As India’s Deaths Surpass 200,000, Focus on Virus Variants Grows

A patient receives oxygen inside a car in Delhi.
Credit…Atul Loke for The New York Times

As supplies run dangerously low and hospitals in India are forced to turn away the sick, scientists are trying to determine what role variants of the coronavirus might be playing.

Doctors, the public and the media are citing anecdotal — but inconclusive — evidence to suggest that a homegrown variant called B.1.617 is driving the country’s worsening outbreak. But researchers outside of India say the limited data so far suggests instead that a better-known variant, B.1.1.7., that walloped Britain late last year may be a more considerable factor.

Authorities in India reported nearly 3,300 daily deaths on Wednesday. That brings the official total to nearly 201,200 people lost, though experts believe the true figure is much higher. Daily new infections also surged to nearly 357,700, another record.

The presence of the variant could complicate the taming of India’s Covid-19 disaster. A number of doctors point to anecdotal evidence that people who have been fully vaccinated are getting sick.

“The current wave of Covid has a different clinical behavior,” said Dr. Sujay Shad, a senior cardiac surgeon at Sir Ganga Ram Hospital, where two of the doctors needed supplemental oxygen to recover. “It’s affecting young adults. It’s affecting families. It’s a new thing altogether. Two-month-old babies are getting infected.”

Scientists say that different variants seem to dominate specific parts of India. For instance, the B.1.617 variant has been detected in a large number of samples from the central state of Maharashtra while the B.1.1.7 variant is rising quickly in New Delhi.

“There are variants that are more transmissible than what we all coped with a year ago,” said Dr. Jeffrey Barrett, director of the Covid-19 genomics initiative at the Wellcome Sanger Institute in Britain. “Things can change really quickly, so if a country doesn’t react quickly enough, things can go from bad to very bad very quickly.”

Beyond the variants, scientists believe there are other, possibly more obvious factors that could be powering India’s deadly second wave.

India has just scraped the surface in terms of vaccinating its population, with less than 2 percent fully vaccinated. Experts also blame lax public behavior after last year’s first wave and missteps by Prime Minister Narendra Modi. And they note that India’s schools had started reopening in recent months — a possible factor behind rising infections among young people.

A broad lack of data plagues the scientific chase for variants and whether they are contributing to the severity of India’s crisis. Fast-moving mutations complicate the picture because it isn’t immediately clear how quickly they spread or how they respond to vaccines.

In India, the health care system wasn’t on alert for the impact of variants at home, even as they began to spread globally, said Dr. Thekkekara Jacob John, a senior virologist in the southern state of Tamil Nadu.

“We were not looking for variants at all,” he said. “In other words, we missed the boat.”

A staff member at a vaccination center prepares a vial of the Moderna Covid-19 vaccine.
Credit…Dmitry Kostyukov for The New York Times

The Pfizer-BioNTech and Moderna coronavirus vaccines are 94 percent effective at preventing hospitalization in fully vaccinated adults 65 or older, according to a small study released by the Centers for Disease Control and Prevention on Wednesday.

The findings, which are consistent with the clinical trial results, are the first real-world evidence from the United States that the vaccines protect against severe Covid-19. Older adults are at the highest risk of hospitalization and death from the disease. More than 573,000 people have died across the country related to the virus, according to a New York Times database, and as of Tuesday, 141.8 million people have received at least one dose of one of three federally authorized vaccines, including about 96.7 million people who have been fully vaccinated.

“These findings are encouraging and welcome news for the two-thirds of people aged 65 and up who are already fully vaccinated,” Dr. Rochelle Walensky, the C.D.C. director, said in a statement. “Covid-19 vaccines are highly effective and these real-world findings confirm the benefits seen in clinical trials, preventing hospitalizations among those most vulnerable.”

The study is based on data from 417 patients who were admitted to 24 hospitals in 14 states between January 1 and March 26. Approximately half were 75 or older.

Both the Pfizer and Moderna vaccines require two shots, spaced three to four weeks apart. Older adults who were partially vaccinated — that is, they had received one dose of the vaccine more than two weeks prior — were 64 percent less likely to be hospitalized with the coronavirus than unvaccinated seniors, the researchers reported.

The vaccines did not reduce hospitalization rates in people who had received their first dose less than two weeks prior. The body requires time to mount an effective immune response, and people are considered fully vaccinated two weeks after the last dose in the series.

“This also highlights the continued risk for severe illness shortly after vaccination, before a protective immune response has been achieved and reinforces the need for vaccinated adults to continue physical distancing and prevention behaviors,” the scientists wrote.

The seven-day citywide positive test rate has been falling since a peak in January and is now between 3 and 4 percent.
Credit…Jeenah Moon for The New York Times

After months of persistently high coronavirus caseloads, New York City appears to have finally reached a turning point. The city’s second wave is ebbing, a half-year after it began, New York City’s health commissioner, Dr. Dave Chokshi, said.

Throughout April, virus cases, hospitalizations and deaths have all been declining, which epidemiologists attribute to the climbing rate of vaccination as well as the arrival of warm weather, drawing people outdoors.

From a second-wave peak of nearly 8,000 cases in a single day in January, New York City, as of last week, was averaging about 2,000 virus cases per day. The seven-day positive test rate has fallen, too, and is now between 3 and 4 percent, according to the city’s data, the lowest it has been since the fall — but still a lot higher than its low of 1 percent last summer.

Public health officials say that by July, if the city stays on its current trajectory, that number could drop to below 600 cases a day, perhaps lower.

But epidemiologists and city officials warn that the epidemic is not close to over in New York, even though there are promising signs.

Hospitalizations have dropped faster for people over 65 — a group prioritized for vaccinations early on — than for other groups. Yet more than 1,500 Covid-19 patients remain hospitalized in New York City, and the death toll on some days is still around 40.

While some neighborhoods now have positivity rates of under 1 percent, in others that rate is six or seven times higher. Officials also worry that uneven vaccination coverage could lead to a situation where the virus persists in some corners of the city, but not others. Manhattan, the borough with the highest median household income, is far more vaccinated than the Bronx, the poorest, reflecting vaccine hesitancy in some parts of the city and underscoring the longstanding inequalities in health care that the virus has laid bare.

And there are signs that the pace of vaccinations is slowing. So far 52 percent of adults across the city have received at least one dose.

“I feel good that we are beginning to see a vaccine effect on transmission here,” said Dr. Denis Nash, an epidemiologist at the City University of New York’s School of Public Health. “But we still have a long way to go, and there are so many New Yorkers and so many neighborhoods that are more affected by this pandemic that are being left behind.”

Customers dined outdoors at Good Bar in Brooklyn earlier this month.
Credit…Gabby Jones for The New York Times

New York will end next month a longstanding curfew that forced bars and restaurants to close early in a bid to fight the spread of the coronavirus, Gov. Andrew M. Cuomo said on Wednesday.

The announcement came a day after leaders in the State Legislature said they would move to suspend an unpopular directive that required customers to order food when purchasing alcohol at bars and restaurants. The repeal would take effect after it passed both legislative chambers in Albany, which could happen this week.

The curfew, which currently requires establishments to stop serving customers at midnight, will end statewide on May 17 for outdoor dining areas and May 31 for indoor dining.

Mr. Cuomo, a third-term Democrat, first ordered the restriction last November as the state tried to stave off a second surge of the virus, saying at the time that indoor dining was likely a cause of the spread. He loosened the curfew in recent months as cases have fallen, moving it from 10 p.m. to midnight.

The hospitality industry and some state lawmakers have long criticized the curfew as arbitrary, pointing to a lack of evidence that late-night dining was contributing in any meaningful way to the virus’s spread.

The state will also allow people in New York City to sit at bars starting on Monday, for the first time since Mr. Cuomo implemented a statewide shutdown last March. Even as establishments have been allowed to welcome customers indoors, patrons were required to be seated at tables.

The restaurant industry welcomed the news.

“It’s great news that the state will finally undo the bar stool ban and lift the arbitrary midnight curfew,” said Andrew Rigie, the executive director of the New York City Hospitality Alliance, an industry group. “These outdated policies made it too difficult for too many small business owners and workers to support themselves and their families, and were a grave inconvenience to customers.”

The state will also loosen restrictions on catered events at residences. Beginning on Monday, they can have more than 10 people indoors and 25 people outdoors, provided events follow any necessary mask and social-distancing directives. Curfews on all catered events will also be lifted next month.

Officials in the state have gradually taken steps to roll back virus-related restrictions as more New York residents become vaccinated and cases of the virus fall.

The city’s second wave is finally ebbing, a half-year after it began, with virus rates and hospitalizations plunging, though city officials warn that the epidemic is not close to over in the city.

On Monday, Mr. Cuomo said the state would next month raise the capacity limits on offices statewide to 75 percent from 50 percent and on gyms outside New York City to 50 percent from 33 percent.

He also last month raised the maximum capacity for indoor dining for restaurants in New York City to 50 percent, up from 35 percent. Restaurants in the rest of the state are allowed to serve customers at 75 percent occupancy.

Luis Ferré-Sadurní contributed reporting.

A candlelight vigil on March 25 for nursing home residents who died of the coronavirus.
Credit…Eduardo Munoz/Reuters

The effort by Gov. Andrew M. Cuomo’s office to obscure the pandemic death toll in nursing homes in New York State was far greater than previously known, with aides repeatedly overruling state health officials over a span of at least five months, according to interviews and newly unearthed documents.

Mr. Cuomo’s most senior aides engaged in a sustained effort to prevent the state’s own health officials, including Howard Zucker, the health commissioner, from releasing the true death toll to the public or sharing it with state lawmakers, these interviews and documents showed.

A scientific paper, which incorporated the data, was never published. An audit of the numbers by a top Cuomo aide was finished months before it became publicly known. Two letters, drafted by the Health Department and meant for state legislators, were never sent.

The number of nursing home residents who died in first wave of the pandemic has been a particularly sensitive question for the Cuomo administration, which initially put the number at around 6,000.

The full data on nursing home deaths was not released until this year, after a report by the state attorney general in late January found that the official tally might have undercounted the true toll by as much as 50 percent. That was something Mr. Cuomo’s aides had known since the previous spring, The New York Times found.

Crowds gathered at the Portland Farmers Market at Portland State University in Portland, Ore., this month.
Credit…Kristina Barker for The New York Times

While coronavirus cases are falling in much of the United States, infections are spiking in Oregon, where a new wave is set to push a third of counties into the most severe level of restrictions.

In the past two weeks, virus cases have risen 54 percent and hospitalizations are up 39 percent, according to a New York Times database.

A total of 15 counties, including some in the Portland metro area, will move back into the fourth and most extreme level of restrictions by Friday, after meeting the state’s threshold, the governor’s office said on Tuesday. In these counties, indoor dining will be prohibited and businesses such as gyms and movie theaters must significantly reduce capacity.

The new limits are likely to prompt a political backlash. Some states that have endured recent surges, like Michigan, where cases have leveled off but still remain high, have chosen not to tighten restrictions again and instead asked residents to take greater precautions in an effort to halt the spread of the virus.

“This is not a step I take lightly,” Oregon’s governor, Kate Brown, said at a news conference last week. “However, it could be the last time we need to impose this level of restrictions given our vaccination trends and the virus’ behavior.”

Public health experts have suggested a combination of factors could be driving the surge, including more contagious variants, increased travel during spring break and the loosening of state guidelines before vaccination rates had risen sufficiently. As of Tuesday, nearly 30 percent of the state’s population was fully vaccinated and 43 percent had received at least one dose, according to a New York Times database.

“We didn’t get down far enough,” Ken Stedman, a biology professor at Portland State University, told local news outlet KATU, “and now we seem to be going back up again.”

Members of the National Guard outside the Capitol in Washington this month. The building is under strict security measures and pandemic safety protocols.
Credit…Amr Alfiky/The New York Times

Congressional officials have ramped up security and drastically limited the number of attendees for President Biden’s first joint address to Congress on Wednesday, preparing the Capitol for the long-awaited speech under the strictures of a pandemic and a heightened threat level after the deadly Jan. 6 riot.

Inside the cavernous House chamber, Mr. Biden will address only 200 people instead of the usual 1,600. Only a fraction of members of the House and the Senate — some chosen by lottery, others on a first-come, first-served basis — have received invitations, and just a small group of the usual dignitaries from the other branches of government will attend.

Chief Justice John G. Roberts Jr. will be the lone member of the Supreme Court on hand, according to a court spokeswoman. Instead of the full complement of the Joint Chiefs of Staff, Gen. Mark A. Milley, the chairman, will attend, along with Defense Secretary Lloyd J. Austin III.

Denied their traditional privilege of inviting a guest to sit in the House gallery for the speech, some lawmakers have resorted to remote invitations. Speaker Nancy Pelosi’s virtual guest is a doctor who runs a community health center for Asian-Americans and Pacific Islanders in her hometown, San Francisco; Representative Sara Jacobs, a California freshman, invited a child-care worker.

But the Capitol itself will be emptier than it has ever been for the speech. The House sergeant-at-arms has asked anyone who does not have a ticket to attend — including lawmakers — to leave the building by 5 p.m. Wednesday, hours before Mr. Biden is to arrive.

The unusual preparations promise to lend a surreal mood to what is usually an elaborate and tradition-bound ritual in Washington — a State of the Union-style address delivered by a newly sworn-in president. They are the latest reminder of the challenges facing Mr. Biden, who took office during one of the more difficult and traumatic stretches in modern American history.

Ursula von der Leyen, president of the European Commission, in Brussels on Saturday. The deal she brokered will establish the European Union as Pfizer’s biggest client.
Credit…Ksenia Kuleshova for The New York Times

For a month, the European Union’s top executive, Ursula von der Leyen, had been exchanging texts and calls with Albert Bourla, the chief executive of Pfizer. Two things became clear: Pfizer might have many more vaccine doses it could offer the bloc. And the European Union wanted them.

That personal diplomacy played a big role in a deal, to be finalized this week, in which the bloc will lock in 1.8 billion doses from Pfizer.

The deal will establish the European Union as Pfizer’s biggest client and allow the bloc to resell or donate the vaccines to partners, empowering it to support poorer countries’ struggling immunization efforts.

Yet Europe might have more pressing concerns: Its own vaccination drive is still playing catch-up. As of this week, 22 percent of European Union nationals have received at least one dose of a Covid-19 vaccine, compared with 42 percent of Americans, 51 percent of Britons and 60 percent of Israelis, according to a New York Times database.

Police officers carrying off a demonstrator who was protesting coronavirus restrictions at a rally in Berlin on April 21.
Credit…Filip Singer/EPA, via Shutterstock

The German domestic intelligence agency is keeping close tabs on a group of coronavirus deniers, who, in their protests against restrictions and tendency to believe in conspiracy theories, have found common cause with far-right extremists.

Government officials said the movement’s close ties to extremist organizations, such as the “Reich citizens” — or “Reichsbürger,” as they are known in German, referring to a group that refuses to accept the legitimacy of the modern German state — were troubling. Many of the coronavirus deniers say they also believe in QAnon conspiracy theories, and protesters are frequently seen holding signs with anti-Semitic tropes. A number of journalists have been attacked while covering the demonstrations.

A spokesman for the Interior Ministry said in a statement, “Our basic democratic order, as well as state institutions such as parliaments and governments, have faced multiple attacks since the beginning of the measures to contain the Covid-19 pandemic.” Several regional intelligence agencies have already been observing participants in the movement, he added.

The group of deniers, which started as a fringe movement last spring, has grown into a coordinated effort that organizes mass demonstrations across Germany. The rallies occasionally turn aggressive, and many have ended in scuffles with law enforcement officers.

Members of the group, which goes by “Querdenken” or “lateral thinking” in German, coordinate over Facebook, Telegram and YouTube. Parts of AfD, a German right-wing populist party, have allied themselves with protesters. The national intelligence agency’s formal observation of the deniers’ group is the first step in a procedure that could lead to it being declared anti-constitutional and ultimately banned.

A week ago, about 8,000 people in Berlin protested the passing of a law that gives the federal government power to implement tougher restrictions. Germany has seen a persistently high average number of new daily cases recently, averaging about 18,000 a day, according to a New York Times database, up from about 8,000 a day two months ago.

Migrants were met by members of the Border Patrol after crossing from Mexico into the United States by inflatable raft at a short stretch of the Rio Grande.
Credit…Peter van Agtmael for The New York Times

As the United States vaccinates more people and several states begin to reopen, public health officials warn that the failure of U.S. authorities to test adult migrants for the coronavirus in jam-packed border processing centers is creating a potential for new transmissions — even among migrants who may have arrived healthy at America’s door.

More than 170,000 migrants crossed the border in March, many coming from countries still grappling with high infection rates. The government says it has insufficient time and space to test them upon their arrival, so testing is being postponed until the newcomers are released to local community groups, cities and counties.

But that is usually after they have spent days confined in tight spaces with scores of strangers, often sleeping shoulder-to-shoulder on mats on the floor.

There have been no reported instances of mass spread at U.S. border facilities, and overall numbers of cases are relatively low, according to the Department of Homeland Security. But local officials and shelter operators say they fear the true number of cases could be much higher.

Waiting to refill oxygen cylinders in New Delhi on Tuesday. Families of the sick are filling social media with pleas for oxygen as supplies run low.
Credit…Atul Loke for The New York Times

When 54-year-old Niranjan Saha started complaining of breathlessness at home last week in New Delhi, his wife, Usha Devi, immediately suspected the coronavirus. With India’s outbreak worsening and hospitals turning away patients, she rushed into their sons’ room.

“Do whatever you want but find me an oxygen cylinder,” Mrs. Devi told Anikat, 21, and Mukul, 19. “Sell my gold, but get a cylinder.”

In India, amid probably the world’s gravest current outbreak, families beg for aid, and flames from funeral pyres burn day and night. Oxygen has become one of the scarcest commodities. On Wednesday, the Indian Health Ministry reported 3,293 deaths from the virus, taking the country’s toll to more than 200,000 since the pandemic began, and 357,000 new infections, breaking the global one-day record it set just days ago.

The Indian government says that it has enough liquid oxygen to meet medical needs and that it is rapidly expanding its supply. But production facilities are concentrated in eastern India, far from the worst outbreaks in Delhi and in the western state of Maharashtra, requiring several days’ travel time by road.

Families of the sick are filling social media with pleas for oxygen as supplies run low at hospitals or because they are trying to administer care at home. Others are turning to relatives, friends, co-workers, local politicians — anyone who might have a lead on a cylinder.

A few days after Mr. Saha, a salesman, first complained of symptoms, he tested positive for the coronavirus. Watching images of Indian patients gasping for breath in ambulances, he told his wife that he would prefer to “die at home” rather than begging strangers for help.

Their sons began looking anyway.

They set off across Delhi on a motorbike, stopping at hospital after hospital to ask if any had a bed and oxygen supply. They called friends and sent mass texts on WhatsApp. They approached a politician from the Aam Aadmi Party, which runs the Delhi government. No one could help.

Mr. Saha’s condition worsened and his fever soared. Lying in bed, he pleaded with Mrs. Devi to find a doctor.

“I don’t want to die,” he said, grasping her hand.

On Sunday evening, four days after he had tested positive, his sons stopped outside an oxygen refill shop in southern Delhi. A man stepped forward and offered to help. Relieved, Anikat and Mukul prepared to hand over the money their mother had given them: 10,000 rupees, about $135, the standard rate for a cylinder.

“Sixty thousand,” the man said.

The young men were stunned. That was nearly as much as their father earned in a year.

“But do you have a choice?” Anikat Saha said. “What do you do when your patient is dying?”

Some in Delhi say they have paid at least 10 times the usual price for oxygen, and the news media have carried reports of cylinders being looted from hospitals. A Delhi court on Tuesday said that the local government had failed to curb a mushrooming black market and described those hoarding supplies as “vultures.”

“When hundreds of people die over something as basic as medical oxygen, it is a massive governance failure,” said Asim Ali, a research scholar at the Center for Policy Research, a think tank in New Delhi.

The brothers spoke to their mother, who made desperate calls to neighbors and relatives in Assam, their father’s home state. In the end, they did not have to pawn her gold jewelry: They scraped together the money and carried the cylinder away on their motorbike.

At home, they couldn’t immediately figure out how to connect their father to the oxygen supply. By the time they got it to work, the oximeter on his finger showed his blood oxygen level dropping below 50 — dangerously low. For several hours, he drew shallow breaths through the tube.

But then his eyes closed and his body lay still.

They called an ambulance and Mrs. Devi rode with her husband to a hospital where they were told they might find a bed. They arrived to find a line of ambulances waiting outside with patients. Mr. Saha died before he could be admitted.

GLOBAL ROUNDUP

Olympic hopefuls modeling the Australian team’s outfits last month.
Credit…Steven Saphore/Agence France-Presse — Getty Images

Australia will fast-track vaccinations for athletes and support staff attending the Tokyo Olympics and Paralympics, the government said on Tuesday.

The contingent of about 2,000 will be eligible to be vaccinated in the country’s second-highest priority group, at the same time as people age 70 and older, emergency workers and people with existing medical conditions and disabilities.

Amid the country’s sluggish vaccine rollout, the announcement prompted some backlash. Critics took issue with athletes receiving preferential treatment when some high-priority workers and other vulnerable people are still waiting for vaccines.

To date, Australia has vaccinated only about 7 percent of its population, largely because of problems with supply and poor coordination between state and federal governments and clinics. Earlier this month, the rollout was hobbled further when the government stopped recommending the AstraZeneca vaccine, the only vaccine that the country is manufacturing domestically, for people under 50. Two weeks ago, the government dropped its initial goal to vaccinate the entire population by the end of the year.

The Australian minister for sports, Richard Colbeck, said in a statement on Tuesday afternoon, “our athletes deserve the opportunity to compete.” He added that vulnerable Australians remained an “absolute priority” for the vaccine rollout.

The chief executive of the Australian Olympic Committee, Matt Carroll, responded in a statement. “There will be hundreds of very grateful athletes, coaches and their families relieved to know that their hard work over five years has been worth it,” he said. “This added layer of assurance is what they were seeking.”

On Wednesday, Mr. Carroll told reporters that the committee had engaged a private contractor to conduct the vaccinations, meaning, “there’s no load on the public system whatsoever.”

The rollout to the athletes and support staff is expected to begin next week, he added, noting that they would receive either the Pfizer vaccine, for athletes under 50, or the AstraZeneca vaccine.

In other updates from around the world:

  • In the coming weeks, officials in Britain will announce a plan to allow people to travel to select countries without having to quarantine upon returning. The plan involves the use of a National Health Service app to verify that travelers have received a Covid-19 vaccination or recently tested negative, Grant Shapps, the country’s transport secretary, told Sky News. Civil society groups have raised concerns about vaccination passports, saying that they could invade privacy or disadvantage certain marginalized communities.

  • Andalusia, a region in southern Spain, said it would reopen travel across its eight provinces starting midnight on Wednesday, part of a national plan to ease restrictions. The vaccine rollout in Spain has accelerated in recent weeks, with 23 percent of the population having had at least one shot. The medical authorities in Seville, the capital of Andalusia, on Wednesday began offering the one-dose Johnson & Johnson vaccine.

  • An aunt of Prime Minister Narendra Modi of India died after contracting the coronavirus in the western Indian state of Gujarat. Narmadaben Modi, 80, was hospitalized after her condition deteriorated 10 days ago and she was taken to hospital, Prahlad Modi, Mr. Modi’s younger brother, told reporters. Gujarat is one of the Indian states where crematories are running overnight to handle the volume of dead bodies. Officials there are widely believed to be undercounting the actual number of deaths.

Watching the Stockyards Championship Rodeo in Fort Worth, Texas, where mask mandates have been lifted.
Credit…Shelby Tauber for The New York Times

The Centers for Disease Control and Prevention recommends that fully vaccinated Americans can, in most cases, avoid wearing masks outdoors. But this group of nearly 100 million, scattered across the country, remains for now under the authority of a patchwork of mask mandates, varying by state and sometimes by county, dictating when and where face coverings should be worn.

Some states, like Arizona and Texas, have already lifted mask mandates. But most indoor mask mandates could be eased or eliminated by the summer, said Dr. Arthur Reingold, chair of the epidemiology division at the School of Public Health at the University of California, Berkeley — as long as people continue to get vaccinated, and as long as the United States avoids the troubling waves it has endured over the past year.

About 2.7 million Covid-19 vaccine doses are being administered nationally each day on average — a drop from the peak of more than 3.3 million this month, when those who were most eager and able to get shots were getting them quickly.

By summer, Dr. Reingold said, “there won’t be big regional differences” in mask wearing as there are now. Strict outdoor masking has been standard behavior in urban centers like New York City and San Francisco, but less common in other parts of the country.

The C.D.C. on Tuesday advised that Americans who are fully vaccinated against the coronavirus no longer need to wear masks outdoors, except in some cases, like during large gatherings.

Gov. Andrew M. Cuomo said that New York would adopt the C.D.C.’s guidance on outdoor mask wearing, and Gov. Gavin Newsom of California said, “If you’re fully vaccinated, outdoors and not in a large crowd — you do not need to wear a mask.”

A federal mask policy “was always going to be somewhere between difficult and impossible to achieve” in the United States, Dr. Reingold said. Still, outside of places like airports and stores — where strictly enforced mask requirements have sometimes led to heated confrontations — mask wearing has often been an individual choice, as local government mask mandates have rarely led to fines or punishment.

The C.D.C. is maintaining its advice on other safety measures, saying that all adults should wear masks and stay six feet apart at outdoor performance and sporting events and in indoor shopping malls and movie theaters.

President Biden said on Tuesday at an outdoor news conference that the updated guidance was a step toward getting “life in America closer to normal.”

Xavier Becerra, the secretary of health and human services, said on “CBS This Morning” on Tuesday, “The message is clear: You’re vaccinated? Guess what, you get to return to a more normal lifestyle.”

Reuben and Estafania Alarcon’s son Eric, who has autism, has been disadvantaged by virtual learning.
Credit…Bryan Anselm for The New York Times

Perhaps no one feels the strain of remote learning more acutely than the youngest, highest-need students, whose ability to access in-person early intervention classes, targeted behavior analysis and speech therapy is considered key to their academic success.

In New Jersey, school districts in two towns five miles apart — with similar population sizes and similarly high rates of coronavirus cases — made radically different choices about whether and how to reopen schools during the pandemic.

In Rutherford, where schools have been mostly open, young children with autism have spent more than 700 hours in class since September. In Secaucus, the number of hours is closer to just 100.

Reuben Alarcon, part of a group of parents who have criticized the Secaucus Public School District’s reopening policies, said he was worried that the educational opportunities his son Eric, who will be 4 next month, lost during a crucial year of brain development would cause lifelong harm.

“He will sometimes use one or two words to ask for something. Sometimes he surprises us and he blurts out a sentence,” Mr. Alarcon said. “He would be so much more ahead had he had the full-time class.”

A staff member distributes the second version of the Tokyo 2020 playbook before a press briefing earlier today.
Credit…Pool photo by Franck Robichon

Organizers of the rescheduled Summer Olympics released a second round of so-called playbooks on Wednesday, with updated protocols for those taking part in the world’s largest sporting event this July.

Among the new rules: Athletes will be tested daily, but they will not need to quarantine. Visitors will be asked to stay off public transit. And members of the news media, along with other officials, will be urged to eat takeout meals alone.

Thomas Bach, the International Olympic Committee president, said the revised protocols were “based on the best scientific and medical expertise” and the experience of hundreds of sports events over the last year, involving thousands of athletes.

Organizers have not mandated that Olympians be vaccinated, and will not address whether domestic spectators will be allowed into Olympic stadiums and arena until June. Overseas spectators are barred from the Games, but tens of thousands of people will enter Japan this summer after nearly a year in which the country’s borders have been mostly closed to nonresidents.

Many in Japan are jittery that the Games could turn into a Covid superspreader event. In several public polls, a majority said they would prefer the Olympics be postponed again or canceled altogether, and some public health experts have questioned whether the Games are safe to stage under current pandemic conditions.

Like many other television shows, “Law & Order: SVU” had to adjust to resume production during the pandemic. The actors Ice-T and Jamie Gray Hyder shot a recent episode.
Credit…Virginia Sherwood/NBC

The unions representing television actors and crews are in talks with the major studios about extending — and possibly changing — the pandemic safety protocols they agreed on last year, like frequent testing and letting some employees record from inside closets.

The economic effects of the pandemic on the entertainment industry have been felt most acutely in the cities like Los Angeles and New York, where, at least in prepandemic times, roughly two thirds of the country’s film, television and theatrical jobs were located. In New York City, for instance, officials have estimated that employment in the arts, entertainment and recreation sector fell by 66 percent from December 2019 to December 2020.

Aiming to revive the industry during the pandemic, television producers said that they have had to test several times each week, hire orange-vested “Covid officers” and bring on extra cleaning companies — all of which have ballooned budgets by as much as 15 percent.

But unions have sometimes struggled to find a balance between keeping workers safe and helping them earn a living: some members have complained that one union’s safety rules have made it too hard to find work.

With vaccinations rising, television executives are now having to decide which innovations of the pandemic are worth holding onto, like whether to permit voice actors to keep working from home or holding virtual auditions.

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