A Welcome Logistical Challenge for States as More Vaccine Arrives

Here’s what you need to know:

Credit…Philip Cheung for The New York Times

Hoping to hasten California’s emergence from the coronavirus pandemic, the state will begin channeling 40 percent of new vaccine doses to low-income communities hit hardest by the coronavirus, officials in Gov. Gavin Newsom’s administration said late on Wednesday.

The strategy is an effort to make the vaccine rollout more equitable and reduced the number of counties considered most at risk, as well as speed California’s ability to reopen, officials said.

The targeted communities are defined using a composite “health equity” index that assesses need based on income, education, transportation and housing availability. State data has indicated that when vaccination efforts are targeted at poorer Californians, wealthier people have gamed the system. Black and Latino residents have been inoculated in smaller numbers than their white neighbors.

California faced a surge in infections in December and January, but cases have fallen 40 percent statewide — to late October levels — in the past two weeks, intensifying calls for the state government to relax restrictions.

Governor Newsom, whose handling of the pandemic has helped fuel a Republican-led recall campaign against him, has crisscrossed the state, opening vaccination centers and assuring people that immunization is the “light at the end of the tunnel.” But he has also made clear that the virus and its variants remain lethal: At least 287 new coronavirus deaths and 4,316 new cases were reported in California on March 2.

When the governor of Texas announced this week that the state would lift its mask mandate, Mr. Newsom tweeted that the move was “absolutely reckless.”

Administration officials said California would keep in place its mask mandate. The vaccine blitz, they said, was aimed at quashing the further spread of Covid-19 so people could go back to work and businesses could reopen safely.

About 1.6 million vaccine doses have so far been delivered in low-income communities.

Once two million vaccines have been administered in those locations, officials said, the state will adjust its color-coded tier system to make it easier for counties to move into less restrictive categories, which will hasten the reopening of schools. When there are four million doses in the targeted areas, additional tiers will be adjusted to further ease reopenings.

United States › United StatesOn March 3 14-day change
New cases 66,714 –17%
New deaths 2,369 –8%
World › WorldOn March 3 14-day change
New cases 419,698 +1%
New deaths 10,837 –19%

U.S. vaccinations ›

Where states are reporting vaccines given

Cars lined up in late February at a mass vaccination site at Dodger Stadium in Los Angeles.Credit…Mario Tama/Getty Images

There’s been a lot of hopeful news lately about the nation’s vaccine supply. A third vaccine, from Johnson & Johnson, received emergency authorization over the weekend, and a rival drugmaker, Merck & Co., has agreed to help manufacture it. President Biden announced on Tuesday that the country would have enough doses available for every American adult by the end of May.

Now state and city governments face the challenge of getting all those doses into people.

Gov. Andrew M. Cuomo of New York announced that three state-run mass vaccination sites — at Yankee Stadium, the Javits Center, and the New York State Fairgrounds in Syracuse — will begin administering vaccines around the clock.

In New York City, Mayor Bill de Blasio has said repeatedly that the city’s vaccination program was being held back mainly by lack of supply. Eligible New Yorkers have reported difficulties securing vaccine appointments, and there have been long lines at both city-run and state-run vaccination sites in the city.

At a news conference on Wednesday, Mr. de Blasio welcomed the news that more doses would be coming, but he did not accelerate the timeline for his goal of getting five million doses administered by the end of June. (As of Wednesday morning, the city had administered more than two million, with 720,000 adults fully vaccinated so far.)

“There is a difference between it being produced and getting it everywhere it needs to be,” Mr. de Blasio said.

The city plans to bring roughly 1,000 student nurses into clinics and hospitals to help them vaccinate more people.

Eligible only in some counties

Eligible only in some counties

Eligible only in some counties

State and local leaders across the country announced their own plans for the welcome inflow of doses.

Oklahoma intends to use the Johnson & Johnson vaccine, which is given in a single shot, for people who might otherwise be hard to track down when it is time for a second dose, like the homeless, Gov. Kevin Stitt told The Tulsa World. Mr. Stitt said he expected supply to begin outpacing demand by late March or early April.

In California, the state has launched a new, centralized distribution system headed by the insurance giant Blue Shield, intended in part to speed the pace of vaccinations.

In recent days, Missouri came under criticism after several mass vaccination events in rural areas ended with hundreds of doses left over, and some even wasted, even as urban residents faced long waits to get shots. Now, with 50,000 Johnson & Johnson doses expected to arrive in the state this week, Gov. Mike Parson said distribution plans would be adjusted to send more teams and more doses to the Kansas City and St. Louis regions.

In Chicago, city and Illinois state officials announced on Tuesday that a new mass vaccination site at the United Center would start giving shots next Tuesday, a day earlier than originally planned, with more than 110,000 appointments available.

The state expects about 100,000 doses of the Johnson & Johnson vaccine to arrive this week.

“Still, we don’t have enough vaccine for everybody who wants it,” the city’s public health commissioner, Dr. Allison Arwady, said Tuesday. “But every day, that calculus is improving.”

President Biden at the White House on Tuesday.Credit…Doug Mills/The New York Times

President Biden lashed out on Wednesday at the governor of Texas and others who have relaxed Covid-19 restrictions, describing their actions as “Neanderthal thinking” and insisting that it was a “big mistake” for people to stop wearing masks.

The president, who has urged Americans to remain vigilant in the fight against the coronavirus, said it was critical for public officials to follow the guidance of medical doctors and public health leaders as the U.S. vaccination campaign progresses.

“The last thing we need is Neanderthal thinking that in the meantime, everything’s fine, take off your mask and forget it,” Mr. Biden told reporters at the White House. “It’s critical, critical, critical, critical that they follow the science. Wash your hands, hot water. Do it frequently, wear a mask and stay socially distanced. And I know you all know that. I wish the heck some of our elected officials knew it.”

Earlier in the day, the White House press secretary, Jennifer Psaki, called on Texans and others to follow the guidance of the country’s top medical officials, who have warned mayors and governors not to recklessly abandon restrictions.

“This entire country has paid the price for political leaders who ignored the science when it comes to the pandemic,” Ms. Psaki said.





C.D.C. Warns Against Loosening Coronavirus Restrictions

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, warned against loosening coronavirus restrictions on Wednesday. This comes after Texas announced on Tuesday that it would lift its mask mandate.

We are at a critical nexus in the pandemic. So much can turn in the next few weeks. On the one hand, cases in the country are leveling off at rates, at rates just on the cusp of potential to resurge. And the B.1.1.7. hyper-transmissible variant looms ready to hijack our successes to date. And on the other hand, stamina has worn thin. Fatigue is winning, and the exact measures we have taken to stop the pandemic are now too often being flagrantly ignored. All the while, we are just on the verge of capitalizing on the culmination of a historic scientific success, the ability to vaccinate the country in just a matter of three or four more months. How this plays out is up to us. The next three months are pivotal. I think we at the C.D.C. have been very clear that now is not the time to release all restrictions. I do think that, as I said in my remarks, the next month or two is really pivotal in terms of how this pandemic goes. As we scale up vaccination, we really do need to decrease the amount of virus that is circulating as we’re trying to vaccinate all of the public. I will also note that every individual has — is empowered to do the right thing here, regardless of what the states decide for personal health, for public health, for their health, of their loved ones and communities. I would still encourage individuals to wear masks, to socially distance and to do the right thing to protect their own health.

Video player loadingDr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, warned against loosening coronavirus restrictions on Wednesday. This comes after Texas announced on Tuesday that it would lift its mask mandate.CreditCredit…Kevin Lamarque/Reuters

Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, warned governors and mayors again on Wednesday not to lift Covid-19 restrictions prematurely.

Her latest warning, the third in less than a week, came after officials in several states, including Texas and Mississippi, announced on Tuesday that they are easing rules like mask mandates and capacity limits in businesses.

“Now is not the time to release all restrictions,” Dr. Walensky said at the White House briefing. She said the United States is at a pivotal moment when it could either quell the spread of the coronavirus through precautions and vaccinations, or stoke a new surge of infections.

“So much can turn on the next few weeks,” she said. Andy Slavitt, a senior White House adviser, said health officials in every state agree that “now is the wrong time to lift the mask mandate.”

New cases, deaths and hospitalizations have been decreasing over the past week, according to a New York Times database. Compared with two weeks ago, cases were down 19 percent, and hospitalizations were down 29 percent. Deaths were down 9 percent. As of Tuesday, the C.D.C. estimated that 15 percent of the population had received at least one dose of a virus vaccine, while nearly 8 percent had received both.

Mr. Biden said Tuesday that the nation was expected to have enough doses of vaccine available by the end of May to inoculate the whole adult population. He acknowledged it would take longer to get everyone vaccinated.

With new virus variants spreading, Dr. Walensky urged people to wear masks, to avoid crowds and travel, and to “do the right thing to protect their own health,” regardless of what their state officials dictate.

“Fatigue is winning, and the exact measures we’ve taken to stop the pandemic are now too often being flagrantly ignored,” she said.

The World Health Organization issued its own warning on Monday against easing virus restrictions too soon, particularly with the circulation of new variants.

The C.D.C. has issued detailed guidance about reopening schools and workplaces. Dr. Walensky is most concerned about lifting mask mandates and fully reopening businesses without regard to the need for social distancing, according to one federal official familiar with her thinking.

While many states have eased some restrictions in recent weeks, Gov. Greg Abbott of Texas, a Republican, made the most expansive move.

Not all Texas businesses are on board. Even as it filed for bankruptcy on Wednesday, a Texas-based movie theater chain, Alamo Drafthouse, pushed back against the relaxation, saying in a message to patrons that masks and social distancing would still be required at its theaters across the state.

Gov. Tate Reeves of Mississippi, another Republican, lifted his state’s mask order on Tuesday, though he said he still recommended that people wear them and practice social distancing.

Democrats are slowly easing restrictions now as well. Gov. Gretchen Whitmer of Michigan said her state would relax limits on nursing homes and allow restaurants, shops and other businesses to accept more customers, starting on Friday. Gov. John Bel Edwards of Louisiana said that bars in his state could reopen and live music could resume indoors, though the state’s mask mandate would continue. And in San Francisco, Mayor London Breed said indoor dining, museums and movie theaters will be allowed to reopen on Wednesday at limited capacity.





First Lady and Education Secretary Push for In-Person Classes

The first lady, Jill Biden, and the education secretary, Miguel Cardona, advocated a return to in-person learning during the first of two visits they made on Wednesday to reopened schools.

[children talking] “What do you say, boys and girls?” Children: “Welcome to kindergarten.” “I love that Ninja Turtles — does that help you breathe better because it’s Ninja Turtles? I bet it does. And you’re Spider-Man. I saw that, right? And you have a beautiful one, too. I love it.” “You’re young to be reading, right? That’s really good that you’re reading already.” “Across the country, future Lin-Manuel Miranda’s are sitting at home instead of going to the drama club. Future astronauts like Mark Kelly are sitting at home instead of going to a science lab to spark that wonder of science. We must continue to reopen America’s schools for in-person learning as quickly and as safely as possible. The president recognizes this, which is why he took bold action yesterday to get teachers and school staff vaccinated quickly.” “Like Miguel said, you know, teachers want to be back. We want to be back. I’m a teacher. I am teaching virtually. And last week, I said to my students, ‘Hey, guys, how are you doing?’ And they said, ‘Dr. B., we’re doing OK, we’re doing OK. But we can’t wait to be back in the classroom.’”

Video player loadingThe first lady, Jill Biden, and the education secretary, Miguel Cardona, advocated a return to in-person learning during the first of two visits they made on Wednesday to reopened schools.CreditCredit…Pool photo by Mandel Ngan

MERIDEN, Conn. — Following President Biden’s call on Tuesday to have every school employee receive at least one vaccine shot by the end of March, the White House began a campaign to drum up support for the quick reopening of the nation’s schools by sending the first lady, Jill Biden, and the newly confirmed education secretary, Miguel Cardona, on a two-state tour of reopened schools on Wednesday.

Mr. Biden’s promise to vaccinate teachers elevated his push to reopen schools even before the nation is fully inoculated. At the White House’s direction, vaccinations will be available at local pharmacies through a federal program. With the states setting priorities for eligibility otherwise, there remains a limit on actually getting shots in arms.

At their first stop in Meriden, Conn. — Dr. Cardona’s hometown — the secretary said that quickly vaccinating teachers would be his “top priority.”

“We must continue to reopen America’s schools for in person learning as quickly and as safely as possible,” he said at an elementary school where students were learning in masks and behind plexiglass dividers. “The president recognizes this, which is why he took bold action yesterday to get teachers and school staff vaccinated quickly.”

As the state education commissioner in Connecticut, he pushed to reopen the state’s schools during the coronavirus pandemic. The White House now expects Dr. Cardona to do the same on a national scale, as teacher’s unions around the country raise concerns about the safety of resuming in-person instruction.

Dr. Biden, who has a doctorate in educational leadership and teaches full-time at Northern Virginia Community College, said that while the White House would be following Dr. Cardona’s lead, both she and her students were impatient to return safely to classrooms.

“Teachers want to be back,” she said. “We want to be back. Last week I said to my students, ‘Hey, guys, how’re you doing?’ And they said ‘Dr. B, we’re doing OK, but we can’t wait to be back to the classroom.’”

Parents across the country are frustrated with the pace of reopening, and in some cases are starting to rebel. Nationally, fewer than half of students are attending public schools that offer traditional in-person instruction full time. And many teachers have rejected plans to return to the classroom without being vaccinated.

Even so, most schools are already operating at least partially in person, and evidence suggests that they are doing so relatively safely. Research shows in-school virus spread can be mitigated with simple safety measures like masking, distancing, hand-washing and open windows.

“Let’s treat in-person learning like an essential service that it is,” Mr. Biden said on Tuesday, even as he noted that not every school employee would be able to get a vaccine next week. “And that means getting essential workers who provide that service — educators, school staff, child care workers — get them vaccinated immediately.”

Educators will be able to sign up to receive a vaccine through a local drugstore as part of a federal program in which shots are delivered directly to pharmacies, Mr. Biden said. White House officials said Mr. Biden’s move to speed up vaccination of teachers is based on the president’s view that they are critical to getting the country back to normal.

Jen Psaki, the White House press secretary, said Wednesday that inoculating teachers is “not a prerequisite,” but that Mr. Biden believes they should be “prioritized.”

At least 34 states and the District of Columbia are already vaccinating school workers to some extent, according to a New York Times database. Others were quick to fall in line after Mr. Biden announced his plan. On Tuesday, Washington State added educators and licensed child care workers to its top tier for priority, accelerating its plan by a few weeks.

In guidelines issued last month, the Centers for Disease Control and Prevention urged that elementary and secondary schools be reopened as soon as possible, and offered a step-by-step plan to get students back in classrooms. While the agency recommended giving teachers priority, it said that vaccination should “nevertheless not be considered a condition for reopening schools for in-person instruction.”

Many schools are already fully open in areas with substantial or high community transmission, where the agency suggests schools be open only in hybrid mode or in distance-learning mode. The agency says those schools can remain open if mitigation strategies are consistently implemented, students and staff are masked, and monitoring of cases in school suggests limited transmission.

The agency’s guidelines say that six feet of distancing between individuals is required at substantial and high levels of community transmission. Many school buildings cannot accommodate that, which may lead some districts to stick with a hybrid instruction model when they might otherwise have gone to full in-person instruction.

Many local teachers’ unions remain adamantly opposed to restarting in-person learning now, saying that school districts do not have the resources or the inclination to follow C.D.C. guidance on coronavirus safety. Without vaccinations, the unions say, adults in schools would remain vulnerable to serious illness or death from Covid-19 because children, while much less prone to illness, can nevertheless readily carry the virus. Studies suggest that children under 10 transmit the virus about half as efficiently as adults do, but older children may be much like adults.

The unions have a ready ear in the White House. Dr. Biden, a community college professor, is a member of the National Education Association, and the president has a long history with the unions. Dr. Biden and Mr. Cardona were scheduled to meet with Randi Weingarten, the president of the American Federation of Teachers, in Connecticut, and with Becky Pringle, the N.E.A. president, in Pennsylvania.

On Dr. Biden’s tour, Ms. Weingarten jumped in at points to speak about the need for flexibility with different teaching styles.

Epidemiological models have shown that vaccinating teachers could greatly reduce infections in schools. “It should be an absolute priority,” said Carl Bergstrom, an infectious diseases expert at the University of Washington in Seattle.

Still, requiring that teachers be vaccinated could greatly slow the pace of school reopenings, he and other experts acknowledged.

Teachers’ unions want not just vaccination, but also that districts improve ventilation and ensure six feet of distancing — two measures that have been shown to reduce the spread of the virus. (The C.D.C. guidelines emphasize six feet of distance only when prevalence of the virus is high, and nodded only briefly to the need for ventilation.) The unions have also insisted that schools not open until the infection rates in their communities are very low.

Apoorva Mandavilli and Michael D. Shear contributed reporting.

New virus cases among health care workers in the Los Angeles County fell to 69 for the week of Feb. 14, from more than 1,800 cases during the week of Nov. 29, the county said.Credit…Isadora Kosofsky for The New York Times

What was once a flood of health care workers catching the coronavirus in Los Angeles County has now slowed to a trickle, in large part because the vast majority of them have been vaccinated, local public health officials said. Reports of new virus cases among health care workers in the county have fallen by 94 percent since late November, just before vaccination began.

The statistics are encouraging, both in Los Angeles County and across the country. Some health care workers initially expressed reluctance to get a Covid-19 vaccine shot, often out of fear about the safety of the vaccines, which were hurried into use under emergency authorizations from the Food and Drug Administration.

Workers in nursing homes and long-term care facilities, which have been hot spots during the pandemic, have been of special concern: At one point, those workers accounted for one-quarter of all cases among health care workers in Los Angeles County.

But by the end of February, the county said, 69 percent of health care workers in those facilities — including 78 percent of nursing home and long-term care facilities staffs — had received at least one shot of vaccine.

The results have been stark: 434 new virus cases were reported in the county among nursing-home health care workers during the week of Nov. 29, but for the week of Feb. 14, there were 10 cases, according to county data.

The same has happened with the county’s health care workers in general: New cases fell to 69 for the week of Feb. 14, from more than 1,800 cases during the week of Nov. 29, the county said.

“High rates of vaccination are correlated with the lowest rates of cases and deaths among health care workers at nursing homes,” the county public health department wrote in a statement on Monday, “and we are grateful to everyone that got vaccinated and to the teams that coordinated vaccinations at each site.”

The county as a whole made major progress over the same period, with new cases overall down 71 percent. But even so, the risk of getting the virus there remains high.

A recent survey by the Kaiser Family Foundation found that Los Angeles County is ahead of most of the country in getting health care workers immunized. The nationwide survey, conducted between Feb. 15 and Feb. 23, found that 54 percent of health care workers had already received at least one dose of vaccine by then, and 10 percent more said they planned to get a shot as soon as they could. Some 15 percent said they would “definitely not” get the vaccine.

A nurse discussing the next chemotherapy cycle to a 14-year-old cancer patient in Malta last May. Credit…Darrin Zammit Lupi/Reuters

More than three-fourths of hospitals surveyed in 79 countries reported disruptions in delivery of medical care to children with cancer because of the pandemic, according to a new study published Wednesday.

While researchers have been closely watching the effect of the coronavirus crisis on pediatric cancer patients, the study in The Lancet Child & Adolescent Health, a medical journal, focuses on how the pandemic interrupted care, particularly in low- and middle-income countries. Earlier studies had examined the impact on particular countries or regions.

A third of the institutions surveyed said they had witnessed higher levels of treatment abandonment, in which a child with a cancer diagnosis either did not get treatment or delayed getting care for more than a month. Many centers also reported a scarcity of chemotherapy agents and interruptions in radiotherapy, according to the study.

“These are all very worrisome findings at the end of the day,” Dr. Daniel Moreira, the director of global professional education at St. Jude Children’s Research Hospital and one of the study’s authors, said in an interview. Residents of lower-income countries already have worse health conditions than those in resource-rich countries, and the pandemic could exacerbate those disparities, he said.

Dr. Moreira noted that even those countries with ample resources experienced declines in the diagnosis of pediatric cancers. About half of the world’s 400,000 pediatric cancers are typically undiagnosed, he said, representing a significant public health challenge even before the pandemic.

Dr. Moreira said it is too early to tell whether the drop in the number of cancer diagnoses among children will lead to an increase in undiagnosed cases and a higher number of deaths as a result. “It’s probably years before we see the full effect,” he said.

The study was conducted from June 22 to Aug. 21 of 2020 for 213 centers.

Fans attending the Super Bowl in February.Credit…Eve Edelheit/Reuters

When the Super Bowl was held in Tampa, Fla., last month, with tens of thousands of fans in attendance, there was wide concern that the big game and the hoopla surrounding it would result in mass spread of the coronavirus.

Experts in Florida have been trying since then to gauge to what extent those fears became reality, and the early signs are that the effect was fairly limited. A public health official said on Wednesday that the state had tracked 57 cases of Covid-19 to official Super Bowl activities.

“All in all, we identified very low numbers of Covid directly associated with any of these Super Bowl-associated events,” said Michael Wiese, an epidemiologist with the Florida Health Department’s office in Hillsborough County.

Four of the cases were identified outside Florida, Mr. Wiese said.

The Hillsborough office asked health departments throughout the state and across the country to share reports of any positive cases linked to the game itself or to events like the N.F.L. Experience, an outdoor fan festival held before the game, and a victory boat parade on the Hillsborough River afterward. (The hometown Tampa Bay Buccaneers defeated the Kansas City Chiefs, 31-9.)

Case tracking began the week before the Feb. 7 game and continued for two weeks after the Feb. 10 parade.

The tally of 57 cases is probably incomplete. Mr. Wiese said that when contact tracers call people seeking information about where they were and when, only about half of them respond.

Hillsborough County did see a rise in new cases and in its test virus positivity rate in the weeks after the Super Bowl, compared with the rest of Florida, Mr. Wiese said. He said the increases were probably the result of private gatherings to watch the game. Crowds of maskless people also packed the streets of Tampa after the game to celebrate the Bucs’ victory.

“This information, along with the low numbers of cases reported, really leads to a conclusion that the transmission that was occurring after the Super Bowl was the family get-togethers, the household parties, the bars and restaurants — that kind of unofficial gatherings and events associated with the Super Bowl,” he said.

Mr. Wiese was joined in a virtual news conference by Rob Higgins, the head of the Tampa Bay Super Bowl host committee, who said the health and safety measures adopted by the N.F.L., including mandatory masks, were successful.

Nearly 25,000 fans, including 7,500 vaccinated health workers, were at the game, along with about 12,000 workers and members of the news media, he said. A total of more than 280,000 people attended or worked at the N.F.L. Experience.

“The Super Bowl was not a superspreader,” Mr. Higgins said.

Global Roundup

Berlin last week. Medical experts have warned that Germany may be at the beginning of a new wave of the pandemic.Credit…Sean Gallup/Getty Images

Amid the spread of more coronavirus variants and a slight uptick in infections, Chancellor Angela Merkel and state governors agreed Wednesday on a pathway to reopening that is to start next week.

For the first time, there will be a national plan that takes regional infection rates into account.

“Spring 2021 will be different from spring a year ago,” Ms. Merkel told reporters after the nine-hour meeting with state governors.

The chancellor noted that reliable rapid tests for the virus and vaccines were not available when the country first had to shut down in March of 2020.

After 12 weeks of lockdown, nonessential shops, museums and zoos will be allowed to open next week in regions where there are fewer than 50 infections per 100,000 people in seven days. If the incidence is between 50 and 100 infections per 100,000, openings will be more limited and in most cases will require an appointment.

Further openings, such as outdoor dining, could happen as early as late March, if the incidence rates fall even further. And schools, which have already started reopening, will go to more full-time schedules, depending on the state.

But it all comes with a big caveat: If infections surpass a weekly rate of 100 per 100 000 — as is currently the case in nearly 60 districts in the country — localities will have to go back into lockdown.

Ms. Merkel noted that as the more contagious B1.1.7 variant overtakes the original virus in the near future, the country will be in a “very delicate situation.” Medical authorities had warned against reopening too quickly, but the push from state governors to resume normal life was substantial.

The ambitious reopening plan is reliant on the availability of rapid virus tests, which will be made widely available, with the state financing one test per week per person.

Despite the measures in place for the last months, there has been a slight increase in new infections in Germany. On Tuesday, the German health authorities registered about 9,000 new cases, about 1,000 more than the same day the week before. A New York Times database puts the seven-day average at 8,172; two weeks ago, it was 6,121.

In other news from around the world:

  • In the Netherlands, a pipe bomb exploded at a coronavirus testing center on Wednesday, causing damage but no injuries, the public broadcaster NOS reported. The lone security guard present in the town of Bovenkarspel when the device was detonated was unhurt, but windows were broken, the police said. There have been multiple protests in the Netherlands against virus restrictions, some at times violent. In January, a testing center in the town of Urk was set alight after the government imposed a curfew.

  • The Greek government is introducing new lockdown restrictions, including extended curfews and stricter terms for leaving the house for exercise, amid an upward trend of cases. Over the past week, there has been an average of 1,686 cases per day in Greece, according to a New York Times database. Vassilis Kikilias, the health minister, has warned that hospitals in Athens are at emergency levels because of the increase in patients with Covid-19. The use of military and private hospital facilities will be expanded to cope with the increase in patients, he said.

  • North Korea is expected to receive about 1.7 million doses of the Oxford-AstraZeneca shots by the end of May, according to a report released on Tuesday by Covax, an international body established to promote global access to coronavirus vaccines. The AstraZeneca doses are among about 237 million that Covax says it expects to distribute worldwide over the same period. The North’s state news media has long insisted that the country has no confirmed Covid-19 cases, but outside experts are skeptical.

  • Pelé, the Brazilian former soccer star, said in an Instagram post that he had received a coronavirus vaccine. He urged his nearly six million followers to continue wearing masks and taking other safety precautions. “This will pass if we can think of others and help each other,” he wrote. Brazil has reported more than 10.5 million cases and 257,000 deaths, some of the highest tallies in the world.

  • Bharat Biotech, an Indian pharmaceutical company, said Wednesday that its vaccine, Covaxin, had shown 81 percent efficacy in interim trials. The announcement came two months after Indian regulators approved the shots for emergency use despite a lack of published data showing that they were safe and effective.

Emergency workers administering vaccine at a drive-thru station at the Oakland Coliseum last month.Credit…John G Mabanglo/EPA, via Shutterstock

More than 4,000 people vaccinated at a site in Oakland, Calif., may have been given a smaller dosage than is recommended, a local television station reported, though a state official gave assurances that no one was given inadequate protection.

“Neither the state of California nor FEMA are aware of any instance of even a single individual being under-vaccinated on the Oakland Coliseum site,” Brian Ferguson, a spokesman for the California Governor’s Office of Emergency Services, said in a statement on Wednesday.

“The public should rest assured that vaccines administered at the Coliseum are being dispensed in a manner consistent with medical and scientific best practices and will work as designed,” Mr. Ferguson said.

His comments came after a report from KTVU, a Fox affiliate, that some people who received the Pfizer vaccine at the site in Oakland on Monday were given .2 milliliters of the vaccine, instead of the optimal .3 milliliters.

The report cited a pair of unnamed emergency medical technicians who said the problem was linked to a new batch of syringes delivered to the vaccine site. Those syringes “left about a third of vaccine stuck in the bottom of the plastic container,” KTVU reported.

In his statement, Mr. Ferguson said, “We cannot substantiate this TV station’s reporting and have serious concerns on the accuracy of the claims they are making.”

He said state and federal officials at the site were working with the Centers for Disease Control and Prevention, Pfizer and others “to ensure the highest level of medical care and quality assurance are adhered to at this site.”

People waited in line Sunday with the hope of receiving leftover Covid-19 vaccine doses that would otherwise expire and be tossed out each day at the Kedren Community Health Center on in Los Angeles.Credit…Mario Tama/Getty Images

After weeks of waiting, Judy Franke’s vaccine breakthrough came when her phone rang at 8 p.m. one freezing February night. There were rumors of extra doses at the Minneapolis Convention Center. Ms. Franke, 73, had an hour to get there. No guarantees.

“I called my daughter and she said, ‘I’m putting my boots on right now,’” said Ms. Franke, a retired teacher with a weakened immune system.

Credit…Jenn Ackerman for The New York Times

The clamor for hard-to-get vaccines has created armies of anxious Americans who haunt pharmacies at the end of the day in search of an extra, expiring dose and drive from clinic to clinic hoping that someone was a no-show to their appointment.

Some pharmacists have even given them a nickname: Vaccine lurkers.

Even with inoculation rates accelerating and new vaccines entering the market, finding a shot remains out of reach for many, nearly three months into the country’s vaccination campaign. Websites crash. Appointments are scarce.

The leftover shots exist because the Moderna and Pfizer vaccines have a limited life span once they are thawed and mixed. When no-shows or miscalculations leave pharmacies and clinics with extras, they have mere hours to use the vaccines or risk having to throw them away.

And so, tens of thousands of people have banded together on social-media groups. They trade tips about which Walmarts have extra doses. They report on whether besieged pharmacies are even answering the phone. They speculate about whether a looming blizzard might keep enough people home to free up a slot.

“It’s like buying Bruce Springsteen tickets,” said Maura Caldwell, who started a Facebook page called Minneapolis Vaccine Hunters to help people navigate the search for appointments. The group has about 20,000 members.

Health experts said the scavenger hunt for leftovers highlighted the persistent disparities in the U.S. vaccination rollout, where access to lifesaving medicine can hinge on computer savvy, personal connections and the ability to drop everything to snag an expiring dose.

In Minnesota, when Ms. Franke arrived at the convention center, there were about 20 other people already milling around in the lobby, she said, and a health worker quickly emerged to inform them that there were no leftovers.

But many in the crowd stuck around, and after a half-hour, the vaccination team allowed people 65 and older, teachers and emergency responders to get their shots. Ms. Franke lined up and said she cried with relief on the car ride home to the suburbs.

People waiting in a line this week stretching around the Jacob K. Javits Convention Center on Midtown Manhattan’s west side, to receive a coronavirus vaccine at the site which has been converted into a mass vaccination center in New York City.Credit…Mike Segar/Reuters

Three mass vaccination sites across New York State will begin administering doses overnight, Gov. Andrew M. Cuomo said this week, as officials seek to use an influx of new vaccines manufactured by Johnson & Johnson to significantly expand the vaccination effort.

The state said Tuesday it expected to receive about 164,800 doses of the Johnson & Johnson vaccine this week. In a news conference on Wednesday, Mr. Cuomo said that adding appointments and running the three mass vaccination sites around the clock would allow the state to get the vaccine “in arms as soon as possible.”

Mr. Cuomo also said that there would then be a lag before the state receives its next allocation of the Johnson & Johnson vaccine.

“This pilot plan will maximize the initial doses of the Johnson & Johnson vaccine and get as many shots in arms as possible,” Mr. Cuomo said.

Two of the sites will be in New York City: Yankee Stadium in the Bronx and Javits Center in Manhattan. The third will be at the New York State Fair’s fairgrounds in Syracuse, N.Y.

Vaccinations at Yankee Stadium will begin on Thursday, and doses there are reserved for Bronx residents who meet the current eligibility requirements. The site, which had been open from 8 a.m. to 8 p.m., will now also schedule vaccine appointments from 8 p.m. to 7 a.m. People can schedule their appointments starting today at somosvaccinations.com or by calling 1-833-SOMOSNY (1-833-677-6769).

Starting on Friday, the Javits Center site will be open for overnight vaccinations from 9 p.m. to 6 a.m. and the State Fair site will be open from 10 p.m. to 6 a.m.

New York residents can start making appointments for overnight vaccinations at both sites starting on Thursday at 8 a.m. by visiting this state website or by calling the state hotline at 1-833-NYS-4-VAX (1-833-697-4829).

Mr. Cuomo said the state would run overnight vaccinations until it exhausted its initial supply of Johnson & Johnson vaccine. The new plan reflects how the addition of the Johnson & Johnson vaccine is not only expanding the overall supply of doses, but giving rise to novel ways of reaching people.

On Tuesday, Mayor Bill de Blasio said the city would primarily use the Johnson & Johnson vaccine to start a new program for in-home vaccinations for homebound older people who might otherwise not be able to make appointments. The vaccine is a single shot, which makes it easier to administer, and it is also easier to transport, he said.

“We’ll reserve as much as we can for that,” Mr. de Blasio said of the Johnson & Johnson vaccine. “The rest of it we’ll be using as part of our general effort.”

Dr. Mitchell Katz, the city’s public hospitals chief, said that the city’s public health system expected to receive its first doses of the Johnson & Johnson vaccine on Thursday.

Mr. de Blasio, who has not yet been inoculated, said that he planned to get the Johnson & Johnson vaccine “in a very public way” to boost confidence in it. Though the vaccines from Moderna and Pfizer-BioNTech showed a somewhat higher efficacy rate in clinical trials, studies show that the Johnson & Johnson vaccine provides strong protection against severe disease and death from Covid-19, and may reduce the spread of the virus by vaccinated people.

Justina Roberta Santos, 84, received a coronavirus vaccine during a campaign to inoculate older people with mobility issues, in Rocinha, Brazil, last month.Credit…Dado Galdieri for The New York Times

Covid-19 has already left a trail of death and despair in Brazil, one of the worst in the world. And now, the country is battling a more contagious variant, even as Brazilians toss away precautionary measures that could keep them safe.

On Tuesday, Brazil recorded more than 1,700 Covid-19 deaths, its highest single-day toll of the pandemic.

Preliminary studies suggest that the variant that swept through the city of Manaus appears able to infect some people who have already recovered from other versions of the virus. And the variant has slipped Brazil’s borders, showing up in small numbers in the United States and other countries.

Although trials of a number of vaccines indicate that they can protect against severe illness even when they do not prevent infection with the variant, most of the world has not been inoculated. That means even people who had recovered and thought they were safe for now might still be at risk, and that world leaders might, once again, be lifting restrictions too soon.

“You need vaccines to get in the way of these things,” said William Hanage, an epidemiologist at Harvard T.H. Chan School of Public Health, speaking of variants that might cause reinfections.

Brazilians hoped that they had seen the worst of the outbreak last year. Manaus, capital of the northern state of Amazonas, was hit so hard in April and May that scientists believed the city may have reached herd immunity.

But then in September, cases in the state began rising again. By January, scientists had discovered that a new variant, which became known as P.1, had become dominant in the state. Within weeks, its danger became clear as hospitals in the city ran out of oxygen amid a crush of patients, leading scores to suffocate to death.

Throughout the pandemic, researchers have said that Covid-19 reinfections appear to be extremely rare, which has allowed people who recover to presume they have immunity, at least for a while. But that was before P.1 appeared.

One way to tamp down the surge would be through vaccinations, but the rollout in Brazil has been slow.

Brazil began vaccinating health care professionals and older adults in late January. But the government has failed to secure a large enough number of doses. Wealthier countries have snapped up most of the supply, while President Jair Bolsonaro has been skeptical both of the disease’s impact and of vaccines.

Margareth Dalcolmo, a pulmonologist at Fiocruz, a prominent scientific research center, said that Brazil’s failure to mount a robust inoculation campaign had set the stage for the current crisis.

“We should be vaccinating more than a million people per day,” she said. “We aren’t, not because we don’t know how to do it, but because we don’t have enough vaccines.”

Other countries should take heed, said Ester Sabino, an infectious-disease researcher at the University of São Paulo who is among the leading experts on the P.1 variant.

“You can vaccinate your whole population and control the problem only for a short period if, in another place in the world, a new variant appears,” she said. “It will get there one day.”

Gov. Andrew M. Cuomo at a news conference on Wednesday.Credit…Office of the NY Governor, via Associated Press

In his first news conference since a sexual harassment scandal engulfed his administration, Gov. Andrew M. Cuomo announced that New York would ease restrictions on residential and social gatherings later this month and begin to allow more people inside arts and entertainment venues.

The loosened rules, announced as New York approaches one year since Mr. Cuomo first issued shutdown orders that brought social and economic activity to a halt, mark a step forward in the state’s reopening process.

But the announcement was overshadowed by questions about the allegations against Mr. Cuomo. Since last Wednesday, Mr. Cuomo, 63, has been accused of sexually harassing two former aides and making unwanted advances at a wedding with a third woman. He has also faced a torrent of criticism in recent weeks over his administration’s handling of nursing homes during the pandemic.

At the news conference — the first time that the governor answered questions from reporters since a coronavirus briefing on Feb. 22 — Mr. Cuomo acknowledged that he unintentionally “acted in a way that made people feel uncomfortable” and said he was “sorry for whatever pain I caused anyone.”

Still, he said multiple times that he “never touched anyone inappropriately,” as two women have described, and focused largely on the intent of his actions.

Mr. Cuomo had been silent in recent days, even as Monday marked the anniversary of the state’s first confirmed case of the coronavirus, a crisis that put Mr. Cuomo and his daily briefings in the national spotlight.

On Tuesday, the Democrat-led statehouse moved to add limits and oversight on Mr. Cuomo’s pandemic-era powers, though he would retain the ability to issue executive orders that are deemed crucial to the state’s coronavirus response.

Those orders include the loosened limits that Mr. Cuomo announced in his news conference on Wednesday.

Starting March 22, New York will raise the maximum capacity on outdoor gatherings at private residences to 25 people from 10, though indoor gatherings will remain capped at 10 people. The limits on social gatherings in public spaces will be raised to 100 people indoors and 200 outdoors from 50 for both. Masks and social distancing will remain required.

The state will also begin to allow events at sports, arts and entertainment venues with fewer than 10,000 seats starting on April 2, after first allowing events at larger venues last week.

Smaller spaces will be allowed to reopen at 33 percent capacity, with limits of 100 people indoors and 200 people outdoors. Venues that require attendees to show proof of a negative coronavirus P.C.R. test can boost their capacity to 150 indoors and 500 outdoors.

A handful of venues immediately said they would begin holding live performances, which, with a handful of limited exceptions, have not taken place in New York since Broadway shut down last March 12.

As of Wednesday, the statewide positive test rate over a seven-day average was at 3.18 percent, Mr. Cuomo said, down from a high of 7.94 percent on Jan. 4, when cases were surging after holiday gatherings and travel.

But New York, along with New Jersey, has been adding new coronavirus cases at the highest rates in the country over the last week: Both reported 38 new cases per 100,000 people. (The nation as a whole is averaging 20 per 100,000 people.) And New York City is currently adding cases at a per capita rate roughly three times higher than Los Angeles County.

The governor urged residents to continue to adhere to guidance on face coverings and social distancing.

“In my opinion, some states are going too far, too fast,” Mr. Cuomo said. “And that is a danger because Covid is still a risk. And you relax those restrictions too far, you will see the beast rise up again.”

Offices in Manhattan. Property taxes can make up 30 percent or more of the money that cities and towns take in and use to fund schools, police forces and other public services.Credit…Timothy A. Clary/Agence France-Presse — Getty Images

Dormant offices, malls and restaurants have turned cities around the country into ghost towns. They foreshadow a fiscal time bomb for municipal budgets, which are heavily reliant on property taxes and are facing real-estate revenue losses of as much as 10 percent in 2021, according to government finance officials.

While many states had stronger-than-expected revenue in 2020, a sharp decline in the value of commercial properties is expected to take a big bite out of city budgets when those empty buildings are assessed in the coming months. For states, property taxes account for just about 1 percent of tax revenue, but they can make up 30 percent or more of the taxes that cities and towns take in and use to fund local schools, police forces and other public services.

The coming fiscal strain has local officials from both parties pleading with the Biden administration and members of Congress to quickly approve relief for local governments.

Lawmakers in Washington are negotiating over a stimulus package that could provide as much as $350 billion to states and cities. The aid would come after a year of clashes between Democrats and Republicans over whether assistance for local governments is warranted or if it’s simply a bailout for poorly managed states.

On Saturday, the House passed a $1.9 trillion bill that would provide aid to cities and states and garnered no Republican support. The Senate is expected to take up the bill this week with a vote that is likely to break down along similar party lines. Republicans have continued to object to significant aid for states, saying most are in decent financial shape and cherry-picking data to support their argument, such as revised budget estimates that show improvement because of previous rounds of federal stimulus, including generous unemployment benefits.

For local officials from both parties, however, the help cannot come soon enough and they have been making their concerns known to Treasury officials and members of Congress.

The pandemic has upended America’s commercial property sector. In cities across the country, skyscrapers are dark, shopping centers are shuttered and restaurants have been relegated to takeout service. Social-distancing measures have redefined workplaces and accelerated the trend of telecommuting.

American cities are facing red ink for a broad swath of reasons but the pain is unevenly distributed. In some cases, a rise in residential real-estate values will make up for the commercial property downturn, and some segments, such as warehouses, have been doing well as online shopping lifts demand for distribution centers. States that do not have income taxes, such as Florida and Texas, are more vulnerable to fluctuations in real-estate values.

Spain’s former King Juan Carlos, left, and his daughter Princess Elena in 2019. Princess Elena and her sister Princess Cristina received Covid-19 vaccinations while visiting their father  in Abu Dhabi.Credit…Andrea Comas/Associated Press

The sisters of King Felipe VI of Spain received Covid-19 vaccines in the United Arab Emirates last month, even though they are not yet eligible for early shots in their home country.

Princess Elena, 57, and Princess Cristina, 55, justified their vaccination on the grounds that they were visiting their father, the former King Juan Carlos, who has been living in Abu Dhabi. In a statement the sisters sent El Mundo, a newspaper, on Wednesday, they said they hoped to visit their father regularly and that, while visiting him last month, “we were offered the possibility to get vaccinated, which we accepted. If it had not been for this circumstance, we would have got access to vaccination in Spain, whenever it would have been our turn.”

Their justification was denounced by some left-wing politicians, led by Pablo Iglesias, Spain’s deputy prime minister and a co-founder of the Unidas Podemos party. Mr. Iglesias said on Wednesday that Spanish society could not accept that some citizens get privileged access to vaccinations overseas. “There is a debate about the usefulness of the monarchy that is growing every time the royal household offers new scandals that produce huge indignation among an important part of society,” Mr. Iglesias said.

Credit…Enrique Calvo/Reuters

The royal household stressed that King Felipe, his wife and children would wait in line to get vaccinated in Spain, and that the two princesses do not hold any official role within the royal household. But their weeklong trip to Abu Dhabi required security approval, and the government-covered cost of their travel bodyguards amounted to about 33,000 euros, according to La Política Online, a Spanish media outlet.

The former monarch, Juan Carlos, left Spain for Abu Dhabi last summer amid a series of fraud investigations related to his wealth, led by prosecutors in both Switzerland and Spain. The vaccination of his daughters was revealed by the Spanish news media only days after a controversial disclosure regarding a payment of about €4 million in back taxes Juan Carlos made to Spain’s tax agency in connection with transactions made on his behalf by a foundation based in Liechtenstein and headed by one of his cousins, Álvaro de Orleans. In 2014, Juan Carlos abdicated in favor of his son, Felipe.

Credit…Gregg Vigliotti for The New York Times

Guidelines by the Centers for Disease Control and Prevention on how cities should deal with homeless people sleeping in the streets during the pandemic are straightforward: If private rooms are not available, “allow people who are living unsheltered or in encampments to remain where they are.”

Clearing encampments, the agency explains, “increases the potential for infectious disease spread” by causing people to “disperse throughout the community and break connections with service providers.”

But in New York City last year, officials went in the other direction: They nearly doubled the number of “cleanups” of places where homeless people were sleeping, which involved removing and discarding belongings.

From March 1 to Dec. 12, the city performed 1,077 cleanups, compared with 543 during the same period in 2019. The statistic was released by the city in response to a Freedom of Information Act request by the Urban Justice Center, a nonprofit whose Safety Net Project helps homeless people.

In response to an email asking why the city increased cleanups in 2020, a spokesman for the City Department of Homeless Services, Isaac McGinn, wrote: “In our city, we don’t allow obstructions of public places or encampments and any time the city encounters, learns of, or receives a report about a condition on the street that needs to be addressed, the city addresses it as quickly as possible, with multiple city agencies responding as appropriate.”

When the city dismantles a street site, it offers outreach services to people living there and tries to persuade them to accept placement in a shelter, Mr. McGinn wrote. With the city’s subways now closed overnight for cleaning as a pandemic precaution, some people who had sought refuge in the transit system have moved to the street.

The city added more than a thousand beds in private rooms in hotels last year to safely accommodate homeless people during the pandemic, but as of December, only people with certain health problems qualify for them. Most homeless people who seek shelter from the city are placed in group shelters or in rooms with roommates, according to the Urban Justice Center.

In the group shelters, nearly 3,000 people have tested positive for Covid-19 and 102 have died of it, the city reported on Wednesday. The city has recorded 172 Covid-19 cases and 12 deaths among people living on the street.

“The city completely disregarded the C.D.C.’s guidance,” said Peter Malvan, an organizer with the Safety Net Project who was once homeless.

Single homeless adults staying in shelters have been eligible for vaccination since mid-January, and the city said Wednesday that more than 3,100 people at shelters — some residents, some staff members — had received at least one vaccine. As of Monday, there were about 18,500 single adults in shelters.

A woman walks outside the National Stadium, the main venue for the opening and closing ceremonies for the Summer Olympics Games in Tokyo on February 11, 2021.Credit…Philip Fong/Agence France-Presse — Getty Images

Organizers of the Tokyo Olympics will decide by the end of March if they will allow international spectators to attend the Games this summer in Japan. The timetable was revealed at a news conference on Wednesday by Seiko Hashimoto, the organizing committee president, who acknowledged the ongoing coronavirus pandemic meant a total ban on overseas fans remained a possibility.

“When we think of the current situation, whether it is Japan or overseas, we are under a very difficult situation,” Hashimoto said. “That is a fact. In the end the decision about spectators will be whether we can maintain a safe and secure Games.”

Officials in Japan are scrambling to find a safe way to host the Olympics, which were postponed for one year last summer because of the pandemic. Concerns about ballooning costs and the prospect of thousands of overseas travelers entering the country have soured much of the country on the effort. The project took another hit last month when Yoshiro Mori, the previous president of the Tokyo Olympics, was forced to step down after making sexist comments at a meeting. On Wednesday, the organizing committee — at a news conference where it was represented by an all-woman group of officials — announced that 12 additional members, all of them women, would join its executive board. Out of 45 board members, 19 are now women.

In an effort to alleviate concerns around safety, Thomas Bach, the president of the International Olympic Committee, reiterated on Wednesday that the I.O.C. was urging all countries to find ways, within the rules of their national vaccination programs, to have their Olympic athletes vaccinated before the start of the Games.

“I can inform you that a considerable number of national Olympic committees have already secured this pre-Tokyo vaccination, and a very considerable number of national Olympic committees are in good contact with their respective governments to allow for this vaccination for Tokyo after the first wave of the risk population has been vaccinated,” Bach said.

The propriety of moving athletes and coaches to the front of vaccination lines has split the Olympic movement. Some countries, including Israel, Mexico and India, have said they will do so, and a few already vaccinating their athletes. Others, including the United States, Britain and Italy, have said their athletes will wait their turn.

Volunteers from the Colis du Coeur Zakaria association hand out food to people in the working-class district of Marolles, in Brussels, in February, thanks to donations from individuals.Credit…Stephanie Lecocq/EPA, via Shutterstock

Philanthropic giving in response to the Covid-19 pandemic topped $20 billion last year, orders of magnitude more than past disasters, man-made or natural, according to a report released Wednesday by the groups Candid and the Center for Disaster Philanthropy.

The total includes global giving by foundations, corporations, public charities and wealthy individuals.

“It’s far and away more than we have ever seen for disasters,” said Grace Sato, director of research at Candid. “It’s an overused term to say unprecedented, but I would say funding for Covid-19 has been unprecedented in terms of giving.”

By comparison, Candid found only $1 billion in gifts responding to the terror attacks of Sept. 11, 2001, and just $362 million for the Ebola crisis in West Africa less than a decade ago.

Demands on frontline charities have grown even as they face immense financial pressure. The Center for Civil Society Studies at Johns Hopkins University estimated that nearly 1 million jobs had been lost in the nonprofit sector in the United States from the start of the pandemic through January 2021, a 7.7 percent decline from February 2020.

The needs created by lockdowns, shortages of medical equipment and millions of deaths were unusual, but many of the names leading the way in giving last year are familiar. Among foundations, the two biggest givers were the Bill and Melinda Gates Foundation, which pledged $1.33 billion in response to the crisis, and the Rockefeller Foundation, which pledged more than $1.1 billion.

Corporations were responsible for 44 percent of total giving, with Google’s philanthropic arm pledging $1.16 billion.

Ms. Sato said the report did not capture smaller individual gifts to frontline charities, work by mutual-aid societies or crowdsourced fund raisers. It did include significant gifts announced by major donors, including MacKenzie Scott, a relative newcomer to mega-philanthropy.

Ms. Scott, a novelist and the ex-wife of Amazon founder Jeff Bezos, gave away nearly $6 billion last year. The report counted $4 billion of that as responding to the pandemic, totaling nearly three-quarters of Covid-19 related giving by high-net-worth individuals.

While the more than $20 billion in donations was an enormous amount of giving compared with past crises, that figure is dwarfed by the trillions of dollars in government stimulus packages.

“Compared to government spending, it’s a drop in the bucket,” Ms. Sato said.

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