A nurse checking on patients who just received a vaccine in Ulaanbaatar, Mongolia, last month.
Credit…Khasar Sandag for The New York Times

Coronavirus cases are surging in Mongolia, where more than half the population is fully vaccinated, prompting a new focus on the effectiveness of its main vaccine, developed by China’s Sinopharm.

Mongolia reported 1,312 new cases of the coronavirus on Wednesday as the country’s total infections neared 70,000, almost all recorded since January. New daily infections have risen more than 70 percent in the past two weeks, according to a New York Times database.

The landlocked nation has emerged as an outlier in the global scramble for vaccines among developing nations, securing enough doses for its eligible population thanks to its strategic location between Russia and China — two vaccine manufacturing giants with global ambitions. Mongolia has signed deals for 4.3 million doses of the Sinopharm vaccine and one million doses of Russia’s Sputnik V vaccine, although only 60,000 Sputnik doses have arrived so far.

Chinese vaccines, such as the ones made by Sinopharm and another company, Sinovac, use inactivated coronaviruses to trigger an immune response in the body. They have been shown in studies to be less effective than the vaccines developed by the pharmaceutical companies Pfizer and Moderna, which use newer mRNA technology.

Sinopharm’s vaccine initially came under scrutiny because of a lack of transparency in its late-stage trial data. The vaccine faced more questions after the island nation of the Seychelles, which relied heavily on Sinopharm to inoculate its population, also saw a spike in cases, although most people did not become seriously ill.

“Inactivated vaccines like Sinovac and Sinopharm are not as effective against infection but very effective against severe disease,” said Ben Cowling, an epidemiologist and biostatistician at the University of Hong Kong School of Public Health.

“Although Mongolia seems to be having a spike in infections and cases, my expectation is that there won’t be large number of hospitalizations,” he added.

And some virus variants may spread fast enough to cause concern even in countries where much of the population has vaccinations effective against them: Britain is dealing with a rise in cases linked to the Delta variant, despite having more than half of its adult population fully vaccinated, largely with shots from AstraZeneca and Pfizer.

Still, the wave of infections has raised questions in Mongolia over why the government relied on the Sinopharm shots instead of a vaccine proven to be more effective. It came as Mongolians headed to the polls on Wednesday to vote for president, the first election since the constitution was amended to limit the president to one six-year term. The prime minister is the head of government and holds executive power.

A year ago, Mongolia was among the few countries in the world that boasted no local coronavirus cases, but an outbreak in November changed that. A political crisis ensued and protests over perceived mishandling of the outbreak led the prime minister to resign in January.

The new prime minister, Oyun-Erdene Luvsannamsrai, has promised to revive a flagging economy and end social distancing restrictions that have hurt businesses. A fresh wave of cases could threaten this pledge.

Explorer of the Seas (front), a Royal Caribbean cruise ship, along with other cruise ships in Miami, late May. It’s unclear if cruise lines will be able to sail out of cities in Florida.
Credit…Joe Raedle/Getty Images

Cruise lines are starting to make plans to sail this summer out of Florida, which one company called “the cruise capital of the world.” But the state’s ban on vaccine passports complicates how ships can navigate its ports.

Some cruise lines, such as Norwegian Cruise Line, plan to sail with fully vaccinated crews and ensure that guests are also fully vaccinated. But while the federal government says employers can make on-site employees get vaccinated, a Florida state law prohibits businesses from requiring a vaccine passport, or proof of Covid-19 vaccination, in exchange for services.

The law has local officials concerned that their cities lose out if cruise lines decide to skip Florida ports, as Frank Del Rio, chief executive of Norwegian Cruise Line, recently threatened to do as a last resort.

On Monday, the company announced that it planned to set sail this summer from New York, Los Angeles and two Florida cities, Port Canaveral and Miami. The cruise line, however, did not specify how it planned to sail out of Florida.

Mr. Del Rio said the company was in contact with Gov. Ron DeSantis’s staff and legal team to “ensure that we can offer the safest cruise experience for our passengers departing from the cruise capital of the world.”

Other cruise lines, such as Royal Caribbean International, might bow to the state’s vaccine passport ban. Announcing its voyage plans out of Miami this summer, the cruise line said that its crews would be fully vaccinated, while guests were “strongly recommended to set sail fully vaccinated, if they are eligible.”

Royal Caribbean guests who are not vaccinated — or unable to prove that they are — will have to be tested for the virus, and could be subject to other protocols to be announced later, the cruise line said.

Last week, the mayors of Broward County, Fort Lauderdale and Hollywood sent a letter to Governor DeSantis urging him to reconsider the state’s position on vaccine passports. They argued that the cruise lines “are ready to set sail” based on U.S. Centers for Disease Control guidelines, but that the ban on vaccine passports prevented them from doing so.

“We are extremely concerned that unless a resolution can be reached, this impasse over the rules will result in the loss of the cruise industry in Broward County and Florida overall,” the mayors wrote.

Workers near a wholesale market in Wuhan, China, in March 2020.
Credit…Hector Retamal/Agence France-Presse — Getty Images

In the two years before the pandemic began, markets in the Chinese city of Wuhan were selling nearly three dozen animal species that can harbor pathogens that jump to humans, researchers have found, shedding new light on the possible role of the wildlife trade in the coronavirus’s origins.

The researchers found sales in Wuhan of mink, palm civets and raccoon dogs, but they did not find sales of pangolins or bats, which have been suspected as possible sources. of the coronavirus.

In all, the researchers documented sales of more than 47,000 animals across 38 species in Wuhan markets between May 2017 and November 2019. Thirty-three of the species have previously been infected with diseases or disease-bearing parasites that can affect humans, the researchers said.

China suspended the sale and consumption of wild animals as the coronavirus began spreading rapidly early last year. The country’s wildlife trade played a key role in the SARS outbreak in the early 2000s.

A team of experts who led a World Health Organization mission to Wuhan this year examined vendor records and other evidence from the city’s animal markets. But the team reached no firm conclusions about the markets’ role in the outbreak, or about the specific species through which the coronavirus might have spread to humans.

More than a year into the pandemic, the question of the virus’s origins remains largely unresolved. The Biden administration last month announced a new push to investigate whether it could have accidentally leaked from a laboratory in Wuhan.

Mr. Biden action came as top health officials renewed their appeals this week for a more rigorous inquiry. And it followed mounting criticism of a report from a team of international experts convened by the World Health Organization that largely dismissed the possibility that the virus had accidentally escaped from a Chinese laboratory called the Wuhan Institute of Virology.

Many scientists support investigating all possibilities, including the laboratory origin, even though they think the virus was probably transmitted from animals to humans outside of a laboratory. Angela Rasmussen, a virologist at University of Saskatchewan’s Vaccine and Infectious Disease Organization, said of the new study, “I think this puts a big point in the column of natural origin through intermediate species.” She said that while the paper “doesn’t prove anything” it “provides clear evidence that the wildlife markets really haven’t been investigated enough.”

The study of the animal markets, published this week in the journal Scientific Reports, was written by authors affiliated with China West Normal University, Oxford University and the University of British Columbia.

Between 2017 and 2019, one of the researchers conducted monthly surveys of all 17 shops in Wuhan markets that sold live wild animals for food and pets. Seven of these shops were at the city’s Huanan seafood market. Several early Covid cases in Wuhan were discovered in people with connections to that market.

The researchers originally carried out the surveys to investigate a tick-borne virus. But their results became “serendipitously” relevant to the Covid-19 pandemic, the researchers wrote.

Among the other species on sale in Wuhan, according to the researchers, were badgers, hedgehogs, weasels, porcupines, marmots, red foxes, flying squirrels, crested myna birds, snakes, vipers, cobras and Siamese crocodiles. Almost all of the animals were “sold alive, caged, stacked and in poor condition,” the researchers wrote, and were often butchered on site.

A mass vaccination program for older people at a clinic outside Johannesburg, South Africa, last month.
Credit…Themba Hadebe/Associated Press

Mastercard’s charitable arm has promised to donate $1.3 billion for vaccines in Africa, one of the largest corporate donations of the pandemic, as the continent struggles to contain a surge of infections.

The Mastercard Foundation said on Tuesday that its donation would be deployed over three years “in partnership” with the Africa Centers for Disease Control and Prevention. It said the goals were to strengthen the agency’s capacity, “lay the groundwork” for local vaccine manufacturing, acquire vaccines for at least 50 million people and help deliver shots to millions more.

“Ensuring inclusivity in vaccine access, and building Africa’s capacity to manufacture its own vaccines, is not just good for the continent, it’s the only sustainable path out of the pandemic and into a health-secure future,” John N. Nkengasong, the director of the Africa Centers for Disease Control and Prevention, said in the statement announcing the donation.

Africa is battling a sharp, sudden rise in coronavirus infections and deaths that experts believe is linked to the rise of new variants. The latest hot spots include Botswana, Namibia and Tunisia, according to a New York Times database.

But as of Wednesday only about 38 million, or slightly more than 2 percent, of the continent’s 1.3 billion people had received at least one dose of a coronavirus vaccine, according to the Our World in Data project. That was roughly the number of first doses given so far in Italy, which has a population of about 60 million.

Mastercard’s donation is the latest effort to address the glaring vaccination gap between rich and poor countries.

Last week a group of wealthy countries, foundations and private companies pledged $2.4 billion for global vaccination efforts and announced plans to share a total of 54 million doses from their domestic supplies with countries in need, for example.

The World Health Organization said last week that only 0.4 percent of all Covid-19 vaccine doses had been administered in low-income countries. And pharmaceutical companies have only manufactured a fraction of the 11 billion shots that researchers at Duke University estimate will be needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity.

Global Roundup

At a cafe in Paris last month. Cafe terraces could reopen in mid-May, after being closed since fall.
Credit…Andrea Mantovani for The New York Times

France, which has seen its coronavirus situation improve in recent weeks, is beginning its third phase of a gradual reopening. Indoor service in bars, cafes and restaurants will be allowed to resume, although at limited capacity, and terraces will be able to operate at 100 percent capacity.

And a nighttime curfew will be moved back to 11 p.m. from 9 p.m.

President Emmanuel Macron said on Tuesday that the previous phase three weeks ago, which relaxed coronavirus restrictions for outdoor dining in place since the fall, “was a real success.”

“I want to thank the French people because what we are doing is very demanding but everyone is holding on — that’s why we have these results,” Mr. Macron told BFM TV, adding that he was filled with a “somewhat cautious optimism” about the coming weeks.

The improvement is largely a result of a vaccination campaign that has gathered speed over the past two months, after being hampered for weeks by logistical issues and AstraZeneca’s various missteps in delivering its vaccine.

France is now vaccinating about half a million people on average every weekday. Some 28 million people, about 42 percent of the total population, have received at least a first shot of vaccine, while 12 million people are fully vaccinated.

The number of new daily infections has dropped in France from 20,000 at the beginning of May to 6,000 on Tuesday. Meanwhile, the number of patients in intensive care units has fallen below 3,000 after peaking at 6,000 in late April.

“We have a virus that is less circulating,” Jean-François Delfraissy, the head of the government’s scientific council, told RTL radio on Tuesday, adding that coronavirus figures were “falling more rapidly than we had imagined.”

The government started its reopening on May 3 by allowing schools to reopen and lifting limits on travel from home. Then came the reopening of restaurant and cafe terraces in mid-May.

France is also reopening on Wednesday for international tourism, removing the need for coronavirus tests for vaccinated Europeans and allowing vaccinated tourists from most of the rest of the world, including the United States, to also come back but with a negative test in hand.

Mr. Delfraissy said that the summer “should go well” but added that he expected a rebound of infections in the fall, though on a much smaller scale than last fall.

In other news around the world:

  • A two-week lockdown in Melbourne, Australia, will be eased beginning on Friday after outbreaks of the infectious Delta and Kappa coronavirus variants were contained, officials said. Schools and shops in Australia’s second-largest city will be allowed to reopen, and residents will be permitted to leave their homes for nonessential purposes. But people will still be barred from having visitors at home, and from traveling more than 25 kilometers, or about 16 miles, from where they live, as concerns linger over possible community spread of the virus. Officials reported just one new case on Wednesday, down from a peak earlier this month, when there were 94 active cases.

  • Cafes and restaurants in Belgium resumed indoor service on Wednesday, the first step of the country’s “summer plan” that also includes the reopening of gyms, cinemas and concert venues in limited capacity. As the European soccer championship begins on Friday, with Belgium among the favorites, gatherings of up to 400 people are also allowed, including in front of giant screens. Belgium’s prime minister, Alexander De Croo, said on Twitter: “Be cautious, but most of all: enjoy!”

  • In China, the Institute of Medical Biology at the Chinese Academy of Medical Sciences on Wednesday delivered the first doses of its Covid-19 vaccine for emergency use domestically, according to the government newspaper Science and Technology Daily. Like other leading vaccines developed by Chinese organizations, including Sinopharm and Sinovac, the shot uses inactivated coronaviruses to develop immunity. The report did not indicate if or when doses of the new vaccine would be administered. In total, China has administered more than 800 million vaccine doses, health officials said.

Elian Peltier, Raymond Zhong and Yan Zhuang contributed reporting.

In a March survey, roughly 60 percent of people said they struggled with pandemic-related insomnia.
Credit…Flora Hanitijo for The New York Times

In a survey of thousands of adults last summer, the American Academy of Sleep Medicine found that 20 percent of Americans said they had trouble sleeping because of the pandemic.

Not surprising. But when the academy repeated its survey 10 months later, in March, with coronavirus infection rates falling and more people being vaccinated, sleep problems had only gotten worse: Roughly 60 percent of people said they struggled with pandemic-related insomnia, and nearly half reported that the quality of their sleep had diminished.

“A lot of people thought that our sleep should be getting better because we can see the light at the end of the tunnel — but it’s worse now than it was last year,” said Dr. Fariha Abbasi-Feinberg, a sleep medicine specialist and spokeswoman for the American Academy of Sleep Medicine. “People are still really struggling.”

Studies show that in the pandemic, people tended to keep irregular sleep schedules, going to bed far later and sleeping in longer than usual, which can disrupt our circadian rhythms. We slashed our physical activity levels and spent longer indoors; gained weight and drank more alcohol; and erased the lines that separate work and school from our homes and our bedrooms — all of which are damaging to sleep.

Mandy Lin, 43, left, and her 9-year-old son returning to their apartment in Philadelphia last week. Ms. Lin stays close to home because she is fearful of anti-Asian attacks.
Credit…Hannah Yoon for The New York Times

Millions of Americans may be leaping into a summer of newly unmasked normalcy, but a surge in anti-Asian attacks during the pandemic is now holding back many Asian American families from joining them.

As schools phase out remote learning, companies summon employees back to work and masks fly off people’s faces, Asian Americans say that America’s race to reopen is creating a new wave of worries — not about getting sick, but about whether they will be attacked if they venture back onto a bus or accosted if they return to a favorite cafe or bookstore.

In more than a dozen interviews across the country, Asian Americans detailed fears about their safety and a litany of precautions that have endured even as the country has reopened.

Stop AAPI Hate, a coalition of community and academic organizations, tracked more than 6,600 attacks and other incidents targeting Asian Americans and Pacific Islanders from March 2020 to March 2021. A survey this spring found that one in three Asian Americans worried about becoming victims of hate crimes.

Asian Americans said they hoped the threats would ebb as more people got vaccinated and the pandemic faded. But person after person echoed the same worry: There is no vaccine against bigotry.

A rapid test center in Saarbrücken, Germany.
Credit…Laetitia Vancon for The New York Times

Want to go out for a meal indoors in Germany? Get a test. Want to stay at a hotel as a tourist or work out at the gym? Same answer.

For the many Germans who have not yet been vaccinated, the key to Covid freedom has come from the end of a nasal swab, and rapid-test centers have multiplied at a speed usually reserved for the country’s autobahn.

Abandoned cafes and nightclubs have been converted. Wedding tents have been repurposed. Even the back seats of bicycle taxis have a new use, as tourists have been replaced by Germans being swabbed by testers in full protective gear.

Germany is one of a handful of countries betting heavily on testing — as well as vaccines — to beat the pandemic. The idea is to find potentially infectious people before they can join crowds in concert halls and restaurants and spread the virus.

The testing system is a far cry from much of the United States, where in many places, people began dining indoors or sweating together in gyms with few if any requirements. Even in Britain, where the government gives out free rapid tests and schoolchildren have taken more than 50 million since January, they are not part of everyday life for most adults.

Uwe Gottschlich, 51, is one of those who is taking tests to return to a semblance of normalcy. On a recent day, he took a seat in the comfortable rear of a bike taxi that used to pedal tourists around Berlin’s central landmarks.

Karin Schmoll, the manager of the bike taxi company, now retrained to administer tests and wearing a green full-body medical gown, gloves, a mask and a face shield, approached, explained the procedure, and then asked him to remove his mask so she could delicately probe his nostrils with a swab.

“I’ll be honest,” Mr. Gottschlich said. “I’ve done this every day for the last three days.”

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