Johnson & Johnson Pause Will Continue Until C.D.C. Panel Meets Again

Use of the vaccine had been halted because of a possible link to rare blood clots. The panel will reconvene in about a week. Here’s the latest on Covid-19.,

LiveUpdated April 14, 2021, 9:50 p.m. ETApril 14, 2021, 9:50 p.m. ET

With injections halted across the country, federal health authorities are studying rare blood clots in a small number of vaccine recipients. A study endorses keep middle seats vacant on planes to curb the virus.

Waiting to receive a vaccine in Vieques, Puerto Rico, last month.
Waiting to receive a vaccine in Vieques, Puerto Rico, last month.Credit…Carlos Giusti/Associated Press

Puerto Rico is reporting a sharp rise in new coronavirus cases and hospitalizations amid a lagging vaccine rollout, and officials are worried that a combination of new variants and people neglecting basic pandemic safety measures may be making things worse.

The island is reporting an average of 1,019 new cases a day — a jump from just 211 a month ago, according to a New York Times database. Hospitalizations have spiked 91 percent in the past two weeks, and deaths are on the rise again.

Like much of the United States, Puerto Rico started to report a drop in cases in mid-January, but in the spring it began to reverse course.

At a news briefing on Monday, Puerto Rico’s health secretary, Carlos Mellado, urged people to change their behavior. More than half the cases, he said, have been traced to family activities.

“I think that there’s a citizen responsibility here,” he said in Spanish. “Every person has to empower themselves for their own health.”

Asked whether he would support a lockdown, Mr. Mellado said, “I won’t discount anything.”

Last week, Puerto Rico announced that it would temporarily close schools again, just a month after some were allowed to reopen for the first time in a year. Gov. Pedro Pierluisi also issued an executive order that went into effect last week extending Puerto Rico’s overnight curfew, prohibiting certain mass gatherings and ordering commercial businesses and restaurants to close at 9 p.m.

“Faced with an uptick in cases like we’re seeing, my responsibility is to act immediately,” Mr. Pierluisi said.

Mr. Mellado said many people don’t seem to understand the severity of the situation, noting that more contagious variants may be contributing to the spread of the virus and that even people who have been fully vaccinated shouldn’t flout the safety protocols.

Residents and experts have also expressed concern about the increasing tourism to the island, with many visitors seemingly ignoring virus precautions. Puerto Rican business owners told CNN last month that visitors often don’t follow mask-wearing rules or respect the curfew. And recent viral videos have highlighted the issue, with — one showing dozens of people crowded together, dancing and singing without masks at a popular San Juan plaza.

Puerto Rico has been slow to vaccinate its population, lagging behind most states and U.S. territories. About 26 percent of its population has received at least one dose of a Covid-19 vaccine, including about 16 percent who are fully vaccinated. Puerto Rico made all people age 16 or older eligible for a vaccine on Monday.

For Puerto Rico, the pandemic has been yet another crisis. The island has also had to contend with a devastating hurricane, a political crisis and a series of earthquakes in recent years. The Biden administration recently announced that it would release $1.3 billion in delayed aid to Puerto Rico to protect against future climate disasters and remove restrictions on another $4.9 billion.

United States > United StatesOn Apr. 13 14-day change
New cases 77,312 +8%
New deaths 987 -27%
World > WorldOn Apr. 13 14-day change
New cases 581,087 +21%
New deaths 12,368 +23%

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Where states are reporting vaccines given

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Preparing doses of the Johnson & Johnson coronavirus vaccine in Houston last month.
Preparing doses of the Johnson & Johnson coronavirus vaccine in Houston last month.Credit…Go Nakamura for The New York Times

An advisory committee for the Centers for Disease Control and Prevention met on Wednesday to discuss the decision made on Tuesday to pause use of the Johnson & Johnson Covid-19 vaccine because of its possible link to extremely rare blood clots. After a robust afternoon discussion, the panel decided they needed more time to assess the data and risks, and would not vote on a recommendation until they meet again in a week or 10 days.

The emergency meeting followed the Food and Drug Administration’s announcement on Tuesday that it was studying six cases of rare and severe blood clots in women aged 18 to 48, one of whom died. All of the women had received the Johnson & Johnson vaccine before developing the clots, though it is unclear whether the vaccine is responsible. As of Tuesday, more than seven million people in the United States have received the shot, and another 10 million doses have been shipped out to the states, according to C.D.C. data.

Following the call from federal health agencies on Tuesday, all 50 states, Washington, D.C., and Puerto Rico on Tuesday quickly paused or recommended that providers pause the administration of the vaccine. The U.S. military, federally run vaccination sites, and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix also paused the injections.

The Advisory Committee on Immunization Practices, or ACIP, is a panel of independent experts who advise the C.D.C. on its vaccine policies. At the meeting, the experts reviewed and debated data from the rare blood clots, including a seventh case, and heard comments from the public, before voting on how to proceed.

The clotting disorder of concern in the vaccine recipients is different — and much rarer — than typical blood clots, which develop in hundreds of thousands of people every year. The seven women had not only clotting in the brain, but a notably low level of platelets, parts of the blood that help form normal clots. Three had large, dangerous clots in other parts of their body as well as in the brain.

Use of the vaccine began on Mar. 2, and the first case of blood clots in the brain was reported on Mar. 19. About 1.4 million women ages 20 to 50 — the age range of those who had the clots — received the vaccine.

The panel experts discussed the known background rates of each condition in the general population, but noted that there is not enough data to precisely estimate how often they occur at the same time.

But based on somewhat rough estimates, the clotting disorder in women ages 20 to 50 who received the Johnson & Johnson vaccine occurred at least three times more often than would be expected, according to Dr. Tom Shimabukuro, a safety expert from the C.D.C.

“Right now, we believe these events to be extremely rare, but we are also not yet certain we have heard about all possible cases, as this syndrome may not be easily recognized as one associated with the vaccine,” Dr. Rochelle P. Walensky, the C.D.C. director, said at a White House news conference on the pandemic on Wednesday.

During the panel discussion, one expert reminded the panel that the “risk window” for the condition among vaccine recipients was still open and new cases might emerge, because nearly 3.8 million people had received the shot within the last two weeks.

Other experts encouraged dissemination of health information on diagnosis and treatment of the condition, so that awareness would be spread among doctors, emergency rooms and people who received the vaccine. They noted that patients with the condition need to be treated as soon as possible because the clots are so serious. Some patients needed invasive procedures to remove large clots from blood vessels in their brains.

The committee’s assessment comes at a crucial time, while the nation is racing to vaccinate as many people as possible to curb the steady accumulation of cases, particularly as worrisome variants gain traction. Some public health experts were disappointed in the F.D.A.’s recommendation to suspend the Johnson & Johnson vaccine, arguing that preventing these extremely rare potential side effects was not worth the trade-off of slowing the vaccination campaign and potentially eroding the public’s trust of vaccines in general.

So far, Johnson & Johnson’s vaccine has amounted to about 5 percent of immunizations in the United States. Several panel members reiterated that two other vaccines — from Moderna and Pfizer-BioNTech — are available, neither associated with the clotting problem, so continuing the pause would not stop most people in the United States from being vaccinated.

At the news conference, Jeffrey D. Zients, the White House’s pandemic coordinator, said that the pause would not generally interrupt the momentum of the country’s vaccination campaign.

“In the very short term, we do expect some impact on daily averages as sites and appointments transition from Johnson & Johnson to Moderna and Pfizer vaccines,” he said. “We have more than enough Pfizer and Moderna vaccine supply to continue or even accelerate the current pace of vaccinations.”

Noah Weiland and Madeleine Ngo contributed reporting.

Registering for a dose of the Pfizer BioNTech vaccine at the Parc des Expositions in Angers, France, on Tuesday.
Registering for a dose of the Pfizer BioNTech vaccine at the Parc des Expositions in Angers, France, on Tuesday.Credit…Stephane Mahe/Reuters

The European Union will receive an extra 50 million doses this month of the coronavirus vaccine developed by Pfizer and BioNTech, a lift in its effort to speed up inoculations in the face of difficulties with vaccines developed by AstraZeneca and Johnson & Johnson.

The announcement by Ursula von der Leyen, the president of the European Commission, is part of the European Union’s hard pivot to mRNA vaccines such as Pfizer’s, staking its future coronavirus response on them.

The moves come a day after Johnson & Johnson suspended the rollout of its vaccine in the European Union and as the bloc continued to suffer the fallout from restrictions on the AstraZeneca vaccine, after reports of extremely rare but serious potential side effects from both.

The 27-nation bloc has also entered negotiations with Pfizer over the supply of 1.8 billion new vaccine doses — including booster shots to prolong immunity and new vaccines to tackle emerging variants — in 2022 and 2023, Ms. von der Leyen said.

In another setback for AstraZeneca, Denmark on Wednesday became the first country to permanently stop the administration of the company’s vaccine, saying the potential side effects were significant enough to do so given that it had the pandemic under control and could rely on two other vaccines, from Pfizer and Moderna.

The European Union has not canceled its existing orders of the AstraZeneca and Johnson & Johnson vaccines, but signaled it was not going to be placing more.

The European Medicines Agency, the bloc’s top drug regulator, continues to say that for most people the benefits of the AstraZeneca vaccine far outweigh the risks of a dangerous, but extremely rare, blood disorder. On Wednesday, the agency said it was expediting its investigation of “very rare cases of unusual blood clots” in recipients of the Johnson & Johnson vaccine, and expected to issue a recommendation next week.

While the evaluation is ongoing, the agency reiterated its view that the benefits of that vaccine also outweigh the risks.

The European Union’s turn away from AstraZeneca follows difficult months in which relations between the company and the bloc deteriorated over delayed shipments and unpredictable supply. And since then, concerns over the possible side effects have exacerbated vaccine skepticism that was already dangerously high in Europe.

Those problems have contributed to Europe’s falling seriously behind vaccination campaigns in the United States and Britain. The bloc is hoping the new Pfizer shipments will help it begin to catch up and to meet its goal to fully vaccinate 70 percent of its adult population by the end of the summer, some 255 million people.

Pfizer’s commitment to bring forward the delivery of the 50 million doses, which were originally slated for the end of the year, means the company will deliver a total of 250 million doses to the bloc by the end of June.

“We need to focus now on technologies that have proven their worth: mRNA vaccines are a clear case in point,” Ms. von der Leyen said.

Monika Pronczuk contributed reporting.

The study used aerosol dispersal data from before the coronavirus pandemic that did not take into account any protective effect of masks worn by passengers.
The study used aerosol dispersal data from before the coronavirus pandemic that did not take into account any protective effect of masks worn by passengers.Credit…Alyssa Schukar for The New York Times

Keeping the middle seats vacant during a flight could reduce passengers’ exposure to airborne coronavirus by 23 to 57 percent, researchers reported in a new study that modeled how aerosolized viral particles spread through a simulated airplane cabin.

“Farther is always better in terms of exposure,” said Byron Jones, a mechanical engineer at Kansas Sate University and co-author of the study. “It’s true in airplanes, it’s true in movie theaters, it’s true in restaurants, it’s true everywhere.”

But the study may have overestimated the benefits of empty middle seats because it did not take into account mask-wearing by passengers.

“It’s important for us to know how aerosols spread in airplanes,” said Joseph Allen, a ventilation expert at Harvard T.H. Chan School of Public Health who was not involved in the study. But he added, “I’m surprised to see this analysis come out now, making a big statement that middle seats should stay open as a risk-reduction approach, when the model didn’t include the impact of masking. We know that masking is the single most effective measure at reducing emissions of respiratory aerosols.”

Although scientists have documented several cases of coronavirus transmission on planes, airplane cabins are generally low-risk environments because they tend to have excellent air ventilation and filtration.

Still, concern has swirled around the risk of airplane travel since the pandemic began. Planes are confined environments, and full flights make social distancing impossible. Some airlines began keeping middle seats vacant as a precaution.

The new paper, published Wednesday in the Morbidity and Mortality Weekly Report, is based on data collected at Kansas State University in 2017. In that study, the researchers sprayed a harmless aerosolized virus through two mock airplane cabins. (One was a five-row section of an actual single-aisle plane; the other was a mock-up of a double-aisle wide-bodied plane.) The researchers then monitored how the virus dispersed through each cabin.

For the new study, researchers from Kansas State and the Centers for Disease Control and Prevention used the 2017 data to model how passengers’ exposure to an airborne virus would change if every middle seat remained open in a 20-row single-aisle cabin.

Depending on the specific modeling approach and parameters they used, keeping the middle seats vacant reduced the total exposure passengers experienced in the simulation by 23 to 57 percent, compared with a fully occupied flight.

“Some airline carriers have been operating with a vacant seat policy, and this study supports the effectiveness of that intervention, in the context of other measures that are in place,” a C.D.C. spokesperson said in an emailed statement.

This reduction in risk stemmed from increasing the distance between an infectious passenger and others as well as from reducing the total number of people in the cabin, which lowers the odds that an infectious passenger would be aboard in the first place.

The laboratory experiments on virus dispersal in aircraft cabins were conducted several years before the current pandemic began, and did not account for any protection that wearing masks could provide.

Masking would reduce the amount of virus that infectious passengers emit into the cabin air and would likely lower the relative benefit of keeping middle seats open, Dr. Allen said.

Dr. Jones concurred. “In general, I would think that wearing a mask would make this effect much less pronounced,” he said. He also noted that simply being exposed to the virus does not mean that someone will be infected by it.

“The extent to which exposure reduction might decrease transmission risk is not yet understood,” the C.D.C. spokesperson said.

The cost-benefit analysis is tricky for airlines. But purely from a health perspective, keeping middle seats open would be helpful, providing a buffer between an infectious person and others nearby, according to Alex Huffman, an aerosol scientist at the University of Denver who was not involved in the study. “Distance matters, for both aerosols and droplets,” he said.

— Emily Anthes

About 15 percent of people vaccinated in Denmark so far were given the AstraZeneca vaccine.
About 15 percent of people vaccinated in Denmark so far were given the AstraZeneca vaccine. Credit…Pool photo by Liselotte Sabroe

Denmark on Wednesday became the first country to plan to permanently stop administering the AstraZeneca vaccine, a month after suspending its use following reports that a small number of recipients had developed a rare but serious blood-clotting disorder.

The director general of the country’s health authority, Soeren Brostroem, said Denmark was able to halt use of the vaccine because it had the pandemic under control and could rely on two other vaccines, from Pfizer and Moderna.

The Danish announcement is another setback for the AstraZeneca shot, which is easy to store and relatively cheap, and was expected to be the foundation of vaccination campaigns around the world.

The country initially suspended the use of the vaccine on March 11, along with Iceland and Norway. Several other European countries, including France, Germany and Italy, followed suit last month.

The European Union’s drug regulator, the European Medicines Agency, later recommended that countries keep using the vaccine, saying its benefits far outweighed any potential risks for most people.

Last week, though, the European regulator listed blood clots as a potential very rare side effect of the vaccine.

Several countries that had paused and restarted use of the vaccine have since said they would stop using it in younger people. Britain, which has administered around 20 million AstraZeneca doses, said it would offer alternative vaccines to people under 30.

“Based on the scientific findings, our overall assessment is there is a real risk of severe side effects associated with using the Covid-19 vaccine from AstraZeneca,” Dr. Brostroem, the Danish health official, said in a statement. “We have, therefore, decided to remove the vaccine from our vaccination program.”

“If Denmark were in a completely different situation and in the midst of a violent third outbreak, for example, and a health care system under pressure,” he added, “then I would not hesitate to use the vaccine, even if there were rare but severe complications associated with using it.”

Danish health officials said that they might reintroduce the AstraZeneca vaccine “if the situation changes.”

Public health officials have warned that pausing administration of vaccines like AstraZeneca’s or Johnson & Johnson’s could do more harm than good. They note that among seven million people vaccinated with the single-dose Johnson & Johnson vaccine in the United States, six women had developed the rare blood clots — fewer than one in one million. It is not yet known whether the vaccine had anything to do with the clots, but even if it did, the risk is smaller than that of getting struck by lightning in a given year (one in 500,000).

Denmark, which has a population of 5.8 million, has managed to contain the pandemic better than its neighbor Sweden or many other European countries. As of Wednesday, Denmark had recorded 2,447 Covid-related deaths.

Almost one million people in the country have received at least a first dose of a vaccine, 77 percent of them the one from Pfizer, according to Denmark’s Serum Institute. Around 15 percent received a first dose of the AstraZeneca vaccine before the authorities suspended its use last month, and the remaining 8 percent received the Moderna vaccine.

The country’s health authorities said that people who received a first dose of the AstraZeneca vaccine would be offered a different vaccine for their second dose.

Jasmina Nielsen contributed reporting.

Health workers prepare to test a patient for coronavirus in Elandsdoorn, South Africa.
Health workers prepare to test a patient for coronavirus in Elandsdoorn, South Africa.Credit…Jerome Delay/Associated Press

South Africa has faced blow after blow to its pandemic-control efforts: A worrisome variant swept across the country, driving a devastating second wave of coronavirus cases. Then officials had to scramble for an alternative when the vaccine it had bet on, from AstraZeneca, proved ineffective against the variant, which can partially dodge the body’s immune system response.

Now the alternative — Johnson & Johnson’s single-dose vaccine, the only one now in use in South Africa — has run into trouble as well, over concerns of rare blood clots that emerged in a handful of people in the United States who had received the shot. It is unclear whether the vaccine is responsible.

South Africa’s health minister, Dr. Zwelini Mkhize, announced on Tuesday that the country would temporarily halt its vaccine program for medical workers, which has inoculated around 290,000 people so far. Dr. Mkhize said he expected the program — a clinical trial — to resume in a few days, after the authorities have had a chance to look into the blood clot cases in the United States.

“Science must be respected at all times, although this may mean a disruption in our plans,” Dr. Mkhize said on Tuesday.

In an emergency meeting on Wednesday, a panel of experts advising the C.D.C. on the issue of the blood clots asked for more time to assess the data and risks involved in the use of the Johnson & Johnson vaccine. They said they would not vote on a recommendation until they meet again in a week or 10 days.

South African health authorities have been gearing up to extend vaccinations to the general public starting in May. That program relies on 30 million doses of the Johnson & Johnson vaccine and 30 million of the two-shot Pfizer-BioNTech vaccine, which South African officials recently secured.

The country halted use of the AstraZeneca vaccine after evidence emerged that it did not protect clinical-trial participants from becoming mildly or moderately ill from the variant, known as B.1.351, that is now dominant in the country. South African authorities then pivoted to the Johnson & Johnson vaccine, which is manufactured in the country under license and has a 64 percent efficacy rate in South Africa, according to an analysis by the U.S. Food and Drug Administration.

Health experts say that the decision on Tuesday to pause vaccinating health care workers is the kind of thing that happens often in clinical trials, and that it probably won’t have any major implications for vaccinating the general public.

“At the moment, there is nothing to indicate that this will delay the national rollout program,” said Dr. Richard Lessells, an infectious diseases specialist at the KwaZulu-Natal Research and Innovation Sequencing Platform.

Even so, if evidence emerges to implicate the Johnson & Johnson vaccine in blood clotting problem, and health officials begin to question its safety, it could be a devastating blow for South Africa, the African country hardest hit by the coronavirus, as it races to inoculate its population before an even more dangerous variant appears.

“The U.S. has access to other vaccines to fill a gap, in terms of not using the Johnson & Johnson vaccine,” said Shabir Madhi, a virologist at University of the Witwatersrand who ran the AstraZeneca vaccine trial in South Africa. “That sort of luxury doesn’t exist in other countries, including South Africa.”

Global Roundup

 People wait for their vaccines at Brent Central Mosque in London earlier this month.
People wait for their vaccines at Brent Central Mosque in London earlier this month.Credit…Andrew Testa for The New York Times

Researchers in Britain investigating the effects of using one coronavirus vaccine for a first dose and another for a second have expanded their trial, they said on Wednesday, a day after the pause in the rollout of the Johnson & Johnson vaccine in the United States, the European Union and South Africa fueled uncertainties about vaccination campaigns.

Mixing doses could help countries weather vaccine supply shortages. Some governments have also recommended that some people who have received a first dose of the AstraZeneca vaccine receive a second injection of a different vaccine after a small number of recipients developed a rare blood-clotting disorder.

On Wednesday, German health authorities recommended that anyone under 60 who had received an initial inoculation with the AstraZeneca vaccine be given either the Pfizer/BioNTech or the Moderna vaccine for their second shot.

Some 2.2 million AstraZeneca doses were given to Germans younger than 60 when the authorities first began administering the vaccine, only to reverse that strategy after detecting several dozen cases of clotting.

Public health officials have emphasized that the benefits of the vaccines that have come under scrutiny still far outweigh the potential risks for most people, and some have warned that pausing their rollout could do more harm than good.

The Com-Cov study led by the University of Oxford began in February using AstraZeneca and Pfizer shots, but on Wednesday the researchers announced that they would recruit more volunteers and expand the trial to include doses of the vaccines developed by Novavax and Moderna.

“If we can show that these mixed schedules generate an immune response that is as good as the standard schedules, and without a significant increase in the vaccine reactions, this will potentially allow more people to complete their Covid-19 immunization course more rapidly,” said Dr. Matthew Snape, the lead investigator of the trial.

Researchers are expecting to publish their first findings by July, although the study will run for a year.

In other news around the world:

  • Reduced air pollution during the first lockdown in France may have led to “non-negligible health benefits,” the national public health agency said on Wednesday. A study by the agency estimated that the two-month lockdown last spring had avoided roughly 2,300 deaths from exposure to particulate matter pollution and another 1,200 from exposure to nitrogen dioxide, mainly related to traffic.

  • India has recorded a record 184,372 new coronavirus cases in 24 hours, officials said on Wednesday, as Maharashtra State, the country’s second most populous, prepared to impose a 15-day lockdown. The authorities in Maharashtra ordered its 120 million residents to remain indoors except for essential reasons beginning Wednesday evening. Hospitals there are running out of beds and essential supplies, and the state’s top official, Uddhav Thackeray, has asked the central government to mobilize the Indian Air Force to deliver oxygen cylinders. The leader of the state of Uttar Pradesh, Yogi Adityanath, said on Wednesday that he had tested positive for the coronavirus and was self-isolating.

  • Infections are surging in Thailand, which reported 1,335 new cases on Wednesday, its highest one-day total of the pandemic. Although the country has kept the virus largely under control for more than a year, officials are worried that the latest outbreak, centered in Bangkok, could spread nationwide as people visit relatives during the ongoing Songkran holiday, which marks the Thai New Year. With less than 1 percent of the population vaccinated, most of Thailand’s provinces have imposed entry restrictions.

Aurelien Breeden contributed reporting.







‘We Were Thrown A Curveball’: De Blasio Addresses Vaccination Plan

Mayor Bill de Blasio and the city health commissioner, Dr. Dave A. Chokshi, addressed New York City’s coronavirus vaccination effort and the impact of the pause of Johnson and Johnson vaccines on appointments. The city said that most people will be able to continue with their scheduled appointments, but will receive a different vaccine.

“Let’s be blunt. Yesterday, we were thrown a curveball. The news about Johnson & Johnson, which I hope and believe will be a very temporary pause, but yesterday we were thrown a curveball and our job is to hit that ball out of the park anyway, to just keep going, keep moving forward. New Yorkers do that no matter what. The vaccination effort has built and grown, no matter what. And we’re going to keep building it.” “The vast majority of New Yorkers who booked appointments for the J&J vaccine will keep the same appointment, and receive Pfizer or Moderna instead. Second, we did have to reschedule about 4,000 people yesterday. Those New Yorkers received messages about new appointments for later this week.”

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Mayor Bill de Blasio and the city health commissioner, Dr. Dave A. Chokshi, addressed New York City’s coronavirus vaccination effort and the impact of the pause of Johnson and Johnson vaccines on appointments. The city said that most people will be able to continue with their scheduled appointments, but will receive a different vaccine.CreditCredit…Spencer Platt/Getty Images

New York City officials said Wednesday that the vast majority of people who were supposed to receive Johnson & Johnson’s coronavirus vaccine would keep their scheduled appointments but instead receive either the Pfizer-BioNTech or Moderna vaccine.

The change came after federal health authorities called for a pause in Johnson & Johnson vaccinations on Tuesday as they investigated a rare blood-clotting disorder that emerged in a small number of recipients. States, including New York, followed suit in halting the injections.

About 4,000 people who were supposed to receive Johnson & Johnson shot had to reschedule their appointments on Tuesday, a relatively small number of the tens of thousands of people who are vaccinated daily, city officials said at a news conference.

The city had been relying on the vaccine to inoculate hard-to-reach New Yorkers, including people who are homebound. That homebound program will be suspended through Sunday, though the city is helping to arrange transport to a nearby vaccine site where that’s possible, said the city health commissioner, Dr. Dave Chokshi.

“We were thrown a curveball” on Tuesday by news of the disorder, Mayor Bill de Blasio said, “and our job is to hit that ball out of the park anyway.”

Some public health experts are concerned that the pause could sour the public on the shot and contribute to conspiracy theories and hesitancy to be vaccinated.

Dr. Chokshi said that “vaccines usually carry a very small risk of side effects, but it’s also important to keep in mind the other side of the equation, to remember that authorized vaccines protect us from diseases that threaten us so much more.”

He added that “to put a new twist on an old idiom, we may have more to fear from fear itself.”

In an emergency meeting on Wednesday, a panel of experts advising the Centers for Disease Control and Prevention on the blood clot issue asked for more time to assess the data and risks involved in the use of the Johnson & Johnson vaccine. They said they would not vote on a recommendation until they meet again in a week or 10 days.

The Johnson & Johnson vaccine pause comes as coronavirus cases in the city remain stubbornly high, even as more than five million vaccine doses have been administered overall.

Worrisome variants of the virus are a likely reason for the continued spread in the city, public health officials have said. A recent analysis shows that such variants could account for more than 75 percent of new cases genetically analyzed in the city. Sequencing capabilities remain limited in the city, only providing a glimpse of the full picture of how the variants are impacting each community.

The two main variants drawing concern from city officials are B.1.526, which was first discovered in the city, and B.1.1.7, which was first detected in Britain, spread around the globe, became the dominant version in the United States and now makes up nearly 30 percent of cases sequenced in the city.

Even though both variants have become increasingly prevalent in the city, hospitalizations seem to be on a slight decline, according to city data.

“We’ve got to keep our guard up, but the strategy remains the same,” Mr. de Blasio said. “Vaccination works, that part is clear, and that’s where we just have to put all of our efforts to once and for all beat them back.”

At his own news conference later in the day, Gov. Andrew M. Cuomo said that he would reopen racetracks and allow restaurants, bars and catered events to stay open an hour later each night.

Starting on April 19, closing time at bars and restaurants will be pushed back to midnight, and catered events can go until 1 a.m., he said. Horse and automobile races will be allowed to reopen at 20 percent capacity for outdoor events starting on April 23.

The decision to further relax restrictions comes as conditions in New York have improved slightly, but are still worse than those in much of the rest of the country.

According to a New York Times database, New York State is adding new virus cases at the fifth-highest rate in the country. As of Tuesday, the state was reporting an average of 36 new virus cases a day for every 100,000 residents, compared to 21 for the nation as a whole.

Sarah Cahalan contributed reporting.

Gov. Gretchen Whitmer of Michigan implored her state's residents to follow precautions.
Gov. Gretchen Whitmer of Michigan implored her state’s residents to follow precautions.Credit…Michigan Office of the Governor, via Associated Press

Michigan’s worst-in-the-nation coronavirus outbreak shows no signs of abating. Daily reports of new cases continue to climb. Hospitalizations are approaching peak levels. And deaths are rising, too.

But Gov. Gretchen Whitmer, a Democrat who unapologetically locked down her state last year, signaled again on Wednesday that she had no plans to impose new restrictions.

“Instead of mandating that we’re closing things down, we are encouraging people to do what we know works,” Ms. Whitmer said, stressing that a mask mandate and occupancy limits remained in place in the state. “It’s not the policy problem. It is a variant and compliance problem.”

Ms. Whitmer finds herself overseeing a rapidly escalating crisis with no easy solutions. Sixteen of the 17 metro areas with the highest recent case rates in the country are in her state, which has accounted for more than 10 percent of all U.S. cases reported in the last week.

The governor has also clashed publicly with the Biden administration, which has declined to send the extra vaccines she requested and instead suggested a shutdown.

In the meantime, the situation remains dire.

“Patients are again lining our hallways, like they were last spring,” said Dr. Joneigh Khaldun, the state’s chief medical executive, describing the situation in Michigan hospitals. She added: “Just because something is open and legal, it does not mean that you should be doing it.”

Politically, imposing another shutdown in Michigan would range from difficult to untenable, especially given Ms. Whitmer’s tense relations with the Republicans who control the State Legislature. Earlier this week, State Representative Steve Johnson, a Republican, said that ordering a new lockdown would amount to “political suicide.” Even most Democrats have avoided calling for such a step.

“It’s the governor’s decision, and to me it’s not a clear-cut decision one way or the other,” Mayor Mike Duggan of Detroit said Wednesday. He blamed backyard parties and maskless private gatherings — not restaurants or gyms — for driving up case reports in his city.

“If she shuts these things down, and the gatherings are in private homes, have you really made an impact?” said Mr. Duggan, a Democrat.

Instead of ordering a new shutdown, Ms. Whitmer spent much of her news conference on Wednesday talking about the benefits of therapeutics, including monoclonal antibodies, and urging people to be open to those treatments if they are given a Covid-19 diagnosis. She also pleaded with residents to wear masks and get vaccinated.

“We are seeing people abandoning the protocols, we are seeing more mobility,” Ms. Whitmer said. “And the worst part is, we now have the existence of variants here in Michigan that are just easier to spread.”

Outside the National Stadium in Tokyo on Wednesday. The Olympics are scheduled to begin there on July 23.
Outside the National Stadium in Tokyo on Wednesday. The Olympics are scheduled to begin there on July 23.Credit…Tomohiro Ohsumi/Getty Images

Organizers marked 100 days until the start of the Tokyo Olympics on Wednesday with a subdued ceremony amid tougher restrictions and growing questions over the event as Japan endures another surge of coronavirus infections.

The governor of Tokyo, Yuriko Koike, pledged that officials would do everything to deliver a “memorable tournament.” Wearing a mask and gloves, she unveiled statues of the Olympic mascots inside Tokyo government headquarters while a video link showed another group of officials unveiling a monument of the Olympic rings atop fog-shrouded Mount Takao, 30 miles west of the capital.

But parts of Tokyo and other municipalities remain under a quasi-state of emergency ordered last week to stem what officials describe as Japan’s fourth wave of infections. Japan has recorded nearly 3,200 infections a day over the last week, according to a New York Times database — few by the standards of the United States and Europe, but a worryingly high number for Asia.

The host nation is also lagging in vaccinations: Shots for those 65 and just began on Monday. So far, Japan has inoculated only frontline medical workers, who make up less than 1 percent of the population, and it will be far from fully vaccinated by July 23, when the Games are scheduled to begin.

Japan is calling these the “Recovery Olympics” — highlighting the nation’s recovery from the devastating earthquake, tsunami and nuclear disaster in 2011, as well as the world’s recovery from the pandemic. But the Games, originally scheduled for last year, are marching on despite more than 70 percent of the Japanese public saying they should be delayed again or called off entirely.

Organizers announced last month that international spectators would be barred, although thousands of athletes from over 200 nations are expected to compete. The ceremonial torch relay has been making its way across Japan with little fanfare; its two-day leg in Osaka this week was diverted off public roads and took place in an empty park.

President Jair Bolsonaro of Brazil has been dismissive of pandemic precautions, even as his country became one of the hardest hit by the coronavirus in the world.
President Jair Bolsonaro of Brazil has been dismissive of pandemic precautions, even as his country became one of the hardest hit by the coronavirus in the world. Credit…Ueslei Marcelino/Reuters

RIO DE JANIERO — Brazil’s Congress launched an inquiry on Tuesday into the government’s handling of the Covid-19 pandemic, raising tensions between President Jair Bolsonaro and local elected officials.

The investigation is expected to give critics of Mr. Bolsonaro a high-profile forum to outline missteps by the government over the past year that turned Brazil into the hardest hit nation at this stage of the pandemic.

Mr. Bolsonaro has spoken dismissively about the severity of the virus, calling it a “measly flu,” and has opposed restrictive measures to limit its spread, including lockdowns and business shutdowns. Even as the death toll from Covid-19 in Brazil exceeded 4,000 a day for the first time last week, Mr. Bolsonaro’s government was fighting in court to keep churches open.

Mr. Bolsonaro has also endorsed the use of a cocktail of drugs that leading medical organizations have concluded are ineffectual, and in some cases dangerous, for Covid-19 patients.

For months, the leaders of Brazil’s Congress showed little interest in investigating the government’s failures or holding officials accountable. But a Supreme Court justice ordered the leader of the Senate last week to open a special inquiry, because a sufficient number of senators were in favor.

Mr. Bolsonaro criticized the effort last week, saying that a legislative inquiry would further polarize the country at a time of crisis.

“What we need least is more conflict,” he said in an interview with CNN Brasil.

Mr. Bolsonaro has pressed his allies in Congress in recent days to broaden the scope of the inquiry to cover the actions of state and municipal governments as well as his own administration.

Health experts say Brazil’s response to the pandemic has been disastrous. A highly contagious variant of the virus that was first discovered in Brazil last year has overwhelmed hospital systems in several states and driven up contagion in neighboring countries. Brazil is now averaging more than 70,000 new cases a day, rivaling the United States, whose population is half again as large.

“Brazilian authorities’ refusal to adopt evidence-based public health measures has sent far too many to an early grave,” Christos Christou, the international president of Doctors Without Borders, said in a statement. “This has put Brazil in a permanent state of mourning, and led to the near collapse of Brazil’s health system.”

Last week, Brazil accounted for 26 percent of the world’s Covid deaths and 11 percent of newly reported cases, according to the organization. Brazil’s population is about 2.7 percent of the world’s population.

Credit…Chiara Zarmati

In March, a year into the pandemic, Jane Fraser, the chief executive of Citigroup, made a new workplace rule: no video calls on Fridays.

“After listening to colleagues around the world,” she wrote in a companywide blog post, “it became apparent we need to combat the ‘Zoom fatigue’ that many of us feel.”

Video calls have emerged as such a widespread pain point in this era of remote work that the term “Zoom fatigue” has entered our lexicon — a catchall phrase referring to the tiredness related to video calls on any number of platforms.

Now, research from Stanford University published on Tuesday found that women experience significantly more Zoom fatigue than men.

The research, which hasn’t been peer-reviewed, suggests that video calls amplify longstanding gender dynamics in group settings and exacerbate an already wide gender stress gap, with women consistently reporting more stress and stress-related health conditions than men, according to the American Psychological Association.

During in-person meetings, people aren’t staring into your face from nearby — some might be typing notes, some might be reading. Video calls disrupt that natural rhythm, forcing everyone logged in to stare at each other, a phenomenon known as “hyper gaze.”

“From an evolutionary standpoint, if somebody was very close to you and staring right at you, this meant you were going to mate or get in a fight,” said Jeremy Bailenson, founding director of Stanford University’s Virtual Human Interaction Lab and a co-author of the study. Constantly being on high alert, he said, creates stress.

He and other researchers created a scale to measure five types of fatigue associated with video calls: general (overall tiredness), social (wanting to be alone), emotional (being overwhelmed and “used up”), visual (symptoms of stress on one’s eyes) and motivational (lacking the drive to start new activities). In their most recent survey of over 10,000 participants, the researchers found that women of all ages scored higher on all five.

In a second survey, the researchers discovered that women reported more mirror anxiety — a psychological phenomenon where seeing oneself in a mirror can trigger heightened self-focus, which in turn creates more anxiety and depression. The self-view in video calls seems to be replicating the mirror anxiety effect, said Geraldine Fauville, a researcher who worked on the study.

As companies consider post-pandemic work culture, the solutions to Zoom fatigue aren’t going to be as simple as switching off self-view (which the researchers recommend you do anyway) or abandoning video calls, said Mollie West Duffy, co-author of “No Hard Feelings: The Secret Power of Embracing Emotions at Work.”

“I don’t think anyone has a playbook for how to do this perfectly,” Ms. Duffy said, “so we’re going to all try to do our best and then we’re going to have to be willing to have conversations two months in about how to adapt.”

The Heliix Health Passport uses an encrypted code to show the results of a recent Covid test or vaccination.
The Heliix Health Passport uses an encrypted code to show the results of a recent Covid test or vaccination.Credit…Ethan Miller/Getty Images

With all American adults soon to be eligible for Covid-19 vaccines and businesses and international borders reopening, a fierce debate has kicked off across the United States over whether a digital health certificate (often and somewhat misleadingly called a “vaccine passport”) should be required to prove immunization status.

Currently, Americans are issued a white paper card as evidence of their Covid-19 shots. But these can easily be forged, and online scammers are already selling false and stolen vaccine cards.

While the federal government has said it will not introduce digital vaccine passports by federal mandate, a growing number of businesses say they will require proof of vaccinations for entry or services.

The drive has raised privacy and equity concerns. States such as Florida and Texas have banned businesses from requiring vaccination certificates.

Governments, technology companies, airlines and other businesses are testing different versions of the digital health passes and are trying to come up with common standards so that there is compatibility between each system and health records can be retrieved securely.

Here’s what we know.

For the moment, only if you live in New York. Last month, it became the first state in the United States to launch a digital health certificate called the Excelsior Pass, which verifies a person’s negative coronavirus test result and if they are fully vaccinated.

Some airlines including Lufthansa, Virgin Atlantic and Jet Blue have started to use the digital health app, Common Pass, to verify passenger Covid-19 test results before they board flights.

It depends on state regulations. The Biden administration has said there will be no federal vaccination system or mandate. Individual states hold primary public health powers in the United States and have the authority to require vaccines.

All states except New Hampshire have their own immunization registries and some cities, like New York, have their own.

Currently states are required to share their registries with the Centers for Disease Control and Prevention, but the data is not public and could be withheld.

“There are a whole lot of valid concerns about how privacy and technology would work with these systems, especially as Silicon Valley does not have a great history delivering technologies that are privacy enhancing,” said Brian Behlendorf, executive director of Linux Foundation Public Health, an open-source, technology-focused organization.

Some argue that such a credential would intrude on personal freedoms and private health choices.

Others worry that an exclusively digital system would leave some communities behind, especially those who do not have access to smartphones or the internet.

The World Health Organization says it does not yet support requiring vaccination passports for travel because of the uncertainty over whether inoculation prevents transmission of the virus, as well as equity concerns.

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