CoronavirusCovid News: Biden Commits $1 Billion to Widen Access to At-Home Tests

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The White House says it will spend $1 billion to increase the supply of rapid at-home tests.

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White House Pledges $1 Billion for At-Home Covid Tests

Jeffrey D. Zients, the White House’s Covid-19 coordinator, said the investment would help make 200 million at-home rapid coronavirus tests available to Americans each month starting in December.

In the past few months, testing has increased, particularly at-home testing, a convenient option that came to market earlier this year. To meet this increased demand, the president’s plan ramps up both the availability of test and access to free testing. And today we’re making another billion dollar investment to further mobilize testing manufacturers. This means companies will be able to expand production of tests even further based on the United States government’s commitment to procure an additional 180 million rapid tests over the course of the next year, with tens of millions more tests coming to market over the course of the next 30 days. Today’s billion-dollar investment to further expand testing production puts us on track to quadruple the amount of at home rapid tests available for Americans by December. So that means we’ll have available supply of 200 million rapid at-home tests per month starting in December, with supply of tens of millions of additional tests coming on the market across the next few weeks.

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Jeffrey D. Zients, the White House’s Covid-19 coordinator, said the investment would help make 200 million at-home rapid coronavirus tests available to Americans each month starting in December.CreditCredit...Scott Olson/Getty Images

The White House on Wednesday announced a billion-dollar investment in at-home rapid coronavirus tests that it said would help quadruple their availability by later this year.

By December, 200 million rapid tests will be available to Americans each month, with tens of millions more arriving on the market in the coming weeks, Jeffrey D. Zients, the White House’s Covid-19 coordinator, said at a news conference. Mr. Zients also said the administration would double the number of sites in the federal government’s free pharmacy testing program, to 20,000.

The changes reflect the administration’s growing emphasis on at-home testing as a tool for slowing the spread of Covid-19. President Biden in September said that he would use the Defense Production Act to increase the production of rapid testing kits and would work with retailers, including Amazon and Walmart, to expand their availability. He pledged $2 billion to the effort, or roughly 280 million tests.

The Biden administration’s commitment “allows the manufacturers to have the confidence in the demand to scale up their production,” Mr. Zients said. “It’s an expansion of the industrial base, so that more manufacturing occurs, based on the U.S.’s commitment to the testing sector.”

By December, the U.S. will produce about a half billion tests a month, roughly half of which will be the at-home units, he added.

The Biden administration’s efforts to expand testing access received a significant boost on Monday, when the Food and Drug Administration authorized Acon Laboratories’ at-home test. Dr. Jeffrey E. Shuren, the director of the agency’s medical devices center, said the move could double at-home testing capacity in the coming weeks.

“By year’s end, the manufacturer plans to produce more than 100 million tests per month, and this number will rise to 200 million per month by February 2022,” he said. Like tests already available from Abbott, Quidel, Becton Dickinson and other makers, Acon’s test is made to detect proteins from the virus on a nasal swab, and produces results in 15 minutes.

Mr. Zients did not say which tests the administration’s investment would go to purchase.

Asked why the White House had not moved sooner to spend more on tests, Mr. Zients said the administration had increased access to at-home tests “as the innovation allowed for” more tests to come to the market.

Rapid tests can cost as little as $10, which public health experts say can still be prohibitively expensive for some people. Mr. Zients said on Wednesday that the Acon test would likely cost less than $10. “As we get more and more tests approved, and manufacturing ramps up, pricing should come down,” he said.

Rapid tests are not as sensitive as P.C.R. tests, but experts say they are still accurate in detecting the virus in someone who is in the first week of displaying symptoms, when the viral load is likely to be highest.

Some pharmacies and retailers have recently struggled to keep tests in stock, or have had to place limits on how many customers can purchase. Demand has increased with the school year underway and employees returning to many workplaces.

Last week, Ellume, an Australian company that makes a widely available at-home coronavirus test, recalled nearly 200,000 test kits because of concerns about a higher-than-expected rate of false positives. The recall did not affect most of the 3.5 million test kits Ellume has shipped to the United States.

Biden says vaccine mandates are the only way to defeat the virus.

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Biden Urges Private Employers to Require Covid Vaccines

President Biden encouraged large private companies to mandate coronavirus vaccinations for their workers, arguing that the existing requirements his administration put in place have proved effective against Covid-19.

The Labor Department is going to shortly issue an emergency rule, which I asked for several weeks ago, and they’re going through the process, to require all employees with more than 100 people, whether they work for the federal government or not, this is within the purview of the Labor Department, to ensure their workers are fully vaccinated or face testing at least once a week. In total, this Labor Department vaccination requirement will cover 100 million Americans, about two-thirds of all the people work in America. And here’s the deal. These requirements are already proving that they work. Starting in July, when I announced the first vaccination requirement for the federal government, about 95 million eligible Americans were unvaccinated. This was mentioned a little bit earlier. Today, we’ve reduced that number to 67 [million] eligible Americans who aren’t vaccinated. And today, we released a new report outlining effective vaccination requirements that are already proving their worth. I’m calling on more employers to act. My message is require your employees to get vaccinated. With vaccinations, we’re going to beat this pandemic finally. Without them, we face endless months of chaos in our hospitals, damage to our economy and anxiety in our schools and empty restaurants, and much less commerce. Look, I know that vaccination requirements are a tough medicine, unpopular with some, politics for others, but they’re life-saving and game-changing for our country.

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President Biden encouraged large private companies to mandate coronavirus vaccinations for their workers, arguing that the existing requirements his administration put in place have proved effective against Covid-19.CreditCredit...Doug Mills/The New York Times

President Biden on Thursday appealed to private companies to mandate coronavirus vaccinations for employees, asking them to take initiative as an effort that he announced last month to require 80 million American workers to get the shot undergoes a lengthy rule-making process and may not go into effect for weeks.

The president, delivering remarks at a construction site outside Chicago, said that encouraging Americans to get vaccinated had helped, but it had not gone far enough to address the pandemic.

“Even after all of these efforts, we still have more than a quarter of the people in the United States who are eligible for vaccinations but didn’t get the shot,” Mr. Biden said. “That’s why I’ve had to move toward requirements.”

He said mandates had not been his first instinct, but the requirements were “already proving that they work.”

Mr. Biden said in September that he would use the full force of his presidency to push some 80 million American workers to be vaccinated against the coronavirus, reaching into the private sector to mandate that all companies with more than 100 workers require vaccination or weekly testing. He ordered the Occupational Safety and Health Administration to draft a new rule that would make those requirements enforceable, a process that White House officials said at the time would take at least three or four weeks.

The president said on Thursday that the rule would be put in place quickly, but officials familiar with the process said it was likely to take several more weeks.

In the meantime, Mr. Biden sought to shift responsibility toward companies, which he said would help lead the United States out of the pandemic: “Businesses have more power than ever before to change the arc of this pandemic and save lives.”

Mr. Biden chose to visit the Chicago area in part because it is the home of United Airlines, one of the first major carriers to require shots for its 67,000 U.S. employees. Other airlines have followed with similar requirements, including American Airlines, Southwest, JetBlue and Alaska Airlines. The president spoke at a site controlled by Clayco, a construction company that has required vaccines and testing for its employees.

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Idaho’s governor and lieutenant governor duel over vaccine mandates.

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Janice McGeachin speaking at a rally in Idaho Falls, Idaho, in May.Credit...John Roark/The Idaho Post-Register, via Associated Press

Lt. Gov. Janice McGeachin of Idaho took advantage of an out-of-state trip by Gov. Brad Little on Tuesday to issue an executive order forbidding educational institutions to require proof of vaccination from employees. She said on Twitter that in her pursuit of “individual liberty,” she had “fixed” an order the governor had issued earlier.

Governor Little’s order, made in the spring, prohibits state agencies from requiring or issuing proof of Covid vaccinations, but does not specifically name universities and public K-12 schools. When he returned Wednesday from a trip to Texas, he promptly repealed Ms. McGeachin’s order, writing that he had notified her that “no official business would require her services in an acting governor capacity” during his absence.

The lieutenant governor, who is elected independently of the governor, is challenging Mr. Little for the position, and the two have feuded throughout their tenure. Ms. McGeachin has consistently criticized Mr. Little’s measures to contain the virus, casting his restrictions as government overreach. And this week was not their first round of political one-upping.

In May, when Mr. Little was away at the Republican Governors Association conference, Ms. McGeachin issued a ban on mask mandates, which he then repealed. Idaho did not have a statewide mask mandate, but an executive order required masks at long-term care facilities and said they were “strongly recommended” elsewhere. Nor did Mr. Little prevent municipalities from issuing their own directives on masks.

On Tuesday, Ms. McGeachin also asked about mobilizing the Idaho National Guard and sending troops to the Mexican border, where Mr. Little and other Republican governors had traveled that day.

Mr. Little replied on Facebook that “attempting to deploy our National Guard for political grandstanding is an affront to the Idaho constitution.” In the past he has described Ms. McGeachin’s activity in his absence as “irresponsible” and “self-serving.”

Asked about the battles, Jaclyn J. Kettler, a political scientist at Boise State University, noted that although both Mr. Little and Ms. McGeachin are Republicans, the lieutenant governor is further to the right politically and that there is tension between the two, particularly regarding coronavirus rules and restrictions.

While Ms. McGeachin’s base might be cheering her on for defying Mr. Little, Professor Kettler said, “there are many Idahoans that are perhaps baffled or frustrated with these type of developments.”

“The Covid situation here is not great,” she said.

About 42 percent of eligible people in Idaho are vaccinated, according to a New York Times database. The state’s recent weekly average has been about 1,300 new cases a day.

With rich countries paying more for vaccines, the supply for Latin America is falling short, the W.H.O. says.

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Residents wait outside a vaccination center in hopes of getting a second dose of the Covid vaccine in Caracas, Venezuela, last week.Credit...Ariana Cubillos/Associated Press

The U.N.-backed vaccine program will fail to meet its target for delivering doses to Latin America and the Caribbean this year, in part because wealthy countries that pay more for the shots are buying up most of the supply, a World Health Organization official said Wednesday.

The global Covax program, the primary source of Covid vaccines for most of the world, aimed to provide enough doses this year for Latin American and Caribbean countries to inoculate 20 percent of their people. But most countries have only received around 30 percent of the supply they contracted through Covax, said Dr. Jarbas Barbosa, assistant director of the Pan American Health Organization, a division of the W.H.O.

“Producers are not prioritizing delivery to the Covax mechanism,” Dr. Barbosa said at a news conference. “They continue to prioritize the bilateral agreements they have because in these bilateral agreements the vaccines are more expensive.”

Wealthy countries have raced far ahead of the rest of the world in vaccination rates, and continue to buy doses as demand for booster shots rises. The W.H.O. said last week that only nine of Africa’s 54 countries had met the goal of vaccinating 10 percent of their people by the end of September.

India’s prohibition on exporting vaccines has contributed to delays in delivering shots to other parts of the world. India, the world’s largest drug producer, imposed the ban in May as it fell behind on domestic vaccination, but it said recently that with production expanding and its own inoculation program gaining speed, it would lift the embargo this month.

Covax is focusing on delivery of vaccines to countries that have so far vaccinated less than 10 percent of their population. In the Americas, that includes Jamaica, Nicaragua and Haiti.

With the Covax program faltering, the Pan American Health Organization has struck separate deals to buy millions of vaccine doses from China’s Sinopharm and Sinovac, as well as AstraZeneca. But those agreements still fall far short of meeting the need.

Around 37 percent of the population in Latin America and the Caribbean has been fully vaccinated, but access in the region has been very uneven; Cuba, Chile and Uruguay are among the most highly vaccinated countries in the world.

“We continue to urge countries with surplus doses to share these with countries in our region, where they can have life-saving impact,” said Dr. Carissa F. Etienne, director of the P.A.H.O.

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A man wrote on Facebook that someone with Covid-19 had licked items in a Texas supermarket. A federal jury sent him to prison.

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An H-E-B store in the Las Palmas neighborhood of San Antonio. Prosecutors said Christopher Charles Perez wrote on Facebook that items at another H-E-B store had been contaminated with the coronavirus.Credit...Christopher Lee for The New York Times

In April 2020, Christopher Charles Perez posted a message on Facebook saying that he had paid someone infected with Covid-19 to lick groceries at a San Antonio grocery store.

“My homeboys cousin has covid19 and has licked everything for past two days cause we paid him too,” Mr. Perez wrote in a post about an H-E-B supermarket. “YOU’VE BEEN WARNED.”

The claim was not true, and the post came down after 16 minutes, according to court documents.

But someone anonymously submitted a screenshot of the post to the Southwest Texas Fusion Center, a group of law enforcement agencies that investigates possible criminal and terrorist activity. When the F.B.I. confronted Mr. Perez, he said he had been trying to scare people from going to public places “to stop them from spreading the virus,” according to a federal affidavit.

Mr. Perez, 40, of San Antonio, was found guilty in June of disseminating false information and hoaxes related to biological weapons. On Monday, a federal judge sentenced him to 15 months in federal prison.

In a statement, federal prosecutors said that Mr. Perez had been trying to frighten people with threats of “spreading dangerous diseases.” His arrest in April 2020 came early in the pandemic, when there was still uncertainty over how the coronavirus spread, and as people were wiping down their groceries and emptying stores of disinfectant.

“Perez’s actions were knowingly designed to spread fear and panic,” Christopher Combs, the special agent in charge of the F.B.I.’s San Antonio field office, said in the statement. The sentence, he said, “illustrates the seriousness of this crime.”

Mr. Perez’s sentence, which included three years of supervised release, requires him to seek mental health treatment and take mental health medication.

Moderna’s vaccine profits propel three new names onto Forbes’s list of the 400 richest Americans.

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The headquarters of Moderna Therapeutics in Cambridge, Mass., in May 2020.Credit...Brian Snyder/Reuters

The financial windfall at Moderna, the biotech company behind one of the three federally cleared Covid-19 vaccines, has propelled three new names onto Forbes magazine’s list of the 400 richest people in the United States.

Using stock prices and exchange rates from early September, the magazine’s list added Noubar Afeyan, Moderna’s chairman and co-founder; Robert Langer, a Massachusetts Institute of Technology professor and Moderna co-founder; and Timothy Springer, a Harvard Medical School professor and early investor in the company. The stated net worth of each was more than $3.5 billion.

A representative for Moderna did not immediately respond to a request for comment.

The coronavirus pandemic has been an economic catastrophe for much of the country, but the richest have done well, Forbes noted when it published the list on Tuesday: The 400 people included saw their collective wealth increase 40 percent during the last year.

Moderna makes one of the three vaccines authorized for use in the United States. Headquartered in Cambridge, Mass., the company was founded in 2010 with the goal of bringing RNA-related products to market. Its only commercial product is the Covid vaccine, for which the U.S. government provided $1 billion to support design and testing. With countries around the world buying as much vaccine as possible, Moderna’s valuation topped $100 billion this summer.

The company’s stock price Wednesday was more than four times its value at this time last year, even though its share prices have been slipping, with a major drop of about 18 percent in the past week alone. Most of that drop came on Friday, after the pharmaceutical giant Merck said that its new pill to treat Covid-19 reduced the risk of hospitalization and death by about 50 percent. Merck plans to seek federal emergency use authorization for the antiviral pills.

That drop significantly reduced the worth of the three Moderna billionaires. Dr. Springer was No. 176 on the list and worth $5.9 billion when the Forbes calculations were made on Sept. 3, a figure that had dropped to $4.6 billion by Wednesday. The reported worth of Mr. Afeyan, No. 212, fell from $5 billion to $3.8 billion. And the wealth of Dr. Langer, No. 222, slipped from $4.9 billion to $3.7 billion, Forbes said.

Moderna’s vaccine, which is built around messenger RNA, as is the one developed by Pfizer-BioNTech, was authorized for emergency use for people 18 and older by the Food and Drug Administration last December. Moderna submitted its vaccine for an emergency use authorization in 12- to 17-year-olds in June and for full federal approval in August; regulators’ decisions are pending.

More than 283 million doses of Moderna’s vaccine have been administered in almost 40 countries that reported their vaccine distribution data to the Our World in Data Project at Oxford University, and Moderna’s revenues have ballooned since the vaccine saw widespread use.

In its most recent financial statement Moderna said that its total revenues were $4.4 billion for the three months ending June 30, 2021, compared to $67 million for the same period in 2020. Net income for the six months ending on June 30, 2021, was $4 billion, compared to a net loss of $241 million during the same period in 2020.

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Nebraska restores its Covid data dashboard after taking it down over the summer.

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Getting tested for the coronavirus in Omaha, Neb. last July. When the state of emergency ended in Nebraska this summer, so did Test Nebraska, which gave free coronavirus tests to hundreds of thousands of residents.Credit...Nati Harnik/Associated Press

Tracking community transmission is at the heart of efforts to stop the spread of the coronavirus, scientists say, and in most states the daily dashboards showing new cases have been a critical tool for public health officials trying to track the trajectory of the virus, which has killed 700,000 Americans.

Yet for three crucial months this summer, Nebraska did not report any county-level information to the public. State officials stopped sharing counts of new coronavirus cases by county with the public on June 30, just as the Delta variant began surging in the United States.

That was by design. Gov. Pete Ricketts, a Republican who opposes both mask and vaccine mandates, allowed his emergency order to expire in June, and the state’s unusually strict privacy laws were reinstated, which he said prohibited the continued release of the data.

At the time, the number of new cases in Nebraska had reached a low in the state, and Test Nebraska, which gave free virus tests to hundreds of thousands of residents, ended its operations shortly after the emergency ended.

The virus continued to spread in the state, however, driven by the highly contagious Delta variant. Hospitalizations increased tenfold from the end of June through mid-September. New cases rose sharply in August. Deaths increased as well.

On Sept. 20, after coronavirus hospitalizations surpassed 10 percent of the state’s capacity of staffed hospital beds, Mr. Ricketts announced that county-level case data would once again be made public on a new “hospital capacity” state dashboard.

But he said the data will disappear again if the number drops below 10 percent on a 7-day rolling average. And the state is still not reporting county-level deaths.

Public health experts in Nebraska were dismayed all summer about the decision to delete the dashboard, and state legislators wrote a letter requesting that it be restored.

A handful of the state’s 93 counties continued to provide daily data on their websites throughout the pandemic because they have more than 20,000 residents.

That meant that the only real-time data on the virus across the state that doctors like Dr. David Brett-Major, an infectious disease specialist, had during July and August was watching sick people stream into the emergency department of the University of Nebraska Medical Center in Omaha.

“If the tests are only happening when the cases are more severe, then you’re not getting a broad look,” he said in a recent interview.

Susan Bockrath, the executive director of the Nebraska Association of Local Health Directors, said her group brought up the missing dashboard repeatedly with state officials, pointing out it was also a necessary tool in the campaign against pandemic misinformation.

The dashboard was removed just as Stephanie Summers, board of education president in David City, was trying to determine the best policy for students and families in her rural community one hour west of Omaha. Mr. Ricketts has told Nebraskans to get vaccinated, but declined to require masks, despite pleas from some public health officials.

“The state cannot insist on an individual’s freedom to choose to wear, or not wear, a mask, or whether or not to get vaccinated, and then also withhold the data needed for citizens to make informed decisions,” she said, adding that she fully agreed with state leaders in emphasizing those individual freedoms.

While the dashboard has mostly been restored, some doctors doubt the current testing system is capturing the reality on the ground. Two dozen doctors sent a letter in early September to Mr. Ricketts asking for the return of Test Nebraska.

“Our access to testing is so bad right now, and the turnaround so bad, that these numbers are probably vast underestimates, and not accurate just because there is not enough testing,” said Dr. Bob Rauner, chief medical officer of OneHealth Nebraska, a group of 65 locally owned medical clinics across the state.

The governor and his aides have defended their decision to stop the flow of data on privacy grounds, saying publishing county-level data could violate the state’s version of HIPAA, which prevents the release of patients’ personal health information without their consent.

Experts say privacy becomes a concern in releasing data from counties with only a handful of cases, and for that reason, states generally suppress information in jurisdictions with fewer than five cases or deaths.

‘Covid toes’ may be caused by a powerful immune response, a new study finds.

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Discoloration on a teenage patient's toes indicates the condition known as Covid toes — painful, often red lesions resembling chilblains.Credit...Northwestern University, via Associated Press

Shortly after the pandemic erupted last year, doctors were baffled by a surge of patients, mostly teenagers and young adults, who came in complaining of chilblains — painful lesions on their toes, and sometimes also on their fingers.

The condition came to be called Covid toes. They were seen, like the loss of smell and taste, as yet another strange telltale sign of the disease, even though most of the patients tested negative for coronavirus. Physicians were hard-pressed to explain the association.

The lesions are red or purple in white people, and often purplish or brownish in people of color. They cause painful burning or itching sensations, and sometimes make it difficult for people to wear shoes or walk.

Now a study from France, published in the British Journal of Dermatology, sheds some light on the causes of Covid toes. The research indicates that the lesions may be a side effect of the immune system’s shift into high gear in response to exposure to the virus, which can damage cells and tissues in the process.

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A patient of Southeast Asian descent with the Covid toe condition.Credit... Stanford Dermatology/VisualDx

The French researchers analyzed blood samples and skin biopsies from 50 patients who had chilblainlike lesions for the first time in April 2020, and who were referred to St.-Louis Hospital in Paris. Slightly more than half of the patients had other symptoms suggestive of Covid-19, like coughing, shortness of breath and loss of smell, but all of them tested negative for the virus on PCR tests.

The samples showed high levels of Type 1 interferon, a protein that activates the body’s immune system to fight viruses, but which may also cause damage. The researchers also found high levels of an antibody that can inadvertently attack the body’s own cells.

Abnormal changes in the linings of the blood vessels may also play a role in the lesions, the study suggests.

Although the relationship between coronavirus infection and chilblainlike lesions “is still controversial,” the authors wrote, the “peaks of chilblainlike lesions concomitant with peaks of Covid-19 deaths in 2020 strongly suggest that this disorder is closely related to SARS-CoV-2 infection.”

The explanation for Covid toes is not entirely surprising; one of the hallmark features of the disease is an immune system overreaction called a cytokine storm, which may ultimately cause more illness than the virus itself.

German scientists published a paper last year saying they had found a strong localized interferon-driven response in three young men who came in with chilblains. That paper suggested that the men, who tested negative for the coronavirus, may have developed chilblains several weeks after an initial infection caused mild or asymptomatic disease, and that the interferon-driven immune response may have led to early control of the virus and prevented respiratory disease.

Dermatologists say that people with Covid toes generally do well and are unlikely to develop severe Covid, and that the symptoms reflect a healthy immune response to the virus.

Dr. Esther E. Freeman, director of global health dermatology at Massachusetts General Hospital, said the new study provides insight into the links between of Covid toes and mild infection.

“A lot of the studies around Covid have focused on severe Covid, and mild and moderate disease has often been overlooked,” Dr. Freeman said. “I tell my patients with Covid toes, ‘It’s almost like a side effect of your body doing a good job of controlling the virus.’”

The new study suggested that treating Covid toes with local or systemic anti-inflammatory agents may be effective.

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Some countries have a new strategy for vaccinating children: one dose, for now.

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A 13-year-old was among the first of her age group to get a vaccine in Minneapolis in May. Credit...Aaron Nesheim for The New York Times

Even as parents in the United States wrestle with difficult questions over vaccinating their children against the coronavirus, families in other countries have been offered a novel option: giving children just one dose of the vaccine.

Officials in Britain, Hong Kong, Norway and other countries have recommended a single dose of the Pfizer-BioNTech vaccine for children ages 12 and older — providing partial protection from the virus, but without the potential harms occasionally observed after two doses.

Health officials in those countries are particularly worried about increasing data suggesting that myocarditis, an inflammation of the heart, may be more common among adolescents and young adults after vaccination than had been thought.

The risk remains very small, and significant only after the second dose of an mRNA vaccine. But the numbers have changed the risk-benefit calculus in countries where new infections are mostly lower than in the United States.

Advisers to the Centers for Disease Control and Prevention reviewed data on myocarditis in June and unanimously voted to recommend the vaccine for children ages 12 and older, saying that the benefits far outweighed the risk.

Myocarditis was among the concerns that led the Food and Drug Administration to ask vaccine makers this summer to increase the number of children in clinical trials. The issue is likely to be the focus of intense discussion when agency advisers meet later this month to review the evidence for vaccinations of children ages 5 to 11 years.

A correction was made on 
Oct. 8, 2021

An earlier version of this article incorrectly described actions taken by regulators in Sweden and Denmark. They have halted use of the Moderna vaccine in younger populations; they have not begun offering single doses. The article also misstated the timing of an F.D.A. meeting on authorization of the Pfizer-BioNTech vaccine for children. It is later this month, not next week. 

How we handle corrections

Los Angeles requires proof of vaccination to enter many businesses, one of the nation’s strictest rules.

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A customer gets a hair cut at the Lucas Salon in the Elysian Valley neighborhood of Los Angeles, Calif. in July.Credit...Alex Welsh for The New York Times

Los Angeles will require most people to provide proof of full coronavirus vaccination to enter a range of indoor businesses, including restaurants, gyms, museums, movie theaters and salons, in one of the nation’s strictest vaccine rules.

The new law, which was approved by the Los Angeles City Council on Wednesday, will allow people with medical conditions that do not allow them to be vaccinated, or who have a sincerely held religious objection, to instead show proof of a negative coronavirus test taken within the preceding 72 hours.

It will take effect on Nov. 4, which city officials have said should give the city and businesses enough time to figure out how the rule should be enforced.

Some council members have expressed concern that businesses would be unfairly burdened by the requirement, and that the city’s law is inconsistent with Los Angeles County rules that apply to neighboring communities and require masks indoors, but not proof of vaccination.

Still, city leaders said at a lengthy discussion of the measure last week that they wanted to move with urgency.

“We can’t let the perfect be the enemy of the good,” Kevin de León, a council member, said at the previous meeting.

A growing number of bars and restaurants are, on their own, already checking vaccination status. And mounting evidence suggests that employer vaccination mandates have been effective in boosting immunization rates.

In California, requirements that health care workers be vaccinated have helped increase vaccination rates at major health systems to 90 percent or higher. Major corporations have said their requirements have resulted in surging vaccination rates.

Implementing rules that require people to prove their vaccination status has been complex. A number of competing electronic “vaccine passports” are available, but some people need paper verification.

In August, New York became the first city in the nation to require proof that workers and customers at indoor sites for dining, physical fitness and entertainment had received at least one dose of a vaccine.

Not long after, some cities and counties in California, including San Francisco, followed suit. The addition of Los Angeles — by far the largest city in the state, with 4 million people — significantly alters the balance.

California’s elected leaders — especially Gov. Gavin Newsom — have highlighted pandemic restrictions across the state to draw a contrast with other states, where rules are more lax and cases among unvaccinated people have strained hospitals. California has one of the lowest case rates in the nation, and 70 percent of residents age 12 and older are fully vaccinated.

Last week, Mr. Newsom announced the nation’s first requirement that schoolchildren be vaccinated, starting as soon as next fall.

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‘We’re not out of danger’: A threat lingers even as new U.S. cases and deaths decline.

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Shoppers in Manhattan last month. On Friday, the country surpassed 700,000 total deaths in the pandemic.Credit...Stephanie Keith for The New York Times

New coronavirus cases, hospitalizations and deaths are falling as the United States begins to recover from a persistent summer surge that strained hospitals across the country and killed over 100,000 Americans in just three and a half months.

As of Tuesday night, virus cases in the United States had averaged more than 101,000 a day for the past week, a 24 percent decrease from two weeks ago. Reported new deaths are down 12 percent, to 1,829 a day. Hospitalizations have decreased 20 percent and are averaging below 75,000 a day for the first time since early August, according to a New York Times database.

Public health officials, however, said the pandemic remained a potent threat. Most of the Covid deaths in that span were people who were unvaccinated, and about 68 million eligible Americans have yet to be inoculated. That leaves the country vulnerable to continued surges.

“We’re not out of danger,” Ali Mokdad, a University of Washington epidemiologist who is a former Centers for Disease Control and Prevention scientist, said in an interview this week. “This virus is too opportunistic and has taught us one lesson after another.”

He worries about people dropping their use of masks and traveling more, as they have after earlier drops in new cases — actions that could help fuel a fresh surge in December and January.

The number of new daily cases in the United States has fallen 35 percent since Sept. 1, according to a New York Times database. The drop was especially stark in Southern states that had the highest infection rates during the Delta variant surge that started in June.

Florida, which averaged more than 20,000 new cases a day during much of August, is reporting fewer than 6,000 infections a day. Louisiana, which weeks ago was averaging more than 5,000 cases daily, has about 1,000 cases each day.

“This wave is petering out,” Edwin Michael, a professor of epidemiology at the University of South Florida, in Tampa, said in an interview. “If there were waning immunity, then we should be at the beginning of another wave now.”

Only 57 percent of Floridians are fully vaccinated, and Dr. Michael said his biggest worry was the greater chance for the virus to genetically mutate while people remain unvaccinated across the country. Still, he said, “this might be the last wave, pending any new variants that arrive, and the boosters will help with that.”

While there are about 20,000 fewer Covid patients hospitalized nationwide than at the start of September, many hospitals in hard-hit parts of the country remain overstretched. That is especially true in Alaska, which leads the country by a wide margin in recent cases per person. The threat of flu season could worsen matters.

Newly reported cases in Montana and Wyoming, which had reported some of the worst outbreaks in recent weeks, appear to have stabilized. In both states, less than 50 percent of the population is inoculated against the coronavirus. Montana is at 49 percent fully vaccinated, and Wyoming 42 percent. Only West Virginia, at 40 percent, has a lower rate.

Nearly 2,000 Covid-related deaths are being reported nationally each day, and the United States surpassed 700,000 deaths on Friday. About 65 percent of the eligible U.S. population is fully vaccinated against the virus.

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