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Positive coronavirus samples being sequenced at Duke University in Durham, N.C., this month to determine which variants are circulating in the community.
Credit…Pete Kiehart for The New York Times

Vaccinations are picking up pace. The spread of the coronavirus in the United States has slowed drastically. The Centers for Disease Control and Prevention is urging K-12 schools to reopen safely and as soon as possible.

But just as states are again lifting mask-wearing mandates and loosening restrictions, experts fear that more contagious variants could undo all that progress.

That threat seems only to grow as researchers learn more. British government scientists now believe the more contagious variant that is ravaging Britain is also “likely” to be deadlier than earlier versions of the virus, according to a document posted on a government website on Friday. An earlier assessment on a smaller scale warned last month that there was a “realistic possibility” the variant was more lethal.

The variant, also known as B.1.1.7, is spreading rapidly in the United States, doubling roughly every 10 days, another recent study found.

In line with an earlier warning from the C.D.C., the study predicted that by March the variant could become the dominant source of coronavirus infection in the United States, potentially bringing a surge of new cases and increased risk of death.

Vaccine distribution is accelerating — the U.S. is now averaging about 1.66 million doses a day, well above the Biden administration’s target of 1.5 million — but B.1.1.7 has a worrisome mutation that could make it harder to control with vaccines, a Public Health England study found this month.

The variant has spread to at least 82 countries, and is being transmitted 35 percent to 45 percent more easily than other variants in the United States, scientists recently estimated. Most people who catch the virus in Britain these days are being infected by that variant.

The British research on B.1.1.7’s lethality did come with caveats, and the reasons for the variant’s apparently elevated death rate are not entirely clear. Some evidence suggests that people infected with the variant may have higher viral loads, a feature that could not only make the virus more contagious but also potentially undermine the effectiveness of certain treatments.

But government scientists were relying on studies that examined a small proportion of overall deaths. They also struggled to account for the presence of underlying illnesses in people infected with the new variant, and for whether the cases originated in nursing homes.

Bill Hanage, an epidemiologist at Harvard University, said that although “we do need to have a degree of caution” in looking at the findings, “it’s perfectly reasonable to think that this is something serious — I am certainly taking it seriously.”

“It’s pretty clear we have something which is both more transmissible and is more worrying if people become infected,” he said.

Angela Rasmussen, a virologist at Georgetown University, said relaxing restrictions now would be “courting disaster.” She urged Americans to “be extra vigilant” about mask wearing, distancing and avoiding enclosed spaces.

“You don’t want to get any variant,” Dr. Rasmussen said, “but you really don’t want to get B.1.1.7.”

The United States confirmed its first case of the B.1.1.7 variant on Dec. 29. Unlike Britain, it has been conducting little of the genomic sequencing necessary to track the spread of new variants that have caused concern, though the Biden administration has vowed to do more.

On Friday, for the fifth time in six days, the number of new virus cases reported in the United States dipped below 100,000 — far less than the country’s peak of more than 300,000 reported on Jan. 8.

As the number of virus cases and hospitalizations has fallen, the Republican governors of Montana, Iowa, North Dakota and Mississippi have recently ended statewide mask-wearing mandates. In New York, Gov. Andrew M. Cuomo, a Democrat, has allowed indoor dining to resume at 25 percent capacity, though experts have repeatedly warned that maskless activities, such as eating, in enclosed spaces are high-risk.

Although virus case numbers are moving in the right direction, the loosening of restrictions has unnerved experts like Saskia Popescu, an epidemiologist at George Mason University in Virginia.

“Now more than ever, with novel variants, we need to be strategic with these reopening efforts and be slow and not rush things,” she said.


United States ›United StatesOn Feb. 1314-day change
New cases84,717–37%
New deaths3,373*–16%

*Includes many deaths from unspecified days

World ›WorldOn Feb. 1314-day change
New cases344,554–28%
New deaths10,713–16%

U.S. vaccinations ›

Where states are reporting vaccines given

Residents of Good Shepherd nursing home in Wheeling, W.Va., participating in a penny auction last Monday. 
Credit…Amr Alfiky/The New York Times

WHEELING, W.Va. — After nearly a year in lockdown for the residents of Good Shepherd Nursing Home — eating meals in their rooms, playing bingo through their television sets and isolating themselves almost entirely from the outside world — their coronavirus vaccinations were finished and the hallways were slowly beginning to reawaken.

In a first, tentative glimpse at what the other side of the pandemic might look like, Betty Lou Leech, 97, arrived to the dining room early, a mask on her face, her hair freshly curled.

“I’m too excited to eat,” she said, sitting at her favorite table once again.

It has been a tragic year for nursing homes in America. More than 163,000 residents and employees of long-term care facilities have died from the coronavirus, about one-third of all virus deaths in the United States. Infections have swept through some 31,000 facilities, and nearly all have had to shut down in some way.

For more than a million residents of nursing homes, the lockdowns themselves have been devastating. Cut off from family and largely confined to their rooms, many residents lost weight and saw ailments worsen. Some grew increasingly confused. Others sank into depression and despair.

West Virginia has emerged as one of the first states to finish giving two doses of vaccines to the thousands of people inside its nursing homes, so Good Shepherd, a 192-bed Catholic home in Wheeling, was among the first facilities in the country to begin tiptoeing back toward normalcy last week.

Good Shepherd locked down in March, even before the virus was found in West Virginia. Residents went without visits with loved ones, outings to the movies, even fresh air. Twice, the nursing home tried loosening restrictions, only to lock down again.

An outbreak in November claimed the lives of five residents.Fifteen others got sick during the outbreak, including Ms. Leech. After recovering in the nursing home’s Covid-19 ward, she was feeling better, she said, and eager to return to some version of normal life.

But even with the vaccinations completed, everything has not gone back to normal. Residents are allowed to socialize together again, but they are also asked to continue wearing masks. They sit several feet apart. And most relatives and friends still cannot come to visit.

The continuing precautions offer insights into the complications of reopening, far beyond nursing homes. About 20 percent of people at Good Shepherd — mostly staff members and a few residents — declined to be vaccinated, reflecting a hesitance that has emerged across the country. Cases in the surrounding county remain high. More research is needed to understand whether vaccinated people might still be able to transmit the virus.

People getting vaccinated this month at Castle Hill Community Center in New York. About 10 percent of people in the state have received their first dose.
Credit…James Estrin/The New York Times

Starting Sunday, New Yorkers with chronic health conditions like obesity and hypertension can schedule their appointments to get the Covid-19 vaccine at state-run mass vaccination sites. They join a growing number of people in the state who are eligible for the vaccine despite a shortage in supply.

Those who are now eligible include adults who have certain health conditions that may increase their risk of severe illness or death from the coronavirus. Aside from obesity and hypertension, other conditions that would qualify New Yorkers for the vaccine include pulmonary diseases and cancer, Gov. Andrew M. Cuomo announced this month. He also made pregnancy a qualifying condition.

Appointments for people who are in this group can be scheduled for as early as Monday, though most people will probably face a long wait because vaccine doses are scarce now. New Yorkers must provide proof of their condition with a doctor’s note, signed certification or medical documentation, Mr. Cuomo said.

“While this is a great step forward in ensuring the most vulnerable among us have access to this lifesaving vaccine, it’s no secret that any time you’re dealing with a resource this scarce, there are going to be attempts to commit fraud and game the systems,” Mr. Cuomo said in a statement.

In New York State, about 10 percent of the population has received its first dose, according to data gathered by The New York Times. More than seven million people are eligible in the state, including people ages 65 and older, health care workers and teachers.

New York City recently opened mass vaccination sites at Yankee Stadium in the Bronx and Citi Field in Queens to better reach communities hit hard by the virus.

To check on eligibility and schedule an appointment, New Yorkers can complete a prescreening on the state’s website. They can also call the state’s vaccination hotline at 1-833-NYS-4VAX (1-833-697-4829) for more information about vaccine appointments.

Tevon James, 5, getting his temperature checked in December before heading into his kindergarten class at P.S. 316 Elijah G. Stroud Elementary School in the Crown Heights section of Brooklyn, N.Y.
Credit…Anna Watts for The New York Times

For Julie Zuckerman, an elementary school principal in Manhattan, the summer felt like one never-ending day filled with fear and confusion about New York City’s plan to resume in-person teaching. But in the months since classrooms opened in September, something has shifted.

Teachers at the school, Public School 513 in Washington Heights, appear more at ease, and some say they would like to be in their classrooms even when the building closes because of coronavirus cases. Parents, too, seem more confident: About half of the students are in the building most days, up from less than one-third in September.

Ms. Zuckerman expects that even more children will return this spring.

“People have made their peace; they’re not in crisis in the same way,” she said. “I feel there’s a huge night-and-day difference between what was going on last spring and what’s happened this year.”

New York’s push to reopen classrooms in the fall — it was the first big school district in the country to do so — was a risky, high-stakes experiment. The city has had its share of miscommunication, logistical stumbles and disruptions — especially when classrooms and school buildings have closed frequently because of virus cases.

The city requires a school to shutter for up to 10 days if two unrelated positive cases are confirmed there. Individual classrooms close when one or more positive cases are detected.

The number of closures has risen considerably over the past few weeks, as test positivity rates across the city have remained high and weekly in-school testing has increased. New Yorkers have struggled to cope with the frequent interruptions to learning — and to parents’ schedules.

Even so, parents, teachers, principals and union leaders are finding reasons for optimism at the midpoint of the academic year. In-school virus transmission has been very low, and there is broad agreement that children have benefited from being in classrooms.

“Having the kids here is so much better for them, for everyone,” Ms. Zuckerman said.

The strength of the plan will be tested again when about 62,000 middle school students return to classrooms for the first time since November.

New York offers a preview of what other big city districts in the U.S — most prominently Chicago, where more schools are set to open next month — can expect as they inch closer to reopening classrooms after almost a year of remote learning.

Matthew Burris, 9, watches his mother, Erica Jackson get her finger pricked for a COVID-19 antibody test during Shared Harvest Foundation and myCovidMD’s free testing in honor of Dr. Martin Luther King, Jr. at Southside Church of Christ in Los Angeles last month.
Credit…Sarah Reingewirtz/The Orange County Register, via Associated Press

Two officials at the Food and Drug Administration said on Saturday that they had erred by allowing manufacturers to sell Covid-19 antibody tests that had not been proved accurate, flooding the United States with unreliable blood tests early in the pandemic.

The officials, Dr. Jeffrey Shuren and Dr. Timothy Stenzel, said in an essay published in The New England Journal of Medicine that the F.D.A.’s guidance on March 16, 2020, which allowed companies to sell tests without emergency use authorization, “was flawed.”

Within two weeks of that guidance, 37 manufacturers told the F.D.A. that they were introducing the tests in the United States, a number that swelled to 164 by the end of April, the officials said. Many of those tests turned out to be inaccurate, and by May the F.D.A. demanded that companies submit data that proved that their tests were reliable or they could be banned.

As of this month, the officials said, the F.D.A. had issued 15 warning letters regarding the tests, removed references to 225 tests from its website and issued “import alerts” regarding 88 companies, meaning their imported tests will receive additional scrutiny — and could be blocked — at the border.

“Our experience with serology tests underscores the importance of authorizing medical products independently, on the basis of sound science, and not permitting market entry of tests without authorization,” they wrote in the essay, referring to the blood tests. “Knowing what we know now, we would not have permitted serology tests to be marketed without F.D.A. review and authorization, even within the limits we initially imposed.”

Soon after the tests first appeared in the United States, scientists discovered that many were flawed, even as some government officials and employers were saying the tests could be crucial to easing restrictions imposed during the pandemic. One review, which was not peer-reviewed, found that of 14 tests on the market, only three gave consistently reliable results.

Many others gave false positive results, signaling that someone had already been infected with the coronavirus and had a heightened level of protection when that was not the case. Even some of the most effective tests did not detect antibodies in 10 percent of people who actually had them.

The F.D.A.’s website lists the antibody tests that have been given emergency authorization and provides information about the effectiveness of those tests.

In the essay, Dr. Shuren and Dr. Stenzel acknowledged that, although the F.D.A. had been operating with “limited and evolving information” and that other factors led to the prevalence of the faulty tests, the March 16 policy was what had “allowed it to happen.”

Those We’ve Lost

Dr. David Katzenstein was a virologist and researcher at Stanford who focused on AIDS, especially in southern Africa.
Credit…TeachAids

This obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.

Dr. David Katzenstein may have been a dreamer, “with sometimes brilliant and sometimes slightly off-the-wall ideas,” one colleague said recently. But from the beginning, in a biosphere spawning new undetected and unconstrained killers, he was no ivory-tower researcher regarding the world through a microscope.

After medical school, he interned at the University of New Mexico, where his work with Indigenous peoples developed into an abiding commitment to help underserved populations prevent and deal with infectious diseases.

For 35 years, as a virologist and clinician, he not only helped advance the prevention, diagnosis and treatment of H.I.V. and AIDS; he also made those techniques available to middle- and low-income patients in sub-Saharan Africa.

Dr. Katzenstein, who was professor emeritus of infectious diseases and global health at Stanford Medicine in California, died on Jan. 25 in Harare, Zimbabwe. He was 69. The cause was Covid-19, his stepdaughter, Melissa Sanders-Self, said.

“Imbued with a passionate belief in social justice, David Katzenstein had an outsized impact on the fight against H.I.V. in sub-Saharan Africa,” Dr. Lloyd Minor, dean of the Stanford University medical school, said in a statement.

While at the University of California, the International Antiviral Society-USA said, Dr. Katzenstein established a relationship with the medical microbiology department at the University of Zimbabwe’s medical school and became “one of the first U.S.-based H.I.V. researchers to commit to working in this region of the world.”

In 1989, he joined the Stanford faculty as a clinical assistant professor of infectious diseases and was named the associate medical director of Stanford’s AIDS Clinical Trial Unit, which conducted research, including clinical trials, into antiretroviral drugs that extended the lives of people with H.I.V.

He focused on the challenges posed by resistance to antiviral H.I.V. drugs and was among the first researchers to publicize the problem in Africa.

In Zimbabwe, he directed the Biomedical Research and Training Institute in Harare, where he trained clinical researchers and introduced modern diagnostic and monitoring techniques to community health programs.

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