A sudden, sharp rise in coronavirus cases in many parts of Africa could amount to a continental third wave, the World Health Organization warned on Thursday, a portent of deeper trouble for a continent whose immunization drives have been crippled by shortfalls in funding and vaccine doses.
The W.H.O., an arm of the United Nations, said that test positivity had risen in 14 African countries over the last seven days, with eight reporting a surge of more than 30 percent in new cases. Infections are steadily climbing in South Africa, where four of nine provinces are battling a third wave. There has also been a sharp increase in cases in Uganda, with hospitals overwhelmed with Covid patients and authorities mulling a lockdown.
The W.H.O. attributed the rise to loose compliance with social restrictions, and increasing travel, along with the arrival of winter in southern Africa.
Experts also believe that the spread of new coronavirus variants — like those first identified in South Africa, the United Kingdom and India — is contributing to the surge, and the ensuing rise in deaths. While Africa has reported less than 3 percent of global coronavirus cases, the W.H.O. said that the continent accounted for 3.7 percent of total deaths. And that is almost certainly a severe undercount, since in the vast majority of African countries, most deaths are never formally registered.
“The threat of a third wave in Africa is real and rising,” Dr. Matshidiso Moeti, the W.H.O. regional director for Africa, said in a statement. She added: “It’s crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of Covid-19.”
But while many wealthier countries have vigorous vaccination campaigns, and some are on track to reopen fully, many of Africa’s poorer countries face a huge challenge in accessing vaccines.
Out of a continental population of 1.3 billion people, only 31 million have received at least one dose, Dr. Moeti said. Seven million are fully vaccinated. In Kenya, one of Africa’s biggest economies, with more than 50 million people, only 1,386 people have received two doses of a vaccine.
Countries like Ghana and Rwanda have run through their first deliveries of vaccines through Covax, the global facility working to ensure the equitable distribution of vaccines.
Vaccine hesitancy has affected the rollout in nations like Malawi, while concerns over rare blood clots and limitations in inoculation capacity pushed the Democratic Republic of Congo to donate millions of doses to other African states before they expired.
The rising cases, the W.H.O. warned, could overwhelm already creaky health care systems struggling with limited intensive care beds, oxygen and ventilators.
To forestall a full-blown crisis, Dr. Moeti urged “countries that have reached a significant vaccination coverage to release doses and keep the most vulnerable Africans out of critical care.”
The White House, besieged with requests from other nations to share its supply of coronavirus vaccine, announced Thursday that it would distribute an initial 25 million doses this month across a “wide range of countries” in Latin America and the Caribbean, South and Southeast Asia, and Africa, as well as the Palestinian territories, war-ravaged Gaza and the West Bank.
The doses are the first of a total 80 million that President Biden has pledged to send overseas by the end of this month. Three-quarters of the initial batch will be given to the international vaccine effort known as Covax, officials said at a White House briefing on the pandemic, though administration officials are helping decide where to send them.
The rest will be reserved for “immediate needs and to help with surges around the world” and regions dealing with “urgent, present crises,” said Jake Sullivan, the president’s national security adviser, including in India, Ukraine and Iraq as well as the West Bank and Gaza.
But the donation is nowhere close to enough. About 11 billion doses are needed to vaccinate 70 percent of the world’s population against the coronavirus, according to estimates from researchers at Duke University. As of last month, the analytics firm Airfinity estimated that 1.7 billion doses had been produced.
Thursday’s announcement comes a week before Mr. Biden leaves for Cornwall, England, to meet with the heads of state of the Group of 7 industrialized nations, where the global vaccine supply is certain to be a topic of discussion. Officials said the Biden administration would donate additional doses throughout the summer as they become available.
“This is just the beginning,” said Jeffrey Zients, Mr. Biden’s coronavirus response coordinator. “Expect a regular cadence of shipments around the world, across the next several weeks.”
While China and Russia have used vaccine donations as an instrument of diplomacy in an effort to extract favors from other nations, Mr. Biden has insisted the United States will not do that — a point that Mr. Sullivan emphasized on Thursday in describing the White House strategy.
Nearly two-thirds of U.S. adults have had at least one shot of a coronavirus vaccine, and the rate of new cases and deaths has plummeted, contributing to an overall picture across the country that is “encouraging and uplifting,” Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said on Thursday.
But the picture around the world, especially in poorer nations in Africa and Central and South America, where vaccination rates are much lower, is bleak. According to data from Johns Hopkins University, Uruguay, Argentina, Colombia and Paraguay are all awash in new cases; in Colombia, nearly 500 people a day have died of the coronavirus over the past several weeks. A sudden, sharp rise in coronavirus cases in many parts of Africa could amount to a continental third wave, the World Health Organization warned on Thursday.
Abdi Latif Dahir contributed reporting.
An earlier version of this item misspelled the name of a vaccine maker. It is Novavax, not Novovax.
Nearly a year ago, more than 43 percent of coronavirus deaths in the United States were tied to long-term-care facilities. Now, the deaths of people connected to such facilities has dropped to 31 percent, according to a New York Times database, revealing an improving picture for the oldest Americans.
Throughout the pandemic, The Times has tracked Covid-19 cases and deaths in nursing homes, assisted-living centers, memory care units and other long-term facilities for older people, and has identified more than 1.38 million infections among residents and employees of the facilities, as well as more than 184,000 deaths. The virus has spread easily in these facilities, and has been particularly lethal for unvaccinated adults in their 60s or older.
“Coronavirus highlighted some of the needs of both the residents themselves and the facilities,” said Cindy Prins, an epidemiologist at the University of Florida, citing a need for more oversight, greater examination of infection controls and better training for staff members.
She said the pandemic had also forced many people to re-evaluate their views on long-term care.
“I’m sure there are people who are feeling like, ‘Could I have cared for them at home? Could I have a different outcome?’” Dr. Prins said.
Since vaccines have arrived, deaths in nursing homes, in particular, have fallen significantly. According to the federal Centers for Medicare and Medicaid Services, nursing homes across the United States reported more than 5,000 deaths per week from early December through mid-January. Since late March, the homes have reported fewer than 300 deaths a week.
Still, deaths slowly continue to mount. Though health care workers were among the first group to become eligible for inoculation, vaccination hesitancy has remained a challenge at long-term care facilities.
With reports of infections occurring among vaccinated people in long-term-care facilities in Chicago and Kentucky, the Centers for Disease Control and Prevention have stressed that inoculating workers and residents is essential to preventing further spread of the virus.
The federal government is requiring nursing homes to report the vaccination status of their residents and staff members in order to examine the impact of the vaccines. More than 4.9 million residents and employees in long-term-care facilities have received at least one dose of a Covid-19 vaccine through a federal program, according to the C.D.C. Others have been vaccinated through state and local efforts.
“Reporting vaccination rates is critical to facilitating in-person visitations in nursing homes,” said Dr. David Gifford, the chief medical officer for the American Health Care Association and National Center for Assisted Living, a trade group that represents more than 14,000 U.S. nursing homes and long-term care facilities.
He added: “It is important that we not judge facilities with low vaccination rates but instead seek to understand whether additional resources or outreach can be done to encourage more staff and residents to get the vaccine, or help facilities acquire additional vaccines for new patients and hires.”
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A widely available rapid antigen test is highly sensitive in young children with symptoms of Covid-19, according to a small new study. Among children younger than 7, the test detected 100 percent of cases, researchers reported in a forthcoming paper in the journal Pediatrics.
The test was somewhat less sensitive in older children and did generate a substantial number of false positives in children of all ages, however. Among children who did not have the virus, 8 percent to 10 percent of them tested positive on the antigen test, the researchers found.
“One hundred percent sensitivity in children less than seven years is excellent — outstanding,” said Dr. Alejandro Hoberman, a pediatrician at the Children’s Hospital of Pittsburgh and the senior author of the study. “The problem was the false positives.”
The new findings suggest that while the test could help schools and day cares operate more safely, it may be more useful for ruling infections out than at definitively detecting them.
Rapid antigen tests are generally cheaper and faster — but less sensitive — than P.C.R. tests, considered the gold standard for Covid diagnosis. But there has been relatively little research on their performance in children.
The results do not mean that there is no role for rapid antigen testing or that every test will perform similarly, Dr. Hoberman said. “I would like to see other folks replicate our findings and do this in pediatrics and see how it behaves.”
Although children who are 12 or older are now eligible for vaccination, there are no vaccines authorized for use in younger children. Young children are roughly half as likely to catch the virus as adults, but some who do contract it can become very ill. A number of studies have also suggested that they may also be about half as likely to transmit the virus to others, but the precise risk, which appears to increase with age, remains unclear.
The new study, led by researchers at the Children’s Hospital of Pittsburgh, enrolled 199 children and young adults, who ranged in age from 2 months to 20 years old. All participants had at least one symptom of Covid-19 and had been symptomatic for less than a week.
The researchers took two nasal swabs from each participant — one from each nostril. They sent one swab from each child for a P.C.R. test and analyzed the other with Abbott’s BinaxNOW, a common rapid antigen test.
In total, 39 participants tested positive for the virus on the P.C.R. test. Overall, the antigen test accurately detected 85 percent of those cases, which is a reasonable level of sensitivity for the test, Dr. Hoberman said.
The test was even more sensitive among children under 7, detecting 100 percent of cases in that group. This enhanced sensitivity may stem from the fact that children infected with the coronavirus could have more of the virus in their upper respiratory tracts than adults do. “In general, young children tend to have high viral loads compared to adults,” Dr. Hoberman said.
Across the board, however, there were a significant number of false positives. Among children under 7, 8 percent with a negative P.C.R. result tested positive on the antigen test, the researchers found; that figure rose to 10 percent among participants 7 or older.
This relatively high proportion of false positives means that positive test results should be confirmed by P.C.R. analysis, the researchers say. Repeated antigen testing may also reduce the problem posed by false positives.
Afghan and American health officials issued urgent health warnings on Thursday describing alarming spikes in reported cases of coronavirus in Afghanistan, where the health ministry recently declared a third wave of the pandemic since the virus first struck in early 2020.
Hospitals are rapidly filling up with Covid-19 patients, the health ministry reported. Some hospitals said they were running out of oxygen, and the U.S. Embassy said some Americans had reported being denied hospital admittance because of a lack of beds.
“The U.S. Embassy strongly suggests that U.S. citizens make plans to leave Afghanistan as soon as possible,” the American mission said in a statement Thursday.
The embassy noted that Afghanistan remained at Level 4, the highest category, of a Travel Health Notice issued by the U.S. Centers for Disease Control and Prevention. The country is also under a State Department Level 4 Travel Advisory that warns Americans not to travel to Afghanistan because of high security and health risks.
Few Afghans wear masks or practice social distancing. Bazaars, shops, restaurants and buses are crowded with customers jammed shoulder-to-shoulder, with limited public access to soap and clean water for hand-washing.
In its daily coronavirus report, the country’s health ministry said the rate of positive tests had risen sharply on Wednesday to 34 percent — one of Afghanistan’s highest daily rates since the pandemic began. Four of the country’s 34 provinces reported positivity rates of 50 percent or higher. The reported figures reflect only a fraction of the country’s total number of actual infections and deaths. Testing is severely limited and Afghanistan’s struggling health system is chronically underfunded and overwhelmed by high rates of disease, poverty and malnutrition.
Still, the numbers offer a sense of scale. The 1,500 positive cases reported nationwide for Wednesday, and the 34 coronavirus deaths reported the same day, were among the highest daily totals since the pandemic began, the health ministry said.
In other news around the world:
In Hong Kong, experts warn that the incentives offered by businesses and the government may not be enough to overcome vaccine hesitancy and reach a goal of herd immunity. They warned that other solutions are urgently needed before the territory faces a “fifth wave.”
About 10,000 of the 80,000 volunteers who had stepped forward to help with the Olympics in Tokyo have quit. The chief executive of the Games’ organizing committee, Toshiro Muto, said on Wednesday that there were still enough volunteers to assist with the Olympics and Paralympics, and that operations for both events would not be affected.
A church is the center of an outbreak in Vietnam’s largest city. The husband and wife who founded the church were stalwarts of their community for more than 20 years. Now, they have been blamed by the authorities for a major coronavirus outbreak, are facing a criminal investigation and have been held accountable on social media for a lockdown in their neighborhood and a ban on religious services nationwide.
As India’s Covid-19 vaccination drive falters, the country’s Supreme Court has demanded that Prime Minister Narendra Modi’s government explain how it plans to meet its target of inoculating about 900 million adults by the end of the year.
Facing vaccine shortages, Canada’s immunization advisory body said on Tuesday that people who had received a first dose of the AstraZeneca vaccine could be given either the Pfizer-BioNTech or Moderna vaccines as their second dose.
Reporting was contributed by Ian Austen, Suhasini Raj, Mujib Mashal, Richard C. Paddock, Chau Doan, Jennifer Jett, Joy Dong, Hisako Ueno
The United States is roughly on track to meet President Biden’s goal of getting every adult at least one shot of a Covid-19 vaccine by July 4 if the current vaccination pace holds. But much of the country has seen a significant slowdown in recent weeks, and the positive national trend hides deeply uneven progress among the states.
A handful of states are unlikely to reach 70 percent of their adult residents before the end of the year.
“You reach a certain rate nationally, which looks excellent and would really suggest that you are in a place to reduce the likelihood of infectious spread, but that can be misleading,” said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, which represents state health agencies.
“You still have these significant pockets and states where the rates of immunity are much lower,” he added. “So we could have another wave pop up.”
In many states in the Deep South and Mountain West, vaccinations have leveled off because of limited access and shot hesitancy.
Alabama, Louisiana, Mississippi and Wyoming have vaccinated fewer than half of their adult residents, and projections show that they are unlikely to reach much more than half by early July.
Travelers returning to Britain from Portugal or its island territories of Madeira and the Azores will no longer be able to avoid quarantining as of Tuesday, British officials announced on Thursday, complicating the plans of Britons hoping for easy getaways to the country this summer.
In mid-May, Britain had put Portugal and 12 other countries and territories with low coronavirus caseloads on a “green list,” allowing British visitors to avoid a quarantine period on their return home from those locations.
As cases remain generally low in Britain, residents fatigued by a miserable winter and a four-month national lockdown began flocking to Portugal, because most of the other green-listed places were either not accepting tourists or were not already favored destinations for British travelers. The process still involved multiple forms and P.C.R. virus tests, whose costs could total hundreds of dollars.
The decision to move the country off the green list was a “safety-first approach,” Grant Shapps, Britain’s transport secretary, told the BBC on Thursday.
Portugal had remained on Britain’s green list even as the rate of positive coronavirus cases there rose 37 percent over the past two weeks, and British fans poured into the city of Porto to see two of England’s top soccer teams, Chelsea and Manchester United, face off in the Champions League final last Saturday. (Chelsea won.)
Officials did not add any new countries to the green list, dealing a blow to Spain, which had hoped to be added after seeing its virus numbers improve. Britain was the largest source of overseas travelers to Spain before the pandemic, accounting for 18 million of almost 84 million foreign visitors in 2019.
The announcement disappointed British visitors who had already booked trips to Portugal, or hoped for wider travel in Europe. It also dismayed a travel industry that has suffered in the pandemic.
The decision not to add countries to the green list “is a total disaster for the already fragile travel industry and is likely to lead to further airline failures and many more job losses,” Brian Strutton, acting general secretary of the British Airline Pilots Association, said in a statement. “Our airlines need this summer season if they are to survive.”
In Portugal, vendors had been excited to welcome back tourists, typically a major financial boost for the country. But some people had grumbled about foreign visitors not following local restrictions, including outdoor mask-wearing and a 10:30 p.m. curfew.
While the Italian government has said that people have a right to get vaccinated no matter their legal status, in practice, many undocumented migrants and homeless people have been overlooked — a risk not only for them, doctors say, but for the whole country.
The official explanation in many cases is bureaucracy. Most Italian regions require a social security number to book an appointment on their online platforms, but only three of 20 regions in the country accept the temporary numbers given to hundreds of thousands of migrants.
And in a nation where immigration is a hot-button issue, some have also been asking whether Italians should remain the priority, at least until more shots are available.
“The system forgot about these people,” said Marco Mazzetti, a doctor and the president of the Italian Society of Migration Medicine, “but they are the most fragile.”
Dr. Mazzetti also points out that migrants are often domestic workers.
“If we don’t control the virus circulation among these people who come inside our homes to help us,” Dr. Mazzetti said, “we don’t control the virus circulation in the country.”
Constant Méheut and Christopher F. Schuetze contributed reporting.
One of New York City’s hottest tickets is about to get even harder to get: Shakespeare in the Park plans to sharply curtail capacity when it returns to the Delacorte Theater this summer after losing a year to the pandemic, officials announced on Thursday.
The 1,800-seat theater currently plans to allow only 428 attendees for each performance of “Merry Wives,” the adaptation of Shakespeare’s “The Merry Wives of Windsor” being put on by the Public Theater.
In a news release, officials said the capacity limit was put in place because of the need for social distancing. They said all theatergoers over age 2 would be required to wear a mask and either provide proof of full vaccination or a recent negative coronavirus test to attend.
The decision to significantly limit the size of the audience stands in contrast to some other New York venues, most of them indoors, that have elected to reopen to bigger crowds.
It is possible that the limits could be eased before opening night. A spokeswoman for the Public said Thursday that the theater would await updated health and safety guidance from the state and would adapt its policies as needed.
Tickets to Shakespeare in the Park, as usual, will be free and limited to two per person. But this summer, officials said there will be no winding in-person lines to wake up early for; instead, tickets will be distributed entirely through what they called “an advanced digital lottery” hosted on a platform called Goldstar.