The New York State attorney general, Letitia James, accused the Cuomo administration of undercounting coronavirus-related deaths at nursing homes by as much as 50 percent, according to a report released on Thursday.
The count of deaths in state nursing homes has been a source of controversy for Gov. Andrew M. Cuomo and state Health Department officials, who have been sensitive to any suggestion that they played any role in the number of nursing home deaths, which the state put at more than 8,500.
They have also been accused of obscuring a more accurate estimate of nursing home deaths, because the state only counted deaths at the actual facilities, rather than including deaths of residents who were transferred to a hospital and died there.
In the 76-page report released by the attorney general, Letitia James, a survey of nursing homes found consistent discrepancies between deaths reported to the attorney general’s investigators and those officially released by the Health Department.
In one instance, an unnamed facility reported 11 confirmed and presumed deaths to the Health Department as happening on site through early August. The attorney general’s survey of that same facility, however, found 40 deaths, including 27 at the home and 13 in hospitals.
“Preliminary data obtained by O.A.G. suggests that many nursing home residents died from Covid-19 in hospitals after being transferred from their nursing homes, which is not reflected in D.O.H.’s published total nursing home death data,” a summary of the report’s findings reads.
The findings of Ms. James, a Democrat, could put her in direct conflict with Mr. Cuomo, the state’s three-term Democratic incumbent, who has touted his and his administration’s response to the coronavirus crisis, despite more than 42,000 deaths in the state.
Ms. James’s report also found a number of homes that “failed to comply with critical infection control policies,” including not isolating residents who had tested positive for the virus or screening employees for it.
The death toll in the state’s nursing homes has been a source of agony for residents and their families, and a political liability for Mr. Cuomo, who has pushed back on accusations that his administration did not do enough to safeguard a highly vulnerable population. In particular, Mr. Cuomo was criticized for a March 25 memo from the Health Department which ordered nursing homes to accept patients who had tested positive.
In late July, the Health Department released a report that refuted the assertion that the policy might have led to outbreaks in nursing homes, finding instead that most of those patients “were no longer contagious when admitted and therefore were not a source of infection.” The report also concluded that the virus was instead spread by employees who did not know they were contagious.
“Tomorrow our fridges will be empty.”
That warning came from Josep Maria Argimon, a health official in Catalonia, and he was referring not to food but to the dwindling supplies of something almost as precious: the coronavirus vaccine.
On Wednesday, Spain became the first European country to partly suspend immunizations because of a lack of doses. It did so first in Madrid, for two weeks, and said that Catalonia, the northeastern region that includes Barcelona, could soon follow.
It has not gone easily for the European Union since it approved its first vaccine in late December and rushed to begin a vast immunization campaign across its 27 member states.
But the early problems have snowballed into a full-blown crisis.
Countries across the bloc have felt the pain of vaccine shortages even as a new wave of the virus rages. The pandemic has prompted prolonged lockdowns in most member countries, and there is also anxiety over the spread of at least two highly infectious variants that are straining national health systems.
It is unclear when the supply might improve.
The bloc is also in an escalating dispute with AstraZeneca over the drug maker’s announcement that it would cut deliveries by 60 percent because of production shortfalls. And Pfizer informed the European Union this month that it had to drastically cut its vaccine deliveries until mid-February while it upgraded its plants to ramp up output, adding to the supply problems.
In a rare bit of good news, the French drug maker Sanofi said on Wednesday that it would help produce more than 100 million doses of the Pfizer-BioNTech vaccine, starting this summer — but those doses will most likely come too late to salvage vaccination plans for the first half of 2021.
When the European Union approved its first vaccine in December, it was already weeks behind nations like the United States and Britain. While it is flush with cash, influence and negotiating heft, the bloc of 27 nations has also found itself lagging countries such as Israel, Canada and the United Arab Emirates.
Last week, the European Union’s executive branch, the European Commission, set a goal of having 70 percent of its population inoculated by this summer. Just days later, the president of the European Council, Charles Michel, pronounced that “difficult.”
As of this week, a mere 2 percent of E.U. citizens had received at least one dose of a coronavirus vaccine, according to numbers collected by the research site Our World in Data. That compares with around 40 percent for Israel, 11 percent for Britain and just over 6 percent for the United States.
Many countries, particularly poorer ones, are struggling to secure any vaccines at all. But the delays in Europe have created tensions.
Some critics have blamed the European Commission, which struck deals on behalf of the member states to secure a total of 2.3 billion vaccine doses from several companies.
Some of its agreements were struck weeks after those reached by the United States and Britain. AstraZeneca and some European opposition politicians say that the delay put the bloc at the back of the line for deliveries. The commission has challenged those claims.
“We reject the logic of first-come, first-served,” the bloc’s heath commissioner, Stella Kyriakides, said at a news conference on Wednesday. “That may work at the neighborhood butcher, but not in contracts and not in our advanced purchase agreements.”
Germany’s vaccination advisory committee, which provides recommendations to the government, is cautioning against using the AstraZeneca shot on adults age 65 and above, saying in a draft report released on Thursday that “there currently is not sufficient data to assess the vaccination effectiveness above 65 years.”
The German Health Ministry, which usually follows the advice of the committee, declined to comment. The European Medicines Agency, the regulatory body for the European Union, is expected to announce on Friday whether the vaccine will be approved for use in the bloc. Britain has been administering the AstraZeneca shots to all age groups after it became the first country to give the vaccine emergency authorization, in December.
British regulators have said that data on the efficacy and safety of the vaccine “are currently limited” in people age 65 and older.
But concerns about the scarce data on older people could limit the use of the AstraZeneca shot: European regulators are considering authorizing it only for people under 65, two E.U. officials said.
Neither AstraZeneca nor Oxford University, which helped develop the vaccine, has released figures on how effective the shot is in older people. But data on older people’s immune responses have suggested that the vaccine will help protect them from the virus, the company has said.
The Oxford team, which was in charge of the earliest trials of the vaccine, did not want to vaccinate older people until they had collected extensive safety data for younger participants, Pascal Soriot, the chief executive of AstraZeneca, said in an interview with La Repubblica, an Italian newspaper, this week.
Other vaccine makers, Mr. Soriot said, decided to vaccinate older people in trials before they had accumulated as much safety data, allowing them to make stronger claims about efficacy in that age group.
In the United States, the Food and Drug Administration is waiting on data from a clinical trial that enrolled about 30,000 participants, mostly Americans, and that will include more older people. The results are expected in the coming weeks. AstraZeneca is expected to have sufficient safety data from that study to file for emergency use authorization from the F.D.A. around the first week of March.
Benjamin Mueller and Rebecca Robbins contributed reporting.
The Well section set out to answer some of the most commonly asked questions about the coronavirus vaccine, and a few that are perhaps not so common. Using an experimental tool that relies on machine learning, you can even try posing a few questions of your own.
Below are excerpts. You can see the whole thing here.
Getting the Vaccine
Is the vaccine free?
You should not have to pay anything out of pocket, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Despite safeguards to prevent surprise bills, health experts worry that patients might stumble into loopholes that leave them vulnerable to having to pay. To be sure, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available. — Sarah Kliff
What to Expect
I’ve heard that taking a pain reliever after getting a Covid-19 vaccine could blunt its effectiveness. Is that true?
Most experts agree it’s safe to take a pain reliever or fever reducer like acetaminophen or ibuprofen to relieve discomfort after you get vaccinated. You shouldn’t try to stave off discomfort by taking a pain reliever before getting the shot. Because fevers and other side effects are also a sign that the body is mounting a strong immune response, some researchers have questioned whether giving a pain reliever or fever reducer before or after a shot might blunt the effectiveness of the vaccine. Several medical groups, including the Henry Ford Health System and UCI Health, advise against taking pain relievers before your shot but agree that it’s fine to take an over-the-counter pain reliever for discomfort after getting the vaccine. — Tara Parker-Pope
Is it true that cosmetic injections (like those used to plump lips or smooth out wrinkles) can cause an allergic reaction to the vaccine?
A rare side effect has been seen in a few people who have been injected with dermal fillers. One to two days after getting the vaccine during the Moderna clinical trials, three women (out of 15,184 people) developed swelling where they had previously been injected with cosmetic fillers. The American Society for Dermatologic Surgery said that viral and bacterial illnesses, other vaccinations and dental procedures have been linked to similar reactions. The group said people with dermal fillers should not delay or avoid the Covid-19 vaccine. If you’re concerned or not sure what type of injection you’ve gotten in the past, check with the doctor who gave you the cosmetic treatment. — Tara Parker-Pope
Fertility and Pregnancy
Will pregnant women be given priority to get the vaccine?
Pregnancy is on the list of conditions that the Centers for Disease Control and Prevention identified as putting a person at high risk of becoming seriously ill or dying from Covid-19. However, whether a pregnant woman is now eligible for vaccination depends on the rules in the state where she lives. Eligibility can change overnight, so check your state health department website. Because the vaccine hasn’t been studied in pregnant women, they should consult their doctors about whether to be vaccinated. — Tara Parker-Pope
Will partners of pregnant women be given priority for getting the vaccine?
No, partners of pregnant women will not get to cut the line and will have to wait until their age or risk group becomes eligible. — Dani Blum
Understanding the Vaccine
I’ve heard rumors and jokes about microchips in the new vaccines. What is that about?
The false conspiracy theory about microchips emerged after Bill Gates, the founder of Microsoft, made a comment about “digital certificates” that might one day be used to show a person had been tested or vaccinated for Covid-19. The reference prompted conspiracy theories to circulate online speculating that a tracking microchip would be planted by the government to surveil the movements of Americans. For months, widely shared videos and viral posts on social media have baselessly claimed that such technologies could find their way into syringes delivering shots. None of the rumors are true. — Katherine J. Wu and Tara Parker-Pope
A civil rights activist once called Los Angeles an “imperfect paradise.”
It was an apt phrase to sum up the scene at Dodger Stadium the other day: a flawed, hopeful work in progress, ringed by hills topped with palm trees in 72-degree sunshine in late January, that was putting more shots of coronavirus vaccine into people’s arms in a few hours than almost all other sites do in an entire day.
A sea of cars waiting for hours in the stadium parking lot waited some more. All the runners — the workers who dashed between the lanes of idling vehicles to fill empty coolers with the vaccine — were busy running.
“You need more vaccine?” a trim 49-year-old man in a mask asked a nurse. “I’ll get it.”
His name was Eric Garcetti, and his day job is being mayor of Los Angeles, but he has been working the stadium’s front lines off and on since the vaccination site opened on Jan. 15. It helps him better understand and fix the logistical problems, he says.
In the past few weeks, the mayor and other local and state officials have come under intense scrutiny for their handling of the virus and the vaccination rollout. Mixed messages led to widespread confusion.
But for all the mishaps, Los Angeles has a higher vaccination rate than other large cities and counties — 83 percent of the doses the city has received have been administered, compared with 74 percent in New York City; 52 percent in Bexar County, which includes San Antonio; and 58 percent of the doses ordered in Maricopa County, which includes Phoenix.
A day at the Dodger Stadium site showed the enormous challenge ahead, and the dizzying logistics of giving out perishable doses by the thousands in a sprawling space never intended to help cope with a public health crisis.
“Something that wasn’t here suddenly is — and the decision to build this was made less than two weeks ago,” Mr. Garcetti said. “We’re driving the car at 60 miles an hour while we’re building it.”
The coronavirus can warp the body’s defenses in many ways — disarming early warning systems, for example, or causing immune cells to misfire. But a spate of new studies suggests another insidious consequence: The infection can provoke the production of antibodies that mistakenly attack the patient’s own tissues instead of the virus.
The latest report, published online this week, suggests that so-called autoantibodies can persist months after the infection has resolved, perhaps causing irreparable harm. If other studies confirm the finding, it may explain some of the lingering symptoms in people who have recovered from Covid-19. The syndrome, sometimes referred to as long Covid, can include dementia, “brain fog” and joint pain.
Autoantibodies are not new to science: They are the misguided soldiers of the immune system, tied to debilitating diseases such as lupus and rheumatoid arthritis, which arise when the body attacks its own tissues.
The newest study is small, with just nine patients, five of whom had autoantibodies for at least seven months. It has not yet undergone peer review for publication, and the authors urged caution in interpreting the results.
“It’s a signal; it is not definitive,” said Dr. Nahid Bhadelia, medical director of the special pathogens unit at Boston Medical Center, who led the study. “We don’t know how prevalent it is, and whether or not it can be linked to long Covid.”
The question of autoimmunity following coronavirus infection is urgent and important, Dr. Bhadelia added. As many as one in three survivors of Covid-19 say they still experience symptoms.
“This is a real phenomenon,” she said. “We’re looking at a second pandemic of people with ongoing potential disability who may not be able to return to work, and that’s a huge impact on the health systems.”
Vietnam reported 82 coronavirus infections on Thursday, the first cases of local transmission in nearly two months, and the government said that some may be connected to the new variant that has been spreading rapidly in Britain.
Prime Minister Nguyen Xuan Phuc has called on the two northern provinces where the cases were reported to close their borders to prevent people from leaving, the state-run news media reported on Thursday.
Vietnam has been relatively successful in containing the virus. Before the latest outbreak in the northern provinces, Hai Duong and Quang Ninh, the country had reported only about 1,550 cases and 35 deaths.
The new cases arrived at an inconvenient time. Officials from the governing Communist Party are meeting this week in Hanoi, the capital, to select their next leaders, an event that takes place once every five years. And people across the country are preparing to celebrate the Lunar New Year, Vietnam’s biggest holiday.
Vietnam’s largest outbreak occurred in July in the central city of Danang, sickening hundreds and causing all 35 of the country’s reported deaths before it was contained.
Health officials initially reported two new cases Thursday morning. But the number rose to 82 by the afternoon, after health workers began tracing and isolating the first patients’ contacts.
Of 138 people tested in Hai Duong, 72 were positive for the virus, Health Minister Nguyen Thanh Long said, according to a recording of comments made at an urgent meeting on the sidelines of the Communist Party congress. All of those patients work at a local electronics factory, local news media reported.
The first worker found to have contracted the virus is said to have had contact with a Vietnamese national who later traveled to Japan, where he tested positive for the variant that has spread in Britain.
The other 10 cases appear to have originated with a worker at Van Don International Airport in Quang Ninh Province who was responsible for taking arriving passengers to quarantine.
The German health minister, Jens Spahn, says that his country is facing another 10 weeks of vaccine shortages and has called for a meeting between the heads of government and leaders of the pharmaceutical industry to address the lack of supply.
The situation has increasingly angered Germans who were promised an efficient immunization campaign. Even the most vulnerable have struggled to get access to the potentially lifesaving shots.
The German government helped fund development of the Pfizer-BioNTech vaccine with 738 million euros, or about $895 million, only to see it first administered in Britain. But many immunization centers set up across Germany stand empty, and older adults who were to be among the first to be vaccinated have been turned away.
“We are facing at least 10 hard weeks, given the lack of vaccines,” Mr. Spahn said on Twitter on Thursday.
Instead of approving and purchasing vaccine doses on its own, Germany chose to band together with 26 other European Union countries to ensure equal access across the bloc. But the process has been slowed by squabbling between members over sluggish vaccine production. This week, it became further bogged down by a dispute with the British-Swedish pharmaceutical maker AstraZeneca, after the company announced that it would not be able to meet its delivery quotas to the European Union.
In other news from around the world:
In the Philippines, the Food and Drug Administration granted emergency approval on Thursday to the AstraZeneca vaccine, saying that it was 70 percent effective after the first of two doses. The country has reported more than 500,000 cases and 10,000 deaths during the pandemic, second only to Indonesia in Southeast Asia. It has signed a deal with AstraZeneca for 17 million doses, with the first expected to arrive in May.
Hundreds of tennis players, coaches and officials who had traveled to Melbourne for the Australian Open were scheduled to begin exiting quarantine on Thursday after spending two weeks in a biosecurity hub. They were forced into a hard lockdown after people on their chartered flights tested positive for coronavirus. There are currently five active coronavirus cases connected to the Australian Open, according to the government agency overseeing the quarantine.
Japan’s national broadcaster reported on Thursday that the International Swimming Federation, known as FINA, planned to postpone its artistic-swimming qualification event for the Tokyo Olympics because of the coronavirus. The competition, which was to be held at the Tokyo Aquatics Center in March, would have been the first test event for the reorganized Summer Games. It was rescheduled for May.
A businessman from Taiwan has been fined more than $35,000 after he was caught on camera repeatedly breaking rules requiring him to quarantine at home. The man, who returned to Taiwan last week from mainland China, left his home seven times when he was supposed to be in isolation, according to officials in the city of Taichung, where he lives. Taiwan has some of the strictest quarantine rules in the world, a critical part of its success in fighting the virus, and the government routinely punishes and shames people found to be violating regulations. “This misbehavior was serious and must be punished heavily,” Lu Shiow-yen, the mayor of Taichung, said at a news conference this week.
Public health workers found themselves stuck in a snowstorm on an Oregon highway this week, with only six hours to get the coronavirus vaccines they were carrying to people waiting for their shots about 30 miles away.
But with a jackknifed tractor-trailer ahead of them, the crew realized that they could be stuck for hours — and that the six doses of the Moderna vaccine would expire. So they began walking from car to car, asking stranded drivers if they wanted to be vaccinated on the spot.
“It was a strange conversation,” said Michael Weber, the public health director in Josephine County, Ore. “Imagine yourself stranded on the side of the road in a snowstorm and having someone walk up and say: ‘Hey. Would you like a shot in the arm?’”
Most drivers laughed at the offer of a roadside coronavirus vaccine and politely declined, even though Mr. Weber said that he had a doctor and an ambulance crew on hand.
But all six doses went to grateful drivers. Mr. Weber said that making the decision to administer the vaccines on the highway was easy.
“Honestly, once we knew we weren’t going to be back in town in time to use the vaccine, it was just the obvious choice,” he said. “Our No. 1 rule right now is nothing gets wasted.”
Every winter, Pang Qingguo, a fruit seller in northern China, makes the 800-mile trip to his ancestral home to celebrate the Lunar New Year, the biggest holiday of the year in China, with his family.
The coronavirus ruined the festivities last year, stranding Mr. Pang in the northern city of Tangshan as many Chinese cities imposed lockdowns. Now, as China confronts a resurgence of the virus, the pandemic is set to spoil the holiday again, with the authorities announcing onerous quarantine and testing rules to dissuade migrant workers like Mr. Pang from traveling for the new year, which begins this year on Feb. 12.
Mr. Pang, who describes his home in the northeastern province of Heilongjiang as the “happiest place,” is anguished by the rules. He has taken to social media in recent days to express frustration about his situation and post photographs of his 7-year-old daughter, whom he has not seen in more than a year. “Society is so cruel,” he wrote in one post.
Many of China’s roughly 300 million migrant workers face a similar reality as the government tries to avoid a surge in cases during what is typically the busiest travel season of the year.
The authorities have demanded that people visiting rural areas during the holiday spend two weeks in quarantine and pay for their own coronavirus tests. Many migrants, who endure grueling jobs for meager wages in big cities, say those restrictions make it impossible to travel.
The rollout of the rules has drawn widespread criticism in China, with many people calling the approach unfair to migrant workers, who have long been treated as second-class citizens under China’s strict household registration system. The workers have been among the most deeply affected by the pandemic, as the authorities have carried out scattered lockdowns to fight the virus and employers have reduced hours and pay.
In a regular year, hundreds of millions of people travel by plane, train and car to be with their families for the Lunar New Year. The holiday, which typically includes big festive banquets and fireworks, is normally the only time that many workers can return to their hometowns to see loved ones. This year, many are making plans to spend the holiday alone.
Rigorous scientific studies tracing the transmission of coronavirus in schools have been few and far between during the pandemic. But on Tuesday, the Centers of Disease Control and Prevention published a study of 17 rural schools in Wisconsin that found there was little in-school transmission, even though the virus was raging in the surrounding communities.
Experts and advocates have pointed to the study as evidence that it is possible to keep schools open safely even when community transmission is high, provided that mitigation measures — including strongly enforced requirements to wear masks and keeping students in stable groups — are used.
Among 5,530 students and staff members in Wood County, Wis., there were 191 coronavirus cases reported during the study, from Aug. 31 to Nov. 29. Only seven cases were attributed to in-school transmission, all among students. There was no surveillance testing, so some asymptomatic cases might have been missed. Overall, the rate of infection among students and staff was about one-third lower than in the county as a whole.
The study’s senior author, Dr. Tracy Beth Hoeg, a sports medicine physician with a doctorate in epidemiology, said the fact that no teachers or other staff members appeared to have been infected in school was “very, very reassuring.”
But others, including allies of teachers’ unions who oppose reopening before educators have been vaccinated, are already arguing that the study’s findings should not be widely applied.
The study setting was rural, and the students in the schools were mostly white. But it wasn’t obvious that the conditions in the schools were very different than those in urban districts. Students ate and attended classes indoors.
The students, who ranged from kindergartners to 12th graders, were in small, stable groupings of 11 to 20 students. Not all districts that have reopened created such small class settings. But in most urban districts that have reopened, only a fraction of students have returned in person, so class sizes are generally small — 9 to 12 students in New York City, for instance.
On CNN on Tuesday night, President Biden’s chief of staff, Ron Klain, said the study’s take-home message was that schools could open safely when they had an infusion of money to do so. Mr. Biden has proposed a $1.9 trillion package, which needs Congressional approval, that includes funding for reopening schools. The president is a close ally of teachers unions, which have been calling for major government investments in making schools safer.
The Wisconsin districts received a $150,000 grant to purchase cloth masks for all students. Mr. Klain suggested the grant had underwritten more safety measures. He also twice understated the size of the student settings in the schools, saying they were “classes of about 11 or 12,” and later, “classrooms of 12 on average.”
“What that study in Wisconsin from the C.D.C. showed,” Mr. Klain said, “was that 17 schools that got a sizable grant from a private foundation to put in the kinds of safety measures they needed — students in very small pods, classes of about 11 or 12, distanced, in a rural area — they could go to school safely.”
Asked by the CNN anchor, Erin Burnett, why teachers’ unions were ignoring the scientific evidence in opposing reopening, Mr. Klain disagreed.
“I think what you’re seeing is schools that haven’t made the investments to keep the students safe,” he said.
Tanzania’s president cast doubt on coronavirus vaccines and other measures to curb the spread of the pandemic, doubling down on his line of reasoning that only God could protect the East African nation. His comments came a day before the World Health Organization urged the nation to take measures to protect its population.
President John Magufuli of Tanzania, speaking to a large, unmasked crowd in the country’s northwest on Wednesday, questioned the efficacy of vaccines and discouraged the Ministry of Health from pursuing doses, saying the shots were not “beneficial” to the East African nation.
“Vaccines don’t work,” Mr. Magufuli, 61, said in his speech. “If the white man was able to come up with vaccinations, then vaccines for AIDS would have been brought. Vaccines for tuberculosis would have made it a thing of the past. Vaccines for malaria would have been found. Vaccines for cancer would have been found.”
On Thursday, Dr. Matshidiso Moeti, the regional director for the W.H.O. in Africa, urged the Tanzanian government to share data, establish measures to protect its citizens from the virus and prepare for the vaccine. “Science shows that #VaccinesWork,” Dr. Moeti tweeted.
From the start of the pandemic, the Tanzanian government has been widely criticized for its approach to the virus, and Mr. Magufuli’s personal denial of the severity of the public health concerns has grown increasingly problematic in recent months. On Wednesday, he warned Tanzanians about being used as “guinea pigs” in the vaccine rollout, asked them to eat well and pray to God, and said that they need not expect any restrictions from his government.
“I do not expect to announce a lockdown even for one day because our God is living, and he will continue to protect Tanzanians,” Mr. Magufuli said to applause.
Mr. Magufuli also accused some Tanzanians of leaving the country to get vaccinated, only to bring back a “strange type” of the coronavirus. Mr. Magufuli has in the past scoffed at social distancing and mask wearing, promoted an unproven herbal tea from Madagascar as a cure and questioned testing kits supplied by the Africa Centers for Disease Control and Prevention. Since the middle of last year, his government has also not shared any data on the virus with the World Health Organization, with reported cases in the country, which has a population of about 58 million, still at 509, with 21 deaths.