Covid-19: Delhi Court Rebukes Indian Government Over Oxygen Crisis

Deaths mount during an oxygen shortage in India, and a high court intervenes.

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Oxygen cylinders outside a shop in South Delhi. A court said it would start punishing government officials for failing to deliver oxygen.Credit...Atul Loke for The New York Times

A severe shortage of medical oxygen in India has left people gasping for their final breaths in their hospital beds, a sign of government futility in its fight against a crushing wave of coronavirus infections.

The latest tragic consequence came on Sunday night, when at least 12 people hospitalized with Covid-19 died in Chamarajanagar, southwestern India, because of a lack of oxygen, according to the regional authorities. Hospital officials were left desperately dialing senior government functionaries and made calls to neighboring officials for help. Videos from the hospital showed relatives of sick patients using towels to fan their loved ones in an attempt to save them.

Local officials provided different accounts of the death toll at the hospital. Some said that at least 10 died from oxygen deprivation. Others said that 14 more died after the accident but that they died of comorbidities related to Covid, not directly from the oxygen shortage.

Many countries, including Mexico, Nigeria, Egypt and Jordan, have faced oxygen shortages that have led to deadly accidents and driven up virus deaths. The World Health Organization estimated earlier this year that 500,000 people were in need of oxygen supply every day, but that number is likely to be much higher with the outbreak in India.

The Indian authorities have said that the country has enough liquid oxygen to meet medical needs and that it is rapidly expanding its supply. But production facilities are concentrated in eastern India, far from the worst outbreaks in New Delhi and in western areas of the country, requiring several days of travel by road.

Ritu Priya, a professor at the Center of Social Medicine and Community Health at Jawaharlal Nehru University in New Delhi, called the oxygen shortage a failure of governance. “We were not able to channelize oxygen distribution over the past year when that is what we should have been doing,” Dr. Priya said.

“We are living from oxygen cylinder to oxygen cylinder,” she said.

On Sunday, the New Delhi High Court said that it would start punishing government officials for failing to deliver oxygen after hospitals in the capital successfully sought an injunction, The Associated Press reported.

The Supreme Court also weighed in on Sunday, urging the central and state governments to consider another lockdown to gain control of the virus and to create an emergency stockpile of oxygen, according to the Indian news media.

Critics have blasted Mr. Modi’s handling of the crisis. A sudden, harsh lockdown imposed early in the pandemic sent millions of laborers scrambling back to their home villages and disrupted the economy. When cases dropped, Mr. Modi’s government failed to heed warnings of a potential resurgence from scientists, and its Covid-19 task force did not meet for months. Mr. Modi declared a premature victory over Covid in late January during what proved to be a mere lull in infections.

Now, cremation grounds are working day and night, burning thousands of bodies. The country is rife with the more lethal and transmissible B.1.1.7 variant of the coronavirus, first found in Britain, as well as a local variant, B.1.617. Experts are worried that the unchecked outbreak will spawn more dangerous variants of the coronavirus.

On Monday, the Indian federal Health Ministry reported 368,147 new cases and 3,417 deaths from the virus, a figure that generally remains low on the first day of the week. India reported new daily cases of as much as 392,488 on Saturday, a tally that no other country has ever seen. The real toll is far higher, according to experts.

Indian officials announced over the weekend that the army had opened its hospitals to civilians and that the first batch of the Russian vaccine, Sputnik V, had arrived, a boost to India’s flagging inoculation campaign.

Over the weekend, aid from a half-dozen countries arrived at airports across India; it included 157 ventilators from the United Arab Emirates, 500 oxygen cylinders from Taiwan and 1,000 vials of the medicine Remdesivir from Belgium.

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On Sunday, the United States delivered the third of six aid shipments to New Delhi, including 1,000 oxygen cylinders. Britain donated more than 400 oxygen concentrators, and France sent eight oxygen generators, each of which can serve 250 hospitalized patients.CreditCredit...Pool photo by Prakash Singh

Vaccines are badly needed in India, where shortages forced several states on Saturday to delay expanding access to everyone aged 18 and over. While it is a global power in vaccine production, India didn’t purchase enough doses to protect itself: Less than 2 percent of its 940 million adults have been fully vaccinated.

Aid shipments are beginning to flow into India, including oxygen supplies from the U.S., Britain and France.

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Relief supplies from the United States  arriving at the Indira Gandhi International Airport cargo terminal in New Delhi, India, on Friday.Credit...Pool photo by Prakash Singh

Countries around the world are accelerating deliveries of desperately needed medical supplies to India as the country endures an unrelenting, catastrophic coronavirus wave.

On Sunday, the United States delivered the third of six aid shipments to New Delhi, including 1,000 oxygen cylinders; Britain donated more than 400 oxygen concentrators; and France sent eight oxygen generators, each of which can serve 250 hospitalized patients.

Oxygen in India has been in short supply as it grapples with a crushing second virus wave, leaving some dying Covid patients gasping for air in hospital beds. Others, unable to find room in overwhelmed health care centers, have died in hospital parking lots, or at home.

On April 15, the Indian health ministry said in a statement that India had a daily production capacity of about 7,700 tons of oxygen, some of which is used for industrial purposes, with 55,000 tons in reserve. A week later, a government official told the Delhi High Court that medical demand had reached 8,800 tons per day, beyond the daily production capacity.

More than three dozens countries large and small have pledged to help India, which on a single day this weekend reported a world record of 401,993 new cases. Daily deaths have nearly doubled over the last two weeks, hitting 3,689 on Saturday.

Relatives of the sick have taken to social media with pleas seeking not only portable oxygen tanks, but also hospital beds or medicines like remdesivir. The country’s misery has been compounded by a series of deadly hospital accidents, including a fire on Saturday that killed 16 Covid patients and two health care workers in the city of Bharuch, in western India.

Over the weekend, aid from a half dozen countries touched down at airports across India; they included a shipment of 157 ventilators from the United Arab Emirates, 500 oxygen cylinders from Taiwan and 1,000 vials of the medicine Remdesivir from Belgium.

President Biden has been under intense pressure to do more to address the crisis in India. His administration intends to make up to 60 million doses of the AstraZeneca vaccine available to other countries, as long as federal regulators deem the doses safe. Vaccines are badly needed in India, where shortages forced several states on Saturday to delay expanding access to everyone aged 18 and over.

The United States has pledged to provide $100 million worth of supplies, which will include 15 million N95 masks and a million rapid diagnostic tests. On Sunday, Ron Klain, the White House chief of staff, said that the Biden administration had sent the raw materials to produce 20 million vaccine doses, and he said the U.S. was considering whether to lift patents on vaccines to boost global production.

“We are rushing aid to India,” Mr. Klain said in an appearance on CBS’ “Face the Nation.” The administration, he added would soon announce “how we can get this vaccine more widely distributed, more widely licensed, more widely shared.”

The United Kingdom announced it will send another 1,000 ventilators, in addition to the oxygen concentrators, 200 ventilators, and three oxygen generation units that were pledged last week.

France announced plans to deliver additional oxygen generators and medical equipment beyond the supplies that arrived Sunday. Air Liquide, a French industrial gases company, will begin shipments of several hundred tons of oxygen next week.

Tracking the Coronavirus ›

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India’s outbreak is a danger to the world. Here’s why.

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A health worker administers a Covid-19 test in Gauhati, India, on Saturday.Credit...Anupam Nath/Associated Press

The coronavirus surge that is lashing India, where countless funeral pyres cloud the night skies, is more than just a humanitarian disaster: Experts say uncontrolled outbreaks like India’s also threaten to prolong the pandemic by allowing more dangerous virus variants to mutate, spread and possibly evade vaccines.

The United States will begin restricting travel from India later this week, but similar limitations on air travel from China that President Trump imposed in the early days of the pandemic proved to be ineffectual.

“We can ban all the flights we want but there is literally zero way we can keep these highly contagious variants out of our country,” said Dr. Ashish Jha, the dean of the Brown University School of Public Health.

What are variants, and why should we care?

As the coronavirus spreads among human hosts, it invariably mutates, creating opportunities for new variants that can be more transmissible or even more deadly. One highly contagious variant, known as B.1.1.7, crushed Britain earlier this year and is already well entrenched in the United States and Europe.

Recent estimates suggest that B.1.1.7 is about 60 percent more contagious and 67 percent more deadly than the original form of the virus. Another worrisome variant, P.1, is wreaking havoc across South America.

On Friday, India recorded 401,993 new cases in a single day, a world record, though experts say its true numbers are far higher than what’s being reported. Peru, Brazil and other countries across South America are also experiencing devastating waves.

Virologists are unsure what is driving India’s second wave. Some have pointed to a homegrown variant called B.1.617, but researchers outside of India say the limited data suggests that B.1.1.7 may be to blame.

I’m already vaccinated. Should I be worried?

With 44 percent of adults having received at least one dose, the United States has made great strides vaccinating its citizens, though experts say the country is far from reaching so-called herd immunity, when the virus can’t spread easily because it can’t find enough hosts. Vaccine hesitancy remains a formidable threat to reaching that threshold.

In much of the world, however, vaccines are still hard to come by, especially in poorer countries. In India, less than 2 percent of the population has been fully vaccinated. “If we want to put this pandemic behind us, we can’t let the virus run wild in other parts of the world,” Dr. Jha said.

Preliminary evidence suggests that the vaccines are effective against the variants, although slightly less so against some.

“For now, the vaccines remain effective, but there is a trend toward less effectiveness,” said Dr. Céline Gounder, an infectious disease physician and epidemiologist at Bellevue Hospital in New York.

Vaccine makers say they are poised to develop booster shots that would tackle especially troublesome variants, but such a fix would be of little help to poorer nations already struggling to obtain the existing vaccines. Experts say the best way to head off the emergence of dangerous variants is to tamp down new infections and immunize most of humanity as quickly as possible.

Dr. Michael Diamond, a viral immunologist at Washington University in St. Louis, said that the longer the coronavirus circulates, the more time it has to mutate, which could eventually threaten vaccinated people; the only way to break the cycle is to ensure countries like India get enough vaccines.

“In order to stop this pandemic, we have to vaccinate the whole world,” Dr. Diamond said. “There will be new waves of infection over and over again unless we vaccinate at a global scale.”

Nepal halts all domestic and international flights in an effort to curb a huge spike.

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Nepalese Army officials saluted the bodies of Covid-19 victims at a crematorium in Kathmandu, the Nepali capital, on Saturday.Credit...Bikash Karki/Agence France-Presse — Getty Images

Public fury over Nepal’s growing wave of coronavirus infections has been rising in the country, with many people blaming travelers from India and several other virus-stricken countries as well as government ineptitude in handling the pandemic and large political rallies.

In response, Nepal halted all domestic flights on Sunday and announced that it would suspend international flights starting Wednesday.

As India’s crisis has worsened over recent weeks, people from several Indian states thronged to Nepal via land and air routes. Some were Nepali migrant workers returning home; others aimed to travel onward to third countries.

Last week, Nepal responded by banning third-country travel via Nepal and imposing two-week lockdowns in several cities, closing schools, colleges, factories, nightclubs and theaters. Public gatherings are also banned.

But those moves have so far done little to quell infections, which are spiking in Nepal’s densely populated cities, including Kathmandu, the capital, and metropolitan areas bordering India to the southwest.

The number of infections reported in Nepal has escalated rapidly since mid-April, from a seven-day average of new daily cases of less than 100 to more than 4,500 as of Saturday. On Sunday, Nepal reported 7,211 new cases.

Three cabinet members have been hospitalized with the virus, and the government is scrambling to arrange for oxygen imports and hospital beds.

Health experts have attributed the country’s second wave in part to the unchecked flow of Nepali migrant workers from India and in part to large political rallies organized by the ruling Communist Party of Nepal (Unified Marxist and Leninist) and other opposition parties that aimed to show strength during the pandemic.

This is the second time Nepal has suspended international flights in response to the pandemic. In April 2020, it halted international flights for more than five months.

According to accounts in Nepali news outlets, chartered cargo flights will continue to fly.

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A teacher at a Miami school tells students not to hug their vaccinated parents

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Centner Academy’s elementary school campus in Miami. The school threatened teachers’ employment if they got a coronavirus vaccine during the school year.Credit...Scott McIntyre for The New York Times

MIAMI — A fifth-grade teacher peddled a bogus conspiracy theory recently to students at Centner Academy, a private school in Miami, warning them that they should not hug parents who had been vaccinated against the coronavirus for more than five seconds because they might be exposed to harmful vaccine shedding.

“Hola Mami,” one student wrote in an email to her parents from school, saying that the teacher was “telling us to stay away from you guys.”

Nearly a week before, the school had threatened teachers’ employment if they got a coronavirus vaccine before the end of the school year.

Alarmed parents frantically texted one another on WhatsApp, trying to find a way to pull their children out at the end of the term. But inside the school, “hundreds of queries from all over the world” came in for teaching positions, according to the administration. More came from people who wanted to enroll their children at the school.

The small school became a national beacon for anti-vaccination activists practically overnight last week, just as public health officials in the United States wrestled with how to overcome vaccine skepticism.

Leila Centner, the school’s co-founder, who says she is not against fully tested vaccines, wrote on Instagram that journalists are “trying to destroy my reputation because I went against their narrative.”

Devoted supporters cheered her on.

“We won’t let them take you down!” one of them wrote on Instagram. “We stand strong with you! You’re an angel trying to save our kids and teachers.”

The virus is surging in Alaska’s interior, straining a Fairbanks hospital.

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Brittany Karns, staff pharmacist at the Chief Andrew Isaac Health Center, prepares a single vial of the Moderna vaccine for travel in Fairbanks, Alaska.Credit...Nathan Howard/Reuters

Dr. Angelique Ramirez, the chief medical officer of the main health care system in Fairbanks, Alaska, started the monthly coronavirus briefing in April by saying that she thought March’s meeting would be the last. But amid a new surge of cases in the state, one of the country’s worst surges, Dr. Ramirez was blunt about her past assessment.

“I was wrong,” she said.

With nearly 100,000 people, the Fairbanks metropolitan area is Alaska’s second largest and the largest in the state’s vast interior. According to a New York Times database, the number of new coronavirus cases in the borough of which Fairbanks is the seat, North Star, has risen by 253 percent over the past two weeks. The positivity rate has doubled since March, to about 10 percent from 5 percent, and hospitalizations at Fairbanks Memorial Hospital, the area’s only hospital, have hit a record number.

“This place is on fire with Covid,” Dr. Barb Creighton, an internist at Fairbanks Memorial Hospital, said at the meeting.

Experts are unsure what is driving the surge, though a low vaccination rate certainly plays a role. Thirty-six percent of Alaskans are fully vaccinated, and in some boroughs that number is over 50 percent, but in the Fairbanks area just 29 percent of the population has been fully vaccinated.

“There is no big outbreak or two big outbreaks that are really driving this,” said Dr. Joe McLaughlin, the state epidemiologist for Alaska. “We have cases and clusters being associated with a wide range of different settings.”

With two-thirds of the older population in Fairbanks having received at least one dose of a vaccine, those who have recently been hospitalized in Fairbanks are younger than the Covid patients during the winter, when there was a peak in case numbers. Dr. Creighton said people who were hospitalized in April tended to be in their 40s and 50s and were unvaccinated because they were waiting to see what side effects might come from receiving a Covid-19 vaccine.

“We are seeing them stay longer because they are not dying,” Dr. Creighton said. “We are giving them noninvasive ventilation and they are staying for two, three weeks and turning around, which I’ve never been more proud of.”

But while those older patients during the winter peak were largely grateful to be receiving care, those hospitalized now feel differently.

“Some of these folks are folks that are anti-vaxxers, anti-maskers, and they don’t believe they have Covid or are sick because of it, and our staff is getting pretty angry folks,” Shelley Ebenal, the chief executive of the health care system, Foundation Health Partners, said, imploring the system’s trustees to share their appreciation of the hospital staff with them.

She sounded a dire warning: “We are not out of Covid, and our staff in particular is not out of Covid. Our morale is really low.”

A correction was made on 
May 4, 2021

A caption in earlier versions of this article misidentified a hospital pharmacist in Fairbanks. She is Brittany Karns, not Brittany Karma. 

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Can 78,000 volunteers at the Tokyo Olympics protect themselves and the athletes from the coronavirus?

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Barbara G. Holthus, a volunteer and deputy director of the German Institute for Japanese Studies in Tokyo, said she worries that the Olympic Games could become a superspreader event.Credit...Noriko Hayashi for The New York Times

TOKYO — For Olympic host cities, one of the keys to a successful Games is the army of volunteers who cheerfully perform a range of duties, like fetching water, driving Olympic vehicles, interpreting for athletes or carrying medals to ceremonies.

If the rescheduled Tokyo Games go ahead as planned this summer, roughly 78,000 volunteers will have another responsibility: preventing the spread of the coronavirus, both among participants and themselves.

For protection, the volunteers are being offered little more than a couple of cloth masks, a bottle of sanitizer and mantras about social distancing. Unless they qualify for vaccination through Japan’s slow age-based rollout, they will not be inoculated against the coronavirus.

“I don’t know how we’re going to be able to do this,” said Akiko Kariya, 40, a paralegal in Tokyo who signed up to volunteer as an interpreter. The Olympic committee “hasn’t told us exactly what they will do to keep us safe.”

Global Roundup

Migrant workers say Hong Kong’s new testing rules are discriminatory.

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Lining up for coronavirus tests in Hong Kong on Sunday. As well as undergoing screening, migrant domestic workers must also be vaccinated before they can renew their contracts.Credit...Jerome Favre/EPA, via Shutterstock

Thousands of foreign domestic workers lined up for mandatory testing in Hong Kong on Sunday after two were found to be infected with new coronavirus variants, a sweeping campaign that some governments and advocacy groups called discriminatory because it was targeting such a large population.

In addition to undergoing testing in the next week, migrant domestic workers must also be vaccinated before they can renew their contracts, according to new rules announced on Friday. Those who already completed their vaccinations more than two weeks ago were exempt from the new testing requirements.

Hong Kong has more than 370,000 foreign domestic workers, mostly women from the Philippines and Indonesia who often work long hours at low wages doing housework and caring for children and older adults. Under Hong Kong law, they are excluded from obtaining permanent residency rights, which are granted to most others after seven years in the city.

Advocates for the workers say that such exclusions make foreign domestic employees a permanent underclass in Hong Kong and that the testing and vaccination requirements are new examples of the prejudice they face.

The mandatory testing “is clearly an act of discrimination and stigmatization against migrant domestic workers,” Dolores Balladares-Pelaez, chairwoman of the advocacy group United Filipinos in Hong Kong, said at a news conference on Saturday. She said that in the case of other outbreaks in Hong Kong, such as a cluster of more than 130 cases that emerged from a high-end gym, testing orders were tailored far more narrowly.

Teodoro Locsin Jr., the foreign secretary of the Philippines, said on Twitter that Hong Kong’s mandatory vaccination requirement “smacks of discrimination” because it targets only a subsection of all foreign workers in Hong Kong.

Hong Kong officials have said that the testing requirements are strictly based on risk levels, and that foreign domestic workers’ regular social gatherings, plus the high transmissibility of the new strain, raise the risk of new outbreaks.

At a site on a basketball court on Hong Kong Island, hundreds of workers waited to be tested on Sunday afternoon. One of them, Mary Acapulco, 29, said she had received her second shot days earlier, too late to avoid the mandatory test.

Ms. Acapulco, who is from the Philippines and has spent five years working in Hong Kong, said she had resigned herself to spending her single day off this week being tested.

“I’m upset, of course. That’s why I got vaccinated,” she said. “But anyway, it is for safety.”

In other developments around the world:

  • Pfizer will ship 4.5 million vaccine doses to South Africa by June, according to a statement from Health Minister Zweli Mkhize. The first shipment of 325,260 doses is scheduled to arrive Sunday night and shipments will continue on a weekly basis. “The vaccine supply will increase to an average of 636,480 doses weekly from 31 May which will see us accumulating close to 4.5 million doses by the end of June,” said Mkhize.

  • Malaysia has reported its first case of the coronavirus variant that has been contributing to the devastation in India, Health Minister Adham Baba said on Sunday. The variant, called B.1.617, is more lethal and more transmissible. On Wednesday, Malaysia had banned flights to and from India to prevent the spread of the variant.

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Russia’s vaccine diplomacy sows discord across Europe.

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The old town of Bratislava, Slovakia. Uproar in the country over the decision to order Russia’s Sputnik V vaccine forced Prime Minister Igor Matovic to step down.Credit...Akos Stiller for The New York Times

It remains unclear whether Sputnik V, the world’s first registered vaccine, is the medical breakthrough proclaimed last summer by President Vladimir V. Putin of Russia, but the shot has already proved to be remarkably effective in spreading disarray and division in Europe.

In France, President Emmanuel Macron talked to Mr. Putin recently about possible deliveries of Sputnik, which Mr. Macron’s own foreign minister derided as a “propaganda tool.” The Austrian chancellor, Sebastian Kurz, furious that European regulators have been slow in approving Sputnik, has clashed with Germany’s leader, Angela Merkel, over the bloc’s vaccination program, which so far involves only Western vaccines. Skepticism over Russia’s intentions with its vaccine runs deep across the former Communist lands of East and Central Europe

In Slovakia, Prime Minister Igor Matovic’s decision to order two million doses of the Sputnik vaccine from Russia blew up in his face, costing him his job last month and almost toppling the whole government — the most concrete example of how Russia’s vaccine diplomacy has had side effects that can be highly toxic.

N.Y. mayoral candidates are making radically different bets about the city’s mood as it moves toward reopening.

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A restaurant in Lower Manhattan last month. A recent poll showed 34 percent of likely Democratic primary voters surveyed believed reopening businesses would be a top priority for the city’s next mayor.Credit...Benjamin Norman for The New York Times

The signs of New York City’s recovery are everywhere: Vaccinations are on the rise; restaurant and bar curfews are ending; occupancy restrictions are easing in offices, ballparks and gyms. By July 1, Mayor Bill de Blasio says the city should be “fully reopened.”

In this new and uncertain phase, the candidates vying to be the city’s next mayor are making radically different bets about the mood and priorities of New Yorkers, and how best to coax the city back to life. As the mayoral candidates barrel toward the June 22 Democratic primary, sharp distinctions are emerging around how to handle the city’s recovery.

A recent Spectrum News NY1/Ipsos poll found that 34 percent of likely Democratic primary voters viewed reopening businesses and the economy as the top priority for the next mayor, second only to stopping the spread of Covid-19 and closely followed by crime and public safety.

The challenge for all the candidates is to offer the right mix of experience and empathy, energy and vision, to engage a diverse electorate that experienced the coronavirus crisis and its fallout in very different ways.

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Real estate brokers are back in the office — and trying to get corporate America there, too.

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Alice Fair, a commercial real estate broker, has been seeking subletters at 3 World Trade Center in Manhattan.Credit...John Muggenborg for The New York Times

The people who profit off corporate America’s use of offices are trying to coax corporate America back to the office.

Commercial real estate brokers are back in their own workplaces in force. Having refined their sales pitches to emphasize air filtration systems, flexible lease terms and swing space, they are out to prove the office will soon return to something close to what it was.

After years of continuous growth, the industry has seen commissions fall as vacancy rates climb to the highest levels in decades. Across America’s top markets, 1.3 billion square feet of office space is now available.

More than a year of forced work-from-home has upended the truism that a company needs to have an office — leaving some chief financial officers running the numbers on potential savings in rent and some employees loath to return to life as it was.

Real estate executives — chest-thumping optimists who are usually bullish on their prospects — are facing existential questions.

15 counties in Oregon are pushed into the state’s most severe level of restrictions.

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Oregon Places 15 Counties Under Its Strictest Lockdown Restrictions

Kate Brown, governor of Oregon, announced on Friday that 15 counties would move into the state’s most severe level of restrictions to combat a new wave of coronavirus cases.

Cases are widespread, driven by new, more contagious variants. Oregon leads the nation for our rate of increase in cases over the last two weeks. In fact, this is the fifth straight week Oregon has recorded case increases of 20 percent or more. Our hospitalizations have nearly doubled what they were a week ago. While fewer seniors are being hospitalized, thanks to vaccinations, Covid-19 is now knocking more younger people off their feet. The portion of hospitalized cases of people 18 to 34 has increased by almost 50 percent. I was presented with data showing two paths Oregon could take. One, in which we took no additional action and stood by while more people died from this disease. Or another, that required a temporary tightening of restrictions for certain counties but could save hundreds of lives and prevent as many as 450 hospitalizations over the next three weeks. As your governor, I chose to save lives. And I recognize that this puts many Oregon businesses and working families in a difficult place. So I’ve worked with the legislature to secure $20 million in urgent relief for Oregon businesses impacted by extreme risk. We can get this aid quickly in the hands of our businesses. And I encourage all impacted businesses to apply for assistance. Economic relief is something I can do as your governor to help Oregonians impacted by this fourth surge. What I can’t do is bring back someone’s life lost to this virus.

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Kate Brown, governor of Oregon, announced on Friday that 15 counties would move into the state’s most severe level of restrictions to combat a new wave of coronavirus cases.CreditCredit...Kristina Barker for The New York Times

More than half of American states are reporting significant declines in coronavirus cases, but in Oregon, a new wave of the virus has pushed a third of the state’s counties to tighten lockdown restrictions.

Oregon is reporting about 816 new cases a day, a roughly 31 percent increase from two weeks ago, according to a New York Times database. Hospitalizations have also risen by about 42 percent in the same period. Deaths from the virus, which tend to lag behind cases for several weeks, remain relatively low.

“Here is the reality Oregon is facing right now: cases are widespread, driven by new, more contagious variants,” the state’s governor, Kate Brown, said at a news conference on Friday. “Oregon leads the nation for our rate of increase in cases over the last two weeks.”

A total of 15 counties, including some in the Portland metro area, moved back into the fourth and most extreme level of restrictions on Friday, after meeting the state’s threshold. In these counties, indoor dining is now prohibited and businesses such as gyms and movie theaters must significantly reduce their capacity.

The new limits are likely to prompt a political backlash. Some states that have seen recent surges, like in Michigan where cases have leveled off but total numbers still remain high, have chosen not to tighten restrictions again and instead have asked residents to take greater precautions in an effort to halt the spread of the virus.

Ms. Brown said she was optimistic that the state would be able to get ahead of the variants over the next two to three weeks, estimating that Oregon could lift statewide restrictions and return to some degree of normalcy by the end of June.

The governor urged Oregonians to get vaccinated, calling it the key to fully reopening the state’s economy.

Public health experts have suggested a combination of factors could be driving the surge, including more contagious variants, increased travel during spring break and the loosening of state guidelines before vaccination rates had sufficiently risen. As of Saturday, nearly 30 percent of the state’s population was fully vaccinated and 44 percent had received at least one dose, according to a New York Times vaccine tracker.

“We didn’t get down far enough,” Ken Stedman, a biology professor at Portland State University, told local news outlet KATU, referring to case numbers, “and now we seem to be going back up again.”

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In Mexico City, officials have lined up a number of entertainment options at vaccination sites.

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Lucha Libre wrestlers wheeling patients inside a vaccination tent in Mexico City this month.Credit...Alejandro Cegarra for The New York Times

In a bid to improve their customer service at vaccination centers, officials in Mexico City have cued up entertainment performances for those waiting for their shots.

Now people can watch operatic performances; large, bare-chested Lucha Libre wrestlers doing the limbo; and men performing tricks with a surprising number of soccer balls. They can join a yoga session, with women in white shirts leading the crowd.

The goal is to make the process as appealing as possible, a woman leading a song and dance performance said on a recent Wednesday.

“Put those little hands in the air!” she shouted to the older people in her care.

The effort is important given the alarming resurgence of the virus in Latin America and the sputtering vaccination efforts in many of its countries. Concerns have been compounded by the rapid spread of a virus variant first discovered in Brazil.

In Canada, residents face long waits for second vaccine doses as cases rise.

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Lining up for Covid-19 vaccines in Toronto in April.Credit...Chris Helgren/Reuters

Naomi Harris plans to drive to Buffalo next week from her home in Toronto to get the second dose of the Pfizer coronavirus vaccine. At home, her second appointment was set for July 1, but she thought that as a caregiver for someone with cancer, that was too long to wait.

Canada’s slow vaccine rollout has left some people waiting four months between doses. While at least 33 percent of Canadians have received one shot, just three percent are fully vaccinated.

New daily cases reached a seven-day average over 8,700 in mid-April, according to a New York Times database, levels not seen since a winter surge. Ontario has been among the hardest hit, reporting 3,700 new cases on Sunday.

Ms. Harris, 47, said she had to be “very pushy” for her mother to get vaccinated in a shorter time than expected. After her mother received a first dose in early March, her second dose was scheduled for June 30, according to Ms. Harris, “which was insane because my mom has cancer and is over 80,” she said.

Eventually, their province of Ontario changed the rules for people with certain types of cancer and Ms. Harris’s mother received her second dose in early April. Ms. Harris is eligible for her shot in Buffalo as a dual Canadian and American citizen who is enrolled in a graduate program in Buffalo remotely. “I can’t take the risk of getting my mom sick,” Ms. Harris said.

As supply increases, officials have said, the wait between two inoculations is expected to shorten, and some initiatives are trying to shrink the gap.

Zain Manji, who runs the company Lazer from Toronto, created a text system with a friend that allows people to find vaccination sites near them. Since its start on April 30, at least 50,000 people have used it.

“I think there’s been a lot of confusion around who is eligible, which locations are vaccinating people, what vaccines that they’re offering,” Mr. Manji said. “People are eager to get it and want to get it as fast as they can,” he added about the vaccine.

The vaccines are coming at a crucial time: Amid a third wave, the worst-affected provinces are reporting case numbers per capita that rival those of India — although figures in India are likely to be underestimated.

In Quebec, a curfew, limits on gatherings, and takeout-only dining have helped to quell cases. Jean-Sébastien Guay, 27, of Montreal had his first shot on Sunday. “It hasn’t been perfect,” he said, but officials communicated consistently. “They all work pretty hard to make it work.”

Peter Hotez, a vaccine expert at Baylor College of Medicine, has been pushing for the Biden administration to offer help to Canada. “This is not a time to hold back,” Dr. Hotez said in a telephone interview. After writing on Twitter that the government should ship more Pfizer doses to Canada, he was met with emotional stories from Canadians.

Adding insult to injury for some Canadians is the possibility of their country opening travel to vaccinated American tourists. “It’s frustrating for me to sit here and watch my friends in the United States going to restaurants, carrying on as if life is normal,” said Ms. Harris, who said she had been in a quasi-lockdown since November.

“In the rest of the world, life is not normal.”

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Adar Poonawalla, head of India’s vaccine giant, speaks from London of the enormous pressure he is under.

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Adar Poonawalla, chief executive of the Serum Institute of India last year. He is in London and discussing manufacturing vaccines outside of India, which has led to backlash on social media. Credit...Atul Loke for The New York Times

In recent months, the chief executive of Serum Institute of India, the world’s largest vaccine manufacturer, has come under increasingly intense pressure as both pro-government voices and leaders of the state governments headed by opposition politicians criticized him.

Some accused him for delays in supplying vaccines; some called him a “profiteer” for not offering Covid-19 vaccines to state governments at cost. There were calls for his company to be nationalized.

In an interview with The Times of London published on Saturday, the executive, Adar Poonawalla, described menacing calls from some of the most powerful men in India, creating an environment so ugly that he anticipated being out of the country for an extended period while he made plans to start producing vaccines elsewhere.

“‘Threats’ is an understatement,” Mr. Poonawalla said. “The level of expectation and aggression is really unprecedented.”

The interview reported that he had flown into London to join his wife and children hours before Britain barred travelers from India on April 23.

“I’m staying here an extended time, because I don’t want to go back to that situation,” he added. “Everything falls on my shoulders, but I can’t do it alone.”

The interview set off a storm on social media, with some interpreting his interest in manufacturing outside India as a threat to move his business and others seeing him as having been driven out of the country by the viciousness of his critics.

Within hours, Mr. Poonawalla wrote on Twitter that he would be returning to India “in a few days.”

The New York Times was unable to reach Mr. Poonawalla directly on Saturday, and a request for comment from his company was not immediately returned.

India, the world’s leading producer of vaccines, is struggling to vaccinate itself out of a crisis as a voracious second wave leaves a tableau of death and despair. When cases were relatively low, the country exported more than 60 million shots. On Saturday, India expanded vaccination eligibility to all people over age 18, but many states said that they would not be able to meet the demand because of a shortage of doses.

Less than 2 percent of India’s 940 million adults have been fully vaccinated, according to data compiled from government sources by the Our World in Data project at the University of Oxford. Several states have reported vaccine shortages, enough to derail plans in some to expand access to everyone 18 and over on Saturday.

All that has made Mr. Poonawalla, a 40-year-old billionaire, a focus for public anger.

Last month, Serum Institute wrote a letter to India’s federal home minister asking for security, citing the threats to Mr. Poonawalla. Just a few days ago, the federal government said it had completed a threat assessment and would have the Central Reserve Police Force protect him. On the same day, Mr. Poonawalla announced on Twitter that he was unilaterally lowering the cost of a Covid vaccine to make it more affordable for government purchase.

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