Covid-19 News: Nurse Shortage Forces Long Island Emergency Room to Close

ImageThe emergency room at Mount Sinai South Nassau in Oceanside, N.Y., will have to handle patients from the Long Beach Emergency Department during the closure.
Credit…Johnny Milano for The New York Times

A Long Island emergency room was forced to close its doors on Monday because of a nursing staff shortage, as a New York state rule took effect that bars unvaccinated medical workers from their jobs.

The free-standing Emergency Department at Long Beach, which is part of Mount Sinai South Nassau, said in a statement that patients would be directed to the hospital’s main campus in Oceanside, N.Y., about five miles north. An ambulance will be stationed at the shuttered facility, the statement said.

The hospital said the closure could last weeks or longer. But closing the Long Beach branch will allow the hospital to maintain adequate staffing at the Oceanside facility, the statement said.

“We regret having to take this step, but the safety of our patients is always our No. 1 priority,” said Dr. Adhi Sharma, the president of the medical center. “This closure should not be interpreted as anything beyond what it is — a temporary measure designed to relieve current staffing challenges in our emergency department. Our nurses, physicians and support staff have been on the front lines of the pandemic for more than 21 months. We will continue to be there for our patients.”

New York’s statewide vaccination mandate for health workers does not allow for religious exemptions, which spurred legal challenges. A federal court upheld the policy late last month.

Mount Sinai South Nassau said it had notified the state Health Department on Friday of the need to close the facility, and had submitted a formal closure plan. In a statement on Monday night, the Health Department said it was reviewing the plan and working with Mount Sinai South Nassau to “explore options.”

For now, Mount Sinai South Nassau is recruiting workers who can show proof of vaccination or valid medical exemptions in the hope of resuming full operations in mid-December.

Mount Sinai’s Oceanside emergency room is a designated trauma facility and sees about 70,000 patients a year, according to the medical center. The Long Beach branch, which opened in 2015, handles about 10,000 patients a year, most of whom are treated and discharged without being transferred to the hospital.

Credit…Don Treeger/The Republican, via Associated Press

A Massachusetts state judge on Monday dismissed criminal charges against two former administrators at a state-run facility for veterans, the Soldiers’ Home in Holyoke, where a coronavirus outbreak last year led to at least 76 deaths, reasoning that their actions did not lead to the infections.

The state’s attorney general, Maura Healey, had sought charges of criminal neglect and permitting body injury to an older person against the two men, Bennett Walsh, the former superintendent at the Soldiers’ Home in Holyoke, Mass., and David Clinton, the facility’s former medical director. Ms. Healey cited their decision to combine two understaffed dementia units, crowding together infected and uninfected men.

The criminal charges against the two men, who resigned their positions last year, were believed to be the first in the country brought against nursing home employees, and they had faced years or even decades in prison if convicted.

But Judge Edward J. McDonough Jr., of Hampden County Superior Court, wrote in his dismissal that he believed the five veterans named in the case had been exposed to the virus before the two units were merged, so the administrators could not be held legally responsible.

“There was insufficiently reasonably trustworthy evidence presented to the grand jury that, had these two dementia units not been merged, the medical condition of any of these five veterans would have been materially different,” he wrote.

Ms. Healey is weighing whether to appeal the decision, a spokeswoman said.

“We are very disappointed in today’s ruling, especially on behalf of the innocent victims and families harmed by the defendants’ actions,” said Jillian Fennimore.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of the most recent seven days of data.

Because of staffing shortages, the facility consolidated the units, which had a total of 42 residents who had different Covid-19 statuses, and residents who were positive or symptomatic were placed six in a room that typically held four veterans. An independent investigation of the deaths quoted nurses who said they knew that the move to combine units would prove deadly to many of their patients.

Relatives of the veterans who died at the facility expressed frustration at the judge’s decision on Monday.

“Absolutely disgusting, our veterans and their families apparently are a disposable commodity,” wrote Susan Perez, whose father, James Miller, died at the home, adding, “Apparently no one is responsible for the deaths of the veterans and trauma to their families.”

Correction: 

An earlier version of this briefing item misstated part of the name of the court where a Massachusetts state judge presides. It is Hampden County Superior Court, not Hampton.

Credit…Doug Mills/The New York Times

More than 90 percent of federal employees will have had at least one coronavirus vaccine shot by the end of Monday, the deadline set by President Biden when he announced vaccine mandates earlier this fall, according to a senior administration official.

The vast majority of those employees are fully vaccinated, and an additional 5 percent of employees are seeking or already have an exception or an extension, the official said. The news was first reported by Reuters.

This means the Biden administration will have achieved 95 percent compliance with the president’s requirement that federal employees have at least one shot or have an approved or pending exception or extension request by Nov. 22, according to the official, who spoke on the condition of anonymity to preview an announcement that White House officials will make later in the day.

Mr. Biden’s mandate for federal workers, announced in September, was part of an aggressive effort to combat the spread of the Delta variant, which has driven caseloads up to levels last recorded a year ago, before vaccines were widely available. The president also mandated vaccination for health care workers and ordered all companies with more than 100 workers to require vaccination or weekly testing for their employees.

“We’ve been patient,” Mr. Biden said then, in a pointed message to people who refused to be vaccinated. “But our patience is wearing thin. And your refusal has cost all of us.”

More than 3.5 million federal workers, both in the United States and around the world, are covered by Mr. Biden’s mandate. Employees who have not complied, and do not have a pending or approved exception or extension request, will be expected to undergo education and counseling, the official said, followed by “additional enforcement steps.”

On Wednesday morning, the Office of Management and Budget will release data on the percentage of employees at each agency who are in compliance with the requirement.

A personnel change in the White House’s coronavirus team is expected next week. On Monday, Dr. Bechara Choucair, the former Chicago health commissioner whom Mr. Biden brought in to oversee the vaccination effort, will leave the administration, according to Jeff Zients, the White House coronavirus response coordinator.

Dr. Choucair was a senior executive at Kaiser Permanente before joining Mr. Biden’s staff and is “returning to the West Coast after staying longer than originally planned,” Mr. Zients said.

Credit…Nic Antaya for The New York Times

A month ago, new coronavirus cases in the United States were ticking steadily downward and the worst of a miserable summer surge fueled by the Delta variant appeared to be over. But as Americans travel this week to meet far-flung relatives for Thanksgiving dinner, new virus cases are rising once more, especially in the Upper Midwest and Northeast.

Federal medical teams have been dispatched to Minnesota to help at overwhelmed hospitals. Michigan is enduring its worst case surge yet, with daily caseloads doubling since the start of November. Even New England, where vaccination rates are high, is struggling, with Vermont, Maine and New Hampshire trying to contain major outbreaks.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of the most recent seven days of data.

Nationally, case levels remain well below those seen in early September, when summer infections peaked, and are below those seen last Thanksgiving. But conditions are worsening rapidly, and this will not be the post-pandemic Thanksgiving that Americans had hoped for. More than 90,000 cases are being reported each day, comparable to early August, and more than 30 states are seeing sustained upticks in infections. In the hardest-hit places, hospitalizations are already climbing.

“This thing is no longer just throwing curveballs at us — it’s throwing 210-mile-an-hour curveballs at us,” said Michael Osterholm, an epidemiologist at the University of Minnesota. He said that the virus had repeatedly defied predictions and continues to do so.

The new rise in cases comes at a complicated moment. Last Thanksgiving, before vaccines were available, federal and local officials had firmly urged Americans to forgo holiday gatherings. But in sharp contrast, public health officials, including Dr. Anthony S. Fauci, the nation’s leading infectious-disease expert, have mostly suggested this year that vaccinated people could gather in relative safety.

Credit…Eric Gay/Associated Press

The chief elected official in Dallas County celebrated a victory on Tuesday in his legal dispute over the governor’s ban on mask mandates, after a state appeals court upheld an earlier injunction against the ban.

The ruling by Fifth Court of Appeals in Dallas affirmed an August ruling by a district judge that Gov. Greg Abbott’s executive order banning mask mandates impeded the ability of Judge Clay Jenkins, the top elected official in Dallas County, to protect his constituents from Covid.

Partisan tensions are at a fever pitch over whether students, teachers and school employees should be required to wear masks. Some Republicans have cast mask rules as an infringement on parental rights, while many Democrats hold that they are a matter of public health.

Mr. Abbott has faced a series of legal challenges since he signed an executive order in July barring mandates for both masks and vaccinations.

Officials in Dallas and elsewhere in Texas have defied the governor by requiring people to wear masks in schools and other indoor public settings.

Credit…Massimo Percossi/EPA, via Shutterstock

BRUSSELS — European governments are toughening their measures against Covid in the face of soaring infection rates and popular resistance, with violent protests over the weekend in numerous countries.

Austria went into lockdown on Monday to try to break the fourth wave of Covid spreading across Europe, while the German health minister, Jens Spahn, warned that by the end of this winter, “just about everyone in Germany will probably be either vaccinated, recovered or dead.”

Tens of thousands of people protested official crackdowns and vaccine requirements in Austria, the Netherlands, Belgium, Denmark, Italy, Switzerland and Croatia, with scattered violence and police use of tear gas and water cannons. Some protesters were organized by far-right parties, but many were simply fed up with almost two years of intermittent state controls over their lives in the name of public health.

Europe has accounted for more than half the world’s reported Covid deaths this month, according to the World Health Organization. On Monday, the Centers for Disease Control and Prevention advised Americans not to travel to Germany or Denmark because of the rising case rates there.

Chancellor Angela Merkel of Germany told her Christian Democratic Party on Monday that the latest surge was worse than anything Germany had suffered so far. And neighboring Austria began its fourth lockdown, one of the few in Western Europe since vaccines became widely available.

Most stores, restaurants, sporting venues and cultural institutions shut down, leaving the streets cold and quiet in the weeks before Christmas. The lockdown, which allows people to leave home only to go to work or to procure groceries or medicines, will last at least 10 days and as many as 20.

Austria has also announced that vaccination will be compulsory as of Feb. 1 — the first Western country to take that step, and one of only a handful around the world. On Saturday, some 40,000 Austrians marched in Vienna to protest the new measures.

In France, President Emmanuel Macron has relied more on persuasion. Proof of vaccination or a recent negative test is required to patronize restaurants and cinemas, which has encouraged many reluctant French to get vaccinated without a national mandate. But anti-vaccination groups remain active in France, as well.

Global roundup

Credit…Olivier Hoslet/EPA, via Shutterstock

France’s prime minister, Jean Castex, said on Tuesday that he had only “mild symptoms” after testing positive for the coronavirus, as the French news media criticized him for apparent past failures to follow the government’s social-distancing recommendations.

“I am well and am continuing to carry out my duties in isolation, strictly following the health protocol,” Mr. Castex said on Twitter.

On that same social network, however, many users shared videos of him appearing to flout distancing recommendations, including one from last week that showed a maskless Mr. Castex shaking hands with elected officials indoors.

The government itself has urged the French in recent weeks not to drop their guard and to continue observing distancing practices as much as possible, even when vaccinated.

Élisabeth Borne, the labor minister, recently warned companies not to become complacent about health guidelines. “Maybe we have lapsed a bit, barrier measures are being less respected,” she told the news channel BFMTV this month.

On Monday, Mr. Castex had just returned from an official trip to Belgium, where he met with Prime Minister Alexander De Croo, when he learned that his 11-year-old daughter had tested positive, his office said in a statement. He immediately took a test, which turned out positive.

President Emmanuel Macron of France chose Mr. Castex, 56, as prime minister in July 2020. Mr. Castex had previously been the top official in charge of lifting the strict nationwide lockdown France imposed during the first wave of the coronavirus pandemic.

Mr. Macron himself was sick with Covid-19 late last year.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The number of daily infections has shot up in France, which is one of several European countries experiencing a new wave of cases.

On Monday evening, Mr. Castex met virtually with elected officials from Guadeloupe, a Caribbean archipelago governed by France that has been rocked by violent unrest over the past few days because of protests against French vaccination mandates.

In a televised statement after the meeting, Mr. Castex condemned the violence and said the government would try to “convince and assist, individually, humanely,” health workers who are reluctant to get vaccinated.

“Vaccination is necessary for protection, most notably against serious forms of the illness,” said Mr. Castex, who is fully vaccinated. “There is no other way.”

In other news from around the world:

  • Officials in South Korea said on Tuesday that they had shut down a religious facility in the city of Cheonan after 210 of its 427 residents tested positive for the coronavirus this week, an outbreak that comes as the country’s cases surge to record highs. At least 191 of those infected in Cheonan were unvaccinated, a health official said. Officials did not release the name of the religious organization, citing disease control laws meant to protect privacy.

  • Germany’s military is set to require service members to be vaccinated after a committee of soldier-representatives and defense ministry staff approved such a step on Monday. The move still requires formal approval. German soldiers abroad have already been required to be vaccinated since the spring. On Tuesday, the defense ministry announced that it would send 6,000 soldiers to help districts dealing with a spike in coronavirus cases.

  • A court in Spain rejected a plan by the government of the Basque region to make it compulsory to show a vaccination passport to enter restaurants, concert halls and other public spaces. The judges ruled on Monday that the latest Covid numbers did not justify the blanket obligation. The regional government said it found the ruling incomprehensible, but that it would not appeal. At least three other regions of Spain had been preparing similar measures.

Video

Video player loading
The protests in France’s Caribbean territory, fueled by longstanding social and economic frustrations, grew increasingly violent as protesters burned cars and looted businesses.CreditCredit…Ricardo Arduengo/Reuters

Violent protests over vaccine mandates have rocked France’s overseas department of Guadeloupe in the Caribbean over the past week, fueled by longstanding social and economic frustrations over inequality with the mainland and simmering anger at being overlooked by the French government.

Guadeloupe, an archipelago of islands, is one of several French overseas territories that have been hit hard by the pandemic over the past few months and where France’s vaccination campaign has been met with the most suspicion and resistance.

A mix of old grievances and new distrust over Covid-19 rules has made the unrest particularly volatile.

Demonstrations that started peacefully with road blocks and pickets in front of the main hospital in Pointe-à-Pitre, Guadeloupe’s largest city, grew increasingly violent over the weekend, as protesters burned cars, looted businesses and clashed with riot police officers, who responded with tear gas.

More than 30 people accused of violence or looting have been arrested, and the local authorities imposed a nighttime curfew. The central government also announced over the weekend that it was sending over 200 police reinforcements.

On Monday, the remains of charred cars littered roads and schools remained closed as President Emmanuel Macron of France appealed for calm and order.

“Our priority is to continue convincing that vaccination is the best protection,” Mr. Macron told reporters during a visit to Amiens, his hometown in northern France. “And to yield nothing to lies, disinformation and the manipulation by some of this situation.”

“There is a very explosive situation, tied to a very local context, to historical tensions that we know of,” Mr. Macron acknowledged, as he accused some of the government’s critics of “using this context and these anxieties” to aggravate the situation.

Over 40 percent of the adult population in Guadeloupe is fully vaccinated, but that figure is nearly 90 percent for all of France including overseas regions, according to official statistics.

The unrest started last week with a strike by local unions that are opposed to France’s vaccine mandate for health workers. Those unions say it was imposed by the central government with little consultation, and are particularly infuriated that unvaccinated health professionals are suspended without pay.

“That is an unheard level of violence against them and their families,” Jean-Marie Nomertin, the secretary general of the Confédération Générale du Travail de la Guadeloupe, one of the protesting unions, said in a statement last week.

Protesters have also rejected France’s health pass, which is needed to gain access to restaurants, museums and other public places and can only be obtained through full vaccination, proof of Covid recovery, or a recent negative test — which must now be paid for out of pocket for those who are not vaccinated and do not have a prescription.

As in other overseas departments like Réunion or French Guiana that are a legacy of France’s colonial empire, Guadeloupe has long felt overlooked by policymakers in Paris, with decades-old anger over stagnant unemployment, high living costs and dysfunctional public utilities that have fueled protests in the past.

Suspicion of public health policies is especially high in the French Caribbean, where the government authorized the use of a highly toxic pesticide called chlordecone on banana plantations for decades, despite repeated health warnings.

“People are afraid, they have no trust,” Harry Durimel, the mayor of Pointe-à-Pitre, told Franceinfo on Monday, adding that local residents were “ready for a confrontation” over vaccine rules if they felt they were being forced “to inject a product in their body.”

On the nearby island of Martinique, unions on Monday called for a general strike over similar concerns.

Credit…Brian Inganga/Associated Press

NAIROBI, Kenya — Kenya will require people to show proof of coronavirus vaccination to enter many businesses, restaurants and government offices starting next month, a major policy shift that has prompted outrage in a country where less than 5 percent of the total population is fully vaccinated.

Mutahi Kagwe, the cabinet secretary for health, said on Sunday that he was concerned about a slowdown in vaccinations and hoped the new rules would persuade more people to get their shots. With schools closing and the country heading into the festive season, he said there were concerns that people would become complacent about public health measures, including social distancing and wearing masks.

The new measure was swiftly criticized by lawyers, activists and the public, who cautioned against a stringent vaccine mandate just weeks after the lifting of a longstanding nationwide night curfew that dampened economic activity.

“It’s clearly unconstitutional,” Waikwa Wanyoike, a prominent constitutional lawyer, said of the mandate, adding that using “threats” to get more people to get inoculated will only create more apprehension about vaccines. “The requirement may be right in terms of asking as many people to be vaccinated but the approach is wrong,” he said in a phone interview.

Vaccination campaigns in Kenya have been hampered by a lack of funding. There have been few awareness campaigns. Nor are there widespread vaccination sites. The authorities at times have scrambled to access or purchase cold storage facilities needed to store the shots.

The new rules will also extend to those planning to visit hospitals, prisons, eateries, bars, national parks and any business serving 50 or more people daily. Drivers of public transportation, along with pilots and air hostesses, will be expected to always carry proof of vaccination. In addition, visitors from Europe will be required to be fully vaccinated to enter Kenya.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The new rules are the most expansive introduced in the continent yet, according to Dr. Githinji Gitahi, who serves on the governing board of the Africa Centres for Disease Control and Prevention. Zimbabwe has mandated that civil servants get shots and requires congregants at places of worship to produce proof of vaccination. Uganda requires all teachers and health care workers to be vaccinated while Namibia has flouted the idea.

Kenya has recorded over 254,700 cases and 5,328 deaths from the coronavirus. While average case rates have dropped in recent weeks, the lag in vaccinations and the spread of the more contagious Delta variant had overwhelmed the country’s health care system. Kenya hopes to vaccinate at least 30 million people before the end of 2022, but like many African countries, it has also struggled to gain access to vaccines.

The new restrictions were met with skepticism, with many lamenting its impracticality. Some pointed to the low vaccination rates among the adult population, with just 8.8 percent of them fully vaccinated. Others said the mandate could open the door to more corruption, bribery and the proliferation of fake vaccine certificates.

Critics said the government should not only make sure that vaccines are available to all but also should come up with better strategies to address misinformation and resistance to getting vaccinated.

Irungu Houghton, the executive director of Amnesty International Kenya, said the new mandate, in its current format, risked depriving people of their right to not only work but also access critical services like health and education.

“This proposal risks domesticating the global vaccine apartheid and creating those with rights and those without,” Mr. Houghton said in a statement.

Credit…Emily Elconin for The New York Times

The American Medical Association voted last week to allow only licensed physicians to write requests for patients seeking medical exemptions from vaccine mandates.

But the association does not have the power to enforce what is, in effect, a symbolic action intended to show concern as tens of thousands of people seek exemptions. While some states prohibit alternative practitioners like homeopaths, chiropractors and naturopaths from writing medical exemptions for vaccines, other states allow it.

“Science supports a vaccine mandate,” said Dr. Gerald E. Harmon, the president of the American Medical Association, “and we do not need to offer routes to evade mandates and undermine public health by seeking out practitioners who are not licensed or medically trained.”

The A.M.A.’s stance reflects increasing frustration among doctors with the spread of misinformation about Covid-19 vaccines and the virus. The association says that alternative practitioners are less likely than licensed physicians to recommend vaccines, and that they may even advise people not be vaccinated.

But removing power from alternative practitioners would not stop patients from getting invalid medical exemption requests. Licensed medical doctors are also writing bogus requests, according to doctors who are being asked to rule on them.

Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, sees the problem with invalid exemptions firsthand. Although California prohibits alternative practitioners from writing vaccine exemptions, patients are finding licensed doctors who will write them.

Dr. Chin-Hong said the university often called on him to evaluate the requests.

“I have never seen one that passed muster,” he said.

Some patients seeking a medical exemption will simply hop from one doctor to another if they are turned down, said Lawrence O. Gostin, a global health law professor at Georgetown University. If the university denies their request, he added, people often turn up again with a request for a religious exemption.

Correction: 

An earlier version of this article misstated which practitioners are prohibited by some states from writing medical exemptions for vaccines. Osteopaths can write exemptions, they are not among the alternative practitioners prohibited from doing so.

Credit…Joel Carrett/EPA, via Shutterstock

Australia, 20 months after shutting its borders, will allow skilled workers and international students to enter the country next month, the government announced on Monday.

The move comes as the Australian government, faced with a severe labor shortage, turns its focus to economic recovery, with 72 percent of the country fully vaccinated.

The new rules go into effect on Dec. 1, the beginning of summer in Australia. Some categories of visa holders, including skilled workers, international students, and those on working holiday and prospective marriage visas, will be allowed to enter Australia for the first time since the start of the pandemic. Over 200,000 people will fall into those categories.

“The return of skilled workers and students to Australia is a major milestone in our pathway back,” Prime Minister Scott Morrison said on Monday at a news conference. “The steps that we are taking today are about securing our economic recovery.”

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

At the start of the pandemic, Australia shut its borders to noncitizens, leaving hundreds of thousands of visa holders stranded outside the country and contributing to a significant worker shortage. Australia has relied on temporary workers for many industries, such as hospitality and agriculture. The travel restrictions also created a severe funding shortfall for universities.

Most tourists are still barred from traveling to Australia, except those from Singapore, South Korea and Japan, all countries that have established travel bubbles with Australia.

Visitors entering Australia will need to be fully vaccinated and return a negative PCR test within three days of boarding their flight. Upon arrival, they will need to follow some quarantine restrictions, depending on the state in which they arrive.

On Sunday, the first planes from Singapore arrived in Sydney and Melbourne under the new travel bubble arrangement, bringing the first tourists into the country since the start of the pandemic.

Credit…Gabby Jones for The New York Times

The lines are getting longer at the Halal Guys food cart in the heart of Manhattan. The number of international visitors buying Statue of Liberty tickets has jumped more than 50 percent. And a few thousand more people are walking through Times Square.

After more than 18 months, the United States reopened its borders on Nov. 8 to vaccinated foreign travelers. Early indications suggest that they have been trickling back to New York, the top American destination city for international tourists.

But many businesses that depend on international visitors, including hotel operators and restaurants, see signs that even more tourists could start streaming in as the year-end holiday season approaches, providing a badly needed boost as the city’s labor force struggles to recover from the pandemic.

The tourism industry has increasingly become a pillar of New York’s economy. A record 66.6 million travelers visited the city in 2019, and their spending supported hundreds of thousands of jobs, from restaurant workers to museum security guards to bus drivers.

Some airlines reported that their first flights carrying tourists to New York in 20 months were fully booked.

“It really seems like the city is happy to show itself to the world again,” said Christiaan Vander Kuylen, who arrived recently from Brussels. “The energy is amazing.”

Credit…Christopher Occhicone for The New York Times

As a company in India tests a cheap and possibly highly effective Covid-19 vaccine, a large group of researchers, most of whom are at Harvard, made the same vaccine and figured out how and why it could work so well, especially in vulnerable older adults.

The Harvard group began with a crucial question about Covid: Which population is most important to protect?

The answer, of course, is older people who are most at risk for severe disease and death.

The Harvard group began testing the vaccine with old mice. Like older people, old mice are much more susceptible to the coronavirus and much more likely to die.

The researchers made a vaccine that included a fragment of the virus’s spike protein, the part that latches onto cells, allowing the virus to enter. Vaccines like the ones made by Moderna and by Pfizer-BioNTech spur cells to make complete copies of the spike, prompting the immune system to make antibodies to block it if a coronavirus tried to infect the person.

But those vaccines are expensive to make and store. In contrast, a snippet of the spike is cheap and can be stored at room temperature. The problem was that it does not elicit much of an immune response.

The Harvard group, led by David Dowling, turned to adjuvants — chemicals that enhance the immune system’s response to vaccines — trying one adjuvant combination after another until they found one that seemed spectacularly successful. With that adjuvant, the vaccine protected mice at least as well as the Pfizer vaccine, said Dr. Ofer Levy, the director of Harvard’s Precision Vaccines Program.

But what about people? Dr. Levy recruited volunteers from his Cambridge synagogue — people in their 60s, 70s and 80s — to provide blood for lab tests to see if the adjuvant that was so good in mice also stimulated the immune system in older people.

It did.

Now the question is what will happen in the trial in India? If the vaccine works, the hope is that it could help solve one of the thorniest problems in stemming the pandemic — how to make vaccines accessible to everyone worldwide.

The Indian government seems to be betting on success. In June, while clinical trials were in their early stages the government preordered 300 million doses. Its maker, Biological E Limited, estimates it will cost $3 a dose.

In contrast, Pfizer’s price is $19.50 a dose but is expected to rise after its pandemic pricing phase ends.

Credit…Andrew Kutan/Agence France-Presse — Getty Images

Papua New Guinea will have vaccinated only a third of its adult population by 2026 if it continues at its current rate, according to new research by an Australian think tank that predicts that some countries in the Pacific will take years to vaccinate their populations.

The research by the think tank, the Lowy Institute, using modeling based on existing vaccination rates and factors such as demography, vaccine acceptance rates and health sector capacity, found that while some countries in the Pacific are leading the world in vaccination rates, others are lagging far behind.

“The Pacific is divided when it comes to vaccinations,” said Alexandre Dayant, the author of the study and a Lowy Institute research fellow, warning that the slow vaccination speed in some nations raised the risk of new variants emerging.

Palau has given 99 percent of residents at least one vaccine dose. Tonga and Samoa are set to vaccinate their adult populations before the end of the year, according to the modeling, which is subject to change.

However, the Solomon Islands are not expected to fully vaccinate their adult population until April 2026, while it is estimated to take Vanuatu until then to vaccinate 86 percent of its adult population. And Papua New Guinea, the slowest in the region, will have vaccinated only about 16 percent of its population by December 2022.

These countries have been hampered by overstretched health care systems and rampant vaccine misinformation, Mr. Dayant said.

Facebook is often people’s primary source of information there, and unsubstantiated theories of Western plots to inoculate people with microchips and black magic circulate on social media, he said, adding: “misinformation spreads much quicker than the virus in the Pacific.”

He said wealthy countries could do more, like bolstering local health care systems. “It is in the interest of the world to vaccinate developing countries,” he said.

Credit…Brendan Mcdermid/Reuters

Seeking to increase the supplies of coronavirus vaccines, treatments and diagnostic tests needed to quell the pandemic around the globe, 15 human rights groups have asked President Biden to apply maximum pressure on the World Trade Organization to grant an intellectual property exemption for the vaccines.

The exemption would mean that any country or company that has the ability to produce a vaccine could do so without having to worry about running afoul of the world economic body’s property right protections. Some public health experts see a W.T.O. exemption as key to bolstering the production of vaccine in developing countries, allowing drugmakers around the world access to closely guarded trade secrets on how viable vaccines have been made.

“The stakes could not be higher,” the groups wrote in a letter to the White House dated Nov. 19. “Failure to enact a waiver will prolong the pandemic leading to more death, illness, economic hardship, and social and political disruption.”

Only 5 percent of people in low-income countries have received at least one dose of a coronavirus vaccine, according to the Our World in Data project at the University of Oxford, a figure that is dwarfed by rates in wealthier countries.

Public Citizen, Oxfam, Amnesty International, Human Rights Watch, Doctors Without Borders and Partners in Health are among the organizations listed on the two-page letter.

“There are people talking about whether or not we should take boosters,” Dr. Joia Mukherjee, chief medical officer of Partners In Health, a global public health nonprofit, said at a news conference on Tuesday. “This, to me, is even a false argument because that plays into the narrative that this is a scarce commodity.”

“It is only a scarce commodity because Pharma wants it to be a scarce commodity so that they can maximize profit,” she said, using shorthand for the pharmaceutical industry. “And we just need to say enough is enough. This is the time for us to show leadership.”

The increase in pressure on the Biden administration comes one week before hundreds of officials converge on Geneva for the W.T.O.’s major ministerial conference on Nov. 30.

In May, the White House said that it supported waiving intellectual property protections for coronavirus vaccines, as it sought to bolster production amid concerns about vaccine access in developing nations.

But the rights groups said in their letter that they were disappointed that the administration had since “been unwilling to take further leadership.” They noted that more than 100 W.T.O. member nations supported a waiver.

Six times as many booster shots of coronavirus vaccine are being administered in wealthy countries around the world each day than primary doses are being given in low-income countries, according to the World Health Organization. The group’s director general, Dr. Tedros Adhanom Ghebreyesus, has called that disparity “a scandal that must stop now.”

The Biden administration said last week that it planned to spend billions of dollars to expand vaccine manufacturing capacity, with the goal of producing at least one billion additional doses a year beginning in the second half of 2022.

Credit…Emily Elconin for The New York Times

Coronavirus cases in children in the United States have risen by 32 percent from about two weeks ago, a spike that comes as the country rushes to inoculate children ahead of the winter holiday season, pediatricians said.

More than 140,000 children tested positive for the coronavirus between Nov. 11 and Nov. 18, up from 107,000 in the week ending Nov. 4, according to a statement on Monday from the American Academy of Pediatrics and the Children’s Hospital Association.

These cases accounted for about a quarter of the country’s caseload for the week, the statement said. Children under 18 make up about 22 percent of the U.S. population.

“Is there cause for concern? Absolutely,” Dr. Sean O’Leary, the vice chair of the academy’s infectious diseases committee, said in an interview on Monday night. “What’s driving the increase in kids is there is an increase in cases overall.”

Children have accounted for a greater percentage of overall cases since the vaccines became widely available to adults, said Dr. O’Leary, who is also a professor of pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado.

Though children are less likely to develop severe illness from Covid than adults, they are still at risk, and can also spread the virus to adults. Experts have warned that children should be vaccinated to protect against possible long-Covid symptoms, Multi-system Inflammatory Syndrome and hospitalization.

At the end of October, about 8,300 American children ages 5 to 11 have been hospitalized with Covid and at least 172 have died, out of more than 3.2 million hospitalizations and 740,000 deaths overall, according to the Centers for Disease Control and Prevention.

At a news conference on Friday, Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, said hospitalizations and deaths among 5- to 11-year-olds were “really startling.”

Dr. O’Leary said it did not help that many schools had softened their safety protocols in the last few months.

“So any protection that might be happening in schools is not there,” he said.

Vaccinations of younger children are likely to help keep schools open. Virus outbreaks forced about 2,300 schools to close between early August and October, affecting more than 1.2 million students, according to data presented at a C.D.C. meeting on Nov. 2.

Dr. O’Leary said that he was especially concerned about case increases in children during the holiday season.

With the pace of inoculations stagnating among U.S. adults, states are rushing to encourage vaccinations for children 5 through 11, who became eligible earlier this month after the C.D.C. authorized the Pfizer-BioNTech vaccine for that age group. In May, the federal government recommended making the Pfizer-BioNTech vaccine available to children ages 12 to 15. Teenagers 16 and older became eligible in most states a month earlier.

The White House estimated on Nov. 10 that nearly a million young children had gotten vaccinated; 28 million are eligible. They receive one-third of the adult dose, with two injections three weeks apart.

All of the data so far indicates that the vaccines are far safer than a bout of Covid, even for children.

Still, about three in 10 parents say they will definitely not get the vaccine for their 5- to 11-year-old child, according to a recent poll by the Kaiser Family Foundation. Only about three in 10 parents said they would immunize their child “right away.”

Covid Thanksgiving: Fully vaccinated family members can celebrate the holidays without masks, Fauci says

“That’s what I’m going to do with my family,” Fauci, the director of the National Institute of Allergy and Infectious Diseases, told CNN’s Dana Bash on “State of the Union.”

However, the nation’s top infectious disease expert also noted if you are traveling or are unaware of the vaccination status of the people around you, then you should wear a mask in those situations.

“Get vaccinated and you can enjoy the holidays very easily. And if you’re not, please be careful,” Fauci said. “Get tested if you need to get tested when you’re getting together, but that’s not a substitute for getting vaccinated. Get yourself vaccinated and you can continue to enjoy interactions with your family and others.”

Fauci’s comments come as the US faces the second holiday season of the pandemic, but the first with safe and effective vaccines now available to people ages 5 and older. Still, a significant part of the eligible population remains unvaccinated.

According to data published Friday by the US Centers for Disease Control and Prevention, nearly 196 million people, or 59{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the total US population is fully vaccinated. But about 26.6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the eligible population, or 83 million people, have yet to receive a first dose.

The vast majority of Covid-19 deaths so far this year have been among unvaccinated people, Dr. Francis Collins, director of the National Institutes of Health, said Sunday.

“More than a thousand people dying every day — the vast majority of them unvaccinated. Those are preventable deaths, probably at least 100,000 of the deaths that have happened this year didn’t need to,” Collins said.

The seven-day average of vaccinations has increased — about 36{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} compared to last week — due in large part to vaccinations among newly eligible children.

Definition of ‘fully vaccinated’ remains the same

Another factor here is vaccine booster doses: As of Friday, the CDC and the US Food and Drug Administration have approved boosters for every adult who received Moderna or Pfizer/BioNTech’s Covid-19 vaccine six months ago or longer.

The agencies had already said everyone who got Johnson & Johnson’s Janssen vaccine two months ago or more should get a booster.

For now, Fauci said the US definition of “fully vaccinated” remains the same — two doses given within a certain timeframe — but those guidelines could potentially change with more data.

The booster question is now much simpler than before

“Two shots for a time frame means you are fully vaccinated, but the thing you want to get the people and the viewers to understand, it isn’t the effectiveness of the vaccine — it’s quite effective — it’s how long it lasts,” he said.

“We’re going to take a look right now at what the durability is of the booster. We’re going to follow people who get boosted,” Fauci told Bash. “It will be guided by the science — and people should not be put off by the fact that as time goes by and we learn more and more about the protection that we might modify the guidelines.”

Fauci underscored the importance of vaccines and boosters going into the next few months, as he noted an uptick in cases is “not unexpected” in the winter.

Those who are eligible for vaccines but remain unvaccinated pose a risk not just to themselves and other people who are unvaccinated, he said, “but it also spills over into the vaccinated people, because no vaccine is 100{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} effective.”

“We have a lot of virus circulating around. We know that there are breakthrough infections and that’s how you get the uptick in cases,” Fauci said. “The bottom line, common denominator of all of this data, is we should get vaccinated if you’re not vaccinated, and boosted if you have been vaccinated.”

CNN’s Maggie Fox contributed to this report.

Does diet influence dementia risk? What we know

Dementia is a leading cause of disability and death worldwide. There is no cure. Recent research has focused on whether diet might influence the risk and progress of dementia. In this Special Feature, Medical News Today assesses the evidence and looks at how you might help reduce your risk of dementia.

Share on Pinterest
What does the latest research say about the link between diet and dementia risk? We investigate. Image credit: Luis Manuel Matias/Addictive Creative/Offset

According to the World Health Organization (WHO), dementia affects more than 55 million people worldwide, with 10 million people receiving a diagnosis each year. About 60-70{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people globally with dementia have Alzheimer’s disease, which affects almost 6 million people in the United States.

It may be the third leading cause of death after cancer and heart disease in certain age groups.

With an aging global population, the WHO predicts that the number of people with dementia will rise to 78 million by 2030 and 139 million by 2050.

According to existing research, diabetes, obesity, and heart disease, which can increase the risk of developing dementia, are all rising in number.

The main symptoms of dementia are memory problems, loss of cognitive function and coordination, and personality changes. The most significant risk factor for dementia is aging — more than 90{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of people with dementia are over 65 — but other factors are also involved.

There is currently no cure for dementia, and most treatments alleviate symptoms without slowing the progress of the disease. So are there ways reduce to reduce this risk?

Keeping fit and healthy can reduce the risk of dementia — and diet is a large part of keeping fit.

In a comment for MNT, Dr. Christopher Weber, director of global science initiatives at the Alzheimer’s Association, noted that:

“Research looking at the relationship between diet and cognition is well-established. There is strong evidence to suggest that what is good for the heart is good for the head, and we know a healthy diet is good for the heart.”

Some studies have suggested that a Mediterranean diet can improve cognitive function. This diet includes plenty of fruit and vegetables, nuts and seeds, olive oil and fish, with small amounts of dairy, eggs, and red meat, together with a moderate amount of red wine.

Recent research showed that a Mediterranean diet has associations with improved cognitive functioning and slowed the progression from mild cognitive impairment to dementia.

An alternative to the Mediterranean diet is the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay). The diet is similar but focuses on green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, seafood, poultry, olive oil, and wine.

This diet highlights the importance of foods and nutrients that have an association with dementia prevention.

A problem with diet studies is that they are observational, and people usually assess their diet through self-reported questionnaires. However, researchers have demonstrated an association between these diets and improved cognitive function.

One study showed a substantially slower cognitive decline in those following the MIND diet. A 2021 study found a positive correlation between MIND diet score, cognitive resilience, and cognitive function.

Interestingly, the researchers found that improved cognitive function was independent of brain pathologies that post-mortems identified in participants.

Dr. Weber commented: “The Mediterranean diet and the MIND diet have been shown in clinical studies to be beneficial to brain and heart health. The Alzheimer’s Association encourages everyone to eat a healthy and balanced diet as a way to help reduce the risk of cognitive decline.”

Processed food is one of the current bad guys. Experts tell us to eat a balanced and varied diet containing plenty of fresh food to stay healthy. But could a diet high in processed food increase your dementia risk?

“There is […] strong evidence linking poor diet (for example, eating a diet high in unhealthy fats and sugar) and increased risk for dementia.”

– Dr. Christopher Weber

In animal models, a diet high in refined carbohydrates increases the risk of dementia and Alzheimer’s. A human study in France replicated this effect and confirmed that older participants who ate a daily snack high in refined carbohydrates were more likely to develop dementia.

Another study has linked processed meat products, such as sausages, salami, and bacon, with dementia. Regular consumption of processed meat increased the relative risk of all dementias by 44{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} and Alzheimer’s disease by 52{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

However, like all the other dietary studies, this was observational and the risks reported are relative rather than absolute. One expert commented that the results “would not persuade me to give up my breakfast bacon.”

Proponents of vitamin and mineral supplements often tout them as a way of compensating for a less than optimal diet, but is there any evidence that they might help combat dementia?

A recent study gave older male rats a processed food diet high in refined carbohydrates and found that their learning and memory skills suffered. Another group of rats on the same diet but with omega-3 supplements showed no memory problems.

The authors of the study explained their findings in terms of the inflammatory response provoked by processed foods. Scientists know that omega-3 resolves inflammation, which might explain the effect in the rats who received it.

However, there is little other evidence to suggest that supplements affect dementia. The WHO advises that a healthy diet and regular exercise will likely have more significant effects.

The link between alcohol and dementia is not entirely clear. While heavy alcohol consumption has strong associations with the development of dementia, the effect of moderate alcohol intake is still open to question.

The majority of studies show an association between low to moderate alcohol use and reduced risk of dementia, particularly for red wine drinkers.

Two systematic reviews, one of which analyzed results from 26 studies, concluded that reducing heavy alcohol use could be an effective dementia prevention strategy.

However, they also noted that those who abstained from alcohol entirely had a higher dementia risk than those who drank in moderation.

Therefore, it is possible that drinking in moderation may have some protective effect, but no observational study can exclude all other factors. It may be that those who drink moderately have a better diet, do more exercise, or are generally in better health.

One study into the effects of moderate drinking in older adults in New Zealand controlled for socioeconomic status but found no evidence for a link between moderate drinking and better health.

So perhaps that protective effect is just wishful thinking from those of us who enjoy an occasional drink!

Research has linked memory decline with inflammation, and this is an area that is attracting a lot of interest.

According to Prof. Tim Spector, Professor of Genetic Epidemiology, King’s College London and Zoe Study lead, “This fits with the ‘inflammaging’ theory that is gaining a lot of traction.”

There are links between inflammation and the gut microbiome. Several clinical studies have seen an association between the gut microbiome and dementia.

One cross-sectional study in Japan found a significant difference between the microbiome of people with dementia and those without the disease.

Those with dementia had a much lower number of Bacteroides, a species known to reduce inflammation. They also had much higher numbers of microbes (enterotype III) that have associations with dementia.

Two other studies back up these findings. One analyzed gut microbiome metabolites, finding that people with dementia had significantly different metabolites from those without the disease.

A second stressed the links between the gut microbiota and dementia development, observing effects on the microglia and cytokine release, which have implications in inflammation and dementia.

“There are large numbers of studies that are pointing in the same direction. People with dementia have sub-optimal microbiomes. The picture is of not only reduced numbers of species but also increased numbers of inflammatory species.”

– Prof. Tim Spector

The gut microbiome and diet have links, and this could be why the Mediterranean and MIND diets have shown positive effects in reducing dementia risk and progression.

“Reduced [microbiome] diversity and [more] inflammatory species are related to poor diet, generally low in fiber and diversity of plants,” Prof. Spector told us. “With elderly people, there’s often a tipping point, such as losing a partner. The diet reduces in quality and diversity. That can accelerate cognitive decline.”

He did, however, stress that there may be a reverse causality. People in the early stages of cognitive decline might reduce the quality of their diet and thereby accelerate the process.

“Studies of centenarians have found that they generally live in areas with a good food culture and lots of socializing,” he added. “It’s not about fats. It’s not about carbohydrates or calories, but can you get fresh, varied food? You need your gut microbes to keep your immune system suppressing inflammation?”

The short answer is probably; that diet may well play a part. Evidence is growing that a varied diet rich in plants will support a varied gut microbiome. And a varied gut microbiome helps to reduce the inflammation implicated in dementia.

“Poor diet harms microbes, which harms the immune system with these knock-on effects of cognitive decline. In dementia, inflammatory aging is the current theory. It’s partly triggered by the immune system which involves the microbes and diet.”

– Prof. Tim Spector

So until randomized control trials can prove how diet influences dementia, it is probably best to eat a diet that reduces the risk of heart disease and supports your microbiome, combining it with regular exercise.

The jury is still out on moderate alcohol consumption, but there is clear evidence that too much alcohol increases the risk of many health conditions, including dementia.

Dr. Weber concluded: “While we continue to learn more about lifestyle factors that have the greatest impact on our overall risk, there are things we can do today that may decrease our risk of cognitive decline as we age. Eating a heart-healthy diet, exercising regularly, and staying cognitively engaged are just a few.”

CDC recommends Covid-19 boosters for all adults

Walensky made her recommendation just hours after CDC vaccine advisers voted unanimously to recommend booster doses of Pfizer/BioNTech’s and Moderna’s Covid-19 vaccines for all US adults six months after they finish their first two doses.

The recommendations simplify previous, complicated guidance for boosters.

“CDC continues to encourage the 47 million adults who are not yet vaccinated to get vaccinated as soon as possible to protect themselves, their families, loved ones and communities,” the CDC said in a statement.

“We also strongly encourage those who were already eligible — older populations and individuals with underlying medical conditions — to get boosted before the holidays.”

Previously, boosters had been authorized for anyone 65 and older who was vaccinated with the Pfizer or Moderna vaccines at least six months ago and for certain adults at high risk of infection or of severe disease. Friday’s vote streamlines this, making clear every adult should or may get a booster six months after finishing the first two doses.

Some 'frustrated' states don't wait for FDA, expand Covid-19 vaccine booster eligibility to all adults

Recent real-world studies suggested that immunity from Covid-19 vaccines begins to wane and protection against milder and asymptomatic disease, in particular, may drop. Studies have shown that booster doses restore that immunity.

Members of the CDC’s Advisory Committee on Immunization Practices heard safety data from the CDC, from Pfizer and from Moderna that showed the boosters have not caused worrying adverse events. The most common reactions are pain at the injection site, headache and fatigue.

“After critical scientific evaluation, today’s unanimous decision carefully considered the current state of the pandemic, the latest vaccine effectiveness data over time, and review of safety data from people who have already received a COVID-19 primary vaccine series and booster,” Walensky said in a statement.

“Booster shots have demonstrated the ability to safely increase people’s protection against infection and severe outcomes and are an important public health tool to strengthen our defenses against the virus as we enter the winter holidays,” she added.

“Based on the compelling evidence, all adults over 18 should now have equitable access to a COVID-19 booster dose.”

Some 'frustrated' states don't wait for FDA, expand Covid-19 vaccine booster eligibility to all adults

The vote comes just in time for people to get boosters before the holidays, the CDC’s Dr. Sara Oliver told the meeting. Even if the added immunity given by boosters doesn’t last long, she said, it can help.

“Even temporary protection may factor into the benefit risk balance, especially as we approach the winter holidays with increased travel and holiday gatherings,” Oliver said.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN this week that recent data from Israel show that, among people age 60 and older, those who received a booster were less likely to become severely ill than vaccinated people who had not received a booster. Rates of severe disease remained highest among those who weren’t vaccinated.

The majority of adults had already been eligible to receive boosters, and several states have already moved to open up boosters to all adults.

‘Everyone is eligible’

Expanding booster eligibility to all adults in the United States may not change the logistics around getting shots into arms.

The vaccine supply for boosters is already established in many places. There are no “extra steps” on the administration side of the booster rollout that need to happen, Adriane Casalotti, chief of government and public affairs at the National Association of County and City Health Officials, told CNN.

“Looking national, we have enough vaccine. There are lots of places that have appointments. Obviously, that varies a little bit depending upon where you live geographically because there’s more demand in some areas than others,” Casalotti told CNN.

Frustrated Biden officials are hoping to simplify the message on Covid-19 with booster decision

“But that being said, I think the main preparation is on the communication side,” Casalotti added. “The communication for the local health care providers and public health departments is that now you don’t have to worry about eligibility if someone asks if they need to get a booster. This is the information — everyone is eligible after six months.”

Around 32 million people in the United States — about 17{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of those who are fully vaccinated — have received a booster dose of Covid-19 vaccine, according to CDC data.

About 18 million seniors have received a booster dose of Covid-19 vaccine, according to CDC data, accounting for more than half of all booster doses administered and increasing the immune response for more than a third of fully vaccinated seniors.

The future of boosters

The US is now averaging 94,943 new Covid-19 cases each day, according to Johns Hopkins University — a 31{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} increase over last week and back to levels last seen more than a month ago. Midwestern states account for more than a third (38{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}) of new cases.

There’s concern that winter weather that drives people indoors and holiday gatherings could lead to even more cases.

“We certainly want people to be as well protected as they could possibly be going into the season,” said Dr. Marci Drees, chief infection prevention officer and hospital epidemiologist for Delaware-based ChristianaCare.

Drees is a Society for Healthcare Epidemiology of America liaison to the CDC’s vaccine advisory committee.

“I think we’re at the point now where for lots of people who were vaccinated last winter and spring, now would be the time that their protection is waning,” she said.

Once people do receive their Covid-19 vaccine booster shots, it’s not clear when they might need another vaccine dose — if ever.

“That certainly is the million-dollar question. We know that the boosters boost people’s immunity back up to that 90{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} to 95{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} range in the short term. We don’t know how long that will last,” Drees said.

“In some ways, we’re forging a new path — and a lot of it is driven by can we get enough immunity in the population so that we can really shut down further transmission,” Drees said. “We know that boosters are not going to end the pandemic. They will help and prevent people from getting sick, but we really still need to push on getting first and second doses into people as well.”

CNN’s Deidre McPhillips contributed to this report.

First Known Covid Case Was Vendor at Wuhan Market, Scientist Says

A scientist who has pored over public accounts of early Covid-19 cases in China reported on Thursday that an influential World Health Organization inquiry had most likely gotten the early chronology of the pandemic wrong. The new analysis suggests that the first known patient sickened with the coronavirus was a vendor in a large Wuhan animal market, not an accountant who lived many miles from it.

The report, published on Thursday in the prestigious journal Science, will revive, though certainly not settle, the debate over whether the pandemic started with a spillover from wildlife sold at the market, a leak from a Wuhan virology lab or some other way. The search for the origins of the greatest public health catastrophe in a century has fueled geopolitical battles, with few new facts emerging in recent months to resolve the question.

The scientist, Michael Worobey, a leading expert in tracing the evolution of viruses at the University of Arizona, came upon timeline discrepancies by combing through what had already been made public in medical journals, as well as video interviews in a Chinese news outlet with people believed to have the first two documented infections.

Dr. Worobey argues that the vendor’s ties to the Huanan Seafood Wholesale Market, as well as a new analysis of the earliest hospitalized patients’ connections to the market, strongly suggest that the pandemic began there.

“In this city of 11 million people, half of the early cases are linked to a place that’s the size of a soccer field,” Dr. Worobey said. “It becomes very difficult to explain that pattern if the outbreak didn’t start at the market.”

Several experts, including one of the pandemic investigators chosen by the W.H.O., said that Dr. Worobey’s detective work was sound and that the first known case of Covid was most likely a seafood vendor.

But some of them also said the evidence was still insufficient to decisively settle the larger question of how the pandemic began. They suggested that the virus probably infected a “patient zero” sometime before the vendor’s case and then reached critical mass to spread widely at the market. Studies of changes in the virus’s genome — including one done by Dr. Worobey himself — have suggested that the first infection happened in roughly mid-November 2019, weeks before the vendor got sick.

“I don’t disagree with the analysis,” said Jesse Bloom, a virologist at the Fred Hutchinson Cancer Research Center. “But I don’t agree that any of the data are strong enough or complete enough to say anything very confidently, other than that the Huanan Seafood Market was clearly a super-spreading event.”

Dr. Bloom also noted that this was not the first time the W.H.O. report, done in collaboration with Chinese researchers, was found to contain mistakes, including errors involving early patients’ potential links to the market.

“It’s just kind of mind-boggling that in all of these cases, there keep being inconsistencies about when this happened,” he said.

Toward the end of December 2019, doctors at several Wuhan hospitals noticed mysterious cases of pneumonia arising in people who worked at the Huanan Seafood Wholesale Market, a dank and poorly ventilated space where seafood, poultry, meat and wild animals were sold. On Dec. 30, public health officials told hospitals to report any new cases linked to the market.

Fearing a replay of SARS, which emerged from Chinese animal markets in 2002, Chinese officials ordered the Huanan market closed, and Wuhan police officers shut it down on Jan. 1, 2020. Despite those measures, new cases multiplied through Wuhan.

Wuhan authorities said on Jan. 11, 2020, that cases had begun on Dec. 8. In February, they identified the earliest patient as a Wuhan resident with the surname Chen, who fell sick on Dec. 8 and had no link to the market.

Chinese officials and some outside experts suspected that the initially high percentage of cases linked to the market might have been a statistical fluke known as ascertainment bias. They reasoned that the Dec. 30 call from officials to report market-linked illnesses may have led doctors to overlook other cases with no such ties.

“At the beginning, we presumed that the seafood market may have the novel coronavirus,” Gao Fu, director of China’s Center for Disease Control and Prevention, said in May 2020, according to China Global Television Network. “But it now turns out that the market is one of the victims.”

By the spring of 2020, senior members of the Trump administration were promoting another scenario for the origin of the pandemic: that the virus had escaped from the Wuhan Institute of Virology, which has a campus roughly eight miles away from the Huanan market, across the Yangtze River.

In January of this year, researchers chosen by the W.H.O. visited China and interviewed an accountant who had reportedly developed symptoms on Dec. 8. Their influential March 2021 report described him as the first known case.

But Peter Daszak, a disease ecologist at EcoHealth Alliance who was part of the W.H.O. team, said that he was convinced by Dr. Worobey’s analysis that they had been wrong.

“That December the eighth date was a mistake,” Dr. Daszak said.

The W.H.O. team never asked the accountant the date his symptoms began, he said. Instead, they were given the Dec. 8 date by doctors from Hubei Xinhua Hospital, who handled other early cases but did not care for Mr. Chen. “So the mistake lies there,” Dr. Daszak said.

For the W.H.O. experts, Dr. Daszak said, the interview was a dead end: The accountant had no apparent links to an animal market, lab or a mass gathering. He told them he liked spending time on the internet and jogging, and he did not travel much. “He was as vanilla as you could get,” Dr. Daszak said.

Had the team identified the seafood vendor as the first known case, Dr. Daszak said, it would have more aggressively pursued questions like what stall she worked in and where her products came from.

This year, Dr. Daszak has been one of the strongest critics of the lab-leak theory. He and his organization, EcoHealth Alliance, have taken heat for research collaborations with the Wuhan Institute of Virology. Last month, the National Institutes of Health said EcoHealth was in breach of the terms and conditions of its grant for research on coronaviruses in bats.

While the doctors at Hubei Xinhua Hospital said that the onset of the accountant’s illness had been Dec. 8, a senior doctor at Wuhan Central Hospital, where Mr. Chen was treated, had told a Chinese news outlet that he developed symptoms around Dec. 16.

Asked about Mr. Chen’s case, China’s National Health Commission said it stood by comments made by Liang Wannian, the leader of the Chinese side of the W.H.O.-China investigation who led the interview with the Hubei Xinhua Hospital doctors. Mr. Liang told a news conference in February of this year that the earliest Covid case showed symptoms on Dec. 8 and was “not connected” to the Huanan market.

In their report, the W.H.O. experts concluded that the virus most likely spread to people from an animal spillover, but they could not confirm that the Huanan market was the source. By contrast, they said that a lab leak was “extremely unlikely.”

The report has come under fire for several errors and shortcomings. The Washington Post revealed in July that the report listed the wrong viral samples for several early patients — including the first official case — and mistakenly linked the first family cluster of cases to the Huanan market. The W.H.O. promised to fix the errors, but they remain in the report on the organization’s website. (The organization said that it would ask the report’s authors if and how they would correct the mistakes.)

In May, two months after the report by the W.H.O. and China was published, 18 prominent scientists, including Dr. Worobey, responded with a letter in Science complaining that the W.H.O. team had given the lab-leak theory short shrift. Far more research was required, they argued, to determine whether one explanation was more likely than the other.

An expert on the origins of influenza and H.I.V., Dr. Worobey has tried to piece together the early days of the Covid pandemic. Reading a May 2020 study of early cases written by local doctors and health officials in Wuhan, he was puzzled to see a description that seemed like Mr. Chen: a 41-year-old man with no contact with the Huanan market. But the study’s authors dated his symptoms to Dec. 16, not Dec. 8.

Then Dr. Worobey found what appeared to be a second, independent source for the later date: Mr. Chen himself.

“I got a fever on the 16th, during the day,” a man identified as Mr. Chen said in a March 2020 video interview with The Paper, a publication based in Shanghai. The video indicates that Mr. Chen is a 41-year-old who worked in a company’s finance office and never went to the Huanan market. Official reports said that he lived in the Wuchang district in Wuhan, miles from the market.

The New York Times was not able to independently confirm the identity of the man in the video.

Along with his fever on Dec. 16, Mr. Chen said he felt a tightness in his chest and went to the hospital that day. “Even without any strenuous exercise, with just a tiny bit of effort, like the way I’m speaking with you now, I’d feel short of breath,” he said.

Dr. Worobey said that the medical records shown in the video might hold clues to how the W.H.O.-China report wound up with the wrong date. One page described surgery Mr. Chen needed to have teeth removed. Another was a Dec. 9 prescription for antibiotics referring to a fever from the day before — possibly the day of the dental surgery.

On the video, Mr. Chen speculated that he might have gotten Covid “when I went to the hospital” — possibly a reference to his earlier dental surgery.

The Washington Post noted in July that the details provided by the W.H.O. for the Dec. 8 case seemed to fit better with an entry from an online database of viral samples linked to someone who got sick on Dec. 16. In response, the W.H.O. had said it was looking into the discrepancy.

An agency spokesman told The New York Times it would be “difficult to comment” on the first known case because the W.H.O. team had limited access to health data. He said it was important for investigators to keep looking for patients infected even earlier.

In Dr. Worobey’s revised chronology, the earliest case is not Mr. Chen but the seafood vendor, a woman named Wei Guixian, who developed symptoms around Dec. 11. (Ms. Wei said in the same video published by The Paper that her serious symptoms began on Dec. 11, and she told The Wall Street Journal that she began feeling sick on Dec. 10. The W.H.O.-China report listed a Dec. 11 case linked to the market.)

Dr. Worobey found that hospitals reported more than a dozen likely cases before Dec. 30, the day the Wuhan authorities alerted doctors to be on the lookout for ties to the market.

He determined that Wuhan Central Hospital and Hubei Xinhua Hospital each recognized seven cases of unexplained pneumonia before Dec. 30 that would be confirmed as Covid-19. At each hospital, four out of seven cases were linked to the market.

By focusing on just these cases, Dr. Worobey argued, he could rule out the possibility that ascertainment bias skewed the results in favor of the market.

Still, other scientists said it’s far from certain that the pandemic began at the market.

“He has done an excellent job of reconstructing what he can from the available data, and it’s as reasonable a hypothesis as any,” said Dr. W. Ian Lipkin, a virologist at the Mailman School of Public Health at Columbia University. “But I don’t think we’re ever going to know what’s going on, because it’s two years ago and it’s still murky.”

Alina Chan, a postdoctoral fellow at the Broad Institute in Cambridge, Mass., and one of the most vocal proponents of investigating a lab leak, said that only new details about earlier cases — going back to November — would help scientists trace the origin.

“The main issue this points out,” she said, “is that there’s a lack of access to data, and there are errors in the W.H.O.-China report.”

Eleanor Goodman contributed translation and Liu Yi contributed research.

F.D.A. Authorizes Coronavirus Booster Shots for All Adults

WASHINGTON — The Food and Drug Administration on Friday authorized booster shots of the two the Pfizer-BioNTech and Moderna vaccines for absolutely everyone 18 and more mature, opening up eligibility to tens of hundreds of thousands extra fully vaccinated grownups.

The transfer simplifies eligibility, fulfills a pledge by President Biden to supply the pictures to just about every American grownup and formally lets a observe already in put in at minimum 10 states. Fearful that waning defense and the onset of wintertime will established off a wave of breakthrough bacterial infections, a rising quantity of governors experienced currently provided boosters to every person 18 and more mature forward of the holiday seasons.

The company claimed the expansion was justified by presently out there scientific trial details as well as genuine-environment proof. In a statement, Dr. Peter Marks, who sales opportunities the F.D.A. division that regulates vaccines, extra: “Streamlining the eligibility requirements and creating booster doses offered to all people 18 several years of age and older will also aid to get rid of confusion about who could receive a booster dose and be certain booster doses are readily available to all who might require just one.”

Dr. Anthony S. Fauci, the federal government’s prime infectious disorder expert, has argued relentlessly more than the past month for booster shots for all older people, a place shared by most of Mr. Biden’s other health advisers. General public well being authorities who argue that healthy youthful older people do not need to have them, he has said, are ignoring the hazards of symptomatic Covid-19.

“Enough is plenty of. Let’s get shifting on below,” he stated at an occasion Wednesday night time. “We know what the info are.”

If the Centers for Disease Manage and Avoidance agrees, all grownups who gained a 2nd shot of either Pfizer or Moderna at the very least 6 months back will most probably be able to get a booster shot by the weekend. The agency’s outside advisers are conference to talk about the situation at midday Friday and will hear from Pfizer, Moderna and C.D.C. workers. A vote is scheduled for 2:45 p.m.

At a White Residence briefing on Wednesday, Dr. Rochelle Walensky, the C.D.C. director, promised that the agency would “quickly review the safety and usefulness knowledge and make suggestions as shortly as we hear from F.D.A.”

The F.D.A.’s motion came soon after months of fierce debate within the administration and the scientific community about who wanted booster photographs, and when. As huge experiments showed defense from all three federally approved vaccines keeping strongly, some outside the house advisers to the F.D.A. and C.D.C. consistently expressed distress with how promptly the administration was relocating to supply the shots.

When the F.D.A. has been evaluating booster details for months, it granted the companies’ requests with exceptional speed. Pfizer-BioNTech filed its request around 10 days back, and Moderna introduced Wednesday that it experienced applied but did not say when.

The agency said that it did not convene its impartial vaccine advisory committee for the reason that the panel experienced already experienced discussed the use of booster pictures thoroughly and “the requests do not increase concerns that would profit from further discussion.” The panel’s tips are nonbinding.

For Moderna, regulators stated, the facts confirmed that 149 scientific trial contributors who received a booster dose experienced higher antibody degrees in comparison with 1,055 review volunteers who acquired only two doses. They claimed Pfizer’s info for 200 members in a clinical trial showed the booster shot raised antibody stages compared to 1 thirty day period soon after a next shot.

Critics have mentioned the administration’s booster marketing campaign was determined by functional or political causes more than scientific kinds. Some explained that federal regulators had been examining safety and efficacy information on the fly. Others have fearful that moving to obvious Pfizer and Moderna booster doses for all older people may possibly inadvertently undermine the vaccines and counsel that two doses are not strongly protecting.

“The proof isn’t there that a large rollout of boosters is definitely going to have that considerably impact on the epidemic,” said Ira M. Longini Jr., a vaccine professional and professor of biostatistics at the College of Florida. He explained that booster doses could boost security at least briefly and may aid a jittery community sense as if they have a further tool in the pandemic, but would do tiny to halt transmission of the virus, which is becoming pushed by the unvaccinated.

Other general public overall health specialists have argued that data from Israel, which rolled out an aggressive booster campaign over the summer time, suggests boosters can reduce transmission premiums they say the added shots are necessary equally to counteract waning security and to limit confusion.

Elaborate eligibility rules coupled with the government’s recent determination to permit men and women pick among the all three vaccines for their booster have also still left the general public somewhat befuddled, proponents of the F.D.A.’s decision on Friday say.

“This conclusion by F.D.A. is overdue,” said Dr. Elizabeth McNally, director of the Centre for Genetic Drugs at Northwestern University’s Feinberg College of Drugs.

“Many individuals experienced difficulties comprehending regardless of whether they ought to or should not get boosters,” she explained in a statement. “This information is considerably clearer — get a booster!”

There is close to universal arrangement among federal officials, point out overall health leaders and exterior experts that persuading the tens of hundreds of thousands of Us citizens who have but to get even their initially shot should stay the prime precedence in making an attempt to curb the pandemic.

Extra than 182 million grown ups in the United States, or 71 percent, are totally vaccinated. So significantly, extra than 32 million of them have gotten an further shot.

Until eventually now, all those qualified for boosters involved folks 65 and older, people of extensive-term treatment facilities, folks with fundamental health care conditions, and individuals whose work or institutional living conditions heightened their risk.

All recipients of Johnson & Johnson’s a single-shot vaccine have presently been cleared to get a booster shot at least two months just after their injection.

Jason L. Schwartz, an affiliate professor of health coverage at the Yale University of Public Wellbeing, explained the most up-to-date shift was “a recognition that the present-day approach to booster tips just is not performing.”

“It’s so confusing that I feel the public has type of shrugged at the importance of boosters,” he explained. “And the teams for whom it’s really important to get boosters — the older people today, the lengthy-time period care people, folks with health-related conditions — aren’t finding boosters at the rates they must. It’s time for a reset.”

The booster rollout is increasing even as community wellbeing industry experts carry on to argue about no matter if young, balanced grownups need added defense. The argument is more robust for recipients of Pfizer’s vaccine than for recipients of Moderna’s, whose security has proved much more strong.

When some reports have observed that the Pfizer vaccine’s effectiveness in opposition to infection and hospitalization drops about 4 months following the 2nd dose, Moderna’s usefulness has remained steadier.

At the similar time, regulators have been anxious by information from Nordic nations and elsewhere suggesting that youthful male Moderna recipients may possibly confront heightened pitfalls of myocarditis, or inflammation of the heart muscle mass — a facet impact that has also been tied to the Pfizer vaccine. The F.D.A. on Friday current the vaccine’s simple fact sheets to take note that some experiments have advised there may possibly be an amplified hazard in adult males beneath 40 “relative to other authorized or authorized mRNA Covid-19 vaccines.”

Regulators stated that while facts was constrained, evidenced proposed a reduced hazard of myocarditis following booster doses than right after 2nd doses of the shot. Concerns about myocarditis are behind the F.D.A.’s selection to wait around to authorize the Moderna vaccine for adolescents.

Scientists have explained the absolute possibility nevertheless continues to be incredibly small, most scenarios are gentle and solve immediately and that Covid-19 can also bring about myocarditis.

The F.D.A. mentioned on Friday that in reviewing broader booster eligibility for Moderna’s and Pfizer’s vaccines, it had examined the latest virus instances and actual-earth knowledge on the dangers of myocarditis and concluded that the added benefits of a booster shot outweighed the challenges. The F.D.A. also noted that the two organizations had been conducting more scientific studies on myocarditis possibility.

At the coronary heart of the booster debate is the query of what vaccines are meant to do. Critics of the administration’s policy argue that despite some diploma of waning safety, the vaccines are even now fulfilling their mission of guarding versus severe illness and hospitalization.

Booster advocates like Dr. Fauci counter that the vaccines ought to also protect against symptomatic condition, in particular considering that some clients prevent hospitalization but endure extensive-time period repercussions.

“I really do not know of any other vaccine that we only stress about trying to keep persons out of the hospitals,” Dr. Fauci claimed at a White House briefing Wednesday. “I believe an significant issue is to avoid people today from finding symptomatic illness,” which includes younger men and women.

In current weeks, point out following point out has moved to allow for booster shots for all older people, which include Massachusetts, Rhode Island, Kansas, Kentucky, Maine, Vermont, Arkansas, California, Colorado and New Mexico.

A host of other nations around the world have taken the exact same technique, which includes Australia, Brazil, Canada, Germany, Hungary, Israel, Japan, Norway and Saudi Arabia. Regulators for the European Union have authorized booster doses of equally Moderna and Pfizer-BioNTech for all adults.

Kitty Bennett contributed research.