2020, and Feb. 28, 2021. They focused on 35,691 participants who said that they had been pregnant when they received the vaccine or became pregnant shortly thereafter.

After vaccination, pregnant participants reported the same general pattern of side effects that nonpregnant ones did, the researchers found: pain at the injection site, fatigue, headaches and muscle pain.

Women who were pregnant were slightly more likely to report injection site pain than women who were not, but less likely to report the other side effects. They were also slightly more likely to report nausea or vomiting after the second dose.

Pregnant V-safe participants were also given an opportunity to enroll in a special registry that tracked pregnancy and infant outcomes.

By the end of February, 827 of those enrolled in the pregnancy registry had completed their pregnancies, 86 percent of which resulted in a live birth. Rates of miscarriage, prematurity, low birth weight and birth defects were consistent with those reported in pregnant women before the pandemic, the researchers report.

“This study is of critical importance to pregnant individuals,” Dr. Michal Elovitz, a maternal-fetal medicine specialist at the University of Pennsylvania, said in an email. “It is very reassuring that there were no reported acute events in pregnant individuals” over the course of the study, she said.

But the report has several limitations and much more research is needed, experts said. Enrollment in the surveillance programs is voluntary and the data are self-reported.

In addition, because the study period encompassed just the first few months of the U.S. vaccination campaign, the vast majority of those enrolled in the pregnancy registry were health care workers. And there is not yet any data on pregnancy outcomes from people who were vaccinated during the first trimester of pregnancy.

“I think we can feel more confident about recommending the vaccine in pregnancy, and especially with pregnant people that are at risk of Covid,” Dr. Gaw said. “But we do need to wait for more data for complete pregnancy outcomes from vaccines early in pregnancy.”

Tracking the Coronavirus ›

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U.S. regulators find more flaws at plant where doses were ruined.

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Federal regulators have found many shortcomings at a plant of Emergent BioSolutions in Baltimore.Credit...Saul Loeb/Agence France-Presse — Getty Images

WASHINGTON — Federal regulators have found serious flaws at the Baltimore plant that had to throw out up to 15 million possibly contaminated doses of Johnson & Johnson’s coronavirus vaccine, casting doubt on further production in the United States of a vaccine that the government once viewed as essential in fighting the pandemic.

The regulators for the Food and Drug Administration said that the company manufacturing the vaccine, Emergent BioSolutions, may have contaminated additional doses at the plant. They said the company failed to fully investigate the contamination, while also finding fault with the plant’s disinfection practices, size and design, handling of raw materials and training of workers.

The F.D.A. has not yet certified the plant, in Baltimore’s Bayview neighborhood, and no doses made there have gone to the public. All the Johnson & Johnson shots that have been administered in the United States have come from overseas.

The report amounted to a harsh rebuke of Emergent, which had long played down setbacks at the factory, and added to problems for Johnson & Johnson, whose vaccine had been seen as a game changer because it requires only one shot, can be produced in mass volume and is easily stored.

The inspection began after routine checks showed that Emergent workers had contaminated at least part of a batch of 13 million to 15 million doses of the Johnson & Johnson vaccine with the harmless virus that is used to make the AstraZeneca shot, which is not yet authorized in the United States.

The F.D.A. findings, based on an inspection that ended on Tuesday, underscore questions raised in reports by The New York Times about why Emergent did not fix problems earlier and why federal officials who oversee its lucrative contracts did not demand better performance.

In statements on Wednesday, the F.D.A., Emergent and Johnson & Johnson all said they were working to resolve the problems at the factory. There was no indication of how long that would take.

Biden asks U.S. employers to give workers paid time off to get vaccinated.

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A vaccination site in Los Angeles County this month.Credit...Allison Zaucha for The New York Times

President Biden on Wednesday called on every employer in America to give employees paid time off to get vaccinated, the administration’s latest move to try to persuade the more than half of the nation’s adults who have yet to get a dose to do so.

“No working American should lose a single dollar from their paycheck because they chose to fill their patriotic duty to get vaccinated,” Mr. Biden said.

White House officials also said the administration would offer a paid leave tax credit to offset the cost for companies with fewer than 500 employees.

The announcement came during a presidential address to mark what Mr. Biden called a major milestone: 200 million shots in the arms of the American people, with a week to go before the president’s 100th day in office. As of Wednesday, more than 199 million doses had been administered across the country beginning Jan. 20, according to data as reported by the Centers for Disease Control and Prevention.

“It’s an incredible achievement for the nation,” Mr. Biden said, while also instructing Americans to continue wearing masks until everyone is vaccinated.

“We all need to mask up until the number of cases goes down, until everyone has a chance to get their shot,” he said.

But the distribution of those shots has been uneven: While New Hampshire has given at least one shot to 59 percent of its citizens (a percentage that includes children, most of whom are not yet eligible), Mississippi and Alabama are at 30 percent.

In New York, Gov. Andrew M. Cuomo said on Wednesday that as of Friday, people 60 and older could get vaccinated at 16 state-run mass vaccination sites without an appointment.

A senior administration official, who previewed the announcement on the condition of anonymity, described the initiative to involve the private sector as the next big opportunity and said employers would be especially effective in reaching out to the large percentage of working Americans who are still unvaccinated.

About 30 percent of unvaccinated employees said they were more likely to get a shot with an incentive like a gift card or paid time off, multiple officials who previewed the announcement said.

The seven-day average of vaccinations has declined slightly in recent days, to 3.02 million a day as of Wednesday, from a high point of 3.38 million last week, according to a New York Times analysis of C.D.C. data.

While many big companies have researched vaccine mandates, and the Equal Employment Opportunity Commission has told employers that they can require vaccination to protect public health, most have found that to be counterproductive and have chosen to incentivize the vaccine instead.

But with Republicans arguing that mandates amount to an intrusion on personal liberty, the White House is steering clear of the discussion, saying the decision to require vaccination or proof of it will be left to individual employers. And with the economy gearing up, managers are reluctant to demand inoculation, fearing too many employees would seek work elsewhere.

State health officials, business leaders, policymakers and politicians are struggling to figure out how to tailor their messages, and their tactics, to persuade not only the vaccine hesitant but also the indifferent. The work will be labor intensive, and much of it may fall on private employers, but the risk is clear: If it takes too long to reach “herd immunity,” the point at which the spread of the virus slows, worrisome new variants could emerge that evade the vaccine.

Mihir Zaveri contributed reporting.

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New coronavirus cases around the world reached a new weekly record, according to the W.H.O.

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The accident happened in the western state of Maharashtra on Wednesday, after the leak in the hospital’s main oxygen tank cut off the flow of oxygen to dozens of critically ill patients.CreditCredit...Associated Press

More new coronavirus cases were reported around the world last week than in any seven-day period since the beginning of the pandemic, according to new data published on Tuesday by the World Health Organization.

Last week’s figure — 5.24 million new cases — broke the previous record set at the beginning of 2021, when 5.04 million new cases were reported in the week ended Jan. 4.

The latest surge is being driven largely by an outbreak in India, where the authorities reported nearly 300,000 new cases on Wednesday alone. The country’s health care system is showing signs of buckling under the country’s second major wave of coronavirus infections, and an accident this week at a Covid-19 hospital in India killed more than 20 people.

India accounts for almost one-third of all new cases worldwide, according to the W.H.O. data. New cases are rising in all regions tracked by the organization except Europe, where they declined by 3 percent last week.

The rate at which new coronavirus-related deaths are being reported is also accelerating, according to the W.H.O. More than 83,000 deaths were reported last week, compared with 76,000 the week before.

By the organization’s reckoning, the overall death toll for the pandemic surpassed 3 million last week. A spokeswoman for the W.H.O., Margaret Harris, noted that it took nine months for the world to reach 1 million pandemic deaths, then four months to pass 2 million, and now three months to reach 3 million.

The Los Angeles schools chief will leave in June, after leading through the pandemic.

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Austin Beutner, superintendent of the Los Angeles Unified School District, says he will depart in June after a three-year tenure.Credit...Patrick T. Fallon/Agence France-Presse — Getty Images

Austin Beutner, who took the helm of the Los Angeles public school system, the second-largest in the nation, during a leadership crisis and shepherded it through the coronavirus pandemic, says he will leave his post as superintendent at the end of June.

“This job is extraordinarily demanding, even in ordinary times,” Mr. Beutner, 61, said in an interview, adding, “It’s been a long three years.”

Los Angeles school trustees had asked him to extend the three-year contract he signed in 2018. But Mr. Beutner, a former financier who has served as a publisher of The Los Angeles Times and a deputy mayor, wrote in a letter to the board on Wednesday that he preferred to move on.

Across the country, pandemic-fatigued civic leaders are reassessing their service.

Nearly one-fifth of the mayors in Massachusetts have said they will not run for re-election. In San Francisco, where political controversies over school names consumed the school board while families clamored for a return to face-to-face classes, the superintendent decided to stay on only after the board agreed in writing not to adopt any new mandates unrelated to reopening, for the time being.

Mr. Beutner’s tenure in Los Angeles has been filled with crises.

A few months after he arrived, teachers who were seeking to curb the influence of charter schools announced their first strike in three decades. The strike was settled after six days. Then in 2020 came the pandemic, emptying classrooms of the roughly 650,000 students the district serves, most of them from low-income households.

Operating under emergency powers and leveraging his contacts in the philanthropic and private sectors, Mr. Beutner was both praised and criticized for his handling of the pandemic.

The district set up an extraordinary social-service net, providing more than 123 million meals to needy children and adults, more than 30 million masks and other items, as well as mass Covid-19 testing and vaccination.

But California was among the last states to resume in-person instruction, in part because Mr. Beutner had agreed with the district’s teachers to make reopening conditional on access to vaccination.

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A league of their own (or a section, anyway) for baseball fans who are fully vaccinated.

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Jackie Robinson Day at Dodger Stadium earlier this month.Credit...Kirby Lee/USA Today Sports, via Reuters

Fully vaccinated baseball fans will be granted their own section at the Los Angeles Dodgers game this weekend against the San Diego Padres.

The set-aside seats, reported by The Los Angeles Times, are part of the many incentives being offered — from doughnuts to beer — to encourage people to get vaccinated against Covid-19. The Miami Heat and the San Francisco Giants have introduced similar sections at their stadiums.

To prove they are fully vaccinated, fans will have to show government-issued I.D. and documentation like a vaccination card, according to the Dodgers’ website. Everyone 16 years and older will have to show proof that at least two weeks have passed since they were fully vaccinated. Fans younger than 16 will be required to show proof of a negative coronavirus test taken within 72 hours before admission.

Face masks will still be required, but social distancing will not. The team said spectators in the sections for the fully vaccinated will be seated directly next to each other.

The game Saturday won’t mark the first time fans have entered Dodger Stadium since the pandemic began. The team’s home opener on April 9 was attended by fans — just not all that many of them. Attendance was capped at around 11,000, about 20 percent of capacity.

In the past week, there has been an average of more than 2,300 daily coronavirus cases in the state, and Los Angeles County has seen an average of 435 daily cases — a 20 percent drop over the past two weeks, according to a New York Times database.

As of Wednesday, more than 40 percent of Californians had received at least one dose of the vaccine, and more than 20 percent had been fully vaccinated.

On April 15, Gov. Gavin Newsom loosened some restrictions in the state, permitting limited outdoor gatherings and live events, depending on a region’s Covid-19 risk level.

An unvaccinated worker set off an outbreak at a U.S. nursing home where most residents were immunized.

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A healthcare worker spoke with a resident and his visitors at a nursing home in Collins, Miss., this month. A new study on recent nursing home outbreaks reinforces the importance of vaccinating both residents and staff.Credit...Rogelio V. Solis/Associated Press

An unvaccinated health care worker set off a Covid-19 outbreak at a nursing home in Kentucky where the vast majority of residents had been vaccinated, leading to dozens of infections, including 22 cases among residents and employees who were already fully vaccinated, a new study reported Wednesday.

Most of those who were infected with the coronavirus despite being vaccinated did not develop symptoms or require hospitalization, but one vaccinated individual, who was a resident of the nursing home, died, according to the study released by the Centers for Disease Control and Prevention.

Altogether, 26 facility residents were infected, including 18 who had been vaccinated, and 20 health care personnel were infected, including four who had been vaccinated. Two unvaccinated residents also died.

The report underscores the importance of vaccinating both nursing home residents and health care workers who go in and out of the sites, the authors said. While 90 percent of the 83 residents at the Kentucky nursing home had been vaccinated, only half of the 116 employees had been vaccinated when the outbreak was identified in March of this year.

The study, released in tandem with one involving Chicago nursing homes, underscored the importance of maintaining measures like use of protective gear, infection control protocols and routine testing, no matter the level of vaccination rates. The rise of virus variants also has increased concerns.

Resistance to vaccines has been steep among nursing home staffs nationwide, and the low acceptance rates of vaccination increase the likelihood of outbreaks in facilities, according to the authors, a team of investigators from the C.D.C. and Kentucky’s public health department.

“To protect skilled nursing facility residents, it is imperative that health care providers, as well as skilled nursing facility residents, be vaccinated,” the authors of the Kentucky study wrote.

The outbreak involved a variant of the virus that has multiple mutations in the spike protein, of the kind that make the vaccines less effective. Vaccinated residents and health care workers at the Kentucky facility were less likely to be infected than those who had not been vaccinated, and they were far less likely to develop symptoms. The study estimated that the vaccine, identified as Pfizer-BioNTech, showed effectiveness of 66 percent for residents and 75.9 percent for employees, and were 86 percent to 87 percent effective at protecting against symptomatic disease.

In the Kentucky outbreak, the virus variant is not on the C.D.C.’s list of those considered variants of concern or interest. But, the study authors note, the variant does have several mutations of importance: D614G, which demonstrates evidence of increased transmissibility; E484K in the receptor-binding domain of the spike protein, which is also seen in B.1.351, the variant first recognized in South Africa, and P.1. of Brazil; and W152L, which might reduce effectiveness of neutralizing antibodies.

In Chicago, meanwhile, routine screening of nursing home residents and staff members identified 627 coronavirus infections in 78 skilled nursing facilities in the city in February, but only 22 were found in individuals who were already fully vaccinated. Two-thirds of the cases in the vaccinated individuals were asymptomatic, the report found, but two residents were hospitalized, and one died.

The authors of the Chicago study said their findings demonstrate that nursing homes should continue to follow recommended infection control practices, such as isolation and quarantine, use of personal protective equipment and doing routine testing, regardless of vaccination status.

They also emphasized the importance of “maintaining high vaccination coverage among residents and staff members” in order to “reduce opportunities for transmission within facilities and exposure among persons who might not have achieved protective immunity after vaccination.”

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Silence is golden, this year, at least, as British town criers compete for glory.

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Outside Windsor Castle, an unofficial town crier with a hand-lettered proclamation announced the birth of a baby boy to Prince Harry and Meghan Markle in 2019.Credit...Alastair Grant/Associated Press

LONDON — Long before newspapers and cable TV, Britain had the town crier, ringing a bell and calling “Oyez! Oyez! Oyez!” in the village square to spread the news — from plagues to wars to royal doings.

But a clear ringing voice, an important quality for the criers of old, will be of no use in this year’s British Town Crier Championships. Entrants will be judged instead on written proclamations of no more than 140 words, known as “cries.” Each cry must end with the words “God Save the Queen.”

“We can’t have a normal competition,” said the current champion, Paul Gough, town crier for the borough of Nuneaton and Bedworth, who is helping organize the event. Because coronavirus restrictions made proclaiming to crowds impossible, last year the competition was simply canceled. This year’s silent format, he said, will level the playing field for those without the strongest voices.

In years past, contestants from across the country congregated at the host municipality extolling the virtues of their own towns while wearing flamboyant 18th-century costumes. Those competing are normally judged on delivery — sustained volume, clarity, diction, accuracy — and on the content of the cry and their presentation.

But this year, silence is golden, and the written word reigns. Mr. Gough said the event raises money for Shout, a mental health help line that also depends on writing — it helps people through texting.

Competitors have taken to the new rules with good humor, and a bit of disappointment.

“What happens if I’m not chosen because they don’t like the way it reads?” said Michael Wood, a three-time national champion and the crier for East Riding of Yorkshire. “It’s a pity because I don’t have a chance to sell it,” using his voice and body movements.

Still, Mr. Wood said, this years rules preserve a major aspect of a winning entry: “Always, humor,” he said. “You would have to have a sense of humor to be stood up there in the first place in modern times in period costume.”

Town criers — from prophets to heralds — existed in biblical times and appeared in Greek mythology. The role was recognized in Britain as early as 1066 in the Bayeux Tapestry, which depicts events leading up to the Norman Conquest.

“We were the original newscasters,” said Mr. Gough. For many people who could not read and write, criers were the only way of knowing what was going on.

Mr. Wood said, “As long as there has been a rock to stand on or a pair of shoulders or a tree to climb, there’s always been somebody to shout an announcement in a village or town square.”

Another group, the Ancient and Honourable Guild of Town Criers, hosted a Zoom competition last June. Jane Smith, the group’s secretary and the town crier for Bognor Regis in England, said the spirit of the competition remains the oral delivery of proclamations, something she was sure would return when the pandemic ends.

“There’s going to be lots of people shouting and ringing bells and proclaiming that everything is coming to an end, and we’re able to go out and meet people again,” she said.

Antibody rates among Black and Hispanic New Yorkers are double those of others, new estimates show.

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At a coronavirus testing site in Harlem last year.Credit...Hiroko Masuike/The New York Times

New York City health officials estimate that nearly a quarter of adult New Yorkers were infected with the coronavirus during the catastrophic wave of last spring, and that the toll was even higher among Black and Hispanic residents.

The estimates, based on antibody test results for more than 45,000 city residents last year, suggest that Black and Hispanic New Yorkers were twice as likely as white New Yorkers to have had antibodies to the coronavirus — evidence of prior infection.

Hispanic New Yorkers had the highest rate, with about 35 percent testing positive for antibodies, according to the study, whose authors include officials and researchers at the city Health Department and the National Institute for Occupational Safety and Health. Among Black New Yorkers, 33.5 percent had antibodies. Among Asian New Yorkers, the rate was about 20 percent. For white New Yorkers, the rate was 16 percent.

Antibody surveys of segments of the population have become a useful way to gauge what percentage of people were infected and what groups were most at risk, especially since there was limited testing for the virus during the first wave.

The new paper, which has been accepted by the Journal of Infectious Diseases, has substantial limitations: Of the 45,000 New Yorkers in the study, fewer than 3,500 were Black, a major underrepresentation. And the participants were recruited partly through advertisements online, which the study’s authors acknowledge may have attracted people who believed they had been exposed to Covid-19.

But the study adds to experts’ understanding of the disproportionate toll that the pandemic has taken on Black and Latino people.

Its findings also come amid a push to vaccinate more people in the United States. A recent survey conducted by the Kaiser Family Foundation found that the number of Americans, particularly Black adults, who want to get vaccinated has continued to increase. According to an analysis last month by The New York Times, Black people were still being inoculated at half the rate of white people. The disparities are especially alarming as Black and Latino people and Native Americans have been dying at twice the rate of white people.

In New York City, about 44 percent of white adults have received at least one dose of a Covid-19 vaccine, while 26 percent of Black adults and 31 percent of Latino adults have, according to city data.

Experts and community leaders across the country say that over all, the lower vaccination rates are linked to technological and linguistic barriers and disparities in access to vaccination sites. Other factors include social media misinformation and a hesitancy to be vaccinated. Hesitancy among African-Americans, experts say, can be tied to a longstanding mistrust of medical institutions that have long mistreated Black people.

The recent data from New York “show how frontline workers bore the brunt of the first wave of the pandemic,” said Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia Mailman School of Public Health, who was not involved in the study. She noted that many jobs with higher levels of exposure — like grocery store employees, child-care providers and transit workers — have comparatively fewer white workers.

“These were the people who did not have the luxury of being able to work virtually,” she said.

Dr. Kitaw Demissie, who is dean of the School of Public Health at SUNY Downstate Medical Center in Brooklyn and was not involved in the study, noted that household crowding may have also contributed to differing infection rates. Some predominately Latino neighborhoods which were particularly hard hit in the first wave had high rates of household crowding.

More than 32,000 people in New York City have died from Covid-19 in total, according to a New York Times database.

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India’s health care system strains under a second surge of coronavirus infections.

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A patient used an oxygen cylinder in a hospital in the western state of Maharashtra on Wednesday. A leak in the hospital’s main oxygen supply caused the deaths of more than 20 people.Credit...Associated Press

India’s health care system shows signs of buckling under the strain of a second wave of coronavirus infections, as the authorities reported nearly 300,000 new cases on Wednesday and an accident at a Covid-19 hospital killed more than 20 people.

The accident happened at a hospital in the western state of Maharashtra after a leak in the hospital’s main oxygen tank stopped the flow of oxygen to dozens of critically ill people. Televised images showed family members wailing in the wards and nurses frantically pounding on the chests of some patients.

India is now home to the world’s fastest-growing Covid-19 crisis, reporting 294,000 new infections on Wednesday and more than 2,000 deaths. Criticism of the government is building, particularly as some large rallies and festivals in the country have been allowed to continue, while supplies of hospital beds, oxygen and vaccines run low amid an increasingly urgent health care crisis.

In some hospitals, officials even said they were just a few hours from running out of oxygen supplies. “Nobody imagined this would happen,” said Subhash Salunke, a medical adviser to the Maharashtra government.

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Climbers trying to scale Mount Everest test positive, and other news from around the world.

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The Everest Base Camp, northeast of the Nepali capital, Kathmandu, in 2018.Credit...Prakash Mathema/Agence France-Presse — Getty Images

Doctors have confirmed the first coronavirus cases among climbers trying to scale Mount Everest, a troubling sign for Nepal’s effort to reopen its lucrative high-altitude tourism industry.

Multiple climbers tested positive at CIWEC Hospital in Kathmandu, Nepal’s capital, after being flown there in recent days from Everest Base Camp, the hospital’s medical director said on Wednesday.

The medical director, Prativa Pandey, declined to offer additional information about the cases, saying only that officials at Everest Base Camp, the starting point for expeditions on the world’s tallest peak, were trying to ensure that groups of climbers were not mingling with one another.

“We are taking it up with the health ministry to see what we can do for the safety of climbers and staff up there,” Dr. Pandey said.

Nepal has reopened Everest and seven other peaks of 26,200 feet and above to small numbers of mountaineers in the hopes of restarting its tourism sector. It suspended all commercial climbing expeditions last year — a risky move for the small, tourism-dependent Himalayan country, which has been battling a resurgence of the coronavirus along with the rest of South Asia.

The government has issued 371 climbing permits to Everest hopefuls, and tourism officials say the number could increase. Journeys to the summit, 5.5 miles above sea level, begin at Everest Base Camp, where climbers stay for roughly two months to acclimate to the altitude.

To guard against an outbreak, Nepal’s government established a temporary high-altitude health care unit at the base camp, at an elevation of 17,600 feet, and expedition operators regularly test climbers for the coronavirus. Officials have mandated masks and social distancing, and said that climbers who were suspected of being infected would be flown out for testing.

A government doctor at the base camp said that three foreign climbers from his clinic were flown to Kathmandu this month after complaining of Covid-like symptoms. At least one, he later learned, tested positive. The doctor said that other climbers had developed similar symptoms and were also flown to Kathmandu for testing. He had no information on their cases.

Mingma Sherpa, the chairman of Seven Summit Treks, Nepal’s largest expedition operator, said that attempts to scale Everest would continue even if some climbers were infected with the virus.

“Expeditions won’t be canceled,” he said. “There’s no point of returning or giving up climbing after reaching base camp.”

In other news from around the world:

  • Prime Minister Kyriakos Mitsotakis of Greece said on Wednesday that cafes and restaurants in the country, shuttered for six months, could reopen for outdoor service on May 3, and that the country’s tourism industry would reopen on May 15. Primary and secondary schools will resume in-person instruction on May 10, he said, and church services will be allowed with limits on Orthodox Easter, May 2 — but domestic travel will remain restricted for the holiday, to minimize the chance that urbanites visiting rural relatives would seed outbreaks in ill-equipped places. Mr. Mitsotakis’ government has come under fire for opening up the country to foreign tourists while keeping restrictions in place for Greeks.

  • The outbreak in India has prompted neighboring Sri Lanka to postpone plans for a two-way air travel bubble, The Hindu newspaper reported. Less than two weeks ago, India’s government said it had finalized an agreement with Sri Lanka, a small island nation whose economy is heavily dependent on tourism, to allow special commercial flights between the two countries. Indian tourists accounted for nearly one-fifth of Sri Lanka’s foreign visitors in January 2020. Infections in Sri Lanka, which reported 367 new cases on Wednesday, have declined sharply since mid-February, but officials warned this week that a new variant was spreading in the country for the first time.

  • France said on Wednesday that travelers arriving from India would be subjected to a mandatory 10-day quarantine, adding to a growing list of countries that the French authorities have restricted travel from to prevent the arrival of worrisome virus variants. Gabriel Attal, a spokesman for the French government, also said that the country expected to lift domestic travel restrictions on May 3 and to authorize outdoor cafe and restaurant seating that month. He said that there were encouraging signs that the current lockdown was yielding results but that pressure on hospitals remained “extremely high.”

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As Maine pushes ahead with vaccines, an old mill town sees a surge of cases.

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Lynn Cummings receiving a first dose of Moderna’s Covid-19 vaccine at a new inoculation clinic in Auburn, Maine, last month.Credit...Robert F. Bukaty/Associated Press

Maine marked a milestone this week: It has now vaccinated at least half of its residents against the coronavirus with at least one shot, one of the first states in the nation to do so. But an old mill and college town in central Maine is reporting a fast rise in cases, dampening the celebration and raising fresh concerns about the virus’s staying power.

Daily confirmed cases in the Lewiston-Auburn metro area, home of Bates College and a vibrant immigrant community, are rising at a faster rate per person than in any other U.S. community with more than 50,000 people, according to a New York Times database.

“The virus has a mind of its own,” said Dale Doughty, deputy city administrator in Lewiston, who has helped coordinate the local coronavirus response. He said that local officials had been working to stop the spread, including with vaccine clinics, but that the pause of the Johnson & Johnson shot had been a setback.

The spike is part of a broader trend in the Northeast, where cases have been rising faster than in other U.S. regions. Delaware, Maine, Pennsylvania and Rhode Island have had among the highest case loads per 100,000 people over the past week. Michigan, which has outbreaks across its metro regions, remains at the top of the list.

Maine has administered more than 1.1 million vaccine doses, and 34 percent of its population is now fully immunized, according to Times data as of Tuesday. All Maine residents age 16 and up have been eligible since April 7.

Nirav Shah, the director of the Maine Center of Disease Control and Prevention, said on Tuesday that he suspected that virus variants, some highly contagious, had been driving the surge.

A spike in cases at Bates College prompted lockdowns that kept students in their rooms nearly around the clock for 12 days. Last week, the college lifted an “in-room” restriction and resumed in-person classes. The college said the outbreak had begun with social gatherings on a weekend in late March.

“The events we have all endured should serve as a powerful reminder that poor choices by a small group of people can have a powerful negative impact on the campus as a whole,” Joshua McIntosh, the vice president for campus life, wrote in a letter announcing the end of the restrictions.

William Wallace, a lecturer at the college who co-chairs a local board that advises Lewiston’s City Council on health matters, said the community had been fairly compliant with masking and social-distancing measures, and that the state had been diligent about testing, which could be uncovering more cases.

“But I think some people are just tired of all these guidelines and let down their guard,” he said. “Now that the weather has come around, people are gathering again. That’s part of it.”

With a slow start to vaccinations, Iraq surpasses 1 million virus cases.

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People waited to receive doses of the Pfizer-BioNTech vaccine at a vaccination site in Baghdad last week.Credit...Ahmad Al-Rubaye/Agence France-Presse — Getty Images

Iraq surpassed one million total coronavirus cases on Wednesday and set a daily record with 8,696 new cases, as government officials urged wary Iraqis to get vaccinated.

Public health officials believe that coronavirus infections in Iraq are significantly underreported, because many people who contract the virus do not seek treatment in the country’s overstretched health care system.

The health ministry reported 38 additional Covid 19-related deaths on Wednesday. More than 15,000 deaths have been recorded since the start of the pandemic.

Iraq did not get its vaccination program started until the end of March. So far it has received about 650,000 doses of various vaccines through Covax, an international initiative to help low- and middle-income countries obtain vaccines, and through a donation from China.

About 275,000 Iraqis — less than one percent of the country’s population of 40 million — have been vaccinated to date.

The health ministry issued a statement Wednesday emphasizing that vaccinations were voluntary and denying that it was forcing citizens to be vaccinated. It called for people who work in restaurants, shopping malls and hospitals to get vaccinated.

Iraq is regarded as one of the most corrupt countries in the world, and its health care system, ravaged by years of conflict and, before 2003, more than a decade of devastating American-led international sanctions, has not been spared. Despite the country’s oil wealth, most hospitals in Baghdad, the capital, rely on patients’ relatives to procure medicine and oxygen the patients need.

Public health officials who administer even the routine vaccination programs for childhood diseases frequently encounter resistance from parents who don’t trust the health ministry.

The government spokesman and culture minister, Hassan Nazim, urged on Tuesday that all Iraqis get vaccinated. He said the government was directing the security and education ministries to encourage the nation’s teachers and security forces to take the vaccines.

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