Digging graves for coronavirus victims at a cemetery in São Paulo, Brazil, on Wednesday.
Credit…Mario Tama/Getty Images

GENEVA — Deaths from Covid-19 and Covid-related causes are likely to be two to three times the number that countries have recorded in their official data, the World Health Organization said on Friday.

Some six to eight million people may have now died from Covid-19 or its effects since the start of the pandemic, compared with 3.4 million deaths recorded in countries’ official reporting, Dr. Samira Asma, assistant director of the W.H.O.’s data division, told reporters.

The W.H.O. also estimates that at least three million people may have died from Covid-19 in 2020, compared with 1.8 million recorded in official data, the W.H.O. reported in annual statistics released on Friday.

The W.H.O. based its assessment on a statistical model that estimates the excess deaths attributable to Covid-19. The technique involves taking the total number of officially recorded deaths and then subtracting the number of deaths that would have been expected on the basis of previous mortality trends if the pandemic had not occurred.

On that basis, the W.H.O. said it estimated that 1.1 million to 1.3 million people in 53 European countries died from Covid-19 in 2020, roughly double the number recorded in official data. The organization also calculates that, over the same period, 1.3 million to 1.5 million people died in 35 countries in the Americas, compared with the 900,000 deaths officially recorded.

The huge discrepancy between the W.H.O.’s estimates and official data underscores the limited capacity of many countries to test their populations for the coronavirus and other weaknesses in official health data. For example, some Covid victims had died before being tested and their deaths did not appear in official reporting, William Msemburi, a W.H.O. data analyst said.

The W.H.O. will present its statistics to the annual meeting of its policymaking assembly in Geneva next week. The numbers will help make the case for countries to invest urgently in bolstering data systems and their capacity to monitor and report health developments.

“We can only be better prepared with better data,” Dr. Asma said.

United States ›United StatesOn May 2014-day change
New cases29,701–36%
New deaths654–14%

World ›WorldOn May 2014-day change
New cases636,014–23%
New deaths12,828–6%

U.S. vaccinations ›

Where states are reporting vaccines given

Moving a Covid-19 patient at Kenyatta National Hospital in Nairobi, Kenya, in April. Just 1.42 percent of the population of Africa has been fully vaccinated.
Credit…Brian Inganga/Associated Press

When the pandemic began, global health officials feared that the vulnerabilities of Africa would lead to devastation. More than a year later, the rates of illness and death from Covid in Africa appear to be lower than in the rest of the world, upending scientists’ expectations.

But if the virus begins to spread more rapidly on the continent, as it has in other regions, new findings suggest that the death toll could worsen.

People in Africa who become critically ill from Covid-19 are more likely to die than patients in other parts of the world, according to a report published on Thursday in the medical journal The Lancet.

The report, based on data from 64 hospitals in 10 countries, is the first broad look at what happens to critically ill Covid patients in Africa, the authors say. The increased risk of death applies only to those who become severely ill.

Among 3,077 critically ill patients admitted to the African hospitals, 48.2 percent died within 30 days, compared with a global average of 31.5 percent, the Lancet study found.

The study was observational, meaning that the researchers followed the patients’ progress, but did not experiment with treatments.

For Africa as a whole, the death rate among severely ill Covid patients may be even higher than it was in the study, the researchers said, because much of their information came from relatively well-equipped hospitals, and 36 percent of those facilities were in South Africa and Egypt, which have better resources than many other African countries. In addition, the patients in the study, with an average age of 56, were younger than many other critically ill Covid patients, indicating that death rates outside the study could be higher.

Reliable data on a country’s deaths and their causes have been hard to come by. As the coronavirus pandemic swept across the world in 2020, it has became increasingly evident that in a majority of countries on the African continent, most deaths are never formally registered.

The other eight countries in the study were Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger and Nigeria. Leaders of 16 other African nations had also agreed to participate, but ultimately did not.

Reasons for the higher death rates include a lack of resources such as surge capacity in intensive care units, equipment to measure patients’ oxygen levels, dialysis machines and so-called ECMO devices to pump oxygen into the bloodstream of patients whose lungs become so impaired that even a ventilator is not enough to keep them alive.

But there was also an apparent failure to use resources that were available, the authors of the study suggested. Proning — turning patients onto their stomachs to help them breathe — was underused, performed for only about a sixth of the patients who needed it.

The slow introduction of vaccines across the continent has underscored global problems of vaccine inequality. Just over 24 million vaccines have been administered in Africa, according to the Africa C.D.C., with just 1.42 percent of the population fully vaccinated. In the United States, about 126.6 million people are fully vaccinated and more than 60 percent of adults have received at least one shot.

Facing a resurgent coronavirus and plagued by delays with vaccine supply, South Africa began the second phase of its public vaccination campaign on Monday, opening appointments for people aged 60 or older. The country has a 14.5 percent positivity rate, according to the Africa C.D.C.

Signing up for vaccinations in Kochi, Japan, last month.
Credit…Kyodo News, via Associated Press

Japan on Friday approved the Moderna and AstraZeneca coronavirus vaccines for use in adults, giving the country much-needed new options as it tries to speed up an inoculation campaign that has been one of the slowest in the developed world.

Previously, only the Pfizer vaccine had been authorized for use in Japan, where just 4.1 percent of the population has received a first shot. Vaccinations have been held up by strict rules that allow only doctors and nurses to administer shots, and by a requirement that vaccines be tested on people in Japan before they are approved for use.

Japan is in the midst of a fourth wave of coronavirus infections, just two months before the Summer Olympics in Tokyo are set to begin. Tokyo and eight other prefectures are under a state of emergency that will last at least until the end of this month, and Okinawa is expected to be added to that list. Japan has been reporting about 5,500 cases a day, compared to 1,000 in early March.

A Health Ministry panel recommended on Thursday night that the government approve the Moderna and AstraZeneca vaccines. The health minister, Norihisa Tamura, said that the Moderna shots would be used at mass inoculation sites scheduled to open on Monday in Tokyo and Osaka, which will be staffed mainly by military doctors and nurses.

The government has not said when the AstraZeneca vaccine would be deployed. NHK, the public broadcaster, reported that despite the green light from the government, the use of AstraZeneca might be delayed over concerns that it could be linked to very rare cases of blood clotting.

Scientists have known for decades that coronaviruses can cause disease in dogs, but there has not been any evidence that dogs transmit it to humans.
Credit…Alen Thien/Alamy

Scientists have discovered a new canine coronavirus in a child who was hospitalized with pneumonia in Malaysia in 2018. If the virus is confirmed to be a human pathogen, it would be the eighth coronavirus, and the first canine coronavirus, known to cause disease in humans.

It is not yet clear whether this specific virus poses a serious threat to humans, the researchers stress. The study does not prove that the pneumonia was caused by the virus, which may not be capable of spreading between people. But the finding, which was published on Thursday in Clinical Infectious Diseases, highlights the need to more proactively search for viruses that could jump from animals into humans, the scientists said.

“I think the key message here is that these things are probably happening all over the world, where people come in contact with animals, especially intense contact, and we’re not picking them up,” said Gregory Gray, an infectious disease epidemiologist at Duke University who is one of the study’s authors.We should be looking for these things. If we can catch them early and find out that these viruses are successful in the human host, then we can mitigate them before they become a pandemic virus.”

Seven coronaviruses are currently known to infect humans. In addition to SARS-CoV-2, which is the causes of Covid-19, there are coronaviruses that cause SARS, MERS and the common cold. Many of these viruses are believed to have originated in bats, but can jump from bats to humans, either directly or after a stopover in another animal host.

Scientists have known for decades that coronaviruses can cause disease in dogs, and recent studies have shown that the coronavirus that causes Covid-19 can infect both cats and dogs. But there has not been any evidence that dogs transmit it, or any other coronavirus, to humans.

global roundup

Treating a patient in Lomas de Zamora, Argentina, on May 8. The country hit its highest daily death rate on Thursday.
Credit…Natacha Pisarenko/Associated Press

President Alberto Fernández of Argentina ordered a nine-day lockdown in the worst-affected parts of the country to help curb the spread of the coronavirus as the nation struggled to contain a second wave of the outbreak.

In a speech broadcast nationally on all radio and TV stations, Mr. Fernández ordered a lockdown that starts on Saturday and ends on May 30 in those regions. That will be followed by another nine days of restrictions, the severity of which will be determined by how much the country is able to control the spread of the virus.

“We are living the worst moment since the start of the pandemic,” Mr. Fernández said. “If we follow the guidelines, we will reduce the impact of this second wave. It is imperative that every local jurisdiction strictly apply these guidelines. There is no space for speculation and there is no time for delay.”

Argentina, like many of its neighbors in Latin America, saw an alarming spike in cases in April that has shown little respite as the region struggles to vaccinate people quickly enough to slow the spread. In the last seven days, the country’s daily average of new cases soared to become the fourth-highest in the world, and deaths rose to be the fifth-highest.

On Thursday, Argentina recorded 39,652 new cases and 494 new deaths. So far, 18 percent of the population has received at least one dose of a vaccine and 4.7 percent are fully vaccinated, according to the Our World in Data project at the University of Oxford. Neighboring Chile has fully vaccinated 40 percent of its population.

In other developments around the globe:

  • Thailand has detected its first 15 domestically transmitted cases of the highly infectious coronavirus variant first found in India, Reuters reported. The cases were discovered among construction workers in Bangkok, the Thai coronavirus task force said on Friday.

  • Prime Minister Pedro Sánchez of Spain announced on Friday that visitors from Britain, Japan, China and a handful of countries would be allowed back into the country from Monday, while Americans and other people who have been vaccinated will be able to visit Spain from June 7. The return of British tourists, who form the largest contingent of holiday makers in many Spanish resorts, was seen as essential to help guarantee the recovery of the Spanish tourism sector. “Spain will be very happy to welcome British tourists,” Mr. Sánchez said, during a tourism conference in Madrid. “They are welcome into our country without restrictions.”

  • While the government of Britain still advises against international cruises, a ship embarked on a domestic journey on Thursday night, the first time any such vessel had set sail from the country for more than a year. Passengers for the four-night cruise around the British Isles had to test negative for the virus before boarding and social distancing and masks are still required in public areas

  • Norway plans to ease some virus restrictions beginning May 27, Reuters reported. Larger groups of people will be allowed to meet and alcohol will be allowed to be served until midnight, Prime Minister Erna Solberg said on Friday. In some places, though, local restrictions will remain tougher than the national rules to prevent regional flare-ups of the virus.

Raphael Minder and Anna Schaverien contributed reporting.

After 14 months of lockdowns — some light, some draconian — many in Europe are again allowed to grab a coffee at a cafe or a pint in a pub, and to stay at a hotel or at a bed-and-breakfast.

Lockdown rules intended to prevent the spread of the coronavirus have been eased in England, France, Germany, Greece, Italy, the Netherlands and Poland, among other places — with many of the restrictions falling away this week.

The virus has killed more than 3.4 million people and sickened more than 165 million. But in Europe, with vaccinations rising, normalcy is once again at hand. After a rough start, 33 percent of people in the European Union have gotten at least one vaccine shot, according to Our World in Data, a University of Oxford tracking site. In Britain, 37 million people have received one dose of the vaccine and 21 million are fully vaccinated.

On Wednesday in Paris, where cafe terraces were once again open, Saïd Belkhiati, a 27-year-old account manager was dressed in a suit and having a drink with a friend.

“It really changes everything,” he said. “For a year, I felt like I was imprisoned, in an open-air jail. Now we are free. I’m enjoying this first breath of freedom. I took a day off to enjoy the reopening. Having a drink here, it’s so nice. Terraces are what make the charm of Paris!”

Noëlle Roche, a 75-year-old retiree, ventured out in the rain in Paris to catch up on a beloved pastime, going to the movies.

“I just watched the movie ‘DNA,’” she said. “I’m happy to be able to go to the movies again,”

“I missed it so much,” she added. “I usually go to the movies several times a week.”

In England, where indoor dining was allowed to restart and movie theaters and museums reopened, there was a note of caution because a variant of the virus that is circulating in India has also been found in Britain.

“We must be humble in the face of this virus,” the health secretary, Matt Hancock, told Parliament on Monday, adding that the variant, with a higher transmission rate, “poses a real risk.” While the overall case numbers remain low, they have been multiplying rapidly.

In Berlin, terraces, beer gardens and outdoor seating at restaurants opened on Friday. Despite some clouds and rain, owners and staff had been preparing all week, taking chairs and tables out of storage, and setting up the kind of tent-like structures that will allow customers nearly all the comforts of indoor dining while staying in line with the current coronavirus guidelines.

Those enjoying the outdoor services will have to present either a vaccination documentation, proof of an old Covid infection or a negative antigen test, which can be taken in one of hundreds of free test stations that the government has funded.

Other attractions, like museums, memorials and some outdoor theaters and cinemas, were opening on Friday under a reservation-only system, under the same testing-vaccine rules as the restaurants.

“It’s just grand — we are so happy that we can open up again and that we can have tourists sitting on our terrace,” said Jan Bubinger, 36, one of the managers at the Ständige Vertretung, a pub and restaurant on the Spree River right in the middle of Berlin’s tourist district.

Mr. Bubinger, who has had to shutter his restaurant for seven months, added that he would make antigen tests available to those without documents so that they don’t have to go to a test center before being served.

Volker Pradel, 61, said, “We are very happy of course,” after welcoming his first guest to the Schleusenkrug, a beer garden close to the Berlin Zoo on the west side of the city. Mr. Pradel, the manager of the eatery, noted, however, that it was difficult finding servers because most people in that profession now work at test or vaccination centers.

A doctor attending to a Covid-19 patient at a hospital in Kotputli area of Rajasthan in India, last week.
Credit…Rebecca Conway/Getty Images

India’s federal health ministry raised an alarm on Thursday, asking state governments to immediately report all cases of a potentially deadly fungal infection that appears to be spreading quickly among Covid-19 patients.

The rare condition, mucormycosis, commonly known as black fungus, was present in India before the pandemic, but it is affecting those with Covid or those who have recently recovered.

Many health experts blame the spread on a central coronavirus treatment, steroids. These drugs can limit inflammation of the lungs, but they also dull the response of the immune system, which can allow infections like the black fungus to take hold.

More broadly, Covid patients with weakened immune systems and underlying conditions, particularly diabetes, are especially vulnerable to black fungus, which has a high mortality rate.

Making matters worse, a shortage of antifungal drugs, like amphotericin B, has made it hard to fight the infection once it attacks. Relatives of the sick have been desperately sending messages over social media seeking the drug.

Courts are pressuring local governments to make antifungal drugs available and pushing for stepped up investigations to stop black-market drugs from being distributed.

Before the pandemic, a vial of amphotericin B would cost around $80, but some relatives of sick people say they have paid as much as $500 on the black market.

Video of a woman saying she would jump off the roof of a hospital if it failed to arrange injections of the medication for her husband spread widely on social media early this week.

The woman, in the central Indian state of Madhya Pradesh, said, “If I don’t get the injection today, then I will jump off the roof of the hospital and commit suicide. I have no other option left.” She added that the hospital had none of the medication and said of her husband, “Where should I take him in this condition?”

In the western state of Maharashtra, which includes the commercial hub of Mumbai, the authorities said at least 90 people had died of fungal infections and more than 1,500 patients were being treated in hospitals.

Rajesh Topai, the health minister of Maharashtra, told reporters on Wednesday that the state was desperate for more supplies of the medicine and begged the federal government, “do anything, but give more vials to Maharashtra.”

In Delhi, the capital, badly hit by the pandemic, hospitals have recorded 185 fungal infection cases and the local government is setting up three dedicated centers inside government-run hospitals to treat the condition.

M.V. Padma Srivastava, a professor and head of neurology department at All India Institute of Medical Sciences, New Delhi, said the number of black fungus cases was increasing every day and the condition was appearing across the country like never before.

She said hospitals received few cases during the first wave of the pandemic but certainly not the numbers they are registering now, amid a virulent second wave.

Of the medication for the disease she said: “It is not one of the common over-the-counter medications. This is a toxic medication by itself. It can’t be given by all and sundry. It is not something which you can take at home. It needs strict monitoring of body parameters because it is a toxic drug.”

The federal government directive requiring state governments to immediately disclose cases follows those of many Indian states that had already required hospitals to report cases of mucormycosis.

A mobile vaccination clinic in Los Angeles last week.
Credit…Patrick T. Fallon/Agence France-Presse — Getty Images

Los Angeles is taking its vaccination efforts on the road.

The city is gradually winding down its mass vaccination sites and will be fully mobile starting Aug. 1, marking what one deputy mayor called “the end of an era.”

“It’s a natural evolution,” said Jeffrey Gorell, the deputy mayor for public safety, who is overseeing vaccine efforts in the city. “Rather than having fixed sites where we ask community members to come to us, the natural progression is for us to move into more of a mobile approach where we can go to the populations where we need to be for areas with the lowest vaccination rates.”

With mobile sites, “we believe we can get to the most challenged areas,” he said.

Mobile vaccine units have been a part of the city’s vaccine program. But as the city’s 10 mass vaccination sites close over the coming weeks, the city will up its mobile units from 10 to 14. The city stopped offering vaccines at Dodgers Stadium on Thursday but other mass sites remain open.

Specially outfitted vans and trailers will give the city “tactical vaccination capabilities” so they can get into communities that may be underserved, hesitant or simply don’t have the time because of work requirements, Mr. Gorell said, adding that mobile teams will be able to extend evening and weekend hours.

“Rather than hunker down at a fixed site waiting for them to come to us, we can be in their neighborhood and available,” Mr. Gorell said. “We’re going to be a truly mobile presence in the city.”

The mobile units will offer all three federally authorized vaccines — the two-dose Pfizer-BioNTech and Moderna vaccines, and the single-shot Johnson & Johnson — and will be able to travel to multiple neighborhoods a day or stay for an entire week. Mr. Gorell said they also plan to target community events, grocery stores, street fairs and other highly trafficked areas. Appointments will not be necessary.

As of Thursday, 54 percent of California residents have received at least one shot and 40 percent are fully vaccinated according to a New York Times database. In Los Angeles County, 40 percent of eligible residents are fully vaccinated.

“With a growing number of residents getting inoculated, we are putting our resources where they will do the most good — delivering doses directly to undervaccinated communities, engaging and educating vulnerable populations, and eliminating barriers to this life-saving vaccine,” Mayor Eric Garcetti said in a statement.

Los Angeles joins a growing fleet of mobile Covid-19 vaccine clinics that are rolling up to neighborhoods in Delaware, Minnesota and Washington State to reach people who have been unable to travel to vaccination centers.

The city is working with community based organizations to help residents understand the science of the vaccine and access the mobile sites.

For Denise Villamil, the director of youth development services at Alma Family Services in East Los Angeles, outreach has been both personal and professional. Ms. Villamil lost her aunt to Covid-19 in December, just a month before vaccines started becoming available in the United States.

“Every person I can get through the line, every person I can get through the registration is one more person who is luckier than those who didn’t in the pandemic,” Ms. Villamil said. “Fear spreads, so does hope. So we’ve seen that in the communities and that’s been the beautiful part of this process. We’ve been able to give hope and see the ripple effect.”

Gov. Larry Hogan of Maryland has enlisted the help of the state’s lottery to get more people vaccinated.
Credit…Patrick Siebert

It’s not every day that an American governor appears alongside a man dressed as a lottery ball.

But that’s exactly what happened on Thursday as Gov. Larry Hogan announced that Maryland would partner with the state’s lottery to provide $2 million in prize money for residents who get vaccinated.

“Our mission is to ensure that no arm is left behind and we’re committed to leaving no stone unturned and using every resource at our disposal to achieve that goal,” Mr. Hogan said.

Beginning May 25, the Maryland lottery will randomly select and award $40,000 to a vaccinated Marylander every day through July 4, when a final drawing will be held for a grand prize of $400,000. Any Maryland resident who has been vaccinated in the state will be automatically enrolled in drawings.

“The sooner you get your shot, the more lottery drawings you will be eligible for,” he said, adding, “There’s no better time than now and there should be no more excuses.”

The state has administered about 5.7 million vaccines, and 44 percent of the state is fully vaccinated, according to a New York Times database. But like other states across the country, vaccination rates have tapered off. States have turned to an array of incentives — including beer, money, transit cards and joints — to get shots into the arms of more Americans.

“Promotions like this are just one more way that we’re reinforcing the importance of getting every single Marylander we can vaccinated against Covid-19,” Mr. Hogan said. All funding will be provided from Maryland’s lottery marketing fund.

“Get your shot for a shot to win,” he said, adding, “that’s a good line.”

Maryland isn’t alone in trying to lure residents with the chance of big winnings. This month, Ohio’s governor, Mike DeWine, offered a $1 million lottery prize for five people who get vaccinated. That effort would be paid for by federal coronavirus relief funds, Mr. DeWine said during a statewide televised address.

And in New York, the state will hand out free scratch-off tickets for the “Mega Multiplier” lottery to those 18 and older who get their shot at 10 state mass vaccination sites next week, Gov. Andrew Cuomo said on Thursday. The pilot program lasts from next Monday to Friday. The tickets could yield prizes from $20 to the $5 million jackpot, he said.

A summer camp in Michigan last year.
Credit…Emily Elconin/Reuters

As vaccinated Americans return to many parts of their prepandemic lives this summer, one group will be left out: children under 12, who cannot yet be vaccinated. So what should families with young children do when everyone else starts socializing again?

We asked experts as part of an informal New York Times survey. The group of 828 who responded included epidemiologists, who study public health, and pediatric infectious disease physicians, who research and treat children sick with diseases like Covid-19.

They noted that this phase was temporary. Pfizer has said vaccines for children ages 2 and up could come as soon as September. Of the survey respondents with young children, 92 percent said they would vaccinate their own children as soon as a shot was approved.

In the meantime, families with young children may need to retain more precautions, like masking and distancing, than their childless friends do. But they said some minimally risky activities could help counteract the mental health effects of pandemic living.

“Kids need to be able to be kids,” said Mac McCullough, an associate professor at Arizona State. “Outdoor activity isn’t perfectly safe, but its benefits are likely to outweigh its risks across an entire population.”

Dining in Florence, Italy, this week. Pressure has built on the government to be more flexible to save the tourism season and to allow Italians to get vaccinated in sun-and-surf regions far from home.
Credit…Susan Wright for The New York Times

ROME — As Dr. Mario Sorlini sits patients down in a vaccination center near the badly affected Italian town of Bergamo, he explains a potential complication of the coronavirus vaccine.

The second dose, he tells patients with terror-stricken faces, will fall on a date during the summer holidays.

“‘But I’ll be in Sardinia then,’” he said that some had responded with distress. Others moan about hotel rooms they’ve already booked. Some, he said, get up and leave.

For months, Italians have hungered for the vaccines that would give them safety, freedom from lockdown and a taste of normal life. After initial pitfalls and hurdles, the vaccination campaign is finally speeding up, but it is heading smack into the summer holidays that are sacred for many Italians and prompting fears among officials that a significant number would rather get away than get vaccinated.

“I am certain that many, after such a hard year, will risk delaying the vaccine” until after the summer holidays, said Renata Tosi, the mayor of Riccione, a beach town that is so identified with summer flings that it lent its name to a recent vacation anthem. That could create a significant danger next autumn, Ms. Tosi wrote in an open letter to the region’s president.

“The Second Shot Blocks Vacation,” read a headline in Messaggero Veneto, a newspaper in northeastern Italy, echoing concerns in papers, websites and social media accounts across the country.

An estimated 20 million Italians — mostly 40- and 50-somethings — face the prospect of getting their second shots in the middle of July or worse, in the riptide that is the Italian August, which pulls people out of cities and into swelling seaside towns.

This year, people have sought vacations with such a vengeance that tourism operators have started using the term “revenge travel” to describe the way Italians are trying to get even with the cruel months of lockdown. Surfing the web for holiday homes has become the new doom scrolling.

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