C.D.C. Head Defends Agency Against G.O.P. Attacks on Pandemic Guidance

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Republican Senators Tear Into C.D.C. During Hearing

Republican senators criticized the Centers for Disease Control and Prevention policies and funding at a hearing on Tuesday. Dr. Anthony S. Fauci had a particularly fiery exchange with Senator Rand Paul.

“With these cases trending down in the United States and more people getting vaccinated, we are cautiously optimistic. However, globally, the pandemic is more severe than ever. India’s surge of cases is tragic, and a reminder that the virus can rapidly outstrip our efforts to contain it if we are not careful. My promise is that C.D.C. will continue to follow the science as our guide, and my appeal is to implore everyone to get a Covid-19 vaccine as soon as possible as the fastest way to end this pandemic.” “Dr. Fauci, do you still support funding of the — N.I.H. funding of the lab in Wuhan?” “Senator Paul, with all due respect, you are entirely and completely incorrect that the N.I.H., has not ever and does not now, fund gain-of-function research in the Wuhan Institute.” “Do they fund Dr. Barrett?” “We do not fund —” “Do you fund Dr. Barrett’s gain-of-function research?” “Dr. Barrett does not do gain-of-function research. And if it is, it’s according to the guidelines, and it is being conducted in North Carolina. And —” “— concerning a bat virus spike protein that he got from the Wuhan Institute into the SARS virus is gain of function —” “That is not —” “You are in the minority because at least 200 scientists have signed a statement from the Cambridge working group saying that it is gain of function.” “Well, it is not.”

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Republican senators criticized the Centers for Disease Control and Prevention policies and funding at a hearing on Tuesday. Dr. Anthony S. Fauci had a particularly fiery exchange with Senator Rand Paul.CreditCredit…Pool photo by Greg Nash

The director of the Centers for Disease Control and Prevention on Tuesday defended the agency against a series of attacks from Republican lawmakers accusing federal scientists of publishing outdated and overly conservative pandemic guidance.

At a hearing with other top federal health officials on the federal government’s pandemic response, Republican senators accused the C.D.C.’s director, Dr. Rochelle P. Walensky, of allowing outside influence in the agency’s schools guidance and being slow to recognize the low risk of outdoor transmission in its mask-wearing recommendations. They said that the agency had lost the trust of Americans looking to return to normal life.

Their complaints were the latest sign of mounting exasperation, some of it among public health experts, with the federal government’s pace in relaxing its recommendations as states across the country move to reopen economies. Frustrations ranged from the practical — asking children to wear masks at camp — to the conspiratorial — suggestions that the National Institutes of Health had supercharged coronaviruses, an accusation Dr. Anthony S. Fauci strongly dismissed.

Throughout the hearing, Dr. Walensky said that the C.D.C. was working to update its guidance documents as more Americans get vaccinated and as scientists glean new insights. She said the agency’s process for drafting guidance — with internal and external expert input — was collaborative and responsive.

Schools, businesses, physicians and local health departments have long looked to the agency’s guidance materials as authorities on the most current science.

Senator Susan Collins, Republican of Maine, complained that the C.D.C. had allowed the American Federation of Teachers to exert undue influence over its latest school reopening guidance.

Dr. Walensky said that a change to the schools guidance was because of an “oversight” — its draft guidance had neglected to include materials on how to protect teachers with compromised immune systems. The back-and-forth was a normal part of the agency’s process for drafting guidance, she said, when agency scientists consider outside advice from industry experts. C.D.C. scientists wrote the recommendations themselves, she said.

Ms. Collins also accused the C.D.C. of misleading Americans in its recent mask guidance on the risks of outdoor spread of the virus, when it announced that “less than 10 percent” of transmission was occurring outdoors, a statistic infectious disease experts have said is misleading.

“We have unnecessary barriers to reopening schools, exaggerating the risks of outdoor transmission and unworkable restrictions on summer camps,” she said. “It matters because it undermines public confidence in your recommendations.”

Senator Bill Cassidy, a Louisiana Republican and physician, told Dr. Walensky that the public was “beginning to disregard what you say that’s true,” warning of consequences if the C.D.C. did not update guidance on how vaccinated Americans could return to offices. He also accused the agency of being slow to acknowledge the minimal risk of outdoor transmission in its mask guidance.

“The American people have just lost patience with us,” he said. “I just ask you to just kind of be aware of their frustration.”

Dr. Walensky said that one challenge was drafting general guidance on the pandemic that applied to areas of the country with wildly different case rates and vaccination successes.

Senator Lisa Murkowski, Republican of Alaska, said that her state was still waiting on the C.D.C. to update its cruise ship guidance, which was threatening to sap the state’s tourism industry.

“Our reality is, if you can’t get ships turned north now, there is no season, whether it is for one week or one month,” she said.

Dr. Walensky said the C.D.C. was holding regular calls with the cruise ship industry, “to understand how they are interpreting their guidance and what they need in order to be able to get boats back in the water.”

The C.D.C.’s guidance and scientific advice was fraught during Donald J. Trump’s presidency for a different reason, when political appointees at the White House and health and human services department attempted to influence and meddle in the agency’s literature to favor reopening.

At one point, Senator Chris Murphy, Democrat of Connecticut, stepped in to defend the officials testifying, saying that scientists were still learning about the new virus and were working to keep their recommendations current.

“We suffered through four years with a president who literally made things up about this virus, who simplified the story over and over and over again,” he said. “It didn’t help us fight this disease. We still have a lot to learn.”

Buddhist monks were tested at a temple in Bangkok after a monk there died of Covid-19.
Credit…Rungroj Yongrit/EPA, via Shutterstock

After a devastating year with wave after wave of coronavirus infections around the world, new cases and deaths are falling in many of the Western nations that were once among the hardest hit. But while the virus recedes in wealthy nations with robust vaccination campaigns, it is pummeling India and threatening to swamp Southeast Asian countries that until now had largely kept the virus at bay.

Taken together, the opposing regional trends add up to a leveling of global daily new cases at “an unacceptably high plateau” that leaves the world in continuing danger, the director general of the World Health Organization, Tedros Adhanom Ghebreyesus, said on Monday.

In Southeast Asia, Dr. Tedros noted that “cases and deaths are still increasing rapidly.”

Cambodia and Thailand, which kept the virus under control throughout 2020, have lately recorded sharp increases in infections. Malaysia announced a new nationwide lockdown on Monday, two days after recording its highest daily case total since January.

Scientists warn that if the virus is allowed to spread unchecked in parts of the world with lower vaccine coverage, dangerous variants will continue to evolve, threatening all countries.

“Globally, we are still in a perilous situation,” Dr. Tedros said. About 772,000 new cases are reported on average each day globally, nearly half in India, where a virus variant, B.1.617, has been spreading.

The W.H.O. deemed B.1.617 “a variant of concern” on Monday. Other variants of concern include B.1.1.7, first identified in Britain and now dominant in the United States, and P.1, originally detected in Brazil.

In the United States, Britain and parts of Western Europe where vaccines have been widely deployed, the virus is subsiding, and people are flocking back to restaurants and other attractions.

Vaccines could soon be available to even more Americans now that the Food and Drug Administration has authorized the use of the Pfizer-BioNTech shot for 12- to 15-year-olds.

Dr. Robert Schooley, chief of the infectious disease division at the University of California San Diego, said that the global rate of cases “remains quite volatile.”

“We’re going to see a bit of a Whac-a-Mole situation for some time to come, as local and regional outbreaks flare up and burn out,” Dr. Schooley said. This will continue to be the case, he said, as long as a substantial part of the global population remains unvaccinated.

While new virus variants make a difference, said Dr. Michael Baker, an epidemiologist at the University of Otago in New Zealand who helped devise the country’s coronavirus response, “the major factors shaping the rise and fall of the pandemic are the behavior of governments and their responses to the pandemic.”

Dr. Baker noted that more than one-fifth of the world’s population lives in countries that have essentially stamped out the virus, including China, Taiwan, Vietnam, Australia, and New Zealand, and some wealthy nations are vaccinating their people rapidly enough to bring transmission rates down substantially. “However, many low- and middle-income countries have far less access to vaccine and other control measures, so are continuing to experience poorly controlled epidemics,” he said.

Saskia Popescu, an infectious-disease epidemiologist who is an assistant professor at George Mason University, said that Americans should not be lulled into thinking the virus is defeated, because “we have to see the crisis in India as a wake-up call for global vaccine equity.” She added, “Covid-19 isn’t gone anywhere until it’s gone everywhere.”

A cremation ground for Covid-19 victims along the banks of the Ganges River, in Garhmukteshwar, India, this month.
Credit…Archana Thiyagarajan/Agence France-Presse — Getty Images

As the chaos of India’s coronavirus outbreak spreads across the country, infections are surging in states and rural areas with fewer resources, where sickness and death are much harder to track. One measure of the misery, medical workers say, is that poor people are disposing of bodies in rivers because the cost of cremations has shot up.

The authorities believe that is what happened when villagers in northern India discovered dozens of bloated corpses washed up on the banks of the Ganges River along the boundary of Bihar and Uttar Pradesh, two states where the virus is raging.

Residents found the bodies on Monday evening in Chausa, a riverine village in Bihar. Stunned onlookers crowded around the remains, many with brightly colored clothes sticking to them, floating in the shallows.

Some officials said that roughly 30 bodies had been discovered. Witnesses put the figure at more than 100. Some people in the area have a custom of sending the remains of loved ones, weighted with stones, into the Ganges, the holiest river in Hinduism. But authorities suspect that many of these people died of Covid-19.

“I’ve never seen so many bodies,” said Arun Kumar Srivastava, a government doctor in Chausa, who said that it was likely that some were Covid-19 victims. In the past few days, he said, he has seen more and more people transporting dead bodies, sometimes on their shoulders.

“Definitely,” Dr. Srivastava said, “more deaths are happening.”

The outbreak in India shows no sign of letting up, with the health ministry reporting more than 386,000 new cases and nearly 3,900 deaths on Tuesday. A quarter of a million people have died nationwide from the virus, although experts believe that the true toll is much higher because of low testing levels and the large number of deaths in India that typically go unrecorded.

As Covid-19 deaths have overwhelmed funeral grounds, some crematories are charging five or 10 times the usual price for last rites. Kishan Dutt Mishra, an ambulance driver in the Chausa area, said that the price of wood had risen beyond what many families could afford.

Driving a seven-mile stretch along the Ganges between Chausa and another nearby town, Buxar, Mr. Mishra said that he saw body after body washed up along the river.

“I have never seen even a few bodies, let alone so many of them, lining the river all through this stretch,” he said.

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Biden Announces Ride-Share Partnership to Encourage Vaccines

President Biden announced a partnership with ride-share apps Uber and Lyft to offer free transportation to and from vaccination sites in order to encourage more Americans to get vaccinated against the coronavirus.

Today, I’m also announcing additional steps to ensure that transportation is less of a barrier. From May 24 through July 4, Uber and Lyft, Uber and Lyft are both going to offer everyone free rides to and from vaccination sites. I think that is really stepping up — both Uber and Lyft — free rides to, they’‘ll weight and from, they’ll take you back home. And it makes it easy for students who will work with federal pharmacy partners to bring on-campus vaccine sites to dozens of the nation’s largest community colleges, this summer. And I want to thank the governors here for making it easy as possible for students to get vaccinated. I’m announcing today that FEMA is making support available immediately for community vaccination outreach efforts. This will help states, tribes, territories, local governments and community and faith-based organizations to make more progress on the ground. Things like phone banking, door-to-door canvassing, pop-up vaccination sites and workplaces and houses of worship.

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President Biden announced a partnership with ride-share apps Uber and Lyft to offer free transportation to and from vaccination sites in order to encourage more Americans to get vaccinated against the coronavirus.CreditCredit…Mark Abramson for The New York Times

President Biden said on Tuesday that Uber and Lyft, two of the country’s largest ride-sharing services, would provide free rides to vaccination sites beginning May 24, an agreement intended to help him reach his goal of getting 160 million adults fully vaccinated by July 4.

Mr. Biden said that the ride-sharing initiative would last until then.

In a meeting with a group of six governors from states including Ohio, Utah and Maine, he detailed other initiatives as well, including an effort to create vaccination sites at community colleges and another to send FEMA officials around the country to encourage residents to receive a shot. The announcement marked an aggressive new phase of the administration’s efforts to combat vaccine hesitancy and expand access.

“We’re going to be able to take a serious step toward return to normalcy by Independence Day,” Mr. Biden said, referring to a benchmark he set in March. “And there’s a lot of work to do though to get there. But I believe we can get there.”

Though about 152 million people had received at least one vaccine shot in the United States as of Monday, according to the Centers for Disease Control, the pace of vaccination has slowed in recent weeks.

Experts say they had expected the slowdown, but vaccine reluctance — in part stemming from an 11-day pause in administering the Johnson & Johnson single-dose vaccine — will remain a significant obstacle. Only a small percentage of Americans who have not yet been vaccinated say they will definitely do so, according to recent polls.

To encourage more shots in arms, some governors, including Jim Justice of West Virginia, have started to experiment with incentives that could sway reluctant or disinterested Americans: Last month, Mr. Justice said the state would give $100 savings bonds to young people who get vaccinated, though officials are still trying to work out the details of the program. In New York, officials are offering free rail and subway tickets with vaccinations.

The governors who met virtually with the president on Tuesday had ideas of their own. Gov. Janet Mills of Maine told Mr. Biden that the state would offer vouchers to L.L. Bean, free fishing and hunting licenses, and tickets to local sporting events as incentives.

“We’re calling this ‘your shot to get outdoors,’” Ms. Mills said. “Oh, it’s corny, I know, but we know that people in Maine found refuge in relief and Mother Nature throughout the pandemic.”

Mr. Biden seemed amused by the idea, replying, “My guess is that’s probably going to work.”

Gov. Mike DeWine of Ohio said that the Ohio National Guard had set up small vaccination stations at nursing homes around the state. Gov. Spencer Cox of Utah said that pop-up clinics were appearing at churches and that health officials were working with clergy members to communicate information about the vaccines to congregants.

Mr. Cox also praised the move by the Food and Drug Administration to authorize the Pfizer-BioNTech vaccine for children 12 to 15 years old: “Mr. President, we’re really good at having kids here, so we’re excited to have that opportunity,” he said.

In New York, officials are looking even further afield for potential takers for their allotments of doses. Gov. Andrew M. Cuomo said Monday that the state was waiving residency requirements for vaccination in New York City, meaning tourists from around the country and world could come and get vaccinated for free.

The move was first pitched by Mayor Bill de Blasio as a way to increase tourism, and a vaccine pop-up clinic in Times Square is already serving tourists. Other sites in places popular with tourists are expected to follow.

“We had historic levels of tourism before the pandemic, as many as 67 million tourists in a single year,” Mr. de Blasio said Tuesday. “We want that to come back and I think rolling out the red carpet, welcoming people back, saying if you need to be vaccinated, we want to help you out, is just a smart thing to do.”

A quad test uses a polymerase chain reaction to look for multiple pathogens with a single sample.
Credit…Sanford Health

So-called quad tests, now available at thousands of hospitals and clinics, can detect not only the coronavirus but also two types of influenza and the respiratory syncytial virus, or R.S.V.

That might not seem essential given that the United States, like many other countries, witnessed a shocking absence of a flu season this past winter. But as the country begins to reopen, doctors say that flu and other pathogens could make a comeback this fall.

What’s more, even as a growing number of people get vaccinated against Covid, there are still some 40,000 new infections every day in the United States, so testing will still be in demand.

Unlike the antigen tests, the quad test looks for a virus’s genetic material using a polymerase chain reaction, or P.C.R. The P.C.R.-based method is far more accurate than the antigen approach, though P.C.R. sequencing of patient samples used to be more cumbersome and relied on multistep procedures.

Several factors might precipitate the flu’s return in the fall: children returning to school, declining use of masks and perhaps a lack of recent immune system exposure to the flu. If more people get sick in the fall, they will want to know if it is flu or the coronavirus.

A teenager waiting for his Covid-19 shot at a vaccination site inside a school in Denver on Saturday.
Credit…Kevin Mohatt for The New York Times

The F.D.A.’s decision to authorize Pfizer’s coronavirus vaccine for 12- to 15-year-olds presents a bright new opportunity in the push for broad immunity in the United States. But the challenges are more daunting than for immunizing older, more independent teenagers.

Surveys suggest that many parents — even those who eagerly got their own Covid shots — are reluctant to vaccinate pubescent children. Yet doing so will be critical for further reducing transmission of the virus and smoothly reopening middle and high schools.

Following the F.D.A.’s decision on Monday, states, counties and school districts are trying to figure out the most reassuring and expedient ways to reach younger adolescents as well as their parents, whose consent is usually required by state law. They are making plans to offer vaccines not only in schools but also at pediatricians’ offices, day camps, parks and even beaches.

“The game changes when you go down as young as 12 years old,” said Nathan Quesnel, the superintendent of schools in East Hartford, Conn. “You need to have a different level of sensitivity.”

A year after Americans abandoned parking lots, strip malls, sports arenas and department stores, they are returning to them in their new guise as vaccination centers. Sinna Nasseri, a photographer; and Michael Kimmelman, an architecture critic, lead us through the recolonization of public space.

Medical workers tending to a coronavirus patient in an emergency room in New Delhi last week.
Credit…Adnan Abidi/Reuters

Scientists in India are studying whether coronavirus variants, including one first identified in the western Indian state of Maharashtra last year, are contributing to the country’s devastating second wave.

On Monday, India recorded about 330,000 new cases. Its death toll is closing in on 250,000, which experts believe is almost certainly an undercount.

Though clinical data has not been made publicly available, anecdotally, doctors are reporting higher numbers of young people and children testing positive for the virus and more patients with severe disease requiring oxygen support.

Some experts suspect that the surge is caused by the B.1.1.7 variant, first reported in Britain, and by B.1.617, the one discovered in Maharashtra that is distinguished by a mutation at two locations of the spike protein’s coding sequence.

One of these mutations is also found on a variant first identified in California. Experts say changes to the shape of the spike protein — which latches on to human cells — could make it more transmissible and better able to evade an immune response.

Gagandeep Kang, a pre-eminent Indian virologist, said there was not enough data to conclude whether either variant was contributing to India’s deadlier second wave.

“There is some conflicting data regarding the B.1.1.7 variant, which seems to indicate in some studies that it does cause more severe disease, in other studies not,” she said.

Based on reports from hospitals, Dr. Kang said, it appeared that the B.1.617 variant was causing more severe disease, but that again, there was insufficient data to draw any conclusions. She said that real-time genetic information would be needed to determine that B.1.617-infected people needed more oxygen. “We don’t know that,” she added.

The Indian government said that the Indian SARS-CoV-2 Genomics Consortium, a network of labs created in December that is monitoring genomic changes in the virus, has asked states to send more samples along with patient clinical data to help evaluate whether the double-mutation variant is more transmissible.

However, the consortium said earlier this month that B.1.617, which it categorizes as a variant of concern, was being identified more often in some states as their infection numbers rose.

Global Roundup

Two Chinese men who created an online cache of banned reports on the coronavirus, defying government censorship, pleaded guilty on Tuesday to “picking quarrels and provoking trouble,” a vague charge that Chinese prosecutors often use against politically troublesome defendants.

Chen Mai and Cai Wei, both in their 20s, used Github — an internet platform widely used by software developers to share code and information — to preserve Chinese news reports and articles that censors had erased from their original sites. They stored more than 100 articles about the coronavirus outbreak in China in early 2020.

Credit…Chen Kun
Credit…via Associated Press

Their archive, called Terminus 2049, included materials such as a candid account by a doctor who tried to warn others about the spreading contagion and descriptions from medical workers who said they were desperately short of protective wear.

The Chinese government has been reluctant to apply its usual heavy-handed censorship to Github because it is so important to high-tech companies. That makes the platform a place where users can occasionally challenge government controls on information.

Chen Kun, the brother of Chen Mei, said that the accusations laid out by prosecutors made it clear that the authorities were angry at the defendants for challenging censorship at a time when leaders in Beijing faced a surge of public anger over missteps and concealment as the coronavirus was spreading in central China.

The prosecutors accused Mr. Chen and Mr. Cai of operating a separate online forum that they said included “a great deal of fake news” and “insults of national leaders,” according to Chen Kun, who lives in France and relayed accounts from his mother, who attended the trial in Beijing.

“The whole trial was a charade,” he said in a brief interview, adding that the defendants could not freely choose their own lawyers. “The court-appointed lawyers clearly played along with official demands.”

Mr. Chen, 28, and Mr. Cai, 27, were detained in April 2020 as China began to emerge from its coronavirus outbreak. Both men pleaded guilty to the charges, possibly in the hope of securing an early release. The verdict is expected to be announced at a later hearing.

In other news around the world:

  • Malaysia announced a new nationwide lockdown beginning on Wednesday in an attempt to slow the spread of the virus before this week’s Eid holiday. Restaurant dining and most nonessential travel will be banned under the four-week lockdown. Like many Southeast Asian nations, Malaysia has been grappling with a resurgence of the virus, and over the weekend it recorded its highest daily infection totals since January. Experts trace the latest surge, in part, to the government’s decision to relax measures over the Muslim holy month of Ramadan by allowing evening prayer services, reopening food bazaars and permitting restaurants to operate through the night.

  • The head of the International Olympic Committee postponed a visit to Japan as the country tries to contain a resurgence of the coronavirus less than three months before the Tokyo Olympics. Thomas Bach, the I.O.C. president, had been scheduled to meet with Japanese officials and participate in the ceremonial torch relay next week. But after a state of emergency was extended through the end of the month in Tokyo and other areas, the Games’ organizing committee said on Monday that it would try to reschedule Mr. Bach’s visit “at as early a date as possible.” The Tokyo Games, postponed from last year, are facing growing opposition at home as Japan fights a stubborn fourth wave of infections.

  • A court in northeastern Spain struck down a nighttime curfew imposed by regional authorities in Navarre. In the ruling on Tuesday, the court said the measure did not meet the criteria of “necessity and proportionality” to justify requiring people to stay indoors at night. Spain’s nationwide state of emergency for the pandemic ended on Sunday, leaving the courts to decide whether regional lockdown restrictions can continue.

Registered Nurse Dionne Dias injecting John Gray with the Novavax Vaccine which is undergoing Phase III safety/efficacy trials at Howard University Hospital in Washington in January.
Credit…Kenny Holston for The New York Times

Novavax, one of the first players in the race to vaccinate the world against Covid, delivered disheartening news on Monday, saying that its highly protective vaccine would not be authorized in the United States or Britain until at least July, and that it would not reach peak production until the end of the year.

The delays, announced during an earnings call with investors, are the latest setback for the little-known Maryland company, which was granted up to $1.6 billion from the U.S. federal government last year and whose product has shown robust results in clinical trials.

Despite these wins, the company has struggled to demonstrate that it can deliver on its promise to supply the world with 2 billion doses this year. Novavax has never brought a vaccine to market in its 34-year history.

On the call, the company’s president and chief executive, Stanley C. Erck, said that the regulatory and manufacturing hurdles causing the delay have now been resolved.

Investors did not appear to agree: By Tuesday morning, the company’s stock had fallen to $133.86, down nearly 17 percent, although it rebounded somewhat later in the day.

“I don’t see a lot going well for them at this point,” said Rob Smith, the managing director of Capital Alpha Partners, an investment research firm.

The company’s delay is unlikely to affect wealthy countries like the United States, which is flush with other vaccines.

But it is likely to have significant repercussions for the rest of the world, given that just last week, Novavax finalized a deal with Gavi, a public-private global vaccine partnership, to supply 1.1 billion doses of its shot to low- and middle-income countries.

Dogfish Head Craft Brewery is struggling to hire manufacturing workers for its beer factory and staff members for its restaurants.
Credit…Alyssa Schukar for The New York Times

As employers race to hire before an expected summertime economic boom, they are voicing a complaint that is echoing all the way to the White House: They cannot find enough workers to fill their open positions and meet the rising customer demand.

Many managers are unwilling to raise wages and prices enough to keep up, as they worry that demand will ebb in a few months and leave them with permanently higher payroll costs. They are instead resorting to short-term fixes, like cutting hours, instituting sales quotas and offering signing bonuses to get people in the door, Jeanna Smialek and Jim Tankersley report for The New York Times.

In and around Rehoboth Beach, Del., at least 10 people, managers and workers alike, cited expanded payments as a key driver of the labor shortage, though only two of them personally knew someone who was declining to work to claim the benefit.

In Delaware, Wawa gas stations sport huge periwinkle blue signs advertising $500 signing bonuses, plus free “shorti” hoagies each shift for new associates. A local country club is offering referral bonuses and opening up jobs to members’ children and grandchildren. A regional home builder has instituted a cap on the number of houses it can sell each month as everything — open lots, available materials, building crews — comes up short.

Scott Kammerer oversees a local hospitality company that includes a brewery and restaurants. He has been able to staff adequately by offering benefits and taking advantage of the fact that he retained some workers because his restaurants did not close fully or for very long during the pandemic.

But he has also raised wages. The company’s starting non-tip pay rates have climbed to $12 from $9 two years ago. Mr. Kammerer has not been forced to raise prices to cover increasing costs, because business volume has picked up so much — up 40 percent this year compared with a typical winter — that profits remain solid.

Credit…Michael Hirshon

Andrew Ferren, an American citizen who has lived in Madrid for much of the past 20 years, traveled to the United States to get vaccinated. Read his full essay on the experience here.

In mid-March, as friends and family were getting vaccinated in the United States, and as production problems and health concerns about some vaccines slowed the European Union’s already sluggish campaign, my husband and two children and I found ourselves packing our suitcases for New York.

A few weeks later, we returned for the second dose of the Pfizer-BioNTech vaccine.

Recent news articles have focused on American expats who have considered going back to the United States to get vaccinated. While it’s impossible to determine the exact numbers, I know about half a dozen Americans across Europe who, like us, made that decision.

The U.S. government has no program for vaccinating Americans abroad, and expats — all of whom maintain the same rights (voting, for example) and responsibilities (filing income taxes) of residents — are free to fly home and get vaccinated.

But the act of taking matters into one’s own hands can feel daunting, and there was also the fear that we might turn up for our shots only to be told they were out of vaccines.

A man speaks on the phone as a doctor tries to revive his wife inside an emergency ward, in Bijnor district, Uttar Pradesh, India, on Tuesday.
Credit…Danish Siddiqui/Reuters

NEW DELHI — The desperation that engulfed New Delhi, India’s capital, over the past few weeks is now spreading across the entire country, hitting states and rural areas with fewer resources.

This week, dozens of bodies washed up on the banks of the Ganges, most likely the remains of people who perished from Covid-19.

States in southern India have threatened to stop sharing medical oxygen with each other, fiercely protective about holding on to whatever they have as their hospitals swell with the sick and infections skyrocket.

And at one hospital in Andhra Pradesh, a rural state in southeastern India, furious relatives went on a rampage in the intensive care unit after lifesaving oxygen suddenly ran out — the latest example of the same tragedy repeating itself, of patients dying while gasping for air.

Cases in New Delhi and Mumbai may be leveling off. But many other places are getting bowled over by runaway outbreaks. The World Health Organization now says that a new variant of the virus detected in India, B.1.167, may be especially transmissible, which is just adding to the sense of alarm.

Every day the Indian media delivers a heavy dose of turmoil and grief. On Tuesday, it was televised images of distraught relatives furiously beating the chests of loved ones who had died after the oxygen ran out, and headlines including “Bodies of Suspected Covid-19 Victims Found Floating” and “As Deaths Go Up 10 Fold, Worrying Signs from Smaller States.”

India is suffering from a worrying shortage of medical oxygen. Nearly 200 patients have died because of this, according to an Indian news site that has been tracking the string of deadly incidents.

At the same time, the national vaccine campaign is spluttering. The roughly two million doses that have been administered each day over the past few days are lower than the highs a few weeks ago, when some days the country gave out more than three million doses. Many people can’t find any appointments to get the shot. Some vaccination sites have completely run out, officials say.

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