There are 11 states in the United States where at least 20 percent of older adults still haven’t received a Covid shot, potentially putting the recovery there at risk.
People 65 and older were given top priority for vaccinations because they are far more vulnerable to serious illness and death from the coronavirus than younger people are. Those 65 and older have the highest rate of vaccination among all age groups, with 87 percent having received at least one dose, compared with 60 percent for people ages 18 to 64, and 31 percent for those 12 to 17.
But in 11 states, seniors who have yet to get a dose of the vaccine pose a risk to their states’ recovery as most places remove restrictions aimed at limiting new outbreaks.
Most of them are in the South: Alabama, Arkansas, Louisiana, Mississippi, North Carolina and Tennessee. Georgia, Idaho and Missouri are at the 20 percent threshold. West Virginia and Wyoming also have more than 20 percent of people 65 and over without one dose.
“The 20 percent lines up pretty well with a group of people, especially in the South, who say, ‘No way, no how am I getting vaccinated,’” said Dr. Michael S. Saag, associate dean for global health and professor of medicine at the University of Alabama at Birmingham.
Among the factors at play, he said: conspiracy theories, a belief in pseudoscience and a libertarian mind-set that says, “You can’t tell me what to do.”
“Convincing them that it is in their own interest is a tough nut to crack,” Dr. Saag said. “For the state of Alabama and other Southern states, this is not for a lack of effort or resources. This is about a population resistant to receiving the message.”
Older people, in general, feel more threatened from the coronavirus and more likely to die from it, experts say, and it’s not surprising that they have been among the most receptive to the vaccines. After older age groups were given priority when the first vaccines were authorized for emergency use in December, the proportion of those dying started dropping immediately.
Across the United States, those 50 and older continue to make up the bulk of Covid-19 deaths, and the virus continues to kill hundreds of people daily.
Death rates remain high in pockets of the nation where vaccination rates are not. Experts are concerned that Southern states, where vaccination rates are lagging, could face a surge in coronavirus cases over the summer.
“All epidemics are local at the end of the day, and transmission is person to person,” Dr. Saag said. “There is going to be a hot pocket of transmission if someone becomes infected and others around them are unvaccinated. This is not Epidemiology 101, this is common sense.”
Last year, a summer surge lasted until September in the South. This year, many people are vaccinated, and there is residual immunity from those who have already had it, Dr. Saag said.
What’s more worrying for him, he said, is the dropping of mask ordinances as the more infectious Delta variant spreads. U.S. health officials this week classified the Delta variant, which was first found in India, as a “variant of concern,” sounding the alarm because it spreads rapidly and may cause more serious illness in unvaccinated people.
“We’re sitting on a powder keg,” Dr. Saag said.
A Kaiser Family Foundation poll found last month that 10 percent of unvaccinated seniors said that they would “definitely not” get inoculated against the coronavirus. But the same poll showed signs that some hesitant people have been persuaded: About a third who had planned to “wait and see” whether they would get vaccinated said that they had made vaccine appointments or planned to do so.
Domestic spectators will be allowed to attend Olympic events in Tokyo this summer, the president of the Games announced on Monday, ending months of speculation that athletes could be deprived of a live audience in an effort to reduce the risk of coronavirus transmission.
The decision settles the last major logistical issue facing the organizers of the Games, which have been delayed for a year because of the pandemic, all but guaranteeing that the event will go forward despite lingering concerns. Spectators from overseas were barred from attending in March in a major concession to the realities of the pandemic.
The president of Tokyo 2020, Seiko Hashimoto, said that the International Olympic Committee had agreed that crowds would be allowed up to 50 percent of a venue’s capacity, up to 10,000 people. However, if the pandemic situation worsens or if emergency measures are declared by the Japanese government, the Games could be held without spectators.
The decision to allow people in Japan to attend events indicates a growing certainty that the Tokyo Games, which are scheduled to begin on July 23 and run through Aug. 8, will go on, after months of concern that they could become a superspreader event as athletes and other personnel pour into the city from around the world.
Concerns have diminished substantially in recent weeks as Japan’s virus case numbers drop and vaccination rates skyrocket. After a slow rollout, the country is now administering nearly one million doses of the vaccine every day. About 18 percent of the population has received a first dose of a Covid-19 vaccine, and 7.3 percent are fully vaccinated, according to a New York Times database.
Nevertheless, worries remain. Japan’s top coronavirus adviser, Shigeru Omi, has consistently warned against allowing spectators, which he believes adds an unnecessary layer of risk. This month, organizers said that about 10,000 of the 80,000 volunteers who signed up to help with the Games had quit, citing fear of infection among their reasons.
As recently as May, a poll showed that 83 percent of people in Japan disapproved of plans to go through with the event. But those numbers have turned around along with the improvement in the country’s virus situation.
Olympic officials said that more than 80 percent of athletes had been vaccinated. Other groups, including staff members, journalists covering the event and some volunteers, will also receive shots.
Conscious of the public’s concerns, Olympic officials have also agreed to strict conditions on the Games. Athletes will be tested regularly for the coronavirus and their movements will be restricted and monitored. Failure to abide by the rules could lead to disqualification or even deportation.
The Games will have rules for spectators aimed at reducing the risks of transmission, including mask wearing, a ban on shouting, and specific guidelines on travel to and from venues.
A panel of expert advisers to the committee told reporters on Friday that the rules were likely to be stricter than those currently in place for other live sporting events, such as baseball.
The Chinese government accused the United States on Monday of interfering in its internal affairs after Washington shipped 2.5 million doses of Moderna’s Covid-19 vaccine to Taiwan, saying that any form of vaccine assistance should not be used as a form of “political manipulation.”
China regards Taiwan as its own territory and is acutely sensitive to any form of interaction between the United States and the self-governed democracy. The donations, which were more than triple the original amount that the Biden administration had promised, were celebrated in Taiwan.
In Beijing, Zhao Lijian, a spokesman for the Chinese Foreign Ministry, criticized the move.
“We urge the U.S. not to use vaccine assistance to engage in political manipulation and not to interfere in China’s domestic affairs,” Mr. Zhao said at a regular news briefing.
The vaccine donations come at a time when tensions between the United States and China are running high over Taiwan. Chinese officials were annoyed this month when three U.S. senators visited the island to announce the original pledge of 750,000 doses.
Mr. Zhao also took aim at Taiwan’s governing Democratic Progressive Party, headed by President Tsai Ing-wen, which has long been considered a thorn in Beijing’s side. Mr. Zhao said that the party had “tried all means to obstruct the shipment of vaccines from the mainland to Taiwan and even lied that the mainland is obstructing its procurement of vaccines.”
Taiwan’s leaders had previously blamed “Chinese intervention” for their inability to buy doses from the German company BioNTech, which developed its vaccine with Pfizer.
A Chinese company, Fosun Pharmaceutical, claims the exclusive commercial rights to distribute BioNTech’s vaccine in Taiwan, but for many in the self-governing democracy, the idea of buying shots from a mainland Chinese business is unpalatable.
Afghanistan’s medical oxygen supply is under serious strain, a government official said on Monday, as the country’s third wave of coronavirus cases pummels its already feeble health care system.
“There is more need for oxygen, and the number of patients is too high,” said Dr. Osman Tahiri, an adviser in Afghanistan’s Ministry of Public Health. “We are worried that the situation may become more critical.”
Dr. Tahiri said that the government had tried to contend with dwindling supplies by installing oxygen generators in hospitals in Kabul, the country’s capital, and in provinces across the country. That plan, he said, has been hampered by fighting in several areas.
The shortage in oxygen was first reported by The Associated Press.
The ministry recorded nearly 2,000 coronavirus cases and more than 70 deaths on Monday, part of an upward trend in the country in recent weeks, driven in part by new variants of the coronavirus. Last week, the government recorded the most deaths in a single day — 101 — since the start of the pandemic.
The true death toll and number of new cases is probably far higher than those recorded by the government, as there is limited coronavirus testing in Afghanistan.
The country’s problems extend much further than the recent coronavirus surge, however. This is especially true in the country’s more rural reaches where recent Taliban offensives have wedged many civilians in the crossfire between government and insurgent forces, and a dry winter has precipitated a coming drought.
In some cases, road closures and gun battles at a key border crossing on the Tajikistan-Afghanistan border have stopped oxygen bottles from getting to hospitals.
“The war has affected 100 percent of the oxygen supply and the roads are completely closed,” said Ihsanullah Fazly, director of health in Kunduz, a province in the country’s north that has been racked with fighting in recent days.
The conflict and hoarding of oxygen supplies has also led to price gouging.
“There is an atmosphere of fear of the virus in the country, so people buy oxygen beforehand, which has led to a lack of oxygen and even multiplied the price of oxygen,” Dr. Tahiri said.
Ahmad Fardin, who works for an oxygen sales company in Kabul, said that empty oxygen bottles once sold for around $20. Now they can cost upward of $150.
“Hundreds of people are waiting behind the gates of oxygen companies to buy oxygen,” he said.
The government of Qatar has announced that everyone attending the World Cup to be held in the country next year must be fully vaccinated for the coronavirus. And with up to 1.5 million international fans expected to descend on the Gulf nation during the world’s largest soccer tournament next November, the logistics will be no small feat.
The Qatari government has plans to secure one million shots to immunize unvaccinated attendees if global inoculation efforts are not enough, the prime minister, Sheikh Khalid bin Khalifa bin Abdulaziz al-Thani, told state news media on Sunday.
“We are currently negotiating with a company to provide one million doses of Covid-19 vaccines in order to immunize and vaccinate some of those coming to Qatar,” he said, according to Reuters, though he did not indicate which company he was referring to.
Qatar has spent billions of dollars preparing for the 2022 World Cup after winning hosting rights in 2010. The country will become the first in the Middle East to hold the four-week tournament.
In April, Sheikh Mohammed bin Abdulrahman al-Thani, Qatar’s foreign minister, said that vaccination programs were being developed for attendees of the World Cup to ensure a “Covid-free event,” according to Reuters. Gianni Infantino, the president of FIFA, said in February that matches would play to full stadiums in the Gulf nation next year.
Qatar is currently administering the Pfizer-BioNtech and Moderna vaccines to its citizens and residents. About 57 percent of the population have received one dose, and 44 percent have been fully vaccinated, according to data compiled by The New York Times.
Canadian citizens and permanent residents who are fully vaccinated will be able to forgo a 14-day quarantine when arriving in the country, the Canadian government announced Monday. The new policy spares them from a polarizing requirement that they stay in a government-approved quarantine hotel.
The closure of Canada’s border with the United States to nonessential travel was recently extended to July 21, angering people on both sides of the border who have been irked by family separations and the inability to plan vacations or shopping trips.
The Canadian government has defended the hotel quarantine policy, which requires travelers to pre-book a three-day minimum stay at a government-approved hotel — at a nonrefundable cost of as much as 2,000 Canadian dollars — as a necessary measure to help keep the coronavirus at bay. Travelers are allowed to finish their quarantine at home once the Covid-19 test they take upon arrival at the airport comes back negative.
Health Minister Patty Hajdu said the cautious approach was predicated on the desire to keep Canadians safe and not to “squander” hard-earned progress in the fight against the coronavirus.
But critics have castigated the quarantine hotel policy as overly expensive and an encroachment on individual liberty. An advisory panel recently advised scrapping the policy, saying that many Canadians were opting to pay a heavy fine rather than stay in the hotels. Others were choosing to fly to the United States and then enter Canada by car, because the hotel-quarantine policy did not apply to travelers arriving by land.
The relaxing of the hotel policy for fully vaccinated Canadian travelers takes effect at 11:59 p.m. Eastern time on July 5. It was greeted with muted joy because most Canadians are not yet fully vaccinated and because it does not apply to non-Canadians, including Americans, unless they are essential-service workers who qualify for an exemption to quarantining.
As of June 18, about 4.9 million Canadians, or 13 percent of the population, had been fully vaccinated, and another 19.5 million, or 51 percent, had received the first of two doses, according to data from Canada’s public health ministry. Those figures are expected to rise rapidly once the country obtains larger supplies of vaccine.
The $1.9 trillion American Rescue Plan enacted in March, as well as a $900 billion pandemic aid package passed in December, are heavily front-loaded. They were set up to get money out the door fast.
But one consequence of that strategy is that fiscal policy in the quarters ahead will subtract from economic growth.
Financial experts mostly project that the economy, with strong momentum in the labor market and huge pools of pent-up savings by households, will be strong enough to keep growing despite the fading of the fiscal boost. To avoid an economic downturn, a huge handoff must occur from government-driven demand to the private sector.
There is no modern precedent for such huge swings in sums the government is pumping into the economy. And there is a risk — recently acknowledged by a top Federal Reserve official — that if pandemic-era savings are disproportionately held by the affluent, they will sit on that cash rather than spend it.
Most Americans eligible for stimulus checks of a combined $2,000 per person have already gotten them. The Treasury Department said this month that $395 billion of that cash is now shipped.
While unemployment insurance payments remain elevated, that spending is also tapering as people return to work — and supplements to those payments are scheduled to expire in September. Much of the other spending was either near-term, focused on things like vaccine rollout; or will be spent very gradually, such as on an expanded child tax credit and grants to state and local governments.
France announced on Monday that concerts with a standing audience could resume on June 30 and that nightclubs could reopen from July 9, bringing some relief to the country’s entertainment industry, which has been hobbled by the pandemic.
Alain Griset, a government minister, told reporters on Monday, “In this new phase where the health crisis begins to subside, we will be able to look forward to this summer in good conditions and to party in complete safety.”
The decision comes as France lifts the last remnants of coronavirus-related restrictions that have fueled a deep sense of fatigue in the country, particularly since the start of the third national lockdown this spring. The country’s eight-month nighttime curfew was lifted on Sunday, three days after the government dropped mandatory mask wearing outdoors.
Mr. Griset said that guests would have to show a digital health pass to enter nightclubs. The pass, available in a phone app, shows proof of either vaccination, a positive coronavirus test within the last six months — but more than two weeks old — or a recent negative test.
The coronavirus situation in France has largely improved in recent weeks, with fewer than 3,000 daily new infections on average. After a sluggish start at the beginning of the year, the country’s vaccination campaign has accelerated and about half of the population has now received at least a first shot of the vaccine. A quarter are fully vaccinated.
In other news from around the world:
The authorities in South Australia on Saturday barred entry to the state to travelers from the eastern suburbs of Sydney, in New South Wales, after an outbreak of the coronavirus in that city on the country’s eastern coast. The cluster of cases in Sydney, totaling 11 on Monday, is believed to have started after a limousine driver, whose passengers included international airline crew, tested positive for the more virulent Delta variant. South Australia has also banned travelers from Melbourne, in Victoria State, where an outbreak this month sent the city of five million into a two-week lockdown.
A member of Uganda’s Olympic team tested positive for the coronavirus after arriving in Japan on Saturday, local news media reported, citing government officials. The person was traveling with eight other athletes, all of whom have so far tested negative, reports said. The case comes amid a scramble to ensure the safety of Olympians before the Tokyo Games begin on July 2.
Indonesia will introduce new coronavirus restrictions in response to a rise in cases in the country. The rules will be placed on crowded centers including malls and markets, limiting capacity to 25 percent, Airlangga Hartarto, the country’s coordinating minister for economic affairs, told reporters on Monday. Indonesia logged 13,737 new cases on Sunday, the highest since January.
The United States extended restrictions on nonessential travel at land and ferry crossings with Canada and Mexico until July 21, the Department of Homeland Security said in a post on Twitter. But the department also said that there had been “positive developments in recent weeks” and that it was working with government agencies and with Canada and Mexico to identify the parameters under which restrictions could be eased.
The number of so-called black fungus cases in India has shot up to more than 30,000 from negligible levels in just three weeks. The deadly disease has sickened former coronavirus patients across the country, and doctors believe that hospitals desperate to keep Covid-19 patients alive made choices that left them vulnerable.
Indian states have recorded more than 2,100 deaths, according to news reports. The federal Health Ministry in New Delhi, which is tracking nationwide cases to allot scarce and expensive antifungal medicine for the condition, called mucormycosis, has not released the number of fatalities.
The pandemic has drawn stark lines between rich nations and poor, and the mucormycosis epidemic in India stands as the latest manifestation. During the second wave of the coronavirus, which struck India in April, its creaky, underfunded medical system lacked beds, oxygen and other necessities as infections and deaths soared.
The mucormycosis epidemic adds even more urgency to the difficult task of protecting India’s 1.4 billion people, only a small fraction of whom have been vaccinated against the coronavirus. They remain vulnerable to a third wave and the consequences that could follow.
“Mucormycosis will tail off and go back to baseline as the Covid cases subside,” said Dr. Dileep Mavalankar, an epidemiologist. “But it may come back in the third wave unless we find out why it is happening.”
Many doctors in India think they know why. The bone-and-tissue-eating fungus can attack the gastrointestinal tract, the lungs, the skin and the sinuses, where it often spreads to the eye socket and the brain if untreated. Treatment for the disease involves complex, often disfiguring surgery and an uncommon and expensive drug, contributing to a mortality rate above 50 percent.
Mucormycosis is not passed from person to person. It develops from commonplace spores that sometimes build up in homes and hospitals. Doctors believe that India’s crowded hospitals, and their dire lack of medical oxygen, left the fungus an opening.
Without enough oxygen, doctors in many places injected patients with steroids, a standard treatment for doctors battling Covid globally. Steroids can reduce inflammation in the lungs and help Covid patients breathe more easily.
Many doctors prescribed steroids in quantities and for durations that far exceed World Health Organization recommendations, said Arunaloke Chakrabarti, a microbiologist and the co-author of a study examining the causes of India’s mucormycosis outbreak. Those steroids may have compromised Covid patients’ immune systems and made them more susceptible to fungal spores.
The steroids may have also dangerously increased blood sugar levels, leaving people with diabetes vulnerable to mucormycosis. They could also increase the chance of blood clots, leading to malnourished tissue, which the fungus attacks, said Dr. Bela Prajapati, who oversees treatment for nearly 400 patients with mucormycosis.
Desperate doctors may not have had the chance to ask patients whether they had diabetes or other conditions before resorting to steroids.
“Doctors hardly had any time to do patient management,” Dr. Chakrabarti said. “They were all looking at how to take care of the respiratory tract.”
FRESNO, Calif. — On a Tuesday afternoon in April, among tables of vegetables, clothes and telephone chargers at Fresno’s biggest outdoor flea market were prescription drugs being sold as treatments for Covid.
Vendors sold $25 injections of the steroid dexamethasone, several kinds of antibiotics and the anti-parasitic drug ivermectin. Chloroquine and hydroxychloroquine — the malaria drugs pushed by President Donald J. Trump last year — make regular appearances at the market as well, as do sham herbal supplements.
Such unproven remedies, often promoted by doctors and companies on social media, have appealed to many people in low-income immigrant communities in places across the United States where Covid-19 rates have been high but access to health care is low. About 20 percent of Hispanic people in the United States lack health insurance, and the proportion is far higher among undocumented immigrants.
What’s more, some immigrants mistrust doctors who don’t speak their language or who treat them curtly — and those concerns have been amplified by harsh political rhetoric directed at Mexicans and Central Americans.
“My community fears that the government might be trying to get rid of us,” said Oralia Maceda Méndez, an advocate at a Fresno-based community group for Indigenous people from Oaxaca, Mexico.
A woman in Fresno recently described how her husband, a farmworker, had fallen so sick from Covid-19 that he couldn’t breathe or walk, but he refused to go to the hospital because he had heard rumors that undocumented immigrants had checked in and never left.
She took him to a wellness clinic, where a doctor gave him injectable peptide treatments, recalled the woman, who requested anonymity because of her immigration status.
She wasn’t prepared, she said, for the $1,400 bill, which included the cost of syringes and vials labeled thymosin-alpha 1, BPC-157 and LL-37. Pulling them out of a cabinet in the kitchen of her mobile home, she said she didn’t know exactly what they were, and she still feels the sting of the price.
“I was shocked, but I was trying to act like it was OK because I had to be strong for my husband and my kids,” she said. He grew sicker despite the injections, but the family had no funds left for care. More than a month passed before he was well enough to return to the fields.
Some unregulated drugs can be dangerous. And even if they aren’t a health risk by themselves, they can lead people to postpone seeking help from doctors, which can be deadly. Delayed treatment is one reason Black and Hispanic people have died from Covid at twice the rate as white people have in the United States.
Alternative therapies can also limit a patient’s treatment options because doctors worry about toxic drug interactions, said Dr. Kathleen Page, an infectious-disease specialist at Johns Hopkins University School of Medicine in Baltimore.
“I’m not upset at patients when they tell me what they’ve taken,” Dr. Page said. “I’m upset about the system that makes it easier for them to get help from nontraditional places than from regular health care.”
Sandy Sirias contributed reporting. This story was supported by the Pulitzer Center.
SHANGHAI — Dozens of huge container ships have been forced to drop anchor and wait. Freight rates have surged. Stores in the United States and Europe find themselves with understocked shelves, higher prices or both.
The blockage of the Suez Canal in March? No, there is another disruption in global shipping. This time, the problem lies in Shenzhen, a sprawling metropolis adjacent to Hong Kong in southeastern China.
Global shipping has been disrupted by the pandemic for months, as Western demand for goods made in Asia has outstripped the ability of exporters to get their containers onto outbound vessels. But the latest problem in Shenzhen, the world’s third-largest container port after Shanghai and Singapore, is making the difficulties even worse.
The shipping delays are related to the Chinese government’s stringent response to a recent outbreak of the virus. Shenzhen, a metropolis of more than 12 million, has had fewer than two dozen locally transmitted coronavirus cases, which city health officials have linked to the Alpha variant, which was first identified in Britain.
Shenzhen has responded by ordering five rounds of coronavirus testing of all 230,000 people who live anywhere near Yantian container port, where the first case was detected on May 21. All further contact between port employees and sailors has been banned. The city has required port employees to live in 216 hastily erected, prefabricated buildings at the docks instead of going home to their families every day.
The port’s capacity to handle containers plummeted early this month. It was still running at 30 percent below capacity last week, the port announced, and state-controlled media said on Monday that full recovery may require the rest of June.
“A few weeks into a very substantial port congestion in Yantian caused by a Covid-19 outbreak, supply chain disruptions continue to be very present in global trade,” Maersk, the world’s largest container shipping line, said in a statement on Thursday.
Long lines of container ships awaiting cargo bound for North America, Europe and elsewhere have had to anchor off Shenzhen and Hong Kong as captains now wait as long as 16 days to dock at Yantian. Small vessels mounted with their own cranes have been ferrying many containers straight from riverfront factory docks in the Pearl River Delta to container ships near Hong Kong, as exporters try to bypass delays at Yantian.
“It looks like rush hour — there’s a lot of ships waiting,” said Tim Huxley, the chairman of Mandarin Shipping, a container shipping line based in Hong Kong. He predicted that sorting out all of the shipping delays at Yantian and elsewhere could take the rest of this year.
The Suez Canal was blocked for almost a week by the Ever Given container ship in March, while Yantian coincidentally halted all loading of export containers for six days early this month. But Yantian’s problems have now dragged on much longer. Simon Heaney, the senior manager for container shipping research at Drewry Maritime Research in London, said that the global transportation disruption caused by the Yantian port problems was similar to the Suez Canal blockage, although differences between the two incidents make any statistical comparison difficult.
The average cost of shipping a 40-foot container from East Asia to Europe or North America has roughly quadrupled in the past year. Rates have soared upward this month with the Yantian difficulties.