Covid-19 Live Updates: U.S. Clinics in Underserved Areas to Get Vaccine to Help Address Inequity

The Biden administration will begin delivering coronavirus vaccine directly to a network of federally funded clinics in underserved areas next week, officials said Tuesday, part of its effort to bring racial equity to a vaccination campaign aimed at eradicating a pandemic that has taken a disproportionate toll on communities of color.

The program, though, will be relatively small at first; the administration is allocating one million doses for 250 so-called “federally qualified health centers,” said Dr. Marcella Nunez-Smith, a Yale University professor who has been appointed by President Biden to lead a Covid-19 Equity Task Force. She said it would ramp up as supply expands.

“Equity is our North Star here,” Dr. Nunez-Smith said during a White House virus team briefing. “This effort that focuses on allocation for community health centers really is about connecting with those hard-to-reach populations across the country.”

Just as the pandemic has laid bare racial disparities in health care, it has exposed disparities in who is getting vaccinated. In cities like Washington, D.C., wealthy white residents are lining up to be vaccinated in low-income communities of color.

Experts say there are several reasons. People in underserved neighborhoods face a variety of obstacles, including registration phone lines and websites that can take hours to navigate, and lack of transportation or time off from jobs to get to appointments. And people of color, particularly Black people, are more likely to be hesitant about getting vaccinated, in light of the history of unethical medical research in the United States.

At the same time, the Biden administration is having trouble collecting data on the race and ethnicity of those vaccinated, a critical component of the racial equity effort. The Centers for Disease Control and Prevention reported last week that it has such data for just 52 percent of vaccine recipients.

“These data are just critical for us to have,” Dr. Nunez-Smith said in a recent interview. “It’s just at the core of the work that we need to do.”

The pace of vaccinations is increasing, amid expected — albeit slow — growth in supply, which continues to be a limiting factor. As of Monday, the seven-day average of vaccine doses administered across the United States was reported by the C.D.C. to be about 1.46 million doses a day.

Gov. Andrew M. Cuomo of New York, speaking to reporters after a call between governors and Jeffrey D. Zients, Mr. Biden’s coronavirus response coordinator, said he did not expect supply to substantially increase unless or until the Food and Drug Administration grants emergency approval to the vaccine made by Johnson & Johnson, which is expected in the coming weeks.

So far, just two vaccines, one by Moderna and the other by Pfizer-BioNTech, have emergency authorization from the F.D.A.

“You now have about 10 million New Yorkers waiting on 300,000 doses,” Mr. Cuomo said. “A big question on the call with the White House coordinator, by the governors, is ‘Supply, supply, supply — when will the supply increase?’”

When Mr. Biden became president, the federal government was shipping 8.6 million doses of vaccine to states each week. That number is about to go up to 11 million — an increase of 28 percent, Mr. Zients said. That tracks with expected increases in manufacturing.

The one million doses to the community clinics will be in addition to the supply being sent to the states. Separately, the White House announced last week that on Thursday, the administration will begin shipping an additional one million doses to 6,500 pharmacies.

People with dementia have significantly greater risk of contracting the coronavirus, and are much more likely to be hospitalized and die from it, than people without dementia do, a new study of millions of medical records in the United States has found.

Their risk could not be entirely explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home, and having conditions like obesity, asthma, diabetes and cardiovascular disease. After researchers adjusted for those factors, Americans with dementia were still twice as likely to have gotten Covid-19 as of late last summer.

“It’s pretty convincing in suggesting that there’s something about dementia that makes you more vulnerable,” said Dr. Kristine Yaffe, a professor of neurology and psychiatry at the University of California, San Francisco, who was not involved in the study.

The study found that Black people with dementia were nearly three times as likely as white people with dementia to become infected with the virus, a finding that experts said probably reflects the fact that people of color generally have been disproportionately harmed during the pandemic.

“This study highlights the need to protect patients with dementia, especially those who are Black,” the authors wrote.

The study was led by researchers at Case Western Reserve University in Cleveland who analyzed electronic health records of 61.9 million people age 18 and older in the United States from Feb. 1 through Aug. 21, 2020. The data, collected by IBM Watson Health Explorys, came from 360 hospitals and 317,000 health care providers across all 50 states and represented a fifth of the American population, the authors said.

The researchers found that out of 15,770 patients with Covid-19, 810 of them also had dementia. When the researchers adjusted for general demographic factors — age, sex and race — they found that people with dementia had more than three times the risk of getting Covid-19. When they adjusted for Covid-specific risk factors like nursing home residency and underlying physical conditions, the gap closed somewhat, but people with dementia were still twice as likely to become infected.

Experts and the study authors said the reasons for this vulnerability might include cognitive and physiological factors.

“Folks with dementia are more dependent on those around them to do the safety stuff, to remember to wear a mask, to keep people away through social distancing,” said Dr. Kenneth Langa, a professor of medicine at the University of Michigan who was not involved in the study. “There is the cognitive impairment and the fact that they are more socially at risk.”

As the European Union began its campaign to line up vaccines, it was slower off the mark, focused on prices while the United States and Britain made money no object, and succumbed to an abundance of regulatory caution. All of those things have left the bloc flat-footed as drugmakers fall behind on their promised orders.

But the 27 countries of the European Union are also attempting something they have never tried before and have broken yet another barrier in their deeper integration — albeit shakily — by casting their lot together in the vaccine hunt.

In doing so, they have inverted the bloc’s usual power equation. Bigger, richer countries like Germany and France — which could have afforded to sign contracts directly with drugmakers, as the United States and Britain did — saw their vaccine campaigns delayed by the more cumbersome joint effort, while smaller countries wound up with better supply terms than they were likely to have negotiated on their own.

For the bulk of E.U. nations, that experiment has been beneficial. But it has not necessarily been greeted happily in the wealthiest countries, and it has left leaders like Chancellor Angela Merkel of Germany and President Emmanuel Macron of France open to criticism at home.

They and E.U. leaders have nonetheless stood by their decision and the impulse for solidarity, even as the finger-pointing has begun.

“What would people have said if Germany and France had been in competition with one another for the purchase or production of vaccines? That would have been chaos,” Mr. Macron said at a news conference on Friday after a virtual meeting with Ms. Merkel. “That would have been counterproductive, economically and from a public health perspective, because we will only come out of this pandemic when we have vaccinated enough people in Europe.”

But even as the leaders of Europe’s traditional power duo talked up the 2.3 billion doses ordered as an indication of the wisdom of a joint approach, they conceded that a full campaign could not be expected before March.

Just over 3 percent of E.U. nationals had received at least one vaccine dose by the end of last week, compared with 17 percent in Britain and 9 percent in the United States.

A million doses of the AstraZeneca-Oxford vaccine had been shipped recently to South Africa from India. The first injections were set for Wednesday. After weeks of rich countries vaccinating doctors and nurses against the coronavirus, a respite from the anxiety and the trauma seemed to be nearing in South Africa, too.

Then, all of a sudden, the plans were shelved. The country’s leaders on Sunday ordered the rollout of the vaccine halted after a clinical trial failed to show that it could prevent people from getting mild or moderate cases of Covid-19 caused by the coronavirus variant that has overrun the country.

The new findings from South Africa were far from conclusive: They came from a small clinical trial that enrolled fewer than 2,000 people. And they did not preclude what some scientists say is the likelihood that the vaccine protects against severe disease from the variant — a key indicator of whether the virus will overwhelm hospitals and kill people.

But even if the vaccine is shown to prevent severe disease, scientists say, what happened in South Africa is a warning to the world. As quickly as scientists developed vaccines, the virus has seemed to evolve even more quickly. Instead of eradicating the virus, scientists now foresee months, if not years, of vaccine makers continually having to update their booster shots to protect against new variants.

And if the variant first seen in South Africa, now present in 32 countries, becomes the dominant form of the virus elsewhere, those countries could face a far slower crawl out of the pandemic.

The news was not all bad. Other vaccines offer some protection against the variant from South Africa, though less than against earlier versions of the virus. Among them is Johnson & Johnson’s vaccine, which prevented hospitalizations and deaths in clinical trials in the country. Despite not yet being authorized there, it could be rolled out to some health workers by mid-February as part of what officials vaguely described as “a research project.”

AstraZeneca is working to produce a version of its vaccine that can protect against the variant from South Africa by the fall.

Still, the findings rattled scientists, undercutting the notion that vaccines alone will stop the spread of the virus anytime soon. And they led to new, and more urgent, demands that richer countries donate doses to poorer countries that could become breeding grounds for mutations if the virus spreads unchecked.

A number of coronavirus variants are raising worries that they may draw out the pandemic or make vaccines less effective. Here are four that have been in the news lately and what we know about them.

B.1.1.7

• First emerged in Britain.

• Thought to be about 50 percent more infectious than earlier versions.

• Preliminary evidence suggests that it is about 35 percent more deadly.

• Current vaccines appear to work well against it.

This variant has been detected in more than 70 countries, including the United States, where it is doubling roughly every 10 days. Experts predict that it could become the country’s dominant source of infection by March. Learn more about B.1.1.7.

B.1.351

South Africa halted its use of the AstraZeneca-Oxford vaccine on Sunday after evidence emerged that the vaccine did not protect against mild or moderate illness caused by B.1.351. The variant has spread to at least 24 countries, including the United States, where it has been detected in Maryland, South Carolina and Virginia.

P.1

A close relative of B.1.351, this variant has spread to several countries, including the United States, where it has been detected in Minnesota and Oklahoma.

CAL.20C

This variant was found in more than half of the coronavirus test samples that were screened in Los Angeles.

For more information and the latest news on these variants, check our tracker.

House Democrats on Monday rolled out a main plank of President Biden’s stimulus plan, proposing legislation to send direct payments of $1,400 to Americans earning up to $75,000 and households with incomes up to $150,000.

The plan, drafted the day before key committees are scheduled to begin meeting to consider it, is at odds with proposals from some Republicans and moderate Democrats who want to curtail eligibility for direct payments, targeting it to lower-income people. Mr. Biden has said he is open to such modifications.

For now, the measure would allow individuals paid up to $100,000 and households up to $200,000 to be eligible for some payment, though the size of the checks would phase out gradually for those with incomes above $75,000, or $150,000 for a family.

The bill, unveiled by Representative Richard E. Neal, Democrat of Massachusetts and the chairman of the Ways and Means Committee, was one of a series that Democrats presented on Monday ahead of a week of legislative work to solidify the details of Mr. Biden’s stimulus proposal.

The decision to keep the income cap at the same level as the last round of stimulus payments comes after days of debate among the House Democratic caucus over the size of the checks. Some moderates pushed to restrict the full amount to those who make $50,000 or less and households making up to $100,000.

The legislation also includes significant changes to the tax code and an increase in an extension of weekly federal unemployment benefits. It would raise the $300-a-week payment to $400 a week and continue the program — currently slated to begin lapsing in March — through the end of August.

The $1.9 trillion plan would also provide for billions of dollars for schools, colleges, small businesses, and a provision that would increase the federal minimum wage to $15 by 2025, a progressive priority.

With nearly a year of coronavirus experience behind them, leaders at many universities in the United States ushered in the new term pledging not to repeat the errors of last year, when infection rates soared on campuses and in the surrounding communities.

But although most schools have pledged to increase testing, it is an expensive proposition at a time when many are struggling financially, and not all are testing students as often as recommended by public health experts.

The plans to keep the virus under control, for example, at the University of Michigan — which had more than 2,500 confirmed cases by the end of the fall semester — included increasing testing, offering more courses online, limiting dorm rooms to one occupant and offering no tolerance for rules violations. Yet already more than 1,000 new virus cases have been announced by the school since Jan. 1.

Other universities across the country have also encountered obstacles to a smooth spring, including the unexpected challenge of emerging variants — detected in recent days at the University of Texas at Austin, the University of Miami, Tulane University in New Orleans and the University of California, Berkeley — and the more common problem of recalcitrant students.

At Vanderbilt University in Nashville, students returning after winter break were required to be tested upon arrival and were then asked to avoid social interactions while awaiting results. But some had other ideas.

“We identified a cluster of positive Covid-19 cases linked to students who did not follow the arrival shelter-in-place rules,” a campuswide email reported on Jan. 23, blaming two student organizations for violating protocols. “More than 100 students are now in quarantine.”

The foundation of most university plans for the spring semester centers on increased testing to identify infected students before they display symptoms, and then placing them in isolation. The testing push has grown since July, when a study recommended that students be tested twice a week to better detect asymptomatic infections.

The American College Health Association later embraced the idea, issuing guidelines in December. “For the spring, we specifically recommend that all students are tested on arrival and twice a week thereafter if possible,” said Gerri Taylor, a co-chair of the organization’s Covid-19 task force.

Ms. Taylor said her organization did not know what percentage of schools had adopted the recommendations, and a survey of colleges across the country revealed a variety of requirements, ranging from voluntary testing to mandatory testing twice a week.

Global Roundup

In Bolivia, bodies are piling up at homes and on the streets again, echoing the horrific images of last summer, when a deadly surge in coronavirus infections overwhelmed the country’s fragile medical system. The Bolivian police say that in January they recovered 170 bodies of people thought to have died from Covid-19, and health officials say intensive-care units are full.

“When 10 or 20 patients die, their beds are full again in a few hours,” said Carlos Hurtado, a public health epidemiologist in Santa Cruz, Bolivia’s largest city.

The resurgence of the virus in Bolivia is part of a larger second wave throughout Latin America, where some of the world’s strictest quarantine measures are giving way to pandemic fatigue and concerns about the economy.

The International Monetary Fund said on Monday that it was revising its 2021 growth forecast for Latin America and the Caribbean to 4.1 percent from 3.6 percent. Warning that the surge in cases could threaten an economic recovery that is already expected to take longer than in other parts of the world, the fund predicted that regional output will not return to pre-pandemic levels until 2023.

While the number of new cases is falling, deaths remain at near-record highs in many parts of the region, just as some governments begin vaccination efforts.

Brazil and Mexico have each been averaging over 1,000 daily Covid-19 deaths for weeks; their total pandemic death toll is now surpassed only by that of the United States. Deaths in Brazil have matched their summer peak, while in Mexico they are far higher than any earlier peak, though they have begun falling in recent days.

In Bolivia last summer, mortality figures reviewed by The New York Times suggested that the country’s real death toll was nearly five times the official tally, indicating that Bolivia had suffered one of the world’s worst epidemics. About 20,000 more people died from June through August than in past years, according to a Times analysis — a vast number in a country of about 11 million people.

Bolivia is now reporting an average of 60 coronavirus deaths per day, approaching the numbers from last summer. Experts believe the higher mortality rate is caused by the more contagious virus variants originating in neighboring Brazil and elsewhere, but they lack the instruments to analyze the virus’s genetic code.

Despite the rising death rate, the Bolivian authorities have not implemented the quarantine measures used to help curb the virus’s first wave a year ago. Officials in Bolivia and other Latin American nations are touting their nascent vaccination programs as a reason to avoid lockdowns, even though few countries in the region beyond Brazil have procured a meaningful number of doses.

Only 20,000 vaccine doses have arrived in Bolivia, although the government says it plans to vaccinate eight million people by September.

In other global developments:

• More cases linked to a quarantine hotel in Victoria, Australia, were reported on Tuesday as an employee and returned traveler both tested positive for the virus. The traveler had completed her quarantine period, making her the second person this week to test positive after leaving a facility.

• Starting next week, travelers who return to Britain from countries where variants of the virus are widespread will have to pay 1,750 pounds ($2,410) for a 10-day hotel quarantine, the authorities said on Tuesday. Those who lie about where they have been could face prison terms of up to 10 years, Britain’s health secretary, Matt Hancock, said. The list of affected countries include Portugal, as well as most of South America and southern Africa.

• A “very small number” of British soldiers in Kenya have tested positive in an outbreak at a training camp, the British Defense Ministry said. The camp, about 120 miles north of the capital, Nairobi, has about 100 permanent employees and about 280 who rotate in and out, according to the British military. The base closed last year but reopened last month.

• Greece is closing the schools in Athens again, and tightening other restrictions, because of a surge in new cases in the capital, Prime Minister Kyriakos Mitsotakis announced on Tuesday. Mr. Mitsotakis appealed to Greeks to “stay united” despite their frustration with a lockdown, the country’s second, that was imposed in early November. The Athens schools had reopened last month. Most retail stores in the country will remain closed, and a curfew in the capital and other major cities was extended last week.

An expansion of Alabama’s lagging Covid-19 vaccination program drew large crowds of people on Monday as the state opened the last of eight new sites for inoculations.

The centers are a huge expansion of a vaccination program that has struggled to gain traction. Only 7.7 percent of eligible Alabamians have gotten at least one vaccine dose, according to a New York Times database, placing the state last among the 50 states and the District of Columbia.

Long lines of cars formed outside a downtown stadium in Selma, a hospital parking deck in Dothan and the site of a former shopping mall in Montgomery, where teams of workers delivered vaccinations through car windows. Shots were available to anyone over 65 and to select groups that included educators, farm workers, grocery employees and state legislators.

Before the centers opened, only about 700,000 medical workers, emergency medical workers, nursing home residents and people 75 and over were eligible to be vaccinated. The opening of the eight centers coincided with an expansion of eligibility for vaccination that raised that total to about 1.5 million.

Each of the eight centers is equipped to give 5,000 vaccinations by week’s end. By comparison, workers at Southeast Health medical center in Dothan had vaccinated fewer than 4,700 people since vaccines first became available in late December, the hospital spokesman, Mark Stewart, said in an interview.

Mr. Stewart said thousands of applicants had already sought appointments in the Dothan area. About 900 vaccinations were to be given out by day’s end, he said.

“It’s so good to see people.”

That was Naomi Osaka, the three-time Grand Slam champion, moments after her first-round win on Monday afternoon at the Australian Open. She stood at a microphone on the court at Rod Laver Arena and peered up at a crowd that seemed, if not normal, then something like it.

That was how it was on Monday across the grounds of Melbourne Park, where international sports returned, however temporarily, to something like it was before the pandemic.

Spectators lined up for tickets. They waited in security lines, pondered whether to order burgers or fish and chips, and decided how many $13 beers they could stomach.

The tournament could safely occur now only because the Grand Slam tennis season happens to start in a country that has arguably controlled Covid-19 better than anywhere else, thanks to months of enforced lockdowns, closed borders, and thorough testing and contact tracing. Just 909 people in Australia, which has a population of more than 25 million, have died of Covid-19. The country has averaged a half-dozen cases a day during the past two weeks, nearly all of them international arrivals.

Compromises have been made at this year’s event: Spectators are capped at 30,000 per day, about half the number that would usually attend. But their roars were appreciated more than ever.

“That’s one of the biggest motivations that we have, the source where we draw our energy and strength and motivation,” said Novak Djokovic, the world No. 1. “Especially at my age and stage of my career, I’m looking to feed off that energy from the crowd.”