South African health care workers were given the Johnson & Johnson vaccine at a hospital in Johannesburg in March.
Credit…Joao Silva/The New York Times

South Africa will resume the use of the Johnson & Johnson vaccine to inoculate health care workers next week, offering some relief to the country that has suffered a series of blows to its vaccination efforts in recent months, according to South African authorities.

The country suspended an early-access Johnson & Johnson vaccination program last week after health officials in the United States put a pause on the vaccine amid concerns of rare blood clots that emerged in a handful of people who received it.

South Africa’s decision to move forward again was the second green light this week for Johnson & Johnson. On Tuesday, the European Union drug regulator also recommended resuming the rollout of the company’s vaccine.

Now, many eyes are on Washington, where a federal advisory panel is scheduled to meet Friday to discuss whether to lift the pause in the United States.

The blood clots that led to the Johnson & Johnson suspensions were all reported in the United States. In South Africa, officials confirmed Thursday that no cases of clots have been reported among the roughly 290,000 health care workers who have received the vaccine so far.

“The temporary suspension in South Africa was in line with government’s commitment to ensure comprehensive measures are undertaken regarding vaccine rollout,” Khumbudzo Ntshavheni, a cabinet minister, told reporters on Thursday.

Health experts welcomed the resumption of the vaccine campaign in South Africa, which has recorded more coronavirus cases than any other country on the continent and has suffered serious setbacks in its attempt to combat the virus in recent months.

In February, health officials scrapped plans to use the AstraZeneca vaccine after it proved ineffective against a variant of the virus now dominant in South Africa. The decision came a week after a million doses of the vaccine arrived in the country and amid a devastating second wave of virus cases.

Though the Johnson & Johnson vaccine has not yet been approved for general use in South Africa, it has been used as part of a research study offering early access to the vaccine to the country’s 1.2 million health care workers.

South African health officials are gearing up to extend vaccinations to the general public starting in May. In a first step to launching a national rollout, the country last week opened its vaccine registration to people over 60 years old, who will be among the first to be inoculated.

That plan depends on tens of millions of doses of the Pfizer-BioNTech vaccine, which requires two doses and will be used in major cities. The single-shot Johnson & Johnson vaccine, which is easier to store and better for hard-to-reach populations, will be used in the country’s rural areas.

United States › United StatesOn Apr. 27 14-day change
New cases 51,938 –24%
New deaths 764 –5%

World › WorldOn Apr. 27 14-day change
New cases 815,788 +15%
New deaths 14,391 +6%

U.S. vaccinations ›

Where states are reporting vaccines given
The intensive care unit  after a fire broke out in Vijay Vallabh Hospital in Virar, near Mumbai, India, on Friday.
Credit…Rajanish Kakade/Associated Press

At least 13 coronavirus patients were killed in a hospital fire in Maharashtra State in India on Friday morning as the country experienced an enormous surge of infections and deaths.

The fire swept the intensive care unit of Vijay Vallabh Hospital in the city of Virar, about 45 miles north of Mumbai, the state capital, the authorities said.

Several patients were rescued and moved to another I.C.U., the hospital’s chief executive, Dilip Shah, told the N.D.T.V. news channel. Mr. Shah told reporters that the blaze might have been caused by a malfunctioning air-conditioning unit.

No information was immediately available on the condition of the survivors.

It was the second hospital tragedy involving Covid-19 patients this week in India. At least 22 patients were killed on Wednesday in a hospital in Nashik, another city in Maharashtra, after a leak cut off their oxygen supply.

India is now reporting the most daily coronavirus infections of any country since the pandemic began. The health ministry recorded more than 330,000 infections in a 24-hour period on Friday, and more than 2,200 deaths. That surpassed the previous day’s total of more than 310,000 new cases and 2,100 deaths.

People waiting in line to register for a vaccination in Brooklyn earlier this month.
Credit…Spencer Platt/Getty Images

Federal health officials appear to be leaning toward lifting their recommended pause on the use of Johnson & Johnson’s coronavirus vaccine after finding only a limited number of additional cases of a rare blood clotting disorder among recipients.

Instead, the Food and Drug Administration is likely to attach a warning to the vaccine’s label to inform health practitioners — and the public — about the exceedingly uncommon, but dangerous possible side effect.

Federal health officials are waiting to act until they hear from a committee of outside experts who advise the Centers for Disease Control and Prevention. The committee is scheduled to meet on Friday to discuss whether to recommend lifting, extending or modifying the pause that was initiated on April 13.

“We know that it’s not a good thing to leave the pause going for any longer than it absolutely has to go for,” Dr. Peter Marks, the Food and Drug Administration’s top vaccine regulator, said Thursday, adding that a protracted pause could contribute to greater vaccine hesitancy. “Once, essentially, the adequate discussion has occurred, we’re prepared to move as quickly as we possibly can.”

When top federal health officials abruptly decided early last week to recommend a temporary halt in the use of the shot, six women had been reported to have suffered from the disorder, a combination of clots in the brain that led to bleeding and low platelets, components of the blood that normally help to heal wounds.

That was fewer than one in a million recipients of Johnson & Johnson’s shot in the United States. But officials worried that more cases were hidden or could develop shortly as the new vaccine rolled out.

That fear has not materialized.

Dr. Marks and Dr. Janet Woodcock, the F.D.A.’s acting commissioner, said the clotting disorder appeared to be nearly as rare as they hoped it would be when they recommended the pause.

“We’ve now received more cases, but it isn’t an avalanche,” Dr. Woodcock said “We’re not seeing a big surge, which is a great relief.”

Even if the C.D.C.’s advisory committee decides Friday that the benefits of Johnson & Johnson’s single-dose vaccine outweigh its risks, the company will still face manufacturing hurdles at a Baltimore plant that regulators have refused so far to certify. That plant was supposed to deliver the bulk of the nearly 100 million doses the firm had promised to have ready by the end of May.

But it would mean a temporary surge of about 10 million shots that were effectively put on hold when the pause was announced.

People relaxed in the Place des Vosges in central Paris on Saturday. Prime Minister Jean Castex said that France will relax many of its coronavirus restrictions in May. 
Credit…Dmitry Kostyukov for The New York Times

The French government outlined plans on Thursday to gradually reopen the country starting in early May, stoking hopes that life might finally return to something close to normal after more than a year of on-and-off pandemic restrictions.

Prime Minister Jean Castex said at a news conference that primary school students would be allowed to return to classrooms on Monday, followed by middle and high school students the following week. Travel restrictions will be lifted on May 3.

Depending on how things are going at that point, Mr. Castex said, retail stores, outdoor dining, and certain cultural and sporting activities could start to reopen in mid-May.

The pandemic situation appears to be improving in France, with the daily average number of new cases falling to about 32,000 from 42,000 the week before. Hospitalizations seem to have plateaued at nearly 6,000.

“The peak of the third wave seems to be behind us,” Mr. Castex said.

The government is hoping to alleviate the deep sense of pandemic fatigue that has taken root in France. When the country went into its third lockdown at the start of April, once again closing schools and “nonessential” retail stores, the move was met with anger and some pointed protests.

Hundreds of lingerie shops across France, closed under the lockdown order, have been mailing panties to Mr. Castex since the beginning of the week, as part of a campaign called “Action Culottée,” meaning “cheeky action,” which was coordinated on Facebook.

The country’s vaccination campaign, which stumbled for months, has gathered speed recently, and is now administering about 2.5 million doses a week. More than 13 million people have received at least one dose so far, and the country aims to raise the figure to 20 million — 30 percent of the population — by mid-May. Even so, France lags far behind countries like the United States, Britain and Israel in its vaccination efforts.

To limit the spread of highly transmissible virus variants, Mr. Castex said, France will tighten testing and quarantine requirements for travelers arriving from five countries — Brazil, Chile, Argentina, South Africa and India — where the variants are circulating widely.

The Atlantic City boardwalk last July.
Credit…Michelle Gustafson for The New York Times

With summer on the horizon, states are beginning to rethink social-distancing measures.

In Rhode Island, Gov. Dan McKee said that starting May 7, the state will stop requiring masks outside, and social gatherings can increase to 25 people indoors and 75 people outdoors. By May 28, the state will lift capacity limits on businesses and houses of worship, the bar areas of restaurants will be able to open, and dance floors can once again be filled.

“It’s a good day for everyone here in the Ocean State,” Mr. McKee said at a news conference on Thursday. “It’s a little early to put a ‘Mission Accomplished’ sign up, but we’re getting ready to order that sign.”

Mr. McKee attributed the reopening plans to the state’s vaccination rate — 48 percent of residents have received at least one shot, and 33 percent are fully vaccinated, according to a New York Times database. But masks will still be required indoors.

Rhode Island is not alone.

On Monday, Gov. Ned Lamont of Connecticut said that the state would phase out all pandemic restrictions, except the indoor mask mandate, by May 19. And in New Jersey, Gov. Phil Murphy said on Wednesday that he would announce “a pretty significant amount of guidance” for summer activities next week.

“We don’t want to lurch, in other words go forward and then have to pull something back,” Mr. Murphy said at his weekly news conference. “And we don’t want to start that now. But we also owe people our best guesses for what it’s going to look like for graduation, summer, the beaches and what not.”

As more people get vaccinated and the outdoors become more appealing with spring weather and sunshine, one question persists: Do people still need to wear masks outside? Science shows that the risk of viral transmission outside is very low. The Times’s Well columnist, Tara Parker-Pope, suggests making sure activities meet two out of the following three conditions: outdoors, distanced and masked.

Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, said on Thursday that the agency was “looking at the outdoor masking question” and whether to revise current guidance.

Global Roundup

Police officers stood guard in Berlin as Germans demonstrated against coronavirus measures on Wednesday.
Credit…Christian Mang/Reuters

BERLIN — State lawmakers in Germany approved a new version of a law on Thursday boosting the federal government’s power to enforce uniform coronavirus lockdown rules. New restrictions are expected in most districts soon after the president signs the bill into law, which could be as early as Thursday afternoon.

The law, which Chancellor Angela Merkel’s cabinet passed last week, is a response to a disjointed virus response by state governments, which previously had the ultimate say in carrying out restrictions. For months, experts have called for a lockdown to control Germany’s surging third wave of coronavirus infections.

Under the law passed by the federal council of states on Thursday, the rules would apply uniformly across the country but would depend on the rate of infection in each district, leading to more severe lockdowns in highly affected areas. There would be a curfew from 10 p.m. to 5 a.m. in districts with more than 100 new infections per 100,000 people in a week. Restaurants would remain closed, and nonessential stores would require an appointment and a negative test result in districts with more than 150 new infections per 100,000 people. Schools would close if 165 new infections per 100,000 were registered.

Germany is currently measuring 161 infections per 100,000 in a week, according to the health authorities, which also counted 29,518 new infections on Wednesday.

As many as 8,000 people, including right-wing extremists and coronavirus deniers, took to the streets in Berlin to protest the measures on Wednesday. Several lawsuits against it have already been announced.

Germany has recorded more than 80,000 deaths so far.

In other developments across the world:

  • Japan’s auto industry group canceled the biennial Tokyo Motor Show, scheduled for the fall, because of rising coronavirus cases, the Kyodo News agency reported. It was the first cancellation in the 67-year history of the event, which drew around 1.3 million people in 2019. Akio Toyoda, the chairman of the industry group and president of Toyota Motor Corp., said at a news conference that “it seems difficult to offer main programs in a safe environment.” The cancellation came as Japan reported 5,291 new infections, the highest daily total in three months. And it raised more questions about plans for the Tokyo Olympics, which organizers have insisted will begin in July even as officials plan to impose emergency measures in Tokyo and other municipalities.

  • The European Union will not order an extra 100 million vaccines from AstraZeneca foreseen in its contract, a European Commission spokesman said Thursday, underscoring the soured relationship between the pharmaceutical company and the bloc of 27 countries. The bloc could have added 100 million doses of vaccines to its existing order of 300 million from AstraZeneca but the time to do so has passed, Stefan de Keersmaecker, the spokesman, said. The European Union is embroiled in a dispute with the British-Swedish company over its inability to deliver expected doses, which has set the bloc’s vaccination efforts back significantly. They have been in a legal arbitration process for weeks, and the bloc is considering suing.

A man who died of complications from the coronavirus was being cremated in Mumbai on Wednesday.
Credit…Atul Loke for The New York Times

India’s rapidly worsening coronavirus outbreak is now expanding on a scale beyond any previously measured in more than a year of the pandemic: The health ministry reported more than 310,000 new infections on Thursday, the most recorded in any country on a single day.

India’s total eclipsed the previous one-day high of 300,669 recorded coronavirus cases, set in the United States on Jan. 8, according to a New York Times database, though differences in testing levels from country to country, and a widespread lack of tests early in the pandemic, make comparisons difficult.

Over the past two months, the outbreak in India has exploded, with reports of superspreader gatherings, oxygen shortages and ambulances lined up outside hospitals because there were no ventilators for new patients.

As cases worldwide reach weekly records, a substantial proportion of the new infections are coming in India, a sobering reminder that the pandemic is far from over, even as infections decline and vaccinations speed ahead in the United States and other wealthy parts of the world. India has surpassed 15.6 million total reported infections so far, second-most after the United States.

The death toll has also begun to climb precipitously.

On Thursday, the Indian government recorded 2,104 deaths, and an average of more than 1,600 people have died of the virus every day for the past week. That is less than the tolls at the worst points of the pandemic in the United States or Brazil, but it is a steep increase from just two months ago, when fewer than 100 people in India were dying daily.

There are signs that the country’s health system, patchy even before the pandemic, is collapsing under the strain. On Tuesday, at least 22 people died in an accident in the central city of Nashik when a leak in a hospital’s main oxygen tank cut the flow of oxygen to Covid-19 patients.

The picture is staggeringly different from early February, when India was recording an average of just 11,000 cases a day, and domestic drug companies were pumping out millions of vaccine doses. More than 132 million Indians have received at least one dose, but supplies are running low and experts warn that the country is unlikely to meet its goal of inoculating 300 million people by the summer.

Critics say Prime Minister Narendra Modi, who imposed a harsh nationwide lockdown in March 2020 in the early stages of the pandemic, failed to prepare for a second wave or to warn Indians to remain vigilant against the virus, especially as more infectious variants began to spread.

Mr. Modi’s Hindu nationalist government has also allowed a massive Hindu festival to take place, drawing millions of pilgrims to the banks of the Ganges River, and his party has held packed political rallies in several states.

“India’s rapid slide into this unprecedented crisis is a direct result of complacency and lack of preparation by the government,” Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics and Policy in Washington, wrote in The New York Times on Tuesday.

The hardest-hit region is Maharashtra, a populous western state that includes the financial hub of Mumbai. On Wednesday, the state’s top leader ordered government offices to operate at 15 percent capacity and imposed new restrictions on weddings and private transportation to slow the spread of the virus.

This week, Britain’s prime minister, Boris Johnson, and Japan’s prime minister, Yoshihide Suga, called off plans to visit India. On Thursday, the Australian prime minister, Scott Morrison, said that direct flights from India would be reduced by about 30 percent, and that Australians would be allowed to travel to India only in “very urgent circumstances.” Canada also suspended all direct flights from India and Pakistan starting Thursday night for 30 days.

Megan Fairchild practicing in her parent’s home in Utah.
Credit…Kim Raff for The New York Times

At the beginning of the pandemic, one of Megan Fairchild’s former dance teachers gave her some advice: Now would be a really great time to get pregnant. Ms. Fairchild, a principal at New York City Ballet, was aghast.

“I was like, that’s a ridiculous idea and the last thing on my mind right now,” she said. “This is going to last a couple months, and I don’t want to not be there when we get back.”

But when it became clear that her kind of live performance, dancing for thousands at Lincoln Center, would not be resuming anytime soon, the decision to have another child came to her in three words when she was meditating: Do it now.

For much of the pandemic year, Ms. Fairchild, 36, was pregnant with twins. On April 10, she gave birth to two girls.

She’s not the only one to have taken advantage of the theatrical shutdown. The dance world is experiencing a full-blown baby boom.

A nurse giving a vaccination on Sunday at the Javits Center in Manhattan.
Credit…Kevin Hagen for The New York Times

Both the Pfizer-BioNTech and Moderna vaccines will effectively prevent serious illness and death from a homegrown coronavirus variant that has kept cases in New York City stubbornly high, two independent studies suggest.

City officials had repeatedly warned that the variant, B.1.526, may be more contagious and may dodge the immune response. But researcher say that the antibodies stimulated by Pfizer-BioNTech and Moderna vaccines are only slightly less potent at controlling the variant than the original form of the virus.

“We’re not seeing big differences,” said Michel Nussenzweig, an immunologist at Rockefeller University in New York who is a member of the team that published one of the studies on Thursday.

The results are based on laboratory experiments with blood samples from small numbers of vaccinated people and have not yet been peer-reviewed. Still, they are consistent with what is known about similar variants, several experts said, and they add to a growing body of research that suggests that the two main vaccines in the United States are protective against all of the variants identified so far.

“The take-home message is that the vaccines are going to work against the New York variant and the South African variant and the U.K. variant,” said Nathan Landau, a virologist at N.Y.U.’s Grossman School of Medicine who led the study.

Federal regulators have found many shortcomings at a plant of Emergent BioSolutions in Baltimore.
Credit…Saul Loeb/Agence France-Presse — Getty Images

WASHINGTON — Federal regulators have found serious flaws at the Baltimore plant that had to throw out up to 15 million possibly contaminated doses of Johnson & Johnson’s coronavirus vaccine, casting doubt on further production in the United States of a vaccine that the government once viewed as essential in fighting the pandemic.

The regulators for the Food and Drug Administration said that the company manufacturing the vaccine, Emergent BioSolutions, may have contaminated additional doses at the plant. They said the company failed to fully investigate the contamination, while also finding fault with the plant’s disinfection practices, size and design, handling of raw materials and training of workers.

The F.D.A. has not yet certified the plant, in Baltimore’s Bayview neighborhood, and no doses made there have gone to the public. All the Johnson & Johnson shots that have been administered in the United States have come from overseas.

The report amounted to a harsh rebuke of Emergent, which had long played down setbacks at the factory, and added to problems for Johnson & Johnson, whose vaccine had been seen as a game changer because it requires only one shot, can be produced in mass volume and is easily stored.

The inspection began after routine checks showed that Emergent workers had contaminated at least part of a batch of 13 million to 15 million doses of the Johnson & Johnson vaccine with the harmless virus that is used to make the AstraZeneca shot, which is not yet authorized in the United States.

The F.D.A. findings, based on an inspection that ended on Tuesday, underscore questions raised in reports by The New York Times about why Emergent did not fix problems earlier and why federal officials who oversee its lucrative contracts did not demand better performance.

In statements on Wednesday, the F.D.A., Emergent and Johnson & Johnson all said they were working to resolve the problems at the factory. There was no indication of how long that would take.

Nepal’s dethroned king, Gyanendra Shah, center, at Golden Temple in Amritsar, India, last year.
Credit…Sameer Sehgal/Hindustan Times, via Getty Images

KATHMANDU, Nepal — At the beginning of this month, Nepal’s dethroned king, Gyanendra Shah, and his wife, Komal, traveled to northern India for the Kumbh Mela, a Hindu pilgrimage where millions seek a dip in the Ganges River to absolve themselves of their sins.

Gyanendra bathed in the river, and for 10 days, he and his aides mingled in crowds and met ascetics, Hindu leaders and other dignitaries. On April 18, he and Komal flew home to Nepal, where supporters welcomed them at the airport and formed a procession to escort them home, chanting pro-Hindu and pro-monarchy slogans along the way.

Three days later, the couple tested positive for the coronavirus. Now they are in quarantine at their residence in Kathmandu, the capital, while health officials in Nepal try to trace anyone who was in contact with them.

“Both king and queen have isolated themselves from other family members,” said Phani Raj Pathak, an aide to Gyanendra, who was dethroned when Nepal became a republic in 2008 and ended a two-century-old Hindu monarchy. The former ruler, who is in his 70s, retains support among some Hindus in Nepal as well as among critics of the elected government.

The infections have cast a harsh spotlight on the Kumbh Mela, where millions of Hindu pilgrims have gathered for weeks, shoulder to shoulder and often maskless, even as highly infectious variants of the coronavirus surge across South Asia. On Thursday, India reported more than 312,000 new infections, the highest daily total in any country since the pandemic began.

The Indian government has defended the gathering as safe, even as news media report thousands of infections among participants. Organizers say that attendees are required to wear masks and show proof of a negative coronavirus test, but they acknowledge that given the size of the event, many could have flouted the rules.

Now there are fears that the Kumbh Mela will cause the virus to explode in Nepal, which shares a porous border with India.

“The majority of people weren’t wearing face masks,” said Yogini Saritanandi, a pilgrim who returned to Nepal. She said she had seen “nothing other than a sea of humans on the bank of the Ganges.”

She said the authorities in the northern city of Haridwar, where the Kumbh Mela is being observed this year, began to slightly restrict entry after a few ascetics were reportedly infected and after India’s prime minister, Narendra Modi, urged organizers to observe social distancing. But it appeared to be too late.

“People got Covid one after another,” said Ms. Saritanandi, 43. “When I saw this, I thought of my 10-year-old son, and I cut my visit short to return to Nepal earlier.”

As Indian states impose new lockdowns, tens of thousands of Nepali migrant workers have returned from India without undergoing coronavirus tests. After reporting no new infections for much of January, Nepal is now averaging more than 1,100 cases a day, according to a New York Times database.

The government has closed schools and colleges in urban areas and tried to speed up vaccinations, with more than 1.7 million people having received at least one shot. But the inoculation drive was slowed after India restricted exports of vaccines to fight the outbreak at home, leaving Nepal to rely on a donation of shots from China.

A man used a self-administered coronavirus test kit in Durham, N.C., in February.
Credit…Pete Kiehart for The New York Times

The health effects of Covid-19 not only can stretch for months, but also appear to increase the risk of death and chronic medical conditions even in people who were never sick enough with Covid to be hospitalized, according to a new study published Thursday in the journal Nature.

Researchers looked at medical records of more than 73,000 people across the United States who were infected with the coronavirus between March and November 2020 and did not require hospitalization. In the period from one to six months after becoming infected, those patients were 20 percent more likely to need outpatient medical care, and 60 percent more likely to die, than people who had not contracted the coronavirus.

The Covid survivors experienced a vast array of long-term medical problems that they had never had before — not just lung issues from the respiratory effects of the virus, but symptoms that could affect virtually any organ system or part of the body, from neurological to cardiovascular to gastrointestinal. They were also at greater risk of mental health problems, including anxiety and sleep disorders.

Some of the patients’ post-Covid medical issues — like diabetes, kidney disease and some heart problems — could become chronic conditions that would require treatment for the rest of their lives.

Most of the nearly 32 million people who have contracted the coronavirus in the United States have not needed hospitalization, so the findings may have wide implications. But the study sample and the control group they were compared with may not be very representative of the general public: They were Veterans Health System patients, overwhelmingly men with a median age over 60.

A pregnant woman receiving the Pfizer vaccine in Schwenksville, Pa., in February.
Credit…Hannah Beier/Reuters

In an early analysis of coronavirus vaccine safety data, researchers at the Centers for Disease Control and Prevention have found no evidence that the Pfizer-BioNTech or Moderna vaccines pose serious risks during pregnancy.

The findings are preliminary and cover just the first 11 weeks of the U.S. vaccination program. But the study, which included self-reported data on more than 35,000 people who received one of the vaccines during or shortly before pregnancy, is the largest yet on the safety of the coronavirus vaccines in pregnant people.

During the clinical trials of the vaccines, pregnant women were excluded. That left patients, doctors and experts unsure whether the shots were safe to administer during pregnancy.

“There’s a lot of anxiety about whether it’s safe and whether it would work and what to expect as far as side effects,” said Dr. Stephanie Gaw, a maternal-fetal medicine specialist at the University of California, San Francisco.

The new data, Dr. Gaw said, demonstrate that “a lot of pregnant people are getting the vaccine, there isn’t a significant increase in adverse pregnancy effects at this point, and that side effect profiles are very similar to nonpregnant people.”

“I think that’s all very reassuring,” she said, “and I think it will really help providers and public health officials more strongly recommend getting the vaccine in pregnancy.”

Covid-19 poses serious risks during pregnancy. Pregnant women who develop symptoms of the disease are more likely to become seriously ill, and more likely to die, than nonpregnant women with symptoms.

Because of those risks, the C.D.C. has recommended that coronavirus vaccines be made available to pregnant women, though it also suggests that they consult with their doctors when making a decision about vaccination.

The new study, which was published on Wednesday in The New England Journal of Medicine, is based largely on self-reported data from V-safe, the C.D.C.’s coronavirus vaccine safety monitoring system. Participants in the program use a smartphone app to complete regular surveys about their health, and any side effects they might be experiencing, after receiving a Covid-19 vaccine.

The researchers analyzed the side effects reported by V-safe participants who received either the Pfizer or Moderna vaccine between Dec. 14, 2020, and Feb. 28, 2021. They focused on 35,691 participants who said that they had been pregnant when they received the vaccine or became pregnant shortly thereafter.

After vaccination, pregnant participants reported the same general pattern of side effects that nonpregnant ones did, the researchers found: pain at the injection site, fatigue, headaches and muscle pain.

Women who were pregnant were slightly more likely to report injection site pain than women who were not, but less likely to report the other side effects. They were also slightly more likely to report nausea or vomiting after the second dose.

Pregnant V-safe participants were also given an opportunity to enroll in a special registry that tracked pregnancy and infant outcomes.

By the end of February, 827 of those enrolled in the pregnancy registry had completed their pregnancies, 86 percent of which resulted in a live birth. Rates of miscarriage, prematurity, low birth weight and birth defects were consistent with those reported in pregnant women before the pandemic, the researchers report.

“This study is of critical importance to pregnant individuals,” Dr. Michal Elovitz, a maternal-fetal medicine specialist at the University of Pennsylvania, said in an email. “It is very reassuring that there were no reported acute events in pregnant individuals” over the course of the study, she said.

But the report has several limitations and much more research is needed, experts said. Enrollment in the surveillance programs is voluntary and the data are self-reported.

In addition, because the study period encompassed just the first few months of the U.S. vaccination campaign, the vast majority of those enrolled in the pregnancy registry were health care workers. And there is not yet any data on pregnancy outcomes from people who were vaccinated during the first trimester of pregnancy.

“I think we can feel more confident about recommending the vaccine in pregnancy, and especially with pregnant people that are at risk of Covid,” Dr. Gaw said. “But we do need to wait for more data for complete pregnancy outcomes from vaccines early in pregnancy.”

Jackie Robinson Day at Dodger Stadium earlier this month.
Credit…Kirby Lee/USA Today Sports, via Reuters

Fully vaccinated baseball fans will be granted their own section at the Los Angeles Dodgers game this weekend against the San Diego Padres.

The set-aside seats, reported by The Los Angeles Times, are part of the many incentives being offered — from doughnuts to beer — to encourage people to get vaccinated against Covid-19. The Miami Heat and the San Francisco Giants have introduced similar sections at their stadiums.

To prove they are fully vaccinated, fans will have to show government-issued I.D. and documentation like a vaccination card, according to the Dodgers’ website. Everyone 16 years and older will have to show proof that at least two weeks have passed since they were fully vaccinated. Fans younger than 16 will be required to show proof of a negative coronavirus test taken within 72 hours before admission.

Face masks will still be required, but social distancing will not. The team said spectators in the sections for the fully vaccinated will be seated directly next to each other.

The game Saturday won’t mark the first time fans have entered Dodger Stadium since the pandemic began. The team’s home opener on April 9 was attended by fans — just not all that many of them. Attendance was capped at around 11,000, about 20 percent of capacity.

In the past week, there has been an average of more than 2,300 daily coronavirus cases in the state, and Los Angeles County has seen an average of 435 daily cases — a 20 percent drop over the past two weeks, according to a New York Times database.

As of Wednesday, more than 40 percent of Californians had received at least one dose of the vaccine, and more than 20 percent had been fully vaccinated.

On April 15, Gov. Gavin Newsom loosened some restrictions in the state, permitting limited outdoor gatherings and live events, depending on a region’s Covid-19 risk level.

A 5K run organized by New York Road Runners in October.
Credit…John Minchillo/Associated Press

New York Road Runners, the club that puts on the New York City Marathon, has announced the return of its first regularly scheduled race since the beginning of the pandemic.

On Thursday, the club said that it would hold the annual New York Mini 10K on June 12. The 10-kilometer, women-only race has been held annually since 1972, with the exception of last year.

“This is our first real table setting,” said Kerin Hempel, the organization’s interim chief executive. “It’s starting to feel like ‘OK, we’re back, we’re coming back.’”

This will not be the first race the club has held since the onset of the pandemic.

The organization has held a series of “return to racing” events as pilots starting last fall, allowing very small fields to run with safety protocols in place. Among other measures, the races had temperature checks, staggered starts and different corralling of runners.

Those events, Ms. Hempel said, have given N.Y.R.R. the confidence to move ahead with its first regularly scheduled race since March 2020.

The Mini 10K field will be smaller than in past years, with a cap of 1,200 runners. The race will also have safety protocols, such as requiring runners to mask up at the start and finish. (They will be strongly encouraged to wear masks during the race, too.)

It will be the first time N.Y.R.R. has welcomed elite athletes since the 2019 New York City Marathon, with 25 elite athletes expected at the starting line. The 2019 Mini 10K champion, Sara Hall, will return to defend her title.

The announcement comes as runners look ahead — with cautious optimism — to the return of major road races. Ms. Hempel anticipated the question on the minds of many: What does this mean for the New York City Marathon?

“We’ve been saying the marathon is going to happen,” she said. “It’s more about what it’s going to look like, and how many people we can accommodate on the course.”

The Daniel Patrick Moynihan Courthouse of the Federal District Court in Manhattan in January.
Credit…Jefferson Siegel for The New York Times

In Manhattan’s Federal District Court, witnesses now testify from Plexiglas booths. New handsets let defendants communicate with lawyers confidentially, but at a distance. Jurors are sit spaced apart on elevated platforms, and deliberate and eat lunch in a separate courtroom. As New York reopens, the sprawling federal and state court systems have transformed the way they operate in order to bring people back into buildings safely and clear case backlogs. Nowhere have the changes been more visible than in jury trials.

The court spent $1 million reconfiguring 11 courtrooms and stocking courthouses with sanitizer, gloves, masks and antimicrobial pens. To get the system moving again, the court decided that criminal trials generally would be given precedence. And since trials had begun again, the court was having no difficulty attracting juries — since, for some, jury duty was preferable to staying at home. Judge Loretta A. Preska, overseeing a recent trial in Manhattan, recalled a juror in a blouse with a V-neck edged by large ruffles.

“When I admired it,” Judge Preska recalled, “she smiled broadly and replied to the effect that she had been at home for nine months and was delighted to dress to come to court.”

The federal court has successfully held more than a dozen trials since restarting in February. In New York’s state courts, where jury trials restarted on March 22, roughly 200 have been resolved through verdicts, guilty pleas or settlements, a court spokesman said.

There have been some bumps in the road. As jury selection began in one civil case in Brooklyn Supreme Court, a plaintiff’s lawyer said he could not proceed while wearing a mask because it interfered with his breathing, and asked to wear a face shield instead. Justice Lawrence Knipel, citing court rules, denied the request and dismissed the case.

Mandatory masking also butted up against the Sixth Amendment right of accused people to confront the witnesses against them. Judges determined, as a result, that witnesses had to testify without masks, which raised other issues.

Eventually the court constructed the Plexiglas witness booth with a HEPA filter. To allow defendants and lawyers to keep their distance, they installed telephone-style handsets engineered to amplify whispers.

But the complications did not end there. Take, for example, the Manhattan federal court trial of two men charged with conspiracy to commit bank fraud.

An inoculation at a union hall in Chicago this month. Coronavirus cases in Illinois are starting to recede.
Credit…Kamil Krzaczynski/Agence France-Presse — Getty Images

For weeks, Illinois, like much of the Upper Midwest, has been troubled by a stubbornly high daily load of reported coronavirus cases, leading to climbing numbers of hospitalizations and deaths. But new data is signaling that the virus might be on the verge of retreating.

Illinois is reporting an average of about 2,840 new cases a day, down nearly 16 percent from April 17. Central Illinois, which saw major growth in cases earlier this month, is now improving, according to a New York Times database — especially in Peoria, one of the metropolitan areas where the virus had been spreading the fastest.

“It is great we have seen some abatement in local hot spots,” said Dr. Emily Landon, the chief epidemiologist at the University of Chicago, who has been advising Gov. J.B. Pritzker, a Democrat, on the state’s pandemic response. Dr. Landon cautioned, though, that other pockets of the state, especially those with low vaccination rates, remained ripe for “a fiery outbreak.”

“I wouldn’t say everybody is out of the woods,” she said.

Indeed, hospitalizations remain high in Illinois and other Great Lakes states like Michigan and Minnesota, putting mounting pressure on health care systems. Hospitalizations in Illinois are up by about 25 percent over the past two weeks, as are hospitalizations in Michigan and Minnesota. In the past two weeks, deaths have risen by 20 percent in Illinois and 48 percent in Michigan.

The surge grew particularly worrisome in Michigan, which continues to lead the nation in daily cases per person but has recorded a 27 percent decline over the past two weeks.

Minnesota has recorded an 8 percent drop in daily new cases in the past two weeks, but a 25 percent increase in hospitalizations.

The case counts surged as variants were starting to spread widely, and states have been racing to vaccinate as many people as possible. More than a quarter of Illinois’s population is now fully vaccinated, and 44 percent of people have received at least one shot. Officials said the recent surge might be burning itself out in part because of the growing number of people who are protected.

“We have seen a beginning of, maybe, a lessening of the rise of cases,” Mr. Pritzker said last week. “I don’t want to predict anything, because this virus is unpredictable. But I think at least in the short term, that seems to be good news.”

Officials in Illinois said that when vaccinations first became widely available, people started taking fewer precautions, even though highly contagious variants were spreading.

“It led to the perfect storm,” said Monica Hendrickson, public health administrator for the Peoria City/County Health Department, who noted that recent cases had been highest among young people, the last to become eligible for the vaccine.

In Michigan, where 40 percent of adults have received at least one vaccine dose, Gov. Gretchen Whitmer, a Democrat, has asked the Biden administration for extra doses, but the administration has so far held to its policy of distributing doses by population and not demand.

The director of the Centers for Disease Control and Prevention, Dr. Rochelle P. Walensky, said at a White House news conference last week that securing extra doses was not the most immediate or practical solution. She said that Michigan — whose metro areas include 15 of the 17 worst outbreaks in the nation — needed to enact shutdown measures to quickly slow the virus’s spread.

The situation in Illinois remains dire. Dr. Michael Cruz, chief operating officer at OSF HealthCare, said on Thursday that about a half-dozen of the hospital system’s medical centers in Illinois were at more than 90 percent of capacity. He said it was too early to say whether the recent decline in new case reports was a “true inflection point.” In Michigan, 24 hospitals hit 90 percent of capacity last week.

“The virus does what the virus does,” Dr. Cruz said. “Let it hang around long enough, it will start mutating.”

The Centers for Disease Control and Prevention is recommending lifting the pause on the Johnson & Johnson Covid-19 vaccine for all adults while adding a warning label.
Credit…Alessandro Grassani for The New York Times

A panel of advisers to the Centers for Disease Control and Prevention has recommended lifting the pause on the Johnson & Johnson Covid-19 vaccine for all adults while adding a warning label about a rare but dangerous blood clotting disorder. But a central mystery persists: How might a vaccine that has been given to nearly eight million people cause the side effect in just a few of them?

There’s no clear answer yet, but Dr. Andreas Greinacher, a researcher at University Medicine Greifswald in Germany, is leading one effort to find out. At a news conference on Tuesday, he said that he had reached an agreement with Johnson & Johnson to inspect the components of the vaccine to see if it could disrupt the normal blood clotting process under certain rare conditions.

“We just agreed that we would like to work together,” he said.

It’s possible, Dr. Greinacher said, that the Johnson & Johnson vaccine can cause rare side effects by the same process that he suspects is responsible for similar side effects from the AstraZeneca vaccine. The main ingredient in both vaccines are harmless viruses known as adenoviruses, which slip into human cells and deliver a coronavirus gene that will later cause an immune response.

On Tuesday, Dr. Greinacher and his colleagues released a report on how the AstraZeneca vaccines might trigger the side effect. The study has not yet been published in a scientific journal.

The scientists found that components in the AstraZeneca vaccine could stick to a protein that platelets release during the formation of blood clots. These clumps of molecules could be seen by the body as foreign invaders, the scientists speculated, triggering a cascade of reactions that cause platelets to turn into dangerous clots.

Dr. Paul A. Offit, a vaccine expert at Children’s Hospital of Philadelphia who was not involved in the study, found Dr. Greinacher’s study intriguing but far from the final word. “He throws out a lot of possibilities,” he said.

Dr. Offit said it was not clear which of the many factors the researchers studied might explain the rare blood clots in people vaccinated with AstraZeneca’s doses. “It’s like sipping from a fire hose,” he said.

At a news conference on Tuesday, Dr. Greinacher said that the research might point to ways, in the AstraZeneca vaccine, of lowering the risk of the clots or treating the side effects. But he emphasized that the small risk of those side effects was strongly outweighed by the protection that vaccines such as AstraZeneca’s provide against Covid-19.

“Not being vaccinated is far more dangerous than being vaccinated and at risk for this adverse drug reaction,” he said.

A vial containing doses of the Johnson & Johnson Covid-19 vaccine.
Credit…Bryan Anselm for The New York Times

The Food and Drug Administration ended its recommended pause on the Johnson & Johnson Covid-19 vaccine on Friday and will add a warning to its label to note the potential risk of rare blood clots.

The decision, which clears the way for states to resume vaccinations, came after a panel of advisers to the Centers for Disease Control and Prevention voted to end the pause in a meeting on Friday.

The shot could be deployed again by Saturday morning, Dr. Peter Marks, the F.D.A.’s top vaccine regulator, said at a news conference Friday evening.

Johnson & Johnson injections ground to a halt last week in the United States and Europe after reports emerged of a rare blood clotting disorder in six women who had received the vaccine. Nine additional cases have been confirmed since then, all in women. Three women have died from the rare clots and seven remain hospitalized, four of whom are in the intensive care unit.

The European Union resumed its rollout on Tuesday after Johnson & Johnson added a warning label to the shots. The F.D.A. on Friday released updated fact sheets that accompany the agency’s emergency use authorization, which officials said would reach physicians and the public by the time they get the shot.

In a warning to recipients of the vaccine, the F.D.A. noted that most of those who developed the rare clots were women between the ages of 18 and 49, and that the “chance of having this occur is remote.”

At the meeting, Dr. Tom Shimabukuro, the deputy director of the C.D.C.’s immunization safety office, presented the nine new confirmed cases, which brings the total to 15. All the cases have been in women, and 13 have been in women between 18 and 49 years old. The disorder combines blood clots, often in the brain, and a low level of platelets, blood cells that typically promote clotting.

The clotting disorder is “rare but clinically serious,” Dr. Shimabukuro said at the meeting.

The overall risk of developing the clotting disorder is extremely low. Women between 30 and 39 appear to be at greatest risk, with 11.8 cases per million doses given. There have been 7 cases per million doses among women between 18 and 49.

Dr. Rochelle P. Walensky, the C.D.C. director, said the government planned to emphasize the safety and effectiveness of the vaccine to doctors and Americans who might be hesitant to take it after the pause.

She said the C.D.C. had talked to health providers for young women, including the American College of Obstetricians and Gynecologists. The pause and investigation into the rare disorder, she added, should give the public confidence in the system used to monitor vaccine safety.

Nearly 8 million doses of the Johnson & Johnson vaccine have now been administered. Among men and women who are 50 or over, there has been less than one case per million doses.

Roughly 10 million doses or more of the Johnson & Johnson vaccine, produced at the company’s factory in the Netherlands, are sitting on shelves across the United States and could be deployed immediately. Several states, including Texas, Alabama, Utah and Wisconsin, said they expected to follow the recommendations of the C.D.C. and F.D.A. once the decision was made.

Dr. Walensky said that she heard intense interest from governors about resuming use of the shot.

“They wondered why we had paused and they were anxious to have this back, have an opportunity for a single-dose vaccine, for a one-and-done possibility,” she said.

The vaccine has immense potential benefits. If vaccinations resume for all adults, 26 to 45 cases of the clotting disorder would be expected over the next six months, according to a model that Dr. Sara Oliver, a C.D.C. scientist, presented at Friday’s meeting. However, 600 to 1,400 fewer Covid-19 related deaths would be expected over the same time period.

The vaccine, which is easy to store and requires just one shot, is also especially well-suited for use in hard-to-reach populations, including people who are homebound, homeless, or incarcerated.

Additional potential cases of the clotting disorder, including some in men, are currently being reviewed. Dr. Shimabukuro also mentioned one case that developed in a 25-year-old man who participated in a clinical trial of the vaccine.

Twelve of the 15 women in the confirmed cases developed blood clots in the brain. Many also had clots elsewhere. Initial symptoms, which include headaches, typically begin six or more days after vaccination, Dr. Shimabukuro said. As the disorder develops, it can cause more severe headaches, nausea and vomiting, abdominal pain, weakness on one side of the body, speech difficulties, loss of consciousness and seizures.

Dr. Shimabukuro noted that seven of the women were obese, two had hypothyroidism, two had high blood pressure, and two were using oral contraceptives. It is not yet clear whether any of these factors might increase the risk of developing the clotting disorder after vaccination.

The patients’ symptoms closely resemble a rare syndrome that can be caused by heparin, a widely used blood thinner, Dr. Michael Streiff, a hematologist at Johns Hopkins University, told the panel. Heparin, which might typically be used to treat blood clots, should not be used to treat these patients, he said.

Doctors should consider the rare clotting disorder if patients develop blood clots and low levels of platelets within three weeks of receiving the Johnson & Johnson vaccine, Dr. Streiff said.

“Recognition that this syndrome exists is helping to improve outcomes,” he said.

The F.D.A.’s decision comes as the federal government is also investigating problems at a Baltimore factory that was slated to help satisfy the country’s vaccine demand. Emergent BioSolutions, the plant’s operator, has produced tens of millions of doses of Johnson & Johnson’s vaccine, but they cannot be distributed until regulators certify the plant.

After Emergent had to discard up to 15 million possibly contaminated doses of the vaccine last month, federal regulators conducted an inspection that found a series of problems, including the risk that other batches could have been contaminated.

The Emergent BioSolutions plant in Baltimore.
Credit…Jim Lo Scalzo/EPA, via Shutterstock

AstraZeneca, which shipped millions of doses of its coronavirus vaccine to Mexico and Canada last month at the direction of the Biden administration, said on Thursday that the doses had been made at a Baltimore plant where production was halted because of serious manufacturing flaws.

AstraZeneca’s vaccine, made until recently by Emergent BioSolutions in Baltimore, is not authorized for use in the United States, and tens of millions of doses have been sitting idly at manufacturing plants. But the White House said last month that the federal government, which committed last year to buying 300 million doses from the company, intended to “loan” 2.5 million doses to Mexico and 1.5 million doses to Canada.

Whether regulators from those countries inspected the Emergent plant before accepting the AstraZeneca doses, and whether American officials warned them of the ongoing issues at the site, is unclear.

The New York Times reported this month that from early October to January, Emergent discarded five lots of the AstraZeneca vaccine — each the equivalent of two million to three million doses — because of contamination or suspected contamination, according to internal logs, a government official and a former company supervisor.