Covid-19: The U.S. Is Edging Toward Normal, Alarming Some Officials – The New York Times

Heres what you need to know:A hot dog vendor in Los Angeles reopened on Monday after being closed for two months. The restaurant has been in business since 1939.Credit...Frederic J. Brown/Agence France-Presse Getty Images

Tens of thousands of students walked into classrooms in Chicago public schools on Monday for the first time in nearly a year. Restaurants in Massachusetts were allowed to operate without capacity limits, and venues like roller skating rinks and movie theaters in most of the state opened with fewer restrictions. And South Carolina erased its limits on large gatherings.

Across the country, the first day of March brought a wave of reopenings and liftings of pandemic restrictions, signs that more Americans were tentatively emerging from months of isolation, even if not everyone agrees that the time is ripe.

There are plenty of reasons for optimism: Vaccinations have increased significantly in recent weeks, and daily reports of new coronavirus cases have fallen across the United States from their January peaks.

In Kentucky, all but a handful of school districts are now offering in-person classes, while the state races to vaccinate teachers as quickly as possible. Gov. Andy Beshear told reporters last week that the states falling infection statistics showed that immunizations were beginning to make an impact.

It means vaccinations work, he said. Were already seeing it. Were seeing it in these numbers. Its a really positive sign.

Dr. Anthony S. Fauci, President Bidens chief medical adviser for Covid-19, said at a news briefing on Monday that for small groups of people who have all been fully vaccinated, there was a low risk in gathering together at home. Activities beyond that, he said, would depend on data, modeling and good clinical common sense, adding that the Centers for Disease Control and Prevention would soon have guidance for what vaccinated people could safely do.

The positive signs come with caveats. Though the national statistics have improved drastically since January, they have plateaued in the last week or so, and the United States is still reporting more than 65,000 new cases a day on average comparable to the peak of last summers surge, according to a New York Times database. The country is still averaging about 2,000 deaths per day, though deaths are a lagging indicator because it can take weeks for patients to die.

More contagious variants of the virus are circulating in the country, with the potential to push case counts upward again. Testing has fallen 30 percent in recent weeks, leaving experts worried about how quickly new outbreaks will be known. And millions of Americans are still waiting to be vaccinated.

Given all that, some experts worry that the reopenings are coming a bit too soon.

Were, hopefully, in between what I hope will be the last big wave, and the beginning of the period where I hope Covid will become very uncommon, said Robert Horsburgh, an epidemiologist at the Boston University School of Public Health. But we dont know that. Ive been advocating for us to just hang tight for four to six more weeks.

The director of the C.D.C., Dr. Rochelle Walensky, said at the briefing on Monday that she was really worried about the rollbacks of restrictions in some states. She cautioned that with the decline in cases stalling and with variants spreading, we stand to completely lose the hard-earned ground we have gained.

And the plateauing case levels must be taken extremely seriously, Dr. Walensky warned at a briefing last week. She added: I know people are tired; they want to get back to life, to normal. But were not there yet.

After some counties in Washington State allowed movie theaters to reopen, Nick Butcher, 36, made up for lost time by attending screenings of the Lord of the Rings trilogy for three straight nights. He bought some M&Ms at the concession stand, sat distanced from others in the audience, and said he felt as though things were almost back to normal.

A first dose of the Oxford-AstraZeneca vaccine substantially reduced the risk of older people becoming ill with Covid-19, scientists in Britain reported on Monday, the strongest sign yet that a shot that much of the world is relying on to end the pandemic will protect the elderly.

Four weeks after the first dose, the vaccine was roughly 60 percent effective in preventing Covid-19 among people at least 70 years old in England, the scientists wrote in a paper that was posted online on Monday but not yet published in a journal or vetted by other researchers.

That figure appeared to rise in the following week, though there was a high level of statistical uncertainty in the subsequent number.

For countries across Europe that have been hesitant about authorizing the AstraZeneca vaccine for use in older people, the data could resolve some of those doubts. The early clinical trials of the AstraZeneca vaccine did not enroll as many older people as the trials of other shots, making a number of European countries uneasy about using it in that age group.

But Britain decided to authorize the vaccine for people of all ages, creating a valuable store of data on its effectiveness.

In France, one of the countries that had restricted the AstraZeneca vaccine to younger people, the countrys health minister said people over 65 with pre-existing conditions would be able to receive the vaccine, Reuters reported.

In part because of the age restrictions, countries across Europe have been slow to use their doses of the AstraZeneca vaccine, with some health workers holding out for the Pfizer-BioNTech vaccine instead.

The same study from England showed strong protection from the Pfizer vaccine. Among people at least 70 years old, a first dose was 61 percent effective in preventing Covid-19 up to four weeks after the shot, a figure that then plateaued, the study said.

In people at least 80 years old, a first dose was 70 percent effective at preventing Covid-19 four weeks later, a figure that rose to 89 percent two weeks after the second shot. (Britain has decided to delay second doses of both the Pfizer and AstraZeneca shots up to 12 weeks after the first.)

The results demonstrate that a single dose of either the Pfizer-BioNTech or the Oxford-AstraZeneca vaccine provides a high level of protection against severe disease in the most vulnerable age groups, Azra Ghani, a professor of infectious disease epidemiology at Imperial College London, said of the findings.

Because Britain authorized the AstraZeneca vaccine later than the Pfizer vaccine, there is less data on the effectiveness of a full two-dose course of the AstraZeneca vaccine.

Both vaccines were also highly effective at preventing coronavirus-related hospitalizations in the study from England.

The study was part of a wealth of data that has emerged from Britains mass inoculation program showing that the vaccines were working as intended. No other large nation is inoculating people as quickly as Britain, the first country in the world to authorize and begin using both the Pfizer shot and the one developed by AstraZeneca and the University of Oxford.

California lawmakers and Gov. Gavin Newsom on Monday announced a plan intended to encourage districts to reopen schools, the latest state to take the step that has drawn contentious deliberations across the country.

The agreement includes $2 billion in incentives and fast-tracked vaccinations to lure teachers back for at least some of the remaining school year.

President Biden has pushed for schools to safely reopen, even if that means limited in-person learning, having called for them to be open five days a week, but has been vague about what that would look like. Less than half of students in the United States are attending public schools that offer traditional full-time schedules, frustrating both parents and educators.

In Philadelphia, elected officials, teachers unions and health agencies have urged strict caution, putting most districts on hybrid schedules, while some remain fully remote. In the city itself, the teachers union and district reached a reopening deal to return students in kindergarten through the second grade to classrooms in phases over the month of March. The city is expediting teacher vaccination and purchasing air purifiers, and hopes to return older students to school before the end of the academic year.

The new schools chancellor in New York City, the largest public school district in the country, pledged on Friday to at least partially reopen high schools by the end of the year. While the citys schools were among the first in the country to reopen last fall, the in-person learning has been inconsistent because of the virus, and high schools have been closed since November.

The new measures in California come as the state emerges from a towering post-holiday spike in coronavirus cases. The aim is to restore six to 12 weeks of in-person class for the regular school year, which ends in late June in most of the states districts. Most of Californias six million schoolchildren have been receiving only remote instruction for the past year.

Rather than mandating reopening, the state will make a time-limited offer of grants to help pay for coronavirus testing, upgraded ventilation and other campus safeguards, along with $4.6 billion for extended class time and summer school.

The money is modest by California standards. The state spent nearly $100 billion last year on its public school system, and the $2 billion pot will be open to more than 1,000 school districts. Those with plans to reopen after March 31 will be eligible for less money, with grants shrinking to zero for schools opening after May 15.

And reopenings are likely to be limited, particularly where the virus and its variants are still surging. In counties with the states highest-risk purple designation Los Angeles, for instance schools will only have to offer face-to-face class for high-needs students and children in transitional kindergarten through second grade to be eligible for reopening money.

In lower-risk counties, districts applying for the grants also will have to offer face-to-face class in elementary schools and at least one middle school and one high school grade.

But the incentives, along with the governors promise last week to earmark 10 percent of new first doses of vaccines for school employees, establish Californias clearest blueprint so far for restoring in-person instruction for the bulk of the states six million-plus public school students. And they address key demands of the states powerful teachers unions. Most large districts, including those in Los Angeles, San Diego and San Francisco, have been operating remotely for the vast majority of students for nearly a year.

On Monday, Austin Beutner, the Los Angeles districts superintendent, said Mr. Newsom had procured enough vaccine doses for its schools to inoculate 40,000 teachers, bus drivers, custodians and other school employees within the next two weeks enough to reopen Los Angeles classrooms at least through second grade by mid- to late April if school employee unions comply.

Leaders of United Teachers Los Angeles, which represents educators in the nations second-largest school district, have asked members to vote this week on a proposed endorsement of their conditions for an in-person return, which include teacher vaccines, stringent health measures and a potential sticking point: a rate of community transmission that is significantly lower than present before schools can reopen.

California school districts need agreements with their unions in order to reopen, although most of the states other large districts have already worked out at least a framework for an in-person return.

Long Beach, where city and school district officials have been working together to vaccinate teachers since January, for instance, are on track to resume in-person classes on March 31. And the schools in Elk Grove, near Sacramento, have said elementary students there could be back in classrooms, at least part time, by the middle of this month.

Dana Goldstein contributed reporting.

Extraordinarily high staff turnover at U.S. nursing homes most likely contributed to the shocking number of deaths at the facilities during the pandemic, the authors of a new study suggested.

The study, which was published Monday in Health Affairs, a health policy journal, represents a comprehensive look at the turnover rates in 15,645 nursing homes across the country, accounting for nearly all of the facilities certified by the federal government. The researchers found the average annual rate was 128 percent, with some facilities experiencing turnover that exceeded 300 percent.

Researchers pointed to the findings to urge Medicare to publish the turnover rates at individual nursing home sites, as a way of putting a spotlight on substandard conditions and pressuring owners to make improvements.

Inadequate staffing and low pay have long plagued nursing homes and quality of care for the more than one million residents who live in these facilities. But the pandemic has exposed these issues even more sharply, with investigations underway into some states oversight of the facilities as Covid-19 cases spiraled unchecked and deaths skyrocketed.

The high turnover rate most likely made it harder for nursing homes to put in place strong infection controls during the pandemic, and led to rampant spread of the coronavirus, said Ashvin Gandhi, the lead author and a health economist and assistant professor at the University of California Los Angeles Anderson School of Management.

Nursing-home owners blame inadequate reimbursement from Medicaid, the federal-state program for elderly skilled nursing care.

Workforce recruitment and retention is among the most pressing challenges confronting long-term care providers, and we have been calling for help for years, Dr. David Gifford, the chief medical officer for the American Health Care Association and National Center for Assisted Living, a trade group, said in an emailed statement.

Its high past time that providers receive the proper resources to invest in our frontline caregivers in order to improve quality care, he said.

Nursing home staff members have also shown resistance to getting vaccinated against the coronavirus. If a nurse who was immunized leaves and is replaced, the facility will need to ensure the new employee is also vaccinated, especially given the reluctance of some workers to get a coronavirus shot.

Trying to do a one-shot vaccination push isnt enough, Dr. Gandhi said. You need continued vaccination outreach.

New York City added workers in the food service and hotel industries to the list of people eligible for coronavirus vaccination on Monday, the same day the governors of Florida and Ohio announced expansions for eligibility in their states.

The expansions come as the supply of vaccines being distributed nationally is ramping up, and after a third vaccine, a single-shot dose from Johnson & Johnson, was authorized for emergency use by the Food and Drug Administration over the weekend. The pace of U.S. vaccinations is again accelerating, up to about 1.82 million doses per day on average, according to a New York Times database, above last months peak before snowstorms disrupted distribution.

In New York City, people who work in regional food banks, food pantries and permitted home-delivered meal programs became eligible on Monday to receive a vaccine. Hotel workers who have direct contact with guests also became eligible.

The governor of Florida, Ron DeSantis, said on Monday that people 50 and older who work in K-12 schools, law enforcement or firefighting would become eligible on Wednesday. Florida was one of the first states that decided to vaccinate anyone 65 and older, even before most essential workers, which led to long lines and confusion.

Gov. Mike DeWine of Ohio said on Monday that the state would receive more than 448,000 doses this week, including more than 96,000 doses of the Johnson & Johnson vaccine. He said that in response to this significant increase in the amount of vaccine coming into Ohio, a new group of people would be eligible on Thursday to get a shot.

That group includes people with Type 1 diabetes, pregnant women and certain workers in child care and funeral services, as well as law enforcement and corrections officers.

To stay ahead of more contagious and possibly more deadly virus variants, states have been racing to ramp up vaccinations and expand eligibility. But they have often done so before the supply could increase quickly enough, creating shortages and making it harder for people to get vaccination appointments.

Widespread testing is crucial in controlling the spread of the coronavirus and squashing new outbreaks, experts say. But the amount of testing in the United States has fallen by 30 percent in recent weeks.

From a high of nearly 14 million tests a week in early January, the pace fell to fewer than 10 million a level not seen since October in the week ended Feb. 24, according to the Covid Tracking Project.

Some areas report even sharper declines: Michigan is testing about half as many people now as it was in November, and Delawares state-run sites are testing about one-third as many. Los Angeles Countys sites, which were running flat out last month, tested just 35 percent of their capacity last week.

Experts cited a number of factors that could be contributing to the slump:

Fewer exposures. Since daily tallies of new coronavirus infections have fallen sharply, fewer people may be having contacts that would prompt them to seek a test.

Less travel. The holiday rush is over, reducing the need for people to get tested before or after trips.

Bad weather. The severe storms and Arctic temperatures that battered much of the country, from Texas to the Northeast, caused many testing sites to close temporarily.

The vaccine rollout. Some states have shifted their limited public health resources, and their public messaging, toward vaccination efforts at the expense of testing.

Pandemic fatigue. Some experts worry the decline may be yet another symptom of public exhaustion and frustration with pandemic precautions and safety measures.

All those forces may be at play, said Dr. Jennifer Nuzzo of the Johns Hopkins Bloomberg School of Public Health: My sense is that its probably that there are fewer options for testing, fewer communications about it, people may be perceiving that its less necessary maybe they just dont see the point any more.

The slump in testing, at a time when a clear picture of the pandemic is still badly needed, worries some epidemiologists. Theres nothing about the current situation that has made testing any less necessary, Dr. Nuzzo said.

Among other things, less testing makes it harder to follow the viruss mutations and to get ahead of variants that may be more contagious or deadly, said Dr. Rick Pescatore, the chief physician at the Delaware Division of Public Health. We cant identify variants until we first identify positives.

But the decline in testing may not be a cause for alarm and may even be a good sign if it reflects wider progress in tamping down the pandemic, said Dr. Clemens Hong, who runs Los Angeles Countys testing program.

The biggest reason for the drop in testing demand, I think, is the decrease in infections and spread, Dr. Hong said. Covid-19 is not spreading as quickly right now, which means theres fewer people with symptoms, and also fewer people having contact with people with Covid-19. Thats just the reality.

Across the country, new case reports have dropped sharply since mid-January. At its peak on Jan. 8, the U.S. reported a seven-day average of over 259,000 new cases. Now, the seven-day average is less than 70,000, as of Saturday.

Hospitalizations and deaths have followed suit, and vaccine distribution is rapidly increasing: 15 percent of the U.S. population has now received at least one dose.

Nonetheless, Dr. Hong said, testing remains vital to getting ahead of outbreaks.

Even with all these declines and the rollout of the vaccines, its just not enough, he said. We dont have enough immunity in the community to prevent another surge. We may never see a surge like we saw in December and January again, but well see little pockets and little surges that will try to come to life, and we just need to put them out.

When Johnson & Johnsons coronavirus vaccine won emergency use authorization on Saturday from the Food and Drug Administration, the move augmented the nations vaccination effort with a third major tool one that differs markedly from the first two authorized vaccines, made by Pfizer-BioNTech and Moderna.

Most notably, it is administered in a single dose instead of two, and can be kept unfrozen in an ordinary refrigerator for up to three months features that promise greater flexibility as public health officials try to immunize Americans as quickly as possible.

Much is still to be determined about how this new tool will be used. Here is what we know so far.

Within the next few days. Johnson & Johnson started shipping out doses on Monday, and they can be used as soon as they reach vaccination sites starting on Tuesday.

At first, the increase in availability will be limited. The company had about 3.9 million doses on hand to ship right away, but after that, deliveries could be patchy for a few weeks. (For comparison, the nation is using up that many doses of the Pfizer-BioNTech and Moderna vaccines in a little more than two days.)

By the end of March, Johnson & Johnson says it will ship roughly 16 million more doses. Even so, the Pfizer-BioNTech and Moderna vaccines will continue to make up the majority of the nations supply.

The same way the two earlier vaccines are: in proportion to each state or territorys population.

Thats still under discussion. The Centers for Disease Control and Prevention has said that the vaccine can be given to people 18 and over, and state officials are working out what their policies will be.

Because the new vaccine is given in a single shot and doesnt require cold storage, some experts and officials have suggested directing it toward hard-to-reach segments of the population (like rural residents or homeless people), or to people who might not keep an appointment for a second shot (like college students or those with mobility issues).

But there is concern about appearing to favor or disfavor some groups, and the Biden administration has said it will insist that the new vaccine be distributed equitably.

Thats not clear. Right now, people are getting whichever vaccine the site has on hand when their turn comes, and appointment scheduling systems generally dont tell users beforehand which it will be. Depending on how states decide to deploy the Johnson & Johnson vaccine, though, it may be possible to effectively choose what you get by choosing where you sign up to get it.

Health experts say the best shot is the one you can get the soonest, whichever one it turns out to be. All three authorized vaccines are highly protective, and the differences among them pale in comparison, they say, with the risk you would run by being picky and passing up a chance to get a shot because it was not your top choice.

A Frontier Airlines flight from Miami to La Guardia Airport in New York was canceled on Sunday night after a large group of passengers, including several adults, refused to wear masks, the airline said.

By Monday morning, the airline was facing accusations of anti-Semitism for its treatment of the passengers, who are Hasidic Jews, as well as demands for an investigation from the Anti-Defamation League of New York and other groups. Frontier steadfastly held to its position that the passengers had refused to comply with federal rules requiring them to wear masks.

Several phone videos that have surfaced do not show the confrontation that took place between the passengers and the Frontier crew members, only the aftermath. The video footage from inside the aircraft appeared to show members of the group wearing masks. Some passengers said that the episode escalated because just one member of the group, a 15-month-old child, was not wearing one.

Videos of the passengers exiting the plane amid chaos, captured by other people on the flight, were posted on Twitter by the Orthodox Jewish Public Affairs Council. In one video, a passenger says, This is an anti-Semitic act.

Another video showed a couple holding a maskless baby in a car seat, as children could be heard crying and a woman explained that the young children in their group, sitting in the back of the plane, had taken off their masks to eat.

A Frontier Airlines spokeswoman said in a statement that a large group of passengers repeatedly refused to comply with the U.S. governments federal mask mandate.

GLOBAL ROUNDUP

NEW DELHI Prime Minister Narendra Modi of India was vaccinated against the coronavirus on Monday as the country began the next phase of its inoculation drive, one of the largest in the world.

India has approved two coronavirus vaccines for emergency use: the Oxford-AstraZeneca vaccine, which is produced by the Serum Institute of India, the worlds largest vaccine producer; and Covaxin, which was developed by Bharat Biotech, an Indian pharmaceutical company.

Mr. Modi received the first of two doses of Covaxin, in line with his pitch for a self-reliant India, which he reiterated in his monthly radio address over the weekend. The first condition for self-reliance is to have pride in the things of ones own country, he said.

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Covid-19: The U.S. Is Edging Toward Normal, Alarming Some Officials - The New York Times