Covid-19: Britain Begins to Reopen, Emerging From One of the World’s Longest Lockdowns

People drinking at a pub in South London on Monday, as Britain begins to re-emerge from one of the longest lockdowns in the world.
Credit…Andrew Testa for The New York Times

On Monday, Britain’s lockdown — one of the longest and most stringent in the world — finally began drawing to an end.

For people across Europe, struggling with yet another wave of the pandemic and demoralized by a vaccine rollout that, outside of Britain, has been deeply troubled, this is hardly a time to rejoice.

And Britons — who have lost more than 150,000 people to the pandemic — know better than anyone that they are facing a wily adversary, a shape-shifter of a virus that spins off variants that can threaten medical advances with a few mutations.

But just past the stroke of midnight on Monday, a few select establishments in England served their first drinks since being forced to close in December and January, and more than a year after the first of three national lockdowns was imposed to limit the spread of the virus.

Later in the morning, thousands of gyms, salons and retail stores opened their doors for the first time in months, bringing a frisson of life to streets long frozen in a state of suspended animation. Friends reunited, and families shared a meal at outdoor cafes for the first time in months.

The weather may have been chilly — there were even some snow flurries — and pubs were limited to outdoor service. But the moment was embraced with an enthusiasm born of more than a year of on-and-off deprivation and uncertainty, one in which a once-unimaginable level of government decree became a way of life.

Prime Minister Boris Johnson called it “a major step forward in our road map to freedom.”

Monday was the start of a phased reopening that is scheduled to culminate on June 21, when the government says it hopes to lift almost all restrictions in England. Scotland, Wales and Northern Ireland are following separate but similar timetables, which means that some of the restrictions eased on Monday in England will remain in place a while longer in those places.

Lockdowns of one form or another have become so commonplace around the world that it can be hard to recall a time when they did not exist. The word began entering the popular lexicon in the weeks and months after the virus first emerged in China and the authorities there moved aggressively to restrict the movement of its citizens.

While no country matched China’s draconian measures, liberal democracies have been engaged in a yearlong effort to balance economic, political and public health concerns. Last spring, that meant about four billion people — half of humanity — living under some form of stay-at-home order.

Britain, which held out longer than many of its European neighbors, entered its first national lockdown on March 26, 2020.

At the height of the epidemic in January, Britain was averaging almost 60,000 new coronavirus infections and more than 1,200 Covid-19 deaths each day. In the past week, the daily averages were about 2,500 cases and 36 fatalities.

On Monday, as Britons flocked to stores and restaurants, there was widespread hope that after so many false dawns, there will be no going back.

People crowding for outdoor dining at a restaurant in Ann Arbor, Mich., last week.
Credit…Emily Elconin/Reuters

The Biden administration and Michigan’s Democratic governor are locked in an increasingly tense standoff over the state’s worst-in-the-nation coronavirus outbreak, with a top federal health official on Monday urging the governor to lock down her state.

As the governor, Gretchen Whitmer, publicly called again for a surge of vaccine supply, the director of the Centers for Disease Control and Prevention said at a White House news conference that securing extra doses was not the most immediate or practical solution to the outbreak. She said that Michigan — whose metro areas include 16 of the 17 worst outbreaks in the nation — needed to enact shutdown measures to stamp out the crush of infections.

“The answer is not necessarily to give vaccine,” said the director, Dr. Rochelle Walensky. “The answer to that is to really close things down, to go back to our basics, to go back to where we were last spring, last summer, and to shut things down.”

Michigan’s outbreak — driven by a highly infectious virus variant, loosened restrictions, travel, youth sporting events and uneven compliance with the remaining rules — is by far the worst in the country. The state is averaging seven times as many cases each day as it was in late February, and hospitalizations have roughly doubled in the past two weeks. Nonetheless, Ms. Whitmer has stopped well short of the far-reaching shutdowns that made her a political lightning rod last summer, with armed protesters storming the Statehouse to demand an end to coronavirus restrictions.

The Biden administration, however, has held fast to distributing vaccines by state population, not by triage, shying away from anything that could look like inequitable distribution or political favoritism at a time when vaccine supply remains tight in many places.

“It’s important to understand how we’ve approached vaccine distribution from the beginning: It’s done with equity in mind. It’s done with the adult population in mind,” the White House press secretary, Jen Psaki, said Monday. “We don’t pick by our friends. We don’t pick through a political prism.”

Michigan’s renewed fight with the virus was a warning for other states seeing new increases in cases and could have far-reaching consequences. Reports of new cases have increased by 45 percent in Illinois over the past two weeks, with especially high infection rates around Peoria. And as new, more contagious variants spread, caseloads are rising in Minnesota, Pennsylvania and several other states.

In an interview on Sunday with CBS’s “60 Minutes,” the Federal Reserve chair, Jerome H. Powell, said the American economy had “brightened substantially” as more people have been vaccinated and businesses have reopened. But he cautioned that “there really are risks out there,” specifically coronavirus flare-ups, if Americans return to normal life too quickly.

“The principal risk to our economy right now really is that the disease would spread again more quickly,” Mr. Powell said.

In recent days, Ms. Whitmer, an ally of President Biden’s, has diverged repeatedly from the president, asking him in a private call last week for extra vaccines, and, after being turned down, continuing to press her case in public that vaccination is the answer.

Bobby Leddy, a spokesman for Ms. Whitmer, said the state was suffering not from a failure of policymaking, but from the new variants that are more contagious and from Michiganders who are not complying with the governor’s orders. “Which is why it’s important for us to ramp up vaccinations as quickly as possible,” he said.

Ms. Whitmer was joined in the call for more vaccines by Representatives Fred Upton, a Republican, and Debbie Dingell, a Democrat, who sent a letter last week to Mr. Biden pleading for extra doses for their state.

Ms. Whitmer, who called last week for voluntary pauses to indoor dining, youth sports and in-person high school, said on Monday that she planned to extend existing restrictions on in-person officework for six more months. She has also appealed to Michigan residents to take more “personal responsibility,” language that echoed Republican governors and contrasted sharply with her own response to earlier surges.

Students lining up to enter Clara Barton High School in Crown Heights last month.
Credit…Anna Watts for The New York Times

Starting later this month, about 51,000 New York City public school students who have been learning remotely for the past year will be able to return to classrooms, Mayor Bill de Blasio announced on Monday, including middle and high school students.

The announcement marks one of the most significant changes prompted by last month’s guidance from the Centers for Disease Control and Prevention that schools could reduce social distancing between students in classrooms to three feet from six. For now, only elementary schools will switch to three feet.

Students in all grades who signed up for in-person classes over the last several weeks will be able to return starting April 26, Mr. de Blasio said. Previously, the city had committed only to bringing back elementary school students who wanted to switch to in-person classes.

Though a large number of families are eager for their children to return to classrooms, the families of about 650,000 of the city’s roughly 1 million students have decided to have them continue learning from home through the end of the school year in June. The families have made that choice even though the city schools have had very low transmission, and tens of thousands of educators are fully vaccinated. Last week, the city also eased a school closure rule that had led to frequent temporary closures, which frustrated many parents.

It is difficult to generalize why hundreds of thousands of families have kept their children home. Some parents may prefer to keep a remote schedule for the next few months for the sake of consistency. Other families have expressed concern about relatively high test positivity rates in New York City’s wider population. Some parents of high school students in particular are concerned that their students would be learning from their laptops even in classrooms.

Mr. de Blasio has said he expects most schools to offer full-time in-person instruction for all or most students for the final months of the school year. The mayor said the school system would be operating at full capacity come September, with all students able to attend school full-time.

Waiting to ride the Staten Island Ferry in New York last month.
Credit…Carlo Allegri/Reuters

New York City health officials said on Monday that infections with the coronavirus variant that first emerged in Britain, B.1.1.7, have been increasing in every borough, but slightly more in southern Brooklyn, eastern Queens, and Staten Island. Genetic analysis shows that B.1.1.7 now accounts for about 30 percent of cases sequenced citywide.

The data, which was included in new maps and a report released by the city, represents the first time officials have offered a ZIP-code level look at how worrisome variants have been spreading in New York, overtaking original versions of virus and clustering in some parts of the city more than others.

The report and maps, which were published Monday afternoon on the city’s health department website, also show that a variant first emerged in New York City, B.1.526, has been increasing at even a faster clip, and now represents some 45 percent of cases genetically sequenced in the city. The maps released Monday show that while B.1.526 is found in all five boroughs, it is slightly more common in the Bronx and parts of Queens.

Overall, more than 70 percent of genetically sequenced coronavirus cases now circulating in the city represent worrisome variants. The data, which spans January 1 to March 27, represents less than 5 percent of all positive test results in the city, as sequencing capabilities remain limited. As a result, it only provides a glimpse of the full picture of how the variants are impacting each community.

New York City has remained at a high plateau of coronavirus cases since February, with some 3,000 to 4,000 new cases reported per day, according to city data. The spread of these variants is likely a key reason that cases have not fallen more even as vaccinations rise, the city’s health department said in the report.

Hospitalizations have been falling, but very gradually, as the most vulnerable get vaccinated. Deaths have also been declining, but at a slower than desired pace, and have been averaging about 50 per day.

The United States has seen an exponential rise of B.1.1.7, which is now the most dominant variant across the country, according to the Centers for Disease Control and Prevention. That variant is about 60 percent more contagious and 67 percent more deadly than the original form of the coronavirus, according to the most recent estimates.

It has slammed Europe and helped fuel the worst-in-the-nation outbreak in Michigan. Until recently, the variant’s rise in the United States was somewhat camouflaged by falling infection rates overall, leading some political leaders to relax restrictions on indoor dining, social distancing and other measures. The C.D.C.’s efforts to track down the variants have greatly improved in recent weeks and will continue to grow, though Britain, which has a more centralized health care system, began a highly promoted sequencing program last year that allowed it to track the spread of the B.1.1.7 variant.

Vaccines do appear to be effective against the variant.

Less is known about the B.1.526 variant, which was first documented by researchers in the Upper Manhattan area of New York City last November and has since spread widely through the city and beyond. City officials have said that the variant may be more transmissible, and is outpacing even B.1.1.7 in some neighborhoods.

But it is still unknown whether the variant has an impact on disease severity, re-infection, or vaccine effectiveness. The city said it has no evidence that it does, but that it is studying those possibilities.

The city also warned on Monday that the P.1 variant, which was first identified in Brazil, is increasing its presence, though its incidence as a percentage of total cases remains very low.

The city did not release data or a map showing where P.1 cases have been identified. It has previously said that the variant accounted for 1.3 percent of sequenced samples as of late March — just 24 total cases of P.1. The variant maps released on Monday also excluded all ZIP codes where the total number of sequenced cases was fewer than three.

P.1 is also more transmissible than original versions of the virus, and there is some evidence of immunity evasion among both people who previously had Covid-19 and fully vaccinated people. It is spreading widely in South America and has appeared in many states.

The city’s report did not mention the B.1.351 variant, first found in South Africa, which can partially dodge the body’s immune system response. The city had previously reported sequencing 6 total cases of B.1.351.

John F. Kennedy Airport in New York in January.
Credit…Spencer Platt/Getty Images

New York will no longer require international travelers arriving in the state to quarantine though it continues to recommend they do so, according to new guidance released by the Health Department.

The change was intended to bring the state in line with travel recommendations issued earlier this month by the Centers for Disease Control and Prevention.

In that guidance for international and domestic travel, the C.D.C. said that people fully vaccinated against the coronavirus could travel safely “at low risk to themselves” but should still follow health precautions in public such as wearing masks. Federal health officials also said that they preferred all people avoid travel while the threat of the virus remained so high in the United States. The C.D.C. also cited a lack of vaccine coverage in other countries, and concern about the potential introduction and spread of new variants of the virus that are more prevalent overseas.

The C.D.C. requires all international travelers arriving in the United States to show proof of a recent negative test result before boarding their flights. When fully vaccinated Americans travel abroad, they only need to get a coronavirus test or quarantine if the country they are going to requires it. However, the guidance says they must have a negative coronavirus test before boarding a flight back to the United States, and they should get tested again three to five days after their return.

New York State health officials said in their guidance, released Saturday, that they still recommend all international travelers get tested three to five days after arriving in the state.

They also suggested that unvaccinated travelers should self-quarantine for as many as 10 days and avoid people at risk of serious illness from the virus for two weeks.

The new international guidance came after the state also ended its requirement that domestic travelers to New York quarantine upon arrival. At the time, Gov. Andrew M. Cuomo traced the decision to the pace of vaccinations and a decline in virus figures across the state, though the state was adding new cases at a higher rate than the country as a whole.

As of Sunday, the state’s average daily positivity test rate over the previous week was at 3.27 percent. Virus-related hospitalizations were at 4,083, their lowest number since Dec. 2, according to Mr. Cuomo’s office.

According to a New York Times database, New York State is adding new virus cases at the fifth-highest rate in the country. As of Sunday, the state was reporting an average of 37 new virus cases a day for every 100,000 residents over the last week. The nation as a whole was averaging 21 new cases per 100,000 people.

Allegheny Health Network hosted a vaccine clinic last week in Coraopolis, a suburb of Pittsburgh.
Credit…Emily Matthews/Pittsburgh Post-Gazette, via Associated Press

The state of Pennsylvania and the city of Los Angeles are accelerating plans for wider Covid-19 vaccine eligibility this week, as the United States approaches universal eligibility for adults.

Most states and U.S. territories have already expanded access to include anyone over 16. Others, including Massachusetts, New Jersey, Oregon and Washington State, have plans in place for universal adult access to start in the next few days. All states are expected to get there by Monday, a deadline set by President Biden.

Some states have local variations in eligibility, including Illinois, where Chicago did not join a statewide expansion that began Monday.

California as a whole has set Thursday as its date, but Mayor Eric Garcetti of Los Angeles said on Sunday that all residents age 16 or older in his city, the nation’s second largest, would become eligible two days earlier. In Pennsylvania, Gov. Tom Wolf said on Monday that all adults there would be eligible on Tuesday, six days earlier than previously planned.

“We need to maintain acceleration of the vaccine rollout, especially as case counts and hospitalization rates have increased,” Mr. Wolf said in a statement.

Expanded eligibility has not always brought immediate access. Demand for vaccination continues to outstrip supply in much of the nation, with people scrambling to book scarce appointments as they become available. And supplies of Johnson & Johnson’s one-dose vaccine will be extremely limited until federal regulators approve production at a Baltimore manufacturing plant with a pattern of quality-control lapses, the White House’s pandemic response coordinator said on Friday.

“We urge patience as we continue to ramp up our operations, obtain more doses, and enter this new phase of our campaign to end the pandemic,” Mr. Garcetti said.

More than 120 million people — or more than one-third of the U.S. population — have now received at least one dose of a Covid-19 vaccine, according to the Centers for Disease Control and Prevention. The nation is administering about 3.2 million doses a day on average.

Two of the three vaccines authorized for use in the U.S. — those made by Moderna and Johnson & Johnson — are authorized for use in adults. The third, from Pfizer-BioNTech, is authorized for anyone 16 or older, and the company is seeking to expand that range to include youths 12 to 15. No vaccine has yet been authorized for use in younger children.

Global Roundup

Devotees in the Ganges River during Kumbh Mela, or pitcher festival, one of the most sacred pilgrimages in Hinduism, in Haridwar, northern state of Uttarakhand, India, on Monday.
Credit…Karma Sonam/Associated Press

Even as India hit a record for daily coronavirus infections, and its total caseload rose to second in the world behind the United States, the images that dominated Indian news media on Monday were of a crowded religious festival along the banks of the Ganges River.

The dissonance was a clear manifestation of the confusing messages sent by the authorities just as India’s coronavirus epidemic is spiraling, with a daily high of 168,000 cases and 900 deaths reported on Monday.

Yet millions of devotees have thronged the holy city of Haridwar for the monthlong Kumbh Mela, or pitcher festival, when Hindu pilgrims seek absolution by bathing in the Ganges. Officials have said that about one million people will participate every day, and as many as five million during the most auspicious days, all crowded into a narrow stretch along the river and searching for the holiest spot to take a dip.

Already, fears are running high that one of the most sacred pilgrimages in Hinduism could turn into a superspreading event.

Dr. S. K. Jha, a local health officer, said that an average of about 250 new cases had been registered each day recently. Experts have warned that many more infections are going unrecorded, and that devotees could unwittingly carry the virus with them as they return to their homes across the country.

India is in the grip of the world’s fastest growing outbreak, with more and more jurisdictions going back into varying stages of lockdown. Infections are spreading particularly fast in Mumbai, the country’s financial hub, and the surrounding state of Maharashtra, where the government has announced a partial weekday lockdown and near-total closure over the weekends.

The situation is also worsening in the capital, New Delhi, which reported more than 10,000 new cases on Sunday, surpassing the previous daily high of nearly 8,500. The state government has imposed a curfew and ordered restaurants and public transport systems to run at half capacity. Arvind Kejriwal, Delhi’s top official, has said more restrictions may follow.

Hospitals in several states are reporting shortages of oxygen, ventilators and coronavirus testing kits, and some are also running low on remdesivir, a drug used in serious Covid-19 cases. India has halted the export of remdesivir until the situation improves.

India is also trying to ramp up its vaccination drive, with about three million people being inoculated daily and 104 million doses administered so far. But with many vaccination centers nationwide expressing concern over possible shortages, India’s large pharmaceutical industry has sharply reduced its exports of the AstraZeneca vaccine in order to keep more doses at home, creating serious challenges for other countries that had been relying on those shipments.

On Monday, Indian experts recommended the use of Russia’s Sputnik-V coronavirus vaccine, which would become the third available in the country if approved by the authorities.

After months of lower-than-expected infections and deaths from the virus, critics say Indian officials have sent dissonant messages about the seriousness of the crisis. Police officers are enforcing curfew and mask rules, sometimes resorting to beatings captured on videos shared across social media. But senior political leaders, including the prime minister, Narendra Modi, have been holding large rallies for local elections.

Mr. Modi’s Hindu nationalist government has also allowed the religious festival to proceed — in contrast to what happened last spring, at the start of the pandemic, when India’s health ministry blamed an Islamic seminary for fanning a far smaller outbreak. Critics say rhetoric from members of Mr. Modi’s party contributed to a spate of attacks against Muslims, a minority of about 200 million people in a Hindu-dominated country of 1.3 billion.

In other news around the world:

  • Bangladesh has announced a weeklong lockdown, closing offices, factories and transport services starting Wednesday, and banning domestic and international flights. The country is facing its severest coronavirus outbreak so far, averaging nearly 7,000 daily new infections, according to a New York Times database, as the virus sweeps across South Asia.

  • In France, all people over 55 are eligible to receive the AstraZeneca and Johnson & Johnson vaccines starting Monday, as the authorities try to ramp up their vaccination campaign after a sluggish start. Health Minister Olivier Véran said on Sunday that France would also extend the period between the first and second shots of the Pfizer and Moderna vaccines to six weeks from four, echoing Britain’s strategy. Over 14 million people have received a first injection.

  • High schools reopened in Greece on Monday after five months closed. The reopening only applies to senior high-school classes, and pupils and teachers will have to take a virus test twice a week before returning to classrooms. Thousands did so at home on Sunday, with just 613 positives out of some 380,000, a rate of 0.16 percent, according to state television. Stores in the country reopened last week.

  • The world’s wealthy nations should commit $30 billion to a global mass vaccination campaign, Gordon Brown, a former prime minister of Britain, said on Monday. Lower-income countries’ inoculation efforts are trailing far behind richer nations’ and the divide has led to allegations of a “vaccine apartheid,” Mr. Brown warned in an op-ed for The Guardian. “The costs may still be in billions, but the benefit will be in trillions,” he wrote.

Anna Schaverien, Constant Méheut and Niki Kitsantonis contributed reporting.

Eric Doulman taking a photo of his graduating daughter, Hannah, in front of photos of her graduating class outside James Madison High School in Brooklyn last May.
Credit…James Estrin/The New York Times

Schools and colleges across New York State will be allowed to hold graduation ceremonies for students this spring, with restrictions depending on type of venue or its capacity, Gov. Andrew M. Cuomo said on Monday.

Outdoor ceremonies with more than 500 people, for example, must not exceed 20 percent of the venue’s capacity, and attendees must have proof of vaccination or a recent negative coronavirus test result. Indoor ceremonies with fewer than 100 people cannot exceed 50 percent of the venue’s capacity, though the vaccination or test requirement in that case will be optional, Mr. Cuomo said.

After the pandemic hit last spring, officials in New York and across the nation warned that graduation ceremonies could fuel the virus’s spread, and many such events were canceled.

Colleges and universities began experiencing major outbreaks after students returned in the fall, and more than 120,000 cases have been linked to U.S. colleges and universities since Jan. 1. As they’ve been shuttled back and forth to campuses, depending on whether they’ve been open or closed, scientists have feared students were spreading the virus.

This spring, vaccinations have tracked upward, but dangerous virus variants are spreading and case counts remain high in many places. That has left colleges struggling to find a consensus on how best to mark commencement.

Mr. Cuomo said that New York State’s new rules on graduation will take effect on May 1. But he said officials are still encouraging drive-through or virtual graduation ceremonies as safer options, and he warned that the pandemic was far from over.

According to a New York Times database, New York State is adding new virus cases at the fifth-highest rate in the country. As of Sunday, the state was reporting an average of 37 new virus cases a day for every 100,000 residents over the last week. The nation as a whole was averaging 21 new cases per 100,000 people.

Scientists working at a Regeneron facility in New York State in 2020.
Credit…Regeneron, via Associated Press

A monoclonal antibody cocktail developed by the drug maker Regeneron offered strong protection against Covid-19 when given to people living with someone infected with the coronavirus, according to clinical trial results announced on Monday. The drug, if authorized, could offer another line of defense against the disease for people who are not protected by vaccination.

The findings are the latest evidence that such lab-made drugs not only prevent the worst outcomes of the disease when given early enough, but also help prevent people from getting sick in the first place.

Using the cumbersome drugs preventively on a large scale won’t be necessary: Vaccines are sufficient for the vast majority of people and are increasingly available.

Still, antibody drugs like Regeneron’s could give doctors a new way to protect high-risk people who haven’t been inoculated or who may not respond well to vaccination, such as those taking drugs that weaken their immune system. That could be an important tool as rising coronavirus cases and dangerous virus variants threaten to outpace vaccinations.

Regeneron said in a news release that it would ask the Food and Drug Administration to expand the drug’s emergency authorization — currently for high-risk people who already have Covid but are not hospitalized — to allow it to be given for preventive purposes in “appropriate populations.”

There’s “a very substantial number of people” in the United States and globally who could be a good fit to receive these drugs for preventive purposes, said Dr. Myron Cohen, a University of North Carolina researcher who leads monoclonal antibody efforts for the Covid Prevention Network, a National Institutes of Health-sponsored initiative that helped to oversee the trial.

“Not everyone’s going to take a vaccine, no matter what we do, and not everyone’s going to respond to a vaccine,” Dr. Cohen said.

Regeneron’s new data come from a clinical trial that enrolled more than 1,500 people who lived in the same household as someone who had tested positive for the virus within four days. Those who got an injection of Regeneron’s drug were 81 percent less likely to get sick with Covid compared to volunteers who got a placebo.

Dr. Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital who was an investigator for the study, said the data were “promising” for people who have not yet been vaccinated. (An earlier version of this item incorrectly said that Dr. Gandhi was not involved in the study.)

Even so, he said, the study did not enroll the type of patients that would be needed to assess whether the drug should be used preventively for immunocompromised patients. “I would say we don’t yet know that,” Dr. Gandhi said.

Regeneron’s cocktail, a combination of two drugs designed to mimic the antibodies generated naturally when the immune system fends off the virus, got a publicity boost last fall when it was given to President Donald J. Trump after he got sick with Covid.

The treatment received emergency authorization in November. Doctors are using it, as well as another antibody cocktail from Eli Lilly, for high-risk Covid patients.

But use of the antibody drugs has been slowed not by a shortage of doses, but by other challenges, though access has improved in recent months. Many patients don’t know to ask for the drugs or where to find them.

Many hospitals and clinics have not made the treatments a priority because they have been time-consuming and difficult to administer, in large part because they must be given via intravenous infusion. Regeneron plans to ask the F.D.A. to allow its drug to be given via an injection, as it was administered in the results of the study announced on Monday, which would allow it to be given more quickly and easily.

The positivity rate for Covid tests in Gaza has been running very high, a sign of rapid community spread. A health worker collected a nasal swab sample from a man in Gaza City on Monday.
Credit…Mohammed Abed/Agence France-Presse — Getty Images

Severe and critical cases of Covid-19 have hit record highs this week in the blockaded Gaza Strip, a development that health experts attributed to the proliferation of the highly transmissible coronavirus variant first identified in Britain.

Medical officials in the Hamas-run Health Ministry estimated that the variant now accounts for four out of five new cases in Gaza. They detected it in the densely populated territory for the first time in late March.

“We are in a dangerous place,” said Dr. Majdi Dhair, the director of the ministry’s preventive medicine department. “We expect more people to become infected and more people to enter hospitals. We ask God to pull us out of this situation.”

Over the past three weeks, severe cases — typically when a patient’s oxygen level falls to 94 percent or less — have risen to 219 from 58, according to ministry data. Critical cases, which can involve respiratory failure, septic shock or multiple organ dysfunction, jumped to 58 from 17.

On top of that, the ministry said on Monday that about 38 percent of the 4,700 virus test results it had received over the preceding 24 hours were positive — one of the highest rates in the past month.

Dr. Dhair said he believed that hospitals in Gaza were prepared to handle more severe and critical cases, but that they would probably have to postpone some surgical procedures to free up intensive care beds.

Devastated by years of conflict, Gaza’s hospitals were already dealing with challenging circumstances before the first cases of community transmission of the virus were discovered in the territory in August.

Gaza’s population is overwhelmingly young, and less than 1 percent of residents have been vaccinated so far.

The sharp rise in severe and critical cases has come just before the Muslim holy month of Ramadan, which begins on Tuesday. Traditionally during Ramadan, many Palestinians in Gaza would gather for large meals after sunset, pack streets in popular commercial districts and crowd into mosques for special evening prayers. But a number of those traditions will be prohibited this year because of the pandemic, the authorities said.

A QR code in a London cafe, for use with the British government’s contact tracing app.
Credit…Neil Hall/EPA, via Shutterstock

An update to the contact tracing app used in England and Wales has been blocked from release by Apple and Google because of privacy concerns, renewing a feud between the British government and the two tech giants about how smartphones can be used to track Covid-19 cases.

In an attempt to trace possible infections, the update to the app would have allowed a person who tests positive for the virus to upload a list of restaurants, shops and other venues they recently visited, data that would be used by health officials for contact tracing. But collecting such location information violates the terms of service that Google and Apple forced governments to agree to in exchange for making contact tracing apps available on their app stores.

The dispute, first reported by the BBC, highlights the supernational role that Apple and Google have played responding to the virus. The companies, which control the software of nearly every smartphone in the world, have forced governments to design contact tracing apps to their privacy specifications, or risk not having the tracking apps made available to the public. The gatekeeper role has frustrated policymakers in Britain, France and elsewhere, who have argued those public health decisions are for governments, not private companies to make.

The release of the app update was to coincide with England’s relaxation of lockdown rules. On Monday, the country began loosening months of Covid-related restrictions, allowing nonessential shops to reopen, and pubs and restaurants to serve customers outdoors.

An older version of the contact tracing app continues to work, but the data is stored on a person’s device, rather than being kept in a centralized database.

To use the app, visitors to a store or restaurant take a photo of a poster with a QR code displayed in the business, and the software keeps a record of the visit in case someone at the same location later tests positive.

Apple and Google are blocking the update that would let people upload the history of the locations they have checked into directly to health authorities.

The Department of Health and Social Care said it is in discussions with Apple and Google to “provide beneficial updates to the app which protect the public.”

Apple and Google declined to comment.

A vaccination center at the Royal Exhibition Building in Melbourne, Australia, last month.
Credit…James Ross/EPA, via Shutterstock

Australia has given up on the goal of vaccinating its entire population against Covid-19 by the end of the year, following updated advice from health officials that younger people should not receive the AstraZeneca vaccine, as well as delays in the delivery of doses.

The Australian government said last week that it had accepted a recommendation by a panel of health experts that people under 50 receive the Pfizer-BioNTech vaccine instead of the one developed by AstraZeneca, which had been the centerpiece of Australia’s vaccination program. The change in guidance came after European regulators found links between the AstraZeneca vaccine and rare blood clots, prompting several countries to restrict use of the shot.

Prime Minister Scott Morrison said Friday that the government had ordered another 20 million doses of the Pfizer vaccine, doubling what it had already purchased. But they are not expected to be available until the fourth quarter of this year, dealing a blow to the government’s previously stated goal of inoculating all of its 25 million people by then.

Mr. Morrison appeared to acknowledge the change in timeline in a Facebook post on Sunday.

“The government has also not set, nor has any plans to set any new targets for completing first doses,” Mr. Morrison said. “While we would like to see these doses completed before the end of the year, it is not possible to set such targets given the many uncertainties involved.”

Public health experts have criticized Mr. Morrison’s government for relying too heavily on the AstraZeneca vaccine, a relatively cheap and easy-to-use shot but one whose troubles have jeopardized inoculation efforts in multiple countries. They said the setback to Australia’s vaccination program risked undermining the country’s success in containing the spread of the coronavirus since recording its first case in January 2020.

“We’re in a position a year later where that hard-won success is jeopardized by a completely incompetent approach to a vaccine rollout,” said Bill Bowtell, a public health policy expert and adjunct professor at the University of New South Wales in Sydney.

Australia has made four separate agreements for the supply of Covid-19 vaccines that would give it a total of 170 million doses, enough to inoculate its population more than three times over. Plans to manufacture almost all of its 54 million AstraZeneca doses domestically were approved last month.

But the Australian government has been under fire for weeks over the sluggish pace of its vaccination rollout, which began in late February. By the end of March, when the government had aimed to vaccinate four million people, only about 600,000 had actually been inoculated. As of Sunday, Australia had administered fewer than 1.2 million doses.

Australian officials have attributed the slow rollout to delays in the delivery of millions of vaccine doses manufactured in the European Union, which has curbed exports amid its own supply shortages. The export restrictions mainly affect the AstraZeneca vaccine.

After enduring strict lockdowns for much of the past year, Australians are now enjoying relatively normal life in a country that has all but stamped out the virus. But public health experts warn that until more of the population is vaccinated, those freedoms are precarious.

“Having eliminated Covid, they thought a mass vaccination campaign would lock that in,” Mr. Bowtell said of the Australian public. “Now they are being deeply disillusioned.”

Covid-19 vaccinations at a monastery in Bangkok this month.
Credit…Adam Dean for The New York Times

Thailand is facing its worst coronavirus outbreak just as millions of people head to their home provinces during the country’s biggest travel holiday.

The latest wave of infections, which has sent at least eight cabinet members into isolation, is centered in a Bangkok nightlife district said to be popular with government officials and wealthy partygoers. The country, which until now has largely kept the virus under control, set a record Monday for new daily cases with 985.

One top health official warned that Thailand could soon face as many as 28,000 new cases a day in the worst-case scenario. The government announced it would set up field hospitals as Covid-19 wards at existing facilities begin to fill up.

Officials ordered the closure of hundreds of bars and nightclubs, but critics say the government has been inconsistent in its efforts to bring the outbreak under control. The prime minister, Prayuth Chan-ocha, stopped short of banning travel between provinces for the Songkran holiday, which begins on Tuesday and marks the beginning of the Thai New Year.

“Whatever will be, will be,” he said last week in explaining his decision. “The reason is it’s a matter that involves a huge number of people. The government will have to try to cope with that later.”

Dozens of provinces have imposed their own restrictions on travelers coming from Bangkok and other affected areas, prompting many Thais to cancel their trips. But many others set off over the weekend.

During earlier outbreaks, the government often acted quickly to require face masks, ban foreign tourists, impose quarantine restrictions and lock down hard-hit areas. It has reported fewer than 34,000 cases — mostly from a January surge traced to a seafood market near Bangkok — and just 97 deaths.

But it has been lax in testing and slow to vaccinate. So far, it has procured about 2.2 million doses and given at least one to about 500,000 people. Thailand’s population is 70 million.

Vaccine production is not expected to begin in earnest until June, when a manufacturer in Thailand is scheduled to begin producing 10 million doses a month of the AstraZeneca vaccine.

Health officials were alarmed by the recent discovery of dozens of cases of the highly infectious coronavirus variant first identified in Britain. The finding highlighted the inadequacy of Thailand’s virus testing and suggested that its quarantine procedures have not been as effective as officials believed.

Tourism operators have been especially angered by the government’s lackadaisical approach to obtaining vaccine supplies. The tourism industry, which normally accounts for about 20 percent of the nation’s economy, is highly dependent on foreign visitors and has been calling for widespread vaccinations to speed its recovery.

The outbreak in Bangkok has also prompted questions about the activities of some top officials and their aides.

The transportation minister, Saksayam Chidchob, who was hospitalized with Covid-19, was criticized for not being forthcoming about his whereabouts during times when he may have been exposed to the virus. He denied visiting the gentlemen’s club at the center of the outbreak and said he believed he had contracted the virus from an aide.

Eyan Gallegos, 11, a middle schooler in Washington, completing his homework in his room.
Credit…Gabriella Demczuk for The New York Times

Parents with school-age children have struggled to combine their usual work and family responsibilities this past year with at least some degree of home-schooling.

But mothers and fathers of middle-schoolers — the parenting cohort long known to researchers as the most angst-ridden and unhappy — are connecting now in a specific sort of common misery: the pressing fear that their children, at a vital point in their academic and social lives, have tripped over some key developmental milestones and may never quite find their footing.

Experts say some of their worries are justified — up to a point. The pandemic has taken a major toll on many adolescents’ emotional well-being.

Yet as the nation begins to pivot from trauma to recovery, many mental-health experts and educators are trying to spread the message that parents, too, need a reset. If adults want to guide their children toward resilience, these experts say, then they need to get their own minds out of crisis mode.

Early adolescence is considered a critical period, a time of brain changes so rapid and far-reaching that they rival the plasticity and growth that take place in the newborn to 3-year-old phase.

These changes make children more capable of higher-level thinking and reasoning. They also make them crave social contact, attention and approval.

Remote learning and social distancing are in many ways the opposite of what children in this age group want and need.

It’s been hardest on middle schoolers,” said Phyllis Fagell, a therapist and school counselor who wrote the 2019 book “Middle School Matters.” “It is their job to pull away from parents, to use these years to really focus on figuring out where they are in the pecking order. And all of that hard work that has to happen in these years was just put on hold.”

Yet Ms. Fagell and many other experts in adolescent development were adamant that parents should not panic — and that the spread of the “lost year” narrative needed to stop.

Getting a full picture of what’s going on with middle schoolers, they agreed, requires holding two seemingly contradictory ideas simultaneously in mind: The past year has been terrible. And most middle schoolers will be fine.

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