One year after becoming ill with the coronavirus, nearly half of patients in a large new study were still experiencing at least one lingering health symptom, adding to evidence that recovery from Covid-19 can be arduous and that the multifaceted condition known as “long Covid” can last for months.
The study, published Thursday in the journal The Lancet, is believed to be the largest to date in which patients were evaluated one year after being hospitalized for Covid. It involved 1,276 patients admitted to Jin Yin-tan Hospital in Wuhan, China, who were discharged between Jan. 7 and May 29, 2020.
The researchers, who also evaluated the patients six months after hospitalization, found that while many symptoms improved over time and many of the 479 people who had been employed when they got Covid had returned to their original job, 49 percent of patients still had at least one health problem.
And shortness of breath and mental health issues such as anxiety or depression were slightly more prevalent 12 months later than at the six-month mark, the researchers reported, saying the reasons for that “worrying” increase were unclear.
The researchers also compared the patients in the study with people in the community who had not had Covid but had similar pre-existing health conditions and other characteristics. After 12 months, Covid survivors had worse overall health than people who had not been infected. They were also much more likely to be experiencing pain or discomfort, anxiety or depression, and mobility problems than those who had not had the disease.
The patients, whose median age was 57, were given physical exams, lab tests and a standard measure of endurance and aerobic capacity called a six-minute walk test. They were also interviewed about their health.
The study involved patients who were sick enough to be hospitalized, but who were generally not the most severely debilitated. About 75 percent required supplemental oxygen when they were hospitalized, but most did not need intensive care, ventilators or even high-flow nasal oxygen, a noninvasive method.
Women were more likely than men to have some lingering symptoms, including mental health issues and lung function problems. One of the most common symptoms was fatigue or muscle weakness, reported by 20 percent of patients. But that represented a significant decrease from the 52 percent who reported such symptoms six months after hospitalization.
Some issues, like shortness of breath, were more common in people who had been more severely ill. But some issues did not correlate to severity of the initial illness. For example, 244 patients underwent a lung function test, which found that from six months to one year after hospitalization, there was no decrease in the proportion of patients with reduced flow of oxygen from their lungs to their bloodstream — regardless of how ill the patients had been initially.
“The need to understand and respond to long Covid is increasingly pressing,” said an editorial The Lancet published about the study. “Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many millions of people globally.”
It added: “Long Covid is a modern medical challenge of the first order.”
India has given at least one Covid-19 vaccine shot to more than half of the eligible population, a milestone in a country that initially struggled to roll out enough doses for its 1.4 billion people.
The country’s health ministry said it was ramping up its vaccination drive and working with regional governments to accelerate the pace of inoculation as they race to stave off another wave of infections.
India is still recording about 33,000 cases a day. With more than 32 million total Covid-19 cases, the country is second only to the United States in terms of number of cases and the third to record more than 400,000 total deaths. Scientists widely believe the official figures vastly undercount the toll.
So far, the country has fully vaccinated around 15 percent of the eligible population since the beginning of the drive in January. Health officials said they have given more than 610 million doses of three approved vaccines.
India’s vaccine supplies will get a major lift when the country begins using Zydus Cadila’s DNA-based vaccine beginning in the first week of October. Health ministry officials say over 473 million people have received the first dose and another 138 million have received both shots. That covers just over 50 percent of India’s adult population based on the country’s projected midyear count for 2020.
The country’s daily vaccination drive also ramped up in August with over 5.2 million administered, compared with 4.3 million shots administered in July.
Government officials have said they are aiming to vaccinate all Indians by the end of this year. But some Indian states are still struggling with the vaccination drive because of the resource disparities and the sheer size of the population.
Officials are cautioning against relaxing attitudes, one reason behind the devastating second wave of the coronavirus that struck earlier this year.
Balram Bhargava, the director general of the Indian Council of Medical Research, a top government science body, said on Thursday that although vaccines reduce the severity and reduce chances of hospitalization, people should continue with wearing masks. Relaxed attitudes, he said, could have disastrous consequences.
“Only fully vaccinated people should attend social gatherings,” he said. “The second wave is still on in India. In some states, an upsurge is being observed in a few districts.”
Since May, a third wave of the pandemic has ripped through countries in southern and eastern Africa. One country in North Africa — Tunisia — is experiencing its fourth wave.
The continent, with a population of 1.3 billion people, has recorded almost 7.6 million cases and at least 191,000 Africans have died. A brutal wave of infections driven by the Delta variant has strained health systems in countries from South Africa to Tunisia, and from Zambia and Senegal, where vaccination rates are far lower than in Europe and North America.
But the World Health Organization said on Thursday that coronavirus infections in the continent had stabilized and the once slow vaccination rate has picked up pace.
Dr. Matshidiso Moeti, the W.H.O. regional director for Africa, told an online news conference that nearly 248,000 new cases had been reported in the past week, down from 282,000 in mid-July. At the same time, the number of vaccinations in the continent had tripled to 13 million.
“The third wave appears to be stabilizing but cases are still very high,” she said.
Many of the administered vaccine doses arrived as donations and sharing arrangements through the Covax program. Originally, the program hoped to vaccinate 20 percent of the African population this year. But Covax, co-led by the W.H.O. to provide vaccines to poorer countries, has been plagued by delays.
The W.H.O. now aims to vaccinate 10 percent of people in Africa by the end of September, according to Dr. Moeti. “117 million doses are due to arrive in the coming month and up to 34 million additional doses will be needed to reach that target,” she said.
Dr. Moeti called the goal a very daunting task and urged countries to continue sharing supplies. “With international solidarity we can protect those at highest risk of Covid-19 in all countries in the world,” she said.
In other developments around the world:
As of Friday, 33 American service members on the Osan Air Base in Pyeongtaek, South Korea, tested positive for the coronavirus, according to military and health officials. The cluster infection broke out after a “no-mask party” last Saturday in a club on the base, according to reports from state media. South Korea is experiencing its worst wave of the pandemic, with much of the country under its strictest social distancing regulations. The cluster of infections came as joint military drills wrapped up between South Korea and the United States. South Korean military officials have conducted pre-emptive tests on 800 people: No Korean military personnel have tested positive.
Thailand will lift most coronavirus restrictions on retail and dining beginning in September and permit gatherings of up to 25 people in Bangkok and other high-risk areas, Reuters reported. The country’s Covid-19 task force said on Friday that the changes were necessary to revive the Thai economy safely. But the country is battling its worst coronavirus outbreak and struggling to ramp up vaccinations, with only one in 10 people inoculated so far.
Jin Yu Young contributed reporting.
Rohingya in Myanmar will be vaccinated against the coronavirus, Gen. Zaw Min Tun, the spokesman for Myanmar’s military junta, said at a news conference on Friday.
In 2017, a military crackdown in Myanmar against the Rohingya drove hundreds of thousands of men, women and children from their homes.
Vaccinations are set to begin on Saturday, people in the camps said. Abhishek Kumar Singh, a Rohingya man who is a leader in Thet Kal Pyin camp, confirmed that the Rohingya would receive 20,000 vaccine doses, sponsored by the U.N. Commission on Human Rights, according to documents seen by The New York Times. There are a total of 13 camps in Sittwe, the capital of Rakhine State, with a population of about 200,000 Rohingya. The first priority will be people 65 and older.
“The Bengalis in Rakhine State, including Buthidaung and Maungdaw, will be vaccinated with Covid-19. All of them are our people,” Gen. Zaw Min Tun said, while using terminology that implies the Rohingya, members of a Muslim ethic group that has been living in Myanmar’s Rakhine State for generations, belong in neighboring Bangladesh.
Rohingya in Bangladesh have begun receiving vaccinations. But no attempt has been made until now to vaccinate the Rohingya in Myanmar, and some are skeptical that the vaccines will come through.
“The military is pretending to the international community to get a good political image. I never trust them,” said Mr. Singh, who lives in the Rohingya camp in Sittwe.
A military coup in February ousted the government led by Daw Aung San Suu Kyi, and Myanmar’s vaccination program has been in turmoil. Like many others, the country experienced a surge over the summer.
Myanmar has recorded 383,514 total cases of the virus and 14,850 deaths, according to the Center for Systems Science and Engineering at Johns Hopkins University.
The Supreme Court on Thursday rejected the Biden administration’s latest moratorium on evictions, ending a political and legal dispute during a public health crisis in which the administration’s shifting positions had subjected it to criticism from adversaries and allies alike.
The court issued an eight-page majority opinion, an unusual move in a ruling on an application for emergency relief. The court’s three liberal justices dissented.
The decision is likely to have immediate real-world consequences, putting hundreds of thousands of tenants at risk of losing shelter, while the administration struggles to speed the flow of billions of dollars in federal funding to people who are behind in rent because of the coronavirus pandemic and its associated economic hardship. Only about $5.1 billion of the $46.5 billion in aid had been disbursed by the end of July, according to figures released on Wednesday, as bureaucratic delays at the state and local levels snarled payouts.
The majority opinion, which was unsigned, said the Centers for Disease Control and Prevention had exceeded its authority.
“The C.D.C. has imposed a nationwide moratorium on evictions in reliance on a decades-old statute that authorizes it to implement measures like fumigation and pest extermination,” the opinion said. “It strains credulity to believe that this statute grants the C.D.C. the sweeping authority that it asserts.”
Justice Stephen G. Breyer, writing for the three dissenting justices, faulted the court for its haste during a public health crisis.
“These questions call for considered decision-making, informed by full briefing and argument,” he wrote. “Their answers impact the health of millions.”
Proponents of the moratorium said the court’s ruling would devastate impoverished Americans dealing with the economic fallout of a pandemic now in its fourth wave.
Owners and realtors, who had challenged the moratorium, hailed the court’s move.
Facing a tenfold increase in coronavirus hospitalizations since July 9, Oregon leaders have deployed the National Guard to hospitals, dispatched crisis teams to the hardest-hit regions of the state and ordered educators and health care workers to get vaccinated or lose their jobs.
Now, Gov. Kate Brown has gone beyond what any other state has done in battling the summer surge, requiring that both vaccinated and unvaccinated people wear masks when gathering closely in public, even when outdoors. The measure takes effect on Friday. She said more restrictions might be needed as the coming days unfold and the state tries to keep in-person schooling on track.
“All options are on the table,” Ms. Brown said in an interview this week.
Oregon’s aggressive approach in restoring pandemic safety rules is a stark divergence from states in the South, where outbreaks have been even worse but where many governors have resisted requirements for masks and vaccinations. But with the arrival of the Delta variant, Oregon has become one of a handful of states where cases and hospitalizations have escalated beyond even the records set during the worst part of the pandemic last year.
The virus is rampaging through rural communities where vaccination rates remain low. Hospitals across the state are near capacity, almost 50 percent beyond the state’s previous peak in December. Last week, a coronavirus patient in Roseburg died while waiting for an I.C.U. bed.
The Oregon Health Authority director, Patrick Allen, said the situation was so “dire” that he was urging unvaccinated people to avoid engaging in any nonessential activities.
“It’s that simple. It’s that urgent,” he said.
Denmark, whose health minister said on Thursday that the country had fully vaccinated 80 percent of residents over age 12, will no longer consider Covid-19 a “socially critical disease.” It will drop all Covid restrictions as of Sept. 10.
The heath minister, Magnus Heunicke, made the announcement on Twitter on Friday. The socially critical designation is a political one, which allowed officials to implement measures such as national closures and requirements for coronavirus passes.
Denmark has reported a total of 342,866 virus cases and 2,575 deaths since the pandemic began, according to the Center for Systems Science and Engineering at Johns Hopkins University. The country has been averaging just under 1,000 new cases a day in recent weeks.
Mr. Heunicke said that as of Sept. 10, the country would phase out the last of its “important restrictions,” including having to show coronavirus passes at nightclubs and sporting events, according to Jyllands-Posten, the Danish newspaper.
He said if the situation changed, the government would not hesitate to intervene, and he urged vigilance.
But he said, “It is the good Danish epidemic management that makes this possible, and I want to say thank you to everyone involved for a gigantic job.”
As schools return to in-person learning with masks and social distancing, some districts are facing another challenge: getting students to class.
Thousands of school bus drivers were furloughed, fell ill or quit as classes moved online last year because of the coronavirus pandemic, school and union officials said. Now districts across the country are trying to lure them back, offering signing bonuses and juggling schedules and bus routes to make up for the shortfall. One school in Delaware is even paying parents to drive their children to school.
“There are reports of shortages across the country,” said Joanna McFarland, the chief executive of HopSkipDrive, which works with districts on transportation solutions. “It is the worst that we have seen in a very long time, if not ever.”
Driver shortages have been an issue for years, but the pandemic made things worse. Many school bus drivers retired or quit out of fear of becoming exposed to the virus in an enclosed space, a risk some new drivers were also reluctant to take. Some quit over mask mandates, while others were furloughed or got sick, further diminishing the pool.
As the start of the 2021-22 academic year approached, officials sounded the alarm. HopSkipDrive, which conducted a national survey of 1,186 transportation and district officials, said that efforts to prepare for the coming school year would be hobbled by the shortages. The National School Transportation Association, which represents bus companies, warned this year that new drivers would not be able to fill the shortfall caused by furloughs and the loss of drivers from the work force.
The training of replacements is not keeping pace. It can take up to eight weeks for a driver to get a commercial license, the association said. Additional training is required for drivers who transport children with special needs and behavioral issues.
From late spring into early summer, Britain’s elementary and secondary schools were open during an alarming wave of Delta infections.
And they handled the Delta spike in ways that might surprise American parents, educators and lawmakers: Masking was a limited part of the strategy. In fact, for the most part, elementary school students and their teachers did not wear them in classrooms at all.
Instead, the British government focused on other safety measures, widespread quarantining and rapid testing.
“The U.K. has always, from the beginning, emphasized they do not see a place for face coverings for children if it’s avoidable,” said Dr. Shamez Ladhani, a pediatric infectious-disease specialist at St. George’s Hospital in London and an author of several government studies on the virus and schools.
The potential harms exceed the potential benefits, he said, because seeing faces is “important for the social development and interaction between people.”
The British school system is different than the American one. But with school systems all over the United States debating whether to require masking, Britain’s experience during the Delta surge does show what happened in a country that relied on another safety measure — quarantining — rather than face coverings for young children.
The U.S. Open welcomed almost 750,000 fans onto its grounds in 2019 during its two-week run, and comparable numbers are expected to attend this year.
But two years ago, there was no coronavirus pandemic. Last year, the tournament was held without fans, and this year the United States Tennis Association will allow them back into what could be one of the most heavily attended mass gatherings in New York since the pandemic began in 2020.
With the tournament set to begin in earnest on Monday, the association issued protocols for fans and players on Tuesday, and the policies are far more relaxed than they were last year.
No proof of vaccination or a recent negative coronavirus test will be required for fans to enter the grounds, and no masks will be required when they are outdoors. Guidelines issued by the Centers for Disease Control and Prevention recommend wearing masks outdoors.
Much of the event is held outdoors, and the two roofed stadiums — Arthur Ashe and Louis Armstrong — will be considered outdoors, too, even if the roofs are closed. That is because the stadiums’ ventilation systems are considered adequate, U.S.T.A. officials say.
Players will be granted more freedom of movement than they were given last year, when many complained about isolation because they had been sequestered in a hotel in Long Island. All players will be tested upon arrival and then tested every four days after that. If they test positive, they will have to withdraw from the tournament, regardless of what stage the event is in, according to Stacey Allaster, the tournament director.
The player would also have to go into isolation for 10 days at his or her hotel or accommodation.
The qualifying rounds started on Tuesday, without fans. But once the main event begins on Monday, it will almost be business as usual, with maskless fans roaming the grounds and sitting next to one another, much as it has been with New York City’s two baseball teams, the Mets and the Yankees.
Maryland on Thursday prepared to join a growing list of states that have decided to require students and teachers to wear masks in school to combat the wave of coronavirus cases sweeping the country.
The state’s board of education voted in a special meeting to approve a statewide school mask mandate. The emergency regulation will move to a legislative committee for final approval, which is expected within days.
Gov. Larry Hogan, a Republican, has said he would not order a school mask mandate and has left the decision up to schools boards. In the early days of the pandemic, Governor Hogan drew bipartisan praise for his aggressive response, but this year he surprised public health experts and state officials when he suddenly loosened Covid restrictions in March.
The issue of masks in schools has become a partisan battle in several states. Republican governors in Florida and Texas have tried to stop local districts from implementing mask requirements, casting them as an infringement on parental rights and individual freedom. They have faced resistance from some districts in Democratic strongholds, who have the support of the Biden administration.
In Maryland, Democrats control both houses in the state legislature, and the leaders have signaled their support for masks. On Thursday, Senate lawmakers issued a statement urging the board to implement the mask policy, which they said recognizes “the importance of keeping Maryland students in the classroom through proven mitigation strategies.”
Board of Education members said they hoped the mask rule would lessen the risk of disruptive quarantines for students. “I believe that having an in-school mask mandate is going to help us to meet our goal to have students stay in classrooms,” said Rachel L. McCusker, a school board member and Carroll County teacher who introduced the motion.
The C.D.C. has advised schools to quarantine all students in a classroom if they are unmasked and have come in contact with a person who tests positive for coronavirus. But if all students and staff are masked, only those who have been in close contact with an infected person are required to be quarantined. The guidelines say students must remain in quarantine for at least seven days, though often longer under most circumstances.
Kevin Bokoum, a student member of the Maryland board of education, said he supported the rule. “Anything is better than having to go back online,” he said. “It’s not even a burden.”