Daily Archives: April 6, 2021

A girl carries cassava leaves on her back as she walks back home from the field in Beni, Democratic Republic of Congo, October 8, 2019. REUTERS/Zohra Bensemra/File Photo

GENEVA (Reuters) - A record 27.3 million people in Democratic Republic of Congo, or about one-third of its population, are suffering from acute hunger, largely because of conflict and the economic impact of the COVID-19 pandemic, the United Nations said on Tuesday.

The figure makes Congo home to the most people needing urgent food assistance in the world, the World Food Programme (WFP) and the U.N. Food and Agriculture Organization (FAO) said in a joint statement.

Besides conflict and the pandemic, the number also rose because the latest analysis covered more people than previous ones.

For the first time ever we were able to analyse the vast majority of the population, and this has helped us to come closer to the true picture of the staggering scale of food insecurity in the DRC, Peter Musoko, WFPs country representative, said.

This country should be able to feed its population and export a surplus. We cannot have children going to bed hungry and families skipping meals for an entire day, he said.

The worst-hit areas were in the eastern provinces of Ituri, North Kivu, South Kivu and Tanganyika, as well as the central Kasai provinces, all of which have been affected by conflict.

People forced by fighting to flee their home have returned to find their crops destroyed. Some have been surviving by eating only taro, a root that grows wild, or cassava leaves boiled in water, the statement said.

Militia violence has persisted in Congo for decades, particularly in the eastern borderlands with Burundi, Rwanda and Uganda, despite the official end to a civil war in 2003.

Of the 27.3 million going hungry, about 6.7 million people were in the emergency phase, which is the last one before famine, an analysis by the Integrated Food Security Phase Classification (IPC) found.

Reporting by Stephanie Nebehay; Writing by Nellie Peyton; Editing by Aaron Ross and Barbara Lewis

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Conflict and COVID-19 drive hunger to record levels in Congo - Reuters

FILE PHOTO: The Carnival Panorama cruise ship sits docked, empty of passengers, as the global outbreak of the coronavirus disease (COVID-19) continues, in Long Beach, California, U.S., April 16, 2020. REUTERS/Lucy Nicholson

(Reuters) - Carnival Corp, the worlds largest cruise operator, is currently not taking a position on mandatory COVID-19 vaccinations for passengers before traveling, a company spokesman told Reuters on Tuesday.

The companys statement comes just a day after rival Norwegian Cruise Line Holdings Ltd said it would mandate travelers be vaccinated under a proposed plan to restart U.S. cruises in July.

The U.S. cruise industry is currently under a no-sail order from the Centers for Disease Control and Prevention (CDC).

Last week, the agency updated its guidance for the resumption of passenger voyages, which included the need for COVID-19 vaccinations and more frequent reporting of coronavirus infections from cruise operators.

However, Carnival said on Monday the guideline was largely unworkable and stood in stark contrast to the approach taken in other travel and tourism sectors.

Norwegian and Royal Caribbean Group have both said they would restart cruises from the Caribbean later this year with vaccinated passengers.

We continue to closely monitor the evolving situation with vaccines globally, a Carnival spokesman said in an emailed statement.

Reporting by Uday Sampath in Bengaluru; Editing by Ramakrishnan M.

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Carnival says not taking stance on mandatory COVID-19 vaccinations for travelers - Reuters

Community members do not need to be patients of CHAS Health to receive the vaccine at Spokane Community College. Here's what you need to know about the new clinic.

SPOKANE, Wash. A new COVID-19 vaccination clinic run by CHAS Health is opening at Spokane Community College on Wednesday, April 7.

The site will be located at SCC's Walter S. Johnson Sports Center (Building 5) and is scheduled to be in operations over the coming weeks and months to meet demand, CHAS Health said in a press release. CHAS previously served as the provider for the Spokane Arena mass vaccination clinic in partnership with the Washington State Department of Health. Safeway has since taken over as the provider at the site.

Community members do not need to be patients of CHAS Health to receive a vaccine but they must meet current eligibility requirements in Washington state. Everyone age 16 and older will be eligible to receive the vaccine in Washington on April 15.

An appointment is required to receive the vaccine walk-ins are not available. Those who are looking to schedule an appointment can do so online. Appointments for the clinic are available beginning Thursday, April 8.

CHAS is also moving its drive-thru COVID-19 testing from the Spokane Arena to SCC. Testing will open at SCC on Wednesday, April 14. Vaccination and testing will be offered Wednesday through Saturday through the spring.

People can drive to both the vaccination and testing location at the SCC campus using the entrance on East Nora Avenue from Mission Avenue. Bus access is available using STA Route 29 to SCC.

Based on previous experiences with both COVID-19 testing and vaccination, CHAS Health knew we would need a large space to successfully vaccinate community members, said Aaron Wilson, CEO of CHAS Health. The leadership of Spokane Community College reached out to us offering their facilities as a centralized location for vaccinations as well as testing that would be easy for community members to access. Their teams have been tremendous in supporting this effort with our internal CHAS Health team. We truly thank them for inviting us to campus and supporting this effort to provide COVID-19 vaccination and testing to the community."

Additional information about the vaccination and testing clinic, including a map on the location is available on CHAS Health's website.

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COVID-19 vaccine appointments available at SCC starting Thursday: How to schedule one - KREM.com

A new vaccine for Covid-19 that is entering clinical trials in Brazil, Mexico, Thailand and Vietnam could change how the world fights the pandemic. The vaccine, called NDV-HXP-S, is the first in clinical trials to use a new molecular design that is widely expected to create more potent antibodies than the current generation of vaccines. And the new vaccine could be far easier to make.

Existing vaccines from companies like Pfizer and Johnson & Johnson must be produced in specialized factories using hard-to-acquire ingredients. In contrast, the new vaccine can be mass-produced in chicken eggs the same eggs that produce billions of influenza vaccines every year in factories around the world.

If NDV-HXP-S proves safe and effective, flu vaccine manufacturers could potentially produce well over a billion doses of it a year. Low- and middle-income countries currently struggling to obtain vaccines from wealthier countries may be able to make NDV-HXP-S for themselves or acquire it at low cost from neighbors.

Thats staggering it would be a game-changer, said Andrea Taylor, assistant director of the Duke Global Health Innovation Center.

First, however, clinical trials must establish that NDV-HXP-S actually works in people. The first phase of clinical trials will conclude in July, and the final phase will take several months more. But experiments with vaccinated animals have raised hopes for the vaccines prospects.

Its a home run for protection, said Dr. Bruce Innis of the PATH Center for Vaccine Innovation and Access, which has coordinated the development of NDV-HXP-S. I think its a world-class vaccine.

Vaccines work by acquainting the immune system with a virus well enough to prompt a defense against it. Some vaccines contain entire viruses that have been killed; others contain just a single protein from the virus. Still others contain genetic instructions that our cells can use to make the viral protein.

Once exposed to a virus, or part of it, the immune system can learn to make antibodies that attack it. Immune cells can also learn to recognize infected cells and destroy them.

In the case of the coronavirus, the best target for the immune system is the protein that covers its surface like a crown. The protein, known as spike, latches onto cells and then allows the virus to fuse to them.

But simply injecting coronavirus spike proteins into people is not the best way to vaccinate them. Thats because spike proteins sometimes assume the wrong shape, and prompt the immune system to make the wrong antibodies.

This insight emerged long before the Covid-19 pandemic. In 2015, another coronavirus appeared, causing a deadly form of pneumonia called MERS. Jason McLellan, a structural biologist then at the Geisel School of Medicine at Dartmouth, and his colleagues set out to make a vaccine against it.

They wanted to use the spike protein as a target. But they had to reckon with the fact that the spike protein is a shape-shifter. As the protein prepares to fuse to a cell, it contorts from a tulip-like shape into something more akin to a javelin.

Scientists call these two shapes the prefusion and postfusion forms of the spike. Antibodies against the prefusion shape work powerfully against the coronavirus, but postfusion antibodies dont stop it.

Dr. McLellan and his colleagues used standard techniques to make a MERS vaccine but ended up with a lot of postfusion spikes, useless for their purposes. Then they discovered a way to keep the protein locked in a tulip-like prefusion shape. All they had to do was change two of more than 1,000 building blocks in the protein into a compound called proline.

The resulting spike called 2P, for the two new proline molecules it contained was far more likely to assume the desired tulip shape. The researchers injected the 2P spikes into mice and found that the animals could easily fight off infections of the MERS coronavirus.

The team filed a patent for its modified spike, but the world took little notice of the invention. MERS, although deadly, is not very contagious and proved to be a relatively minor threat; fewer than 1,000 people have died of MERS since it first emerged in humans.

But in late 2019 a new coronavirus, SARS-CoV-2, emerged and began ravaging the world. Dr. McLellan and his colleagues swung into action, designing a 2P spike unique to SARS-CoV-2. In a matter of days, Moderna used that information to design a vaccine for Covid-19; it contained a genetic molecule called RNA with the instructions for making the 2P spike.

Other companies soon followed suit, adopting 2P spikes for their own vaccine designs and starting clinical trials. All three of the vaccines that have been authorized so far in the United States from Johnson & Johnson, Moderna and Pfizer-BioNTech use the 2P spike.

Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.

Dr. McLellans ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. This guy is a genius, said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. He should be proud of this huge thing hes done for humanity.

April 5, 2021, 4:37 a.m. ET

But once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.

It made sense to try to have a better vaccine, said Dr. McLellan, who is now an associate professor at the University of Texas at Austin.

In March, he joined forces with two fellow University of Texas biologists, Ilya Finkelstein and Jennifer Maynard. Their three labs created 100 new spikes, each with an altered building block. With funding from the Gates Foundation, they tested each one and then combined the promising changes in new spikes. Eventually, they created a single protein that met their aspirations.

The winner contained the two prolines in the 2P spike, plus four additional prolines found elsewhere in the protein. Dr. McLellan called the new spike HexaPro, in honor of its total of six prolines.

The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.

Dr. McLellan also hoped that HexaPro-based vaccines would reach more of the world especially low- and middle-income countries, which so far have received only a fraction of the total distribution of first-wave vaccines.

The share of the vaccines theyve received so far is terrible, Dr. McLellan said.

To that end, the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.

Meanwhile, Dr. Innis and his colleagues at PATH were looking for a way to increase the production of Covid-19 vaccines. They wanted a vaccine that less wealthy nations could make on their own.

The first wave of authorized Covid-19 vaccines require specialized, costly ingredients to make. Modernas RNA-based vaccine, for instance, needs genetic building blocks called nucleotides, as well as a custom-made fatty acid to build a bubble around them. Those ingredients must be assembled into vaccines in purpose-built factories.

The way influenza vaccines are made is a study in contrast. Many countries have huge factories for making cheap flu shots, with influenza viruses injected into chicken eggs. The eggs produce an abundance of new copies of the viruses. Factory workers then extract the viruses, weaken or kill them and then put them into vaccines.

The PATH team wondered if scientists could make a Covid-19 vaccine that could be grown cheaply in chicken eggs. That way, the same factories that make flu shots could make Covid-19 shots as well.

In New York, a team of scientists at the Icahn School of Medicine at Mount Sinai knew how to make just such a vaccine, using a bird virus called Newcastle disease virus that is harmless in humans.

For years, scientists had been experimenting with Newcastle disease virus to create vaccines for a range of diseases. To develop an Ebola vaccine, for example, researchers added an Ebola gene to the Newcastle disease viruss own set of genes.

The scientists then inserted the engineered virus into chicken eggs. Because it is a bird virus, it multiplied quickly in the eggs. The researchers ended up with Newcastle disease viruses coated with Ebola proteins.

At Mount Sinai, the researchers set out to do the same thing, using coronavirus spike proteins instead of Ebola proteins. When they learned about Dr. McLellans new HexaPro version, they added that to the Newcastle disease viruses. The viruses bristled with spike proteins, many of which had the desired prefusion shape. In a nod to both the Newcastle disease virus and the HexaPro spike, they called it NDV-HXP-S.

PATH arranged for thousands of doses of NDV-HXP-S to be produced in a Vietnamese factory that normally makes influenza vaccines in chicken eggs. In October, the factory sent the vaccines to New York to be tested. The Mount Sinai researchers found that NDV-HXP-S conferred powerful protection in mice and hamsters.

I can honestly say I can protect every hamster, every mouse in the world against SARS-CoV-2, Dr. Peter Palese, the leader of the research, said. But the jurys still out about what it does in humans.

The potency of the vaccine brought an extra benefit: The researchers needed fewer viruses for an effective dose. A single egg may yield five to 10 doses of NDV-HXP-S, compared to one or two doses of influenza vaccines.

We are very excited about this, because we think its a way of making a cheap vaccine, Dr. Palese said.

PATH then connected the Mount Sinai team with influenza vaccine makers. On March 15, Vietnams Institute of Vaccines and Medical Biologicals announced the start of a clinical trial of NDV-HXP-S. A week later, Thailands Government Pharmaceutical Organization followed suit. On March 26, Brazils Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.

Meanwhile, the Mount Sinai team has also licensed the vaccine to the Mexican vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.

To the nations involved, the prospect of making the vaccines entirely on their own was appealing. This vaccine production is produced by Thai people for Thai people, Thailands health minister, Anutin Charnvirakul, said at the announcement in Bangkok.

In Brazil, the Butantan Institute trumpeted its version of NDV-HXP-S as the Brazilian vaccine, one that would be produced entirely in Brazil, without depending on imports.

Ms. Taylor, of the Duke Global Health Innovation Center, was sympathetic. I could understand why that would really be such an attractive prospect, she said. Theyve been at the mercy of global supply chains.

Madhavi Sunder, an expert on intellectual property at Georgetown University Law Center, cautioned that NDV-HXP-S would not immediately help countries like Brazil as they grappled with the current wave of Covid-19 infections. Were not talking 16 billion doses in 2020, she said.

Instead, the strategy will be important for long-term vaccine production not just for Covid-19 but for other pandemics that may come in the future. It sounds super promising, she said.

In the meantime, Dr. McLellan has returned to the molecular drawing board to try to make a third version of their spike that is even better than HexaPro.

Theres really no end to this process, he said. The number of permutations is almost infinite. At some point, youd have to say, This is the next generation.

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Researchers Are Hatching a Low-Cost Covid-19 Vaccine - The New York Times

Crew sets up chairs before starting a COVID-19 vaccination clinic at the Minnesota Vikings' TCO Performance Center in Eagan. (FOX 9)

EAGAN, Minn. (FOX 9) - All COVID-19 vaccinations scheduled to take place Wednesdayat the Minnesota Vikings practice facility in Eagan are being postponed after the center suffered weather damage, according to an official with state emergency operations center.

Twin Cities Orthopedics Performance Center had been serving as a temporary, state-runcommunity COVID-19 vaccination site.

State and Vikings officials confirmed to FOX 9TCO will not be used this week as planned for the vaccination clinic due to the weather damage. Currently, only the appointments scheduled for Wednesday have been postponed. The appointments later in the week remain scheduled as the state searches to find a new site to hold the clinic.

"The state is working around the clock to identify an alternate location and will contact impacted patients directly to provide an opportunity to reschedule their appointments as soon as possible," read a statement in part.

Tuesday night, Minnesotans started receiving text messages notifying them that their vaccination appointment at TCO would be postponed dueto "weather-related damage requiring repairs at the vaccination site".

Monday night, thunderstorms moved through the Twin Cities metro area.

Continue reading here:

COVID-19 vaccine appointments at TCO postponed due to weather damage - FOX 9

A sign requiring face masks and COVID-19 protocols is displayed at a restaurant in Plymouth, Mich., on March 21. Coronavirus cases in Michigan are skyrocketing after months of steep declines, one sign that a new surge may be starting. Emily Elconin/Bloomberg via Getty Images hide caption

A sign requiring face masks and COVID-19 protocols is displayed at a restaurant in Plymouth, Mich., on March 21. Coronavirus cases in Michigan are skyrocketing after months of steep declines, one sign that a new surge may be starting.

After more than two months of steep declines, coronavirus infections are on the rise again nationally along with COVID-19 hospitalizations in many states.

In the past seven days, the U.S. reported slightly more than 65,000 new cases per day on average, a jump of 20% from two weeks earlier. Many states have seen even more dramatic growth, as high as 125% in Michigan, according to an NPR analysis of data from Johns Hopkins University.

And hospitalizations have risen for seven consecutive days in more than a dozen states, mostly in the Midwest and Northeast, according to the University of Minnesota's COVID-19 Hospitalization Tracking Project.

These signs all point to the growing threat of another significant surge in COVID-19 cases, experts say.

But there's cautious optimism that it's not likely to be as devastating as the previous wave, which saw 200,000 or more confirmed cases a day on average for most of December and early January, according to data tracked by Johns Hopkins University.

"Thanks to the rapid rollout of vaccines, I don't think we'll have a surge that is anything like what we've seen before," says Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security. "Still, any additional deaths at this point are tragedies, given that we have on hand vaccines that could have prevented them."

What's driving the growth in infections?

Another surge is inevitable, says epidemiologist Bill Hanage of the Harvard T.H. Chan School of Public Health. But he adds that "it might not be national, not all at the same time, and the consequences will vary depending on how many people are vaccinated when it kicks off."

Indeed, the rise in cases so far isn't consistent across the country. The Midwest has seen a 58% increase in new cases over the past 14 days, while the number of cases in the Northeast has climbed by 30%. Cases in the West rose by 5% and the South shows a slight decline.

Overall, 33 states and the District of Columbia have rising cases with seven states (plus Puerto Rico) growing by more than 50%.

A host of factors are fueling the resurgence. States have been loosening restrictions, while pandemic fatigue has led to less vigilance about precautions such as mask-wearing, social distancing and hand-washing.

Perhaps the biggest unknown is how the rapid spread of one particular coronavirus strain may play out.

The highly contagious B.1.1.7 variant represents a growing share of cases in the U.S. and is likely driving the current increase, notes Hanage. The strain, which emerged in the U.K., is up to 50% more infectious, and new research suggests it's more likely to result in serious illness and death as well.

Hospitalizations are another sign of how the surge is ramping up. The growth over the past week or so is the first time since the winter surge that hospitalizations appear to be rising: 10 states experienced spikes of 10% or more; four states Michigan, South Dakota, Connecticut and Maryland saw rises of about 15% or more, according to the University of Minnesota's COVID-19 Hospitalization Tracking Project.

"A matter of choice"

For now, there's still plenty of reason for hope. The vaccine rollout is happening fast, though unevenly. So far, about 17% of U.S. adults are fully vaccinated.

And the vaccines appear to be effective at preventing severe illness and death from all the strains currently circulating, including the B.1.1.7 variant, Hanage told NPR's All Things Considered. So it's a race to get people vaccinated before the fast-spreading variant can take over.

There are two more positive factors to consider: the warming weather and existing immunity from previous infections, says Natalie Dean, a biostatistician at the University of Florida.

The fact that a lot of people have been infected naturally during the last surge and even earlier "will help take the edge off a bit of what potentially can happen in the future," she explains. "And the fact that we're moving out of the winter months into the spring, all of those things are working to our advantage."

Still, Harvard epidemiologist Hanage notes that it's important to pay attention to high-risk groups who may not be getting vaccinated as quickly.

"It doesn't take a large number of infections in the most vulnerable groups to cause serious problems," he told NPR.

Researchers NPR spoke to all cautioned that public policy and Americans' behavior can still make a huge difference in how bad this next surge will be.

Alessandro Vespignani, a disease modeler at Northeastern University in Boston, warns that relaxing measures like social distancing now could turn this into a bigger surge. Instead, he says, we need more time for the vaccination campaign to roll out.

"We really need to keep fighting for a few weeks," he says. "We see that light at the end of the tunnel and it's just a matter of keeping things together for a few more weeks. It's a matter of choice at this point."

How long will this surge last?

Ashish Jha, dean of Brown University's School of Public Health, says he's concerned about the next four to six weeks, but he expects that "once we get further into May, things will stabilize and start getting better."

The COVID-19 forecasting team at the Children's Hospital of Philadelphia PolicyLab says they see signs that the new surge won't be as prolonged as winter's. In this week's forecasting update, they estimate cases in several Michigan cities may soon reach a spring peak, and they forecast the New York City region may also be stabilizing.

Other experts say a surge could last until June and that there's a chance it could be quite severe.

Nicholas Reich, an epidemiologist at the University of Massachusetts, Amherst, says he "would be surprised but not shocked" if the surge did in fact rise to the levels seen in winter. Right now, he says, Michigan at least "is headed in that direction with scary velocity."

Though this resurgence of COVID-19 isn't generally expected to be as bad as the winter wave, experts repeatedly urge that now is not the time to relax.

Earlier this week, CDC Director Dr. Rochelle Walensky said that despite the positive momentum, she described feeling a sense of "impending doom" as the number of cases climbs.

"It will be critical for individuals to commit to masking and keeping gatherings small to protect communities in the coming weeks," says Lauren Walens, strategic operations and communications director of the Children's Hospital of Philadelphia's PolicyLab.

Melissa Nolan, a professor of epidemiology at the University of South Carolina's Arnold School of Public Health, says the current uptick could in fact be followed by yet another flare-up in cases this summer.

"Our models are suggesting June as another peak, approximately a quarter the size of last summer's," she says, as a result of adults and children who remain unvaccinated.

Indeed, the trajectory and duration of the surge will depend a lot on how quickly people get vaccinated and what Americans and their state and local governments do in the meantime.

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Is The US In For Another Big COVID Surge? : Shots - Health News - NPR

Heres what you need to know:The biopharmaceutical company Emergent BioSolutions,a contract manufacturer of coronavirus vaccine.Credit...Jim Lo Scalzo/EPA, via Shutterstock

The Biden administration on Saturday put Johnson & Johnson in charge of a Baltimore contract plant that ruined 15 million doses of its Covid-19 vaccine, and moved to stop the facility from making another vaccine, developed by AstraZeneca, senior federal health officials said.

The extraordinary move by the Department of Health and Human Services will leave the Emergent BioSolutions facility solely devoted to making the Johnson & Johnson single-dose vaccine and is meant to avoid future mix-ups, according to two senior federal health officials. Johnson & Johnson confirmed the changes, saying it was assuming full responsibility for the vaccine made by Emergent.

The change came in response to the recent disclosure that Emergent, a manufacturing partner to both AstraZeneca and Johnson & Johnson, accidentally mixed up the ingredients from the two different vaccines, which forced regulators to delay authorization of the plants production lines.

Federal officials are worried that the mix-up will erode public confidence in the vaccines, just as President Biden is making an aggressive push to have enough vaccine doses to cover every American adult by the end of May. At the same time, there is deep concern about the safety of the AstraZeneca vaccine, amid a health scare that has prompted some European countries to restrict its use.

AstraZeneca said in a statement that it would work with the Biden administration to find an alternative site.

The ingredient mix-up, and Saturdays move by the administration, is a significant setback and public relations debacle for Emergent, a Maryland biotech company that has built a profitable business by teaming up with the federal government, primarily by selling its anthrax vaccines to the Strategic National Stockpile.

A spokesman for Emergent declined to comment, except to say that the company would continue making AstraZeneca doses until it received a contract modification from the federal government.

Experts in vaccine manufacturing said that in the past, the Food and Drug Administration had a rule to prevent such mishaps by not allowing a facility to make two live viral vector vaccines, because of the potential for mix-ups and contamination.

Unlike Johnson & Johnson, AstraZeneca does not yet have emergency F.D.A. authorization for its vaccine. With three federally authorized vaccines (the other two are by Pfizer-BioNTech and Moderna), it is unclear whether the AstraZeneca vaccine, which has had a troubled history with regulators, could even be cleared in time to meet U.S. needs.

However, one of the federal officials said the Health and Human Services Department was discussing working with AstraZeneca to adapt its vaccine to combat new coronavirus variants.

None of the Johnson & Johnson doses made by Emergent have been released by the F.D.A. for distribution. The agencys acting commissioner, Dr. Janet Woodcock, said in a statement that the agency takes its responsibility for helping to ensure the quality of manufacturing of vaccines and other medical products for use during this pandemic very seriously.

But she made clear that the ultimate responsibility rested with Johnson & Johnson. It is important to note that even when companies use contract manufacturing organizations, it is ultimately the responsibility of the company that holds the emergency use authorization to ensure that the quality standards of the F.D.A. are met.

Emergents Baltimore facility is one of two facilities that were built with taxpayer support and are federally designated as Centers for Innovation in Advanced Development and Manufacturing. Last June, the government paid Emergent $628 million to reserve space there as part of Operation Warp Speed, the Trump administrations fast-track initiative to develop coronavirus vaccines.

Johnson & Johnson and AstraZeneca both contracted with Emergent to use the space. Both companies vaccines are so-called live viral-vector vaccines, meaning they use a modified, harmless version of a different virus as a vector, or carrier, to deliver instructions to the bodys immune system. The Johnson & Johnson vaccine is one dose; AstraZenecas vaccine is two doses.

Last month, Mr. Biden canceled a visit to the Emergent Baltimore plant, and his spokeswoman announced that the administration would conduct an audit of the Strategic National Stockpile, the nations emergency medical reserve. Both actions came after a New York Times investigation into how the company gained outsize influence over the repository.

For the first time, more than three million people, on average, are receiving a Covid-19 vaccine each day in the United States, according to data from the Centers for Disease Control and Prevention. And on Saturday, the country reported over four million doses in a single day for the first time.

The milestones reflect a steady increase in the capacity of states to deliver shots into arms. In early March, the nation surpassed an average of two million doses administered each day, up from around 800,000 doses a day in mid-January. Nearly a third of the United States population has received at least one dose of a Covid-19 vaccine as more states expand eligibility and production ramps up.

The news, which comes as President Biden enters the homestretch of his first 100 days in office and amid the general declines in new virus cases, deaths and hospitalizations since January, offers a sign of hope for a weary nation. But the average number of new reported cases has risen 19 percent over the past two weeks, and federal health officials say that complacency about the coronavirus could bring on another severe wave of infections.

We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said in an emotional plea to Americans this week. But right now Im scared.

The rising vaccination rate has prompted some state officials to accelerate their rollout schedules. This week, Gov. Ned Lamont of Connecticut expanded access to people 16 and older, several days ahead of schedule. And Gov. Jared Polis of Colorado opened universal eligibility about two weeks earlier than planned.

No more having to sort out if youre in or if youre out, said Julie Willems Van Dijk, the deputy secretary of the Department of Health Services in Wisconsin, where anyone 16 or older will be eligible for a vaccine as of Monday. Its time to just move forward and get everybody with a shot in their arm.

In another promising development, federal health officials said on Friday that Americans who are fully vaccinated against the coronavirus can travel at low risk to themselves within the United States and abroad.

But these days, most signs of hope are offset by peril.

Over the past week, there has been an average of 64,730 cases per day, an increase of 19 percent from two weeks earlier, according to a New York Times database. New deaths on average have declined, but they are still hovering around 900 a day. More than 960 were reported on Friday alone.

The C.D.C. predicted this week that the number of new Covid-19 cases per week in the United States would remain stable or have an uncertain trend over the next four weeks, and that weekly case numbers could be as high as about 700,000 even in late April.

Cases are already increasing significantly in many states, particularly in the Midwest and Northeast, as variants of the virus spread and some governors relax mask mandates and other restrictions. Dr. Walensky said this week that if states and cities continued to loosen public health restrictions, the nation could face a potential fourth wave.

Michigan, one of the worst-hit states, is reporting nearly 6,000 cases a day up from about 1,000 a day in late February even though half of its residents over 65 are now fully vaccinated.

And in Ohio, Gov. Mike DeWine said that new variants were aggravating the states caseload, even as vaccinations picked up.

We have to understand that we are in a battle, he said.

As if to underscore how fragile the nations recovery is, a quintessential American ritual the start of the baseball season has already faced a virus-related delay.

Major League Baseball officials said on Friday that the league had found only five positive cases in more than 14,000 tests of league personnel. But because four of those people were Washington Nationals players, the teams Opening Day game against the New York Mets was postponed, and then the teams full three-game weekend series.

Its one of those things that brings it to light that were not through it yet, Brian Snitker, the Atlanta Braves manager, told The Associated Press. Were still fighting this.

Benjamin Guggenheim,Lauryn Higgins and Mike Ives

In Ohio, Gov. Mike DeWine offered school districts early access to Covid-19 vaccines for their staff members if they committed to opening classrooms by March 1.

In Washington, Gov. Jay Inslee declared a state of emergency related to child and adolescent mental health and banned fully virtual instruction starting in April.

In Massachusetts, Gov. Charlie Baker announced that most elementary schools would be required to offer full-time in-person instruction by April 5, and most middle schools by April 28.

The three are part of a significant and bipartisan group of governors who have decided it is time to flex some muscle and get students back into classrooms, despite union resistance and bureaucratic hesitancy.

The push has come from both ends of the political spectrum. Democratic governors in Oregon, California, New Mexico and North Carolina, and Republicans in Arizona, Iowa, New Hampshire and West Virginia, among other states, have all taken steps to prod, and sometimes force, districts to open.

The result has been a major increase in the number of students who now have the option of attending school in person, or will in the next month.

According to a school reopening tracker created by the American Enterprise Institute, 7 percent of the more than 8,000 districts being tracked were operating fully remotely on March 22, the lowest percentage since the tracker was started in November. Forty-one percent of districts were offering full-time in-person instruction, the highest percentage in that time. Those findings have been echoed by other surveys.

In interviews, several governors described the factors motivating their decision to push districts to reopen, including the substantial evidence that there is little virus transmission in schools if mitigation measures are followed, the decline in overall cases from their January peak, and, most of all, the urgency of getting students back in classrooms before the school year ends.

Every day is an eternity for a young person, Mr. Inslee, a Democrat, said. We just could not wait any further.

In the weeks since most of the governors acted, nationwide cases have started to rise again, which could complicate the effort to get children back in school. Many school staff members have already been offered vaccines, which has reduced the resistance from teachers unions to reopening and, provided staff vaccination rates are high, will limit opportunities for the virus to spread in schools.

Even so, in areas where cases are increasing sharply, like Michigan, some schools have had to revert to remote learning temporarily because so many students were in quarantine.

But for the time being, at least, the moves by these governors have yielded significant results.

In Ohio, nearly half of all students were in districts that were fully remote at the beginning of 2021. By March 1, that number was down to 4 percent, and it has shrunk further in the weeks since.

In Washington, before Mr. Inslee issued his proclamation, the states largest district, Seattle Public Schools, was locked in a standoff with its teachers union over a reopening plan. Days after Mr. Inslee announced he would require districts to bring students back at least part time, the two sides reached an agreement for all preschool and elementary school students and some older students with disabilities to return by April 5.

And in Massachusetts, the move by Mr. Baker, a Republican, has spurred a sea change, with dozens of districts bringing students back to school for the first time since the pandemic began, and hundreds shifting from part-time to full-time schedules.

Its worked exceedingly well, Mr. DeWine, also a Republican, said of his decision to offer vaccines to Ohio districts that pledged to reopen. Weve got these kids back in school.

JERUSALEM In the Old City of Jerusalem on Friday morning, in the alleys of the Christian quarter, it was as if the pandemic had never happened.

The winding passageways that form the Via Dolorosa, along which Christians believe Jesus hauled his cross toward his crucifixion, were packed with over 1,000 worshipers. The Good Friday procession, where the faithful retrace the route Jesus is said to have taken, was back.

It is like a miracle, said the Rev. Amjad Sabbara, a Roman Catholic priest who helped lead the procession. Were not doing this online. Were seeing the people in front of us.

Pandemic restrictions forced the cancellation of last years ceremony and required priests to hold services without congregants present. Now, thanks to Israels world-leading vaccine rollout, religious life in Jerusalem is edging back to normal. And on Friday, that brought crowds back to the citys streets, and relief to even one of Christianitys most solemn commemorations: the Good Friday procession.

For much of the past year, the pandemic kept the Old City eerily empty. But with nearly 60 percent of Israeli residents fully vaccinated, the citys streets were once again thrumming, even if international tourists were still absent.

At the gathering point for the procession on Friday, there was scarcely space to stand. The crowd moved slowly off, singing mournful hymns as they proceeded along what Christians consider a re-enactment of Jesus last steps.

In the alley outside the chapel of St. Simon of Cyrene, the marchers trailed their fingers over an ocher limestone in the chapel wall. According to tradition, Jesus steadied himself against the stone after a stumble.

Finally, they reached the Church of the Holy Sepulcher, which believers think was the site of Christs crucifixion, burial and, ultimately, resurrection.

For some, the Good Friday procession carried even more resonance than usual its themes of suffering, redemption and renewal seeming particularly symbolic as the end of a deadly pandemic appeared finally in sight.

We have gained hope again, said George Halis, 24, who is studying to be a priest and who lives in the Old City. Last year was like a darkness that came over all of earth.

But for now, that togetherness continues to face limits. There are still restrictions on the number of worshipers at Easter services. Masks are still a legal requirement. And foreigners still need an exemption to enter Israel keeping out thousands of pilgrims, at the expense of local shopkeepers who depend on their business.

A beloved superfan of the University of Alabamas mens basketball team died from complications of Covid-19, his mother said Saturday.

Luke Ratliff rarely missed a game and was known by the Crimson Tide community as Fluffopotamus. He died Friday evening, his mother, Pamela Ratliff, said. A senior at the University of Alabama, Mr. Ratliff was set to graduate in August. He was 23.

He had a personality that was bigger than this world, never met a stranger, Ms. Ratliff said on Saturday.

Mr. Ratliff traveled to the mens N.C.A.A. basketball tournament in Indianapolis to cheer on the Crimson Tide until they lost to U.C.L.A. last weekend. He had recently gone through rapid coronavirus testing multiple times, Ms. Ratliff said, and the tests had come back negative.

He didnt have any of the typical symptoms until the cough set in this week, she said.

Mr. Ratliff was eventually treated for bronchitis and it was later discovered he had contracted Covid-19.

Fans were allowed to fill venues for the tournament up to 25 percent of their normal capacity. In response to Mr. Ratliffs death, the Marion County Public Health Department said in a statement that it would be investigating to determine if anyone in Indianapolis may have been exposed to Covid-19 by any Alabama resident who visited Indianapolis in recent days.

We continue to encourage residents and visitors to practice the simple and important habits that keep us all safe: wearing a mask, washing hands, and social distancing, the department said.

There has been an outpouring of tributes from the Crimson Tide community celebrating Mr. Ratliff.

We will forever remember our #1 fan, Alabama Mens Basketball said on Twitter. We love you.

Nate Oats, Alabamas coach, said Mr. Ratliffs death doesnt seem real.

Fluff has been our biggest supporter since day one, Oats said on Twitter. Put all he had into our program. Loved sharing this ride with him. Youll be missed dearly my man! Wish we had one more victory cigar and hug together. Roll Tide Forever.

Mr. Ratliff described his love for college basketball to The Tuscaloosa News earlier this year.

College basketball is different because its literally right in front of you: You can see it, you can touch it, you can go to it 16 home games a year. Its tangible, thats whats endeared me to it, Mr. Ratliff told the outlet, discussing his preference for the game over football.

On March 31, Mr. Ratliff chronicled the Alabama mens basketball season on Twitter, posting his own personal highlights from the season.

I will finish college having attended 44 of the tides past 45 conference and postseason games, including 42 in a row, Mr. Ratliff wrote. What a freaking ride its been.

Mr. Ratliff is survived by his parents and two brothers.

Three hundred and eighty-seven days after Broadway went dark, a faint light started to glimmer on Saturday.

There were just two performers the tap dancer Savion Glover and the actor Nathan Lane, both of them Tony Award winners on a bare Broadway stage. But together they conjured up decades of theater lore.

The 36-minute event, before a masked audience of 150 scattered across an auditorium with 1,700 seats, was the first such experiment since the coronavirus pandemic forced all 41 Broadway houses to close on March 12, 2020.

Glover performed an improvisational song-and-dance number in which he seemed to summon specters of productions past A Chorus Line, The Tap Dance Kid, Dreamgirls, 42nd Street. He also made a pointed reference to Black life in the U.S., interpolating the phrase knee-on-your-neck America into a song from West Side Story.

Lane, one of Broadways biggest stars, performed a comedic monologue by Paul Rudnick, in which he portrayed a die-hard theater fan who dreams (or was it real?) that a parade of Broadway stars, led by Hugh Jackman, Patti LuPone and Audra McDonald, arrive at his rent-controlled apartment and proceed to vie for his attention while dishily one-upping one other.

The St. James, a city historic landmark built in 1927, was chosen in part because its big and empty. The theater also has a modern HVAC system, and its air filters were upgraded during the pandemic in an effort to reduce the spread of airborne viruses.

The event, while free, was invitation only, and the invitations went mostly to workers for two theater industry social service organizations, the Actors Fund and Broadway Cares/Equity Fights AIDS.

Californians will soon be able to gather indoors, the states public health department announced, edging toward a return to live entertainment as vaccination rates rise and the state recovers from a winter surge in coronavirus cases.

Fridays announcement is one of the latest examples of states easing Covid-19 restrictions as they loosen vaccine eligibility and more shots land in arms. Under the guidelines, gatherings, private events or meetings such as receptions or conferences, and indoor seated live events and performances will be permitted in some counties based on their Covid-19 risk levels, starting April 15.

As of March 30, most of the states counties are under the states red tier or under substantial Covid-19 risk, according to state data. Under the red tier, venues with over 1,500 capacity are limited to 20 percent capacity and proof of testing or full vaccination is required, outdoor gatherings of 25 people are allowed and private indoor events are allowed for up to 100 guests with proof of testing or full vaccination.

Residents can read specific guidelines under each tier in the states Blueprint for a Safer Economy.

Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said in a statement that the lift in restrictions showed the progress the state had made against the virus.

Professional sports teams, such as the Los Angeles Lakers and the Sacramento Kings, applauded the changes.

Coronavirus cases in the state have decreased about 12 percent in the past week to an average of 2,654 cases per day, according to a New York Times database. Almost 20 percent of Californias population is fully vaccinated.

Despite the positive trajectory, state officials are still warning that safety measures must be at the forefront of peoples minds even if some restrictions have loosened.

By following public health guidelines such as wearing masks and getting vaccinated when eligible, we can resume additional activities as we take steps to reduce risk, Dr. Ghaly said.

BUENOS AIRES President Alberto Fernndez of Argentina tested positive for the coronavirus on Saturday and was experiencing mild symptoms despite having been vaccinated earlier this year, becoming the latest in a series of world leaders who have contracted the virus.

Mr. Fernndez said on Twitter that a light headache and a temperature of 99.1 degrees had prompted him to take a rapid antigen test. Its positive finding was confirmed later Saturday by a more rigorous P.C.R. test, said Dr. Federico Saavedra, the presidents physician.

Mr. Fernndezs symptoms were mild due in large part to the protective effect of the vaccine, Dr. Saavedra said.

The president, who first learned the preliminary result on Friday, his 62nd birthday, said he would remain in isolation. I am physically well, and although I would have liked to end my birthday without this news, Im also in good spirits, he wrote on Twitter.

Mr. Fernndez joins a list of world leaders who have contracted the virus, including Andrs Manuel Lpez Obrador of Mexico, Jair Bolsonaro of Brazil, Emmanuel Macron of France and Donald Trump of the United States.

But Mr. Fernndez appears to be the first of those leaders to test positive for the virus after having been fully vaccinated. He received the first dose of Russias Sputnik V vaccine on Jan. 21 and the second on Feb. 11.

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