Member States of the World Health Organization (WHO) have agreed to develop the first draft of a legally binding agreement designed to protect the world from future pandemics. This “zero draft” of the pandemic accord, rooted in the WHO Constitution, will be discussed by Member States in February 2023. Agreement by the Intergovernmental Negotiating Body (INB), comprised of WHO’s 194 Member States, was a milestone in the global process to learn from the COVID-19 pandemic and prevent a repeat of the devastating impacts it has had on individuals and communities worldwide. The INB gathered at WHO headquarters in Geneva from 5-7 December for its third meeting since its establishment in December 2021, following a special session of the World Health Assembly. The Body today agreed that the INB’s Bureau will develop the zero draft of the pandemic accord in order to start negotiations at the fourth INB meeting, scheduled to start on 27 February 2023. This draft will be based on the conceptual zero draft and the discussions during this week’s INB meeting. The INB Bureau is comprised of six delegates, one from each of the six WHO regions, including the Co-Chairs Mr Roland Driece of the Netherlands and Ms Precious Matsoso of South Africa. Read more: Declare COVID-19 vaccines a global common good: Global leaders “Countries have delivered a clear message that the world must be better prepared, coordinated and supported to protect all people, everywhere, from a repeat of COVID-19,” said Driece, Co-Chair of the INB Bureau. “The decision to task us with the duty to develop a zero draft of a pandemic accord represents a major milestone in the path towards making the world safer.” Fellow INB Bureau Co-Chair, Matsoso, said government representatives stressed that any future pandemic accord would need to take into account equity, strengthen preparedness, ensure solidarity, promote a whole-of-society and whole- of-government approach, and respect the sovereignty of countries. “The impact of the COVID-19 pandemic on human lives, economies and societies at large must never be forgotten,” said Matsoso. “The best chance we have, today, as a global community, to prevent a repeat of the past is to come together, in the spirit of solidarity, in a commitment to equity, and in the pursuit of health for all, and develop a global accord that safeguards societies from future pandemic threats.” Read more: WHO DG announces Global Health Leaders Awards The WHO pandemic accord is being considered with a view to its adoption under Article 19 of the WHO Constitution, without prejudice to also considering, as work progresses, the suitability of Article 21.

Japan fully came out of a coronavirus state of emergency for the first time in more than six months as the country starts to gradually ease virus measures to help rejuvenate the pandemic-hit economy as the infections slowed. At Tokyo’s busy Shinagawa train station, a sea of mask-wearing commuters rushed to their work despite an approaching typhoon, with some returning to their offices after months of remote work. The emergency measures, in place for more than half of the country including Tokyo, ended Thursday following a steady fall in new caseloads over the past few weeks, helping to ease pressure on Japanese health care systems. Read:Japan's next leader: Higher wages cure for pandemic doldrums Outgoing Prime Minister Yoshihide Suga thanked the people for their patience and cooperation, and asked them to stick to their basic anti-virus measures. “Once again, I seek your cooperation so that we can return to our daily lives feeling safe,” he said. The lifting of the emergency marked a fresh start for some people. Office worker Akifumi Sugihara, 46, said he is back to the train station for the first time in about a year. “I had been working from home for more than a year, and I came to the office in Tokyo as (the emergency) was lifted today,” he said. “It’s really been a while. I feel it’s a new start.” Another office worker, Kaori Hayashi, 37, said it was an ordinary Friday. “In my mind nothing really has changed,” she said. “We still need to be careful. I will stay vigilant and carry on my life as usual.” Japan is eager to expand social and economic activities while balancing the need to prevent another wave of infections as the weather turns cooler. Officials say the government still needs time to create more temporary COVID-19 treatment facilities and continue vaccinations to prepare for any future resurgence. Read:Japan ex-diplomat Kishida wins party vote, to become new PM The emergency measures have mainly involved requests for eateries to curb alcohol and hours. They can now serve alcohol and operate an hour longer but still have to close at 9 p.m. Daily reported cases have fallen to below 1,600 as of Wednesday nationwide — less than one-tenth of the mid-August peak of around 25,000. Experts attributed the declining numbers to the progress of vaccinations and to people increased their social distancing efforts after being alarmed by the collapse of medical systems during the summer. Nearly more than 59% of Japanese people have been fully vaccinated. Japan has had about 1.69 million cases and 17,641 deaths from COVID-19.

In a major easing of pandemic travel restrictions, the U.S. said Monday it will allow foreigners to fly into the country this fall if they have vaccination proof and a negative COVID-19 test — changes replacing a hodgepodge of rules that had kept out many non-citizens and irritated allies in Europe and beyond where virus cases are lower. The changes, to take effect in November, will allow families and others who have been separated by the travel restrictions for 18 months to plan for long-awaited reunifications and allow foreigners with work permits to get back to their jobs in the U.S. Airlines, business groups and travelers cheered — though they also called the step long overdue. “It’s a happy day. Big Apple, here I come!” said French entrepreneur Stephane Le Breton, 45, finally able to book a trip to New York City that had been put on hold over the virus restrictions. The new policy will replace a patchwork of travel bans first instituted by President Donald Trump last year and tightened by President Joe Biden that restrict travel by non-citizens who have in the prior 14 days been in the United Kingdom, European Union, China, India, Iran, Republic of Ireland, Brazil or South Africa. Read:COVID has killed about as many Americans as the 1918-19 flu White House COVID-19 coordinator Jeff Zients announced the new policies, which still will require all foreign travelers flying to the U.S. to demonstrate proof of vaccination before boarding, as well as proof of a negative COVID-19 test taken within three days of flight. Biden will also tighten testing rules for unvaccinated American citizens, who will need to be tested within a day before returning to the U.S., as well as after they arrive home. The tougher rules for unvaccinated Americans come as the White House has moved to impose sweeping vaccination-or-testing requirements affecting as many as 100 million people in an effort to encourage holdouts to get shots. Fully vaccinated passengers will not be required to quarantine, Zients said. There will be no immediate change to U.S. land border policies, which restrict much cross-border travel with Mexico and Canada. The travel bans had become the source of growing geopolitical frustration, particularly among allies in the UK and EU. The easing comes ahead of Biden meeting with some European leaders on the margins of the United Nations General Assembly this week. “This is based on individuals rather than a country-based approach, so it’s a stronger system,” Zients said. The EU and UK had previously moved to allow vaccinated U.S. travelers in without quarantines, in an effort to boost business and tourism. But the EU recommended last month that some travel restrictions be reimposed on U.S. travelers to the bloc because of the rampant spread of the delta variant of the coronavirus in America. Read:Top doctors say not so fast to Biden’s boosters-for-all plan The Centers for Disease Control and Prevention will require airlines to collect contact information from international travelers to facilitate tracing, Zients said. The U.S. will accept full vaccination of travelers with any of the vaccines approved for emergency use by the World Health Organization, the CDC said. The WHO is reviewing Russia’s Sputnik V vaccine but hasn’t yet approved it. Monday’s announcement was met with applause by the air travel industry, which has lost significant revenue from declines in international travel. Delta Air Lines spokesman Morgan Durrant said, “Science tells us that vaccinations coupled with testing is the safest way to re-open travel, and we are optimistic this important decision will allow for the continued economic recovery both in the U.S. and abroad and the reunification of families who have been separated for more than 18 months.” Worldwide, air travel is still down more than half from pre-pandemic levels, and the decline is much sharper for cross-border flying. By July, domestic travel had recovered to 84% of 2019 numbers, but international travel was just 26% of the same month two years ago, according to figures this month from the airline industry’s main global trade group, the International Air Transport Association. The numbers are similar but not quite as stark for the U.S., where international travel in August was 46% of that in August 2019, according to Airlines for America. Arrivals by non-U.S. citizens were only 36% of the 2019 level. British Prime Minister Boris Johnson tweeted that he was “delighted” by the news. He said: “It’s a fantastic boost for business and trade, and great that family and friends on both sides of the pond can be reunited once again.” Read:Washington Post editorial on COVID-19 origins distorts facts: Chinese embassy Airlines hailed the U.S. decision as a lifeline for the struggling industry. Tim Alderslade, chief executive of industry body Airlines U.K. said it was “a major breakthrough.” Shai Weiss, chief executive of Virgin Atlantic, said it was “a major milestone. ... The U.K. will now be able to strengthen ties with our most important economic partner, the U.S., boosting trade and tourism as well as reuniting friends, families and business colleagues.” “The travel bans were really behind the times,” said Maka Hutson, counsel specializing in immigration issues at the law firm Akin Gump. She said they were very frustrating to European executives who’d been vaccinated but still couldn’t fly to the United States to conduct business. The changes also drew praise from business groups, who have been contending with labor shortages as the economy bounces back with unexpected strength from last year’s coronavirus recession. U.S. employers have been posting job openings — a record 10.9 million in July — faster than applicants can fill them. Myron Brilliant, head of international affairs for the U..S. Chamber of Commerce, said in a statement, “Allowing vaccinated foreign nationals to travel freely to the United States will help foster a robust and durable recovery for the American economy.”

COVID-19 has now killed about as many Americans as the 1918-19 Spanish flu pandemic did — approximately 675,000. The U.S. population a century ago was just one-third of what it is today, meaning the flu cut a much bigger, more lethal swath through the country. But the COVID-19 crisis is by any measure a colossal tragedy in its own right, especially given the incredible advances in scientific knowledge since then and the failure to take maximum advantage of the vaccines available this time. “Big pockets of American society — and, worse, their leaders — have thrown this away,” medical historian Dr. Howard Markel of the University of Michigan said of the opportunity to vaccinate everyone eligible by now. Like the Spanish flu, the coronavirus may never entirely disappear from our midst. Instead, scientists hope it becomes a mild seasonal bug as human immunity strengthens through vaccination and repeated infection. That could take time. “We hope it will be like getting a cold, but there’s no guarantee,” said Emory University biologist Rustom Antia, who suggests an optimistic scenario in which this could happen over a few years. For now, the pandemic still has the United States and other parts of the world firmly in its jaws. Read: Global Covid update: Vaccines put the brakes on pandemic's advance While the delta-fueled surge in infections may have peaked, U.S. deaths are running at over 1,900 a day on average, the highest level since early March, and the country’s overall toll topped 675,000 Monday, according to the count kept by Johns Hopkins University, though the real number is believed to be higher. Winter may bring a new surge, with the University of Washington’s influential model projecting an additional 100,000 or so Americans will die of COVID-19 by Jan. 1, which would bring the overall U.S. toll to 776,000. The 1918-19 influenza pandemic killed 50 million victims globally at a time when the world had one-quarter the population it does now. Global deaths from COVID-19 now stand at more than 4.6 million. The Spanish flu’s U.S. death toll is a rough guess, given the incomplete records of the era and the poor scientific understanding of what caused the illness. The 675,000 figure comes from the U.S. Centers for Disease Control and Prevention. The ebbing of COVID-19 could happen if the virus progressively weakens as it mutates and more and more humans’ immune systems learn to attack it. Vaccination and surviving infection are the main ways the immune system improves. Breast-fed infants also gain some immunity from their mothers. Under that optimistic scenario, schoolchildren would get mild illness that trains their immune systems. As they grow up, the children would carry the immune response memory, so that when they are old and vulnerable, the coronavirus would be no more dangerous than cold viruses. The same goes for today’s vaccinated teens: Their immune systems would get stronger through the shots and mild infections. “We will all get infected,” Antia predicted. “What’s important is whether the infections are severe.” Something similar happened with the H1N1 flu virus, the culprit in the 1918-19 pandemic. It encountered too many people who were immune, and it also eventually weakened through mutation. H1N1 still circulates today, but immunity acquired through infection and vaccination has triumphed. Read: US panel backs COVID-19 boosters only for seniors, high-risk Getting an annual flu shot now protects against H1N1 and several other strains of flu. To be sure, flu kills between 12,000 and 61,000 Americans each year, but on average, it is a seasonal problem and a manageable one. Before COVID-19, the 1918-19 flu was universally considered the worst pandemic disease in human history. Whether the current scourge ultimately proves deadlier is unclear. In many ways, the 1918-19 flu — which was wrongly named Spanish flu because it first received widespread news coverage in Spain — was worse. Spread by the mobility of World War I, it killed young, healthy adults in vast numbers. No vaccine existed to slow it, and there were no antibiotics to treat secondary bacterial infections. And, of course, the world was much smaller. Yet jet travel and mass migrations threaten to increase the toll of the current pandemic. Much of the world is unvaccinated. And the coronavirus has been full of surprises. Markel said he is continually astounded by the magnitude of the disruption the pandemic has brought to the planet. “I was gobsmacked by the size of the quarantines” the Chinese government undertook initially, Markel said, “and I’ve since been gob-gob-gob-smacked to the nth degree.” The lagging pace of U.S. vaccinations is the latest source of his astonishment. Just under 64% of the U.S. population has received as least one dose of the vaccine, with state rates ranging from a high of approximately 77% in Vermont and Massachusetts to lows around 46% to 49% in Idaho, Wyoming, West Virginia and Mississippi. Globally, about 43% of the population has received at least one dose, according to Our World in Data, with some African countries just beginning to give their first shots. “We know that all pandemics come to an end,” said Dr. Jeremy Brown, director of emergency care research at the National Institutes of Health, who wrote a book on influenza. “They can do terrible things while they’re raging.” COVID-19 could have been far less lethal in the U.S. if more people had gotten vaccinated faster, “and we still have an opportunity to turn it around,” Brown said. “We often lose sight of how lucky we are to take these things for granted.” The current vaccines work extremely well in preventing severe disease and death from the variants of the virus that have emerged so far. Read: Washington Post editorial on COVID-19 origins distorts facts: Chinese embassy It will be crucial for scientists to make sure the ever-mutating virus hasn’t changed enough to evade vaccines or to cause severe illness in unvaccinated children, Antia said. If the virus changes significantly, a new vaccine using the technology behind the Pfizer and Moderna shots could be produced in 110 days, a Pfizer executive said Wednesday. The company is studying whether annual shots with the current vaccine will be required to keep immunity high. One plus: The coronavirus mutates at a slower pace than flu viruses, making it a more stable target for vaccination, said Ann Marie Kimball, a retired University of Washington professor of epidemiology. So, will the current pandemic unseat the 1918-19 flu pandemic as the worst in human history? “You’d like to say no. We have a lot more infection control, a lot more ability to support people who are sick. We have modern medicine,” Kimball said. “But we have a lot more people and a lot more mobility. ... The fear is eventually a new strain gets around a particular vaccine target.” To those unvaccinated individuals who are counting on infection rather than vaccination for immune protection, Kimball said, “The trouble is, you have to survive infection to acquire the immunity.” It’s easier, she said, to go to the drugstore and get a shot.

Drenched in sweat, doctors check patients lying on stretchers in the reception area of Lebanon’s largest public hospital. Air conditioners are turned off, except in operating rooms and storage units, to save on fuel. Medics scramble to find alternatives to saline solutions after the hospital ran out. The shortages are overwhelming, the medical staff exhausted. And with a new surge in coronavirus cases, Lebanon’s hospitals are at a breaking point. The country’s health sector is a casualty of the multiple crises that have plunged Lebanon into a downward spiral — a financial and economic meltdown, compounded by a complete failure of the government, runaway corruption and a pandemic that isn’t going away. Read: Fuel tanker explodes in Lebanon, killing 20, wounding dozens The collapse is all the more dramatic since only a few years ago, Lebanon was a leader in medical care in the Arab world. The region’s rich and famous came to this small Mideast nation of 6 million for everything, from major hospital procedures to plastic surgeries. THE NEW NORMAL Ghaidaa al-Saddik, a second-year resident, had just returned from a week off after an exhausting year. Back on duty for a week, she has already intubated two critical patients in the emergency room, both in their 30s. She struggles to admit new patients, knowing how short on supplies the hospital is, scared to be blamed for mistakes and questioning if she is doing her best. Many patients are asked to bring their own medicines, such as steroids. Others are discharged too soon — often to homes where power outages last for days. “You feel like you are trapped,” said al-Saddik. The 28-year-old spends more nights in the staff dorms studying because at home, she has no electricity. She moved to an apartment closer to the hospital that she shares with two other people to save on rent and transportation. With the collapse of Lebanon’s currency amid the crisis, her salary has lost nearly 90% of its value. With fewer and fewer residents, she must now do the rounds for about 30 patients, instead of 10. Her mentor, a senior virologist, has left Lebanon — one of many in a brain drain of medical professionals. “I want to help my people,” she said. “But at the same time, what about me being a better doctor?” RUNNING ON EMPTY The Rafik Hariri University Hospital is Lebanon’s largest public hospital and the country’s No. 1 for the treatment of coronavirus patients. Lebanon has so far registered nearly 590,000 infections and over 8,000 deaths. The hospital, which depended on the state power company, had to start relying on generators for at least 12 hours a day. Since last Monday, the generators have been the only source of power, running non-stop. Most of the hospital’s diesel, sold at the black market at five times the official price, is either donated by political parties or international aid groups. To save on fuel, some rooms run only electrical fans in the sweltering summer heat. Not all hospital elevators are working. Bed capacity has been downsized by about 15% and the ER admits only life-threatening cases. Read: Mired in crises, Lebanon hopes summer arrivals bring relief It is a perpetual crisis that has left the hospital always on the brink, says its director, Firas Abiad. There are “shortages of almost everything.”

The rapidly escalating surge in COVID-19 infections across the U.S. has caused a shortage of nurses and other front-line staff in virus hot spots that can no longer keep up with the flood of unvaccinated patients and are losing workers to burnout and lucrative out-of-state temporary gigs. Florida, Arkansas, Louisiana and Oregon all have more people hospitalized with COVID-19 than at any other point in the pandemic, and nursing staffs are badly strained. In Florida, virus cases have filled so many hospital beds that ambulance services and fire departments are straining to respond to emergencies. Some patients wait inside ambulances for up to an hour before hospitals in St. Petersburg, Florida, can admit them — a process that usually takes about 15 minutes, Pinellas County Administrator Barry Burton said. One person who suffered a heart attack was bounced from six hospitals before finding an emergency room in New Orleans that could take him in, said Joe Kanter, Louisiana’s chief public health officer. Read:COVID vaccines to be required for military under new US plan “It’s a real dire situation,” Kanter said. “There’s just not enough qualified staff in the state right now to care for all these patients.” Michelle Thomas, a registered nurse and a manager of the emergency department at a Tucson, Arizona, hospital, resigned three weeks ago after hitting a wall. “There was never a time that we could just kind of take a breath,” Thomas said Tuesday. “I hit that point … I can’t do this anymore. I’m so just tapped out.” She helped other nurses cope with being alone in rooms with dying patients and holding mobile phones so family members could say their final goodbyes. “It’s like incredibly taxing and traumatizing,” said Thomas, who is unsure if she will ever return to nursing. Miami’s Jackson Memorial Health System, Florida’s largest medical provider, has been losing nurses to staffing agencies, other hospitals and pandemic burnout, Executive Vice President Julie Staub said. The hospital’s CEO says nurses are being lured away to jobs in other states at double and triple the salary. Staub said system hospitals have started paying retention bonuses to nurses who agree to stay for a set period. To cover shortages, nurses who agree to work extra are getting the typical time-and-a-half for overtime plus $500 per additional 12-hour shift. Even with that, the hospital sometimes still has to turn to agencies to fill openings. “You are seeing folks chase the dollars,” Staub said. “If they have the flexibility to pick up and go somewhere else and live for a week, months, whatever and make more money, it is a very enticing thing to do. I think every health care system is facing that.” Nearly 70% of Florida hospitals are expecting critical staffing shortages in the next week, according to the Florida Hospital Association. In Oregon, Gov. Kate Brown announced Tuesday that state employees must be fully vaccinated by Oct. 18 or six weeks after a COVID-19 vaccine receives full federal approval, whichever is later. Her office planned to announce a statewide indoor mask requirement on Wednesday. “Oregon is facing a spike in COVID-19 hospitalizations — consisting overwhelmingly of unvaccinated individuals — that is quickly exceeding the darkest days of our winter surge,” Brown said. “When our hospitals are full, there will be no room for additional patients needing care.” Read:US now averaging 100,000 new COVID-19 infections a day Texas Gov. Greg Abbott on Monday directed state officials to use staffing agencies to find additional medical staff from beyond the state’s borders as the delta variant overwhelms its present staffing resources. He also has sent a letter to the Texas Hospital Association to request that hospitals postpone all elective medical procedures voluntarily. Parts of Europe have so far avoided a similar hospital crisis, despite wide circulation of the delta variant, with help from vaccines. The United Kingdom on Monday had more than 5,900 COVID-19 patients in hospitals, but the latest surge has not overwhelmed medical centers. As of Tuesday, the government said 75 percent of adults have been fully vaccinated. The same was true in Italy, where the summer infections have not resulted in any spike in hospital admissions, intensive care admissions or deaths. About 3,200 people in the nation of 60 million were hospitalized Tuesday in regular wards or ICUs, according to Health Ministry figures. Italian health authorities advising the government on the pandemic attribute the relatively contained hospital numbers to the nation’s inoculation campaign, which has fully vaccinated 64.5% of Italians 12 years of age or older. The U.S. is averaging more than 116,000 new coronavirus infections a day along with about 50,000 hospitalizations, levels not experienced since the winter surge. Unlike other points in the pandemic, hospitals now have more non-COVID patients for everything from car accidents to surgeries that were postponed during the outbreak. That has put even more burden on nurses who were already fatigued after dealing with constant death among patients and illnesses in their ranks. “Anecdotally, I’m seeing more and more nurses say, ‘I’m leaving, I’ve had enough,’” said Gerard Brogan, director of nursing practice with National Nurses United, an umbrella organization of nurses unions across the U.S. “’The risk to me and my family is just too much.’” Hawaii is seeing more new daily virus cases than ever. In a Honolulu hospital’s emergency department, patients have had to wait for beds for more than 24 hours on gurneys in a curtained-off section because there’s not enough staff to open more beds, nurse Patrick Switzer said. “Somebody who’s been sitting in the emergency room for 30 hours is miserable,” he said. He described being “in this constant state of anxiety, knowing that you don’t have the tools that you need to take care of your patients because we’re stretched so thin.” Read:Shots give COVID-19 survivors big immune boost, studies show COVID-19 hospitalizations have now surpassed the pandemic’s worst previous surge in Florida, with no signs of letting up, setting a record of 13,600 on Monday, according to the Department of Health and Human Services. More than 2,800 required intensive care. At the height of last year’s summer surge, there were more than 10,170 COVID-19 hospitalizations. At Westside Regional Medical Center in Plantation, Florida, the number of COVID-19 patients has doubled each week for the past month, wearing down the already short staff, said Penny Ceasar, who handles admissions there. The hospital has converted overflow areas to accommodate the rise in admissions. Some staffers have fallen ill with COVID-19. “It’s just hard. We’re just tired. I just want this thing over,” Ceasar said.

President Joe Biden’s administration drew up a strategy to contain one coronavirus strain, then another showed up that’s much more contagious. This week — a month late — Biden met his goal of 70% of U.S. adults having received at least one COVID-19 shot. Originally conceived as an affirmation of American resiliency to coincide with Independence Day, the belated milestone offered little to celebrate. Driven by the delta variant, new cases are averaging more than 70,000 a day, above the peak last summer when no vaccines were available. And the Centers for Disease Control and Prevention is drawing criticism from experts in the medical and scientific community for its off-and-on masking recommendations. But the delta variant makes no distinctions when it comes to politics. If Biden’s pandemic response is found wanting, Republican governors opposed to pandemic mandates also face an accounting. They, too, were counting on a backdrop of declining cases. Instead unvaccinated patients are crowding their hospitals. The Biden administration’s process-driven approach succeeded in delivering more than enough vaccine to protect the country, sufficient to ship 110 million doses overseas. When the president first set his 70% vaccination target on May 4, the U.S. was dispensing around 965,000 first doses per day, a rate more than twice as fast as needed to reach the July 4 goal. Read: Biden to launch vaccine push for millions of federal workers Then things started to happen. While the White House was aware of public surveys showing swaths of the population unwilling or unmotivated to get a shot, officials didn’t anticipate that nearly 90 million Americans would continue to spurn lifesaving vaccines that offer a pathway back to normalcy. The spread of misinformation about the vaccines enabled a festering fog of doubt that has clung close to the ground in many communities, particularly in Republican-led states. Yet on May 13, when the CDC largely lifted its mask-wearing guidance for fully vaccinated adults indoors, topline indicators were still flashing green. The agency said unvaccinated people should keep wearing masks — and get their shots soon. Biden and Vice President Kamala Harris celebrated by doffing their masks and strolling in the Rose Garden of the White House. Around the country, an everyday celebration spread to coffee shops, supermarkets, beer gardens and restaurants. People planned weddings and music festivals. Drowned out in the applause were expert warnings that there was no way to tell who was and who wasn’t vaccinated, and a country restless for an end to the pandemic was essentially being placed on the honor system. “The single biggest mistake of the Biden presidency when it comes to COVID 19 was the CDC’s precipitous and chaotic change in masking guidance back in May,” said Dr. Leana Wen, a former Baltimore health commissioner and commentator. “It had the direct result of giving people the impression the pandemic was over. It allowed unvaccinated people to have free rein and behave as if they were vaccinated, and therefore we have the surge of the delta variant.” “I think they were naive,” Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said of the CDC. “They saw it as a carrot, as a gift.” Meanwhile, the delta variant had arrived, and in a matter of weeks would become the dominant strain in circulation. Read: Biden woos working class with new ‘buy American’ efforts CDC Director Dr. Rochelle Walensky recently confirmed just how much more contagious delta is. “If you get sick with the alpha variant, you could infect about two other unvaccinated people,” she said. “If you get sick with the delta variant, we estimate that you could infect about five other unvaccinated people — more than twice as many as the original strain.” Last week, the CDC reversed course on masks, recommending that even vaccinated people again mask up indoors in areas where the virus is on the march, now most of the country. The immediate reason was a report by disease detectives of a recent outbreak in Provincetown, Massachusetts. The delta variant was to blame and a majority of those infected had been vaccinated. Although very few vaccinated people got sick enough to be hospitalized, the initial findings showed vaccinated people with breakthrough infections were carrying about as much virus as unvaccinated people. The report fed vaccine doubts in some quarters. Wen, the former health commissioner, said the CDC should have put the Provincetown report in a fuller context that showed vaccines do keep protecting. CDC did not immediately respond to requests for comment. Back on July 4 Biden proclaimed that the nation was declaring its independence from the virus. In recent weeks, he seemed to have moved on from the pandemic. The president was focused on securing a bipartisan deal on infrastructure and on selling the separate Democrats-only legislation to carry out his ambitious domestic agenda. The number of White House COVID-19 briefings dwindled. “We celebrated prematurely,” said Ali Mokdad, an infectious disease expert with the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Biden’s 70% goal was a solid step, said Mokdad, but about half the population is not yet fully vaccinated. Read: Biden says getting vaccinated ‘gigantically important’ Now vaccinations are again edging upward, but the data don’t show a dramatic increase. Meanwhile, Florida Gov. Ron DeSantis and Texas Gov. Greg Abbott, Republicans dismissive of mask requirements, are staring at surges in their states. Together, Florida and Texas accounted for about one-third of new cases nationally in the past week. DeSantis doubled down on defiance Tuesday, blaming “media hysteria” and people spending more time indoors in the sweltering summer. “Even among a lot of positive tests, you are seeing much less mortality that you did year-over-year,” he said at a Miami-area news conference. “Would I rather have 5,000 cases among 20-year-olds or 500 cases among seniors? I would rather have the younger.” Offit, the Philadelphia vaccines expert, says “it’s hard to watch” DeSantis say he won’t abide mask mandates. “Why not?” asked Offit. “That is why his state leads the league in cases.”

As coronavirus cases ravaged India this spring, Anil Sharma visited his 24-year-old son Saurav at a private hospital in northwest New Delhi every day for more than two months. In May, as India’s new COVID-19 cases broke global records to reach 400,000 a day, Saurav was put on a ventilator. The sight of the tube running into Saurav’s throat is seared in Sharma’s mind. “I had to stay strong when I was with him, but immediately after, I would break down as soon as I left the room,” he said. Saurav is home now, still weak and recovering. But the family’s joy is tempered by a mountain of debt that piled up while he was sick. Life has been tentatively returning to normal in India as coronavirus cases have fallen. But millions are embroiled in a nightmare of huge piles of medical bills. Most Indians don’t have health insurance and costs for COVID-19 treatment have them drowning in debt. Read: ‘India open to engaging those who recognise the value of diversity’ Sharma exhausted his savings on paying for an ambulance, tests, medicines and an ICU bed. Then he took out bank loans. As the costs mounted, he borrowed from friends and relatives. Then, he turned to strangers, pleading online for help on Ketto, an Indian crowdfunding website. Overall, Sharma says he has paid over $50,000 in medical bills. The crowdfunding provided $28,000, but another $26,000 is borrowed money he needs to repay, a kind of debt he has never faced before. “He was struggling for his life and we were struggling to provide him an opportunity to survive,” he said, his voice thick with emotion. “I was a proud father -- and now I have become a beggar.” The pandemic has devastated India’s economy, bringing financial calamity to millions at the mercy of its chronically underfunded and fragmented healthcare system. Experts say such costs are bound to hinder an economic recovery. “What we have is a patchwork quilt of incomplete public insurance and a poor public health system. The pandemic has shown just how creaky and unsustainable these two things are,” said Vivek Dehejia, an economist who has studied public policy in India. Even before the pandemic, healthcare access in India was a problem. Indians pay about 63% of their medical expenses out-of-pocket. That’s typical of many poor countries with inadequate government services. Data on global personal medical costs from the pandemic are hard to come by, but in India and many other countries treatment for COVID is a huge added burden at a time when hundreds of millions of jobs have vanished. In India, many jobs returned as cities opened up after a severe lockdown in March 2020, but economists worry about the loss of some 12 million salaried positions. Sharma’s job as a marketing professional was one of them. When he asked his son’s friends to set up the campaign on Ketto to raise funds, Sharma hadn’t seen a paycheck in 18 months. Between April and June this year, 40% of the 4,500 COVID-19 campaigns on the site were for hospitalization costs, the company said. The pandemic has driven 32 million Indians out of the middle class, defined as those earning $10 to $20 a day, according to a Pew Research Center study published in March. It estimated the crisis has increased the number of India’s poor -- those with incomes of $2 or less a day -- by 75 million. “If you’re looking at what pushes people into debt or poverty, the top two sources often are out-of-pocket health expenditure and catastrophic costs of treatment,” said K Srinath Reddy, president of the Public Health Foundation of India. Read:Floods & landslides in India kill over 100 In the northeastern city of Imphal, 2,400 kilometers (1,490 miles) away, Diana Khumanthem lost both her mother and sister to the virus in May. Treatment costs wiped out the family’s savings, and when the private hospital where her sister died wouldn’t release her body for last rites until a bill of about $5,000 was paid, she pawned the family’s gold jewelry to moneylenders. When that wasn’t enough, asked her friends, relatives and her sister’s colleagues for help. She still owes some $1,000. A health insurance scheme launched by Prime Minister Narendra Modi in 2018 was intended to cover around 500 million of India’s 1.3 billion people and was a major step toward easing medical costs. But it doesn’t cover the primary care and outpatient costs that comprise most out-of-pocket expenses. So it hasn’t “effectively improved access to care and financial risk protection,” said a working paper by researchers at Duke University. The program also has been hobbled by disparities in how various states implemented it, said Shawin Vitsupakorn, one of the paper’s authors. Another paper, by the Duke Global Health Institute and the Public Health Foundation of India, found costs of ICU hospitalization for COVID-19 are equivalent to nearly 16 months of work for a typical Indian day laborer or seven to 10 months for salaried or self-employed workers. Meager funding of healthcare, at just 1.6% of India’s GDP, is less, proportionately, than what Laos or Ethiopia spends. At the outbreak’s peak in May, hospitals everywhere were overrun, but public facilities lacked the resources to handle the floods of patients coming in. “The result is a suffering public health system, where the provision of care is often poor, prompting many to flock to private hospitals,” said Dehejia. A public hospital treated Khumanthem’s mother, but her sister Ranjita was admitted to a private one that cost $1,300 per day. Ranjita was the family’s only earner after Khumanthem left her nursing job last year to return home during the first wave of the virus. She’s now hunting for work while looking after her father and her sister’s 3-year-old son. At her home in Imphal, Khumanthem grieved for her mother by remembering her favorite food — chagem pomba, a type of gruel made with vegetables, rice and soybeans. Every few minutes, she looked toward the front gate. Read: India's deaths during pandemic 10X official toll “This is usually the time Ranjita would return home from work,” she said. “I still keep thinking she could walk through the gate any moment now.” Back in New Delhi, Sharma sighed in relief as an ambulance brought his son home from the hospital last week. Saurav needs physiotherapy to build up his weakened muscles, a daily nurse and a long list of medications. It may be weeks before he will be able to stand on his own, and months before the ambitious lawyer who graduated among the top of his class will be able to go to court again. The costs will continue. “Our first priority was to save him,” Sharma said. “Now we will need to figure out the rest.”

China cannot accept the World Health Organization’s plan for the second phase of a study into the origins of COVID-19, a senior Chinese health official said Thursday. Zeng Yixin, the vice minister of the National Health Commission, said he was “rather taken aback” that the plan includes further investigation of the theory that the virus might have leaked from a Chinese lab. He dismissed the lab leak idea as a rumor that runs counter to common sense and science. Read:China blasts dam to divert floods that killed at least 25 “It is impossible for us to accept such an origin-tracing plan,” he said at a news conference called to address the COVID-19 origins issue. The search for where the virus came from has become a diplomatic issue that has fueled China’s deteriorating relations with the U.S. and many American allies. The U.S. and others say that China has not been transparent about what happened in the early days of the pandemic. China accuses critics of seeking to blame it for the pandemic and politicizing an issue that should be left to scientists. Tedros Adhanom Ghebreyesus, the director-general of WHO, acknowledged last week that there had been a “premature push” after the first phase of the study to rule out the theory that the virus might have escaped from a Chinese government lab in Wuhan, the city where the disease was first detected in late 2019. Most experts don’t think a lab leak is the likely cause. The question is whether the possibility is so remote that it should be dropped, or whether it merits further study. The first phase was conducted earlier this year by an international team of scientists who came to Wuhan to work with their Chinese counterparts. The team was accused of bowing to demands from the Chinese side after it initially indicated that further study wasn’t necessary. Zeng said the Wuhan lab has no virus that can directly infect humans and noted that the WHO team concluded that a lab leak was highly unlikely. He added that speculation that staff and graduate students at the lab had been infected and might have started the spread of the virus in the city was untrue. Read:China rejects hacking charges, accuses US of cyberspying Yuan Zhiming, the director of the biosafety lab at the Wuhan Institute of Virology, said they had not stored or studied the new coronavirus before the outbreak. “I want to emphasize that .... the Wuhan Institute of Virology has never designed, made or leaked the novel coronavirus,” he said. The WHO team concluded that the virus most likely jumped from animals to humans, probably from bats to an intermediate animal. The experts visited markets in Wuhan that had sold live animals, and recommended further study of the farms that supplied the market. “In the next step, I think animal tracing should still be the priority direction. It is the most valuable field for our efforts,” Liang Wannian, who headed the Chinese side, said at Thursday’s news conference. Tedros said last week that he hoped for better cooperation and access to data from China. “We are asking China to be transparent, open and cooperate, especially on the information, raw data that we asked for in the early days of the pandemic,” he said. His words were echoed at the same virtual news conference by Germany’s health minister, Jens Spahn, who called on China to intensify cooperation in the search for the origin of the virus. Zeng said China has always supported “scientific virus tracing” and wants to see the study extended to other countries and regions. “However, we are opposed to politicizing the tracing work,” he said. Read:It was premature to rule out Covid lab leak: WHO China has frequently sought to deflect accusations that the pandemic originated in Wuhan and was allowed to spread by early bureaucratic missteps and an attempted coverup. Government spokespersons have called for an investigation into whether the virus might have been produced in a U.S. military laboratory, a theory not widely shared in the scientific community. China has largely ended local transmission of COVID through lockdowns and mask-wearing requirements, and has now administered more than 1.4 billion doses of Chinese vaccines. Just 12 new domestically spread cases were reported Thursday and China’s death toll from the virus has remained unchanged for months at 4,636.

President Joe Biden expressed pointed frustration Wednesday over the slowing COVID-19 vaccination rate in the U.S. and pleaded that it’s “gigantically important” for Americans to step up and get inoculated against the virus as it surges once again. Biden, speaking at a televised town hall in Cincinnati, said the public health crisis has turned largely into a plight of the unvaccinated as the spread of the delta variant has led to a surge in infections around the country. “We have a pandemic for those who haven’t gotten the vaccination — it’s that basic, that simple,” he said on the CNN town hall. The president also expressed optimism that children under 12 will be approved for vaccination in the coming months. But he displayed exasperation that so many eligible Americans are still reluctant to get a shot. Read: Biden backs Trump rejection of China’s South China Sea claim “If you’re vaccinated, you’re not going to be hospitalized, you’re not going to be in the IC unit, and you’re not going to die,” Biden said at the forum at Mount St. Joseph University. “So it’s gigantically important that ... we all act like Americans who care about our fellow Americans.” Over 80 minutes, Biden fielded questions on many of the pressing issues of the day, including his infrastructure package, voting rights and the makeup of the congressional commission that will investigate the Jan. 6 insurrection at the Capitol. He also reflected on what it’s like to be president, saying he’s sometimes taken aback by the pomp that comes with the job and the weight of being “the last guy in the room” left to make the call on daunting decisions. Six months into his presidency, taming the coronavirus remains his most pressing problem. U.S. hospitalizations and deaths are nearly all among the unvaccinated. But COVID-19 cases nearly tripled in the U.S. over two weeks amid an onslaught of vaccine misinformation that is straining hospitals, exhausting doctors and pushing clergy into the fray. Across the U.S., the seven-day rolling average for daily new cases rose over the past two weeks to more than 37,000 on Tuesday, up from less than 13,700 on July 6, according to data from Johns Hopkins University. Just 56.2% of Americans have gotten at least one dose of the vaccine, according to the Centers for Disease Control and Prevention. The president noted that the rise has become so concerning that even his critics are pushing back against vaccine disinformation. Biden made an indirect reference to high-profile conservative personalities at Fox News who have “had an altar call” and are now more openly speaking to their skeptical guests about the benefits of getting vaccinated. Sean Hannity recently told viewers, ”I believe in the science of vaccination” and urged them to take the disease seriously. Steve Doocy, who cohosts “Fox & Friends,” this week told viewers the vaccination “will save your life.” Before boarding Air Force One to return to Washington, Biden told reporters he was “glad they had the courage to say what they’ve said.” Asked about rising prices, Biden acknowledged “there will be near-term inflation” as the economy rebounds from the pandemic but said it was “highly unlikely long-term inflation will get out of hand.” Read:Vaccination 'most patriotic thing', COVID not yet finished: Biden Biden, who traveled to Ohio as he’s trying to rev up support for his economic agenda, visited a union training center ahead of the town hall. The trip comes as the fate of his infrastructure proposal remains unclear after Senate Republicans rejected a $1 trillion blueprint i n a key test vote Wednesday. A bipartisan group of 22 senators said in a joint statement after the vote that they were close to coming to terms on a deal and requested a delay until Monday. Biden expressed confidence in the outcome, saying, “It’s a good thing and I think we’re going to get it done.” While lawmakers wrangle over the details of that proposal on Capitol Hill, Biden made the case that his nearly $4 trillion package is needed to rebuild the middle class and sustain the economic growth the country has seen during the first six months of his presidency. The president’s visit took him near the dangerously outdated Brent Spence Bridge — a chokepoint for trucks and emergency vehicles between Ohio and Kentucky that the past two presidents promised without success to replace. Biden made a passing reference to the structure, telling town hall attendees it’s time to “fix that damn bridge of yours.” He delved into the personal when he faced a question about the scourge of drug addiction, noting he’s “so damn proud” of his son Hunter Biden, who has published a memoir about his struggles with substance abuse. The president also noted he feels a bit self-conscious about some of the fringe benefits that come with the office. He elicited laughter when he said he told some of the White House staff not to come in to serve breakfast. The real reason: The president likes to eat breakfast in his robe. Biden defended the filibuster against repeated questions from CNN moderator Don Lemon about why he feels the need to protect what some critics argue is a legislative tactic once used to protect racist policies. He said he’s trying to bring the country together around the need to protect voting rights, and he doesn’t want “the debate to only be about whether or not we have a filibuster.” Biden said if Democrats removed the filibuster “you’re going to throw the entire Congress into chaos and nothing will get done.” Read:Biden: Infrastructure vow was not intended to be veto threat Back in Washington, House Speaker Nancy Pelosi on Wednesday rejected two Republicans selected by House GOP leader Kevin McCarthy to sit on a committee investigating the Jan. 6 Capitol insurrection. McCarthy said the GOP won’t participate in the investigation if Democrats won’t accept the members he appointed. Lemon asked how Biden could have confidence that Republicans and Democrats can get together on anything when they can’t even come to agreement on investigating the most brazen attack on the U.S. Capitol in 200 years. Biden simply replied, “These people,” a nod to forum’s spectators and his faith in Americans writ large. But Biden seemed to also acknowledge the partisan rift in Washington had become maddening. “I don’t care if you think I’m Satan reincarnated,” Biden said. “The fact is you can’t look at that television and say nothing happened on the 6th and listen to people who say this was a peaceful march.”