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Covid Updates: F.D.A. Authorizes Moderna and J.&J. Boosters and Mix-and-Match Strategy




ImageFilling out a coronavirus vaccination card in Jackson, Ala., earlier this month.
Credit…Charity Rachelle for The New York Times

WASHINGTON — The Food and Drug Administration on Wednesday authorized booster shots for tens of millions of recipients of Moderna’s two-dose coronavirus vaccine and the roughly 15 million who got Johnson & Johnson’s single-dose shot, significantly expanding the nation’s campaign to bolster protection for vulnerable people.

The agency also updated its authorizations for all three vaccines — Moderna, Johnson & Johnson and Pfizer-BioNTech — to allow medical providers to boost people with a different Covid-19 vaccine than the one they initially received, a strategy known as “mix and match.”

That update may dampen interest in Johnson & Johnson’s vaccine, which studies have found provides less protection than the other two. Providers will have the option of offering a Moderna or Pfizer-BioNTech booster, which could trigger a more substantial jump in protective antibodies.

The regulators, who already authorized boosters for high-risk Pfizer-BioNTech recipients last month, did not recommend any one vaccine over another as a booster. They also remained silent on whether it would be preferable to stick with the same vaccine when possible.

The latest authorizations arrived in the middle of a busy stretch of regulatory decisions on vaccines. The F.D.A. is expected in the coming weeks to decide on whether Pfizer and BioNTech’s vaccine should be authorized for children ages 5 to 11. The agency’s independent vaccine committee is set to vote Tuesday to consider the matter and make a recommendation.

Regulators may also decide as early as November whether to authorize boosters for younger Americans who are not at high risk. While many vaccine experts have questioned whether younger, healthy people need booster shots, some advisory committee members last week urged the agency to move to expand eligibility.

The F.D.A.’s move to make a much larger swath of Americans eligible for additional shots on Wednesday followed unanimous votes last week from a key advisory committee to recommend the authorizations. A separate committee advising the Centers for Disease Control and Prevention is scheduled to vote Thursday on its own recommendations for Moderna and Johnson & Johnson boosters.

The C.D.C. director typically endorses that panel’s recommendations as a final step before vaccines are put into use. If the agency agrees with the F.D.A.’s decision, booster shots could be offered as soon as this weekend.

Eligible Moderna recipients could get a half-dose booster of that vaccine at least six months after their second dose. Like Pfizer recipients, the eligible would include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Johnson & Johnson recipients — all of whom are 18 and older — will be eligible for a second shot at least two months after the first.

Credit…Jeremie Souteyrat for The New York Times

Despite high and rising coronavirus case numbers, the British government on Wednesday rejected calls for the immediate reintroduction of some restrictions in England, while warning that they might be needed if the rollout of vaccine booster shots failed to contain the worsening situation.

Speaking at a news conference, the health secretary, Sajid Javid, said that a contingency plan for tighter rules would not be carried out “at this point” but added that he would be “staying vigilant” and warned that new cases could surge to 100,000 a day.

“We will do what it takes to make sure that this pressure does not become unsustainable, and we won’t allow the N.H.S. to become overwhelmed,” Mr. Javid said, referring to Britain’s National Health Service, which is already under pressure. “We are concerned. Everyone is right to be concerned,” he added.

Mr. Javid warned that if the situation deteriorates, he could be forced to activate a contingency plan that would reimpose some restrictions that were scrapped in England in July. Under this plan, mask-wearing rules could return, people could be urged to work from home, and those visiting nightclubs and other venues could be required to show proof of their vaccination status or of a recent negative test. If necessary, he added, “we won’t hesitate to act.”

Still hoping to avoid that step, Mr. Javid urged people to meet outdoors where possible and to wear a face covering in confined spaces. He also appealed directly to people to get boosters adding: “If you are invited for a vaccine, please take it up.”

Earlier, Kwasi Kwarteng, the business secretary, told the BBC in a televised interview that an increase in booster shots was what was “going to give us more protection,” adding that he did not want “to reverse back to a situation where we have lockdowns.”

The government argues that hospital admissions have remained low because of high rates of vaccination. But vaccines are waning in effectiveness at preventing infection, and Britain, which rolled out vaccines early, is now reporting one of the highest rates of new cases in the world. Vaccines still offer robust protection against hospitalizations and deaths.

There have been over 40,000 new cases for seven consecutive days — reaching 49,139 on Wednesday — and 869 patients were admitted to hospitals on Oct. 16. While the death toll is still low compared with last winter’s level, the daily death toll rose to 223 on Tuesday, the highest number since March, before falling back to 179 on Wednesday.

Analysts believe cases in Britain are rising because large numbers of children are unvaccinated and schools do not require face coverings. Among adults, mask wearing is less prevalent than in some other parts of Europe, where they are often required indoors and where cases per capita are much lower.

Health professionals have recommended the reintroduction of some of the measures — such as mandatory mask wearing in some locations — that were swept away in July, when England lifted almost all of its legal restrictions on what the tabloid media called “freedom day.”

The National Health Service Confederation, which represents organizations that provide health services, asked the government on Monday to immediately introduce mandatory face coverings in crowded and enclosed spaces.

“Without pre-emptive action, we risk stumbling into a winter crisis,” said Matthew Taylor, the confederation’s chief executive.

In recent months, Prime Minister Boris Johnson’s strategy has been to focus on rolling out boosters to the most vulnerable people and to vaccinate children ages 12 to 15. But critics say that plan has faltered.

The government has said that it is monitoring the rise in cases and that the current rates are not yet sufficient to justify a switch in strategy to help contain the spread of the virus in England. The government’s main concern has been preventing Britain’s stretched health service from being overwhelmed, and so far, vaccinations have kept the level of hospitalizations manageable, officials have said.

In September, the government in England put on hold proposals to require those entering nightclubs and attending large events like soccer games to show proof of vaccination or of a recent negative test. Scotland and Wales, however, are requiring it.

Credit…Jeenah Moon for The New York Times

New York City took one of its most aggressive steps yet to increase vaccination rates in a city that was once the epicenter of the pandemic, requiring almost every member of the nation’s largest municipal work force to get vaccinated by the end of the month or lose their paychecks.

The new mandate by Mayor Bill de Blasio, following similar requirements for teachers and health care workers that led to a surge in vaccinations, is intended to persuade thousands of city workers who have resisted getting the shot to do so before the winter.

At least 46,000 police officers, firefighters and other city workers have not yet received the vaccine, and the mandate could lead to staffing shortages at a time when the city is still recovering from the pandemic, when shootings rose.

“We need to save lives, and we do it with vaccinations,” Mr. de Blasio, a Democrat with less than three months left in office, said at a news conference. “My goal is to end the Covid era once and for all. It can be done, but only if we keep pressing on.”

New York is one of the first major American cities to require vaccination for its entire municipal work force without a testing option. San Francisco set a similar vaccine mandate for its 35,000 city workers, which goes into effect Nov. 1, and Los Angeles and Chicago have been pushing public workers to get vaccinated. Among the states, Washington and Massachusetts are requiring state employees to be fully vaccinated.

Starting on Nov. 1, New York City workers must have received at least one dose of a coronavirus vaccine and can no longer submit to regular testing as an alternative. The mandate applies to roughly 160,000 city employees. The city has more than 300,000 workers, but nearly half were already required to be vaccinated.

Those who get their first doses at city-run vaccination sites between now and Oct. 29 will receive an extra $500 in their paychecks.

Credit…Benjamin Norman for The New York Times

The announcement on Wednesday that New York City’s municipal employees would be required to get vaccinated against the coronavirus was met with a variety of reactions from the unions that represent those workers, from grudging acceptance to pledges to fight it.

But there is one thing most of the unions agree on: that the mandate could lead some employees to quit or move up their retirement dates, which could put a strain on some city agencies. Virtually all city workers are required to have gotten at least one dose by Nov. 1.

The mandate affects roughly 160,000 employees, who were already required to either show proof of vaccination or submit to weekly testing. The rule announced by Mayor Bill de Blasio on Wednesday removes the testing option.

Harry Nespoli, the president of the Uniformed Sanitationmen’s Association, which represents sanitation workers, said the weekly testing requirement had been working well, and that he believed there was no reason to do away with it.

“I don’t understand why now all of the sudden the city wants to mandate these people,” he said. He said that sanitation workers were unlikely to pass on the virus to members of the public while picking up garbage or clearing streets of snow.

“We don’t come in contact with the public, we don’t hug the public,” said Mr. Nespoli, who is vaccinated and contracted Covid-19 early in the pandemic. “We start at 5 o’clock in the morning. No one’s there, and we do what we have to do and we come in.”

Mr. Nespoli said he believed that the sudden imposition of a mandate was disrespectful. He noted that his members had turned up for work throughout the pandemic, while many other New Yorkers had been able to work from home. “Now you’re going to turn around and say ‘Get the shot or lose your job.’ That’s not right. That’s totally wrong.”

The union representing rank-and-file police officers in New York City, the Police Benevolent Association, pledged to fight the mandate. “Now that the city has moved to unilaterally impose a mandate, we will proceed with legal action to protect our members’ rights,” the union’s president, Patrick J. Lynch, said in a statement.

But others were less enthusiastic about a legal fight.

Gregory Floyd, president of Teamsters Local 237, which represents more than 18,000 municipal workers in New York City, said that he believed Mr. de Blasio had the authority to impose a vaccine mandate and that challenging it with a lawsuit would be fruitless.

“I understand why he’s doing it,” he said. “I can’t say it’s wrong, because we have a pandemic.”

Mr. Floyd’s union represents about 7,400 employees of the New York City Housing Authority, which manages the city’s public housing, and has one of the lowest employee vaccination rates of any municipal agency, at 59 percent.

Mr. Floyd said he anticipated that many unvaccinated employees would get the shot in the days ahead, noting that the $500 incentive the city is offering to those who get their shots at city-run sites would help. “I think with the $500, and needing employment, they will have a conversation with their physician and get vaccinated.”

Still, he predicted that some of Nycha’s workforce “will probably walk away from the job.” He said that rampant misinformation about the vaccine had left many of his members fearful. “They don’t know what the vaccine is going to do to them — they’re afraid of it,” he said.

Other union leaders also thought the mandate would lead some workers to retire early or find other jobs. Mr. Nespoli said he feared the mandate could leave the Department of Sanitation short-staffed when the first snowstorm hit this winter.

The mandate applies to workers at dozens of city agencies, about 46,000 of whom have not received a vaccine dose yet, city officials said. It requires most unvaccinated city workers to have gotten a first dose by Nov. 1.

Henry Garrido, executive director of the city’s largest public union, District Council 37, urged City Hall to slow down. “The proposed mandate must be collectively bargained and we expect City Hall to slow down and sit down with us,” he said in a statement.

Eric Adams, the Democratic mayoral nominee, said he supported the mandate, but that more work was necessary to get the unions on board.

“It is essential we get all of our public employees vaccinated — especially those who interact directly with the public — and I support a mandate,” Mr. Adams said on Wednesday. “But we must also work with our unions to make sure there is buy-in from our workers to ensure compliance.”

Credit…Joedson Alves/EPA, via Shutterstock

Hours before a congressional panel was to announce on national television its recommendation that President Jair Bolsonaro be charged with homicide and genocide for his mishandling of the pandemic, a few senators had second thoughts.

Even though they believed Mr. Bolsonaro was effectively responsible for hundreds of thousands of the 600,000 Covid deaths in Brazil, these senators feared that position might not hold up legally, four panel members said.

Suddenly the highly anticipated report — which still recommended other serious criminal charges against Mr. Bolsonaro — had lost the support of the majority of the panel’s 11 voting members.

The panel, which had riveted the country with its six-month investigation, had a late-night meeting at one senator’s apartment, where, over duck and rice, they debated whether pursuing the more severe charges could jeopardize the prospects of Mr. Bolsonaro’s facing legal consequences.

The report’s author, Senator Renan Calheiros, eventually realized that he would have to walk back the charges to ensure the report would pass the committee and get to the attorney general, who could prosecute of the president. In the end, the main charge against Mr. Bolsonaro was “crimes against humanity.”

The last-minute shift reflects the polarized and complicated political landscape under Mr. Bolsonaro, whose popularity has plummeted since he took office in 2019 but who still retains enormous power.




White House Officials Lay Out Plans to Vaccinate Young Children

Health officials anticipate that regulators will make Covid-19 vaccines available for 5- to 11-year-olds in the coming weeks. The campaign to vaccinate kids will rely on doctors, clinics and pharmacies.

We have secured vaccine supply to vaccinate every child ages 5 through 11, and as soon as the vaccine is authorized by the F.D.A., we will begin shipping millions of doses nationwide. States, tribes and territories are working to ensure that doses continue to be distributed efficiently and equitably across their jurisdictions. And importantly, we worked with Pfizer to modify the packaging of the pediatric doses to make it easier for pediatricians, family doctors and other providers to provide vaccines to children. We are going to be ready pending the F.D.A. and C.D.C. decision, that’ll be based on science, but we want to make sure the operations are ready to accommodate kids. As as we talked about, the needs of kids are different than adults. And at the same time, we need to make sure we have the supply at pharmacies at children’s hospitals, pediatricians offices, family offices, family doctors’ offices, rural clinics, community clinics.

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Health officials anticipate that regulators will make Covid-19 vaccines available for 5- to 11-year-olds in the coming weeks. The campaign to vaccinate kids will rely on doctors, clinics and pharmacies.CreditCredit…Shawn Rocco/Duke Health/Via Reuters

The campaign to vaccinate young children in the United States against the coronavirus will not look like it did for adults. There will be no mass inoculation sites. Pediatricians will be enlisted to help work with parents. Even the vials — and the needles to administer doses — will be smaller.

Biden administration officials, anticipating that regulators will make the vaccines available to 5- to 11-year-olds in the coming weeks, laid out plans on Wednesday to ensure that some 25,000 pediatric or primary care offices, thousands of pharmacies, and hundreds of school and rural health clinics will be ready to administer shots if the vaccine receives federal authorization.

The campaign aims to fulfill the unique needs of 28 million people in the United States, largely still in elementary school, while absorbing the lessons from the rollout of vaccines to other age groups. The 5-to-11 range has far more members than the teenage cohort already approved to receive the vaccine.

“Kids have different needs than adults, and our operational planning is geared to meet those specific needs, including by offering vaccinations in settings that parents and kids are familiar with and trust,” President Biden’s coronavirus response coordinator, Jeffrey D. Zients, told reporters. “So we are going to be ready, pending the F.D.A. and C.D.C. decision that will be based on science.”

The White House announcement came as regulators greatly expanded the number of Americans eligible for booster shots. The Food and Drug Administration authorized boosters on Wednesday for tens of millions of recipients of Moderna’s two-dose coronavirus vaccine and the roughly 15 million who got Johnson & Johnson’s single-dose shot. The agency also updated its authorizations for all three types — Moderna, Johnson & Johnson and Pfizer-BioNTech — to allow medical providers to give people a different vaccine as a booster shot, a strategy known as “mix and match.”

Still, with the school year well underway and the holiday travel season approaching, much of the country has been waiting to see when younger children can receive their first dose.

This month, Pfizer and BioNTech asked the F.D.A. to authorize emergency use of their vaccine for 5- to 11-year-olds. A meeting to discuss the authorization is set for Tuesday, and an F.D.A. ruling could come in the days after, possibly clearing a path for the Centers for Disease Control and Prevention to make recommendations on a pediatric dose in early November.

Regulators have delayed a decision to authorize Moderna’s vaccine for adolescents over concerns about cases of rare heart problems. Both Pfizer-BioNTech and Moderna have expanded the scope of their trials for children ages 5 to 11 as a precautionary measure to detect any rare side effects.

In laying out a plan for distribution before regulators have given their sign-off, the White House is exposing itself to criticism that it is acting before the scientists. Administration officials say they want to make sure that any barriers to access are removed if children are approved to receive the vaccine. Sonya Bernstein, a senior policy adviser for the White House Covid-19 Response Team, stressed that the process was independent of the administration’s plans.

“We know that access is going to be critical here,” Ms. Bernstein said, adding that the administration had in recent weeks explored ways to provide a “kid-friendly experience that makes sure that we’re getting shots in arms with trusted providers in ways that makes parents feel comfortable.”

Other experts said on Wednesday that it made sense for officials to plan ahead.

Credit…Photo by Mikhail Svetlov/Getty Images

With the death toll from the coronavirus continuing to soar, President Vladimir V. Putin of Russia announced new restrictions on Wednesday, declaring that a seven-day period starting Oct. 30 would be a non-working week in the country.

The measure is intended to combat the rapid spread of the virus in Russia, where known deaths from Covid-19 have recently climbed above 1,000 a day.

The Kremlin has hesitated to impose unpopular restrictions because of economic fears and widespread public nonchalance about the pandemic.

The “non-working week” is a new and vaguely defined concept created after the onset of the pandemic. It is not a full lockdown; instead, nonessential workers are encouraged to stay home, while their employers are encouraged to pay them at least the minimum wage to do so.

The chosen week appears to be a compromise: four of the days are already public holidays in Russia.

The last time the Kremlin announced a similar non-working week was in May, a time when there were also several public holidays.

Deputy Prime Minister Tatiana Golikova, who first proposed the measure, said she hoped some regions would introduce the non-working week earlier, starting Oct. 23.

Mr. Putin said it was possible the week would grow. “If necessary, non-working days could be extended beyond Nov. 7,” he told his cabinet in broadcast remarks.

“We only have two ways to get through this — get sick or get vaccinated,” he said in a news conference. “But it’s better to get vaccinated. Why wait for an illness or its serious consequences?”

Ms. Golikova proposed restricting access to certain institutions, including workplaces, to vaccinated, tested or recently recovered people. Moscow introduced and then withdrew a similar measure over the summer.

Mr. Putin said that workers should be paid even if they don’t work, but did not stipulate who would foot the bill. Details about implementing the decree, including who would be considered an essential worker, will be left to regional leaders.

Russian-made coronavirus vaccines, including Sputnik V and the one-dose Sputnik Light, are widely available country, but only 45 million of the country’s 146 million people have been fully vaccinated. Scholars attribute the hesitancy to low levels of trust in the authorities, who have sent conflicting messages about the pandemic since it began last year.

Sputnik V has not been approved by the World Health Organization or the European Medicines Agency, the European Union regulator.

Russian authorities have been critical of Western-made vaccines, which are not available in Russia, while promoting Sputnik. Analysts say that has also contributed to confusion and mistrust.

There is also widespread skepticism about the state’s pandemic statistics, with allegations that officials are underreporting cases and deaths.

Mayor Sergei Sobyanin of Moscow announced on Monday that people who rode the subway without wearing masks would be fined. On Tuesday, he asked Muscovites over 60, who make up 60 percent of all Covid patients in hospitals, to get vaccinated or stay at home.

On Oct. 13, Mr. Sobyanin announced he would pay the equivalent of $140 to older residents as an incentive to get the vaccine. Only one-third of people in Moscow over 65 have been vaccinated, lower than the city’s average.

Andrei Makarov, chair of the lower house of parliament’s budget committee, said Tuesday that 1,100 doctors in Russia had died from Covid during the first six months of this year, more than twice the number who died in all of 2020. Officials estimate that more than 225,300 have people died since the beginning of the pandemic, though independent experts say the government has drastically underestimated the death toll.

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Bucking the trend in much of the Americas, several Caribbean countries are reporting significant surges in known coronavirus infections, World Health Organization officials warned on Wednesday.

Reports of new cases are up 40 percent over the last week in the Dominican Republic and Barbados, said Dr. Carissa F. Etienne, the director of the Pan American Health Organization, a division of the W.H.O.

“In fact,” Dr. Etienne said at a news conference, “half of Barbados’s cumulative Covid infections since the pandemic began have been reported in the last month.”

Cases are also rising in Trinidad and Tobago and some smaller island nations and territories in the region, including St. Martin, St. Kitts and Nevis, Anguilla and the Cayman Islands.

Many Caribbean countries have had difficulty moving quickly with vaccination efforts, both because of difficulty obtaining doses and because of widespread public hesitancy.

“It really troubles me that some of my Caribbean brothers and sisters have been slow to accept the Covid-19 vaccines that have been made available to them,” said Dr. Etienne, who is from Dominica.

Across Latin America and the Caribbean, 41 percent of the population has been fully vaccinated against Covid-19, according to the Pan American Health Organization.

New case reports are declining across North America, and infections and deaths are declining in most of Central America. The picture is also improving in South America, with the exception of Bolivia and Venezuela, the organization said.

Dr. Etienne said it was important for countries in the region to build up testing even as reports of new cases ebbed, so that any fresh outbreaks could be caught before they developed into widespread surges. “More and more, we’re seeing how local hot spots are driving national trends,” she said.

A good approach, she said, would be to integrate surveillance for Covid-19 with monitoring of other respiratory viruses. She said her organization was working with the Centers for Disease Control and Prevention in the United States to develop a new protocol for P.C.R. testing that would screen the same samples for both Covid-19 and influenza.

Strong surveillance networks, she said, could also help detect emerging pathogens before they spread, and serve “as the region’s backbone for pandemic preparedness.”

Credit…Khaled Elfiqi/EPA, via Shutterstock

The Egyptian authorities, anticipating the delivery of tens of millions of doses of Covid-19 vaccines, have issued a sweeping vaccine mandate that encompasses a broad swath of society, including teachers, other government employees, university students and people seeking any government services.

Egypt is the Arab world’s most populous country, with more than 100 million citizens. Its decision to ramp up its vaccination campaign with a mandate follows the model set by wealthier neighbors like Saudi Arabia and the United Arab Emirates, which are far ahead of Egypt in vaccinating their smaller populations.

A spokesman for the Egyptian cabinet, Nader Saad, said on Sunday in a television appearance that beginning on Nov. 15, civil servants will not be allowed into their workplaces unless they can show that they have received at least one vaccine dose, or can provide proof of a negative PCR test each week.

The tests are taken at the worker’s expense and cost $58 each, a daunting amount for someone earning government wages. Employees who do not comply will face disciplinary action, he said.

Mr. Saad said that beginning Nov. 1, public university students will not be allowed on campus without proof of at least one vaccine dose, and that students will not have a testing alternative.

According to the government, slightly more than half of the country’s three million university students and staff members have been vaccinated so far. Of Egypt’s five million government employees and schoolteachers, Mr. Saad said, about 600,000 had yet to receive a dose of vaccine.

By Dec. 1, the proof-of-vaccination requirement will also extend to anyone seeking to enter a government building to access government services.

So far, only 6.3 percent of Egypt’s population is fully vaccinated, and another 6.7 percent have had a first dose, according to the Our World in Data project at Oxford University.

Delays in delivery of vaccination doses through the global Covax program earlier this year stalled the government’s plan to inoculate 40 percent of the population by Dec. 31. In the spring and summer, many people complained of waiting months to receive a response to their applications for vaccine appointments.

But as Egypt began receiving more vaccine doses in recent weeks, the government stepped up its efforts to encourage the public to get the shots, with television ads and bus convoys that offer T-shirts, mugs and flash drives to people who register for the vaccine on the spot. The government also held vaccination drives for civil servants and university students.

Still, some Egyptians remain reluctant, and efforts to raise awareness of the vaccines have lagged.

Egypt’s underfunded health system has been hit hard by the pandemic, which is now in a fourth wave in the country. Hundreds of doctors and medical staff members have lost their lives to Covid, and hospitals struggled at the peak of each wave to accommodate patients. The most recent wave began in late July, as the Delta variant was detected and infections and deaths began rising steadily.

Egyptian officials say they expect to have received 70 million doses by the end of the month. Figures from Our World in Data show that at least 20 million of the doses have been administered.

The government has also begun to produce a Chinese vaccine, Sinovac, domestically, aiming to achieve self-sufficiency and eventually export the vaccine to other African countries.

The country has reported more than 300,000 coronavirus cases and more than 18,000 deaths since the start of the pandemic, but experts say the true figures are most likely much higher. Some analysts have raised concerns that Egypt and other authoritarian governments may be deliberately undercounting cases and deaths; Egypt’s government rejects any such assertion.

Credit…Tamara Kenyon for The New York Times

When Jim Lewis was told earlier this month that his 90-year-old mother, who lives in a nursing home outside of Boise, Idaho, tested positive for the coronavirus, he wondered if she had gotten the virus from an unvaccinated employee.

And he had reason to worry. A little more than half of the workers in the home, Creekside Transitional Care and Rehabilitation, were not vaccinated at the time, federal data show.

“It was obvious that the facility had staff members who were vaccine hesitant,” said Mr. Lewis, whose mother and immediate family are all immunized.

Idaho was hard hit by the Delta surge this summer and early fall, and nursing homes were not impervious to the highly contagious variant that swept through many states with lower vaccination rates. Ten states, including Florida, Michigan and Ohio, still report vaccination rates for nursing home staff under 60 percent.

Others, like New York and California, and some large nursing home chains have imposed their own mandates. But many nursing home administrators are waiting for the federal government to issue new rules that will govern a mandatory vaccination program for all their staff members that President Biden first announced two months ago. And some facilities and labor groups are still pushing for a testing option in lieu of a shot.

But months of delays and vaccine resistance have had wrenching consequences for families like Mr. Lewis’s, who once again are barred from visiting because of outbreaks. Creekside did not return repeated calls and emails seeking comment.

After steep declines earlier this year, Covid cases and deaths in nursing homes climbed in August and September, resulting in about 4,000 deaths — even though nearly 90 percent of the nation’s nursing home residents were fully vaccinated. Residents are particularly vulnerable to breakthrough infections because so many are older and suffer from serious medical conditions, like the multiple myeloma the former secretary of state, Colin Powell, was being treated for when he died from complications of Covid on Monday.

Credit…Abedin Taherkenareh/EPA, via Shutterstock

Iran plans to abandon production of its Fakhravac Covid-19 vaccine for lack of demand, its defense ministry said on Tuesday. Iran’s five other domestic Covid vaccines could also be in jeopardy, as Iranians have shown they prefer imported vaccines.

The Iranian vaccines have been undermined by the health ministry’s decision to back away from initial promises to purchase large quantities of doses from domestic manufacturers.

“We are in the process of planning to end production, because who will we sell it to?” Ahmad Karimi, the director of the Fakhravac vaccine program, told Iranian news outlets on Tuesday. He said about a million doses had been stockpiled.

A day after the defense ministry announced its plans, the head of the country’s Food and Drug Agency promised to purchase three million doses of Fakhravac and another domestic vaccine. It was not clear whether that would affect the defense ministry’s decision about ending production.

The Fakhravac vaccine had received emergency use authorization in Iran but was still undergoing clinical trials to obtain full approval, and the defense ministry, which developed it, was having trouble finding enough participants for those trials.

Iran has been among the countries hardest hit by the pandemic. The official death toll so far is about 125,000, but health officials and independent experts say the true figure is several times higher. Chaotic planning, lack of transparency and official refusal to lock down cities and impose quarantines early in the pandemic led to major surges in infections, hospitalizations and deaths.

When vaccines became available, Iranian officials said they would give priority to domestically made shots, and health officials boasted that they would have the whole population inoculated by the end of the summer and be able to export surplus doses.

The country’s supreme leader, Ayatollah Ali Khamenei, banned American- and British-made coronavirus vaccines, claiming that they had been designed to harm Iranians — a decision that many critics say caused Iran to fall behind on vaccination and led to more illness and death from the virus. Iran has sped up imports in recent months, and the health minister said that about 120 million doses had been obtained from abroad.

About 59 percent of Iran’s 85 million people have received at least one dose of vaccine, and about 30 percent are fully vaccinated, according to official statistics; Iran is not yet giving booster shots on a wide scale.

The Fakhravac vaccine is named for Mohsen Fakhrizadeh, Iran’s top nuclear scientist, who was assassinated by Israel in November 2020. It was developed by the research branch of the defense ministry and given emergency use authorization in September, when a major surge in cases in Iran was beginning to ease.

Mr. Karimi boasted at the time that the defense ministry would soon produce 5 million doses of Fakhravac a day, but production has never come close to that level.

Mr. Karimi said on Tuesday that the health ministry had not delivered on promises to purchase large quantities of domestic vaccines, a complaint that other manufacturers have also raised.

“Unfortunately, due to the flood of imported vaccines, our policymakers are not paying attention to domestic vaccines,” said Abbas Ashtari, the head of biological products at the Razi Research Institute, which produces a vaccine called CovPars.

Credit…Merck’s antiviral pill.

The first easy-to-use Covid-19 treatment could be available in the United States by the end of this year, but it is unlikely to reach developing countries, where hundreds of millions of people remain without access to vaccines, until at least the middle of 2022, according to public health officials.

The Bill and Melinda Gates Foundation announced on Wednesday that it would attempt to expedite the timetable for getting the drug, the antiviral molnupiravir, to low-income countries. It pledged an initial investment of up to $120 million to prompt eight generic drugmakers that have signed licensing agreements with the drug’s developer Merck to start producing the medicine now, a sort of insurance policy gambling that it will be approved by regulatory bodies.

Molnupiravir was developed in record speed by Merck and Ridgeback Biotherapeutics, who have submitted an application to the Food and Drug Administration for emergency use authorization. Merck is already manufacturing the drug in anticipation of that approval, which could come in December.

The U.S. government has a pre-purchase contract for 1.7 billion courses of the medication, a simple pill that in a large clinical trial halved the risk of hospitalizations and death from the coronavirus among high-risk people who took it in the first days of infection. Other well-off countries are rushing to negotiate their own deals — on Wednesday the United Kingdom announced an agreement to buy 480,000 courses, pending approval.

In addition to licensing the eight Indian manufacturing companies to produce generic versions of molnupiravir, Merck is in discussions with the Medicines Patent Pool, a nonprofit backed by the United Nations, raising hopes the simple treatment could be widely accessible in nations where large numbers of unvaccinated people will continue to die of coronavirus infections.

But drug production experts say there are critical challenges, such as the supply of raw materials, regulatory approval and financial investment, that will mean the drug will be available in Omaha long before it is in Zimbabwe.

Credit…Andy Wong/Associated Press

The Olympic torch arrived in Beijing on Wednesday, beginning a countdown to a Winter Games being held under the shadow of the coronavirus pandemic and calls for a boycott over China’s rights abuses in Hong Kong, Tibet and Xinjiang.

The arrival ceremony, like the official lighting of the Olympic flame in Athens on Monday, unfolded without spectators, one of many concessions to Covid-19 that will severely restrict access to the games, which begin on Feb. 4.

China, with the “full support” of the International Olympic Committee, is planning to hold the Games with even greater health protocols than those in place during the Summer Olympics in Tokyo this year.

Only vaccinated and screened residents of China will be able to attend as spectators, while athletes, broadcasters, journalists and others working at the Olympic sites will be confined to one of three bubblelike environments for their entire visit. Those not vaccinated face 21-day quarantines upon arrival.

Wednesday’s ceremonies set the tone for a subdued Games. Only a small delegation at Beijing’s airport greeted the flight that brought the canister carrying the flame. The ceremonial lighting of the flame took place indoors at Beijing’s Olympic Park. International journalists were given less than 12 hours’ notice of the event — and those invited could only attend after a Covid test.

The contrast to 2008, when China first hosted the Olympics, was striking.

The ceremony then took place in Tiananmen Square in front of thousands of spectators, though under intense security because of political unrest in Tibet.

Hu Jintao, China’s leader at the time, presided. The current leader, Xi Jinping, who was already a rising political force, said that China holding the Games was the realization of a century-old dream.

China has taken a zero-tolerance approach to the virus since it controlled the spread last year, keeping its borders largely sealed and squashing periodic flare-ups by locking down entire cities and neighborhoods.

The health measures have also given the country’s authorities tools to maintain even stricter control over potential political protests.

Calls for an official boycott — or even stripping Beijing of its role as host — have gained little traction. Protesters still hope to use the international spotlight to draw attention to China’s authoritarian policies, especially against Tibetans and Uyghurs in Xinjiang, where China has carried out a campaign of mass detention and re-education.

In Athens on Monday, activists managed to elude security during the lighting of the torch, unfurling a Tibetan flag and a banner reading, “No Genocide Games.” Such a breach would be nearly inconceivable in Beijing.

A traditional relay of the torch — a ritual introduced in 1936 when Nazi Germany was host to the Summer Games in Berlin — has also been scuttled, as it was in Tokyo.

In 2008, China’s monthlong international relay became a lightning rod, spurring large and chaotic protests in several cities, including Paris, London and San Francisco.

This time, organizers are planning an abbreviated relay at home on the eve of the opening ceremony in Beijing on Feb. 4. It will pass among the three sites of the games: Beijing, as well as Yanqing and Zhangjiakou, nestled in the hills north of the capital.

Credit…Desiree Rios for The New York Times

Earlier this year, New York created a $2.1 billion fund to help undocumented immigrants and others who weathered the pandemic without access to government relief. The Excluded Workers Fund, by far the biggest of its kind in the country, was intended to provide eligible workers with one-time payments to help cover costs associated with joblessness, such as back rent and medical bills.

But just a few months after the state began accepting applications, the fund is about to run out of money, after a blitz in claims and a speedy distribution of aid.

The fund’s rapid depletion could mean that tens of thousands of applicants might miss out on payments, according to organizers and state lawmakers who championed the fund.

Soaring demand for the fund has placed pressure on Gov. Kathy Hochul to add more money to the pot in what could be an early test of her progressive bona fides as she campaigns next year. Ms. Hochul, a Democrat, had made it a priority to fast-track the disbursement of the original $2.1 billion when she ascended to the state’s top job after Gov. Andrew M. Cuomo resigned in August.

To date, the state has distributed just over two-thirds of the fund, to about 128,000 people, a fraction of the nearly 351,000 claims that were received.

Ms. Hochul said last week that “$2.1 billion was an extraordinary amount of money, and we don’t have that level of money available just to deploy for something like this.”

Credit…Benjamin Norman for The New York Times

The Washington State Patrol announced on Tuesday that 127 employees had left the agency — just under 6 percent of the total work force of about 2,200 — as a result of the state’s vaccine mandate.

Chief John R. Batiste said in a statement that 74 of the departing employees were commissioned officers and 53 were civilian workers.

“We will miss every one of them,” he said. “I truly wish that you were staying with us.”

Monday was Washington State’s deadline for more than 800,000 workers, including those at state agencies, schools and health care facilities, to prove they had been fully vaccinated against the coronavirus. The mandate, issued by Gov. Jay Inslee in August, is among the strictest in the country.

“Covid is a killer and the state is taking action intended to improve public safety,” Chief Batiste said in a message to employees on Monday. “I thank you for staying on post and staying in service to this state and agency. Better days are ahead.”

Law enforcement officers have tended to be more hesitant than the general public to getting vaccinated, and police unions across the United States have clashed with government officials over Covid vaccine requirements.

In Chicago, the head of the police union told officers to ignore a city order to report their vaccination status by the end of the day last Friday.

On Tuesday, Chicago Police Superintendent David Brown said that 21 officers had been placed on “no pay status” for not complying with the city’s order to disclose their vaccination status.

Public health officials like Dr. Anthony S. Fauci, the nation’s top infectious disease doctor, have implored police officers and others responsible for public safety to get vaccinated.

“Think about the implications of not getting vaccinated when you’re in a position where you have a responsible job, and you want to protect yourself because you’re needed at your job, whether you’re a police officer or a pilot or any other of those kinds of occupations,” Dr. Fauci said on Fox News Sunday.

“We now know the statistics — more police officers die of Covid than they do any other causes of death,” he said. “So it doesn’t make any sense to not try to protect yourself, as well as the colleagues that you work with.”

Other agencies and police unions also reported that officers were leaving over vaccine requirements. At least 150 members of the State Police Association of Massachusetts, the union that represents state police, have resigned or intend to do so, the union told NBC Boston.

Credit…Christophe Ena/Associated Press

Leading medical groups have declared a national emergency in child and adolescent mental health triggered by prolonged isolation, uncertainty and grief during the coronavirus pandemic.

In a joint statement on Tuesday, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association said the coronavirus pandemic had worsened an already existing mental health crisis among children and teens.

Inequities resulting from structural racism contributed to disproportionate impacts of the pandemic on children from communities of color, the groups said.

The loss of a loved one has affected children and adolescents more than it has other age groups, research from the American Academy of Pediatrics shows. More than 140,000 children in the United States have lost at least one caregiver since the start of the pandemic, with youth of color disproportionately affected.

“This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by Covid-19 and the ongoing struggle for racial justice, and represents an acceleration of trends observed prior to 2020,” the statement said.

Before the pandemic, mental health concerns and suicide had been rising steadily among children and adolescents between 2010 and 2020. By 2018, suicide was the second leading cause of death for youth ages 10 to 24.

According to the Centers for Disease Control and Prevention, between March and October 2020, emergency department visits for children with mental health emergencies rose by 24 percent for those between ages 5 and 11, and 31 percent for children 12 to 17. Among girls ages 12 to 17, E.R. visits identified as potentially the result of a suicide attempt were up more than 50 percent in early 2021 compared with the same period in 2019, according to the C.D.C.

“We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, their communities, and all of our futures,” Gabrielle A. Carlson, president of the American Academy of Child and Adolescent Psychiatry, said in a statement. “We cannot sit idly by.”

The organizations are urging policymakers to take actions such as increasing federal funding to ensure families have access to mental health services, supporting effective models of school-based care and accelerating the integration of mental health care into pediatric care.

The American Rescue Plan assigned $80 million to the Pediatric Mental Health Care Access program to integrate behavioral health needs into pediatric primary care, and $20 million to supporting youth suicide prevention programs. The plan also contributed $50 million for community-based funding for local behavioral health needs worsened by the pandemic.

Finding a provider can be difficult. The American Academy of Child and Adolescent Psychiatry reported earlier this year that there was a severe shortage of child psychiatrists in nearly every state in the country.

Getting children urgent mental health care can be even more challenging, especially when emergency rooms are full. Earlier this year when hospitals were overwhelmed in Colorado and Connecticut, for example, children were sent out of state for care.




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