President Biden on Monday called on governors and mayors to maintain or reinstate mask-wearing orders, saying that because of “reckless behavior,” the coronavirus was again spreading fast, threatening the progress the nation has made so far against the pandemic.
“People are letting up on precautions, which is a very bad thing,” he said. “We are giving up hard-fought, hard-won gains.”
Mr. Biden asked the nation to persevere, saying that he had directed his coronavirus team to ensure that there was a vaccination site within five miles of 90 percent of Americans within three weeks.
He said doses are now plentiful enough that nine of 10 adults in the nation — or more — will be eligible for a shot by April 19. Previously, he had only called on states to broaden eligibility to all adults by May 1.
While it will take time for everyone to get an appointment, Mr. Biden said, “you won’t have to wait till May to be eligible for your shot.”
Buoyed by promises of bigger shipments of doses in coming weeks, many states have already moved quickly to allow more people to sign up for shots. On Monday, New York said all adults would be eligible starting April 6, joining at least 37 other states that will make all adult residents eligible for vaccinations by mid-April.
Asked if states should pause their reopening efforts, the president replied simply, “Yes.” He said that governors, mayors, local officials and businesses should demand mask-wearing, calling it a “patriotic duty” that is crucial to the nation’s fight against the virus.
Mr. Biden spoke a few hours after Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, issued perhaps her most impassioned warning to date about a possible fourth surge of the coronavirus, saying she felt a recurring sense of “impending doom.”
The nation has “so much reason for hope,” she said, her voice trembling with emotion. “But right now I’m scared.”
“I am asking you to just hold on a little longer, to get vaccinated when you can, so that all of those people that we all love will still be here when this pandemic ends,” she said at a White House briefing.
According to a New York Times database, the seven-day average of new virus cases as of Sunday was about 63,000, a level comparable to late October, and up from 54,000 a day two weeks earlier, an increase of more than 16 percent. Similar upticks in the past over the summer and winter led to major surges in the spread of the virus, Dr. Walensky said. Still, new cases and deaths have declined from the early January peak, though the seven-day average of new deaths remains near 1,000 a day.
Federal health officials have expressed concerned about the spread of variants, as the United States remains behind in its attempts to track them, though the C.D.C.’s efforts to locate them has recently improved and will continue to grow. Some scientists predicted weeks ago that the number of infections could curve upward again in late March, at least in part because of the rise of variants of the coronavirus across the country. The variant that walloped Britain, called B.1.1.7, has led to a new wave of cases across most of Europe. B.1.1.7 is also rising exponentially in Florida where it accounts for a greater proportion of total cases than in any other state, according to numbers collected by the C.D.C.
Dr. Walensky also noted an increase in travel. Over the last week, an average of 1.3 million people passed through security checkpoints at U.S. airports each day, according to the Transportation Security Administration. On Sunday alone, more than 1.5 million people went through T.S.A. screenings — a sharp increase from 180,000 on the same date in 2020.
“I think people want to be done with this,” she said, but what’s different this time is “we actually have it in our power to be done, with the scale of the vaccination. And that will be so much slower if we have another surge to deal with as well.”
The wave of new cases comes as the nation rapidly broadens eligibility for vaccines, the average number of daily shots continues to rise, and a new C.D.C. report released Monday confirmed the findings of last year’s clinical trials that vaccines developed by Moderna and Pfizer are highly effective against Covid-19. The report documented that the vaccines work to prevent symptomatic and asymptomatic infections under real-world conditions.
The seven-day average of vaccines administered hit 2.7 million on Sunday, a slight increase over the pace the previous week, according to data reported by the C.D.C. But worrisome hot spots continue popping up.
In nine states over the past two weeks, virus cases have risen more than 40 percent, the Times database shows. Michigan led the way with a 133 percent increase. The Northeast has also seen a troubling rise in virus cases. Connecticut reported a 62 percent jump in cases over the past two weeks, and New York and Pennsylvania both reported increases of more than 40 percent.
Michigan’s spike has not been traced to any one event, but epidemiologists have noted that cases started to jump after the state eased restrictions for indoor dining on Feb. 1 and lifted other restrictions in January. Other hot spots included North Dakota, where cases rose by nearly 60 percent and Minnesota, where cases have jumped 47 percent. Of those states, North Dakota is the only one without a current mask mandate.
Dr. Walensky on Monday described “a feeling of nausea” she would experience last year when, as a doctor at a Boston hospital, she saw the corpses of Covid-19 patients piled up, overflowing from the morgue; and when she stood, “gowned and shielded,” as the last one in a patient’s room before they died alone, without family.
At the time, she said, there were so many unknowns about the virus. But now, with the vaccination program rapidly gaining speed, she said, she is hopeful the pandemic can be beat.
Dr. Walensky, who has issued several warnings in recent weeks about the need to keep up mask-wearing and social distancing, said she planned to talk to governors about the risks of prematurely lifting restrictions on Tuesday during a weekly call about the pandemic and vaccine rollout.
Bryan Pietsch contributed reporting.
The coronavirus vaccines made by Moderna and Pfizer-BioNTech are proving highly effective at preventing symptomatic and asymptomatic infections under real-world conditions, federal health researchers reported on Monday.
Consistent with clinical trial data, a two-dose regimen prevented 90 percent of infections by two weeks after the second shot. One dose prevented 80 percent of infections by two weeks after vaccination.
The news arrives even as the nation rapidly broadens eligibility for vaccines, and the average number of daily shots continues to rise. The seven-day average of vaccines administered hit 2.7 million on Sunday, a slight increase over the pace the previous week, according to the Centers for Disease Control and Prevention.
But the virus may be gaining renewed momentum. According to a New York Times database, the seven-day average of new virus cases as of Sunday was 63,000, an increase of more than 16 percent over the past two weeks.
Similar upticks over the summer and winter led to major surges in the spread of disease, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said at a news briefing on Monday.
The nation has “so much reason for hope,” she said. “But right now I’m scared.” Dr. Walensky added that she felt a sense of “impending doom.”
Scientists have debated whether vaccinated people may still get asymptomatic infections and transmit the virus to others. The new study, by researchers at the C.D.C., suggested that since infections were so rare, transmission is likely rare, too.
There also has been concern that variants may render the vaccines less effective. The study’s results do not confirm that fear. Troubling variants were circulating during the time of the study — from December 14, 2020 to March 13, 2021 — yet the vaccines still provided powerful protection.
The C.D.C. enrolled 3,950 people at high risk of being exposed to the virus because they were health care workers, first responders, or others on the front lines. None had previously been infected with the coronavirus.
Most — 62.8 percent — received both shots of the vaccine during the study period, and 12.1 percent had one shot. The participants had no previous infections with the coronavirus.
Participants collected their own nasal swabs each week, which were sent to a central location for P.C.R. testing, the most accurate type of test. The weekly swabs allowed the researchers to detect asymptomatic infections as well as symptomatic ones.
The investigators also asked participants about symptoms associated with infection, including fever, chills, cough, shortness of breath, sore throat, diarrhea, muscle aches, or loss of smell or taste. The researchers also analyzed patients’ medical records to detect illnesses.
Fifty-eight percent of the infections were detected before people had symptoms. Just 10.2 percent of infected people never developed symptoms.
Among those who were fully vaccinated, there were .04 infections per 1,000 person-days, meaning that among 1,000 persons there would be .04 infections in a day.
There were 0.19 infections per 1,000 person-days among those who had had one dose of the vaccine. In contrast, there were 1.38 infections per 1,000 person-days in unvaccinated people.
Dr. Walensky urged Americans to continue taking precautions and to waste no time getting the shots as soon as they are eligible.
“I am asking you to just hold on a little longer, to get vaccinated when you can, so that all of those people that we all love will still be here when this pandemic ends,” she said.
A joint inquiry by the World Health Organization and China into the origins of the coronavirus has yielded a 124-page report full of new detail but no profound new insights. And it does little to allay Western concerns about the role of the Chinese Communist Party, which is notoriously resistant to outside scrutiny and has at times sought to hinder any investigation by the W.H.O.
The report, which was leaked to the media on Monday, a day before its scheduled official release, is also not clear on whether China will permit outside experts to keep digging.
An international team of experts spent 27 days in Wuhan, visiting hospitals, live animal markets and government laboratories, conducting interviews and pressing Chinese officials for data, but came away still far from understanding the origins of the pandemic that has killed nearly 2.8 million people worldwide.
“The investigation runs the risk of going nowhere, and we may never find the true origins of the virus,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations.
The report says that China still does not have the data or research to indicate how or when the virus began spreading. Some skeptics outside the country say that China may have more information than it admits.
The expert team also dismisses as “extremely unlikely” the possibility that the virus emerged accidentally from a Chinese laboratory, even though some scientists say that is an important question to explore.
The Chinese government, while granting some degree of access and cooperation, has repeatedly tried to bend the investigation to its advantage. The report was written jointly by a team of 17 scientists from around the world, chosen by the W.H.O., and 17 Chinese scientists, many of whom hold official positions or work at government-run institutions, giving Beijing great influence over its conclusions.
Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle, said after seeing a copy of the report that he was not convinced that a laboratory leak was extremely unlikely. He said he agreed with the report that the virus could have come from a natural zoonosis, but he did not see any reasoning in the report to dismiss the possibility of a lab escape.
One member of the team of experts, Peter Daszak, a disease ecologist who runs EcoHealth Alliance, pushed back against the criticism of the team’s work and of China’s level of cooperation, calling the lab leak hypothesis, which has been promoted by some Trump administration officials, “political from the start.”
The prevailing theory remains that the virus originated in bats, jumped to another animal, and then mutated in a way that enabled it to transmit to humans, and from human to human. But the process of tracing the origins of a virus is notoriously painstaking.
To answer numerous remaining questions, the report recommends further retrospective studies of human infections, including the earliest cases, and more virus testing of livestock and wildlife in China and Southeast Asia. But it is unclear to what degree China would cooperate.
In Washington on Monday, the White House press secretary, Jen Psaki, said experts across the U.S. government, including leaders in veterinary medicine and biosecurity, were currently reviewing the report.
“We have been clear that an independent, technically sound investigation is what our focus is on, and once this is reviewed we’ll have an assessment about the steps forward,” she said.
Earlier in the day, Dr. Anthony S. Fauci, the leading expert in infectious diseases in the United States, and Dr. Rochelle Walensky, the head of the Centers for Disease Control and Prevention, said they had not yet seen the report.
New York can begin vaccinating anyone 30 or older on Tuesday and will make all residents 16 or over eligible on April 6, beating President Biden’s goal of making every adult eligible for a coronavirus vaccine by May 1, Gov. Andrew M. Cuomo announced on Monday.
New York was one of only a few states that had not yet set a timeline for universal adult eligibility. Five states had already expanded eligibility fully by the end of last week; six did so on Monday; seven more will follow later this week, and another six on April 5. At least 11 states have said they would wait until May 1.
Though Mr. Cuomo has gradually loosened vaccine eligibility criteria over the last month, he expressed reluctance last week to set a specific target date for doing away with the state’s requirements. The governor said he did not want to outline a timeline for more widespread vaccination until he was more confident that New York would have adequate vaccine supply on hand for its population.
“I just want to make sure that the allocation projections that we’re getting from the feds are right, frankly,” Mr. Cuomo said at a news conference last week. “I don’t want to say ‘We’re going to open up to 30-year-olds in three weeks,’ and then something happens with the allocation.”
Mr. Cuomo’s announcement comes as New York has been adding new virus cases at one of the highest rates among U.S. states. As of Monday, the state was a seven-day average of 49 new virus cases a day for every 100,000 residents, according to a New York Times database, second only to New Jersey. (The nation as a whole was averaging 19 new cases per 100,000 people.)
Even as the number of new cases continues to mount, the state has not faced anywhere near the level of devastation that it experienced a year ago, when hospitals were overwhelmed with patients and morgues were overflowing.
Buoyed by its vaccination progress, the state has also been gradually reopening businesses in the last several weeks. Mr. Cuomo allowed sporting events and concerts to resume at large venues last month and movie theaters to bring back audiences this month. Restaurants in New York City are now allowed to serve diners indoors at 50 percent capacity, their highest level of indoor dining since Mr. Cuomo shuttered them last year at the onset of the pandemic.
As of Monday morning, 29.6 percent of people in New York State had received at least one shot of a vaccine, while 16.8 percent were fully vaccinated, according to the state’s data.
Currently, all people 50 and over are eligible to receive the vaccine in New York, in addition to teachers, some essential workers and people with certain medical conditions that make them more susceptible to serious illness from the virus.
The Education Department said on Monday that it would abolish the federally subsidized college debts of thousands of students who are disabled and also end paperwork requirements for tens of thousands more — moves aimed at relieving student loan debt made worse by the pandemic.
The agency said the changes will benefit 41,000 disabled borrowers with $1.3 billion in student loans whose debts were forgiven, but then reinstated, because they failed to supply income information during the pandemic. Another 190,000 borrowers whose debts have been forgiven will not have to submit paperwork during the pandemic.
Under Education Department rules, student loan borrowers who are permanently disabled and cannot work may have their debts waived. During a three-year period after they are granted debt relief, they must submit income data proving that they remain unable to work.
A 2016 report by the Government Accountability Office, however, found that 98 percent of the disabled borrowers whose discharged loans have been reinstated were unable to fill out the necessary paperwork.
The announcement came as the Biden administration said it is reviewing ways to alleviate the burden of student loan debt generally. President Biden has proposed forgiving $10,000 in student loan debt for borrowers as some congressional Democrats, including Senator Chuck Schumer, the majority leader, push for even greater relief.
In a related announcement this month, the Education Department said it would scrap a Trump administration policy limiting defrauded students from seeking debt forgiveness.
Reacting to Monday’s announcement on disabled borrowers, Student Defense, a nonprofit education advocacy organization, said it did not go far enough, urging loan forgiveness for an additional 400,000 disabled borrowers with $14 billion in outstanding loans who have not yet been granted forgiveness.
California continued its uneven progress in reopening schools on Monday, as elementary students began to return to classrooms in Long Beach, the state’s fourth-largest district with 70,000 students.
Public schools in the state’s top three districts by enrollment — Los Angeles, San Diego and Fresno — have said they will begin to allow grade-school students back onto campus later in April, as new coronavirus cases have fallen sharply across California.
Schools in Oakland and San Francisco also are scheduled to reopen next month for elementary and special-needs students. But labor agreements in both cities have allowed substantial numbers of teachers to opt out, leaving some schools without enough teachers to reopen and prompting others to scramble for substitutes.
Although many smaller California districts have been open for months, large urban districts on the West Coast generally have lagged behind their counterparts in the rest of the nation. Surging infections in Southern California after the winter holiday were partly to blame for a slow rebound in the Los Angeles school system.
Teachers’ unions generally are more powerful in Democratic-led Washington, Oregon and California than in many other states, and teachers have been wary of returning to what they regard as a hazardous workplace, despite federal guidance that elementary schools in particular are safe when health precautions are followed.
The Long Beach school district has been able to open earlier than other large California school systems because labor unions there agreed last summer to reopen as soon as health conditions permitted, and because the city was able to start vaccinating teachers earlier than other districts in the state.
Unlike most other cities in Los Angeles County, Long Beach has its own public health department, giving the city its own vaccine supplies and the power to set its own vaccine priorities, at a time when the county as a whole was making teachers wait until after other groups, like residents 65 and older, were vaccinated.
“A city with its own health department has the ability to be more nimble,” said Jill Baker, the city’s schools superintendent, who called the return to classrooms this week “exciting and momentous.”
The school district is among the city’s largest employers, and two-thirds of its students qualify for free or reduced-price lunches, so vaccinating school employees and reopening classrooms was viewed as economically important, Ms. Baker said.
About 14,000 students in Long Beach from transitional kindergarten through fifth grade will return this week to school buildings for masked, sanitized and socially distanced instruction. They will be on a hybrid schedule, with students spending about 2½ hours at school each day, five days a week, and completing the school day with remote instruction.
In-person classes for older students are scheduled to resume April 19, with grades 6 to 8 getting the option to return on April 20 and grades 9 to 11 on April 26. The last day of school will be in mid-June.
The state of New York must immediately begin to offer Covid vaccines to all incarcerated people in the state’s prisons and jails, a judge ruled on Monday, making the state one of few in the nation to provide doses to such a broad population behind bars.
The order, the first involving any of the country’s largest correctional systems, comes as the coronavirus continues to roar through facilities in New York. At least 1,100 people living behind prison walls have tested positive for the virus since the start of last month, and five have died.
But even as corrections staff and many other groups, including some who live in close-contact settings like group homes and homeless shelters, have gained access to the vaccines in recent weeks, most incarcerated people in New York have remained ineligible to receive doses.
Justice Alison Y. Tuitt of State Supreme Court in the Bronx wrote in her ruling on Monday afternoon that people in prisons and jails had been arbitrarily left out of the rollout and that doing so was “unfair and unjust” and an “abuse of discretion.”
State officials, she said, “irrationally distinguished between incarcerated people and people living in every other type of adult congregate facility, at great risk to incarcerated people’s lives during this pandemic.”
She added: “There is no acceptable excuse for this deliberate exclusion.”
Epidemiologists and infectious disease specialists widely agreed, even in the earliest stages of vaccination efforts when supply was more limited, that the roughly 50,000 people in correctional facilities across the state should be made eligible because of their uniquely high risk for contracting and spreading the virus. A disproportionate number of them are also Black and Latino, groups that have been hit hard by the pandemic.
But vaccinating incarcerated people has proved politically fraught across the country, and states grappling with the same ethical, logistical and legal questions have drawn up drastically different timelines for offering doses. In some states, officials have backtracked from plans to vaccinate prisoners because of political headwinds.
In New York, most of those behind bars had been left out, though correctional officers were included and other high-risk groups like restaurant workers, public-facing government employees and essential building service workers have recently become eligible.
State officials announced on Monday that all adult residents would be eligible to receive a coronavirus vaccine by April 6, which might have led more people behind bars to soon be offered doses even had the ruling not been issued.
The Centers for Disease Control and Prevention has extended its nationwide moratorium on evictions through June 30, pushing it back from the end of March, when it had been scheduled to lapse.
The move, while widely expected, comes at a precarious moment in the pandemic as the increasing vaccine availability accelerates reopening plans by businesses and local governments — even as millions of families continue to struggle with hardships that might have led to mass evictions.
The C.D.C. issued the moratorium last fall, citing its jurisdictional authority to implement measures needed to promote public health, and agency officials cited those same powers in extending the moratorium on Monday.
“The Covid-19 pandemic has presented a historic threat to the nation’s public health,” the agency’s director, Rochelle P. Walensky, said in a statement. “Keeping people in their homes and out of crowded or congregate settings — like homeless shelters — by preventing evictions is a key step in helping to stop the spread.”
Under Mr. Biden, the Department of Housing and Urban Development earlier this year extended its own moratorium on federally financed housing to June 30. (A previous version of this item misstated the status of that moratorium. It was extended in February.)
The new housing secretary, Marcia L. Fudge, has signaled she would like to extend her agency’s eviction freeze even longer. Department officials have reached out to community groups to elicit suggestions on how to streamline the new rule.
The administration’s $1.9 trillion relief package, passed earlier this month, includes $21.5 billion for emergency rental assistance, $5 billion in emergency housing vouchers, $5 billion for homelessness assistance and $850 million for tribal and rural housing. But that aid will take months to be disbursed.
Initially, the C.D.C. ban was riddled with loopholes that allowed some landlords to evict some tenants. But overall, it helped to create a significant drop in eviction applications filed in the local housing courts.
The federal moratorium is part of a patchwork of federal, state and local efforts to prevent a national health and economic emergency from turning into a monumental housing collapse.
Most states — 43 in all, plus Washington, D.C. — have temporarily halted evictions during the crisis. But the range of protections varies wildly and some tenants, including in the New York City neighborhoods hit hardest by Covid, have been displaced because they were unaware of the protections.
As many as one in five renters said they did not pay last month’s rent, according to Census Bureau surveys, with a third of Black renters reporting a recent missed payment.
Hong Kong officials said Monday that residents stranded in Britain would be allowed to return starting next month, as they announced the easing of multiple coronavirus restrictions.
Hundreds of Hong Kong residents have been stuck in Britain since late December, when the Chinese territory abruptly announced a ban on direct travel from the country after the emergence there of a highly contagious variant of the virus. Starting in the second half of April, they will be allowed to return to Hong Kong on designated flights, officials said. They did not mention any change to similar bans on arrivals from Brazil, Ireland and South Africa.
Hong Kong’s quarantine requirements, which are among the strictest in the world, will also be eased for travelers arriving from “low-risk” countries like Australia, New Zealand and Singapore. Instead of quarantining at designated hotels for 21 days, they will only have to quarantine there for 14 days followed by seven days of self-monitoring. The Hong Kong border remains closed to nonresidents.
Other changes appeared aimed at rejuvenating the city’s struggling vaccination effort. The government announced that it would lift visitation restrictions at hospitals and nursing homes for those who have been inoculated and end mandatory coronavirus testing for restaurant, school and construction workers who are fully vaccinated.
Only 6 percent of Hong Kong’s 7.5 million people have been vaccinated since the campaign began in February. The program suffered a setback last week when packaging defects were discovered in a batch of doses of the Pfizer-BioNTech vaccine, prompting health officials to suspend its use.
Over the weekend, Hong Kong said that a preliminary investigation by BioNTech of Germany and Fosun Pharma — the Chinese company responsible for distributing the vaccine in Hong Kong — found no systematic problems in its shipments. Health officials said that the vaccine remained safe to use and that they would resume administering it “as soon as possible.”
Aside from the Pfizer-BioNTech vaccine, the only other vaccine authorized for use in Hong Kong is the one developed by the Chinese company Sinovac. Polls have shown that the majority of Hong Kong residents are reluctant to take any vaccine, but they are especially wary of Sinovac after reports that several people had died after receiving it. Officials have found no direct link between the shots and the deaths.
The loosening of restrictions comes as Hong Kong is emerging from a fourth wave of infections that began in late November. For two days over the weekend, the city reported zero local cases for the first time in more than four months. On Monday, one local case was reported.
The number of people who have died from Covid-19 in Mexico may be more than 50 percent higher than the official count, new government figures show: The virus may have claimed more than 300,000 lives, a staggering toll for the country of 126 million.
The Mexican government updated its mortality statistics on Saturday, showing that from the start of the pandemic through mid-February, some 294,000 deaths were directly associated with the virus — far exceeding the official toll of about 184,000 recorded up to that point.
Adding official deaths registered since mid-February, the country’s actual coronavirus death toll now appears to stand above 310,000 — more than 50 percent higher than the 201,623 deaths currently recorded on the Mexican government’s coronavirus tracking website.
Extremely low levels of testing and a widespread fear of hospitals in Mexico have lead to a severe undercount of the pandemic’s true cost, with many cases only confirmed as virus-related upon a later revision of death certificates.
The updated numbers showed that there were a total of 417,000 more deaths over all in Mexico than would have been expected in the period since the pandemic began, a figure known as excess mortality. That figure suggests that the pandemic’s true impact could be even higher.
Mexico is struggling with a glacial vaccination campaign: According to Johns Hopkins University, less than 1 percent of the population has been fully vaccinated so far.
On Sunday, 1.5 million doses of the AstraZeneca vaccine arrived in Mexico from the United States, part of a total of 2.7 million doses being sent to Mexico as part of an agreement with President Biden.
KATHMANDU, Nepal — Nepal on Monday received a donation of 800,000 doses of a Covid-19 vaccine from China, which the authorities said would help them restart an inoculation drive that had been halted because of shipment delays in India.
Dr. Jageshwor Gautam, a spokesman for the ministry of health, said the vaccination campaign could resume in less than a week, “once we determine beneficiary age groups.”
China and India, both of which border Nepal, have been jockeying for influence over the Himalayan nation of 30 million people, most recently through vaccine diplomacy.
Nepal had planned its vaccination campaign around the Oxford-AstraZeneca vaccine manufactured by the Serum Institute of India, the world’s largest vaccine producer. One million doses have been donated by the Indian government, and Nepal had bought an additional two million doses from the Serum Institute.
But half of the purchase from the Serum Institute has been delayed indefinitely, health officials in Nepal said, despite an agreement that it would arrive 15 days after the deal. India, which is supplying the AstraZeneca vaccine to more than 70 countries, has begun holding back nearly all of its exports as it tries to suppress a surge in coronavirus cases at home.
Officials in Nepal suspended vaccinations on March 17, citing the shortage of doses.
To fill the gap, they are now relying on a vaccine developed by the Chinese company Sinopharm, which last month became the second approved for emergency use in Nepal after Beijing pledged to provide doses free.
Since its vaccination drive began in late January, Nepal has administered about 1.6 million doses, according to a New York Times database. Dr. Gautam said the 500,000 remaining AstraZeneca doses would be given to frontline health workers, and that there were none available for the rest of the population “at least for now.”
Nepal has recorded almost 277,000 infections and 3,027 deaths, according to a New York Times database. Although the country’s average daily new cases are a small fraction of what they were at their peak last fall, health officials fear a second wave as infections surge in neighboring India. On Monday, India reported 68,020 new infections, the highest one-day rise since October.
Johnson & Johnson said on Monday that it would supply its one-shot vaccine to African Union member states, as the continent experiences a slow rollout of vaccines, an uptick in cases and worries about new virus mutations.
The pharmaceutical company said that its unit, Janssen Pharmaceutica NV, agreed a deal with the African Vaccine Acquisition Trust, an African Union organization, to supply up to 220 million doses of its Covid-19 vaccine beginning in the fall. The organization will also have the possibility of ordering an additional 180 million doses for a combined total of up to 400 million doses through 2022.
The company will supply most of the doses from a plant in South Africa, which is operated by Aspen Pharma. The African Export-Import Bank, a Pan-African bank headquartered in Cairo, will pay manufacturers $2 billion on behalf of member countries in the form of loans.
South Africa’s president, Cyril Ramaphosa, who as the chair of the African Union set up the vaccine trust last year, is expected to tour the Aspen Pharma facilities in Port Elizabeth, on country’s southeast coast, on Monday.
“This agreement is a significant milestone in protecting the health of all Africans,” Mr. Ramaphosa said in a statement. “It is also a powerful demonstration of African unity and of what we can achieve through partnership between the state sector, the private sector and international institutions that puts people first.”
The announcement came as coronavirus cases surpassed 4.1 million in Africa, with more than 111,000 deaths, according to the Africa Centers for Disease Control and Prevention. Concerns have been mounting about the emergence of variants on the continent, particularly in countries like South Africa, where a highly transmissible variant has driven up cases. Scientists also recently said they found a highly mutated variant of the coronavirus in travelers from Tanzania, the East African nation whose leaders have consistently brushed aside the threat of the coronavirus pandemic.
Besides dealing with other deadly outbreaks including Ebola, polio and measles, many nations in Africa are also dealing with vaccine inequity, as developed nations hoard doses and seek to inoculate their entire populations. So far, only 7.7 million vaccines have been administered on the continent, according to the World Health Organization, which last week warned of a slowdown in deliveries even as initial batches were exhausted.
Vaccines were yet to arrive in 10 African countries, the W.H.O. said, while many others continued to face logistical challenges in addition to vaccine hesitancy.
Nations including South Africa have called on governments and pharmaceutical companies to waive vaccine patents to get medicines to more people more quickly.
The Africa C.D.C. has said that a minimum 60 percent of the continent’s population — or 750 million people — must be vaccinated if the virus is to be curbed there. The deal with Johnson & Johnson “enables Africa to meet almost 50 percent of that target,” Dr. John Nkengasong, the head of the Africa C.D.C., said in a statement.
“The key to this particular vaccine is that it is a single-shot vaccine, which makes it easier to roll out quickly and effectively, thus saving lives,” he added.
Palakiko Chandler took their little cousins to Nanakuli Beach on Oahu last weekend and noticed something they hadn’t seen in a while: a parking lot full of rental cars. The tourists were back.
“It was just so packed,” said Mr. Chandler, 27 and a Native Hawaiian. “Me and my cousins were looking at each other like, should we just go home?” The youngest cousins needed several reminders to keep their distance from strangers for virus safety.
For much of the pandemic, Hawaii had some of the strictest rules for visitors in the United States, requiring a 14-day quarantine for everyone arriving in the islands. The policy took a heavy economic toll on a state that depends heavily on tourism, but it was lauded for its success in limiting the impact of the virus for months.
Now, though, Hawaii has reopened for travelers: A negative test within 72 hours of arrival lets them skip the quarantine in most places. At least 28,000 people arrived in Hawaii on each of the last two Saturdays, according to state travel data — the most in a day since the pandemic began, and not far from typical prepandemic levels.
The influx has residents worried. Some have been posting on social media for months, pleading with mainlanders not to come, or if they do, to be mindful of the islands’ isolation and limited resources. The state has a total of 3,000 hospital beds for its population of 1.4 million, and has among the fewest I.C.U. beds per capita of any state; they were often mostly full even before the pandemic.
Hawaii’s precautions did not keep the virus out completely: The islands had a holiday surge, like the rest of the country, and parts of the state are struggling with outbreaks now. Daily new case reports have doubled since late February, with some recent clusters focused on tourism workers. Hospitalizations have increased 17 percent in the last two weeks.
“The looming concerning things are the variants,” said Dr. Damien Kapono Chong-Hanssen of the Kauai Community Health Center. “The California variant has been implicated in what’s happening in Maui right now. Maui is not looking better.”
Mainlanders are making the trip anyway. “Hawaii is again packed with tourists,” wrote the travel site The Points Guy. Favorite sites are sold out, check-in lines are long, and the lines for outbound flights are getting longer.
Tourists are crowding popular beaches without wearing masks or paying much attention to social distancing. Some visitors have gotten rowdy. A pair of arriving tourists were sent home after trying to pay a bribe to avoid the testing requirement.
The situation is worsening the irritation that many state residents feel toward vacationers. Now the tourists aren’t just crowding the island and driving up prices, they say, they are also heedlessly risking everyone’s health.
“Hawaiians and locals alike have always seen the disrespect that tourists bring to our islands,” Mr. Chandler said. “This is kind of the last straw. You’re coming to our home and you’re endangering us during a pandemic.”
“Local people are tired of being treated a certain type of way,” said Charles Kaua Taylor-Fulton, 20, who lives on Oahu. “When tourists come, they can be very rude or entitled. There’s just a sense of entitlement.”
Dr. Lee Buenconsejo-Lum of the University of Hawaii at Manoa said the state’s case numbers are not exploding, at least not yet. But she said she would like to see travelers exhibit the same commitment to wearing masks that locals have. “It’s a matter of constantly educating the tourists,” she said.
Still, the high travel season is just getting started, and restrictions are continuing to ease. Bars have reopened in parts of the state and outdoor weddings are now allowed to welcome up to 100 guests.
“We can already see into the future of summer,” Mr. Chandler said, “and it’s going to be packed.”
Britain, which has now given a first dose of the coronavirus vaccine to more than 30 million people, began a gradual lifting of coronavirus restrictions for most of its population on Monday.
People in England are now allowed to gather outdoors in groups of up to six, or two households, after the end of a stay-at-home order in force since early January.
Outdoor sports facilities, like tennis and basketball courts and swimming pools, are also opening in England. Nonessential retail and outdoor dining are set to return from April 12. Students returned to classes earlier this month. Elsewhere in Britain, Scotland and Wales have also begun easing stay-at-home orders, and Northern Ireland is set to review coronavirus restrictions next month.
For many in Britain, the easing was a cautious optimistic note after months lockdown, the nation’s third. The current lockdown began in January, after a new variant of the coronavirus swept the country, with as many as 60,000 daily cases and 1,800 daily deaths at its winter peak. On Sunday, the country reported 3,862 cases and 19 deaths, according to a New York Times database. London has so far reported no deaths from the virus on Sunday, according to Public Health England. If no reports are added later — the figures are not yet finalized — it would be the capital’s first day without a virus death since September. Officials are hoping a slow lifting will largely remove restrictions on socializing in England by June 21.
Travel abroad for English residents, however, remains banned, with a task force reviewing the rule next month. Officials cautioned that people should still work from home where possible and minimize contact.
In other news from around the globe:
In Australia, the city of Brisbane announced a three-day lockdown after seven people were infected with the coronavirus, the country’s first citywide lockdown in more than a month. Starting at 5 p.m. on Monday, residents of the city, which is Australia’s third largest, will be allowed to leave their houses only for essential purposes such as buying groceries, exercising or seeking medical care, and masks will be mandatory in public. Tests showed the virus spreading in Brisbane is the highly contagious variant first detected in Britain, officials said.
The capital region of the Philippines entered the country’s highest level of lockdown on Monday. Under what is known as enhanced community quarantine, which is set to last until Easter Sunday, Manila and four surrounding provinces are under curfew from 6 p.m. to 5 a.m. People under 18 and over 60, as well as pregnant women and those with chronic health conditions, are instructed to stay home at all times. The capital region, which is home to more than 25 million people, had been on the second-highest level of lockdown since March 22.
Yan Zhuang and Jennifer Jett contributed reporting.