Covid-19 Live Updates: C.D.C. Chief Urges Caution for Unvaccinated Ahead of Memorial Day

As Puerto Rico recovers from a spring virus surge and cases decline, the U.S. territory is steadily relaxing pandemic restrictions, including lifting the nightly curfew that had been in effect since March 2020.

The island is taking a big step toward returning to normal not long after experiencing its worst outbreak. Toward the end of April, Puerto Rico was reporting over 1,000 cases a day, up from about 200 new daily cases in mid-March.

Since then, its case numbers have drastically decreased, as they have around the United States with the steady advance of vaccinations, which Dr. Carlos Mellado López, head of Puerto Rico’s Department of Health, credited for the turnaround. Puerto Rico is averaging 148 coronavirus cases, an almost 60 percent decrease over the past two weeks, according to a New York Times database. Just over 30 percent of the island’s population has been fully vaccinated and 45 percent has been given at least one vaccination shot, numbers that lag the U.S. averages of 39 and 49 percent, respectively.

The easing of restrictions took effect over the past two days, starting with the end of the 10 p.m. to 5 a.m. curfew on Monday. Another change affects fully vaccinated travelers on domestic flights, who no longer need to present a negative coronavirus test before entry and instead must present proof of vaccination, such as a vaccine card.

Puerto Rico will offer the Johnson & Johnson vaccine to any visitors who arrive at the Luis Muñoz Marín International Airport in San Juan, starting Friday, according to The Associated Press. Other changes include increased capacities for businesses from 30 percent to 50 percent, a reopening of the island’s stadiums at 30 percent capacity and a lifting of mask requirements for fully vaccinated people at parks and beaches.

On the mainland, state governments have been rapidly loosening restrictions. On Tuesday afternoon, Louisiana’s governor announced the state would remove capacity restrictions for businesses and the statewide mandate that requires students to wear masks at schools, starting next school year. On Monday, New Jersey’s governor announced fully vaccinated people would no longer have to wear masks indoors. In Hawaii, Gov. David Ige announced on Tuesday that all people, vaccinated and unvaccinated, would no longer have to wear masks outdoors.

In Puerto Rico, experts say many factors led to the island’s spring surge, including the arrival of coronavirus variants, a return to in-person work and dining, tourists flocking to the island for spring break season and gatherings to celebrate Holy Week. As cases soared, worries simmered over hospital bed capacity and the lack of medical professionals needed to address a swell in sickness.

The surge prompted the administration of Gov. Pedro R. Pierluisi in early April to adjust the island’s nightly curfew, shut down in-person instruction in schools and reduce capacities in businesses.

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Fauci Optimistic Over Moderna Vaccine for Teenagers

Moderna said Tuesday that its Covid-19 vaccine was 100 percent effective in a study of adolescents ages 12 to 17. Dr. Anthony S. Fauci, the infectious disease expert, was optimistic about the vaccine’s ability to ensure in-person school in the fall.

“The significance of the Moderna press release that they will have 12 to 18-year-old — that they will have an application in next month.” “Yeah, well, certainly that’s one of the things we would like to have, because if you put the Pfizer together, which already will be able to vaccinate, and are vaccinating 12 to 15-year-olds, together with the recent data from Moderna, which likely would lead as we enter into the beginning of the new fall term, that hopefully we’ll be able to get adolescent vaccine. I mean, high school students vaccinated actually before they enter the fall term, which is really very good news. So now we have not only a single company, Pfizer, but it looks very much like we’ll have the source of another similar vaccine in mRNA for Moderna. So all good.”

Moderna said on Tuesday that its coronavirus vaccine, authorized only for use in adults, was powerfully effective in 12- to 17-year-olds, and that it planned to apply to the Food and Drug Administration in June for authorization to use the vaccine in adolescents.

If approved, its vaccine would become the second Covid-19 vaccine available to U.S. adolescents. Federal regulators authorized the Pfizer-BioNTech vaccine this month for 12- to 15-year-olds.

The Pfizer shot was initially authorized for use in people 16 and older, while Moderna’s has been available for those 18 and up.

Proof of the vaccines’ efficacy and safety for adolescents is helping school officials and other leaders as they plan for the fall. On Monday, Mayor Bill de Blasio said that all public school students in New York City, the largest school system in the United States, would return to in-person learning in the fall.

New York’s move comes as several states have indicated that they will restrict remote learning, including Connecticut, Illinois, Massachusetts and New Jersey.

The Moderna results, which the company announced in a statement, are based on a clinical trial that enrolled 3,732 people ages 12 to 17, two-thirds of whom received two vaccine doses. There were no cases of symptomatic Covid-19 in fully vaccinated adolescents, the company reported. That translates to an efficacy of 100 percent, the same figure that Pfizer and BioNTech reported in a trial of their vaccine in 12- to 15-year-olds.

“These look like promising results,” said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York. “The more vaccines we have to protect adolescents from Covid, the better.”

Moderna also reported that a single dose of its vaccine had 93 percent efficacy against symptomatic disease.

“Those cases that did occur between the two doses were mild, which is also a good indicator of protection against disease,” Saskia Popescu, an infectious disease epidemiologist at George Mason University, said in an email.

The side effects were consistent with what has been reported in adults: pain at the site of the injection, headache, fatigue, muscle pain and chills. “No significant safety concerns have been identified to date,” the company said.

The adolescents in the study will be monitored for a year after their second dose.

The results were announced in a news release that did not contain detailed data from the clinical trial. And Dr. Angela Rasmussen, virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, said that the vaccines’ efficacy can be trickier to evaluate in children, who are less likely to develop symptomatic disease than adults.

Nevertheless, she said, the results are in line with what scientists expected and suggest “that adolescents respond to the vaccine comparably to adults who receive it.”

Moderna said it planned to submit the data for publication in a peer-reviewed journal.

Federal health officials have stopped investigating breakthrough coronavirus infections in vaccinated people unless the cases cause serious disease that leads to a hospitalization or a death.

The Centers for Disease Control, which announced its decision earlier this month, will continue to gather data about mild breakthrough cases that are reported to the agency voluntarily by local health departments, but will only investigate the most serious cases of breakthrough infections — about one in 10.

Until May, the agency was monitoring all cases. A report issued Tuesday said that as of the end of April, when some 101 million Americans had been vaccinated, the agency had received 10,261 reports of breakthrough infections from 46 states and territories, a figure it said was probably a “substantial undercount.”

Of those, 995 people were known to have been hospitalized, and 160 had died, though not all as a direct result of Covid-19, the new study said.

Although the agency will continue to carry out vaccine effectiveness studies, it will focus on specific populations like health care workers, essential workers, the elderly and residents of long-term care facilities, a C.D.C. spokeswoman said.

Some scientists have criticized the retrenchment, saying it is wasting an opportunity to learn about the real-world effectiveness of different vaccines and to pick up on when vaccine protection begins to wane, whether variants play a significant role in breakthrough infections, and whether some patients are more susceptible than others to a post-vaccine infection.

“We are driving blind, and we will miss a lot of signals,” said Ali Mokdad, an epidemiologist at the University of Washington who spent many years as a senior scientist at the C.D.C.

“The C.D.C. is a surveillance agency,” Dr. Mokdad said. “How can you do surveillance and pick one number and not look at the whole?”

But other scientists said they support the C.D.C.’s pivot to concentrate on the most serious cases.

“We have to prioritize what we’re doing, and the priority is to understand the cases associated with severe disease,” said Dr. Kathryn Edwards, a professor of pediatrics in the division of infectious diseases at Vanderbilt University School of Medicine who studies vaccine safety and effectiveness.

Some people who were infected with the virus when they thought they were protected by the vaccine are troubled by the lack of interest in their cases.

“Don’t people want to know about this?” asked Julie Cohn, a 43-year-old mother from Short Hills NJ., who was infected after she was fully vaccinated, and is still suffering lingering effects of Covid-19 nearly two months later. “Where do people like me go? What happens next? The practitioners in my life have been shocked and are trying to figure out how to move forward, but there are so many questions. And if no one is studying this, there won’t be answers.”

For much of the coronavirus pandemic, Taiwan was a sanctuary for performing artists: A rare place that was almost Covid-free, where audiences could attend live dance festivals, full-fledged theater productions and classical music recitals in person.

But a recent surge in cases — Taiwan’s worst outbreak since the start of the pandemic — has brought a halt to cultural life on the self-governing island, forcing performing arts centers, concert halls and museums to shut their doors, just when those kinds of facilities are starting to come back to life in many other countries.

Taiwan’s experience is a reminder of the continuing uncertainty of life in the pandemic, the threat posed by the virus and its power to upset even the most carefully crafted of plans. Semi-staged performances of Verdi’s “Falstaff” have been called off. The French musical “Notre Dame de Paris” has been postponed.

“Everything blew up,” said the American clarinetist Charles Neidich, who recently made the 7,781-mile trip to Taipei from New York, only to have his first live performance in more than 400 days canceled.

Though the number of cases in Taiwan is low compared with many parts of the world — 283 new cases were reported on Tuesday, fewer than in New York City — the island’s authorities are doubling down on restrictions, hoping that lockdowns can bring the virus under control within weeks or months while Taiwan tries to speed up its lumbering vaccination program.

Taiwan’s closing of its borders early in the pandemic and its strict public health measures, including mask mandates and extensive contact tracing, turned the island of 23.5 million into a coronavirus success story. But the emergence of more contagious variants in recent months, a relaxation of quarantine rules and a vaccine shortage gave the virus an opening.

The government has provided tens of millions of dollars in subsidies to arts groups during the pandemic, but some performers say the grants have not been enough to offset losses. Officials say restrictions on large gatherings are necessary to curb the rising rate of infections.

Performers from Taiwan and abroad have been caught in the middle, grappling with lost income and an avalanche of canceled engagements. But many artists are optimistic that concerts, dances, plays and museum exhibitions will soon return.

American citizens abroad who saw their passports expire during the Covid-19 pandemic are now able to return to the United States before renewing their travel documents, a shift of policy announced by the State Department on Monday.

The decision, which applies to Americans who are currently outside the country and hold passports that expired on or after Jan. 1, 2020, comes after reports that more than 100,000 Americans abroad are struggling to obtain consular appointments.

In many countries, American citizens who need to renew their passports must apply in person at a U.S. embassy or consulate. But many of those offices remain hobbled by Covid-19 restrictions and staffing reductions, and some are closed for all but emergency services. Difficulties and delays in getting appointments for renewals have left many Americans without a path back to the United States.

Some American expatriates have turned to immigration lawyers for help. Others have paid high fees to bootleggers and passport courier companies to obtain hard-to-get embassy appointments.

The State Department’s new exception for expired passports applies both to adults, whose documents are valid for 10 years, and to children, whose passports expire after 5 years. It applies only when entering the United States; travelers leaving the country will still be required to have current documents.

New parents should note that the exception does not apply to babies born overseas who have not yet been issued a passport or an official record of a child’s claim to U.S. citizenship, known as a Consular Report of Birth Abroad.

To take advantage of the exception, citizens must be in possession of their expired passport, and must be flying to the United States, either directly or on a connecting flight with a short layover. Expired passports cannot be used for travel from one foreign country to another.

All American citizens returning to the country must still show proof of a negative Covid-19 test result taken within 72 hours of departure.

The official Covid-19 figures in India grossly understate the true scale of the pandemic in the country. Last week, India recorded the largest daily death toll for any country during the pandemic — a figure that is most likely still an undercount.

Even getting a clear picture of the total number of infections in India is hard because of poor record-keeping and a lack of widespread testing. Estimating the true number of deaths requires a second layer of extrapolation, depending on the share of those infected who end up dying.

In consultation with more than a dozen experts, The New York Times has analyzed case and death counts over time in India, along with the results of large-scale antibody tests, to arrive at several possible estimates for the true scale of devastation in the country.

Even in the least dire of these, estimated infections and deaths far exceed official figures. More pessimistic ones show a toll on the order of millions of deaths — the most catastrophic loss anywhere in the world.

The authorities in southern India are investigating a couple who are reported to have chartered a plane and performed a marriage ritual in midair in front of scores of guests, a breach of Covid-19 guidelines in a country that is being devastated by a second wave of the coronavirus.

The couple had intended to tie the knot in front of family and friends at a hotel in the southern state of Tamil Nadu, but coronavirus restrictions capped the guest list at 50 people.

Instead, according to reports in the Indian news media, the couple chartered a commercial aircraft operated by SpiceJet, an Indian carrier, and boarded the plane on Sunday morning along with about 160 people. The flight traveled from Madurai in Tamil Nadu to the city of Bangalore, a journey of more than an hour.

Family members of the couple, whom the authorities have not named, told the airline that they had already gotten married and were taking their guests on a postnuptial joy ride.

As the aircraft flew over the Meenakshi Amman Temple, spread over about 14 acres on the southern bank of Madurai, the bride and groom stood along with other passengers. A video shared on social media showed the groom placing a traditional ornament around the bride’s neck while passengers cheered and took photos.

The bride wore flowers and jewelry, traditional wedding attire for Hindus, while the groom wore customary southern Indian clothes. Guests were pictured maskless and crowded close together on the nearly packed flight.

A SpiceJet spokesperson said that the airline had informed the passengers about pandemic guidelines, including requirements that they wear masks and refrain from photography onboard.

“The agent and the guest passengers were briefed in detail, both in writing as well as verbally, on social distancing and safety norms to be followed as per Covid guidelines both at the airport and onboard the aircraft throughout the journey,” the airline said in a statement.

India on Tuesday reported more than 196,000 new cases and 3,511 deaths from the virus, a slight decline from the global highs of recent weeks. For the 12th consecutive day, the number of people recovering from the virus outnumbered new infections, according to national data, although experts believe that India’s tallies of infections and deaths are significantly lower than the true toll.

Tamil Nadu has India’s fourth-highest coronavirus caseload. The state is averaging 34,000 new cases daily, and recorded 422 deaths from the virus on Monday.

Children who get sick from the rare but serious Covid-related inflammatory syndrome may surmount their most significant symptoms within six months, but they may still have muscle weakness and emotional difficulties at that time, a new small study suggests.

Published in the journal Lancet Child and Adolescent Health on Monday, the study appears to be the first detailed look at the health status of children six months after they were hospitalized with the condition, called Multisystem Inflammatory Syndrome in Children or MIS-C. The syndrome typically emerges two weeks to six weeks after a coronavirus infection, often quite a mild one. MIS-C can result in hospitalizations for children with severe symptoms involving the heart and several other organs.

A major question has been whether children who survive MIS-C will end up with lasting organ damage or other health problems. The new study, which looked at 46 children under 18 who were admitted to a London hospital for MIS-C (it has a different name and abbreviation, PIMS-TS, in Britain), suggests that many of the most serious problems can resolve with time.

“To be honest, I think we all didn’t know what to expect,” said Dr. Justin Penner, a pediatric infectious disease physician at the hospital involved in the study, Great Ormond Street Hospital. “We didn’t know which body systems would require assistance or become a problem one month, three months, six months down the line.”

The children in the study were hospitalized between April 4 and Sept. 1, 2020, part of the first wave of the inflammatory syndrome. They all had systemic inflammation, and most had symptoms involving multiple organ systems, such as the heart, kidneys or circulatory system. Forty-five had gastrointestinal symptoms, and 24 had neurological symptoms like confusion, memory problems, hallucinations, headaches or problems with balance or muscle control.

Sixteen of the children were placed on ventilators, 22 needed medication to help their hearts pump more effectively and 40 were treated with immunotherapies like intravenous immunoglobulin. All survived.

Six months after they were discharged from the hospital, one child still had systemic inflammation, two had heart abnormalities and six had gastrointestinal symptoms. All but one were able to resume school, either virtually or in person.

Still, 18 were experiencing muscle weakness and fatigue, scoring in the bottom 3 percent for their age and sex on the six-minute walking test, a standard test of endurance and aerobic capacity. And 15 were experiencing emotional difficulties like anxiety or severe mood changes, according to questionnaires answered by either the parents or the children.

GLOBAL ROUNDUP

The State Department on Monday warned Americans against traveling to Japan as the country experiences an increase in coronavirus cases less than two months before the start of the Tokyo Olympics.

The move has little practical effect, as Japan’s borders have been closed to most nonresident foreigners since the early months of the pandemic. But the warning is another blow for the Olympics, which are facing stiff opposition among the Japanese public over concerns that they could become a superspreader event as athletes and their entourages pour in from around the world.

The Japanese authorities have insisted that they can carry off the Olympics safely, and the State Department declaration is unlikely to affect the United States’ decision to send its athletes to the Olympics, whose organizers are not requiring participants to be inoculated.

The United States added Japan to a list of dozens of nations that have received its highest-level travel warning — “do not travel” — after the country’s virus incidence rate rose to a threshold that triggers such a declaration.

Starting in late April, large parts of the country entered a state of emergency as more contagious variants of the virus drove a rapid increase in case numbers. Although the numbers in Japan are low by global standards — averaging about 4,800 new cases daily, according to a New York Times database — fewer than 5 percent of residents have received a first shot of a coronavirus vaccine, putting Japan last among major developed nations in its vaccination campaign.

In other news around the world:

• In Australia, the authorities in Melbourne are racing to contain a coronavirus outbreak after four people tested positive on Monday and another five on Tuesday. The outbreak, the first in Victoria State in three months, is believed to stem from a man who was infectious in the state in early May. Officials announced new restrictions on indoor gatherings and renewed pleas for Australians to get inoculated. So far, 3.6 million vaccine doses have been given in Australia, which has a population of 26 million. In response to the new cases, New Zealand said it would pause travel to and from Victoria for three days.

• Health experts in Hong Kong are urging residents to be inoculated before millions of doses of the Pfizer-BioNTech vaccine expire within roughly three months. Less than one-fifth of the city’s 7.5 million people have received a dose amid mistrust of the government, fears over side effects and a lack of urgency as the Chinese territory records few new infections. Thomas Tsang, an adviser to the government’s vaccine task force, said on a radio program on Monday, “What we have is probably all we have for the rest of the year.”