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Children in face masks arriving last week for school in Sittwe, the capital of Rakhine State, on Myanmar’s northwest coast.Credit...EPA, via Shutterstock

Three days before she was arrested by soldiers, Myanmar’s civilian leader, Daw Aung San Suu Kyi, received her first dose of a coronavirus vaccine. Her high-profile inoculation was part of a nationwide campaign to combat the virus through testing, mask-wearing, lockdowns and vaccination.
But like the civilian government that Ms. Aung San Suu Kyi headed, her program to contain Covid-19 was cast aside by the military when it seized power in the Feb. 1 coup.
“There had been a real push toward testing, surveillance and vaccination and all of that just crumbled after the first of February,” said Alessandra Dentice, the head of Myanmar’s UNICEF office.
Now, the country, reeling from a brutal military crackdown and crippled by a monthslong national strike, is paying the price for the junta’s neglect of the pandemic. According to data reported by the regime’s health ministry, the number of daily reported Covid cases has risen sharply, and with limited testing underway, the positivity rate jumped to nearly 22 percent on Thursday. Health experts believe many more cases are going undetected.
Most worrisome are outbreaks in the three largest communities near the border with India, the country where the highly contagious Delta variant was first identified. The variant has been detected among the cases.
As of Thursday, 20 townships in six states and regions have been placed under pandemic-related stay-at-home orders by the military. Outbreaks have also been reported in Yangon, the largest city, and Naypyidaw, the capital. In Mandalay, the second-largest city, all seven townships were placed under stay-at-home orders on Thursday. The six hospitals in the city that accept coronavirus patients have been filled to capacity since last week, according to a local medical charity.
The ousted government in the Southeast Asian nation had acquired 3.5 million vaccines from India before the coup. The junta commandeered most of the shots, but ignored plans to prioritize vaccinations for the elderly. Some shots went to vaccinate soldiers, according to a doctor at a Yangon military hospital. In protest, many doctors refused to get a second dose from the regime.
The military’s unwillingness to provide details about its vaccination program prompted Covax, the global vaccine-sharing program, to delay a shipment of 5.5 million doses in March, said Dr. Stephan Paul Jost, the World Health Organization’s representative for Myanmar. No new shipment has been scheduled.
With doctors and other health care workers on strike against the coup, Myanmar’s health care system may buckle under the outbreak.

Tourists arriving this week in Palma de Mallorca, Spain. The country has built a system that uses a Q.R. code that can be checked before a passenger travels to the airport.Credit...Jaime Reina/Agence France-Presse — Getty Images

Digital Covid-19 certificates aimed at facilitating free movement in the European Union came into force across the bloc on Thursday, a long-awaited milestone for countries hoping to boost their ailing tourism industries — but also a point of friction over the number of vaccines that do not qualify.
Free movement is a key pillar of European integration, and E.U. officials said last month that the certificates would “again enable citizens to enjoy this most tangible and cherished of E.U. rights.”
So far, the European Union lists four vaccines as qualifying for the certificate, all of which have been authorized for use across the bloc. They are the vaccines made by Pfizer-BioNTech, Moderna. Johnson Johnson and AstraZeneca.
That leaves out a vaccine that the international Covax mechanism has distributed across Africa: Covishield, a version of the AstraZeneca vaccine that is manufactured in India. It is, however, accepted in a handful of E.U. member nations.
Without naming the E.U., the Covax facility on Thursday urged “all regional, national and local government authorities to recognize as fully vaccinated” all people who have received a vaccine approved by the W.H.O. when easing travel restrictions, warning that not doing so would create a two-tiered system.
Through a Q.R. code issued by their country of residence, certificate holders will be able to show that they have been either fully vaccinated, tested negative or have immunity after a recent recovery. That will exempt them from most travel or quarantine restrictions.
Many European governments have already eased such rules, and each member nation can still revive protective measures if a country’s health situation deteriorates. Germany, for instance, has imposed restrictions on travelers coming from Portugal, which has faced a surge of new cases driven by the spread of the Delta variant.
While countries have agreed that national health authorities will issue the certificates — most E.U. countries have already been doing so — they are divided over who should check them, where and when.
Germany’s health minister, Jens Spahn, holding a phone with the CovPass Covid-19 certificate last month in Berlin.Credit...Sean Gallup/Getty ImagesCiting privacy concerns, Germany and Austria have not given airlines access to verification devices that they would need to scan the Q.R. codes. France has distributed such tools in airports, and Spain has built a system whereby Q.R. codes can be checked before passengers travel to the airport.
And one country, Ireland, has yet to set up a verification system for the digital certificates, after its national health system was recently targeted by cyberattacks, according to E.U. officials.
The divergences have highlighted the challenges that the E.U. faces in allowing free movement across the bloc.
This week, a group of airlines and airport representatives urged member states to set up verification systems before departure — alongside online check-ins, for instance — to avoid chaotic situations at airports upon arrival.
Echoing some concerns shared by the travel industry, the European Commission, the bloc’s executive arm, noted that the 27 E.U. member states had planned more than 10 verification processes.
“The digital Covid-19 certificate is an important tool that ideally will give people confidence in the easing of travel restrictions,” said Thomas Reynaert, the managing director of Airlines for Europe, an organization based in Brussels that represents the bloc’s largest carriers. “But this can only work for travelers if member states implement it in a harmonized way.”

Medical workers removing a man last week from an emergency tent erected to accommodate a surge of patients at Cengkareng Regional General Hospital in Jakarta, Indonesia.Credit...Tatan Syuflana/Associated Press

In Indonesia, grave diggers are working into the night, as oxygen and vaccines are in short supply. In Bangladesh, urban garment workers fleeing an impending lockdown are almost assuredly seeding another coronavirus surge in their impoverished home villages.
And in countries like South Korea and Israel that seemed to have largely vanquished the virus, new clusters of disease have proliferated. Chinese health officials said on Monday that they would build a giant quarantine center with up to 5,000 rooms to hold international travelers. Australia has ordered millions to stay at home.
A year and a half since it began racing across the globe with exponential efficiency, the pandemic is on the rise again in vast stretches of the world, driven largely by the new variants, particularly the highly contagious Delta variant first identified in India. From Africa to Asia, countries are suffering from record caseloads and deaths, even as wealthier nations with high vaccination rates have let their guard down, dispensing with mask mandates and reveling in life edging back toward normalcy.
Scientists believe the Delta variant may be twice as transmissible as the original coronavirus, and its potential to infect some partially vaccinated people has alarmed public health officials. Unvaccinated populations, whether in India or Indiana, may serve as incubators of new variants that could evolve in surprising and dangerous ways, with Delta giving rise to what Indian researchers are calling Delta Plus. There are also the Gamma and Lambda variants.
“We’re in a race against the spread of the virus variants,” said Professor Kim Woo-joo, an infectious disease specialist at Korea University Guro Hospital in Seoul.

Scotland supporters celebrating at the Euro 2020 soccer championship match between Scotland and England at Wembley Stadium in London on June 18.Credit...Carl Recine/Associated Press

Crowds gathering in stadiums, pubs and bars to watch the European Championship soccer games have driven a rise in coronavirus cases across Europe, the World Health Organization said on Thursday, raising concerns about another wave of infections even though vaccination campaigns have made progress.
“We need to look much beyond just the stadiums themselves,” said Catherine Smallwood, the W.H.O.’s senior emergency officer. “We need to look at how people get there: Are they traveling in large, crowded convoys of buses? And when they leave the stadiums, are they going into crowded bars and pubs to watch the matches?”
In Scotland, more than 2,000 people tested positive after watching a Euro 2020 game either at a stadium, a fan zone or at a pub, according to National Health Scotland. (Nearly two-thirds of those cases were linked to a Euro 2020 game in London in mid-June.) Around 120 fans from Finland were infected after traveling to St. Petersburg, Russia, to watch their team play.
After months of virus restrictions, and with the European Championships postponed for a year, soccer fans have been eager to travel across borders to watch the games in person. Finnish tourists attended games in Russia, French fans traveled to Romania, and Welsh ones supported their team in the Netherlands. In countries like Belgium, Britain and France, bars had reopened just weeks before the tournament began.
But given that most European countries have fully vaccinated less than a third of their populations, the risks are high. Experts say that the lax restrictions imposed on travel for the soccer championship may have serious consequences later in the summer or in the fall.
The rise in cases linked to the tournament comes more than a year after soccer games hosted early last year led to some of the first outbreaks in Europe.
Germany’s interior minister, Horst Seehofer, called the decision by European’s soccer governing body, UEFA, which runs the tournament, to allow large crowds in stadiums “utterly irresponsible.”
Despite the warnings by the W.H.O., British officials are allowing 60,000 fans to attend each of the tournament’s three final games in London next week.

Spraying disinfectant this week in front of the mayor’s office in Bandung, Indonesia.Credit...Novrian Arbi/Antara Foto, via Reuters

Indonesia’s president, Joko Widodo, announced new restrictions on Thursday for parts of Java and Bali islands to contain the rapidly spreading Delta variant, including closing mosques, schools, shopping malls and sports facilities.
The measures will take effect on Saturday and last until July 20, encompassing the Muslim holiday Eid al-Adha, a major event in Indonesia that falls on July 19 and is usually celebrated with large gatherings and the sacrifice of goats and cows.
“As we all know, the Covid-19 pandemic has been growing rapidly in the last few days because of the new variant, which is also a serious problem in many countries,” Mr. Joko said in an address to the nation. “This situation requires us to take more resolute steps so that together we can curb the spread of Covid-19.”
The number of reported cases has been rising daily, reaching a record 24,836 on Thursday, along with 504 deaths, another high. Just six weeks ago, it appeared that the vast Southeast Asian archipelago was making progress against the virus, with fewer than 2,500 daily cases reported.
The Delta variant, first detected in India, is driving a surge of the coronavirus in many parts of the world. In Indonesia, health experts say that the variant has led to the recent rise in cases, which has swamped hospitals and cemeteries, especially in the capital, Jakarta.
The Delta variant makes up 87 percent of the cases in Jakarta, the governor, Anies Baswedan, said earlier this week.
“Hospitals are overflowing, around one in five tests in Indonesia are reportedly coming back positive, and we’re experiencing more deaths now than at any point of the pandemic so far,” said Ade Soekadis, Mercy Corps’ country director for Indonesia.
The new measures stop short of the complete lockdown urged by some health experts.
All places of worship will be closed, workers in nonessential jobs must work from home, restaurants can provide only takeout food, local transit will operate with reduced capacity and public parks will be closed. Weddings with up to 30 attendees will still be allowed.
The measures will apply to nearly all of Java, which includes Jakarta and has a population of about 140 million, and to the most heavily populated parts of Bali, where tourism officials had been hoping to reopen to foreign tourists.
Most hospitals on Java are already over capacity and some are turning away patients, said Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia. According to his projections, the current surge would not peak until at least the end of July and could reach 500,000 cases and 2,000 deaths a day if tougher measures are not adopted.
“The government should do a lockdown,” he said. “Now we are facing our most serious and critical time. If we don’t respond to this situation in a serious way, then we will lose many lives.”

A nurse waiting for patients in May at a vaccination center in Bucharest, Romania.Credit...Robert Ghement/EPA, via Shutterstock

While many countries are desperately trying to get their hands on coronavirus vaccines, others are now finding their supply outstripping demand because of low uptake — to the extent that they are seeking ways to reduce their stockpiles.
Romania is a case in point.
On Tuesday, the Danish government said it had bought more than a million doses of the Pfizer vaccine from Romania. “We can do this deal because Romania is experiencing low vaccination backing and therefore wants to sell excess vaccines which they won’t be able to use,” Denmark’s health minister, Magnus Heunicke, said in a statement. The vaccines were sold at cost.
Last week, Valeriu Gheorghita, the head of Romania’s national coronavirus vaccination campaign, said that 35,000 doses of the AstraZeneca vaccine would probably need to be destroyed because they were set to expire at the end of June. In a news conference on Thursday, he said he had asked AstraZeneca whether the doses’ shelf life could be extended.
Despite a promising start this year to its vaccine rollout, Romania has seen a considerable decline in recent months in the number of people getting vaccinated.
In early May, the country was administering more than 100,000 doses a day, but the number has since dropped significantly. In a 24-hour period ending Wednesday, 20,800 doses were administered, and most of those were the second of the two doses that many vaccines require.
Overall, 4.7 million people in Romania, which has a population of about 19 million, have received one or both doses.
“We had a fraction of the population, maybe 30 percent, who were eager to get the vaccine, and that was very clear from December when they ran the first opinion polls,” said Sorin Ionita, a policy analyst at the Expert Forum, a Bucharest-based research group. “You absorb this fraction of the population, and then everything stops because there was no proper campaign to inform, to change the profound attitudes in the population.”
Romania is one of the most rural countries in the European Union, he said, and that adds to the challenge.
“Even if you get to the village and you organize a vaccine center in the town hall,” Mr. Ionita said, “it doesn’t necessarily mean that people who are 85 can get there easily from the margins of the village.”
The drop in vaccination uptake in Romania also comes as infection rates have fallen sharply: Sunday was the first day in more than a year that the capital, Bucharest, did not record a single new case. But there are concerns about a potential new wave later in the year, especially if vaccination rates remain sluggish.
To date, there have been more than a million confirmed cases in Romania and more than 33,000 related deaths.

Brazil’s minister of health, Marcelo Queiroga, left, and the U.S. ambassador to Brazil, Todd Chapman, receiving a shipment of Johnson Johnson vaccine doses last week.Credit...Carla Carniel/Reuters

When a commercial plane carrying 2.5 million doses of Moderna’s coronavirus vaccine took off on Wednesday from Dallas for Islamabad, Pakistan, U.S. officials had just finished a dizzying bureaucratic back-and-forth to get them there.
The United States had arranged a donation agreement with Moderna and Covax, the year-old vaccine-sharing initiative. Covax had previously worked out indemnity agreements with Moderna, which shield the company from liability for potential harm from the vaccine. U.S. Embassy officials in Islamabad had worked with regulators there to evaluate the Food and Drug Administration’s review of the vaccine. And Pakistani regulators had to pore over reams of materials on the vaccine lots and the factory where they were made before authorizing the shots for use.
The result was a so-called tripartite agreement, a type of deal that has increasingly come to consume the Biden administration’s pandemic response efforts.
Amid criticism from some public health experts that President Biden’s vaccine diplomacy efforts have been slow and insufficient, the White House plans to announce on Thursday that it has fulfilled the president’s pledge to share an initial 80 million doses by June 30.
More than 80 million have been formally offered to about 50 countries, the African Union and the 20-nation Caribbean consortium, with around half already shipped and the rest to be scheduled in the coming weeks, said Natalie Quillian, the Biden administration’s deputy Covid-19 response coordinator.
Researchers have estimated that 11 billion doses of Covid vaccines are needed worldwide to try to stamp out the pandemic. To date, more than three billion vaccine doses have been administered worldwide, equal to 40 doses for every 100 people. Some countries have yet to report a single dose, even as the highly contagious Delta variant spreads around the world, further exposing vaccine inequities.
“If this is the pace at which it will continue, then unfortunately, it’s much slower than what is needed,” Dr. Saad B. Omer, the director of the Yale Institute for Global Health, said of the U.S. effort.

Taking protective measures inside a casino in Atlantic City, N.J., last July.Credit...Michelle Gustafson for The New York Times

New Jersey’s yearlong ban on smoking inside casinos in Atlantic City will end on Sunday as the state continues to relax its coronavirus-related mandates.
But even as Gov. Philip D. Murphy acknowledged an end to the safety rule he implemented when casinos reopened a year ago, he strongly suggested that he supported efforts to make Atlantic City’s nine remaining casinos smoke free permanently.
Of the states with legalized gambling, nine, including New York and Massachusetts, bar smoking inside casinos, and many others permit it only within designated areas, according to the Centers for Disease Control and Prevention.
When asked Wednesday about the Fourth of July end to smoke-free casino floors, Mr. Murphy, a Democrat running for re-election, volunteered that he was “open-minded” to a pending legislative effort to end smoking inside gaming facilities.
“Would I be constructive on legislation?” Mr. Murphy said during a news briefing, adding, “I would be very constructive on that.”
Casinos, one of the state’s most powerful economic drivers, were among the first businesses to close in March 2020, as New Jersey became an early center of the virus, thrusting thousands of employees out of work over night.
An estimated 15.8 percent of workers in and around the seaside gaming hub lost jobs during the pandemic — the third-largest metropolitan decline nationwide, according to a recent study by the William J. Hughes Center for Public Policy at Stockton University.
When casinos reopened last July, smoking, which health officials warned could quickly spread the virus through exhaled vapor, was outlawed.
Some groups, including Smoke Free Atlantic City, a nonprofit funded by the state, have pressed to make the ban permanent even as officials with a casino trade association warned that would drive gamblers away and hurt the region’s recovery.
Bills that would bar smoking have not advanced in the State Legislature.

Fabiana Lopez and her family in line to get vaccinated in Lake Worth, Fla., in April.Credit...Saul Martinez for The New York Times

A new poll has found that Americans are sharply divided by household over vaccination status, with 77 percent of vaccinated adults saying everyone in their household is vaccinated and a similar share (75 percent) of unvaccinated adults saying no one they live with is vaccinated.
Sixty-seven percent of Democrats reported living in households where everyone had been vaccinated, compared with 39 percent of Republicans. Ten percent of Democrats said they lived in homes where no one had been vaccinated, compared with 37 percent of Republicans, according to the poll by the Kaiser Family Foundation, which has been tracking the public’s attitudes toward and experiences with vaccinations.
Overall, half of U.S. adults live in a fully vaccinated household and one in four lives in a completely unvaccinated household. The remainder, about one in five adults, lives in a household occupied by both vaccinated and unvaccinated people, including children under 12 who are not currently eligible to receive a vaccine.
The telephone survey of 1,888 adults 18 and older living in the United States was conducted from June 8 to June 21 and had a margin of error of plus or minus three percentage points.
As policymakers continue to experiment with lotteries, free beers and other incentives, the poll found that workers were more likely to get the shot when their employers encouraged them to and provided paid time off to make it easier. Two-thirds of the employed adults surveyed said their employer had encouraged workers to get vaccinated, and half said their employer had provided them paid time off to get the vaccine and to recover from side effects.
The workers who said their employer had taken either one of those steps were more likely to report having been vaccinated, even after the poll controlled for other demographic variables. The finding suggested that more employers’ encouraging vaccination and offering paid time off could lead to higher vaccination rates among workers.
As virus cases fall across much of the United States, the poll found that optimism over the idea that the pandemic may be ending could hamper vaccination efforts, with half of unvaccinated adults polled saying that the number of cases is now so low there is no need for more people to be vaccinated.
If adult vaccinations continue their current seven-day average rate, about 67 percent of U.S. adults will have received at least one shot by July 4, just shy of President Biden’s target of having 70 percent of adults at least partly vaccinated by that date, according to a New York Times analysis.
Lazaro Gamio contributed reporting.

Melissa Wilhelm Szymanski, at home in Glastonbury, Conn., sorting through medical bills. She was ill with a case of Covid-19 last year that went undetected, leading to $3,200 in charges.Credit...Jessica Hill/Associated Press

The Biden administration is expected to take its first steps on Thursday toward finalizing the details of a ban on surprise medical bills that Congress passed and President Donald J. Trump signed into law last winter. Some experts see the policy as the most important consumer protection legislation regarding health care to come out of Washington in more than a decade.
Surprise medical bills can arise when a doctor or other provider who isn’t in a patient’s insurance network becomes unexpectedly involved in a patient’s care. Patients may go to a hospital in their network, for example, but get treatment from emergency room physicians or anesthesiologists who are not — and who then send patients big bills directly.
Millions of Americans get such bills each year, and the pandemic highlighted the scope of the problem. Those hospitalized with Covid-19 sometimes found themselves facing thousands of dollars in medical debt from bills they could never have prevented.
One Covid patient in Philadelphia ended up with a $52,112 bill for an air ambulance transfer between hospitals while she was unconscious and on a ventilator. A woman in Texas was charged $4,000 by out-of-network doctors who cared for her during a 10-day hospitalization.
The new law, which goes into effect in 2022, would have prevented bills like those. The law was created in late 2020, but Congress gave regulators about a year to write more specific rules about how the policy will work. On Thursday, federal officials are expected to publish the first major regulation interpreting the plan.
“This law represents the single greatest patient protection since Obamacare,” said Adam Buckalew, who worked as a Republican staff member on the committees that wrote the bill in both the House and the Senate. “And it’s solidly bipartisan,” he added. Mr. Buckalew, now a consultant, is advising some health insurance groups interested in the details of the regulation.

Benjamin Smith, the chief executive of Air France-KLM, said that the company’s European leisure sales were strong. But it relies heavily on trans-Atlantic routes.Credit...Regis Duvignau/Reuters

The top executive of Air France-KLM, one of the world’s largest airline companies, was thrilled when Europe eased restrictions on American visitors last month. Now, he wants the United States to return the favor.
While Europe has largely lifted restrictions on vaccinated American tourists, most Europeans are still barred from visiting the United States even if they have been inoculated against the coronavirus, to the frustration of businesses on both sides of the Atlantic Ocean.
“What we’re anxiously waiting for is reciprocity on the part of the U.S. government,” the Air France-KLM chief executive, Benjamin Smith, said in an interview this week. “The trans-Atlantic is the most important long-haul market that we have.”
The U.S. Chamber of Commerce last week called for the easing of travel restrictions put in place under the Trump administration, saying that the return of European business travelers and tourists would “help drive economic growth and job creation for Americans across the country.” Europe has typically been one of the biggest sources of tourists to the United States, especially to New York and other East Coast destinations.
At a news conference on Wednesday, Jen Psaki, the White House press secretary, said the administration was considering lifting the ban.
“We know people want to come here and people want to travel to other places; we understand that,” Ms. Psaki said. She added: “We have these working groups with Canadians, with Europeans, with others to determine the timeline and pace when we can reopen and do it safely.”
U.S. airlines have been enjoying a summer rebound thanks to widespread vaccinations and strong demand for tickets after a year in which many people were confined to their homes. But the industry in Europe is struggling. The number of flights in Western Europe last week was down 49 percent compared with 2019, according to OAG, an aviation data provider. In North America, flights were only down about 24 percent.
Air France-KLM lost $8.4 billion dollars last year. Lufthansa Group, which is based in Germany, and I.A.G., which owns British Airways, Iberia and other airlines, also lost billions.
European airlines rely heavily on trans-Atlantic travel. For KLM, which has its main hub in Amsterdam, and Air France, flights to North America accounted for about 12 percent of overall capacity in 2019, according to Cirium, an aviation data provider. And, despite the ban on most Europeans visiting the U.S., Air France still plans to launch flights to its 12th American city this Friday by starting nonstop service between Denver and Paris.
Even as it awaits the U.S. reopening to European visitors, Mr. Smith said he was hopeful that travel would slowly recover within Europe.
“The leisure component of our Europe business is really strong,” Mr. Smith said. “It’s a bit too early to talk about the business component because it’s never been strong in the summer, but we’ll see how that goes in September.”

Source: New York Times

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