Daily Archives: May 4, 2021

Funeral pyres burn in a disused granite quarry repurposed to cremate the dead due to COVID-19 on Friday in Bengaluru, India. The U.S. is set to impose new travel restrictions against travelers from the country. Abhishek Chinnappa/Getty Images hide caption

Funeral pyres burn in a disused granite quarry repurposed to cremate the dead due to COVID-19 on Friday in Bengaluru, India. The U.S. is set to impose new travel restrictions against travelers from the country.

The Biden administration is set to enact a travel ban on any non-U.S. citizens or permanent residents coming to the country from India as multiple coronavirus variants have driven India's COVID-19 outbreak to troubling new heights. The policy will take effect starting on Tuesday, the White House said.

India had already been under a Level 4 Do Not Travel advisory from the State Department, which issued or updated scores of travel advisories related to the continued spread of the coronavirus last week. The new ban will take the precaution to a new level.

The policy will not apply to U.S. citizens, a Biden administration official said, speaking on condition of anonymity. Lawful permanent residents and other people with exemptions would also be allowed to travel from India to the United States.

As part of existing restrictions on international passengers, anyone arriving in the U.S. would still be subject to coronavirus testing measures and must enter quarantine if they have not been vaccinated.

The travel ban is being imposed on the advice of the Centers for Disease Control and Prevention, according to White House press secretary Jen Psaki.

In a statement issued Friday, Psaki said, "The policy will be implemented in light of extraordinarily high COVID-19 caseloads and multiple variants circulating" in India.

Like many countries, India dealt with an initial wave of the coronavirus in 2020. But it's now enduring a tsunami of new cases, forcing a shortage of key resources, from hospital space to oxygen tanks.

Unlike some nations that have been able to avoid a new spike in deaths and critical hospitalizations despite recent outbreaks, India is also seeing an unprecedented number of deaths. The country reported nearly 3,500 deaths on Friday alone. And some health professionals allege that local officials have pressured them to underreport COVID-19 deaths, as NPR's Lauren Frayer and Sushmita Pathak reported. Testing kits are also in short supply in India, feeding speculation that the scale of the outbreak is even larger than official reports suggest.

India has been setting, and breaking, world records for the most daily reported COVID-19 cases for the past week as its citizens and public health officials watch infection rates rise at terrifying rates. It reached a new high mark Friday when India's Health Ministry reported 386,453 new infections.

The rate of new cases in India has steadily eclipsed the previous world record of more than 312,000 cases that the U.S. reported in early January. The U.S. remains the country with the most reported COVID-19 cases, with more than 32.3 million, according to data compiled by Johns Hopkins University. India has reported nearly 18.8 million cases.

The U.S. is sending several emergency relief shipments to India; the State Department said late Thursday night that the first flight landed.

Vice President Harris also told reporters Friday that a plane loaded with aid, including oxygen, was leaving the U.S. for India that night. "We have long-standing, decades-old relationships with India, with the Indian people in particular, around public health issues," Harris said.

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U.S. Will Impose New Ban On Travel From India As Coronavirus Rages - NPR

A deadly second wave of coronavirus infections is devastating India, leaving millions of people infected and putting stress on the countrys already overtaxed health care system.

Officially, by the beginning of May, more than 19.3 million infections had been confirmed and more than 219,000 people were dead, but experts said the actual figures were most likely much higher. In the same period, India was responsible for more than half of the worlds daily Covid-19 cases, setting a record-breaking pace of more than 300,000 a day.

For the most up-to-date figures, The New York Times is tracking the latest case counts here.

Months ago, India appeared to be weathering the pandemic. After a harsh initial lockdown, the country did not see an explosion in new cases and deaths comparable to those in other countries.

But after the early restrictions were lifted, many Indians stopped taking precautions. Large gatherings, including political rallies and religious festivals, resumed and drew millions of people.

Beginning this spring, the country recorded an exponential jump in cases and deaths.

By April, some vaccinated individuals, including 37 doctors at one New Delhi hospital, were found to have contracted the virus, leaving many to wonder if a more contagious variant was behind the second wave.

Many in India already assume that the variant, B.1.617, is responsible for the severity of the second wave. The variant is sometimes called the double mutant, though the name is a misnomer because it has many more mutations than two. It garnered the name because one version contains two genetic mutations found in other difficult-to-control variants.

Researchers outside of India say the limited data so far suggests instead that the variant called B.1.1.7, which has affected Britain and the United States, is more likely to blame.

So far, the evidence is inconclusive, and researchers caution that other factors could explain the viciousness of the outbreak.

At the center of the Indias crisis is Prime Minister Narendra Modi, who early this year declared victory over the virus.

Mr. Modis Covid-19 task force did not meet for months. His health minister assured the public in March that India had reached the pandemics endgame. As infections rose, Mr. Modi allowed large gatherings to help his governing Bharatiya Janata Party and burnish its Hindu nationalist credentials. His government approved a Hindu festival with millions of worshipers. He campaigned in state elections without a mask at rallies of thousands of maskless supporters.

Critics say his administration was determined to cast an image of India as back on track and open for business despite lingering risks. At one point, officials dismissed warnings by scientists that Indias population remained vulnerable and had not achieved herd immunity as some in his administration were suggesting.

The growing distress across the country has tarnished Mr. Modis aura of political invulnerability, which he won by steamrolling the opposition and by leveraging his personal charisma to become Indias most powerful politician in decades. Opposition leaders are on the attack, and his central hold on power has increasingly made him the target of scathing criticism online.

In the first local elections since the start of the second wave, Mr. Modis B.J.P. was unable was unable to secure a much-sought-after victory on Sunday in West Bengal, one of Indias most populous states. The B.J.P. won more seats in the local legislature than it did in the last election, but was unable to seize control from the opposition All India Trinamool Congress, an indication of displeasure at Mr. Modis handling of the Covid crisis.

Overwhelmed by new cases, Indian hospitals cannot cope with the demand, and patients in many cities have been abandoned to die.

Understand the Covid Crisis in India

Clinics across the country have reported an acute shortage of hospital beds, medicines, protective equipment and oxygen.

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, and it can take several days for supplies to reach there 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.

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.

India is one of the worlds leading vaccine manufacturers, but it has struggled to inoculate its citizens.

Less than 10 percent of Indians have gotten even one dose. Now, the countrys pain may be felt around the world, especially in poorer countries.

India had planned to ship out millions of doses. But given its stark vaccination shortfall, exports have essentially been shut down, leaving other nations with far fewer doses than they had expected.

Charities, volunteers and businesses in India and beyond are trying to help the countrys Covid victims and frontline workers.

(Before giving money to an organization, make sure you feel comfortable with it. In the United States, sites like Guidestar and Charity Navigator grade nonprofits on their effectiveness and financial health.)

Here are a few ways to help.

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What We Know About India's Deadly Second Wave of Covid-19 - The New York Times

With worldwide COVID-19 cases on the rise again, the race to find an effective treatment for the disease continues.

Researchers from Mount Sinai Hospital in New York City, NY, believe that a combination of drugs already approved for use in the United States could be the key in treating COVID-19.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

The researchers combined remdesivir, which doctors already prescribe to hospitalized patients with COVID-19, with different hepatitis C virus (HCV) medications. They hoped to identify a combination that slows viral replication.

Here we see a promising synergy that, if confirmed through additional research and clinical trials, could provide a new antiviral to combat COVID-19, says Dr. Gaetano Montelione, Ph.D., a professor at Rensselaer Polytechnic Institute in Troy, NY.

Since the World Health Organization (WHO) declared the novel coronavirus a pandemic in March 2020, nearly 150 million people have contracted the virus, and approximately 3 million have died.

Over the past year, researchers have investigated numerous drugs and therapies to help treat COVID-19.

Remdesivir, for example, can treat COVID-19 in an inpatient setting. According to one article, remdesivir can target specific viral enzymes or attack a weak point of viral replication within the host.

Certain corticosteroids, such as dexamethasone, can reduce inflammation in people with COVID-19.

Researchers also considered using hydroxychloroquine to treat COVID-19. Doctors use hydroxychloroquine to treat malaria and rheumatoid arthritis, but further research showed that it did more harm than good in people with COVID-19.

The authors of the recent paper, which appears as a pre-proof in the journal Cell Reports, considered 10 different HCV drugs in their study. Their goal was to find something that amplified the effects of remdesivir in people with COVID-19.

The research team thought that the HCV drugs could bind to an enzyme called Mpro. This enzyme is SARS-CoV-2s main protease, which is essential for viral replication.

The team tested the HCV drugs in monkey and human cells. They found that 7 of the 10 drugs could act as a SARS-CoV-2 inhibitor.

Although seven drugs were effective at inhibiting replication of the virus, further experiments showed that four of them inhibited a different protease called PLpro.

The four drugs that were effective at boosting the benefits of remdesivir were paritaprevir, grazoprevir, simeprevir, and vaniprevir.

Those drugs synergized with remdesivir. This means that they increased remdesivirs effectiveness at reducing viral replication by as much as 10-fold.

Combined use of remdesivir with PLpro inhibitors for the treatment of COVID-19 could be a game changer for [people] with COVID-19 who are not vaccinated, says study author Dr. Adolfo Garcia-Sastre.

Dr. Kris White, an assistant professor of microbiology at Icahn Mount Sinai in New York City, NY, believes that the new research could produce a highly effective antiviral cocktail.

Chris Coleman, an assistant professor of infection immunology at the University of Nottingham in the United Kingdom, told Medical News Today that this research has multiple positive aspects.

Targeting two steps of the viral replication means you hit the virus twice, making it less likely that the virus will mutate to escape the treatment, he explained.

Although the combination has much potential, researchers say that there is one major roadblock to overcome: Remdesivir is not an oral drug. People receive it intravenously in a hospital setting, so a doctor would not be able to simply write a prescription and send a person home for treatment.

It can take 30 minutes to 2 hours to inject remdesivir. Additionally, people typically receive it daily, and treatment can last for 510 days.

Administering the medication only in a hospital setting poses a number of problems. Not only would it be less than ideal for people who are ill to travel to receive treatment, but it would also be less accessible due to cost and travel constraints.

Our goal is to develop a combination of oral drugs that can be administered to outpatients before they are sick enough to require hospitalization, says co-corresponding study author Dr. Robert M. Krug.

Dr. Jonathan Stoye, a virologist at the Francis Crick Institute in London, U.K., told MNT that he finds the results promising but that more work is necessary.

This interesting study seeks to identify novel strategies for the therapy of COVID-19 using combinations of FDA-approved, repurposed drugs originally developed against other viruses, said Dr. Stoye.

It clearly demonstrates that drugs targeting the protease of HCV in combination [with] remdesivir show synergistic inhibition of SARS-CoV-2 replication.

However, although these results are promising, they seem rather preliminary since the mechanism by which the drugs synergize is not established. In particular, the true target(s) of the protease inhibitors remains poorly defined.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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New combination of drugs may help treat COVID-19 - Medical News Today

Ursula von der Leyen, president of the European Commission, wears a protective mask during a meeting in Brussels last week. Olivier Matthys/Bloomberg via Getty Images hide caption

Ursula von der Leyen, president of the European Commission, wears a protective mask during a meeting in Brussels last week.

The head of the European Commission said Monday that she is recommending that nonresident travelers vaccinated against COVID-19 and those from "countries with a good health situation" be allowed to travel to the European Union this summer.

However, von der Leyen cautioned in a tweet Monday that if variants of the coronavirus emerge, "we have to act fast: we propose an EU emergency brake mechanism."

Current EU restrictions allow only travelers from seven countries to enter the 27-member bloc, regardless of whether they've been vaccinated.

Last week, von der Leyen said U.S. travelers would be allowed to resume travel to EU countries but did not give a time frame. The economies of many EU nations, such as Spain and Italy, rely heavily on tourism and have been hard hit by the prolonged absence of Americans due to the coronavirus pandemic.

The recommendation is set to be discussed on Tuesday and must be approved by all EU member states to come into force, according to Reuters. Individually, countries could still decide to honor the recommendation even if some don't, the news agency said.

Meanwhile, on Monday, in a letter to President Biden and U.K. Prime Minister Boris Johnson, several groups, including the U.S. Chamber of Commerce and others representing the airline and travel industries in both the U.S. and the U.K., urged the two leaders to reopen their travel markets.

A planned G-7 summit in the U.K. on June 11 the first since the start of the pandemic "would be an ideal opportunity for a joint announcement of the full reopening of the U.S.-UK air travel market for both U.S. and UK citizens," they suggested.

"We are confident that the right tools now exist to enable a safe and meaningful restart to transatlantic travel," the industry groups wrote, according to Bloomberg.

Among the groups that signed on to the letter are Airlines for America, the Global Business Travel Association, the Air Line Pilots Association, Virgin Atlantic, the Association of UK Airlines and the Aerospace Industries Association.

Although air passenger numbers in the U.S. remain historically low, the country has been rebounding, with the Transportation Security Administration reporting that more than 1.6 million people were screened at airports on Sunday, compared with only around 170,000 a year ago.

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EU Moves Closer To Welcoming Vaccinated Tourists This Summer : Coronavirus Updates - NPR

TALLAHASSEE, Fla. Air travel in the U.S. hit its highest mark since COVID-19 took hold more than 13 months ago, while European Union officials are proposing to ease restrictions on visitors to the continent as the vaccine sends new cases and deaths tumbling in more affluent countries.

The improving picture in many places contrasts with the worsening disaster in India.

In the U.S., the average number of new cases per day fell below 50,000 for the first time since October. And nearly 1.67 million people were screened at U.S. airport checkpoints on Sunday, according to the Transportation Security Administration, the highest number since mid-March of last year.

Florida Gov. Ron DeSantis signed legislation giving him sweeping powers to invalidate local emergency measures put in place during the outbreak. While the law doesnt go into effect until July, the Republican governor said he will issue an executive order to more quickly get rid of local mask mandates.

I think this creates a structure thats going to be a little bit more respectful, I think, of peoples businesses, jobs, schools and personal freedom, he said.

Las Vegas is bustling again after casino capacity limits were raised Saturday to 80% and person-to-person distancing was dropped to 3 feet (0.9 meters). New York Gov. Andrew Cuomo announced that New York Citys subways will begin running all night again and capacity restrictions on most businesses will end statewide in mid-May. And Los Angeles County reported no coronavirus deaths on Sunday and Monday, some of which may be attributable to a lag in reporting but was nevertheless a hopeful sign that could move the county to allow an increase in capacity at events and venues, and indoor-service at bars.

EU officials also announced a proposal Monday to relaxrestrictionson travel to the 27-nation bloc this summer, though the final decision is up to its member countries.

Time to revive EU tourism industry and for cross-border friendships to rekindle safely, European Commission President Ursula von der Leyen said. We propose to welcome again vaccinated visitors and those from countries with a good health situation.

In Greece, restaurants and cafes reopened their terraces on Monday after six months of shutdown, with customers flocking to soak up the sunshine. In France, high schools reopened and a ban on domestic travel was lifted.

The once hard-hit Czech Republic, where cases are now declining, announced it will allow people to remove face coverings at all outdoor spaces starting next Monday if they keep their distance from others.

But with more-contagious variants taking hold, efforts are underway to boost vaccination efforts, which have begun to lag. Theaveragenumber of doses given per day fell 27% from a high of 3.26 million on April 11 to 2.37 million last Tuesday, according to the Centers for Disease Control and Prevention.

InDetroit, teams from the citys health department have knocked on nearly 5,000 doors since the weekend to persuade people to get immunized. And Massachusetts governor announced plans to close four of seven mass vaccination sites by the end of June in favor of a more targeted approach.

My plea to everyone: Get vaccinated now, please, President Joe Biden said in Norfolk, Virginia. He stressed that he has worked hard to make sure there are more than 600 million doses of vaccine enough for all Americans to get both doses.

Were going to increase that number across the board as well so we can also be helping other nations once we take care of all Americans, the president said.

Brazil, once the epicenter of thepandemic, has been overtaken by a surge inIndia that has overrun crematoriums and made it clear the pandemic is far from over.

As the U.S. and other countries rushed in aid, India reported nearly 370,000 new cases and more than 3,400 deaths Monday numbers that experts believe are vast undercounts because of a widespread lack of testing and incomplete reporting.

InGermany, Bavarian officials canceled Oktoberfest for a second year in a row because of the safety risks. The beer-drinking festivities typically attract about 6 million visitors from around the world.

And in Italy, medical experts and politicians expressed concern about a possible spike in infections after tens of thousands of jubilant soccer fans converged on Milans main square Sunday to celebrate Inter Milans league title.

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Coronavirus restrictions easing in U.S. and Europe amid disaster in India - MarketWatch

Heres what you need to know:Skiers at Breckenridge Ski Resort in Breckenridge, Colo., on Sunday.Credit...Stephen Speranza for The New York Times

More than half of U.S. states have seen a significant decline in new coronavirus cases over the past two weeks, as federal health officials have begun to suggest that the viruss trajectory is improving. Still, the uneven levels of vaccination across the country point to the challenge of reaching those people who have not gotten shots.

As of Wednesday, the United States was averaging about 52,600 new cases a day, a 26 percent decline from two weeks ago, and a number comparable to the level of cases reported in mid-October before the deadly winter surge, according to a New York Times database. Since peaking in January, cases, hospitalizations and deaths nationwide have drastically declined.

While addressing a joint session of Congress on Wednesday night, President Biden touted the nations progress on vaccinations since he took office, calling it one of the countrys greatest logistical achievements. He also highlighted the passage of the American Rescue Plan, an ambitious relief package to address the economic toll of the pandemic.

Despite the successes, Mr. Biden implored the public to remain on guard.

Over the past two weeks, case numbers have fallen by 15 percent or more in 28 states, the District of Columbia and Puerto Rico, with drops of 30 percent or more in 14 states and the District of Columbia. As of Wednesday, Vermont reported a 54 percent decline in the average number of new cases a day, while Michigan, which had one of the nations most severe recent outbreaks, is now seeing rapid improvement with cases there down 40 percent.

In New York City, which had seen stubbornly high caseloads for months, the second wave is receding a half-year after it started, the citys health commissioner said.

Federal health officials have taken note. After expressing a recurring sense of impending doom last month, Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said on Wednesday that she was beginning to see signs of progress.

Cases are starting to come down. We think that this is related to increased vaccination, increased people taking caution, and so Im cautiously optimistic that were turning the corner, she said on Good Morning America.

But she warned that the virus is an opportunist and could strike in communities with low vaccination rates. Persistent vaccine hesitancy remains a challenge, and the pace of vaccination will ebb, officials have acknowledged, amid issues of supply and demand.

About 43 percent of people have received at least one dose of a Covid-19 vaccine, and 30 percent have been fully vaccinated. Providers are administering about 2.67 million doses per day on average, as of Wednesday, about a 21 percent decrease from the peak of 3.38 million reported on April 13.

The C.D.C.s move to relax mask guidance outdoors this week is a reflection of the rise in the total number of vaccinations and an incentive to get a shot, experts said.

Its another demonstration of what science has been telling us over the last many months, which is that vaccines are effective in preventing the Covid-19 virus from infecting us. And the more people who get vaccinated, the more quickly we can resume our activities, Dr. Vivek Murthy, the surgeon general, said in a Tuesday interview on CNN.

Mr. Biden has set a target date of July 4 for the country to get life in America closer to normal. But public health experts have emphasized that the experience of the pandemic across the world is not universal. India, for example, is experiencing a catastrophic second wave that could have global implications.

Pandemics require global cooperation and mutual support, Dr. Murthy said. When theres uncontrolled spread of the virus in any part of the world, that means that variants can arise, variants which may over time become resistant to the protection that we get from vaccines, which could mean a real problem for us here in the United States.

Allyson Waller and Kevin Draper contributed reporting.

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 countrys 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 Indias 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. Its affecting young adults. Its affecting families. Its 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 doesnt 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 Indias 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 years first wave and missteps by Prime Minister Narendra Modi. And they note that Indias 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 Indias crisis. Fast-moving mutations complicate the picture because it isnt immediately clear how quickly they spread or how they respond to vaccines.

In India, the health care system wasnt 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.

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 Wednesday, 142.7 million people have received at least one dose of one of three federally authorized vaccines, including about 98 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.

Germanys domestic intelligence service said on Wednesday that it would surveil members of the increasingly aggressive coronavirus denier movement because they posed a risk of undermining the state.

The movement fueled in part by wild conspiracy theories has grown from criticizing coronavirus lockdown measures and hygiene rules to targeting the state itself, its leaders, businesses, the press and globalism, to name a few.

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, the Interior Ministry said in a statement confirming that parts of the denier movement were under observation. The Interior Ministry oversees the intelligence agency, the Office for the Protection of the Constitution.

In announcing the decision to keep tabs on conspiracy theorists, intelligence officials noted the movements close ties to extremist groups like the Reichsbrger, who refuse to accept the legitimacy of the modern German state.

The news comes days after Germany instituted new virus rules that apply nationwide and allow the federal government to enforce lockdowns. (Such regulation had previously been in the hands of the countrys 16 states.) It also suggests that the authorities believe coronavirus denier groups could continue to flourish and pose a threat after the pandemic ends.

The movement, called Querdenken, German for lateral thinking, communicates and recruits over social media and has a large presence on the encrypted chat service Telegram, where its main channel has 65,000 subscribers.

A week ago, when Parliament passed the law giving the government powers to impose the latest lockdown, about 8,000 of the movements activists took to the streets in Berlin before being dispersed by the police for ignoring mask and distancing rules. Germany has seen a persistently high number of new daily cases recently, averaging about 19,000, up from about 8,000 two months ago.

Pia Lamberty, a psychologist and expert in the German conspiracy scene, warned of connections between the deniers and far-right extremists. The danger of Querdenken, she said, has long been underestimated.

After months of persistently high coronavirus caseloads, New York City appears to have finally reached a turning point. The citys second wave is ebbing, a half-year after it began, New York Citys 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 citys 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 Yorks 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.

U.S. Round up

New York will end a longstanding curfew next month 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 as state lawmakers voted to suspend an unpopular directive that required customers to order food when purchasing alcohol at bars and restaurants.

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 at restaurants was a likely 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 viruss 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.

Its 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 were vaccinated and cases of the virus fell.

The citys 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 being over in the city.

On Monday, Mr. Cuomo said that next month the state would 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.

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

Luis Ferr-Sadurn contributed reporting.

In other news from around the United States:

Gov. Larry Hogan of Maryland announced Wednesday he would lift the state of Marylands outdoor mask mandate, effective immediately, citing recent guidance from the Centers for Disease Control and Prevention. Starting May 1, restrictions surrounding outdoor dining, including capacity limits and social distancing, will also be lifted. Coronavirus cases in Maryland have dropped 29 percent in the past two weeks, according to a New York Times database.

In Atlanta, certain sports venues are making a return to 100 percent capacity. On Wednesday, the home stadium of the Atlanta Braves, Truist Park, announced it would allow 100 percent capacity at games starting May 7. Capacity at the Mercedes-Benz Stadium, home of the Atlanta Falcons and Atlanta United, will also move up to 100 percent capacity, AMB Sports and Entertainment, the company that owns the two professional teams, said in a statement on Wednesday. The change in restrictions for the Mercedes-Benz Stadium will start May 15.

The effort by Gov. Andrew M. Cuomos 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. Cuomos most senior aides engaged in a sustained effort to prevent the states 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. Cuomos aides had known since the previous spring, The New York Times found.

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 wont 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 for vaccinated people, and Gov. Gavin Newsom of California said, If youre 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: Youre vaccinated? Guess what, you get to return to a more normal lifestyle.

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 Americas 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.

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 Districts 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.

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 worlds 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 countrys 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.

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.

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In U.S., Virus Cases Have Recently Dropped in Over Half of States - The New York Times