Covid News: Study Finds Health Problems Can Persist Long After Infection, Even Among the Asymptomatic
Hundreds of thousands of Americans have sought medical care for post-Covid health problems that they had not been diagnosed with before becoming infected with the coronavirus, according to the largest study to date of long-term symptoms in Covid-19 patients.
The study, tracking the health insurance records of nearly 2 million people in the United States who contracted the coronavirus last year, found that one month or more after their infection, 23 percent of them sought medical treatment for new conditions.
Those affected were all ages, including children. Their most common new health problems were pain, including in nerves and muscles; breathing difficulties; high cholesterol; malaise and fatigue; and high blood pressure.
Post-Covid health problems were common even among people who had not gotten sick from the virus at all, the study found. While nearly half of patients who were hospitalized for Covid-19 experienced subsequent medical issues, so did 27 percent of people who had mild or moderate symptoms and 19 percent of people who said they were asymptomatic.
âOne thing that was surprising to us was the large percentage of asymptomatic patients that are in that category of long Covid,â said Robin Gelburd, president of FAIR Health, a nonprofit organization that conducted the study based on what it says is the nationâs largest database of private health insurance claims.
More than half of the 1,959,982 patients whose records were evaluated reported no symptoms from their Covid infection. Forty percent had symptoms but didnât require hospitalization, including 1 percent whose only symptom was loss of taste or smell; only 5 percent were hospitalized.
Ms. Gelburd said the fact that asymptomatic people can have post-Covid symptoms is important to emphasize, so that patients and doctors know to consider the possibility that some health issues may be aftereffects of the coronavirus. âThere are some people who may not have even known they had Covid,â she said, âbut if they continue to present with some of these conditions that are unusual for their health history, it may be worth some further investigation by the medical professional that theyâre working with.â
The report analyzed records of people diagnosed with Covid-19 between February and December 2020, tracking them until February 2021. It found that 454,477 people consulted health providers for symptoms 30 days or more after their infection. FAIR Health said the analysis was evaluated by an independent academic reviewer but was not formally peer-reviewed.
The report âdrives home the point that long Covid can affect nearly every organ system,â and that some patients may experience âchronic conditions that will last a lifetime,â said Dr. Ziyad Al-Aly, chief of the research and development service at the VA St. Louis Health Care System, who was not involved in the new study.
The most common issue for which patients sought medical care was pain â including nerve inflammation and aches and pains associated with nerves and muscles â which was reported by more than 5 percent of patients, more than a fifth of those who reported post-Covid problems. Breathing difficulties were experienced by 3.5 percent of post-Covid patients. Nearly 3 percent sought treatment for symptoms that were labeled with diagnostic codes for malaise and fatigue.
Other new issues for patients, especially adults in their 40s and 50s, included high cholesterol and high blood pressure. Dr. Al-Aly said such health conditions, which have not been commonly considered aftereffects of the virus, make it âincreasingly clear that post-Covid or long Covid has a metabolic signature marked by derangements in the metabolic machinery.â
Federal health officials have classified the Delta variant of the coronavirus now circulating in the United States as a âvariant of concern,â sounding the alarm because it spreads rapidly and may partially sidestep certain antibody treatments.
Officials with the Centers for Disease Control and Prevention on Tuesday emphasized that the authorized vaccines are highly effective against the variant, however, and urged all Americans who have not yet been inoculated to get fully vaccinated as soon as possible.
In England, the swift spread of Delta variant has forced government officials to postpone the lifting of pandemic restrictions, called Freedom Day, which was to be June 21. Now the government will maintain some restrictions for four additional weeks.
Reports from Britain indicate that single doses of the Pfizer-BioNTech or AstraZeneca vaccine are only 33 percent effective at preventing symptomatic Covid-19 caused by the Delta variant.
In the United States, about 44 percent of citizens are fully vaccinated, according to a database maintained by The Times. In California and New York, states in which vaccination rates are higher, governors are moving to lift restrictions altogether.
âEven though our case counts are declining and people are getting vaccinated, we still have roughly half our population that is unvaccinated,â said Summer Galloway, a Covid-19 adviser to the C.D.C. and executive secretary of the SARS-CoV-2 Interagency Group, which characterizes emerging variants for the U.S. government.
âWe have circulation of a more transmissible variant that is definitely a concern, and our bottom line message here is we want to make sure people are taking this seriously and are getting vaccinated as soon as theyâre eligible and itâs available to them.â
The Delta variant, also known as B.1.617.2, is now one of six variants of concern. The virus first was identified in India in December, and by June was found in 54 countries. It was detected in Britain in late March. Public Health England called it a variant of concern on April 28, and the World Health Organization followed suit in May.
In the United States, the proportion of coronavirus infections attributed to the Delta variant has increased rapidly, from 2.7 percent during the two-week period ending May 22 to nearly 10 percent of cases during the two-week period ending June 5, according to modeling studies used by the C.D.C.
The rapid rise is âthe number one driver for classifying this as a variant of concern,â Dr. Galloway said. Data from Britain suggest that the Delta variant is at least 50 percent more transmissible than the Alpha variant, also called B.1.1.7, she added.
There is still uncertainty about whether the Delta variant causes more severe disease, increasing the risk of hospitalization and death, Dr. Galloway said: âWe donât have hard data to say there is a definitive increase in disease severity, but there is potential for that and we donât want to rule that out.â
The Delta variant âhas rapidly become the dominant variant in England,â accounting for more than 90 percent of new infections, scientists recently reported. The variant contains a mutation in the viral genes that direct production of its spike protein, called the L452R substitution. That mutation is shared by other variants and may make monoclonal antibody treatments less effective.
Scientists determined that the odds of the Delta variant spreading among members of a household were 64 percent greater than that of the B.1.1.7 variant first identified in Britain, which itself is considered both more contagious and more deadly than other variants.
The trajectory of the Delta variant in the United States is unpredictable, but it could present serious challenges, particularly in regions like the South, where vaccination rates are low, and in the more than 100 U.S. counties where fewer than 20 percent of the population is vaccinated, said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
âThis virus continues to throw curveballs at us,â he said.
The White House will host a 1,000-person gathering on the South Lawn on the Fourth of July, a celebratory display meant to signal that President Biden delivered on a promise that Americans could expect to return to some semblance of normal life by the holiday.
Essential workers and military families will be invited to participate in the South Lawn event, and administration officials have encouraged local leaders to hold their own celebrations: âAmerica is headed into a summer dramatically different from last year. A summer of freedom. A summer of joy. A summer of reunions and celebrations,â an email circulated to local leaders by the White House Office of Intergovernmental Affairs said.
The National Parks Service announced that visitors are encouraged to attend a holiday fireworks display on the National Mall and that all nearby monuments will be open. (Last year, attendees were advised to stay socially distanced and to avoid traveling into the capital.)
Mayor Muriel Bowser of Washington also issued a statement that âD.C. is open and ready to welcome back visitorsâ for the holiday.
âWe thank President Biden and his team for acting with urgency to get the vaccine to the American people so that we could save lives, get our country open, and celebrate together once again,â Ms. Bowser said.
The large celebration goes well beyond the scope of what Mr. Biden had promised three months ago. In a televised address in March to mark the anniversary of the World Health Organization declaring the spread of the coronavirus a pandemic, Mr. Biden said the country could expect to celebrate with friends and family on the Fourth of July, as long as they took the chance to get vaccinated and did not prematurely abandon mask wearing, social distancing and other measures to contain the virus.
âJuly 4th with your loved ones is the goal,â he said. âThis is not the time to let up.â
The modest expectations Mr. Biden laid out in his speech have given way to the largest planned event of his presidency, one designed to emphasize the speed with which the Biden administration has gotten shots in arms. Still, with a recent slowdown in vaccination rates, particularly in Southern states, Biden may not reach his goal of 70 percent of Americans vaccinated by July 4. If the pace of adult vaccination continues on the seven-day average, the nation will come in just shy of Mr. Bidenâs target, with roughly 67 percent of adults partly vaccinated by July 4, according to a New York Times analysis.
In recent days, administration officials have subtly started to shift their responses when asked if that goal will still be met.
âThereâs no question itâs a bold and ambitious goal,â Jen Psaki, the White House press secretary told reporters last week. âRegardless of where we are on July 4th, weâre not shutting down shop. On July 5th, weâre going to continue to press to vaccinate more people across the country.â
Still, Mr. Biden has acknowledged the tremendous loss that Americans had endured during the pandemic, as the United States neared 600,000 virus deaths.
âI know that black hole that seems to consume you, that fills up your chest when you lose someone thatâs close to you, that you adored,â he said Monday in Brussels.
He continued: âPlease get vaccinated as soon as possible. Weâve had enough pain.â
Lazaro Gamio and Daniel E. Slotnik contributed reporting.
Jim Wilson/The New York Times
Kendrick Brinson for The New York Times
Ringo H.W. Chiu/Associated Press
Kendrick Brinson for The New York Times
Jim Wilson/The New York Times
Alexandra Hootnick for The New York Times
California lifted most of its Covid-19 restrictions and officially reopened on Tuesday, marking the moment with state-subsidized vacation giveaways and $15 million in vaccine lottery prizes as it emerged from the pandemic politically divided but economically formidable.
One of the last U.S. states to reopen, California had already relaxed many of its health restrictions; others will not be completely phased out until autumn. Still, the formal unwinding of pandemic rules in Americaâs most populous state is yet another signal of a national turn toward recovery. One out of every eight Americans lives in California, which generates 14.5 percent of the nationâs gross domestic product.
âThere is no American recovery without Californiaâs recovery,â Gov. Gavin Newsom said in an interview Monday as merchants prepared to ditch the masks and occupancy constraints that have limited both commerce and the coronavirus. âThe good news is the stateâs economic recovery is well underway.â
The coronavirus has infected some 3.8 million Californians and killed more than 63,000 since the pandemic started â more deaths than any other state, because of the size of Californiaâs population. At the same time, the state has been especially aggressive in combating the virus, occasionally walking a fine legal line in balancing civil liberties with public health needs.
In April, the U.S. Supreme Court struck down some of the stateâs pandemic restrictions on religious gatherings. And Mr. Newsomâs pandemic policies have helped fuel a Republican-led recall campaign against him.
âThe state erred on the side of caution, and thatâs impinged on personal freedom in favor of public health,â said Dr. Christopher Longhurst, the chief information officer for the health system at the University of California San Diego. âBut it saved lives.â
Two earlier attempts at relaxing health rules ended with surges in new cases, but the calculus has changed significantly with immunization.
With help from the Biden administration, California has invested heavily in vaccinations, offering more than $100 million in immunization incentives and opening clinics in a wide range of places, including farmworker communities, strip malls and sports arenas. For months, the state has had one of the nationâs highest vaccination rates and lowest positivity rates.
The governor was scheduled on Tuesday to preside over a vaccine lottery drawing, awarding 10 prizes of $1.5 million each to Californians who had received at least one vaccine dose. Next week, the state will award an array of free California vacations to travelers who have been vaccinated, including a stay at Disneyland â which raised attendance limits and dropped mask requirements for vaccinated visitors starting Tuesday â and 10 weddings at a resort in the Napa Valley.
Most counties had already lowered their case rates to a point that allowed public gatherings and indoor dining service, but the new approach effectively ends the entire color-coded system that set tiers of rules based on infection levels.
Large indoor events, like N.B.A. games and concerts, will require a negative coronavirus test or proof of vaccination for entry. The state has strongly recommended similar requirements for admission to large outdoor venues like Dodger Stadium.
Masks will continue to be required in crowded and high-risk areas â hospitals, long-term-care facilities, public transit, prisons and homeless shelters. But otherwise, the state generally will not mandate masks for people who have been vaccinated, and enforcement will largely be on the honor system.
Tariro Mzezewa contributed reporting from San Francisco.
Restaurants in New York will no longer be forced to space tables six feet apart or use physical partitions; movie theaters will be allowed to pack their auditoriums without spacing seats apart; and entering commercial buildings wonât require a temperature check.
With 70 percent of adults in New York having received at least one dose of a coronavirus vaccine, the state took a major step toward normalcy by eliminating nearly all restrictions on businesses and social gatherings, Gov. Andrew M. Cuomo announced on Tuesday.
The changes, which will take effect immediately, mark yet another milestone in the economic recovery of a state that was once an epicenter of the pandemic, and are expected to bring back the type of scenes familiar to most New Yorkers in prepandemic times.
With the order, the state, in most cases, will end capacity limits and no longer require social distancing, disinfection protocols and health screenings, instead making it optional for businesses to impose such health precautions on their premises.
âThis is a momentous day and we deserve it because it has been a long, long road,â Mr. Cuomo, a third-term Democrat, said at the World Trade Center in Lower Manhattan on Tuesday. He added: âWe can return to life as we know it.â
In addition to the changes in protocols at restaurants, movie theaters and commercial buildings, barber shops and hair salons wonât need to ask their customers for contact tracing information and gyms and fitness centers wonât need to abide by strict disinfecting protocols to clean their exercise equipment.
Mr. Cuomo set the 70 percent threshold that triggered the end of the restrictions last week as a way to spur on the stateâs reopening and incentivize people to get vaccinated, saying âvirtually allâ coronavirus rules would expire. Fourteen other states and Washington, D.C., have all reached the same threshold, according to the latest federal data, with Vermont topping the list at 84 percent.
Even so, the move in New York comes as health officials remain vexed by low vaccination rates in ZIP codes across the state, and in pockets of New York City.
About 65 percent of adults â those 18 or older â have received at least one dose in the city, while 54 percent of city residents of all ages have gotten one dose, according to city data. Some of the lowest adult vaccination rates in the city are in the Bronx (57 percent with a first dose) and in Brooklyn (59 percent).
New Yorkers should still expect to see signs of pandemic life even with the restrictions lifted.
With crowds at the Disneyland entrance, traffic jams on the Los Angeles freeways and triple-digit heat from Sacramento to the San Fernando Valley, Californiaâs governor celebrated the reopening of the stateâs economy on Tuesday, raffling off 10 prizes of $1.5 million each to people who had been vaccinated against Covid-19.
âWe are here today, June 15, to turn the page,â said Gov. Gavin Newsom, hosting the event from Universal Studios Hollywood with an assortment of Minions from the âDespicable Meâ movie franchise and the âTransformersâ robot hero Optimus Prime.
Speaking without a face covering, the governor said it was time âto move beyond capacity limits, to move beyond these color codings, move beyond social distancing and physical distancing, and â yes, as you saw me walk up to the stage â to move beyond mask coverings.â
The nationâs most populous state officially ended most of its coronavirus health restrictions just after midnight, lifting gathering limits on bars and restaurants, and largely dropping face-mask requirements for vaccinated people.
California has been in better shape economically than most states, although its tourism sector âreally had the sledgehammer taken to it,â Mr. Newsom had noted on Monday. The stateâs unemployment rate remains about 4 percentage points higher than before the crisis and higher than the national average, largely because of layoffs at restaurants, hotels and tourist attractions.
Spending on California tourism fell 55 percent last year. Half of the industryâs work force â some 600,000 employees â lost their jobs in the first month after the pandemic hit.
But overall, Californiaâs economy has emerged from the pandemic with preternatural strength. The state budget is running a record surplus, largely because so many tech start-ups went public and so many white-collar employees were able to continue to work remotely. Mr. Newsom is preparing to issue his second round of statewide stimulus checks, this time including taxpayers earning less than $75,000 annually.
And tourist attractions, such as the Universal Studios theme park, are bracing for a rebound. Disneyland, which had reopened to in-state visitors before this week, was jammed on Tuesday as the park expanded its rules to welcome out-of-staters and announced its fireworks shows would return in July.
Jerry Nickelsburg, an adjunct professor of economics at the University of California, Los Angeles, and the director of an economic outlook called the U.C.L.A. Anderson Forecast, said that the stateâs relative economic health appeared to be linked to its public health measures. He added that the data supported the governorâs repeated claims that California had economically outperformed Texas and Florida, both of which were largely open throughout the pandemic.
âCalifornia was one of the most rapidly growing states in the last expansion, and all the factors that led to that still exist,â Mr. Nickelsburg said.
What has been good for the state has been good for Mr. Newsom, who is facing a recall campaign against him. But his approval ratings have improved as the pandemic has receded, and his fellow Democrats, who control the Legislature, now are weighing whether to expedite the anticipated fall election so that he can capitalize on post-pandemic good will.
And Mr. Newsom has been ebullient in recent weeks as he has barnstormed the state, giving away $50,000 vaccine lottery prizes in the run-up to this weekâs grand prize drawings.
âToday is a day to reconnect â to give people hugs, to remind them weâre not out of the woods yet, to remind them weâre all in this together,â the governor said on Tuesday.
âProtect the planet, protect each other,â Optimus Prime added. âAutobots, roll out.â
By 10 a.m. in Los Angeles it wasnât just warm. It was muggy, almost oppressively hot, as if Mother Nature were trying to give Californians a reason to seek shelter indoors. Still, the change seemed to be part of a more gradual shift in the cityâs energy as most of the stateâs pandemic restrictions were lifted on Tuesday.
Mariachi Plaza in the hard-hit Boyle Heights was quiet in the morning. A lone musician, Jesus Falsto, who plays trumpet, said parties had picked up, but no one plays in the square to book gigs anymore.
In the heart of Hollywood, the streets were still relatively muted, although by midday things had started to wake up. A trickle of tourists, many still wearing masks, wove past the TCL Chinese Theatre, a few pausing to take selfies, though the entrance marked by decades of celebrity handprints in the pavement was still blocked off. A worker called out over a loudspeaker, imploring passers-by to buy tickets for tours of the iconic movie house.
Eddie Kakish, 51, sat in the shade near the Madame Tussauds Hollywood wax museum on his mobility scooter with his African grey parrot, Bud, enjoying the fresh air and the music blaring along with a garish electronic billboard.
âIt looks kind of the same as yesterday,â Mr. Kakish remarked of the crowd.
The longtime Angeleno â he has lived here since he was 7 â said he was nevertheless excited for the city he loves to âcome back strongerâ after a difficult year. He described himself as a born-again Christian and said he actually had enjoyed attending church services outside.
At the Hollywood Roosevelt Hotel, built in 1927, the lobby was dark and cool and quiet, but the scene around its Tropicana Pool could almost have taken place any time in the last several decades. Guests in bikinis lounged on chaises nearly all unmasked, or dipped in the aqua water. More than 200 palm trees shaded the pool deck.
Denise Randazzo, the hotelâs vice president of sales and marketing, said that employees were still required to keep their face coverings â at least until the state and the county said otherwise. She said that the hotel didnât expect demand to explode overnight â rather, in the last few weeks, the weekends have been nearly booked as more travelers within driving distance have sought out getaways.
But increasingly, she said, guests are booking stays further in advance. âSummer is peak season, and weâre starting to see those trends again,â she said.
Ms. Randazzo said that the hotel had closed in March 2020 and reopened at limited capacity in June 2020. Since then, it has expanded outdoor dining and other outdoor programming, including pool movie and comedy nights, and rooftop yoga. She said all of those would continue at least through the summer.
âNow, weâre looking forward to next yearâs award shows and Oscar parties,â she said.
While many Californians were celebrating a fully reopened state on Tuesday, a complaint emerged from some residents and officials in the redder parts: It should have happened a long time ago.
âHere in Merced, the majority of people would think that we waited a little too long and were too restrictive,â said Matthew Serratto, the cityâs mayor. âThereâs that general perspective in our community that itâs a little too late. We should have sought a balance that protects peopleâs lives and their health.â
The San Joaquin Valley city of Merced, which has a population around 80,000, is nearly two hours from Yosemite National Park. Merced County has had more than 30,000 coronavirus cases and 474 deaths, with about 1 in 9 residents infected since the start of the pandemic.
The virus has had an impact on Merced. In March, the city mourned the death of a longtime local teacher, Frank Delgado, 79, who was known as Mr. D and who died after contracting pneumonia following a battle with Covid-19, according to The Merced Sun-Star.
And its local restaurants, bars and hotels took a considerable hit. Last July, its former mayor told The Merced Sun-Star that he did not know âhow much longer our businesses, particularly the hospitality industry, can continue under these constrained circumstances.â
Lacey Hoffman, a manager at Strings, an Italian restaurant in downtown Merced, said that her restaurant had done everything it could to survive during the shutdowns.
âWe had to do delivery,â said Ms. Hoffman, who at one point was unemployed during the pandemic. âWe had to close some tables for social distancing. It really sucked.â
With most restrictions lifted, Ms. Hoffman said she was looking forward to having busier tables at the restaurant and being able to wear makeup since she will no longer be required to wear a mask.
âI wish we did open up a little earlier, but it is what it is,â she said.
Gov. Gavin Newsomâs pandemic policies helped fuel a Republican-led recall campaign against him. Some in the state believe Mr. Newsomâs latest moves â the reopening date, cash prizes for the vaccinated through a state-financed lottery drawing â have been done to keep voters happy in the run-up to a recall election.
âI think politics are always involved,â said Mr. Serratto, a Democrat. âYou canât separate any human decision-making from politics.â
Many Californians responded to the stateâs reopening on Tuesday along political lines.
In liberal bulwarks like San Francisco, officials said they would continue to exercise their option to impose tougher pandemic rules than the stateâs, requiring proof of vaccination for employees in high-risk workplaces like hospitals and skilled-nursing centers.
In Los Angeles, Roselma Samala, the co-owner of Genever, an Art Deco-inspired gin bar in the cityâs Historic Filipinotown, said that despite the statewide reopening, she and her partners did not plan to resume indoor service until July 15.
âJust bringing in a dollar isnât worth it to us, if our staffâs health or our communityâs health is going to be impacted,â Ms. Samala said.
In the more rural and conservative Central Valley, Jerry Dyer, the Republican mayor of Fresno, said his constituents largely felt that the health rules could and should have been lifted sooner, and that it was difficult to celebrate reopening without also thinking of the livelihoods that were crushed in the effort to save lives.
âPeople who have been laid off, who have had to stand in food lines for the first time, who were unemployed for the first time,â Mr. Dyer said, âfor those people, itâs bittersweet.â
And in the red-tinged suburbs outside the state capital in Sacramento, small-business owners blamed Gov. Gavin Newsom for the battering they took under state pandemic restrictions. Michael Helmrich, a restaurateur, said he âmight forgive but sure wonât forgetâ the hundreds of thousands of dollars his business lost.
âWe really want to put this behind us and get back to normal,â he said, âwhatever ânormalâ is now.â
Mr. Newsomâs handling of the pandemic and the restrictions the state imposed during the pandemic have helped to fuel a Republican-led recall campaign against him.
Tariro Mzezewa contributed reporting from San Francisco.
Employees at Berkeley Bowl Marketplace, a supermarket known for its aisles of fresh produce, put out a sign on Tuesday informing shoppers that it was OK to enter maskless if they were fully vaccinated.
But the vast majority of people entering the store around midday on Tuesday ignored the option and shopped fully masked, pushing carts past the craft beers, the piles of cherries and the bulk bins of spices and loose tea.
âThis is Berkeley,â said Mitch Capor, a retired probation officer who was loading his groceries into the trunk of his car, a surgical mask tightly fitted over his mouth and nose. âItâs going to take a little time for people to relax and take off their masks.â
The San Francisco Bay Area, the first part of the country to order residents to stay home when the coronavirus began spreading out of control last year, has been among the most diligent in complying with mask orders. Bay Area residents have generally covered up even when outdoors, whether it was hiking on trails in the hills above the Pacific Ocean or chatting with a neighbor outside a suburban house.
Berkeley residents said they expected the practice to linger long after the announcement by Gov. Gavin Newsom that vaccinated Californians could shed their masks in most settings beginning Tuesday.
âItâs the social pressure of everyone else doing it,â said Caeleigh MacNeil, one of the few shoppers at the Berkeley Bowl who chose to forego a mask.
J.J. Johnson of Oakland wore not just one mask, but two, to the store.
âIâm uncomfortable being indoors with a lot of people,â Mx. Johnson said. âThereâs muscle memory from last spring.â
Concerned about the slow pace of coronavirus vaccinations, the Pakistani authorities have decided to take drastic measures, including blocking peopleâs cellphone service in two provinces and suspending the salaries of some government employees who have not been vaccinated.
They say the measures are needed to address deep skepticism about Covid-19 vaccines, and about inoculations more broadly.
Pakistan has long struggled with disinformation about vaccines that have been proven safe and effective, particularly for polio. Parents commonly refuse polio immunization for their children, falsely believing that the vaccine is harmful and part of an American plot to sterilize the children.
That refusal has made Pakistan the last refuge for the polio virus in the world, besides neighboring Afghanistan.
And now conspiracy theories about the side effects of the coronavirus vaccine have become widespread in Pakistan.
âI have heard that people, after getting the coronavirus jab, will die within the two years,â said Ehsan Ahmed, a truck driver in Karachi. âIt is the reason that in our extended family of at least 25 people, no one is willing to vaccinate themselves.â
The government has set a goal of vaccinating between 45 million and 65 million people by the end of this year, and it recently announced plans to spend $1.1 billion to procure doses.
However, as of Tuesday, Pakistan had fully vaccinated roughly 3 million people â less than 2 percent of its population â since the vaccination drive started on Feb. 3, according to government data.
The country has recorded nearly 22,000 deaths from Covid-19 and nearly one million people have tested positive for the virus since the start of the pandemic.
In an effort to compel people to get shots, the local authorities in two provinces â Punjab and Sindh â have announced plans to block the cellphone service of residents who refuse.
âThe government is trying its best to facilitate people in getting the vaccine,â the information minister in Sindh, Syed Nasir Hussain Shah, said. He called the decision to not get a shot âunacceptable.â
The authorities have not announced when the order will take effect or how it will be enforced.
At the same time, the government in Sindh has directed its finance ministry to stop paying government employees who have not been vaccinated, starting in July.
Since the measures were announced, reports of fake vaccination certificates have soared.
This week, the police in the port city of Karachi arrested a person involved in selling forged vaccination certificates at the cityâs largest vaccination center.
They cost around $12.
Within 20 minutes of opening, Portal, a popular brunch spot in Oakland, Calif., had already seated eight tables âÂ not bad for a Tuesday afternoon,Â and exactly what the owner, Kevyn Johnston, said Portal needed.
As California lifted most of its pandemic-related restrictions for restaurants and other businesses on Tuesday, Portal was one of many restaurants expecting to get robust traffic.
âWhat weâre looking for at this point is to dig ourselves out of the hole,â Mr. Johnston said. âWe donât expect the business to bring us back to prepandemic anytime soon.â
Mr. Johnston said Tuesdayâs early turnout at the restaurant was already at least 40 percent better than a typical day over the past year, and he hoped the trend would continue for the rest of the day at his restaurant, where a 90-minute wait for a table used to be common on weekends.
On the eve of the stateâs reopening, Mr. Johnston closed his restaurant for renovations and to update the floor plan. Everything from spare tables to extra salt and pepper shakers were taken out of storage. He rehired a laid-off bartender and set out 13 new bar stools for Tuesday evening.
âWe havenât been able to have condiments out, or reuse menus,â he said.
They would still use scannable menus, he said, but âjust have those traditional menus out for those that want them.â
Mr. Johnston noticed that customers still came in with their masks on, even though the stateâs mask mandate was significantly eased.
Portal is near Lake Merritt, close to the center of Oakland in Alameda County, which has reported almost 90,000 Covid-19 cases over the course of the pandemic.
During the stateâs first shutdown, Portalâs large open patio allowed Mr. Johnston and his staff to go on serving customers outdoors, but he said his restaurant was âbarely breaking even.â The second shutdown was worse, he said: Takeout and delivery orders were barely enough to keep the doors open, and for a while the restaurant was losing $25,000 a month.
âIt was devastating,â Mr. Johnston said. âBut since then, weâve been rebounding quite well, and we see an improvement each week. Californians are anxious to get out and enjoy themselves again. It comes in small waves. Weâre already seeing people that we havenât seen in a long time.â
LONDON â Andrew Lloyd Webber last week promised to open his musical âCinderellaâ in Londonâs West End on June 25 â even if it were illegal to do so.
âWe are going to open come hell or high water,â he told The Daily Telegraph, a British newspaper. If Britainâs government tried to stop him because of rising coronavirus cases, he had one response, he added: âWe will say: Come to the theater and arrest us.â
Now, Mr. Lloyd Webber, 73, has his chance to go to prison â although he doesnât appear to want to take it.
On Monday evening, Prime Minister Boris Johnson of Britain said that social distancing would continue in England until July 19, at least â almost a month later than originally planned.
The decision, announced at a televised news conference, was made because of a rise in coronavirus cases linked to the Delta variant. An average of 7,278 cases per day were reported in United Kingdom in the last week, an increase of 127 percent from the average two weeks ago. Deaths are rising but still very low, with an average of nine a day over two weeks.
Scientists remain at odds over exactly how serious a threat it poses in Britain, however, with some arguing that the most dire predictions about rising hospitalizations underestimate the effect even the current level of vaccinations has on breaking the link between the number of new cases, hospitalizations and deaths.
âI think itâs sensible to wait just a little bit longer,â Mr. Johnson said, adding that the delay would allow more people to be fully vaccinated.
The delay was a gut punch to the British cultural world, which has been desperately seeking an end to social distancing.
The delay leaves âthousands of jobs hanging in the balance,â Julian Bird, chief executive of UK Theater, a trade body, said in a statement. A quarter of nighttime businesses cannot survive longer than a month without new government support, the Night Times Industries Association, which represents clubs and pubs, said in a news release.
The biggest blow may be to Englandâs nightclubs, which were told for the fourth time that they could not reopen at all, even with distancing. Nightclubs in Britain have been closed since March 2020, and over 150 events were planned in London alone for the weekend of June 25, including a sold-out 42-hour-long party at Fabric, a famed club that can hold 1,500 people.
Those were all immediately canceled.
âItâs really, really frustrating,â Cameron Leslie, one of Fabricâs founders, said in a telephone interview. He had hired over 100 staff over the past month, expecting to reopen, and now was not able to furlough them.
âYou can only be pushed and tested so far before our entire sector canât respond anymore,â Leslie added.
Stuart Glen, the founder of The Cause, another London club, said in a telephone interview that the delay would cost him âhundred of thousandsâ of pounds and force him to rearrange 40 events. Heâd had enough, he said. âI think everyone should riot if July doesnât happen,â he said. âThey canât control people like this,â he added.
âItâs so devastating for so many people,â said Yousef Zahar, a D.J. and co-owner of Circus, a nightclub based in Liverpool, that in May held two pilot events featuring 6,000 maskless dancers.
Theaters, museums and music venues were allowed to reopen with distancing last month, but larger venues and all nightclubs have remained firmly shut. Mr. Lloyd Webber has repeatedly said that glitzy productions like âCinderellaâ â which has a 34-strong cast and is already weeks into rehearsals â are financially unviable in half-full theaters.
For those hoping to attend the opening ofâCinderella,â it was still unclear if the show would go on.
âWeâre working hard behind the scenes to make sure everyone gets to the ball,â the showâs producers said in a statement posted on Twitter.
The Indian authorities launched an investigation after an internal government report concluded that some private agencies responsible for coronavirus testing on pilgrims at a sprawling Hindu festival forged at least 100,000 results.
The festival, Kumbh Mela, which ran throughout April, is widely believed to be responsible for a coronavirus surge in many parts of India, as the pilgrims returning from the festival tested positive days after returning to their villages.
The festival drew millions of faithful to the town of Haridwar on the banks of the river Ganges in the northern state of Uttarakhand.
âWe have constituted a four-members committee that will submit its report in two weeks,â Dr. Arjun Singh Sengar, a Haridwar health officer who was in charge of testing for Kumbh Mela, said in an interview. âInitial investigations are pointing toward lapses and fake results.â
Dr. Sengar said that out of 251,000 tests in his district, only 2,273 were positive.
But health experts questioned those numbers, saying the state government underreported positive cases. That suggested it was safe to take part in the pilgrimage, despite evidence that the largely unmasked crowds provided an ideal environment for the virus to spread.
According to a sprawling government report on the lab that conducted rapid antigen tests during the festival, at least 100,000 test results out of 400,000 were fake.
Despite warnings by public health experts and doctors, the regional government led by Prime Minister Narendra Modiâs party advertised the festival in newspapers, inviting pilgrims from across the country.
Before the event, Uttarakhandâs top elected official, Tirath Singh Rawat, mingled with huge crowds of pilgrims, without a mask. When questioned during one of his three visits to the holy site, Mr. Rawat said, âFaith in God will overcome the fear of the virus.â
He tested positive for the coronavirus two days after his last visit to the Ganges.
Officials in Uttarakhand began investigating the test results after a man in the neighboring state of Punjab received a negative test from the health department in Uttarakhand, even though he had not visited the state. He filed a complaint with the Indian Council of Medical Research, a top government body.
Officials alerted the state government, which is now leading the investigation and has stopped payments to dozens of private laboratories and agencies involved in testing.
Testing scams have been a persistent problem in India.
Some, according to a report by the state, have simply filled log books with fake names and addresses, then charged the state government for the service.
In Haridwar, the report found that some sample collectors listed for the festival had never even visited the town.
The authorities said they found phone numbers used multiple times to register pilgrims who were tested, and private agencies carrying out the tests wrote fictional addresses for people who were supposedly tested on their arrival for a dip in the holy waters.
When officials called the numbers in the logs, they found they were false.
When did the coronavirus arrive in the United States?
The first infection was confirmed on Jan. 21, 2020, in a resident of Washington State who had recently returned from Wuhan, China. Soon after, experts concluded that the virus had been in the country for weeks.
A study published on Tuesday offers new evidence: Based on an analysis of antibodies in blood tests, scientists identified seven people in five states who may have been infected well before the first confirmed cases in those states. The results suggest that the virus may have been circulating in Illinois, for example, as early as Dec. 24, 2019, although the first Illinois case was confirmed a month later.
But the new study is flawed, some experts said: It did not adequately address the possibility that the antibodies were in response to coronaviruses that cause common colds. The results could also be a quirk of the tests used. In addition, the researchers did not have travel information for any of the patients, which might have helped explain the test results.
âThis is an interesting paper because it raises the idea that everyone thinks is true, that there were infections that were going undiagnosed,â said Scott Hensley, an immunologist at the University of Pennsylvania.
But the small number of positive samples made it difficult to be sure that they were true cases of infection and not just a methodological error. âItâs hard to know what is a real signal and what isnât,â he said.
If the findings are accurate, however, they underscore the notion that poor testing in the United States missed most cases during the early weeks of the pandemic.
âWithout testing, you canât see whatâs going on,â said Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and lead author of the study. âIn these earlier months in some of these states where we were not suspecting, there was a lot of infection going on there.â
For many Californians, not much may change on Tuesday as the state reopens. Workers will still have to wear masks, even if theyâre vaccinated, for at least part of this week.
And many bars, restaurants and movie theaters have already been open with at least partial capacity for weeks, as coronavirus cases have remained low across the nationâs most populous state.
Still, the lifting of nearly all of the stateâs remaining pandemic restrictions is a significant emotional and psychological milestone for residents of a state that has experienced some of the nationâs most enduring lockdowns.
Hereâs a look back at how the coronavirus pandemic has shaped life in California:
March 9: The Grand Princess cruise ship, which was stranded off the coast of California with coronavirus cases on board, docks at the Port of Oakland. Itâs a floating symbol of Americaâs fear of the virus.
March 13: The stateâs four largest school districts â Los Angeles Unified, San Diego Unified, Fresno Unified and Long Beach Unified â announce theyâll close classrooms, as health officials in Los Angeles confirm eight more coronavirus cases in the county. District officials expect the closures to last weeks.
March 19: Gov. Gavin Newsom orders all 40 million Californians to stay at home as much as possible, not only starting one of the largest-scale public health experiments in recent memory, but also raising difficult questions about what it means to do essential work.
July 1: An alarming surge in cases prompts the state to order bars and indoor dining to close in the stateâs hardest-hit counties. Itâs the most significant rollback yet of the stateâs halting efforts to reopen.
Dec. 3: Amid another surge in cases â the most terrifying California has experienced, because hospitals are overwhelmed â the state imposes new, stringent stay-at-home orders on a regional basis, based on the capacity of intensive care units. Restaurants offering outdoor dining close again. Families brace for distanced holidays.
Broadway producers and the labor union representing stage actors have reached an agreement on health protocols for touring shows that should allow hundreds of performers to return to work at theaters around the United States beginning this summer.
The 17-page agreement says that producers must require all members of the traveling company to be fully vaccinated and mandates free weekly virus tests. It also states that âabsolutely no interactionâ will be permitted between performers and audience members.
The union, the Actorsâ Equity Association, announced the touring agreement with the Broadway League in an email to its 51,000 members Monday evening.
The agreement does not apply to shows on Broadway â the rules for those are still being discussed â and it covers only actors and stage managers, not the many other theater workers represented by different labor unions. But it is a significant development for an industry that has been dark for 15 months, and it gives a first indication of the safety measures producers and performers are envisioning.
Touring shows are a major part of the commercial theater ecosystem. According to the Broadway League, 18.5 million people saw touring shows in about 200 North American cities during the 2018-2019 season, and those tours grossed $1.6 billion.
The United States passed 600,000 Covid-19 deaths on Wednesday, a once-unthinkable number. And had it not been for the removal of hundreds of deaths from official tallies in Northern California, the country would have surpassed the mark sooner.
More than 1,600 deaths had been tied to the coronavirus in Alameda County, Calif., which includes Oakland, when June began. But by this week, the county had reported fewer than 1,300 deaths linked to the virus.
The sudden drop had to do with longstanding questions about which deaths count as coronavirus deaths and which do not. Health departments routinely add or subtract deaths, sometimes by the dozens or even hundreds, as information becomes available about a patientâs residence or the circumstances of their death.
Alameda County, which had previously included in its tally any resident who died while they happened to be infected with the virus, recently tightened its rules to include only those for whom Covid-19 was identified as a cause of death, or for whom the virus could not be ruled out as a cause of death.
âIt is important to accurately report deaths due to Covid-19 so that residents and health officials have a more precise understanding of the impact of the pandemic and response actions in our community,â county officials said in a news release. âUsing the older definition of Covid-19 deaths, a resident who had Covid-19 but died due to another cause, like a car accident,â would still have been counted.
Public health officials across the United States had identified more than 599,860 coronavirus deaths through Tuesday, according to New York Times data, a figure that dropped after The Times adjusted its data to match the Alameda revision. Many experts say they believe the national total to be an undercount. Data on excess deaths, the number of deaths beyond what would be expected based on historical trends, has suggested that the official statistics may not capture the pandemicâs full toll.
As the pace of infection and death slows, public health agencies continue to revisit their death totals.
On Monday, officials in Washington State removed around 30 deaths, some dating back to April 2020, that they said were determined not to be related to Covid-19. On Tuesday, Missouri officials said they were adding 25 deaths, mostly from May, after conducting a weekly sweep of death certificates.
Over the course of the pandemic, the counting of coronavirus deaths has become more standardized. In the last year, many states, including Washington and Ohio, have adjusted their tallies to align with federal guidance, based on death certificates, which calls for counting deaths where the virus was determined to be a factor.
Oklahoma added about 1,800 deaths to its total in April as it worked to implement the federal guidance. Later that month, West Virginia removed 162 deaths because Covid-19 was not listed on the death certificate.
But death certificates, often filled out by a family doctor or county coroner, are subjective by nature and can vary widely in their content, leading to borderline cases.
Adding to the confusion, testing was scarce at the start of the pandemic, meaning many people died with coronavirus symptoms but without any confirmation of infection. Some places, including New Jersey and New York City, have classified those people as probable deaths and included them in their totals.
Study after study has built a consensus around monoclonal antibody drugs for Covid-19: They work best when given early, long before a patient is admitted to the hospital.
But clinical trial data released on Wednesday offered the strongest evidence to date that at least one of the available treatments can sometimes help later in the progression of the disease. Results from a large study in Britain indicated that Regeneronâs antibody treatment can reduce deaths in a subset of hospitalized patients: those whose immune systems are unable to mount a natural response to the virus.
Regeneron, which has emergency authorization for its drug to be given to high-risk patients who are not yet sick enough to be hospitalized, said it plans to ask the Food and Drug Administration to expand its approval to allow the drug to be given to appropriate hospitalized patients.
That could eventually give doctors another tool to help some of the sickest Covid patients. Although the widespread availability of vaccines has sent infection rates plummeting, unvaccinated Americans are still getting seriously ill from the virus. Close to 20,000 patients remain hospitalized with Covid in the United States.
The study enrolled nearly 9,800 hospitalized Covid patients beginning last September. Among those who had not mounted their own natural antibody response when they joined the trial, the group randomly assigned to receive Regeneronâs antibody on top of standard care had a 20 percent reduced risk of death after 28 days, compared with the group that received only standard care. The usual treatment for such patients has typically involved the steroid dexamethasone or the antiviral drug remedesivir.
Regeneronâs drug provided no such statistically meaningful benefit for patients who had mounted their own immune response. âIf you already have antibodies, giving you more may not make much difference,â Peter Horby, a University of Oxford researcher who co-led the trial, said at a news conference.
The results, which have not yet been peer-reviewed and are expected to be posted on a preprint server on Wednesday, came from the Recovery trial, a nationwide effort in Britain to evaluate Covid-19 therapies that has been praised for its rigor and simplicity.
Like other such treatments, Regeneronâs monoclonal antibody is a cocktail of two lab-made drugs designed to mimic the antibodies generated naturally when the immune system fights the virus. Although it is one of three such drugs authorized in the United States, it is the only one currently in use nationwide.
Another cocktail, from Eli Lilly, is no longer being distributed in eight states because of the high prevalence there of the Beta and Gamma variants first seen in South Africa and Brazil, respectively. (Lab experiments indicate that those variants can evade Lillyâs drug.) A third, from GlaxoSmithKline and Vir, has not been ordered by the federal government since being authorized last month.
Israel will no longer require people to wear masks indoors, removing one of the countryâs last remaining coronavirus restrictions as infections continue to decline there, Israelâs health ministry announced on Tuesday.
Hezi Levi, the ministryâs director general, delivered the news as he removed his mask on a morning television show.
Masks will still be required in some cases, including for passengers and crews on airplanes, and for unvaccinated people in care facilities. The decision comes only about two weeks after Israel lifted capacity restrictions and retired its Green Pass System, allowing vaccinated and unvaccinated people equal access to cultural and economic activities. The main limitations that remain concern travel into and out of Israel, which involves strict testing and quarantine rules.
Israelâs vaccine rollout began in December and was remarkably swift, spurred by an ample supply of doses and the Green Pass, which granted vaccinated Israelis more freedoms than people who did not get a shot.
The campaign resulted in a steep decline in confirmed cases from a peak of a seven-day average of more than 8,500 a day in January, to a dozen or so now, according to Our World in Data. More than 63 percent of the population had received at least one shot of the vaccine, Our World in Data said. (Vaccines are available to people 12 and older.)
In Rehovot, a city in central Israel, some residents had ignored the mask mandate, dangling masks under their chins, long before Mr. Leviâs announcement. Masks appeared even rarer after the mandate ended on Tuesday.
Israel is in a moment of political fragility after a coalition government narrowly replaced Benjamin Netanyahu, the countryâs longest-serving leader, from the conservative Likud party, with Naftali Bennett, a hard-right prime minister.
A long-delayed march of far-right activists through Palestinian areas of Jerusalem took place on Tuesday evening. Videos showed that almost none of the marchers wore masks.
In other news around the world:
Portugal on Tuesday reopened its borders to American visitors, as long as they can provide proof of a PCR test taken within 72 hours of their flight, or an antigen test within 24 hours. Portugal is hoping to salvage a summer tourism season that is a pillar of its economy, but the announcement also coincided with Portugalâs registering its highest daily number of new Covid cases since March, with 973 cases reported on Tuesday.
Across the Asia-Pacific region, the countries that led the world in containing the coronavirus are languishing in the race to put it behind them. In southern China, the spread of the Delta variant led to a sudden lockdown last week in Guangzhou, a major industrial capital. Taiwan, Vietnam, Thailand and Australia have also clamped down after recent outbreaks, while Japan is dealing with a fourth round of infections. In some places, like Vietnam, Taiwan and Thailand, vaccinations are barely underway. Others, like China, Japan, South Korea and Australia, have seen a sharp rise in inoculations in recent weeks, while remaining far from offering vaccines to all
Gabby Sobelman contributed reporting from Rehovot, Israel.
Disneyland welcomed out-of-state visitors to Southern California on Tuesday, marking the first time the theme park has been fully open since it closed in the midst of the pandemic more than a year ago.
The reopening came a day after Disneylandâs operators announced that fully vaccinated customers would no longer have to wear masks indoors or outside while at the park, in Anaheim.
Gov. Gavin Newsom said in an interview on Monday that Disneylandâs reopening adds to the optimism that recovery for the rest of the state is well on its way.
âDisneyland is of such iconic status that itâs a confidence boost, perhaps more than anything else,â he said. âIt has a very substantial regional economic impact, which is important.â
Travel and tourism are key to Californiaâs recovery. The state has invested $95 million into expanding marketing campaigns created by âVisit California,â the stateâs tourism office, and it will continue to support travel workers, many of whom lost jobs during the pandemic.
Greg Antonelle, the chief executive of Mickey Travels, a travel agency that helps people plan Disney trips, visited the park and reported that rides were full, most people appeared unmasked and social distancing markers were gone.
âIf you were asleep for the last 15 months and came here today, you wouldnât know a pandemic happened,â said Mr. Antonelle, who traveled with his wife from Florida for the reopening.
Governor Newsom said, âIn the aggregate, itâs going to take a few years for the industry to get back to 2019 numbers, but youâre seeing revenge tourism already take shape in California,â he said, referring to the notion that people are taking trips as ârevengeâ for a year spent stuck at home.
Andrea Conley, a physics teacher who lives in Brea, Calif., said that she has been to Disneyland several times since it reopened at the end of April, and waited to go later in the day on Tuesday to avoid long lines. Though the park wasnât as packed as she anticipated, it felt pretty close to normal.
âDisneyland feels pretty great today,â Ms. Conley said from inside the park. âAbout 30 to 40 percent of people are wearing masks, they are filling rides full and there isnât distancing in the lines, so wait times are less.â