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Virus Deaths Likely Higher Than Official Toll, W.H.O. Says – The New York Times

Waiting in line Karachi, Pakistan, last week to receive vaccines provided through the Covax initiative. The global program’s struggles are one factor among many in the growing gap in vaccination coverage between the world’s rich and poor.
Credit…Rehan Khan/EPA, via Shutterstock

Covax, the global vaccine-sharing program, will receive about 200 million doses of the Johnson and Johnson vaccine in a deal that could eventually boost a flagging campaign to vaccinate the world’s poorest countries.

Gavi, the public-private health partnership co-leading Covax, will purchase the doses at a discounted price from Johnson & Johnson. Gavi said that the goal is to supply the doses this year.

But it was not clear how quickly those doses will start being delivered or whether they can help turn around the struggling Covax program. Jake Sargent, a spokesman for Johnson & Johnson, said the company is “striving to deliver vaccine doses as quickly as possible.”

Only 71 million doses have been shipped out so far through the Covax program, the vast majority of which have been of AstraZeneca’s Covid vaccine. That’s far short of the goal of allocating 237 million doses to participating countries by the end of May that the World Health Organization, another co-leader of Covax, had set in March.

The program’s struggles are one factor among many in the growing gap in vaccination coverage between the world’s rich and poor. Only 0.3 percent of the vaccine doses administered globally have been given in the 29 poorest countries, home to about 9 percent of the world’s population. Covax has been underfunded and behind schedule even before it faced its most significant blow last month when India, facing a devastating coronavirus crisis, halted vaccine exports. That meant that Covax could no longer receive doses from its major supplier, the Serum Institute of India. The Serum Institute signaled this week that it would not be able to provide vaccines beyond India before the end of this year.

And the world is nowhere close to having the 11 billion doses that are needed to vaccinate 70 percent of the world’s population, the rough threshold needed for herd immunity, researchers at Duke University estimate. While global production is difficult to measure, the analytics firm Airfinity estimates the total so far at 1.7 billion doses.

The massive shortfall in supply has left low-income countries increasingly dependent on donations from wealthy countries. President Biden has pledged to donate 80 million doses of vaccines, most from AstraZeneca, and some of which are expected to be given through Covax. The president of the European Commission, Ursula von der Leyen, said on Friday that the bloc aims to donate 100 million vaccine doses to low- and middle-income countries this year.

Other vaccine makers have also said they would step up supply to low-income countries as they fight a push, supported by the Biden administration, to increase vaccine supply by waiving intellectual property protections on Covid vaccines. Albert Bourla, chief executive of Pfizer, said on Friday that the company expects to deliver two billion doses of its vaccine to developing countries in the next 18 months. That projection reflects existing deals with governments, anticipated future agreements and Pfizer’s pledge to supply 40 million doses to Covax.

Prashant Yadav, a management scientist who specializes in health care supply chains, wrote in a guest essay in The New York Times this week that the Covax shortfall shows how the world has become too dependent on India for vaccines. Based on data from the Global Commission for Post-Pandemic Policy, Mr. Yadav calculated that more than 65 percent of all doses of the AstraZeneca vaccine produced globally by April had been manufactured by the Serum Institute of India.

“Building up vaccine-manufacturing capacity in new locations, and creating a more decentralized and more transparent network worldwide, will be expensive, of course. And that, in turn, is likely to raise the price of vaccines,” he wrote. “But the cost of developing resilience is a small burden to bear compared to the losses that India and other countries short of vaccines are suffering today.”

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.

Santa Monica, Calif., last week.
Credit…Marcio Jose Sanchez/Associated Press

California inched closer to fully reopening, promising to lift requirements on social distancing and limits on the number of people indoors on June 15, state officials said on Friday.

People will need to show proof of vaccination or a negative coronavirus test to attend large indoor events, according to the guidelines. Those who are fully vaccinated won’t need to wear a mask in most situations.

The state government had previously announced mid-June as a target for a return to normal but had yet to disclose details. Los Angeles County, the most populous in the state, said it will follow the governor’s guidelines.

“Our case rates continue to be among the lowest in the United States and our vaccination numbers are holding pretty steady,” Gov. Gavin Newsom of California told KABC-TV on Thursday. “This gives me confidence that we’re going to get to June 15.”

As of this week, the state has one of the lowest case and hospitalization rates in the country, according to a New York Times database. California said back in April that it would fully reopen if hospitalization rates were low and there sufficient vaccine supply was available.

California is the latest state to release it’s reopening plan, joining an already growing slate of states that have reopened or are set to next month. But the state is keeping restrictions on indoor events with more than 5,000 attendees and outdoor events with more than 10,000 people.

People attending concerts or sports indoors will need to show either their vaccination card, a picture of it, or documentation from a healthcare provider as proof of inoculation to be allowed in. If someone is not vaccinated, they may show a negative coronavirus test taken no more than 72 hours before the event.

For large outdoor events, organizers are recommended to have these requirements in place, and those who aren’t fully vaccinated or don’t have a negative coronavirus test should be asked to wear face coverings.

During a briefing to reporters on Friday, Dr. Mark Ghaly, director of California Health and Human Services, said the state was “not at this time considering or requiring a vaccine passport for vendors.” But organizers still must have a way to verify vaccination or negative tests, he said.

The state Department of Public Health will also lift all isolation and quarantine requirements for travelers and issue a new travel advisory aligned with C.D.C. guidance.

A classroom that has been arranged to accommodate coronavirus protocols in Louisville, Ky., in March.
Credit…Amira Karaoud/Reuters

Several Covid-19 mitigation measures — including improving ventilation, requiring adults to wear face masks and conducting frequent surveillance testing — can help schools stay open and students remain safe, two new studies suggest.

The studies, published on Friday, come as many school districts are drawing up their plans for the fall. They also follow the Centers for Disease Control and Prevention guidance that all schools teaching students from kindergarten through grade 12 should continue to implement mask-wearing policies through the end of the 2020-2021 school year, after the agency’s recent move to allow for vaccinated people to forego masks indoors. The agency also kept in place its suggestions to observe physical distancing and to test for coronavirus infections.

In one of the new studies, researchers from the C.D.C. and the Georgia Department of Public Health surveyed 169 elementary schools in Georgia that offered in-person learning last fall. The group asked the schools about their pandemic responses and collected data on the coronavirus cases detected between Nov. 16 and Dec. 11, before vaccines were in use in the United States.

The researchers found that the incidence of the virus was 35 percent lower in schools that had improved their ventilation — by opening windows or doors, or using fans — than in schools that did not adopt these practices. In schools that combined better ventilation with air filtration — through the use of HEPA filters, for instance — case rates were 48 percent lower.

Requiring all teachers and staff members to wear masks reduced the incidence of the virus by 37 percent, the researchers found. Schools that required students to wear masks had a 21-percent-lower incidence of the virus, but that reduction was not statistically significant, the scientists found. That may be a result of the fact that adults are more likely to transmit the virus than children are, or simply because of a small sample size.

“Because universal and correct use of masks can reduce SARS-CoV-2 transmission and is a relatively low-cost and easily implemented strategy, findings in this report suggest universal and correct mask use is an important Covid-19 prevention strategy in schools as part of a multicomponent approach,” the researchers write.

A second study, led by researchers at the Utah Department of Health and the University of Utah, tracked the implementation of two coronavirus screening programs in the state’s schools. One program, implemented in January 2021, allowed schools with outbreaks to conduct schoolwide testing instead of shifting to remote learning.

“Schools could either do what they had been doing in the fall, which was switch to remote for a two-week period to interrupt transmission chains, or it could test everyone,” said Dr. Adam Hersh, one of the study’s authors and an expert in pediatric infectious diseases at the University of Utah. “And those who tested negative could return to in-person learning and those who tested positive obviously would be isolated.”

A second testing program required students to be tested for the coronavirus every 14 days in order to participate in sports or other extracurricular activities. Both initiatives relied on rapid antigen tests, which are less sensitive, but cheaper and faster, than the standard P.C.R. tests.

This year, between Jan. 4 and March 20, 28 high schools in the state reported sizable outbreaks. Fifteen schools decided to move to remote instruction for two weeks, while the other 13 decided to conduct surveillance testing instead. Of the 13,809 students who were tested as part of this screening, just 0.7 percent tested positive, the scientists reported. All 13 schools remained open.

“From a public health standpoint, it’s a huge success,” said Kendra Babitz, the coronavirus testing coordinator at the Utah Department of Health and one of the study’s authors. “Testing is and should be a mitigation strategy that schools are using to prevent transmission of SARS-CoV-2 in the school setting,” she added, referring to the virus that causes Covid-19.

Over the course of the winter, 95 percent of school athletic events took place as scheduled, the researchers found, although they did not compare that figure to a control group of schools without screening programs. “That’s in range with what happens in normal season,” Dr. Hersh said. “The show was able to go on.”

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.

A health care worker administered a coronavirus test Friday to a man in Gauhati, India.
Credit…Anupam Nath/Associated Press

The Indian government said it had carried out 2.5 million coronavirus tests over a 24-hour period, the most in a single day since the pandemic began and part of an effort to try to help contain the spread of the country’s devastating second wave.

Balram Bhargava, the director general of the Indian Council of Medical Research, a top government body, said on Thursday that in the last week, daily average testing had been between 1.6 million to 2 million tests. The government hopes to increase the number of daily tests to 4.5 million per day by the end of June.

India has been devastated by a surge in virus cases and deaths, many of which are believed by experts to have gone uncounted. The increase in testing has largely come from an uptick in use of rapid antigen tests. India’s health officials said they increased the share of antigen tests to 60 percent of the overall number of tests administered because labs have been overwhelmed and results from P.C.R. tests come with a longer wait.

Antigen tests are generally considered less reliable than P.C.R., and may mistakenly identify uninfected people as carrying the virus. But the virus is spreading to rural parts of the country where the health infrastructure is deeply underfunded. For some areas, rapid antigen tests are the only option because the distribution is in the hands of government.

“Even as the second wave declines, my patients from rural areas have a different story to tell — one of masses of people with fever, some dying, all without testing,” Dr. Arvinder Singh Soin, a prominent Indian surgeon, said on Twitter. “Terribly worried that there is a Covid surge in rural India that is going largely unchecked & undetected.”

The council that Mr. Bhargava leads approved the use of a self-administered rapid antigen test kit that was developed by Mylab Discovery Solutions, an Indian company, and gives results in 15 minutes. The company is aiming to ramp up production to 60 million kits per month within the next few weeks.

“This easy-to-use test combines a mobile app so that a user can know positive status, submit the result to I.C.M.R directly for traceability, and know what to do next,” said Sujit Jain, the director of Mylab Discovery Solutions. “We are sure this small step will be a big leap in mitigating the second and subsequent waves.”

Vaccinating India’s population of 1.4 billion people is a challenge. At the current rate of administering about 1.8 million doses a day, it would take the country more than three years to vaccinate 80 percent of its population.

The World Health Organization said on Friday that, worldwide, 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, because of the limited capacity of many countries to test their people and other weaknesses in official health data.

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.

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.







Biden Administration Incentivizes Vaccination Through Dating Apps

The Biden administration announced on Friday that they will partner with a number of popular dating apps like Tinder, OkCupid, Hinge, BLK and Chispa, to promote vaccination status among single people.

The pandemic has also had a negative impact on young people’s social lives. Social distancing and dating were always a bit of a challenging combination. So today, dating sites like Bumble, Tinder, Hinge, Match, OkCupid, BLK, Chispa, Plenty of Fish and Badoo are announcing a series of features to encourage vaccinations and help people with that — help people meet people who have that universally attractive quality: They’ve been vaccinated against Covid-19. These sites cater to over 50 million people in the U.S., and are some of the world’s biggest non-gaming apps. Here’s one for you: According to one of the sites, OkCupid, people who display their vaccination status are 14 percent more likely to get a match. We have finally found the one thing that makes us all more attractive — a vaccination. These dating apps will now allow vaccinated people to display badges, which show their vaccination status, filtered specifically to see only people who are vaccinated and offer premium content, details of which I cannot get into. But apparently they include things like boosts and super swipes.

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The Biden administration announced on Friday that they will partner with a number of popular dating apps like Tinder, OkCupid, Hinge, BLK and Chispa, to promote vaccination status among single people.CreditCredit…Alex Brandon/Associated Press

With a non-zero amount of awkwardness, the Biden administration on Friday highlighted a new plan to encourage more people to get vaccinated: an effort by a number of popular dating apps that will encourage pent-up young singles to promote their vaccination status, as the promise of a maskless summer grows tantalizingly within reach.

“We have finally found the one thing that makes us all more attractive: a vaccination,” Andy Slavitt, one of President Biden’s top coronavirus advisers, deadpanned during a virtual briefing for reporters. He later added, “In all seriousness, people are interested in other things in life besides their vaccine.”

Mr. Slavitt said that popular apps like Tinder, OkCupid, and Hinge — along with a suite of others, including BLK and Chispa, that cater to daters in specific communities — will add new features designed to reach a population of young people who may have been largely isolated from each other during the course of the pandemic, and will promote the idea that getting a shot could help users get a date. Tinder plans to launch a “Vaccine Center” to help users find nearby vaccination sites.

Highlighting the work of technology companies that can reach Americans where they are — on their phones — has been a cornerstone of the Biden administration’s efforts to combat access and hesitancy, and remind people who have not yet received a shot that doing so could help the country emerge from the pandemic. Providers are administering about 1.83 million doses per day on average, about a 46 percent decrease from the peak of 3.38 million reported on April 13, according to federal data.

Earlier this month, the president said that Uber and Lyft, two of the country’s largest ride-sharing services, would provide free rides to vaccination sites beginning May 24 and through July 4.

Mr. Slavitt said on Friday that the dating apps effort, which could reach over 50 million people in the United States, was not an official partnership with the companies. But the White House played a significant role in rallying them to participate, said an administration official, speaking on the condition of anonymity because the official was not authorized to comment publicly about the effort.

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. Community Organized Relief Effort (CORE), one of the city’s partners, will continue to operate the mobile program.

“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.”