Coronavirus Updates The latest developments in the COVID-19 pandemic.
The novel coronavirus, first detected at the end of 2019, has caused a global pandemic.

Coronavirus Updates

Latest developments in the COVID-19 pandemic

Tokyo Games Delivery Officer Hidemasa Nakamura holds a sample of an updated version of the playbook during a news briefing on Wednesday. Franck Robichon/Getty Images hide caption

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Franck Robichon/Getty Images

Tokyo Games Delivery Officer Hidemasa Nakamura holds a sample of an updated version of the playbook during a news briefing on Wednesday.

Franck Robichon/Getty Images

The organizers of Japan's Summer Olympics, due to start just weeks from now, say they will administer daily coronavirus tests to athletes and will decide in June on what is a safe number of spectators.

At a virtual meeting on Wednesday, International Olympic Committee President Thomas Bach and representatives of the other organizers discussed measures to keep the coronavirus in check during the games, which begin July 23.

"The IOC is fully committed to the successful and safe delivery of the Olympic and Paralympic Games Tokyo 2020," Bach said in his opening remarks.

He said organizers will "strictly enforce" the restrictions, according to Kyodo News, which said that the revised rules are part of the newest version of the organizers' "playbook."

The games — already delayed by a year due to the pandemic — are set to go ahead despite reluctance among the Japanese public. Recent opinion polls have shown that more than half are not in favor of hosting the games this year.

Japan has had relatively few coronavirus infections to date — around 600,000, with around 10,000 deaths.

Even so, despite securing the largest number of doses of any country in Asia and having among the best health care systems in the world, Japan has struggled to vaccinate its 126 million people. It has one of the lowest vaccination rates among wealthy countries, with less than 2% of its population fully inoculated against COVID-19. That figure is far lower than the U.S. (29.1%) and also lags behind most of Asia.

By the end of the month, Japan will have imported 17 million doses of the Pfizer-BioNTech vaccine, according to a schedule from the Cabinet Office that was cited by Reuters.

Tokyo on Wednesday confirmed 925 infections — its largest single-day figure since the end of January. Osaka, the country's third-most populous prefecture, reported 1,260 cases on Wednesday, Japan Times reports.

A young man receives a COVID-19 vaccine in Charleston earlier this month while overlooking the West Virginia Capitol building. Stephen Zenner/SOPA Images/LightRocket via Getty Images hide caption

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Stephen Zenner/SOPA Images/LightRocket via Getty Images

A young man receives a COVID-19 vaccine in Charleston earlier this month while overlooking the West Virginia Capitol building.

Stephen Zenner/SOPA Images/LightRocket via Getty Images

Young people who get the COVID-19 vaccine in West Virginia won't just gain protection against a deadly virus — they'll also make money.

The state will offer a $100 savings bond to everyone between the ages of 16 and 35 who gets vaccinated, Gov. Jim Justice, a Republican, announced at a Monday briefing. It's part of an ongoing push to get shots into the arms of younger residents, who have been largely slow to roll up their sleeves so far.

"Our kids today probably don't really realize just how important they are in shutting this thing down," Justice said. "I'm trying to come up with a way that's truly going to motivate them — and us — to get over the hump."

The initiative will apply retroactively to people in this age group who have already gotten their shots. It is funded with money from the CARES Act, with Justice adding that officials have "vetted this in every way that we possibly can."

West Virginia's vaccine rollout got off to a famously strong start earlier this year. Despite challenges such as a widespread lack of Internet access, the largely rural state had managed to fully vaccinate such a large percentage of its eligible population by late February that, had it been a country, it would have ranked third in the world.

But as eligibility expanded, the pace of vaccinations slowed. The state now ranks 29th in the country, according to NPR's vaccine tracker, which says 29% of the population has been fully vaccinated and 35.3% has had at least one dose.

West Virginia opened vaccinations to residents ages 16 and older in mid-March but is continuing to prioritize vaccinations for those 65 and older. As of Monday, Justice said, more than 78% of people in the older age group have received at least one dose, while 68.5% have been fully vaccinated.

Demand for vaccines has dipped in recent weeks, with West Virginia Public Broadcasting noting that "most who wanted to be vaccinated have been, and the remaining West Virginians just don't want the shot, leaving local health officials scrambling to use up their shipments."

So the state has turned its attention to vaccinating young people, who are now getting infected at noticeably higher rates.

West Virginia Public Broadcasting reported earlier this month that people younger than 20 were accounting for 26% of all cases statewide, compared to 16% over the course of the pandemic. More than 30 school outbreaks had been reported at the time, many tied to extracurricular activities and social events.

Justice said Monday that the state's 380,000 residents between 16 and 35 are "not taking vaccines as fast as we'd like them to take them."

"If we really want to move the needle, we've got to get our younger people vaccinated," he added.

Justice's goal is to get more than 70% of West Virginia's eligible population vaccinated. He said that if approximately 80% of people in this age group who have not yet gotten the shot choose to do so, the overall statewide vaccination rate will exceed that number.

"If we can get to 70%, we'll shut this virus down," he said. "If we do that, the masks go away, the hospitalizations go away, and the deaths become minimal."

As of Monday, the state's health department had recorded 151,671 total coronavirus cases and 2,821 deaths since the start of the pandemic.

A man receives a dose of the AstraZeneca COVID-19 vaccine at the Rommel Fernández Stadium in Panama City, Panama. In the absence of Food and Drug Administration authorization, the U.S. government has been sitting on a stockpile of doses. Luis Acosta/AFP via Getty Images hide caption

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Luis Acosta/AFP via Getty Images

A man receives a dose of the AstraZeneca COVID-19 vaccine at the Rommel Fernández Stadium in Panama City, Panama. In the absence of Food and Drug Administration authorization, the U.S. government has been sitting on a stockpile of doses.

Luis Acosta/AFP via Getty Images

The United States will release 60 million doses of the COVID-19 vaccine from drugmaker AstraZeneca to other countries over the next several months, the White House announced Monday.

The vaccine, which has not been authorized for use in the U.S., will be released once it clears safety reviews by the Food and Drug Administration. That could happen in the "coming weeks," White House press secretary Jen Psaki said at a press briefing.

The White House did not specify which countries would receive the vaccine, but about 10 million doses are ready to ship once regulatory clearance has been granted, Psaki said. The remaining doses are expected to be distributed throughout May and June.

The AstraZeneca vaccine has been widely used across Europe and elsewhere around the world. But the company has not yet applied for emergency authorization in the U.S. The vaccine is reported to be effective at preventing transmission and hospitalization, but the company has faced questions from U.S. regulators about data from its trials.

In the absence of FDA authorization, the U.S. government has been sitting on a stockpile of millions of doses, with more on order.

"We do not need to use AstraZeneca in our fight against COVID in the next few months," Psaki said at Monday's briefing.

The White House has expressed confidence that the supply of the vaccine doses made by Pfizer, Moderna and Johnson & Johnson will be sufficient for the ongoing vaccination campaign in the United States. More than half of American adults have received at least one shot of the vaccine.

Monday's announcement comes as the Biden administration has been under increased pressure to assist other countries in the fight against the virus, especially India, which has in recent weeks rapidly become the world's worst COVID-19 hot spot.

"The U.S. has a tremendous number of resources at its disposal, and so if the U.S. government really gets involved and decides it's going to help an ally and a fellow democracy, I think it can make a big difference," Dr. Ashish Jha, dean of Brown University's School of Public Health, said in an interview with NPR's Morning Edition.

The White House announced Sunday it would work to send India therapeutics, testing supplies and equipment to help generate and transport more oxygen. The White House also said Sunday it would divert some orders of vaccine materials made by U.S. companies to India so that more vaccine doses can be manufactured there.

On Monday, President Biden reiterated those pledges in a call with Indian Prime Minister Narendra Modi.

Asked about criticisms that the White House has taken too long to send aid to India, Psaki defended the administration's timing.

"The United States has been one of the largest providers of assistance to address the COVID pandemic around the world, including to India," she said. "I will also say that we are continuing to fight a pandemic here."

Public health experts welcomed the news about the Biden administration's decision to share the AstraZeneca vaccine. Many of them had been calling on the administration to release the doses.

"There's only one path out of this pandemic that we are in, and that is getting the world vaccinated," Jha said. "If we don't, we're going to be dealing with this for many, many years. So this has got to be priority No. 1."

Workers greet arrivals at a drive-in vaccination site at University of New Mexico's Gallup campus in Gallup, N.M., on March 23. The Navajo Nation has vaccinated more than half of its adult population, outpacing the U.S. national rate. Cate Dingley/Bloomberg via Getty Images hide caption

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Cate Dingley/Bloomberg via Getty Images

Workers greet arrivals at a drive-in vaccination site at University of New Mexico's Gallup campus in Gallup, N.M., on March 23. The Navajo Nation has vaccinated more than half of its adult population, outpacing the U.S. national rate.

Cate Dingley/Bloomberg via Getty Images

The Navajo Nation has vaccinated more than half of its adult population against COVID-19, outpacing the U.S. national rate and marking a significant turnaround for what was once the site of the highest per-capita infection rate in the country.

About half of the tribe's more than 300,000 enrolled members live on its reservation, which spans Arizona, New Mexico and Utah and is considered the largest in the country. Navajo Nation President Jonathan Nez celebrated the success of the vaccine rollout but urged continued caution in a statement on Sunday.

"Over half of the adult population on the Navajo Nation has been vaccinated, but to reach herd immunity we need more people to get vaccinated," he said. "The great work being done by our frontline health care workers is being recognized nationally and rightfully so. ... Please help them by continuing to take all precautions and staying safe."

According to the Navajo Times, 87.8% of the eligible population — or more than 8 out of 10 people — had received at least one dose as of Friday, and 38.4% had been fully vaccinated. In contrast, NPR's vaccine tracker reports as of Monday, that 42.2% of the U.S. population has had at least one dose and 28.5% has been fully vaccinated.

The Navajo Nation recorded 26 new cases and 10 deaths over the weekend — a marked departure from the end of last year, when it was reporting an "uncontrolled spread" of coronavirus across 75 of its communities.

The coronavirus has hit tribal communities across the U.S. disproportionately hard: Native Americans are among the most at risk when it comes to contracting the virus, and have died at more than twice the rate of white people.

The Navajo Nation specifically has seen some of the country's highest infection rates compared to other states, and in May was home to the highest per-capita infection rate in the U.S.

Cases surged again in November and December, driven largely by social gatherings, and prompted a series of lockdown orders. And while the Navajo Nation's public health orders have been strict, the states that it encompasses have taken different approaches. As Nez told NPR in January, Arizona did not have a statewide mask mandate, while New Mexico did.

"We're like an island, the Navajo Nation within these three states," he said. "If other areas around us are not taking it seriously, it does impact the Navajo Nation."

The rapid spread of the disease has also been attributed to challenges that the reservation has faced for years, like the lack of clean, running water and reliable electricity in many households and the fact that hospitals are few and far apart. The vast geography and lack of infrastructure only made contract tracing efforts even more difficult.

The Indian Health Service has been "underfunded since its inception," Nez told CBS' Face the Nation earlier this month. On a more optimistic note, he said that healthcare professionals have been making the most of their limited resources and that the Biden administration's American Rescue Plan is expected to help facilitate its economic recovery.

Despite logistical challenges and initial vaccine hesitancy, the Navajo Nation's vaccine rollout got off to a strong start — and by the end of January, 1 in 5 residents had received at least one dose. The numbers rose quickly from there.

"I think just because of how hard hit the Navajo Nation was, we've seen a big increase in participation in taking the vaccine," Nez told Face the Nation.

First Lady Jill Biden got a glimpse of that effort last week during a two-day visit to the reservation, where she met with students, educators, women leaders, business owners and health care workers. One of her stops was a vaccination site, which Nez said demonstrates the Biden administration's commitment to "the Navajo Nation and all of our health care workers."

Now, the Navajo Nation is taking steps toward easing certain public health measures.

It moved into "yellow status" on Monday, allowing marinas, parks, museums and indoor dining to open at 25% capacity and most other businesses to operate at 50% capacity.

A separate order allows gatherings of no more than 15 people with face masks and social distancing required, and permits church services and drive-through gatherings with limited occupancy. Gyms and movie theaters remain closed, and a curfew is in place between 11 p.m. and 5 a.m.

In his statement, Nez urged people to continue "pushing back on the virus" by staying home as much as possible, avoiding large gatherings, wearing a mask, practicing social distancing and washing their hands often.

"The pandemic has led to many challenges, but it is also making us stronger and giving us a renewed appreciation for our blessings in life," said Navajo Nation Vice President Myron Lizer. "We have to continue to pray for more strength every day and keep supporting one another. We are in this together and we are overcoming this pandemic day by day."

The Centers for Disease Control and Prevention has released new guidance detailing steps summer camps should take to prevent and respond to COVID-19 infections. Brandon Chew/Chicago Tribune/Tribune News Service via Getty Images hide caption

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Brandon Chew/Chicago Tribune/Tribune News Service via Getty Images

The Centers for Disease Control and Prevention has released new guidance detailing steps summer camps should take to prevent and respond to COVID-19 infections.

Brandon Chew/Chicago Tribune/Tribune News Service via Getty Images

Last year, the coronavirus pandemic forced many summer camps to close and families to change their plans. Now, new guidance from the Centers for Disease Control and Prevention says camps will be able to open for in-person activities, provided they take specific steps to prevent the spread of COVID-19.

The guidance was released over the weekend and applies to both day and overnight camps. It emphasizes the importance of wearing masks, social distancing and getting vaccinated as soon as possible.

"Consistent and layered use of multiple prevention strategies can help camps open safely for in-person activities; protect children, families, and staff; and slow the spread of the virus that causes COVID-19," it reads.

While fewer children have gotten sick with COVID-19 than adults, the CDC explains, they can still get infected and spread the virus to others. The guidance notes the key role that camps play in individuals' social, emotional and physical development, and goes on to outline strategies they can use to maintain healthy environments and prepare to respond to potential infections.

The CDC stressed this guidance is intended to supplement state and local health measures with which camps must comply, and its implementation should be tailored to the specific needs of each community.

"Camp administrators, working with local public health officials, should assess the level of community transmission to understand the burden of disease in the community," it says. "The higher the level of community transmission, the more likely that the virus that causes COVID-19 will be introduced into the camp facility from the community, which could lead to in-camp transmission if layered prevention strategies are not in use."

While all American adults are now eligible to get vaccinated, and a growing number have done so, none of the three COVID-19 vaccines available in the U.S. have been authorized for use in children under the age of 16.

For that reason, the guidance says that camps must continue prevention measures such as mask-wearing and physical distancing even after employees have been fully vaccinated.

Everyone in camp facilities must wear well-fitting masks at all times, with exceptions for certain activities such as eating, drinking and swimming. The guidance recommends disposable masks or cloth masks with two or more layers of fabric, and says they should be stored properly and washed regularly. Staff and campers are urged to have multiple masks on hand to replace ones easily that get wet or dirty.

Camp policies must promote physical distancing indoors and outdoors in line with the current recommendations for K-12 schools, the guidance adds.

It suggests creating cohorts, or groups of campers and staff that stay together throughout the day, and limiting exposure between them. Camps should require at least 3 feet between campers within a cohort, while 6 feet of distance is required in other situations, including during mealtimes and between campers and staff.

Most activities should take place outdoors, and camps should adopt ventilation and disinfection practices for indoor spaces. They should also teach and reinforce hygiene practices such as frequent hand-washing and limiting sharing of objects.

The guidance discourages close-contact and indoor sports, noting the increased risk of spreading COVID-19 in those situations.

It also suggests modifying a number of activities and traditions for safety's sake, such as avoiding group activities where distance cannot be maintained, limiting nonessential visits from other individuals and organizations, and performing activities such as singing and chanting outdoors only.

Campers can take trips to places where they will not mix with others outside of the camp population, such as hiking trails or beaches, it adds.

Several sections of the guidance discuss communication strategies, such as signage and announcements for campers and outreach to their families.

There are specific recommendations for what to do if someone gets sick while at camp, and when campers or staff should stay home. An additional section for overnight camps discusses screening testing, symptom checking and contact tracing policies in more detail.

It also outlines steps campers should take before their arrival, such as quarantining in line with travel guidance and getting either vaccinated or tested within a certain time frame. Upon their return home, campers and staff who are not fully vaccinated should get a viral test after three to five days and self-quarantine for one week.

A man takes a picture at sunset with the Eiffel Tower in the background in March in Paris. The president of the European Commission says fully vaccinated Americans will be able to visit the European Union this summer. Ludovic Marin/AFP via Getty Images hide caption

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Ludovic Marin/AFP via Getty Images

A man takes a picture at sunset with the Eiffel Tower in the background in March in Paris. The president of the European Commission says fully vaccinated Americans will be able to visit the European Union this summer.

Ludovic Marin/AFP via Getty Images

American tourists who have been fully vaccinated will be allowed to visit the European Union this summer, according to officials in Brussels.

Ursula von der Leyen, president of the European Commission, said she expects all 27 EU member states will accept travelers who've received COVID-19 vaccines that the European Medicines Agency has approved. That would include the three vaccines that have been authorized for use in the United States — Moderna, Johnson & Johnson and Pfizer-BioNTech.

"This will enable free movement and travel to the European Union," von der Leyen said Sunday in an interview with The New York Times, which first reported the story.

It is not yet clear when the EU will open up — von der Leyen did not provide a specific timeline, and individual EU member states are permitted to enforce stricter rules than the bloc as a whole. It is also unclear how countries will determine if travelers have been fully vaccinated, but nations and air carriers in Europe have been discussing the use of vaccine passports or vaccine certificates for months.

The International Air Transport Association — a trade association that accounts for 82% of total air traffic — is developing an app that will allow passengers to share tests and vaccination results with governments. The software is designed to help reopen borders without quarantine and revive the global airline industry, which the pandemic has devastated.

Even as the EU is sending positive signals to American travelers, the Centers for Disease Control and Prevention is warning them not to travel to much of Europe, at least not yet. The CDC website warns Americans not to go Greece, Italy, Spain or even the United Kingdom, where more than half of the population has already received a first vaccine dose and outdoor beer gardens have reopened along with nonessential shops.

American tourists are a huge part of the European summer travel market and were sorely missed by businesses last year. For instance, in 2019, more than 5 million Americans visited Italy alone.

There are already signs of growing competition for summer tourist dollars in southern Europe. Earlier this month, Malta announced it would pay people to travel there to help kick-start the island nation's tourist economy. People who book at a five-star hotel on the main island can receive 100 euros, or about $120, plus a match of 100 euros from the hotel. Larger grants are being given to visitors who book on Gozo, a smaller, less-touristed island. The country's tourism authority has budgeted more than $4 million for the incentives in hopes of attracting 35,000 tourists beginning in June.

In addition, Greece reopened its borders this month to fellow EU citizens without a mandatory quarantine if they've been vaccinated against COVID-19 or have tested negative for the virus.

The U.S. and the U.K. have among the highest vaccination rates of large countries in the world and will be among the prime beneficiaries as travel begins to reopen. While that's good news for affluent travelers from those nations, the reopening will also serve to emphasize how the pandemic has exacerbated existing inequalities.

Iraqis in the holy shrine city of Najaf on Sunday mourn relatives killed during a massive fire at a Baghdad hospital dedicated to COVID-19 patients. Ali Najafi/AFP via Getty Images hide caption

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Ali Najafi/AFP via Getty Images

Iraqis in the holy shrine city of Najaf on Sunday mourn relatives killed during a massive fire at a Baghdad hospital dedicated to COVID-19 patients.

Ali Najafi/AFP via Getty Images

A massive fire at a Baghdad hospital dedicated to COVID-19 patients has left at least 82 people dead and dozens injured. Amid calls for action by international organizations, Iraq's prime minister ordered an investigation.

Early reports say the blaze Saturday at Ibn Al-Khatib Hospital in the Iraqi capital was set off by an exploding oxygen cylinder. The flames raged through the facility where patients were being treated for the coronavirus.

Iraq Interior Ministry spokesman Maj. Gen. Khaled Al-Muhanna said 110 people were injured in the explosion.

Prime Minister Mustafa Al-Kadhimi said the incident was the result of negligence and he declared a mourning period in honor of the victims.

Kadhimi also launched an investigation into the fire and demanded results within 24 hours. An investigation will also be launched into the hospital's director, security director and maintenance.

"I say it frankly, the incident is a violation of the Iraqi national security, and it is a setback in every sense of the word. We must not let such events go unnoticed," Kadhimi said in a statement.

The hospital had no smoke detectors, sprinkler system or fire hoses, said Maj. Gen. Khadhim Bohan, the head of Iraq's civil defense forces, according to The New York Times. Flammable material used in false ceilings in the intensive care ward helped the fire spread quickly, Bohan said.

Twenty-eight of the victims suffered from severe symptoms and were on ventilators, leaving them unable to flee once the fire started, said Ali Akram al-Bayati, of the Independent High Commission for Human Rights of Iraq.

The commission demanded action from the Iraqi government, calling the incident a "crime" against patients staying in the hospital due to COVID-19. The commission further called for Kadhimi to dismiss the Iraqi health minister and his deputy ministers.

UNAMI, Iraq's United Nations Assistance Mission, called for stronger protections to prevent further disasters.

Jeanine Hennis-Plasschaert, Iraq's special representative of the U.N. secretary-general expressed shock over the incident and wished the injured a full recovery.

The pandemic has dealt a blow to Iraq's health care system, which was already struggling after decades of war and sanctions on the country. Confirmed COVID-19 infections in Iraq have topped 1 million, according to the World Health Organization.

A new study by Centers for Disease Control and Prevention researchers found no obvious safety concerns in some 35,000 pregnant people who were vaccinated, including in the third trimester. Jessica Christian/San Francisco Chronicle via Getty Images hide caption

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Jessica Christian/San Francisco Chronicle via Getty Images

A new study by Centers for Disease Control and Prevention researchers found no obvious safety concerns in some 35,000 pregnant people who were vaccinated, including in the third trimester.

Jessica Christian/San Francisco Chronicle via Getty Images

The Centers for Disease Control and Prevention "recommends that pregnant people receive the COVID-19 vaccine," CDC Director Rochelle Walensky said Friday, citing a new study on the Moderna and Pfizer-BioNTech vaccines.

Early clinical trials of the two-dose shots did not include pregnant individuals, limiting data and creating a sense of uncertainty for many.

COVID-19 vaccines made by Moderna and Pfizer-BioNTech appear to be safe for people who are pregnant, according to new research from the CDC.

Preliminary findings published this week in The New England Journal of Medicine evaluated data from more than 35,000 pregnant individuals who received the mRNA vaccines, and found no obvious safety concerns.

"Importantly, no safety concerns were observed for people vaccinated in the third trimester, or safety concerns for their babies," Walensky said at a Friday

The CDC, American College of Obstetricians and Gynecologists and American Academy of Pediatrics have all previously issued guidance "indicating that COVID-19 vaccines should not be withheld from pregnant persons," as the study noted.

Researchers looked at data between Dec. 14 and Feb. 28 from three federal databases and registries through which vaccine recipients nationwide can report side effects and provide information about their health.

Pregnant individuals reported pain at the injection site more frequently than their nonpregnant counterparts but fewer follow-up symptoms such as headache, chills, muscle pain and fever.

Researchers said that the rates of preterm births and miscarriages among the vaccinated people who completed their pregnancies during the study period were similar to those of the general pregnant population.

"Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines," they wrote. "However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes."

This study did not look at the Johnson & Johnson vaccine, which was first authorized for use in the U.S. in late February.

Another study published last month found that the Pfizer and Moderna vaccines were safe and effective for pregnant and nursing individuals, and may even offer some protection to their babies. Like this week's study, it noted that people who are pregnant face a higher risk of severe disease and death from COVID-19 than those who are not, though it remains low overall.

The CDC's Walensky acknowledged the decision to get vaccinated while pregnant is a "deeply personal" one and encouraged those who are deliberating to talk to their doctors or primary care providers.

She also highlighted what she described as the latest victories and concerns in the country's effort to vaccinate its way out of the pandemic.

There has been a 10% drop in the seven-day average of new reported cases, with the latest figure showing 62,500 cases per day. The number of daily confirmed deaths is declining but still hovering around 690 per day.

More than 65% of the U.S. population ages 65 and older is fully vaccinated as of Friday, which Walensky called "a reason to celebrate." But she also urged caution, noting that county-level data reveals "unsettling gaps" in the pace of vaccinations.

Some counties have vaccinated more than 65% of their elderly population, while other areas remain below 50%, she said.

"Because this virus is an opportunist, we anticipate that the areas of lightest vaccine coverage now might be where the virus strikes next, and with modest protection for our oldest population, many more deaths could ensue," Walensky warned. "So while we have many reasons to celebrate, we also have the potential — indeed the need — to do more to protect people now."

Nearly 27% of the U.S. population has been fully vaccinated as of Friday, according to NPR's vaccine tracker.

Bottles of the single-dose Johnson & Johnson COVID-19 vaccine await transfer into syringes for administering last month in Los Angeles. Frederic J. Brown/AFP via Getty Images hide caption

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Frederic J. Brown/AFP via Getty Images

Bottles of the single-dose Johnson & Johnson COVID-19 vaccine await transfer into syringes for administering last month in Los Angeles.

Frederic J. Brown/AFP via Getty Images

Use of the Johnson & Johnson COVID-19 vaccine is allowed again now that a panel of experts has voted to put it back in distribution despite rare blood clotting problems.

The Food and Drug Administration and the Centers for Disease Control and Prevention announced Friday after the panel voted that the vaccine is safe and effective at preventing COVID-19, and its benefits outweigh the known risks.

For 10 days the Johnson & Johnson COVID-19 vaccine had been in limbo as U.S. health authorities declared a recommended "pause" on administering the shot.

The CDC and the FDA decided to restart administering the single-dose vaccine and to recommend that anyone with concerns should consult their health care provider. The agencies said the chance of the blood clotting disorder is "very low" and has affected mainly women under age 50.

The CDC vaccine advisory committee did not recommend an additional warning. Several members expressed concerns that a warning could increase vaccine hesitancy, while others worried about the ramifications of not including a warning. That information will likely be added to the instructions and fact sheets for the Johnson & Johnson vaccine.

The hold on Johnson & Johnson's vaccine was prompted by six reported cases of a severe blood clotting disorder called cerebral venous sinus thrombosis, or CVST, among the 7.2 million shots of the one-dose vaccine administered in the United States. A 45-year-old woman died after receiving the vaccine.

At Friday's meeting, the CDC said it had found a few more cases of thrombosis with thrombocytopenia syndrome, of which CVST cases are a subset. It has now identified 13 reported cases among women 18 to 49, and two cases among women 50 and older. No cases were found among men.

That means the rate of reported cases is 7 per million shots administered among women 18 to 49. The rate is 0.9 per million among women 50 and older.

Of the 15 cases of thrombosis with thrombocytopenia syndrome, 12 are of CVST, the rare clotting disorder that originally prompted the CDC's recommended hold.

Three of the 15 women have died, while seven remain hospitalized.

An expert advisory committee to the CDC decided April 14 that it needed more time to assess the data before recommending whether to restart the shots.

The European Union's drug regulator released its assessment this week that the shot's benefits "in preventing COVID-19 outweigh the risks of side effects." The agency determined that the vaccine can still be used without restrictions and that a warning should be added to its product information.

Some had criticized the U.S. pause.

Dr. Ashish Jha, dean of Brown University's School of Public Health, argued that given that most cases of the blood-clotting issue appear in women, the committee last week should have recommended continuing the pause only for women 18 to 49 and resumed it for everyone else.

"Keeping vaccine paused for everyone makes little sense," Jha tweeted, adding that the risk-benefit analysis for keeping the vaccine paused for everyone was "WAY off."

"We're still allowed to cross a busy street, or eat raw/uncooked fish, or stick our face in a fan. But we can't get a shot that protects ourselves and others from serious illness and allows a return to normal life — because it *might* have a 1-in-7-million fatal clotting issue," The Atlantic's Graeme Wood noted last week.

The CDC's principal deputy director, Dr. Anne Schuchat, said when the pause was announced, it was intended "to prepare the health care system to recognize and treat patients appropriately."

The White House said the pause would not have a significant impact on its vaccination plan because most of the vaccines used in the U.S. come from Pfizer and Moderna, but the stoppage did lead to canceled appointments.

Japan on Friday announced a third state of emergency over the COVID-19 pandemic with new restrictions taking effect Sunday. Here, a woman walks on a quiet Dotonbori Street. The arcade is normally one of Osaka's most popular tourist areas. Buddhika Weerasinghe/Getty Images hide caption

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Buddhika Weerasinghe/Getty Images

Japan on Friday announced a third state of emergency over the COVID-19 pandemic with new restrictions taking effect Sunday. Here, a woman walks on a quiet Dotonbori Street. The arcade is normally one of Osaka's most popular tourist areas.

Buddhika Weerasinghe/Getty Images

Japan's central government has declared a third state of emergency due to the COVID-19 pandemic with new restrictions imposed in Tokyo, Osaka, Kyoto and Hyogo prefectures. Local leaders requested the move as they face a sharp rise in new coronavirus cases.

The declaration comes as Tokyo prepares to host the Summer Olympics, slated to begin in July, and just before Japan enters one of its biggest holiday seasons, Golden Week, in late April.

The emergency measures stop short of a full lockdown, but they impose limits on restaurants and other businesses. The strictest rules will apply to places that sell alcohol or offer karaoke. They'll be asked to close entirely, while many other establishments will close at 8 p.m. The new policies, which carry fines but largely rely on voluntary compliance, go into effect on Sunday and will run through at least May 11.

Nationwide, Japan is seeing spikes in new cases and hospitalizations, both of which are soaring toward the record heights that were seen at the start of 2021. Some 5,452 people tested positive for the coronavirus on Thursday, according to the Ministry of Health, Labour and Welfare.

Health officials attribute much of the new wave of cases to the rapid spread of new coronavirus variants that were first detected in the United Kingdom and other countries, Kyodo News reports.

In the Tokyo region, government and sporting officials have continually been forced to adjust plans for the 2020 Games, which were postponed until this summer due to the pandemic. Last month, organizers said no international fans will be allowed to attend the games this summer.

The Olympic torch relay, which has been making its way around Japan, has been rerouted away from public roads in Osaka, site of the worst spike in new cases. And while statues of the mascots for the Tokyo Olympics and Paralympics have now been officially unveiled, they're not yet on full public display due to fears about the spread of the coronavirus, according to public broadcaster NHK.

Japanese health officials are also concerned about the country's very low vaccination rate. Fewer than 850,000 people in Japan are fully vaccinated — a strikingly low number for an advanced country with a population of about 126 million.

Japan's health ministry has authorized only one vaccine, made by Pfizer/BioNTech. That decision came in mid-February, putting the country well behind its peers in the massive effort to roll out and administer vaccine doses to protect against COVID-19. Many Japanese people are also wary of vaccines after a decades-long string of scandals undermined public trust.

Overall, Japan has reported about 560,000 coronavirus cases and 9,800 COVID-19 deaths, according to the latest government data.

UC And Cal State Systems To Require COVID-19 Vaccinations For In-Person Fall Classes

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"Receiving a vaccine for the virus that causes COVID-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end," said Dr. Michael Drake, president of the University of California. Damian Dovarganes/AP hide caption

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"Receiving a vaccine for the virus that causes COVID-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end," said Dr. Michael Drake, president of the University of California.

Damian Dovarganes/AP

The California State University and University of California systems announced on Thursday that all 33 campuses will require students and staff returning for in-person instruction this fall to be fully vaccinated against COVID-19.

The new directive will go into effect once the Food and Drug Administration gives "full approval" to a COVID-19 vaccine. The Pfizer-BioNTech and Moderna shots currently going into people's arms only have an Emergency Use Authorization.

CSU Chancellor Joseph Castro said the two higher education systems enroll and employ more than 1 million students and employees, and called the directive "the most comprehensive and consequential university plan for COVID-19 vaccines in the country."

"Receiving a vaccine for the virus that causes COVID-19 is a key step people can take to protect themselves, their friends and family, and our campus communities while helping bring the pandemic to an end," said Dr. Michael Drake, president of the University of California, in the joint statement.

The university leaders said the timing of the announcement is intended to give students, faculty and other staff ample time to obtain vaccinations before the start of the fall term. Both UC and Cal State have said schools are preparing for mostly in-person instruction and activities this fall.

Students will be required to update immunization documents with their respective universities as they do with other infectious diseases, including measles, mumps, rubella and chickenpox. Medical exemptions or approved exceptions will have to be cleared prior to campus arrival, according to the latest notice.

Universities across the country have been facing similar decisions as they plan to resume in-person instruction and vaccine availability has become more widespread. As of April 19, all states in the U.S. are offering vaccinations to people ages 16 and up.

Intensive Care Unit nurse Subramanya Kirugulige prepares a bed for an arriving COVID-19 patient at Roseland Community Hospital in Chicago in December. A large study has found that people with severe initial cases of COVID-19 tend to be at greater risk of more health problems later on. Scott Olson/Getty Images hide caption

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Intensive Care Unit nurse Subramanya Kirugulige prepares a bed for an arriving COVID-19 patient at Roseland Community Hospital in Chicago in December. A large study has found that people with severe initial cases of COVID-19 tend to be at greater risk of more health problems later on.

Scott Olson/Getty Images

The potential lasting effects of COVID-19 infection are many — and people with more severe initial infections are at greater risk for long-term complications, according to a study published Thursday in Nature.

The study, thought to be the largest post-acute COVID-19 study to date, sheds more light on the lingering effects of COVID-19 known as "long COVID."

Ziyad Al-Aly and his colleagues used the databases of the U.S. Department of Veterans Affairs to examine health outcomes in more than 73,000 people who'd had COVID-19 and were not hospitalized, comparing them with nearly 5 million users of the VA health system who did not have COVID-19 and were not hospitalized.

Six months later, those who'd had COVID-19 were found to be at higher risk of new onset heart disease, diabetes, mental health disorders including anxiety and depression, substance use disorders, kidney disease and other problems.

Al-Aly, chief of research and development service at the VA St. Louis Health Care System, said it was shocking to see that the toll of long COVID is so substantial and multifaceted.

"We knew people have fatigue, we knew people have weakness, we knew about the memory problems or brain fog," he said. "But when you put it all together, the diabetes and heart problems and kidney problems and liver problems and stroke and brain fog and fatigue and anemia and depression and anxiety — and it's actually quite jarring."

It remains difficult for researchers to distinguish which effects are a direct consequence of the viral infection itself, and which are indirect.

Some consequences could be a result of inflammation provoked by the virus, while others could be linked to life changes that might accompany the disease. "When people get COVID and they have to self-isolate and stay at home in quarantine, maybe that is associated with less physical activity, changes in diet, other changes that might also bring about some of those clinical manifestations," Al-Aly said.

Aftereffects from COVID-19 were seen in the respiratory system, as well as nervous system disorders, mental health problems, metabolic and cardiovascular disorders, malaise, fatigue, musculoskeletal pain and anemia. The authors also found increased use of therapeutics including pain medications (such as opioids), antidepressants, and anti-anxiety medications.

The authors also analyzed the health outcomes of more than 13,600 people who had been hospitalized with COVID-19, and compared them with nearly 14,000 people who had been hospitalized with influenza. They found that compared to those who'd been hospitalized with the seasonal flu, COVID-19 survivors who'd been hospitalized saw increased risk and magnitude of post-infection lung problems and other disorders.

The findings do not suggest that everyone who gets COVID-19 will have long-term health effects.

"The majority of people will have no problems and no consequences down the road. They'll get maybe sick for a day or two or three or four. They'll get over the hump. They'll regain their energy, cough will go away, shortness of breath will go away, fever will go away, and they will feel fine," he says.

"But it is true, though, that a minority of people, even if they have mild disease, they are at higher risk of developing some of the consequences that we described here. So the risk is not zero – it's small, but it's not trivial."

The study's subjects skewed male, given the veterans who use VA health care. But while the VA population is about 88% male, the study's large size means that it still included more than 8,800 women who contracted COVID-19.

The U.S. has had at least 31 million confirmed cases of the coronavirus. It's not clear exactly what portion of patients experience its lingering symptoms, but Al-Aly says it's estimated to be 8-10%.

The takeaway from this study, Al-Aly says, is that the health care system needs to get ready for a lot of people living with the consequences of long COVID-19.

"That really represents a significant burden on the health care system that we need to be prepared for," he says. "We shouldn't really act surprised two or three years down the road, when people are having of a lot more diabetes or a lot more people with heart disease show up. We shouldn't really act surprised. We should prepare for it now."

A picture taken on March 29, 2021, shows the new passenger terminal of Bahrain International Airport. Bahrain established diplomatic ties with Israel last year. In Israel and Bahrain, vaccine passports will be entirely digital: a QR code on one's phone, recognized at both countries' passport control, according to an Israeli official. Giuseppe Cacace/AFP via Getty Images hide caption

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A picture taken on March 29, 2021, shows the new passenger terminal of Bahrain International Airport. Bahrain established diplomatic ties with Israel last year. In Israel and Bahrain, vaccine passports will be entirely digital: a QR code on one's phone, recognized at both countries' passport control, according to an Israeli official.

Giuseppe Cacace/AFP via Getty Images

JERUSALEM — Israel and Bahrain on Thursday reached what Israel calls the world's first bilateral agreement for mutual recognition of COVID-19 vaccine passports for quarantine-free travel between two countries, an Israeli diplomat who helped forge the deal tells NPR.

"This is the most effective way to enable movement of people between countries," says Ilan Fluss, head of the Israeli foreign ministry's economic division. "A lot of countries are looking at testing, but it is not enough."

Israel, one of the world's most vaccinated populations per capita, is a leading proponent of vaccine passports — documents or digital forms confirming that a person is vaccinated against COVID-19 — arguing they are key to reopening economies for tourism and business travel. In some countries, there is opposition to the concept, seen as a violation of privacy and civil liberties.

In Israel and Bahrain, the vaccine passports will be entirely digital: a QR code on one's phone, recognized at both countries' passport control, Fluss says. The passports will only contain COVID-19 vaccination information. Personal health records will not be included.

Israel will recognize Bahraini vaccine passports not only for entry, but also to gain access to an Israeli domestic vaccine pass, called the Green Pass, which allows those who are vaccinated against COVID-19 or recovered from the virus to access restaurants, gyms, theaters and other venues.

Israel also grants these passes to citizens who do not wish to be vaccinated, but only for 48 hours and only after they test negative for the virus.

Foreign Minister Gabi Ashkenazi said in a statement that Israel would reach similar agreements with other countries in the coming days. Israel is in talks with the U.S., U.K. and others for mutual vaccine document recognition. The U.S. poses challenges for Israel because its vaccination certificates are often handwritten and not centrally stored digitally.

The pact with Bahrain, a country that established diplomatic ties with Israel last year, paves the way for new Gulf Arab travel to Israel after Israel gradually reopens to foreign visitors in late May, starting with tour groups.

Israel currently recognizes the Pfizer-BioNtech and Moderna vaccines, but not other vaccines available in Bahrain, and is seeking a solution to allow all Bahrainis to enter once the country reopens.

Several countries have already unilaterally recognized Israeli vaccine certificates in a bid to attract Israeli tourists without quarantine requirements, including Greece and Cyprus. Those countries have also announced efforts to forge bilateral travel agreements, as the European Union is working to unveil vaccine passports for EU-wide travel in mid-June.

Global travel continues to be risky because of the coronavirus. Earlier this year, passengers from Taiwan wear protective gear as they arrive at France's Charles de Gaulle Airport, and just this week, the U.S. issued over 100 new travel advisories. Francois Mori/AP hide caption

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Global travel continues to be risky because of the coronavirus. Earlier this year, passengers from Taiwan wear protective gear as they arrive at France's Charles de Gaulle Airport, and just this week, the U.S. issued over 100 new travel advisories.

Francois Mori/AP

The U.S. State Department has vastly expanded its "Do Not Travel list," issuing new Level 4 advisories for more than 115 countries and territories this week. The agency cites "ongoing risks due to the COVID-19 pandemic."

The U.S. Do Not Travel list now includes Canada, Mexico, Germany and the U.K. A Level 3 warning is in place for a smaller group of nations, such as China, Australia and Iceland. Japan is also on the Level 3 list, despite a worrying rise in new coronavirus cases there.

Just a week ago, only 33 countries were on the U.S. Do Not Travel list, according to a cached version of the advisory site. But the State Department warned on Monday that the list would soon include roughly 80% of the world's countries.

More than 150 highest-level travel advisories are in effect — more closely reflecting guidance from the Centers for Disease Control and Prevention, the State Department says.

The CDC's own travel health notices also use a four-tier warning system. For many countries newly added to the State Department's Level 4 list, the CDC cites "a very high level of COVID-19."

As of last week, Brazil and Russia were two of the only large COVID-19 global hotspots on the State Department's most serious warning list. They're now joined by India and virtually all of Europe — places that have seen alarming spikes in new cases.

Bhutan is the only international destination designated as Level 1 — "exercise normal precautions" — on the State Department's travel advisory list.

Sixteen countries are categorized as Level 2 — meaning travelers should exercise increased caution when visiting places such as Thailand, Vietnam, South Korea, Belize and Grenada.

Many of the new or updated Do Not Travel notices cite high levels of coronavirus transmission in the relevant country. But the State Department says it also takes other factors into account, from the availability of coronavirus testing to any travel restrictions the countries might have against U.S. citizens.

In roughly 35 countries or destinations, the CDC says, details about the level of COVID-19 risk are unknown. The health agency urges Americans to avoid traveling to those spots, which include Afghanistan, Nicaragua and the Solomon Islands.

Regardless of a particular country's advisory status, the State Department wants all U.S. citizens to reconsider any travel abroad.

"The COVID-19 pandemic continues to pose unprecedented risks to travelers," the agency said.

More than 3 million people have died from COVID-19 worldwide, according to the World Health Organization. Nearly 144 million coronavirus cases have been reported globally, according to data compiled by Johns Hopkins University.

The Emergent BioSolutions Bayview Campus plant in Baltimore has stopped producing vaccine material following an FDA inspection that found numerous problems. The plant was slated to become part of the Johnson & Johnson COVID-19 vaccine production process. Tasos Katopodis/Getty Images hide caption

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The Emergent BioSolutions Bayview Campus plant in Baltimore has stopped producing vaccine material following an FDA inspection that found numerous problems. The plant was slated to become part of the Johnson & Johnson COVID-19 vaccine production process.

Tasos Katopodis/Getty Images

Peeling paint. Cracked buckets. Employees dragging unsealed bags of medical waste. Procedures ignored. Inadequately trained staff.

All of these were problems noted by U.S. Food and Drug Administration inspectors at the Emergent BioSolutions factory in Baltimore – a facility that is intended to produce materials for the Johnson & Johnson COVID-19 vaccine. That plan is on hold, following a problem last month with a batch of a vaccine ingredient there, and now a range of documented issues at the facility.

The Emergent factory does not yet have FDA authorization to be part of the coronavirus vaccine supply chain, but was ramping up to be.

The FDA initiated an inspection of the company's factory in Baltimore's Bayview neighborhood on April 12. Four days later, the agency asked Emergent to stop manufacturing any new material at the facility, and to quarantine all existing vaccine substance already made there. The company complied, pending results of the inspection and any necessary remediation.

The results of that inspection were released Wednesday by the FDA, and they aren't pretty. The FDA's inspection report listed several troubling observations from visits to the facility and its review of video footage.

The inspection found that Emergent had not thoroughly examined what had led to the documented cross-contamination episode in March, and "did not include a thorough review of personnel movements in and around the facility as a potential source of contamination."

"There is no assurance that other batches have not been subject to cross-contamination," the report stated.

Other observations included:

  • The factory was not maintained in a clean and sanitary condition. Equipment wasn't cleaned and maintained appropriately.
  • Procedures to prevent cross-contamination weren't followed. It noted several instances of employees mishandling unsealed bags of special medical waste. Employees were also seen taking off outer protective garments on the warehouse floor where raw materials were staged for manufacturing.
  • Components and containers were not handled or stored in a manner to prevent contamination.
  • Inadequate written procedures to assure that drugs manufactured have the identity, strength, quality and purity they should.
  • Employees were not trained in the specific operation they performed or in current best practices related to their job function. Inspectors found Emergent had failed to adequately train personnel to prevent cross-contamination between products it was making for different, unnamed clients – presumably Johnson & Johnson and AstraZeneca.
  • It noted peeling floors and rough surfaces in sampling rooms and elsewhere, which "do not allow for adequate cleaning and sanitation." It also noted paint flecks on the floor of corridors and damaged walls.
  • The factory used equipment too small for its intended purpose, describing labs overcrowded with samples.

Some of these problems, such as inadequate training of employees, may take considerable time to fix.

Emergent said in a statement on Wednesday that it is "committed to working with the FDA and Johnson & Johnson to quickly resolve the issues identified. ... While we are never satisfied to see shortcomings in our manufacturing facilities or process, they are correctable and we will take swift action to remedy them."

In an earlier statement on Monday, as it filed a notice with the U.S. Securities and Exchange Commission that it was pausing production at the Baltimore facility, Emergent said that it recognizes "the confusion these recent events may have caused our customers, our employees, and the public. We are steadfastly committed to full compliance with the FDA's strict requirements. We acknowledge that there are improvements we must make to meet the high standards we have set for ourselves and to restore confidence in our quality systems and manufacturing processes."

The administration of Johnson & Johnson COVID-19 vaccine in the U.S. was already put on hold last week due to concerns about a very rare blood clotting disorder that was found in a small number of people who had received the vaccine. Six cases were identified out of nearly 7 million administered doses.

The FDA said Wednesday that "it is often in the public's best interest that the FDA work with firms to quickly resolve compliance matters to ensure that the public has access to medical products that meet the agency's high standards for quality, safety and effectiveness."

"We are doing everything we can to ensure that the COVID-19 vaccines that are given to the people of this nation have met the agency's high standards for quality, safety and effectiveness. We know that every time an American, including members of our own families, receives a COVID-19 vaccine dose, they are putting their trust in us. We are working hard to maintain that trust," the agency said.

Masks Remain Extremely Effective Indoors, But Are They Necessary Outside?

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Most evidence points to the risks of coronavirus transmission outdoors as very low, according to Dr. Ashish Jha of Brown University's School of Public Health. Karen Ducey/Getty Images hide caption

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Most evidence points to the risks of coronavirus transmission outdoors as very low, according to Dr. Ashish Jha of Brown University's School of Public Health.

Karen Ducey/Getty Images

Scientists and public health experts agree that masks are effective at lowering the spread of the coronavirus indoors, where the vast majority of transmission is likely to occur.

But what about outside?

About two dozen states have statewide mask mandates that generally require people to wear masks outside when they're not able to stay at least 6 feet apart. Many cities have their own rules.

But with vaccinations accumulating, some health experts and journalists are arguing that now is a good time for authorities to ease up on outdoor mask requirements. Studies have linked transmission to indoor settings far more than outdoor ones, though data is limited and there are plenty of caveats.

Dr. Ashish Jha, dean of Brown University's School of Public Health, notes that case numbers aren't going down and they've been largely stagnant for the past month or two. But he says the situations driving it are groups of people gathering indoors without masks.

"Once you get outside, it starts becoming really, really uncommon for the virus to spread," he tells NPR's All Things Considered.

Some exceptions could involve people at packed rallies, standing or sitting close together for long periods of time. But beyond those scenarios, "there really just is not much spread happening outdoors."

This interview has been edited for length and clarity.


Interview Highlights

Is there a number we can put on this? How uncommon it would be to pick up a case of COVID-19 if you were outside?

There are estimates that suggest maybe 1 in 1,000 infections happen outside. There are reasons to believe that if you just think about your risk, if you're just out and about walking around, it's probably even much less than that. So those rare instances occur in those contexts of sort of the large, packed rallies. I don't know that we've seen really any cases of somebody who was just, let's say, out for a walk or out for a run and picked up the infection that way. I think you really have to have a lot more exposure than that.

I am a jogger. ... Do we know how much the risk increases when you're breathing really hard, when you're huffing and puffing, trying to get up that hill?

I think if somebody were right next to you and spending, let's say, 10, 15 minutes running in that little stream of breath that you're exhaling, there might be a risk. But somebody you're running by who is there for just a second, the risk is — it's extremely rare.

There will be people listening to us who are screaming at their radios right now saying it's still spreading and the variants are out there and so far, most people aren't fully vaccinated. You shouldn't be having this conversation yet. What do you say to them?

I understand that first of all. But it's really important to be able to have a nuanced discussion of what is safe and what is not. Because one of the problems is if we can't have that discussion, then some people will adhere to all the rules, even ones that are not necessarily very useful, and other people will just ignore all of them.

And right now, while cases are spreading, while the variants are out there and very contagious ones like B.1.1.7 [are] really dominant, I do want people to do things that are safe. And part of that is telling people, you know, what restrictions they can let go of. And so I think it's critically important that we keep indoor mask mandates in for a while. We can't give up on those, not while infection numbers are high. But it also means telling people what they can relax on. And wearing masks outside, again, unless you're in a very, very crowded space for extended periods of time, probably doesn't do much to protect you or protect others.

Ayen Bior, Courtney Dorning and Elena Burnett produced and edited the audio interview.

Boxes containing the Johnson & Johnson COVID-19 vaccine, developed by the company's Janssen Pharmaceuticals unit, are shown at a vaccination center in Los Angeles last week. Allen J. Schaben/Los Angeles Times via Getty Images hide caption

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Boxes containing the Johnson & Johnson COVID-19 vaccine, developed by the company's Janssen Pharmaceuticals unit, are shown at a vaccination center in Los Angeles last week.

Allen J. Schaben/Los Angeles Times via Getty Images

The European Union's drug regulator said Tuesday it had concluded there is a "possible link" between the Johnson & Johnson COVID-19 vaccine and several cases in the U.S. of a rare type of blood clot, but emphasized that the shot's benefits "in preventing COVID-19 outweigh the risks of side effects."

The assessment by the European Medicines Agency, or EMA, comes a week after the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration announced a "pause" in the distribution of the Johnson & Johnson vaccine, developed by the company's Janssen Pharmaceuticals unit, after reporting six cases of cerebral venous sinus thrombosis — a rare type of blood clot — seen in combination with low levels of blood platelets.

The EMA said it had reviewed eight cases of unusual blood clots in the U.S., one of which was fatal, occurring within three weeks of receiving the single-dose Johnson & Johnson vaccine. The agency determined a warning should be added to the vaccine's product information.

"I have to stress again [the cases] are very rare and in the vast majority of cases these vaccines are going to prevent death and hospitalization from COVID-19," EMA Executive Director Emer Cooke said in a briefing. "We have to balance the benefits of the vaccine with the risks."

In a statement, the EMA said that although the chance of experiencing the side effect is "very low," people "should still be aware of symptoms so they can get prompt medical treatment to help recovery and avoid complications."

The pause in distribution in the U.S. due to a handful of cases has also complicated the rollout of the vaccine in Europe, which has been trying to ramp up its immunization campaign. The EU's efforts have also been stymied by reports last month of similarly rare cases of unusual blood clots linked to the vaccine made by AstraZeneca, Europe's primary supplier.

The EMA investigated the AstraZeneca cases and concluded that the vaccine is safe and effective and that its benefits far outweigh the potential risks.

The EU regulator said the eight U.S. cases it examined occurred in people under 60, mostly women. The small number of cases was among more than 7 million doses administered in the U.S. through April 13.

Peter Arlett, the head of data analytics at the EMA, said that the EU agency had also reviewed 287 occurrences with the AstraZeneca vaccine, 25 with the Pfizer-BioNTech vaccine and five with Moderna's vaccine.

The U.S. Department of State will add a slew of countries to its "Do Not Travel List" later this week because of coronavirus danger. Paul J. Richards/AFP via Getty Images hide caption

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The U.S. Department of State will add a slew of countries to its "Do Not Travel List" later this week because of coronavirus danger.

Paul J. Richards/AFP via Getty Images

The U.S. State Department on Monday announced plans to expand travel advisories, urging U.S. citizens to stay home as the COVID-19 pandemic continues to pose "unprecedented risks" around the globe.

The updated travel guidelines are intended to curb visits "to approximately 80% of countries worldwide" that are experiencing dramatic spikes in cases, the department said in a statement. New guidance is expected be released later this week.

The latest recommendations come as the coronavirus "continues to pose unprecedented risks to travelers," and the new guidelines "better reflect the Centers for Disease Control and Prevention's science-based Travel Health Notices," according to the notice.

The State Department added: "As always, we are closely monitoring conditions around the globe, and will regularly update our destination-specific advice to U.S. travelers as conditions evolve."

As of Monday afternoon, the Johns Hopkins Coronavirus Resource Center reported 141,786,586 COVID-19 cases around the world. The United States has confirmed more cases than any other country in the world — 31,733,400 with India, Brazil, France, Russia, the United Kingdom, Turkey, Italy, Spain and Germany rounding out the top 10 spots. Meanwhile, global deaths have surpassed 3 million, according to the latest data.

French President Emmanuel Macron in March extended a nationwide lockdown through the end of April, citing new, faster-spreading variants of the coronavirus. He called it "an epidemic within the epidemic."

As NPR reported, "In Brazil, deaths have topped 3,000 per day as the country is ravaged by the virus. Mexico has recorded more than 211,000 deaths. India has had more than 175,000 deaths and deaths in the United Kingdom have topped 127,000."

Joy, Relief In Airports As Australia And New Zealand Open 'Travel Bubble'

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Families are reunited as travelers arrive on the first flight from Sydney in Wellington on Monday after Australia and New Zealand opened a trans-Tasman quarantine-free travel bubble. Marty Melville/AFP via Getty Images hide caption

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Families are reunited as travelers arrive on the first flight from Sydney in Wellington on Monday after Australia and New Zealand opened a trans-Tasman quarantine-free travel bubble.

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On Monday, Australia and New Zealand launched their long-anticipated travel bubble that will allow residents of each country to visit the other without having to quarantine upon arrival.

Emotional videos capturing long-awaited reunions in arrival halls in various airports across Australia and New Zealand have been circulating online since the first passengers touched down. Thousands are reported to have made the journey across the Tasman Sea in the bubble's opening first day.

Traveler Mark Carrington told Australia's Seven Network that he felt "amazing" after landing in Sydney.

"It's been nearly two years and I haven't seen my partner for that period of time. So it's been very tough," he said.

Before her flight to New Zealand, traveler Denise O'Donoughue told AFP that she felt like the world was returning to some sort of normal.

"What normal's going to be from now on I don't know, but I'm just really, really excited about today," she said.

Until now, New Zealand had required travelers from Australia to quarantine upon arrival. Most Australian states had dropped that requirement late last year.

New Zealand Prime Minister Jacinda Ardern told reporters Monday that the Australia-New Zealand bubble is a significant step in getting New Zealand back to normal.

"What the bubble will mean for each of us personally is important, but what's also important is what it will mean for the economy and our recovery," she said. "According to Tourism New Zealand Forecasting, welcoming Australians back could mean a billion-dollar boost."

Australian Prime Minister Scott Morrison also told reporters that the bubble is a win-win for both countries, who depend greatly on each other for tourism. New Zealand government data shows that about 1.5 million Australians visited New Zealand in 2019, making up about 40% of all visitors and spending nearly the equivalent of $2 billion USD. And about 1.3 million New Zealanders visited Australia that year, accounting for about 15% of all visitors to Australia.

This arrangement has been months in the making after both New Zealand and Australia shut down their borders to most travelers at the start of the pandemic last spring. Compared with many other countries, the two have avoided the worst of the virus.

Australia has logged 29,543 cases and 910 deaths, while New Zealand only 2,596 cases and 26 deaths from the coronavirus, according to Johns Hopkins University.

However, the vaccine rollout in both countries has been slow to get started.

The new travel bubble is not without rules. For example, residents cannot have traveled outside of their country within 14 days and must be without COVID symptoms before departure. They also must continue to wear masks on flights.

Jennifer Nuzzo at the Johns Hopkins Center for Health Security says that while the travel bubble is a step toward normalcy, it's not without risks.

"It's not zero-risk to allow travel in and out of countries. And we've seen this most acutely in Australia where there have been a number of clusters found probably related to travel," she tells NPR. "So it is possible that both countries could see clusters here and there. But so far they've demonstrated a commitment to respond when they do occur."

Nuzzo says it would be difficult to create similar travel bubbles in countries such as the U.S., given that both Australia and New Zealand are much more geographically isolated.

Throughout the pandemic, various plans for travel bubbles have been discussed between countries and cities, including one among the Baltic states that was started, stopped and started again over the last year. Elsewhere in the Pacific, Taiwan and Palau launched their own no-quarantine travel bubble earlier this month.

April 17

Global COVID-19 Deaths Top 3 Million

Relatives attend a COVID-19 victim's burial at a cemetery in Manaus, Amazonas state, Brazil, on Thursday. Michael Dantas/Getty Images hide caption

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Global deaths from COVID-19 has surpassed 3 million, according to the latest data from John Hopkins University.

Leading in those deaths are the United States, with more than 566,000, and Brazil, with more than 368,000. They are followed by Mexico, India and the United Kingdom.

The global death toll reached 1 million in September 2020 and 2 million in January.

The grim milestone comes after health officials in the U.S. paused rollout of the single-dose Johnson & Johnson vaccine after six women experienced rare but severe blood clots a week or two after receiving it.

Overall, more than 129 million people in the U.S. have received at least one dose of COVID-19 vaccine, including 7.8 million doses of the J&J vaccine. More than 82 million Americans — nearly 25% of the population — have been fully vaccinated.

In Brazil, deaths have topped 3,000 per day as the country is ravaged by the virus. Mexico has recorded more than 211,000 deaths. India has had more than 175,000 deaths and deaths in the United Kingdom have topped 127,000.

COVID-19 variants are spreading throughout the U.S., with the more contagious U.K. variant, B.1.1.7, now dominant. On Friday, the Biden administration announced plans to spend $1.7 billion on combating and tracking variants.

Ex-FDA Chief Sees 'Struggle' To Vaccinate More Than Half U.S. Population

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Dr. Scott Gottlieb, then commissioner of the Food and Drug Administration, testifies during a House hearing on in October 2017. In an NPR interview, Gottlieb says he doesn't expect enough demand for the COVID-19 vaccine much beyond 160 million Americans. Drew Angerer/Getty Images hide caption

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Drew Angerer/Getty Images

Dr. Scott Gottlieb, then commissioner of the Food and Drug Administration, testifies during a House hearing on in October 2017. In an NPR interview, Gottlieb says he doesn't expect enough demand for the COVID-19 vaccine much beyond 160 million Americans.

Drew Angerer/Getty Images

One in 4 Americans would refuse a coronavirus vaccine if offered, a recent NPR/Marist poll found. Another 5% are "undecided" about whether they would get the shot. And some researchers are growing worried that this reluctance will be enough to prevent the nation from reaching what's known as herd immunity.

A former head of the Food and Drug Administration also has doubts about reaching herd immunity, the point at which the virus can no longer spread easily through the population.

More than 123 million people, or about 37% of the U.S. population, have received at least one dose of a COVID-19 vaccine and Dr. Scott Gottlieb, who was FDA commissioner from 2017 to 2019, says the nation is reaching a point where supply will outstrip demand. Gottlieb is on the board of directors of Pfizer, which makes one of the coronavirus vaccines.

"I think that there's probably 150 million Americans who are eager to get vaccinated. And as we expand into the younger age cohorts and a new eligible population ... you're not going to see the demand be as brisk," Gottlieb says in an interview with NPR's Morning Edition.

"I think we get to 150 million vaccines. I think we struggle to get to 160 million," he says, which is roughly half the U.S. population. "Beyond that, I think it's going to be difficult. I'm not sure that you have the demand there."

But it's not as bad as that sounds.

"I don't know that we ever get to herd immunity," Gottlieb says. "But I think the combination of vaccinating that many people and having a lot of immunity in the population from prior infections, [is] enough that the level of spread of this virus is going to be substantially reduced."

On Tuesday, the FDA and Centers for Disease Control and Prevention recommended a pause in the use of the Johnson & Johnson COVID-19 vaccine, pending a review of reports of very rare, potentially dangerous blood clots.

Blood clots were found in six recipients, one of whom died. Those affected, all of whom were women, were among about 7 million people in the U.S. who received the J&J shots.

Gottlieb said he expects the pause to be short.

"I think this is probably a temporary pause where the agency is going to evaluate the information it has, see if there is more cases out there to be reported into the agency, perhaps issue some guidance around the use of the vaccine and what doctors should be alert for and then allow the vaccine to continue to be distributed," he says.

He adds, "I think it's more likely than not that there's going to be a resumption in the use of the vaccine for some portion of the population. That should be reassuring to the public."

Jeevika Verma and Arezou Rezvani produced and edited this interview for broadcast.

Jeevika Verma, Milton Guevara, Ziad Buchh, Arezou Rezvani and Fernando Pizarro produced and edited the audio version of this story. Avie Schneider produced for the Web.

Danish health authorities announced Wednesday that the country will continue its COVID-19 vaccine rollout without the shot made by AstraZeneca, citing its possible link to rare blood clotting events, the availability of other vaccines and the "fact that the COVID-19 epidemic in Denmark is currently under control." Dirk Waem/BELGA MAG/AFP via Getty Images hide caption

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Dirk Waem/BELGA MAG/AFP via Getty Images

Danish health authorities announced Wednesday that the country will continue its COVID-19 vaccine rollout without the shot made by AstraZeneca, citing its possible link to rare blood clotting events, the availability of other vaccines and the "fact that the COVID-19 epidemic in Denmark is currently under control."

Dirk Waem/BELGA MAG/AFP via Getty Images

Denmark will stop administering the AstraZeneca COVID-19 vaccine, health officials said Wednesday.

In a statement, the Danish Health Authority emphasized that the shot's benefits outweigh the risks for those who do get it, but said they had decided to discontinue its use because of its possible link to rare cases of blood clotting and the "fact that the COVID-19 epidemic in Denmark is currently under control and other vaccines are available."

"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," said S?ren Brostr?m, director general of the Danish Health Authority. "We have, therefore, decided to remove the vaccine from our vaccination [program]."

All AstraZeneca vaccination appointments will be cancelled, and those who have already received their first dose will get their second in the form of another vaccine, officials said. Individuals who have had forthcoming appointments cancelled will be able to reschedule "based on an assessment of the current epidemic situation."

"The consequence of this decision is that anyone aged 16 or older can expect to receive an offer of vaccination in late June," officials said. "Thus, everyone who accepts the offer will be fully vaccinated about five weeks later – in early August."

COVID-19 cases and deaths have decreased considerably in Denmark following a winter surge. The country reported 4,552 new cases and 14 deaths in the past week, according to data from Johns Hopkins University.

Just under 8% of the population has been fully vaccinated, according to Johns Hopkins. Of that group, Reuters reports that 77% got the Pfizer vaccine, 7.8% had Moderna and 15.3% received AstraZeneca.

Denmark was one of several European countries to temporarily suspend use of the AstraZeneca vaccine in mid-March in order to investigate reports of rare blood clotting events in some recipients.

The European Medicines Agency and World Health Organization both continued to recommend its use, and many of those countries resumed vaccinations within a few days following a preliminary EMA investigation that concluded its benefits outweighed its risks.

Wednesday's announcement comes exactly one week after the EMA said rare blood clotting events should be listed as a possible side effect of the AstraZeneca vaccine, but stressed that it has been proven to prevent severe disease, hospitalization and death from COVID-19. Such clotting events are rare, officials emphasized, and appear to be more common in women under the age of 60.

Several countries including France, Germany and South Korea have reintroduced the vaccine with age restrictions, while others including Australia, Greece and Britain are now recommending alternatives for young people.

Also on Wednesday, the EMA announced that it is continuing to monitor the phenomenon of "very rare blood clots with low blood platelets" occurring after vaccination, and will review more data at the request of the EU's Commissioner for Health and Food Safety.

The review will provide more context on the benefits of ongoing vaccination campaigns, it said, and consider whether to update recommendations for a second dose for those who have already received their first dose of AstraZeneca's vaccine. Public health experts have been largely hesitant about the idea of mixing and matching vaccines without more data, and a newly-expanded U.K. study is working to assess the potential benefits.

"EMA considers the overall benefits of the vaccine continue to outweigh the risks in people being vaccinated," it said, adding that the review "will support ongoing national vaccination campaigns in their decisions on how to optimally deploy the vaccine."

The EMA said last week that the use of the vaccine in member nations' vaccination campaigns would vary based on the severity of the pandemic and availability of vaccines in each country, Danish authorities noted.

And in the case of Denmark, they said, the country has already made progress vaccinating the older age groups at highest risk of becoming severely ill, and has vaccines made by Pfizer-BioNTech and Moderna at its disposal.

Danish authorities said research and scientific studies in Denmark revealed a "higher than expected frequency" in the number of blood clotting events, particularly in veins in the brain, following vaccination.

Brostr?m described the situation as "a known risk of severe adverse effects from vaccination with AstraZeneca, even if the risk in absolute terms is slight."

Brostr?m emphasized that the AstraZeneca vaccine is still approved. He also said that the country may reintroduce it at a later point if the situation changes.

"If Denmark were in a completely different situation and in the midst of a violent third outbreak, for example, and a healthcare system under pressure – and if we had not reached such an advanced point in our rollout of the vaccines – then I would not hesitate to use the vaccine, even if there were rare but severe complications associated with using it," Brostr?m said.

The AstraZeneca vaccine is not currently being used in the U.S., though the company has said it will seek emergency use authorization from the Food and Drug Administration.

Meanwhile, the U.S. is reviewing its own reports of rare blood clotting cases — six out of nearly 7 million doses — in the single-shot Johnson & Johnson vaccine. The FDA on Tuesday recommended its use be paused "out of an abundance of caution" while it reviews data.

That same day, the company announced it would "proactively delay" the rollout of its vaccine in Europe. On the subject of Johnson & Johnson, Danish health officials said they are closely monitoring the risk assessments initiated by authorities in the U.S. and Europe, and will cooperate with research into the safety and efficacy of that and all COVID-19 vaccines.

The novel coronavirus, first detected at the end of 2019, has caused a global pandemic.

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