War-torn Yemen, where the overwhelming majority of the population is unvaccinated, is seeing coronavirus cases multiply and deaths soar, according to a report this week by the British charity Oxfam.
Oxfam found that Covid deaths had increased by more than fivefold in the past month and that recorded Covid cases had tripled. The charity said actual figures were likely to be much higher, with many unregistered cases and deaths.
The official Covid death toll about 1,658, and recorded cases have reached 8,789. But the situation in the country of about 30 million is hard to gauge. “Countless” others have died in their homes or have not been diagnosed because of scarce tests and hospital beds, Oxfam said.
Yemen is still embroiled in a war that began in 2014 when Iran-backed rebels know as the Houthis seized the country’s northwest, including the capital, Sana, sending the government into exile. The government has effectively collapsed, and tens of thousands have died.
The country already faced many health challenges before the coronavirus emerged. Hunger is widespread, medicines are hard to find and there have been outbreaks of cholera and other diseases.
The pandemic has only exacerbated the situation, and rights groups say that it is adding to the burden of an already wrecked health care system.
“Covid has made life even worse for people across the country,” Abdulwasea Mohammed, Oxfam’s policy and advocacy lead for Yemen, said by phone from Sana.
Some relief could come with vaccines, but fewer than 1 percent of Yemenis have so far received a single vaccine dose, and only 0.05 percent are fully vaccinated, according to Oxfam.
The country is relying on vaccines from the global Covax program. But Covax is struggling to meet its global supply target, and only half a million out of a promised 4.2 million doses have reached Yemen so far, Oxfam said.
Few isolation centers exist for Covid patients. The ones that are operating are found only in major cities like the capital Sana, and they are overflowing with people, Mr. Mohammed said. The poorly equipped hospitals are also seeing more people than they can accommodate. And many Yemenis cannot afford transportation to health care facilities.
With half the population having lost their source of income, staying at home means possibly dying of hunger for many Yemenis who have become day earners, Mr. Mohammed said. But appearing to be sick means being shunned, so if they have mild symptoms, people are reluctant to seek medical care or testing for the virus at the very few testing centers available.
In shelters that host over 4 million internally displaced people, a family of 10 is likely to share one small tent, making precautionary measures impossible.
“The country is not able to cope with another health crisis,” Mr. Mohammed said.
Most Yemenis survive on humanitarian aid, which Oxfam says has been in short supply. Only half of a $3.9 billion essential aid package requested by the United Nations from donor countries has been received. The health care system is dangerously underfunded, working with only 11 percent of what it needs, the organization says.
Some had hoped that the pandemic would force Yemen’s warring parties into a truce, but the war continues.
“If anything, it is amazing how little the pandemic has affected the fighting,” said Peter Salisbury, a senior analyst on Yemen for the International Crisis Group, in an interview.
The terror and uncertainty of the war, which has forced people to deal with loss on a daily basis for years, remains a larger concern for many Yemenis than the pandemic itself. “This speaks to the trauma of the conflict,” Mr. Salisbury said.
Alaska, once a leader in vaccinating its citizens, is now in the throes of its worst coronavirus surge of the pandemic, as the Delta variant rips through the state, swamping hospitals with patients.
As of Thursday, the state was averaging 125 new cases a day for every 100,000 people, more than any other in the nation, according to recent data trends collected by The New York Times. That figure has shot up by 42 percent in the last two weeks, and by more than twentyfold since early July.
On Wednesday, the state said it had activated “crisis standards of care,” giving hospitals legal protections for triage decisions that force them to give some patients substandard care. The state also announced an $87 million contract to bring in hundreds of temporary health care workers.
Gov. Mike Dunleavy, a Republican, said that while hospitals were strained, he did not see a need to implement restrictions aimed at curbing transmission. Still, he encouraged people who had not yet received a vaccination to seriously consider it.
“We have the tools available to us for individuals to be able to take care of themselves,” Mr. Dunleavy said. While the state led the nation in vaccinations early in the year, it has been lagging in recent months, with under half of its population fully vaccinated, compared with 55 percent nationally, according to federal data.
Jared Kosin, the head of the Alaska State Hospital and Nursing Home Association, called the surge “crippling” in an interview on Tuesday. He added that hospitals were full, and health care workers were emotionally depleted. Patients recently were kept waiting for care in their cars outside overwhelmed emergency rooms.
There is growing anxiety in outlying communities that depend on transferring seriously ill patients to hospitals in Anchorage, Mr. Kosin said. Transfers are getting harder to arrange and are often delayed, he said.
“We are all wondering where this goes, and whether that transfer will be available, even tomorrow,” Mr. Kosin said.
Critically ill people in rural areas, where many Alaska Natives reside, often have to be taken by plane to a hospital that can provide the treatment they need, said Dr. Philippe Amstislavski, an associate professor of public health at the University of Alaska Anchorage.
“Unlike in the lower 48, you don’t have that ability to move people quickly, because of the distances and remoteness,” said Dr. Amstislavski, who was formerly the public health manager for the Interior Region of Alaska, focusing on rural and predominantly Alaska Native communities.
Mr. Kosin said that if hospitalizations rise much further, hospitals and clinics around the state could be forced to apply crisis standards of care and more extreme triage decisions. “That is the worst-case scenario we could be heading to,” he said.
Alaska Natives, who have historically suffered from health disparities in the state, are disproportionately struggling during the latest virus wave, Dr. Amstislavski said.
Dr. Anne Zink, Alaska’s chief medical officer, said several factors may be contributing to the surge, including summer tourists bringing in and spreading the virus.
“We’re hoping that as the snow falls and we have less people visiting, those numbers will settle down,” Dr. Zink said in an interview Tuesday night.
On the other hand, she noted that cooling weather drives residents indoors, where the virus spreads more readily.
The state’s Canadian neighbors to the east, Yukon and British Columbia, have not suffered such severe outbreaks, Dr. Amstislavski said, possibly because of that country’s stricter travel restrictions and less strained health care system.
The director of the Centers for Disease Control and Prevention on Friday overruled a recommendation by an agency advisory panel that had refused to endorse booster shots of the Pfizer-BioNTech Covid vaccine for frontline workers. It was a highly unusual move for the director, Dr. Rochelle Walensky, but aligned C.D.C. policy with the Food and Drug Administration’s endorsements over her own agency’s advisers.
The C.D.C.’s Advisory Committee on Immunization Practices on Thursday recommended the boosters for a wide range of Americans, including tens of millions of older adults and younger people at high risk for the disease. But they excluded health care workers, teachers and others whose jobs put them at risk. That put their recommendations at odds with the F.D.A.’s authorization of booster shots for all adults with a high occupational risk.
Dr. Walensky’s decision was a boost for President Biden’s campaign to give a broad swathe of Americans access to boosters. The White House had come under criticism for getting ahead of the regulatory process.
The C.D.C.’s statement arrived well past midnight, a sign of the complicated and confusing decision-making surrounding the boosters. The C.D.C. advisers similarly spent two days debating who should get boosters and when, and could not agree on whether occupational risk should qualify as a criterion.
“I am surprised that Dr. Walensky overturned one of the four A.C.I.P. votes today, and I believe others will be as well,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford and the American Academy of Pediatrics liaison to the committee.
But the vote on boosters for occupational risk “was close,” Dr. Maldonado said, and agreed with Dr. Walensky’s decision.
“This addresses not only waning immunity but those at high risk of exposure,” Dr. Maldonado added.
Minutes before Dr. Walensky’s statement, Dr. Amanda Cohn, who oversaw the two-day meeting of the panel, tried to prepare the advisers for the director’s decision.
“Dr. Walensky is reversing the decision to not recommend use of a booster dose in persons at high risk for occupational or institutional exposure,” Dr. Cohn wrote in the email. “I am hoping to share this news with you before you see it in the press.”
Dr. Walensky’s decision to go against her own agency’s advisers came as a surprise to at least some of her staff members: The C.D.C. director’s endorsement of the advisory committee’s recommendations is typically just a formality. Hours before her statement, agency insiders predicted she would stick with the usual protocol because doing otherwise would undermine the process and upset the advisers as well as her own staff.
But experts outside the C.D.C. said Dr. Walensky may have had no choice but to align herself with the F.D.A.’s decision. “There’s a complexity here, because Dr. Walensky was part of the White House announcement” on boosters, noted Dr. Ashish Jha, dean of the Brown University School of Public Health.
Dr. Walensky said providing booster shots to health care workers and others who risk contracting the disease on the job would “best serve the nation’s public health needs.”
SYDNEY, Australia — In the war against the coronavirus’s Delta variant, few if any democracies have demanded as much of their people as Australia.
In the middle of the latest lockdowns, the police in Sydney gave hefty fines to three mothers with strollers chatting in a park. Melbourne’s playgrounds were wrapped in police tape, and traveling from a state with Covid restrictions to one without — for the lucky few granted permission by the authorities — requires two-week stints in quarantine at a hotel or a remote former mining camp.
There are now two Australias. In Perth, offices, pubs and stadiums are crammed and normal as ever — the payoff for a closed-border approach that has made Western Australia an island within an island. In Sydney, residents are approaching their 14th week of lockdown. The working-class areas with the highest infection rates have faced a heavy police presence, and, until recently, a 9 p.m. curfew and just an hour of outdoor exercise per day.
Is the sacrifice worth it?
Australia is at a crossroads with Covid. The confidence and pride of 2020, when lockdowns and isolation brought outbreaks to heel, have been replaced by doubt, fatigue and a bitter battle over how much freedom or risk should be allowed in a Delta-defined future.
Some states are trying desperately to hold on to what worked before, while New South Wales and Victoria, home to the country’s biggest cities, Sydney and Melbourne, are being forced by Delta outbreaks to find a more nuanced path forward. Prime Minister Scott Morrison has thrown his weight behind a plan to reopen when 80 percent of adults are fully vaccinated. But the road ahead may not be smooth — as shown by protests this week over a vaccine mandate — and state leaders are still insisting that they will go it alone.
“We might be looking at the country turning the clock back on itself,” said Tim Soutphommasane, a political theorist at the University of Sydney. “There is an explicit insularity and parochialism that now dictates debate.”