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Health

Nursing properties with extra minority residents had extra Covid deaths: Examine

Derede McAlpin is holding a photo of her mother, Sara McAlpin, 92, who was diagnosed with Covid-19 in Rockville, MD.

Katherine Frey | The Washington Post | Getty Images

Nursing homes with more minority residents reported more than three times as many deaths in Covid as those with more white residents, a large study published on Wednesday found.

The University of Chicago researchers examined 13,312 U.S. nursing homes and analyzed Covid data reported to the Centers for Disease Control and Prevention from May through December. They found that nursing homes where more than 40% of their residents were black or Spanish reported 3.3 times as many deaths and cases in Covid as nursing homes with more white residents.

Nursing homes and other long-term care facilities are hardest hit by the pandemic. Less than 1% of Americans live in such facilities, according to the CDC, but they have caused nearly 40% of all deaths in the United States, according to the COVID Tracking Project.

It is well documented that the pandemic has disproportionately affected the ethnic and racial minorities in the United States. President Joe Biden and his administration have vowed to ensure justice throughout the vaccine distribution process and to prioritize color communities disproportionately affected by the pandemic.

The new study, published on JAMA Network Open, shows how these differences affect nursing homes and has policy implications for vaccine distribution.

The differences were due to some historical factors, the researchers said. For example, minority residents in nursing homes are more likely to live in large facilities that are for-profit, rely more on Medicaid, and “have shortcomings in care,” the researchers said. They added that “Nursing homes in the US are very segregated”

An Empress EMS paramedic loads a suspected COVID-19 patient into an ambulance on April 7, 2020 in Yonkers, New York.

John Moore | Getty Images

“Before the COVID-19 pandemic began, racial differences in the quality of home care were known to be common,” the authors wrote. “Compared to whites, blacks are more likely to be admitted to the lowest quality nursing homes that have lower nursing staffing rates, more serious regulatory deficiencies, and a higher likelihood of being excluded from the Medicaid program.”

The researchers, health economists Rebecca Gorges and Tamara Konetzka, added that the pandemic is a “perfect storm” for residents of nursing homes.

“With minority communities having the highest COVID-19 infection rates and nursing homes in these communities generally being of lower quality, non-white nursing home residents are in the eye of this perfect storm,” they wrote.

The study finds that the death toll of Covid in U.S. nursing homes is likely to decline soon with the introduction of the vaccine. The CDC recommends that states give the vaccine to residents and long-term care workers as a priority before moving on to other segments of the population.

The Federal Pharmacy Partnership for Long-Term Care program allowed states to tap into pharmacies like CVS and Walgreens to help distribute the vaccine. As part of that program, more than 5 million doses have been given to residents and long-term care workers since Tuesday, according to the CDC.

“As vaccination progresses, it will be important for policy makers to consider existing inequalities to ensure that the vaccine distribution process includes a special effort to reach color communities,” the researchers wrote in the study.

They noted some limitations to their study. Institution-level data is publicly available through the CDC, but comprehensive individual-level data is not available. Such data “is needed to understand whether there are intra-facility differences in addition to differences between facilities,” they said.

They added that as of May, the data they analyzed were reported by nursing homes themselves, omitting many of the cases and deaths that had previously occurred. And they said the federal data “didn’t allow any racial classifications other than white, black, and Hispanic.” More detailed data would have enabled further analysis of the data across different racial groups.

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Business

The place can distant staff work throughout the pandemic? Up to now, not Asia

It is often said that remote workers can work from anywhere with an internet connection.

But tell this to someone who just wants to live and work in Bangkok or Bali.

The coronavirus pandemic has pushed millions of workers from their offices to their homes – and many have decided to change countries, at least temporarily. To keep up with this trend, countries in Europe, the Caribbean and the Caucasus are trying to lure these workers with new visa programs for “digital nomads”.

To date, however, no Asian country has officially opened the door to this new remote workforce, leaving them wondering whether to consider themselves their preferred Asian destination or apply to live in another location that is now open to them .

Remote workers want to travel

According to a global Booking.com survey of 20,000 travelers working from home during the pandemic, more than a third have considered working from another destination, Nuno Guerreiro, the site’s regional director, told CNBC’s Global Traveler.

A woman works near the beach on Koh Phangan island, Thailand.

lechatnoir | E + | Getty Images

“Research shows that there is an appetite to work from another destination. Respondents are in Asian countries such as Thailand (60%), Vietnam (52%), Singapore (50%) and China (45%) ). and Hong Kong (39%) outperformed the global average (37%) when it came to expressing interest in such agreements, “he wrote via email.

Respondents from Mexico, Brazil, Colombia, Argentina, Russia and the USA were also very interested.

Wanted: free time and a lower cost of living

Asia featured four of the top ten travel destinations for expatriates to live and work in in 2019. This is the result of the “Expat Insider 2019 Survey” by the expat network website InterNations.

1. Taiwan – Best in the world for affordability of healthcare
2. Vietnam – the best in the world for personal finance
3. Portugal
4. Mexico
5. Spain
6th Singapore – The best in the world for personal safety
7. Bahrain
8. Ecuador
9. Malaysia – Well rated for affordable living and housing costs
10. Czech Republic

Adrien Pierson is co-founder and COO of MillionSpaces, a workspace booking website operating in Singapore and Sri Lanka. He believes other destinations in Asia will be attractive to remote workers for the following reasons:

Photo credit: CNBC.com Source: Adrien Pierson, MillionSpaces

The MillionSpaces service, launched in 2020, enables employees to book workspaces or hold meetings in hotels, bars, restaurants and traditional workspaces for a period of just one hour. Pierson said he believes remote working will stay here because it allows working people – not just retirees – to live at the destination of their choice.

“You are almost … retiring 20 years earlier,” he said.

Places like Phuket, Thailand and Bali, Indonesia are vacation destinations with enough infrastructure to get work done, Adrien Pierson said.

Jasmina007 | E + | Getty Images

American Marta Grutka said she was interested in moving to Bali or Bangkok.

“I’ve lived in Bali in the past and worked from my laptop,” she said. “If border restrictions weren’t an obstacle, I could imagine having Bali as my base from which to work.”

She said “the quality of life for the price” is her main motivation, although she warned that living and working in Bali on a budget is not the same experience as vacationing there.

“Prices are rising dramatically due to the rush of expats going there over the years,” she said. “Several business owners I know recently moved to Bangkok from Bali to pursue a cheaper and more cosmopolitan lifestyle.”

Living and working in Bali is not the same as going on vacation, warned longtime digital nomad Marta Grutka.

Agrobacter | E + | Getty Images

Shuhui Fu from Singapore has been working from home since March 2020. She said if her company moves to permanent remote work that she is “pretty sure will,” she will investigate moving to Japan.

“I’m just fascinated by its culture and vibrancy, and yet there is a resemblance to it [Singapore] in terms of order and security, “she said.

In addition to travel opportunities, Fu is also motivated to exercise for the weather – but not for the warm beaches that draw many travelers to Asia. She would “go somewhere where I can experience the seasons that you cannot do in Singapore.”

A future for remote workers traveling in Asia?

So far, no country in Asia has announced a program specifically designed to attract the influx of remote workers caused by the pandemic.

And whether an Asian nation offers them a formal way to live and work within its borders is unclear. The Asian governments were very excited about this issue and the authorities in Singapore, Bali and Thailand did not respond to CNBC’s questions on the matter.

With the special tourist visa for Thailand, tourists can stay for up to nine months.

Alexander Spatari | Moment | Getty Images

There are still informal ways for remote workers to temporarily live in parts of Asia, although the pandemic has made them difficult to cope with.

“Digital nomads go from place to place and often conduct visa runs,” said Grutka, referring to the practice of crossing national borders to renew tourist visas. “With Covid it is now more expensive and it is more time consuming to take these steps.”

Bali is officially closed to international tourists, although some are finding ways to enter during the pandemic, Singapore digital newspaper Today reports.

The new Thailand tourist visa allows visitors to stay up to 90 days and can be extended twice, provided tourists are quarantined at approved facilities for at least 14 days upon arrival, long-term accommodation plans are proven, and health insurance is at least $ 100,000 Cover.

On the question of whether Asia will ever be officially open to remote workers, Booking.com’s Guerreiro said, “It’s only natural that supply should follow demand.”

The development of vaccines, improved contact tracing and the possibility of remote working becoming a reality in the long run led Guerreiro to predict that it “holds great promise for those who can travel and work virtually anywhere”.

Categories
Politics

Biden unveils Pentagon group to guage U.S. technique for coping with China

President Joe Biden speaks at the Pentagon in Washington, DC on February 10, 2021.

Alex Brandon | AFP | Getty Images

WASHINGTON – President Joe Biden announced on Wednesday a new Department of Defense task force to assess the US military’s China strategy.

“This is how we will meet the China challenge and ensure that the American people win the competition in the future,” said Biden on his first visit as Pentagon Commander in Chief.

The new Pentagon group, comprised of around 15 experts, will be responsible for making recommendations on China-related issues to Secretary of Defense Lloyd Austin. Results and recommendations are due within four months.

“No final public report is expected, although the department will discuss recommendations with Congress and other stakeholders if necessary,” the Pentagon wrote in a statement announcing the new task force.

China’s influence on global trade and international relations has continued to grow, even as the nation faced accountability calls in the initial response to the Covid-19 crisis.

The novel coronavirus that causes the disease emerged in China in late 2019. Biden asked on Wednesday whether the US would hold China accountable.

United States President Joe Biden, accompanied by Vice President Kamala Harris, Secretary of Defense Lloyd Austin, and General Mark Milley, Chairman of the Chief of Staff, will tour African Americans in defense of our corridor of our nations on February 10 at the Pentagon in Arlington, Virginia. 2021.

Alex Brandon | Pool | Reuters

Biden, who has not yet spoken to Chinese President Xi Jinping, said during a speech at the State Department last week that he would work more closely with allies to secure a backlash against Beijing.

“We will face China’s economic abuse,” said Biden, describing Beijing as America’s “most serious competitor.”

Tensions between Beijing and Washington, the world’s two largest economies, increased under the Trump administration. In an interview with CBS, Biden said his government was ready for “extreme competition” with China, but his approach would be different from that of his predecessor.

“I will not do it like Trump. We will focus on the international traffic rules,” said Biden on Sunday.

Following his remarks at the Pentagon on Wednesday, a reporter asked Biden if he was interested in punishing China for the nation’s lack of transparency over the Covid-19 outbreak last year.

“I’m interested in knowing all the facts,” Biden said, according to a pool report.

Flashing pressures china

State Secretary Antony Blinken spoke to his Chinese counterpart Yang Jiechi for the first time at the weekend.

In a tense appeal, Blinken Yang said the US would hold China accountable for explaining a range of issues including human rights abuses.

Blinken also called on Beijing to condemn the recent military coup in Myanmar.

On Wednesday before, Biden announced sanctions against military leaders in Myanmar who led the coup on February 1. Biden also reiterated the call for the Myanmar military to abandon the power he had seized and release his prisoners.

State Department spokesman Ned Price said the United States was coordinating with partners to launch “steep and deep” retaliatory measures.

Biden’s family ties

Speaking alongside Vice President Kamala Harris and Austin, Biden also took a moment to thank the service members and their civilian supporters.

He is the first president in 40 years to have a child serve in the US military and stationed in a war zone.

“The Biden family know what rural service is like and they understand sacrifice. They know how to care for those who seek leadership,” said Austin, who with the president’s late son, Beau Biden, cooperated in Iraq, in his opening remarks.

After the Pentagon address, Austin took Biden and Harris on a tour of the corridor of the building dedicated to Black Service members.

Austin is the nation’s first black Secretary of Defense, and Harris is the first black vice president.

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World News

Stay World Covid-19 Pandemic and Vaccine Updates

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C.D.C. Says Layering and Improving Mask Fit Increases Protection

Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, said wearing more tightly fitting masks or layering masks increases effectiveness in preventing Covid-19.

Research has demonstrated that Covid-19 infections and deaths have decreased when policies that require everyone to wear a mask have been implemented. So with cases, hospitalizations and deaths still very high, now is not the time to roll back mask requirements. I have also seen very many well-meaning people wearing masks that do not fit well or fit incorrectly. In fact, recent survey data from Porter Novelli found that among adults who reported wearing masks in the past week, half said they wore their masks incorrectly in public. New data released from C.D.C. today underscore the importance of wearing a mask correctly and making sure it fits closely and snugly over your nose and mouth. The C.D.C. is updating the mask information for the public on the C.D.C. website to provide new options on how to improve mask fit. This includes wearing a mask with a moldable nose wire, knotting the ear loops on your mask or wearing a cloth mask over a procedure or disposable mask. There are also new options available to consumers called mask fitters, small reusable devices that cinch a cloth or medical mask, and that can create a tighter fit against the face, and thus improve mask performance. The bottom line is this: Masks work and they work best when they have a good fit, and are worn correctly.

Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, said wearing more tightly fitting masks or layering masks increases effectiveness in preventing Covid-19.CreditCredit…Philip Cheung for The New York Times

Wearing a mask — any mask — reduces the risk of infection with the coronavirus, but wearing a more tightly fitted surgical mask, or layering a cloth mask atop a surgical mask, can vastly increase protections to the wearer and others, the Centers for Disease Control and Prevention reported on Wednesday.

New research by the agency shows that transmission of the virus can be reduced by up to 96.5 percent if both an infected individual and an uninfected individual wear tightly fitted surgical masks or a cloth-and-surgical-mask combination.

Dr. Rochelle P. Walensky, director of the C.D.C., announced the findings during Wednesday’s White House coronavirus briefing, and coupled them with a plea for Americans to wear “a well-fitting mask” that has two or more layers. President Biden has challenged Americans to wear masks for the first 100 days of his presidency, and Dr. Walensky said that masks were especially crucial given the concern about new variants circulating.

“With cases hospitalizations and deaths still very high, now is not the time to roll back mask requirements,” she said, adding, “The bottom line is this: Masks work, and they work when they have a good fit and are worn correctly.”

Virus-related deaths, which resurged sharply in the United States in November and still remain high, appear to be in a steady decline; new virus cases and hospitalizations began to drop last month. But researchers warn that a more contagious virus variant first found in Britain is doubling roughly every 10 days in the United States. The C.D.C. cautioned last month that it could become the dominant variant in the nation by March.

As of Feb. 1, 14 states and the District of Columbia had implemented universal masking mandates; masking is now mandatory on federal property and on domestic and international transportation. But while masks are known to both reduce respiratory droplets and aerosols exhaled by infected wearers and to protect the uninfected wearer, their effectiveness varies widely because of air leaking around the edges of the mask.

“Any mask is better than none,” said Dr. John Brooks, lead author of the new C.D.C. study. “There are substantial and compelling data that wearing a mask reduces spread, and in communities that adopt mask wearing, new infections go down.”

But, he added, the new research shows how to enhance the protection. The agency’s new laboratory experiments are based on the ideas put forth by Linsey Marr, an expert in aerosol transmission at Virginia Tech, and Dr. Monica Gandhi, who studies infectious diseases at the University of California, San Francisco.

One option for reducing transmission is to wear a cloth mask over a surgical mask, the agency said. The alternative is to fit the surgical mask more tightly on the face by “knotting and tucking” — that is, knotting the two strands of the ear loops together where they attach to the edge of the mask, then folding and flattening the extra fabric at the mask’s edge and tucking it in for a tighter seal.

Dr. Brooks cautioned that the new study was based on laboratory experiments, and it’s unclear how these masking recommendations will perform in the real world (the experiments used three-ply surgical and cloth masks). “But it’s very clear evidence that the more of us who wear masks and the better the mask fits, the more each of us benefit individually.”

Other effective options that improve the fit include using a mask-fitter — a frame contoured to the face — over a mask, or wearing a sleeve of sheer nylon hosiery material around the neck and pulled up over a cloth or surgical mask, the C.D.C. said.

Even as vaccines are being slowly rolled out across the country, the emergence of the new variants, which may respond differently to treatments or dodge the immune system to some degree, has prompted public health officials to emphasize that Americans should continue to take protective measures like masking.

United States › United StatesOn Feb. 9 14-day change
New cases 96,488 –35%
New deaths 3,170 –20%
World › WorldOn Feb. 9 14-day change
New cases 398,538 –26%
New deaths 14,751 –13%

U.S. vaccinations ›

Where states are reporting vaccines given

A mass vaccination site at Fenway Park in Boston.Credit…Charles Krupa/Associated Press

In a bid to get more residents age 75 and older vaccinated, Massachusetts officials say they will also inoculate the people accompanying them, regardless of age, to mass vaccination sites, which can be confusing to navigate.

“The idea for a mass vaccination site can seem a bit daunting,” Marylou Sudders, the secretary for health and human services in Massachusetts, said at a news conference on Wednesday.

The knowledge that the person accompanying them to the vaccination site will also be inoculated, Ms. Sudders said, may “bring an extra level of comfort to those who may be hesitant or don’t want to bother their caregiver or loved one or a good friend to book an appointment.”

Massachusetts has administered almost a million doses of the vaccine at nearly 130 sites statewide, said Gov. Charlie Baker. About 10 percent of residents have received at least one dose of the vaccine, and 2.8 percent have received both doses, according to a New York Times tracker.

Companions should be able to schedule their vaccine along with that of the older resident, the governor said, and effective Thursday, they now can.

Joan Hatem-Roy, the chief executive of Elder Services of Merrimack Valley, a nonprofit group in Northeast Massachusetts, called the idea “a game changer.”

“I get nervous going to a Patriots game at Gillette, so I can imagine a senior trying to think about going to Gillette Stadium,” one of the vaccination sites, Ms. Hatem-Roy said.

Some expressed concern that younger people who are less susceptible to serious illness from the virus might get a vaccine before people who are 65 or older or who have chronic health conditions.

But Governor Baker said the immediate goal was to make sure people 75 and older are vaccinated.

“Those communities are far more likely to lose their life and get hospitalized as a result of Covid,” he said. “We want to make sure that we make it as easy as we possibly can for folks who fall into that over-75 category to get vaccinated and to get vaccinated early in this process.”

The state’s decision to vaccinate companions came as a surprise to Dr. Ashish Jha, the dean of Brown University’s School of Public Health, who said Massachusetts had not moved as quickly as he had expected on vaccinations. He said he would rather see more vulnerable groups be deemed eligible for the vaccination first and for any transportation issues to be resolved without companions getting shots.

“I do know that the governor is feeling a lot of pressure to improve the performance in the state,” Dr. Jha said. “That may be part of the motivation for doing this, because it will certainly bump up those numbers.”

He does not expect other states to follow suit — at least, not right away.

But Dr. Jha said it might be different in April or May, when the supply of vaccine may outweigh the demand.

In some places, a similar model has been attempted on a smaller scale.

In Albemarle County, Va., 70 caregivers and family care providers for people with intellectual disabilities were vaccinated, according to local affiliate NBC29. In Texas, older and disabled residents said they wanted their home health workers to be vaccinated, but many workers were refusing the inoculation, according to The Texas Tribune.

With fraud already popping up in everything from vaccines to tests to stimulus checks, Dr. Jha worried that scammers might try to use the new Massachusetts program to take advantage of older residents.

“I don’t know how you carefully police that,” he said. “There are bad actors who may try to manipulate this.”

Ms. Sudders offered her own warning on Wednesday, urging older residents’ not to accept offers from strangers to be their vaccine companions.

A vaccination site at Citi Field in Queens on Wednesday.Credit…Kena Betancur/Agence France-Presse — Getty Images

Gov. Andrew M. Cuomo of New York said that large arenas and stadiums across the state would be able to open for events with spectators, at very limited capacity, as soon as Feb. 23. Attendees will be required to provide a negative coronavirus test result.

Venues that hold 10,000 people or more would be allowed to host 10 percent of their normal capacity, if they are approved by the state’s Department of Health.

Attendees will have to provide a negative P.C.R. test, taken within 72 hours of the event, before they can enter. Socially distanced assigned seating will be mandatory, as will face coverings and temperature checks.

While controlling the spread of the coronavirus, the state has to simultaneously “get this economy open intelligently,” Mr. Cuomo said, adding that “this hits the balance of safe reopening, and again a P.C.R. test is as safe as you can get.”

The governor cited the success of a recent Buffalo Bills’ playoff game, attended by about 6,700 people who had to provide a negative coronavirus test before they could enter, as the inspiration for his decision. A negative test result is a snapshot in time of whether the virus can be detected if a person is infected, and may miss individuals who are infected but do not yet carry enough of the virus for the test to come back positive.

“The testing is the key,” Mr. Cuomo said at a news conference on Wednesday.

Mr. Cuomo said that the Barclays Center in Brooklyn would reopen on Feb. 23, for a Brooklyn Nets game against the Sacramento Kings.

But the Bills’ stadium is open air, unlike the Barclays Center. Public health experts say the quality of ventilation is crucial when considering indoor gatherings because the virus is known to spread more easily indoors.

At his news conference, Mr. Cuomo did not offer details on ventilation, but a release from his office later said that in order to reopen venues to professional sports, sites had to “meet enhanced air filtration, ventilation and purification standards.”

Attending an indoor event is risky even with ample ventilation and other precautions, said Saskia Popescu, an epidemiologist at George Mason University.

“Bringing thousands of people indoors for an event that elicits screaming and socializing is not ideal right now,” Dr. Popescu said in an email.

As for playing games at venues like Citi Field or Yankee Stadium, which are being used as vaccination sites, the governor joked that “between innings, people will do vaccines.”

Gareth Rhodes, a member of the governor’s Covid-19 task force, said the state planned to work with teams so the vaccinations could continue.

The Citi Field vaccination site, which serves eligible Queens residents and taxi drivers and food service workers from all five boroughs, opened Wednesday. It will have 200 appointments a day available during its first week of operation and will offer 24-hour service starting next Wednesday, officials said. The site will be able to administer 4,000 doses of the vaccine a week by next week, Mayor Bill de Blasio said at an appearance outside the stadium. It could provide 5,000 doses a day if the city had more supply, he added.

“This site is the beginning of something very big,” Mr. de Blasio said. “The Mets are doing something crucial today for the people of Queens.”

The site was supposed to open the week of Jan. 25, but it was postponed because of vaccine shortages.

The mayor also said that mass vaccination sites were still planned at Empire Outlets in Staten Island and at the Barclays Center, though he did not specify dates when they will open.

The AstraZeneca vaccine being administered in Brazil on Tuesday.Credit…Bruno Kelly/Reuters

A World Health Organization panel of experts on Wednesday recommended that the vaccine developed by AstraZeneca and the University of Oxford be used in countries where concerning new variants of the coronavirus are circulating.

The recommendation came days after a decision by South Africa to halt at least temporarily plans to roll out AstraZeneca’s vaccine.

The decision was announced after a small clinical trial indicated that the vaccine might not protect against mild and moderate cases caused by avariant of the virus first seen in that country. Researchers were unable to draw a conclusion about the impact of the variant, known as B.1.351, on the vaccine’s ability to prevent severe disease.

Despite recommending the AstraZeneca vaccine for use everywhere, W.H.O. scientists conceded that each country should take into account the state of the virus and the type of variants spreading there.

The W.H.O. has not yet granted an emergency-use listing for the AstraZeneca vaccine, a step that would set into motion the rollout of the vaccine in many lower- and middle-income countries.

The W.H.O. will separately consider the vaccine’s two manufacturers: AstraZeneca and the Serum Institute, the Indian producer that will supply many doses for the Covax initiative to bring vaccines to poorer parts of the world. The W.H.O. will weigh those decisions in the next week, with decisions expected around the middle of this month.

The W.H.O. at the end of last year approved Pfizer’s vaccine. Its decision on AstraZeneca’s vaccine is highly anticipated, because countries around the world are counting on the cheap and easy-to-store product.

Countries are expected to begin receiving their first tranches of the AstraZeneca vaccine from Covax later in February.

The W.H.O.’s decisions come as concern is rising about whether certain variants may reduce the effectiveness of Covid-19 vaccines and treatments. The B.1.351 variant has so far generated the most worry. The AstraZeneca vaccine and other leading vaccines still appear to provide strong protection against another, more contagious coronavirus variant first identified in Britain, known as B.1.1.7.

But scientists have cautioned against drawing firm conclusions from preliminary data.

“We are so in the early stages of understanding what any specific change in the virus means for the performance of one or another of the vaccines or the vaccines as a whole,” said Katherine O’Brien, the W.H.O.’s director of immunization, vaccines and biologicals, at Wednesday’s news conference.

For now, South Africa is planning to inoculate health workers starting next week with the Johnson & Johnson vaccine, which prevented hospitalizations and deaths in clinical trials in the country. The vaccine is not yet authorized there, but officials said they would use it as part of an ongoing clinical trial.

As for the AstraZeneca vaccine, South African health officials indicated on Wednesday that they were considering selling or swapping their million doses of the vaccine for different shots. W.H.O. scientists said that they were open to discussing such plans as part of the Covax initiative.

The W.H.O. panel that issued recommendations on Wednesday, known as the Strategic Advisory Group of Experts on Immunization, also advised that the AstraZeneca vaccine be given to adults regardless of their ages, breaking with a number of European countries that have opted to restrict the use of the vaccine to younger people.

The W.H.O. panel also recommended that the two doses of the AstraZeneca vaccine be given between four and 12 weeks apart. The guidance follows the release of a paper last week that found that the vaccine appears to work better when second doses are delayed. Britain and other countries have opted to delay second doses of the vaccine in an effort to get more first doses into their populations.

The University of California campus  in Berkeley.Credit…Jeff Chiu/Associated Press

At the Berkeley campus of the University of California, this was to be the month that academic life began inching back toward normal. Some students who had been sent home last year returned to their dorms in January. The first handful of in-person classes since the pandemic began had been set to resume on Feb. 1.

Instead, a wave of coronavirus infections has sent the campus into an unprecedented lockdown.

Since the beginning of the month, some 2,000 students have been confined to their rooms around the clock, unable even to visit floor-mates. The students are allowed out to go to the bathroom, get food and take twice-weekly coronavirus tests. (There are also exceptions for rare medical needs or emergencies.)

Classes are being held remotely for the foreseeable future.

Confined students are barred even from going outside to sunbathe or exercise, although the university is talking with city health officials about relaxing that prohibition.

“It’s been a little bit of a struggle,” Veronica Roseborough, a freshman quarantined in one eight-story residence hall, said on Wednesday, “but the university is doing what it can to keep cases low.”

The lockdown was ordered after the university reported 44 new infections among its staff and 43,000-plus students on Jan. 30. Since then, 183 more cases have been found, bringing the total since Sept. 9 to 724.

The number of new infections has declined since the quarantine began, officials said, but the lockdown will not end until Feb. 15.

The quarantine is not the only one on a college campus. (Last year, the University of Wisconsin-Madison shuttered 2,000 students in two dorms, and schools nationwide are struggling to control outbreaks.) But it might be the most rigid.

Security has been increased in residence halls to spot rule breakers and unwanted visitors. A cellphone-based “badge” (green for already tested, yellow for a missed test, orange and red for quarantined and Covid-19-positive) is subject to checking by so-called health ambassadors.

Flouting the rules can be costly. Violators can be suspended from classes, and student organizations can be deregistered.

But some students remain undeterred by the penalties.

“Some may disagree with me,” said one student who claimed to slip out regularly to socialize with friends (“I make sure they have a test”).

“My mental health is very important,” the student said.

A hospital worker put a warning label on a body bag holding a deceased patient at Providence Holy Cross Medical Center in Los Angeles last month.Credit…Jae C. Hong/Associated Press

Coronavirus-related deaths, which rose sharply in the United States beginning in November and remain high, appear to be in a steady decline, following in the tracks of new virus cases and hospitalizations, which began to drop last month.

The country has reported about 2,800 deaths a day recently, an average that excludes one anomalous day last week when Indiana announced a large number of backlogged death reports. That national average remains far above the level of early November, before the country’s recent surge, when roughly 825 deaths were being reported daily. But it is down significantly from the peak just a few weeks ago, when the average was more than 3,300 a day.

New coronavirus cases are a leading indicator for deaths, and that statistic has been improving markedly for a month. On Tuesday, the country reported 96,400 new cases, the third day in a row of having fewer than 100,000 new recorded cases, a level not seen since early November.

The seven-day average of new cases, a more reliable indicator of the pandemic’s direction, has fallen more than 50 percent since it peaked on Jan. 8.

Whether that will continue remains in doubt. Researchers warn that a more contagious virus variant first found in Britain is doubling roughly every 10 days in the United States. The Centers for Disease Control and Prevention cautioned last month that it could become the dominant variant in the nation by March.

Deaths tend to lag behind new cases by several weeks, and the day-to-day statistics can be prone to reporting vagaries. For a while, it was hard to discern clear signs that deaths had begun to decline. But the national trend now is unmistakable: The daily average has dropped about 18 percent since Jan. 12.

Although deaths are still rising in some states, including Alabama and South Carolina, far more are reporting sustained declines. Over the past two weeks, reports of virus deaths have dropped more than 40 percent in New Mexico and more than 30 percent in Arkansas, Colorado and Connecticut.

The declines are heartening but are not a reason for people to let down their guard, said Bill Hanage, an epidemiologist and associate professor at Harvard.

Dr. Hanage said the surges in new cases and deaths in December and early January had probably stemmed from the increase in gatherings over the holidays and from the onset of winter. Influenza and most kinds of coronavirus infections peak during winter, and there is little reason to think that Covid-19 is any different. (Influenza is not a coronavirus infection, as an earlier post suggested.)

The more infectious nature of the Covid-19 virus, and the appearance of variants that may spread even more easily, remain a significant cause for caution, he said.

“If in response to these dropping numbers people relax, then it is entirely possible and expected that we will see that decline start to bottom out and even start to increase again,” he said.

A New York Times analysis found that about half of the country’s roughly 465,000 Covid-19 deaths have occurred since the brutal surge began in November.

Maggie Owens and her children, Louise and August, playing in their Chicago home. The city’s teachers approved a deal early Wednesday that would send students, including Louise, back to classrooms.Credit…Jamie Kelter Davis for The New York Times

After a two-week pause of in-person instruction, the Chicago Teachers Union said early Wednesday that its members had approved an agreement to reopen classrooms in the country’s third-largest public school system.

More than 20,000 ballots were cast, with 13,681 members voting in favor and 6,585 voting against, the union said.

Under the agreement, prekindergarten and some special education students will return to classrooms on Thursday. Staff in kindergarten through fifth-grade classrooms will return on Feb. 22, and students in those grades will return on March 1. Staff members in sixth- through eighth-grade classrooms will return March 1, and students on March 8.

The Daily Poster

Listen to ‘The Daily’: What Will It Take to Reopen Schools?

The Biden administration is determined to restart in-person learning quickly. But there are some major hurdles.

As part of the agreement, the city committed to offering 2,000 coronavirus vaccine doses this week to staff members in classrooms that were set to reopen on Thursday and any other employees who live with people who were at high risk from the virus. It would then provide 1,500 doses a week to school staff in the weeks after that.

Teachers who have no students attending in-person classes could continue to teach remotely, and unvaccinated teachers could take unpaid leaves of absence for the next quarter instead of teaching in person. The agreement also set thresholds for what would lead the district, as well as individual schools or classrooms, to temporarily revert to distance learning.

“This plan is not what any of us deserve,” Jesse Sharkey, the president of the Chicago Teachers Union, said in a statement. “This agreement represents where we should have started months ago, not where this has landed.”

“We will protect ourselves by using the school safety committees created under this agreement to organize and see that C.P.S. meets safety standards and mitigation protocols,” Mr. Sharkey said. “Safety Committees will enforce this agreement, have access to information and the ability to change unsafe practices in their school.”

Ms. Sharkey criticized Mayor Lori Lightfoot over her handling of the situation and said that union delegates had passed a vote of no confidence in the mayor and school leadership on Monday night.

Ms. Lightfoot and the chief executive of the district, Janice K. Jackson, said in a statement, “This vote reaffirms the strength and fairness of our plan, which provides families and employees certainty about returning to schools and guarantees the best possible health and safety protocols.”

Ms. Lightfoot, a Democrat, and the union have been locked in one of the most intense disagreements over reopening anywhere in the country. The mayor has argued that the city’s most vulnerable students need the opportunity to return to school in person, while the union condemned the city’s reopening plan as unsafe.

Jill Biden and Doug Emhoff hosted a series of phone calls on Wednesday with nurses’ unions.Credit…Chandler West/White House Photo Office

Jill Biden, the first lady, and Doug Emhoff, the second gentleman, held a series of phone calls on Wednesday with nurses’ unions, including one representing several rural areas around the country that have struggled to keep up with the coronavirus surge, according to an administration official.

In one call, nurses in Huntington, W.Va., shared concerns about dozens of colleagues they said had contracted the virus at a local hospital. In Columbus, Ohio, nurses told stories of health workers’ having to share and reuse N95 masks and fearful that their ranks will be strained by infection.

Nurses are at particularly high risk to contract the virus, according to the federal Centers for Disease Control and Prevention. Nurses, along with doctors and other workers on the front lines, have also reported high rates of depression, trauma and burnout during the pandemic.

And shortages of protective gear remain a chronic issue.

On the calls, Dr. Biden and Mr. Emhoff “told them that this administration is fighting for them,” according to a spokesman for the first lady. But mostly they listened to the nurses and promised to share what they had learned with President Biden and Vice President Kamala Harris.

In the calls, each of which lasted 10 to 20 minutes, the nurses said they were thankful for the administration’s work, but they reiterated the need for more protective gear and more vaccine doses. The conversations turned emotional at times, the spokesman said.

The calls came as Dr. Biden’s broader platform began to emerge during her husband’s first weeks in office.

The first lady has made a point of publicly praising emergency workers. After the Bidens moved into the White House, one of her first official acts was to film a video to thank them, along with members of the military, for ensuring that the inauguration went safely. (When she made the video, she was still wearing her inauguration dress.)

Every four years, we celebrate the beginning of a new administration. It’s the start of a bright new chapter. A time for us all to come together. I’m so grateful to all who worked to create an incredible day – especially in this uniquely difficult year. pic.twitter.com/P3L7OYoANR

— Jill Biden (@FLOTUS) January 21, 2021

Dr. Biden’s other efforts have included a videotaped message with her husband that aired at the Super Bowl last weekend.

“We wanted to thank all the frontline health care heroes, both at the game and watching across the country,” the first lady said. “You and your families carried us through this year with courage, compassion and kindness.”

DemeTech, in Miami, Fla., and other businesses that have jumped into making masks must overcome the ingrained purchasing habits of hospitals, medical supply distributors and state governments.Credit…Scott McIntyre for The New York Times

A year into the pandemic, the disposable, virus-filtering N95 mask remains a coveted piece of protective gear. Continuing shortages have forced doctors and nurses to reuse their N95s, and ordinary Americans have scoured the internet — mostly in vain — to get them.

But Luis Arguello Jr. has plenty of N95s for sale — 30 million of them, in fact, which his family-run business, DemeTech, manufactured in its factories in Miami. He simply can’t seem to find buyers.

After the pandemic exposed a huge need for protective equipment, and China closed its inventory to the world, DemeTech, a medical suture maker, dived into the mask business. The company invested tens of millions of dollars in new machinery and then navigated a nine-month federal approval process that allows them to market the masks.

But demand is so slack that Mr. Arguello is preparing to lay off some of the 1,300 workers he had hired to ramp up production.

“It’s insane that we can’t get these masks to the people who desperately need them,” he said.

In one of the more confounding disconnects between the laws of supply and demand, many of the nearly two dozen small American companies that recently jumped into the business of making N95s are facing the abyss — unable to crack the market, despite vows from both former President Donald Trump and President Biden to “buy American” and buoy domestic production of essential medical gear.

These businesses must overcome the ingrained purchasing habits of hospital systems, medical supply distributors and state governments. Many buyers are loath to try the new crop of American-made masks, which are often more expensive than those produced in China. Another obstacle comes from companies like Amazon, Facebook and Google, which banned the sale and advertising of N95 masks in an effort to thwart profiteers from diverting vital medical gear needed by frontline medical workers.

What’s required, public health experts and industry executives say, is an ambitious strategy that includes federal loans, subsidies and government purchasing directives to ensure the long-term viability of a domestic industry vital to the national interest.

“The government needs to call the outsourcing of America’s mask supply what it is: a national security problem,” said Mike Bowen, the owner of Prestige Ameritech, a Texas mask producer who has testified before Congress about the need to support domestic manufacturers.

Residents waited in their cars to get the Pfizer vaccine at Ratliff Stadium in Odessa, Texas, in January.Credit…Eli Hartman/Odessa American, via Associated Press

The White House, attempting to ramp up its mass coronavirus vaccination effort, is standing up five new inoculation centers, including three in Texas and two in New York that are specifically aimed at vaccinating people of color, officials said Wednesday.

President Biden has said repeatedly that racial equity will be at the core of his coronavirus response, but there are stark racial disparities in the vaccination campaign. In some cities, wealthy white people have been flocking to clinics that primarily serve Black people and Latinos, using up scarce supplies of vaccine.

And the administration’s effort to gather race and ethnicity data on vaccine recipients is faltering.

“This is a perfect example of our equity work coming to life, and this is a model for the potential we have to do this well around the country,” Dr. Marcella Nunez-Smith, the chair of Mr. Biden’s Covid-19 Equity Task Force, said Wednesday during a news conference with Governor Andrew M. Cuomo of New York, referring to the new centers.

“It’s a bold step that we should take as a sign of hope,” Mr. Cuomo said.

On his first day in office, the president directed the Federal Emergency Management Agency to begin establishing federally supported community vaccination centers, with the goal of having 100 centers in operation within a month. On Tuesday, the administration announced that it intends to start shipping one million doses of vaccine per week to federally supported community health centers in underserved neighborhoods.

On Sunday, Mr. Biden told Norah O’Donnell of CBS News that Roger Goodell, the commissioner of the National Football League, had extended an offer for the administration to use all 30 league stadiums to distribute Covid-19 vaccines.

People in underserved neighborhoods face a variety of obstacles in getting vaccinated, experts say, including registration phone lines and websites that can take hours to navigate, and a lack of transportation or time off from jobs to get to appointments. And people of color, particularly Black people, are more likely to be hesitant about getting vaccinated, in light of the history of unethical medical research in the United States.

But Mr. Cuomo said he rejected the term “vaccine hesitancy,” adding, “Let’s call it what it is. It’s a lack of trust — for understandable reasons.”

The New York centers will be located at York College in Queens and Medgar Evers College in Brooklyn, Mr. Cuomo said, and will be capable of vaccinating 3,000 people a day. The federal government will provide a special dosage allocation for the sites, and they will be staffed jointly by the federal government, military personnel and members of the National Guard.

Last week, the administration announced that it was building two mass vaccination clinics in California, one in Los Angeles and the other in Oakland. The Texas clinics will be located in Arlington, Dallas and Houston, White House officials said.

Dr. Evan Saulino, a family physician in Portland, Ore., called for multiple strategies to distribute vaccines.Credit…Tojo Andrianarivo for The New York Times

Primary care doctors have grown increasingly frustrated with their exclusion from the nation’s vaccine rollout, unable to find reliable supplies for even their eldest patients and lacking basic information about distribution planning for the shots.

“The centerpiece should be primary care,” said Dr. Wayne Altman, the chairman of family medicine at Tufts University School of Medicine, who also sees patients in Arlington, Mass. State officials there are using Fenway Park and Gillette Stadium as mass vaccination sites, rather than ensuring practices like his can inoculate patients who are at high risk from the coronavirus.

“If you distribute the vaccine to all these practices and let them go at their pace, it would accelerate this rollout dramatically,” Dr. Altman said.

There are roughly 500,000 primary care doctors in the United States, who have traditionally administered nearly half of all adult vaccinations, inoculating their patients against pneumonia, flu and other infectious diseases. While most physician offices can’t handle storage for the Pfizer-BioNTech vaccine because of its need for special freezers, doctors say they could easily administer the Moderna vaccine with adequate storage measures as well as some of the others likely to become available soon.

“We’re ready,” said Dr. Elizabeth Kozak, an internist in Grand Rapids, Mich. She was approved in early January to deliver the Moderna vaccine. “We haven’t seen a thing, but we’re ready.”

While some physicians say they have received small amounts of the vaccine, many say they are still waiting for any indication about when they might get doses and how they fit into the long-range timetable for broader distribution.

Doctors say they are critical to reaching people who would not otherwise get a vaccine because they are unable or unwilling to go to mass vaccination sites or even their local pharmacy.

“We can’t have one or two strategies for vaccine distribution,” said Dr. Evan Saulino, a family physician in Portland, Ore., who has talked to patients, including those who are Black or Spanish-speaking, who are not sure they want the vaccine. Some of his patients are distrustful of the government and may not want to get a shot from someone in uniform. One person he spoke with would not go to the drugstore but might consider being inoculated at his clinic.

Dr. Kozak, the internist from Michigan, agreed, saying doctors like her could focus their attention on people who can’t easily navigate the current set up. “We might not be able to do the numbers but we are able to do the more fragile and vulnerable populations,” she said.

Global Roundup

Travelers at Heathrow airport in London last month.Credit…Hollie Adams/Getty Images

Vacationing abroad may not be possible for residents of Britain until all adults in the country have been vaccinated, a government official said on Wednesday, raising questions about how the tourism industry might cope with such restrictions and dashing hopes of many who hoped that a relatively successful vaccine rollout in Britain could let them enjoy trips abroad this summer.

The transportation secretary, Grant Shapps, said on British television that international travel would depend on “everybody having their vaccinations” in Britain, and that restrictions could remain as long as other countries have not made significant progress in vaccinations.

“We’ll need to wait for other countries to catch up as well, in order to do that wider international unlock,” Mr. Shapps said.

As of Wednesday, Britain had administered more than 12.5 million vaccine doses, equivalent to about 18 percent of its population, one of the highest rates in the world. At the current pace, the country is on track to give the first shot of a two-dose coronavirus vaccine to its entire population by the end of June.

The authorities have reported a sharp drop in the number of infections in recent days, and Prime Minister Boris Johnson is expected to announce a potential loosening of restrictions this month.

But on Wednesday, Mr. Shapps urged caution about travel plans for this year and advised people not to book vacations either within Britain or abroad. “I’m afraid I can’t give you a definitive ‘will there or will there not be’ the opportunity to take holidays,” he told Sky News.

Mr. Shapps’s warning came a day after the authorities announced new travel restrictions, including prison sentences of up to 10 years for anyone traveling to Britain who lies about where they’ve been.

Mr. Shapps called the measures, including the jail sentence, “appropriate.” Under other restrictions that are set to come into force on Monday, British residents arriving in England from more than 30 countries where coronavirus variants are believed to be widespread, will have to pay up to 1,750 pounds ($2,410) for a 10-day quarantine in government-managed hotel rooms.

Britain has reported 114,000 deaths from the coronavirus, the world’s fifth-highest known death toll.

In other developments around the world.

  • Mexico authorized China’s Sinovac Covid-19 vaccine for emergency use, said Hugo Lopez-Gatell, the deputy health minister, Reuters reported. Earlier this month, the country also authorized the Russian coronavirus vaccine, Sputnik V, for use.

  • Prime Minister Yoshihide Suga of Japan said on Wednesday that the country would begin its vaccination program next week, starting with medical workers.

  • The leaders of the World Health Organization and the United Nations agency for children, Unicef, warned in a joint statement that the vast chasm of inequality in the global vaccine rollout will “cost lives and livelihoods, give the virus further opportunity to mutate and evade vaccines and will undermine a global economic recovery.” Of the 128 million vaccine doses administered globally, more than three quarters were in just 10 countries, while nearly 130 other countries are yet to administer a single dose, the statement said.

A seizure of counterfeit masks at a port warehouse in El Paso, Texas.Credit…U.S. Immigration and Customs Enforcement, via Associated Press

Many were clever fakes.

They were stamped with the 3M logo, and shipped in boxes that read, “Made in the U.S.A.”

But these supposed N95 masks were not produced by 3M, and not made in the United States, federal investigators said Wednesday.

They were counterfeits, and millions of them were bought by hospitals, medical institutions and government agencies in at least five states, federal authorities said as they announced an investigation.

Homeland Security Investigations, which is part of the Department of Homeland Security, said the masks were dangerous because they may not offer the same level of protection against the coronavirus as genuine N95s.

“We don’t know if they meet the standards,” said Brian Weinhaus, a special agent with Homeland Security Investigations.

Cassie Sauer, the president and chief executive of the Washington State Hospital Association, said about two million counterfeit masks might have made it into the state. They were “really good fakes,” she said.

“They look, they feel, they fit and they breathe like a 3M mask,” Ms. Sauer said.

News of the investigation came the same day the Homeland Security Department’s intelligence branch warned law enforcement agencies that criminals on the dark web have been selling counterfeit coronavirus vaccines for “hundreds of dollars per dose.”

Berlin and the rest of Germany have been in lockdown since before Christmas with nonessential stores and schools closed.Credit…Lena Mucha for The New York Times

Germany will remain in lockdown for at least another month because of the danger of more infectious variants of the virus, Chancellor Angela Merkel and governors decided on Wednesday.

“We know that this mutation is a reality now and we know it will increase,” said Ms. Merkel after meeting with governors from the 16 German states. “The question is how quickly will it increase.”

Although a sharp drop in new daily infections shows that a nearly two-month lockdown is having an effect, the authorities worry about the spread of more infectious variants. Nearly 6 percent of the positive coronavirus cases in Germany were found to be caused by more contagious variants, with the variant that has been found in Britain dominating.

The lockdown extension is designed to prevent the contagious variants from gaining steam.

Most shops, museums and services will remain closed until the number of new infections reaches an average of 35 cases per 100,000 people over a week, a rate that should be reached by March if the current trend holds. Over the past week, there has been an average of 68 cases per 100,000 people. The reopening of schools and day care centers, which the government has prioritized, will be overseen by the states and will most likely happen sooner. Hair salons are allowed to open on March 1 under strict safety rules. The opening of other businesses, such as gyms, bars and restaurants, will be discussed at a future meeting, Ms. Merkel said.

Over the past week, there has been an average of 8,887 new cases per day in Germany, far fewer than the nearly 25,000 a day around Christmas, according to a New York Times database.

The lockdown rules are in effect until March 7. Ms. Merkel and state governors will meet again on March 3, to decide on future measures.

Ursula von der Leyen, the European Commission president, addressing lawmakers in Brussels on Wednesday.Credit…Johanna Geron/Reuters

A top European Union official said on Wednesday that the bloc was “not where we want to be” in handling the pandemic, after missteps in lining up vaccine supplies left it lagging behind other countries.

“We were late to authorize,” the official, Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, told lawmakers in Brussels.

“We were too optimistic when it came to massive production, and perhaps too confident that what we ordered would actually be delivered on time,” she said. “We need to ask ourselves why that is the case.”

She stood by the view that buying vaccine doses as a bloc had been the right decision, however.

“I cannot even imagine what would have happened if just a handful of big players — big member states — had rushed to it and everybody else would have been left empty-handed,” she said, adding that it would have been “the end of our community.”

Her comments came as criticism has mounted over Ms. Von der Leyen’s handling of negotiations with pharmaceutical companies to secure vaccines for the 450 million people living in the bloc’s 27 member states.

Whereas Britain and United States have surged ahead in rolling out vaccines, the European Union has been more cautious and price-conscious, leading to a crisis after vaccine producers said there were delays in filing orders.

Its tensions with Britain, which left the bloc’s authority at the end of last year, were magnified after the Commission reversed an attempt last month to restrict vaccine exports into the country via Northern Ireland.

“The bottom line is that mistakes were made in the process leading up to the decision,” Ms. von der Leyen said on Wednesday. “And I deeply regret that. But in the end, we got it right.”

Over 17 million people, or about 4 percent of people living in the bloc, have received at least one vaccine dose, she said.

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Business

How Merck’s Vaccine Misplaced the Covid Race

Founded in 1891, Merck has been in the vaccines business for more than 100 years and has developed some of the world’s most famous vaccines, including mumps, hepatitis A and chickenpox. In 2019, it became the first company to receive approval for an Ebola vaccine from the Food and Drug Administration.

However, as the coronavirus spread around the world, Merck was slow to announce plans for a vaccine. By the time details of two vaccine candidates became known in late May, most of the main competitors had already announced contracts, and Pfizer and Moderna had begun early clinical trials.

But Merck didn’t have to be the first to win. Executives decided to pursue two projects that they believed had advantages over competitors. A vaccine developed in partnership with the International AIDS Vaccine Initiative uses the same technology that is based on a harmless animal virus that led to their successful Ebola vaccine. The other, acquired through the purchase of Themis Bioscience, was based on an existing measles vaccine.

Both experimental Covid vaccines, the company said, would be tested with a single dose, and Merck was also looking to see if whoever used the cattle virus could be given orally – two big advantages over potential competitors, especially in developing countries.

In July, Kenneth C. Frazier, CEO of Merck, warned against acting too quickly. “I think if people tell the public that there will be a vaccine by the end of 2020, for example, they are doing the public a serious disadvantage,” Frazier said in an interview with a professor at Harvard Business School. Mr Frazier recently announced that he will be retiring as managing director later this year, a decision that has long been planned.

In an interview in August, Dr. Nicholas Kartsonis, Merck’s senior vice president of clinical research for vaccines and infectious diseases, said the company’s position as the leading vaccine manufacturer has given him the luxury of time. “We are a much bigger company. We’re not so obliged to be the first, ”he said.

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Health

People Should Guarantee Masks Match Snugly or Double Up, C.D.C Says

On Wednesday, federal health officials urged Americans to save their masks and take measures to tighten them – or even cover a cloth mask with a cloth – saying new research had shown masks to increase the spread of the coronavirus reduce.

Recent laboratory experiments found that virus transmission could be reduced by 96.5 percent if Americans wore tight-fitting surgical masks or a combination of cloth and surgical mask. When announcing the results, Dr. Rochelle P. Walensky, director of the Centers for Disease Control and Prevention, tells Americans to wear a “well-fitting mask.”

“With cases, hospitalizations and deaths still very high, now is not the time to reset mask requirements,” she said. “The bottom line is that masks work, and they work when they fit well and are worn properly.”

Masking is now mandatory on federal properties as well as on national and international transports. Studies conducted in households in Beijing, hair salons in Missouri, and aboard an aircraft carrier in Guam have shown that “any mask is better than none,” said Dr. John T. Brooks, Chief Covid Response Physician at the CDC and lead author of the agency’s new masking research.

“Wearing a mask reduces the spread and new infections are falling in communities where masks are used,” said Dr. Brooks.

While masks reduce the droplets and aerosols exhaled by infected wearers and protect uninfected wearers, air leaking from the edges of a mask can reduce its effectiveness. The agency’s new laboratory experiments showed how the problem can be fixed.

One option is to wear a cloth mask over a surgical mask, the agency said. The alternative is to “knot and tuck” the surgical mask closer to the face – that is, the two strands of the ear loops are knotted together where they are attached to the edge of the mask, and then the extra fabric is folded over and over flattened the mask edge and tuck it in for a tighter seal.

The agency’s experiments relied on three-layer surgical and cloth masks, and only one type of each mask was tested. Other combinations – such as doubling up on cloth masks or wearing two surgical masks, or putting one cloth mask on top of a surgical mask – were not tested.

The advice also arrives after states begin lifting measures to slow the transmission of the virus. About three dozen states have masking requirements, but on Monday Iowa ended its mandate and joined Mississippi and North Dakota, which it did months ago.

States are rushing to resume business and reopen schools. For example, New York Governor Andrew Cuomo announced on Wednesday that fans would be allowed to return to sporting events and concerts with limited capacity and mandatory testing and seating in stadiums and arenas. In New York City, indoor dining can resume on Friday at 25 percent capacity.

Virus-related deaths, which increased sharply in the US in November and remain high, appear to be steadily decreasing. New cases and hospital stays also fell last month.

But the CDC has warned that the new variants, even if cases have receded, could spike infections if Americans drop their guards. Cases of a contagious variant of the virus, first found in the UK, are doubling in the US about every 10 days. The CDC warned last month that it could become the dominant variant in the nation by March.

Until the vast majority of adults are vaccinated, “we want to contain this,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. Masks are an effective and easy way to avoid another disastrous “roller coaster ride,” he added.

Updated

Apr. 10, 2021, 9:41 am ET

“The fewer opportunities we give this virus to reproduce, the less likely it is that mutations will occur and the less likely we are to get new variants,” said Dr. Conductor.

Dr. Monica Gandhi, an infectious disease specialist at the University of California at San Francisco, is the co-author of a paper on improving the effectiveness of masks that inspired the CDC to conduct the new research.

“We want to do our best to contain the transmission with all elements: masking, distancing, hand hygiene, ventilation,” she said. “If we reduce transmission and mass vaccinate at the same time, the virus has no way of evading the vaccine.”

The CDC outlined a few additional options for improving the effectiveness of masks, including using a mask fitter – a face-matched frame – over a mask. Recent studies have shown that fitters can increase protection against virus-containing aerosols by 90 percent or more.

Surprisingly, the agency may also suggest that people consider wearing a sleeve made of pure nylon stocking material around their necks and pulling it onto a drape or surgical mask.

The CDC’s recommendations were based in part on ideas from Dr. Gandhi and Linsey Marr, an aerosol transfer expert at Virginia Tech. The two have recommended a surgical mask covered with a tight-fitting cloth mask, or a three-layer cloth mask consisting of two outer layers of tightly woven fabric that encircles the face and a middle layer of filter material, such as vacuum bag material.

Both the tight fit and filtration are important, said Dr. Marr. Even with an N95 respirator such as that used by health care workers, a good fit is essential.

While a growing number of Americans say they support the wearing of masks, opposition persists in some counties and regions. Dr. Marr said she expected the CDC’s new advice to be ridiculed.

“I’m sure the resistance fighters will say, ‘What’s next? Three masks? Four masks? Asked Dr. Marr. “But there’s a lot of interest from people who want to know how good their masks are and how they can improve them. People want the best possible protection. “

The CDC experiments simulated the production of aerosols from cough and estimated their absorption. While an untied surgical mask blocked 42 percent of the particles and a cloth mask alone blocked 44.3 percent, combining a cloth mask over a surgical mask blocked 92.5 percent of the cough particles, found Dr. Brooks and his colleagues.

When both the source of the aerosols and the exposed form were fitted with either the combination of masks or the knotted and hidden surgical mask, exposure to the recipient was reduced by 96.4 percent and 95.9 percent, respectively.

Neither method was perfect: knotting and tucking together makes the surface area of ​​the mask smaller and potentially more suitable for people with smaller faces, noted Dr. Brooks.

Likewise, the fabric and surgical mask combination works well, but makes the mask thicker and can make it difficult for some people to breathe. The extra layers can also obstruct peripheral vision and increase the risk of tripping or falling.

Breathability is also important, said Dr. Marr. “If you put too many things on top of each other that make it difficult to breathe, it’s counterproductive: it’s more likely that air will find gaps to get in,” she said.

Dr. Brooks emphasized that masking, as Americans currently practice, is not “insufficient”. However, the new council offers “the opportunity to take it to the next level”.

“Now we are concerned about forms of the virus that could transmit more efficiently or interfere with the usefulness of existing diagnostics, therapeutics and vaccines,” he added. “We need to improve our game to slow the spread of the virus and its development.”

Sheryl Gay Stolberg reported from Washington.

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Business

Coping methods may also help folks hitting the ‘pandemic wall,’ ex-AMA president says

Coping techniques can help people struggling with the psychological effects of the Covid crisis, said psychiatrist Dr. Patrice Harris told CNBC.

“I want everyone first of all to give each other grace and space to feel how they feel. Know that we are not helpless,” Harris said on CNBC’s The News with Shepard Smith on Wednesday.

A recent report found that nearly half of US workers surveyed have had mental health problems since the coronavirus pandemic began.

“We’re all hitting this wall, but it’s time to build on our reserves,” said Harris, past president of the American Medical Association.

Harris said, exercising, getting enough food and sleep, and establishing new routines can all help keep people off the “pandemic wall”.

Harris stressed the need to lower personal expectations in the face of the pandemic.

“We should put less pressure on ourselves,” said Harris. “Know that we can’t do everything.”

Maintaining connections with friends and loved ones is vital even in times of social distancing, she said. For those suffering from “zoom fatigue,” Harris suggested phone calls.

When coping mechanisms aren’t enough, Harris stressed the importance of asking for help.

“We have to make sure we get professional help,” said Harris. “And there’s no shame in it.”

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Politics

Home managers present senators beforehand unseen, graphic Capitol safety footage from Jan. 6.

Whispered, panicked calls from frightened employees barricaded in an office. Violent scenes of broken windows and pushed open doors. Frenzied audio between Capitol cops.

On the second day of the impeachment trial, the House impeachment managers showed Senators previously unseen Capitol security footage and displayed a terrifying portrait of the violence that the pro-Trump mob sparked in the Capitol on Jan. 6.

The new evidence was presented by Delegate Stacey Plaskett of the Virgin Islands, who created a methodical narrative of the day and timestamped each new video. Representative Eric Swalwell, Democrat of California, continued the presentation.

When it began, Ms. Plaskett recalled the September 11, 2001 terrorist attacks and reported that a plane was heading for the Capitol.

“Almost every day I remember 44 Americans giving their lives to stop the plane that went to this Capitol,” said Ms. Plaskett, who was serving as the adjutant at the time. “I thank them every day for saving my life and that of many other people. These Americans sacrificed their lives for the love of the country, honor, duty, and all the things America means. The Capitol stands because of such people. “

As each new video and audio clip was introduced, a map of the Capitol remained in the lower corner of the screen, with a red dot tracking the progress of the rioters in the building while more violent images flickered across the screen.

In one scene, Utah Republican Senator Mitt Romney was walking down a corridor where he met Capitol Police officer Eugene Goodman, who appeared to be warning him of the progress of the rioters. Mr. Romney ran off.

Security footage from the Capitol showed the mob pounding through windows first to break through the building before turning to other doors to break them open from the inside as rioters flooded in. Ms. Plaskett recalled the threats the rioters had made publicly against the lives of California spokeswoman Nancy Pelosi and Vice President Mike Pence.

“You were talking about the assassination of the Vice President of the United States,” said Ms. Plaskett. She added that Mr. Pence and his family never left the Capitol during the siege.

After Ms. Plaskett played scenes of lawmakers and their coworkers escaping to safety, she played audio of frightened coworkers from Ms. Pelosi’s office barricaded in a room.

“We need the Capitol Police to get into the hall,” said one, and whispered into a phone in the hope that the rioters outside would not hear anything.

Mr. Swalwell introduced perhaps the cruelest video showing the moment when Ashli ​​Babbitt, one of the rioters, was killed and warned viewers before playing the clip that it would be graphic.

As the impeachment executives played videos and never-before-heard recordings of radio communications from the Capitol Police on January 6, senators from both parties sat in tense silence. Many tried to get a better view. In the back row on the Democratic side, Senators Mark Warner from Virginia and Michael Bennet from Colorado stood up to watch.

On the Republican side, the senators showed little emotion, but paid close attention to it. Many turned their heads from the video screens just to take notes.

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Health

Biden DOJ reverses Trump-era place

An Obamacare sign is seen outside the Leading Insurance Agency, which is offering plans under the Affordable Care Act (also known as Obamacare) on January 28, 2021 in Miami, Florida.

Joe Raedle | Getty Images

The Justice Department informed the Supreme Court on Wednesday that it no longer considers Obamacare to be unconstitutional. This is the last reversal of the department since President Joe Biden’s inauguration in January.

The Supreme Court is considering contesting Obamacare, officially known as the Affordable Care Act, filed by Texas and other Republican-led states. The Justice Department under former President Donald Trump supported Texas in legal pleadings and verbal disputes in November.

California and other blue states are defending the law that gave 20 million Americans health insurance.

“After the change in administration, the Department of Justice has rethought the government’s position in these cases,” wrote Edwin Kneedler, assistant attorney general, in a letter to Scott Harris, the clerk of the court.

The reversal of Biden’s Justice Department was expected. Biden played a role in the implementation of monumental legislation by Congress in 2010 while serving as Vice President under then-President Barack Obama.

The case concerns Obamacare’s individual mandate provision that requires most Americans to purchase health insurance or pay a fine.

The Supreme Court previously upheld the individual mandate as lawful under the tax powers of Congress. After the Republicans in Congress set the penalty at $ 0 in 2017, Texas raised its challenge, arguing that the mandate was no longer a tax.

The Trump Justice Department agreed that the mandate was unconstitutional. The department also argued that if the Supreme Court scraps the individual mandate, it will have to scrap the entire Affordable Care Act.

Kneedler wrote that under Biden the Justice Department had reversed its position on both issues. The department, he wrote, believes the individual mandate determination is lawful and that the provision can be removed if the court does not find it while the rest of the law persists.

During the hearing in the case, it appeared unlikely that the judges would scrap the legislation entirely, although it was not clear whether a majority would find the individual mandate unlawful. Chief Justice John Roberts and Justice Brett Kavanaugh, both Conservatives, suggested they support the separation of individual mandate provisions from the rest of the sweeping law.

Kneedler, who has served in the Justice Department under the presidents of both major political parties for more than 40 years, wrote in the letter that the ministry had not attempted to file further briefs on the case. A decision is expected in the summer.

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Larry Flynt, Who Constructed a Porn Empire With Hustler, Dies at 78

Larry Flynt, a ninth-grade dropout who built a $ 400 million empire around his sexually explicit magazine, Hustler, of raunchy publications, strip clubs, and “adult” stores, and for decades a self-promoted advocate of US freedom against obscenity and defamation battled press, died Wednesday at his Los Angeles home. He was 78 years old.

The cause was heart failure, said his brother Jimmy Flynt.

For a nation that found itself in a sexual revolution in the 1970s, Mr Flynt found himself – defiant, outrageous, relentless – in the conflict area of ​​a cultural and legal war in America: an unpopular hero for civil libertarians, the devil incarnated into one Unlikely alliance of feminists and moral preachers, a puzzle for judges and juries, and a provider of guilty secrets to legions of men sneaking brown paper parcels out of porn shops or mailboxes.

Hustler’s June 1978 cover hit the riddles of a magazine that was all at once violent, satirical, perverse, decadent, cheerfully immoral, and hypocritical. It showed a woman on her head and half in a meat grinder with a plate of hamburger underneath. A “seal of approval” noted: “Prime. Last edition of All Meat. Note ‘A’ pink. “In a caption, Mr. Flynt was quoted as saying,” We will no longer hang women up like pieces of meat. “

But of course, Hustler wasn’t serious. Starting with the first issue in July 1974 and for four decades without a break, it featured glossy, color photos of female genitals, nude women in degrading poses, and often depicted group sex and sex toy fetishes.

Hustler articles featured “Larry Flynt on White House Sex,” “Coverbabe: New Slut In Town,” and “Dirty Bedfellows: Explicit Photos and Dirty Stories from a Real Intern in Washington”. But it wasn’t all sex; There were also articles such as “The Politics of Torture”, “Grenada Invasion: The Real Story Behind Reagan’s” Facts “”, and “Shocking New Facts in JFK Assassination Coverup”.

Mr. Flynt’s major legal win was a long battle against Rev. Jerry Falwell, the television evangelist and founder of the Moral Majority, who sued for $ 45 million in 1983 for libel and emotional distress after Hustler released a parody he remembered about a sexual encounter with his mother in an outbuilding.

A jury denied the libel accusation, saying the parody was obviously not factual, but granted Mr. Falwell $ 200,000 for emotional stress. In 1988 the Supreme Court unanimously threw back the damage and called the parody a constitutionally protected political satire.

Mr. Flynt hailed the decision as the major victory of the first amendment since the obscenity ban on James Joyce’s “Ulysses” was lifted in the 1930s.

For all of Mr. Flynt’s fame, his image as a defender of free speech was bolstered by the 1996 Milos Forman film The People vs. Larry Flynt, in which he was portrayed as some sort of American folk hero, a filthy peddler into the stars and stripes . Woody Harrelson was nominated for an Oscar for his performance as Mr. Flynt. The film received high acclaim from many critics and most, if not all, middle-class libertarians.

But the feminist Gloria Steinem wrote a scathing denunciation on the Op-Ed page of the New York Times. “A pornographer is not a hero,” she said. “At worst, Hustler is portrayed as sticky and maybe even honest because he shows full nudity. What is left out are the images in the magazine of women being beaten, tortured and raped, women being demoted from bestiality to sexual slavery. “

The images shown in Hustler were undoubtedly graphic and often violent: women were depicted crawling at the end of a dog leash, nailed to a cross, wrapped like a deer, and tied to a luggage rack. One envelope showed a woman’s head in a gift box.

Hustler claimed a monthly circulation of three million copies in the mid-1970s, although Forbes peaked at two million in 1976. With explicit sex on cable TV, on DVD and on the Internet, its circulation fell sharply in the 1980s and 1990s. In 1997, the Times reported that Hustler’s circulation was less than a million, but half of the kiosk copies were returned unsold. In 2015, Mr. Flynt cited a circulation of 500,000.

The magazine’s revenues financed numerous Flynt companies for years: dozens of magazines, some mainstream but mostly pornographic, including Tabu, Barely Legal and Asian Fever, the number and type of which varied over time; Hustler strip clubs in a dozen cities; and perhaps an equal number of hustler chain stores selling pornographic videos as well as clothing, magazines, and sex toys.

Mr. Flynt also owned a casino in Gardena, California; operated websites that sell pornography; and licensed the Hustler name to magazines and other sex-oriented companies in Canada, the United Kingdom, South Africa and Australia. Its main profit centers included Hollywood studios, which produced pornographic films, videos and cartoons, many of them with violent and misogynistic themes.

A 1983 Justice Department funded study by Conservative writer and scholar Judith Reisman found that thousands of cartoons in Hustler, as well as its competitors Playboy and Penthouse, depicted rape, botched abortions, and children in sexual poses. “Chester the Molester,” a long-running hustler cartoon about a pedophile, has received many critics, but Mr. Flynt defended it as a dogged social satire.

The value of the Flynt Empire was murky. It was privately owned and had no financial disclosure requirements. Mr Flynt put in estimates of up to $ 700 million, but financial experts said his wealth had changed dramatically over time due to economic conditions, and the 2015 consensus put his net worth at around $ 400 million.

Mr. Flynt, who once entered federal court wearing an American flag diaper, regularly stepped into the limelight with a drum beat – he mocked conservative religious leaders, recorded the sexual peccadillos of politicians, aroused anger and amusement with parodies of patriotism. and attack the dignity of cultural icons.

In 1975, a year after publication began, Hustler drew attention to himself with the publication of nudes of Jacqueline Kennedy Onassis, captured by a paparazzo sunbathing on an Aegean beach. Mr. Flynt bought the paintings for $ 18,000 and quickly sold a million copies of the edition in which they were pictured.

Mr. Flynt was first prosecuted in 1976 on profanity and organized crime charges for selling obscene material in Cincinnati. Charles Keating, later convicted of a notorious savings and credit scandal, founded Citizens for Decent Literature and outraged the public over the case. Mr. Flynt lost on both counts and was sentenced to seven to 25 years. But he only served six days, and the conviction was overturned due to prosecutorial misconduct and judicial bias. The case highlighted Cincinnati as a bastion of conservatism and Mr. Flynt as a dubious free speech advocate.

After being approached by Evangelist Ruth Carter Stapleton, sister of President Jimmy Carter, in 1977, Mr. Flynt announced that he had become a born again Christian and said he had a vision of God when he was in with Ms. Stapleton his jet was in the air. He banned Hustler’s smoking, gave the staff a raise, started a carrot juice diet, and vowed to “rush for God”. But he soon resumed his ventures and vices and called himself an atheist.

In 1978, during a trial in Lawrenceville, Georgia, he was shot dead by an escaped sniper near the courthouse for profanity. Mr. Flynt’s legs were permanently paralyzed and he spent the rest of his life in a gold-plated wheelchair. The assailant Joseph Paul Franklin, a white supremacist who protested Hustler’s portrayal of interracial couples, was captured in 1980. He was never charged with the shooting of Mr. Flynt, but confessed to a number of murders and was executed in Missouri in 2013.

Many profanity cases were brought against Mr. Flynt in later years. He lost some due to jurisdiction or privacy. Most, however, failed the 1973 Supreme Court’s restrictive test, which defined profanity as prurient, overtly objectionable material that had no scientific, literary, artistic, political, or social merit and, as a whole, violated subjective “community standards” – which meant that it could be set in Times Square, but not in Cincinnati around 1976.

Mr. Flynt’s interpretation was easier. “If the first amendment protects a bastard like me,” he said, “then it protects you all. Because I am the worst. “

Larry Claxton Flynt Jr. was born in Lakeville, Kentucky, on November 1, 1942, the eldest of three children to Larry Claxton Flynt, a sharecropper, and Edith (Arnett) Flynt. After his sister Judy died of leukemia in 1951, the family was shattered. His parents divorced. Larry lived with his mother; his brother Jimmy lived with a grandmother.

Larry dropped out of school in Salyersville, Kentucky, when he was 15 and joined the Army with a false birth certificate. After his release, he counterfeited alcohol and joined the Navy in 1960 and became a radar operator.

Released in 1964, he bought a bar in Dayton, Ohio from his mother for $ 1,800 and used the profits to buy two more bars. Then he opened his first hustler club with naked hostess dancers.

In the late 1960s, he opened Hustler strip clubs in Akron, Cleveland, Columbus, Toledo, and Cincinnati. To promote his business, he created a newsletter with naked women. In 1974 it became Hustler magazine.

Playboy, Penthouse and other competitors crowded the kiosks, and Hustler struggled in his first year, also because dealers and wholesalers were reluctant to deal with it. But the pictures of Mrs. Onassis made Hustler notorious overnight and Mr. Flynt a millionaire.

He was married five times. His first three marriages all ended in divorce. In 1976 he married Althea Leasure, who had helped found his company. She contracted AIDS and drowned in a bathtub in 1987. In 1998 he married Elizabeth Berrios. He had five children. One, Lisa Flynt, died in a car accident in 2014.

In addition to his wife and brother, his other children – TJ Flynt, Theresa Flynt, Tonya Flynt-Vega, and Larry Flynt Jr. – and many grandchildren survive him.

Mr. Flynt published a memoir in 1996 entitled “An Inappropriate Man: My Life as a Pornographer, Expert, and Social Outcast” (written with Kenneth Ross). It was the subject of a documentary directed by Joan Brooker-Marks, “Larry Flynt: The Right to Be Left Alone”, he wrote in 2007 with David Eisenbach “One Nation Under Sex” (2011) about former presidents. After Mr. Falwell’s death in 2007, Mr. Flynt said that despite their differences, they became friends. “I’ve always valued his sincerity,” he told the Los Angeles Times, “even though I knew what he was selling and he knew what I was selling.”

Alex Traub and Isabella Paoletto contributed to the coverage.