Demand Overwhelms Some U.S. Vaccine Registration Sites

Credit…Sarah Blesener for The New York Times

When the City of San Antonio’s Covid-19 vaccination registration site went live at 9 a.m. on Saturday, the 9,000 available slots filled up in six minutes. In Michigan, more than 20,000 people tried to enter a health system’s portal for Covid vaccinations at the same time, crippling access to the system.

As states try to scale up vaccine rollouts that have been marred with confusion and errors, the online registration sites — operated by a welter of agencies and using a range of technologies — are crucial. But the problems they are experiencing reveal yet another challenge to getting Americans inoculated: There are many, many more people who want to be vaccinated than there are opportunities to get the shot.

“The registration system worked as designed, but there is far greater demand than available supply at this time,” Dr. Colleen Bridger, an assistant city manager, said in a statement. “When we receive more doses from the State of Texas, we will have more appointments available in the coming days and weeks, and we will keep the public informed about registration opportunities.”

Michigan’s largest health care system, Beaumont Health, had problems with its website on Friday, said Hans Keil, the system’s chief information officer. Beaumont Health, which operates several hospitals in the Metro Detroit area, had recently announced plans to offer residents 65 and older vaccinations, and about 25,000 people tried to gain access to the online portal simultaneously, Mr. Keil said. The portal didn’t crash, but many users couldn’t enter.

“We’re really having to rethink how we have to do our capacity planing,” Mr. Keil said.

On Thursday, Miami-Dade County introduced an online registration tool for appointments. County officials had said they would have a limited number of slots for people 65 and older. The available slots were filled in 20 minutes, said Luisana Pérez Fernández, a spokeswoman for the mayor’s office.

In Georgia, officials tried to roll out vaccines to individuals 65 and older, beginning Monday in DeKalb County. On Thursday, the DeKalb County Board of Health website was experiencing “latency issues” as individuals signed up for the shot.

High demand was apparent offline as well.

In Montgomery County, Tenn., more than 1,000 appointments were scheduled on Tuesday via a phone system before the lines crashed in the afternoon, officials said. On Wednesday, a new website and phone number were added to help handle the load.

Even in states where online registration seemed to go well, some people were stuck with long waits.

In Indiana, more than 21,000 people 65 and older signed up for appointments in the first 90 minutes that registration was open on Friday, and a total of 35,000 people had signed up by an hour later. Officials from the state’s Department of Health said that some 200 people experienced delays.

“Individuals may encounter wait times due to a high volume of interest,” a statement from the department said. “The registration system was designed to put visitors into a holding queue when volume is high.”

Tracking the Coronavirus ›

United States › United StatesOn Jan. 8 14-day change
New cases 300,594 +40%
New deaths 3,895 +29%
World › WorldOn Jan. 8 14-day change
New cases 858,458 +20%
New deaths 15,489 +15%

Where cases per capita are

Credit…Sarah Blesener for The New York Times

At least 151,000 people in the United States have been fully vaccinated against Covid-19, according to a New York Times survey of all 50 states.

Both of the vaccines being used across the country require patients to receive two doses spaced weeks apart, so the process of administering second shots to Americans has only just begun.

The Times sent surveys to state health departments, as well as health officials for territories and federal agencies that have received vaccine allotments from the Centers for Disease Control and Prevention. The tally of fully vaccinated people is an undercount because some states did not provide that information.

The C.D.C., which is not yet reporting the number of people nationally who have gotten a second shot, said on Friday that about 6.7 million people had received a first dose of a vaccine. That falls far short of the goal federal officials set to give at least 20 million people their first shots before the end of 2020.

The rise of new, more transmissible versions of the virus adds urgency to the goal of vaccinating as many people as possible, both to prevent crippling case surges and to protect as many people as possible before the virus develops mutations that might weaken the vaccines’ power against it.

More states are detecting the variant of the virus first identified in Britain. Texas, Connecticut and Pennsylvania confirmed their first cases on Thursday, joining California, Colorado, Georgia, Florida and New York. On Saturday, Gov. Andrew M. Cuomo said that New York had confirmed three new cases of the variant, two of which were related to the first case, from a jewelry store in Saratoga Springs. The third case was in Massapequa, in Nassau County, and “appears to be unrelated” to the other Saratoga outbreak, Mr. Cuomo said.

On Friday, the transition team for President-elect Joseph R. Biden Jr. announced a plan to accelerate vaccinations that includes reversing course and releasing nearly all available doses. That would provide more people with first doses but raise the risk that second doses would not be administered on time; however, ramped up vaccine production is expected to keep enough in the pipeline for timely second doses. Officials from the Food and Drug Administration have spoken out strongly against changing the dosing schedule.

Credit…Stephen Speranza for The New York Times

U.S. states have begun broadening access to Covid-19 vaccines faster than planned, amid tremendous public demand and criticism about the pace of the rollout.

But some public health officials worry that doing so could bring even more chaos to the complex operation and increase the likelihood that some of the highest-risk people will be skipped over. The debate over how soon to expand eligibility is intensifying as deaths from the virus continue to surge, hospitals are overwhelmed with critically ill patients and millions of vaccine doses delivered last month remain in freezers.

Governors are under enormous pressure from their constituents — especially older people, who vote in great numbers and face the highest risk of dying from the virus — to get the doses they receive into arms swiftly.

Some states, including Florida, Louisiana and Texas, have already expanded who is eligible for the vaccine, even though many in the first priority group recommended by the Centers for Disease Control and Prevention — health care workers and residents of nursing homes and other long-term care facilities — have not yet received a shot.

On Friday, New York announces that it would allow people 75 and over and certain essential workers to start receiving a vaccine on Monday.

But reaching a wider area of the population requires more money than states have received for the task, many health officials say, and more time to fine-tune systems for moving surplus vaccine around quickly, to increase the number of vaccination sites and people who give the shots, and to establish reliable appointment systems to prevent endless lines and waits.

Some states’ expansions have led to frantic and often futile efforts by older people to get vaccinated. After Florida opened up vaccinations to anyone 65 and older last month, the demand was so great that new online registration portals quickly overloaded and crashed, people spent hours on the phone trying to secure appointments and others waited overnight at scattered pop-up sites offering shots on a first-come first-served basis.

Similar scenes have played out in parts of Texas, Tennessee and a handful of other states.

Still, with C.D.C. data suggesting that only about a third of the doses distributed so far have been used, Alex M. Azar II, the health and human services secretary, told reporters this past week: “It would be much better to move quickly and end up vaccinating some lower-priority people than to let vaccines sit around while states try to micromanage this process. Faster administration would save lives right now, which means we cannot let the perfect be the enemy of the good.”

Credit…Lucy Nicholson/Reuters

A sustained surge of coronavirus infections has locked Southern California in crisis, overwhelming intensive care wards, ambulance services, funeral homes and local officials.

Dozens of overcrowded hospitals have had to shut their emergency-room doors to ambulances for hours at a time. Medical wards are running dangerously low on a vital necessity: oxygen, and the portable canisters to supply it to patients. Los Angeles County has a coronavirus-related death every eight minutes, a grim toll accompanied in many neighborhoods by the soundtrack of shrieking sirens.

“We’re having our New York moment,” said Dr. Robert Kim-Farley, an infectious disease expert at the University of California, Los Angeles Fielding School of Public Health, recalling the weeks in March and April when New York City was the epicenter of the virus.

It took nearly 10 months for Los Angeles County to hit 400,000 cases, but little more than a month to add another 400,000, from Nov. 30 to Jan. 2. In the coming days, the county, the nation’s most populous, will reach a level where one in 10 residents has tested positive for the virus.

Los Angeles County averaged 171 deaths a day in the seven-day period ending Thursday, the most of any U.S. county and about double the nation’s per capita rate. High as that toll is, it is far smaller than New York City’s daily average of around 800 deaths in the spring, when less was understood about the disease and fewer treatments were available.

California reacted swiftly at the start of the pandemic with the country’s first stay-at-home orders, and had largely avoided the widespread infection and death experienced early on in places like New York. Now many epidemiologists, health officials and elected leaders are trying to understand what went so wrong.

Credit…Joao Silva/The New York Times

The coronavirus has evolved as it has made its way across the world, as any virus is expected to do. But experts have been startled by the pace at which significant new variants have emerged.

Much remains unknown about the new variants, or even how many are sprouting worldwide. Scientists are racing to sequence enough of the virus to know, but only a handful of countries have the wherewithal or commitment to do so with regularity.

With the world stumbling in its vaccination rollout and the number of cases steeply rising to peaks that exceed those seen last spring, experts see a pressing need to immunize as many people as possible before the virus evolves enough to render the vaccines impotent.

“It’s a race against time,” said Marion Koopmans, a Dutch virologist and a member of a World Health Organization working group on coronavirus adaptations.

It was in late October that doctors and nurses at a hospital group in Durban, South Africa, noticed an odd spike in the number of Covid-19 patients in their wards.

“Is this a different strain?” one hospital official asked in a group email in early November.

The ensuing genetic investigation found a more transmissible variant, tipping off researchers in Britain, who found another more transmissible variant that was driving up infections in England. That variant has been found in at least 45 countries, leading to border closures, quarantines and lockdowns.

Vaccines alone will not be enough to get ahead of the virus: It will take years to inoculate enough people to limit its evolution. In the meantime, social distancing, mask-wearing and hand-washing — combined with aggressive testing, tracking and tracing — might buy some time and avert devastating spikes in hospitalizations and deaths along the way.

Yet in the course of the pandemic, governments have often proven reluctant or unable to galvanize support for those basic defenses. Many countries have all but given up on tracking and tracing. Mask-wearing remains politically charged in the United States, despite clear evidence of its efficacy. Cities like Los Angeles have been gripped by a spike in cases linked to Christmas festivities, and national public health officials are bracing for surges, driven by people who ignored advice and traveled during the holidays.

The rapid spread of the new variants is a reminder of the failings and missteps of major countries to contain the virus earlier. Just as China failed to stop travelers from spreading the virus before the Lunar New Year last year, Britain failed to move fast enough ahead of the new variant’s spread. And just as China became a pariah early on in the pandemic, Britain now has the unfortunate distinction of being called Plague Island.

Credit…Paul Faith/Agence France-Presse — Getty Images

Three cases of the coronavirus variant first identified in South Africa have been contained, Irish health authorities said on Saturday, amid growing concerns that a similar, more transmissible version of the virus first found in England is driving up infections to levels that threaten to overwhelm an already overstretched health care system.

“The good thing about the South African variant is we know exactly where those cases came from, they have been contained, controlled and contact traced, and to the best of my knowledge there was no onward transmission,” Cillian De Gascun, the head of Ireland’s national virus laboratory, said on national television.

“The U.K. variant is of more concern to us purely because of the amount of virus that’s on the island, and we know that it’s transmitting in the community,” Mr. De Gascun added.

Ireland’s 14-day infection rate has quadrupled in the past two weeks, and the so-called British variant has been showing up more in test samples. Irish authorities announced a new lockdown this week, and reported over 8,200 new cases on Friday, a record.

“Already exhausted health care workers now face a tsunami of infection even greater than the first wave,” Prime Minister Micheal Martin said as he announced the new measures.

Countries around the world have grappled to contain the new variants. Infections and hospitalizations in Britain have skyrocketed since the country found the variant last month, which has since been identified in about 45 countries.

On Friday, Britain suffered its deadliest daily toll since the beginning of the pandemic, with 1,325 deaths. On Saturday, the toll was 1,035 lives.

Credit…Vatican Media, via Shutterstock

ROME — Pope Francis said in a soon-to-be-televised interview that he would be vaccinated against the coronavirus as early as next week, calling it a lifesaving, ethical obligation and the refusal to do so suicidal.

In the interview, which the Italian newscast TG5 is expected to air on Sunday evening, Francis called on everyone to get the vaccine. A transcript of the pope’s vaccination remarks, which were not immediately confirmed by the Vatican, was provided by Fabio Luca Marchese Ragona, TG5’s Vatican reporter, who conducted the interview.

“It’s an ethical choice, because you are playing with health, life, but you are also playing with the lives of others,” he said, according to the transcript. “I’ve signed up. One must do it.”

Addressing the reluctance some people have toward the prospect, Francis said: “I don’t understand why some say, ‘No, vaccines are dangerous.’ If it is presented by doctors as a thing that can go well, that has no special dangers, why not take it? There is a suicidal denial that I wouldn’t know how to explain. But today one must take the vaccine.”

Francis has sometimes come under criticism for not wearing a mask during the pandemic, and some have expressed concern that world leaders and other attendees at papal audiences could be putting him, or themselves, in danger.

The Vatican has insisted that other social distancing measures, and testing, are employed to maintain safety, though some prelates, including cardinals, have tested positive for the virus within days of interacting with Francis.

During much of the year, the virus crisis forced Francis, who is energized by travel, to stay inside the Vatican’s walls. The Vatican has had to cancel or severely limit even its most important celebrations to avoid large gatherings. The pope has at times underlined the way the virus has changed life, but also the life of the church, by presiding over ceremonies before a vast and empty St. Peter’s Square.

Footage of some of the pope’s remarks was made public in a clip promoting the interview, including his reaction to the storming of the U.S. Capitol by a mob incited by President Trump.

“I was astonished,” Francis said, “because it is a people so disciplined in democracy, no?”

On Christmas Day, Francis called for “vaccines for all,” especially the world’s most vulnerable people.

“Today, at this time of darkness and uncertainty because of the pandemic, there appear different lights of hope,” he said in his Christmas remarks, “such as the discovery of vaccines.”

Credit…Chris Jackson/Agence France-Presse — Getty Images

Queen Elizabeth II and her husband, Prince Philip, received Covid-19 vaccines on Saturday, according to Buckingham Palace, a day after Britain approved a third vaccine and as the country faced one of its deadliest weeks since the pandemic began.

The couple was vaccinated at Windsor Castle, the palace said in a statement, but it was not immediately clear which vaccine the queen, 94, and Prince Philip, 99, received.

Britain started its vaccination rollout last month with the approval of the Pfizer-BioNTech vaccine. It has since approved two other vaccines: last week, the one developed by Oxford University and AstraZeneca, and Moderna’s on Friday.

A royal source said the queen had decided to make her vaccination public to prevent inaccuracies and speculation. The palace’s statement said no further details would be provided.

The queen’s vaccination comes amid a surge of cases that have been attributed to a new variant of the virus and as Britain entered a new national lockdown..

On Saturday, 1,035 people died of the coronavirus in Britain, a day after health officials reported the highest daily death toll since the pandemic started, with 1,325 deaths. Britain has been the worst-hit country in Europe, with nearly 80,000 deaths.

As England re-entered lockdown, figures showed that one in 50 people had recently tested positive. On Friday, London’s mayor, Sadiq Khan, said one in 30 people in London had tested positive.

The queen and Prince Philip have joined over 1.3 million people who have been vaccinated in Britain, where priority has been given to residents in nursing homes and people over 80. Prime Minister Boris Johnson has said he aims to have nearly 15 million of the nation’s most vulnerable people vaccinated by mid-February.

“Our hospitals are under more pressure than at any other time since the start of the pandemic, and infection rates continue to soar at an alarming rate,” Mr. Johnson said on Twitter on Saturday.

“The vaccine rollout has given us renewed hope, but it’s critical for now we stay at home, protect the N.H.S. and save lives,” he added, referring to the National Health Service.

The queen spoke about the impact of the pandemic in her annual Christmas speech.

“This time of year will be tinged with sadness,” she said. “Some mourning the loss of those dear to them, and others missing friends and family members distanced for safety.”

Prince Charles, the queen’s elder son and the heir to the throne, tested positive for the virus last year, as did Prince William, her grandson.

Credit…Jessica Gow/Agence France-Presse — Getty Images

Sweden, which has long shunned the imposition of lockdowns and face mask orders as tools for fighting the coronavirus crisis, has given its government power to act more forcefully to try and stem the spread of the virus.

Parliament on Friday passed an emergency law that will allow the government to limit the number of people in shops, businesses and public places, like theaters and public swimming pools, or even order their closure in case of violations. The government will also be able to fine individuals for breaking virus rules.

The new powers go into effect on Sunday.

Previously, the government was able to only make recommendations on such restrictions. But with the country struggling to battle a second wave, and with emergency wards filling up to critical capacity, the government said it needed more tools.

As of Saturday, Sweden’s total death toll stood at 9,433. The country now has 93 deaths per 100,000 people, less than Britain, which has 120, but far more than its neighbor Norway, with nine.

In a separate decision put in effect Thursday, face masks, long deemed ineffective by Swedish health officials, are now being recommended for use during rush hour on public transport, although they will not be mandatory.

In April, when much of the rest of the world went into lockdowns, Swedes were able to keep going to bars and restaurants, with government and health officials saying they didn’t believe in lockdowns. The country’s Public Health Authority issued some prevention recommendations, but the government legally wasn’t able to order the sort of blanket stay-at-home measures used in other European countries.

Some experts are calling for even stricter measures.

“This law is great but not enough,” said Dr. Fredrik Elgh, a professor of clinical virology at Umea University. “We need a four-week lockdown badly to stop this increase. If we do this now in two weeks time we will see a decrease.”

Credit…Stefani Reynolds for The New York Times

Reports of a highly contagious new variant in the United States, published on Friday by multiple news outlets, are based on speculative statements made by Dr. Deborah Birx and are inaccurate, according to several government officials.

The erroneous report originated at a recent meeting where Dr. Birx, a member of the White House coronavirus task force, presented graphs of the escalating cases in the country. She suggested to other members of the task force that a new, more transmissible variant originating in the U.S. might explain the surge, as another variant did in Britain.

Her hypothesis made it into a weekly report sent to state governors. “This fall/winter surge has been at nearly twice the rate of rise of cases as the spring and summer surges. This acceleration suggests there may be a USA variant that has evolved here, in addition to the UK variant that is already spreading in our communities and may be 50% more transmissible,” the report read. “Aggressive mitigation must be used to match a more aggressive virus.”

Dismayed, officials at the C.D.C. tried to have the speculative statements removed, but were unsuccessful, according to three people familiar with the events.

C.D.C. officials did not agree with her assessment and asked to remove it but were told no, according to one frustrated C.D.C. official, speaking on condition of anonymity for fear of retaliation.

Dr. Birx could not immediately be reached for comment.

The news of a possible new variant first appeared Friday afternoon on CNN, quickly spread to other outlets. Responding to media inquiries about the variant, the C.D.C. issued a formal statement refuting the theory.

“Researchers at the Centers for Disease Control and Prevention are monitoring all emerging variants of the coronavirus, including in 5,700 samples collected in November and December,” according to Jason McDonald, a spokesman for the agency. “To date, neither researchers nor analysts at C.D.C. have seen the emergence of a particular variant in the United States,” he said.

Among the variants circulating in the U.S. are B.1.1.7, first identified in Britain and now driving a surge and overwhelming hospitals there. The variant has been spotted in a handful of states, but the C.D.C. estimates that it accounts for less than 0.5 percent of cases in the country so far.

Another variant circulating at low levels in the U.S., known as B 1.346, contains a deletion that is also present in B.1.1.7. “But I have seen nothing on increased transmission,” said Michael Worobey, an evolutionary biologist at the University of Arizona who discovered that variant.

That variant has been in the United States for three months and also accounts for fewer than 0.5 percent of cases, so it is unlikely to be more contagious than other variants, according to a C.D.C. scientist who spoke on condition of anonymity because he was not authorized to speak about the matter.

All viruses evolve, and the coronavirus is no different. “Based on scientific understanding of viruses, it is highly likely there are many variants evolving simultaneously across the globe,” Mr. McDonald, of the C.D.C., said. “However, it could take weeks or months to identify if there is a single variant of the virus that causes Covid-19 fueling the surge in the United States similar to the surge in the United Kingdom.”

Carl Zimmer contributed reporting from New Haven and Noah Weiland from Washington D.C.

(Correction: Jan. 9, 2021 — An earlier version of this article misidentified the news outlet that first published the report of a possible new variant. It was CNN, not CNBC.)

Credit…Mu Yu/Xinhua, via Associated Press

The Chinese authorities have imposed a stay-at-home order on more than 17 million people in two cities in the northern province of Hebei, an effort to stop the country’s worst coronavirus flare-up in months from spreading to nearby Beijing, the capital.

Officials in the two cities, Shijiazhuang and Xingtai, told residents on Friday to stay at home for seven days to prevent further spread of an outbreak that has caused 349 reported infections in the past week, mostly in Shijiazhuang.

Residents of Shijiazhuang, a city of 11 million that is scheduled to host several events for the 2022 Winter Olympic Games, were barred earlier this week from leaving the city. Major highways have been blocked, train and bus stations closed and most flights canceled. On Saturday, subway, bus and taxi services were also suspended.

Millions of people across Hebei have been tested in recent days, while people who recently traveled to Shijiazhuang and Xingtai are being scrutinized. Chifeng, a city in the northern region of Inner Mongolia, announced on Friday that it was shifting to “wartime” footing after discovering that more than 3,600 people from the two Hebei cities had visited in recent days.

The stay-at-home order on Friday came suddenly, leaving some residents without time to stockpile food. Some people in Shijiazhuang said they had been instructed by their residential compounds to stay at home for 14 days, a week longer than the government requires.

Hebei’s aggressive measures are part of an ongoing effort by the authorities to keep the number of new infections in China close to zero, particularly ahead of the Lunar New Year travel rush that is expected in February. Health officials on Saturday urged the public to reduce travel during the upcoming holiday — which, for tens of millions of migrant workers, is often their only chance of the year to return home from their jobs in distant cities.

Getting the current outbreak under control is especially important, officials say, given the region’s proximity to Beijing, which borders Hebei. Earlier this week, Wang Dongfeng, Hebei’s Communist Party secretary, pledged to make the province “the moat to safeguard Beijing’s political security.”

Credit…Evgeniy Maloletka/Associated Press

Lyudmyla Boiko’s family has already had a harrowing, and lethal, encounter with the coronavirus.

Several family members fell ill, and her daughter-in-law’s mother died. Now, Ms. Boiko, a 61-year-old employee of a botanical garden in eastern Ukraine, is worried about her husband, who has underlying health problems but has not yet caught the virus. She is pinning her hopes on a vaccine.

“I don’t care where the vaccine is produced as long as I’m sure it is safe,” Ms. Boiko said. “Safety should be the first priority.”

But in Ukraine, it is hardly the only consideration.

The country, already caught up in the broader tug-of-war between East and West in European politics, has now also become a focal point in the geopolitics of coronavirus vaccines — so far, to Ukraine’s detriment.

First, talks with Pfizer and other Western vaccine makers to obtain early shipments collapsed after the Trump administration banned vaccine exports. Now, unless the incoming Biden administration steps in, the earliest commercial purchases of Western vaccines will not be delivered before late 2021.

Ukraine’s plight has caught the eye of Russia’s state-controlled news outlets, which have highlighted the failure of Ukraine’s Western allies to step up in a moment of need — and offering Russia’s vaccine as an alternative.

Ukraine’s leaders, who have raised worries about the safety and efficacy of the Russian vaccine and would, in any event, almost literally die before accepting help from Russia, their blood enemy, turned to China, buying its first vaccine in a hurried negotiation in the final two weeks of December.

“Russia, as always, uses this in its hybrid war, as an information weapon,” Maksym Stepanov, Ukraine’s health minister, said in a telephone interview of the country’s effort to inoculate its population. “The issue of vaccines is politicized.”

Maria Varenikova

Credit…Iranian Supreme Leader’s Office

Iran’s supreme leader, Ayatollah Ali Khamenei, has banned the import of any Covid-19 vaccines made in the United States or Britain, repeating his conspiracy theory that vaccines made by Western countries could not be trusted and could harm Iranians.

“Importing vaccines from the U.S. and the U.K. is prohibited,” Mr. Khamenei said in televised comments on Friday. “They are completely untrustworthy.”

Mr. Khamenei’s comments are likely to significantly hinder the country’s already chaotic efforts to secure vaccines as it battles the coronavirus. Iran’s Red Crescent Society then announced it would cancel the import of 150,000 donated doses of the Pfizer-BioNTech vaccine.

For weeks, Iranian health officials and activists inside and outside Iran had been lobbying for exemptions from U.S. sanctions that would allow Iran to make payments for vaccines through Covax, an international body established to promote global access to Covid vaccines.

Before Mr. Khamenei’s announcement, ordinary Iranians had taken to social media with a campaign calling on the government to purchase European and American vaccines that they deemed more trustworthy than Russian and Chinese versions.

Mr. Khamenei’s ban on Friday caused outrage on social media, with some Iranians posting to Twitter that he does not have the right to play with people’s health and to impose his personal views on public health.

Shima Ghoosheh, a lawyer based in Tehran, posted on Twitter that she doubted that the scope of the supreme leader’s authority, as defined by Iran’s Constitution, extended to deciding what types of vaccines should be imported.

Twitter itself also took action, hiding a tweet by Mr. Khamenei on his English account about vaccine conspiracy theories and labeling it with a warning: “This Tweet is no longer available because it violated the Twitter Rules.”

On Saturday, President Hassan Rouhani said foreign companies would not be allowed to test vaccines on Iranians.

Iran last month started a clinical trial on domestically produced Covid-19 vaccines, and some hard-line officials have said inoculation should wait until Iranian-made vaccines are available.

A report by the government’s Center for Strategic Studies said Iran was negotiating with China to purchase vaccines and that acquiring vaccines from Russia and Cuba was also on the agenda. Cuba’s Finlay Institute said on Friday that it had signed an agreement with Iran to collaborate on testing a vaccine candidate.

Credit…Jes Aznar for The New York Times

A religious event that drew nearly 10,000 people in Manila on Saturday risked becoming a super spreader of the coronavirus in the Philippines, whose infection numbers have been among the worst in Southeast Asia.

For the event, which celebrates the feast of the Black Nazarene, an ebony statue of Jesus Christ that many Filipino Catholics believe to be miraculous, the statue is traditionally marched around the city’s Quiapo district. Participants typically clamber over one another to wipe it with handkerchiefs in the belief that it makes wishes come true. Last year, over two million people joined the gathering.

Although Manila’s mayor, Francisco Domagoso, broke with tradition this year and kept the icon in a church, thousands of people nonetheless arrived to pray in the surrounding streets.

Security was tight, with police officers in full combat gear patrolling and reminding people about social distancing guidelines. Others carried batons as they struggled to direct the crowd.

The country’s health secretary, Francisco Duque, said in a statement that he had received reports early in the day of people violating health protocols, although he added that the authorities had been “quick to disperse” those gathered and “ensure strict implementation of physical distancing.”

Mr. Duque had earlier appealed to devotees to opt for virtual Masses rather than physically going to Quiapo.

Credit…Mario Tama/Getty Images

A coronavirus outbreak aboard a September flight from Dubai to New Zealand offered researchers — and airlines — an opportunity to study in-transit contagion.

After the 18-hour flight from Dubai landed in Auckland, local health authorities discovered evidence of an outbreak that most likely occurred during the trip. Using seat maps and genetic analysis, the new study determined that one passenger initiated a chain of infection that spread to four others en route.

Previous research on apparent in-flight outbreaks focused on flights that occurred last spring, when few travelers wore masks, planes were running near capacity and the value of preventive measures was not broadly understood. The new report, of a largely empty flight in the fall, details what can happen even when airlines and passengers are aware of and more cautious about the risks.

The findings deliver a clear warning to both airlines and passengers, experts said.

“The key message here is that you have to have multiple layers of prevention — requiring testing before boarding, social distancing on the flight and masks,” said Dr. Abraar Karan, an internal medicine physician at Brigham and Women’s Hospital and Harvard Medical School who was not part of the study team. “Those things all went wrong in different ways on this flight, and if they’d just tested properly, this wouldn’t have happened.”

The new infections were detected after the plane landed in New Zealand; the country requires incoming travelers to quarantine for 14 days before entering the community. The analysis, led by researchers at the New Zealand Ministry of Health, found that seven of the 86 passengers on board tested positive during their quarantine and that at least four were newly infected on the flight. The aircraft, a Boeing 777-300ER, with a capacity of nearly 400 passengers, was only one-quarter full.

The seven passengers, from five countries, were seated within four rows of one another for the 18-hour duration of the flight. Two acknowledged that they did not wear masks, and the airline did not require mask-wearing in the lobby before boarding. Nor did it require preflight testing, although five of the seven passengers who later tested positive had taken a test, and received a negative result, in the days before boarding.

The researchers found that the passenger whom they believe initiated the outbreak had in fact tested negative, but four or five days before boarding.

“Four or five days is a long time,” Dr. Karan. “You should be asking for results of rapid tests done hours before the flight, ideally.”

Credit…Agence France-Presse — Getty Images

For millions of coronavirus survivors, it’s an increasingly important question: How common, serious and long-lasting are the physical and mental aftereffects of Covid-19?

A new study — believed to be the largest so far in which doctors evaluated patients six months after they became ill — suggests that many people will experience lingering problems like fatigue, insomnia, depression, anxiety or diminished lung function.

The study of 1,733 coronavirus patients who were discharged from a hospital in Wuhan, China, the original epicenter of the pandemic, found that more than three-quarters of them had at least one symptom six months later.

“This is one of the first publications that really describes in some level of detail longer-term outcomes among quite a large group of people,” said Dr. Michael Peluso, an infectious disease physician at the University of California San Francisco, who was not involved in the study. “It documents what people providing clinical care to Covid patients have known for a while now — that a large proportion of people do have long-term health consequences.”

The study, published Friday in the journal Lancet, involved in-person evaluations of people who had been admitted to Jin Yin-tan Hospital for a median of 14 days from Jan. 7 to May 29 last year. 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. About 350 of them also underwent lung function tests, chest CT scans and ultrasounds.

The most common issue was ongoing exhaustion or muscle weakness, experienced by 63 percent of the patients. About one-quarter of the patients reported difficulty sleeping and 23 percent said they experienced anxiety or depression.

“It shows that a substantial portion of people, far higher than you would expect in the general population, are exhibiting symptoms that are having an impact,” said Dr. Steven Deeks, a professor of medicine at the University of California, San Francisco, who is leading a study on long-term coronavirus symptoms that will follow patients for up to two years. “And importantly, there’s no specific pathway, there’s multiple different outcomes that occur: mental health stuff and pulmonary stuff and quality-of-life stuff. This provides pretty solid confirmation for what we’re all are seeing.”