Covid Updates: Federal Regulators Say Benefits Outweigh Key Risks in Vaccine for 5- to 11-Year-Olds

ImageLydia Melo, 7, getting a shot of the Pfizer-BioNTech coronavirus vaccine during a trial at Duke University in Durham, N.C., in September.Credit…Shawn Rocco/Duke University, via Reuters

WASHINGTON — Federal regulators evaluated for the first time on Friday the safety and efficacy of a coronavirus vaccine for children 5 to 11, saying that the benefits of staving off Covid-19 with the Pfizer-BioNTech vaccine generally outweighed the risks of the most worrisome possible side effects in that age group.

The analysis came on the same day that the Food and Drug Administration posted data from Pfizer showing that the vaccine had a 90.7 percent efficacy rate in preventing symptomatic Covid-19 in a clinical trial of 5- to 11-year-olds.

The findings could add momentum for F.D.A. authorization of the pediatric dose on an emergency basis, perhaps as early as next week, opening up a long-awaited new phase of the nation’s vaccination campaign. The agency’s independent vaccine expert committee is set to vote Tuesday on whether to recommend authorization.

In a briefing document posted on the F.D.A. website, the agency said it had balanced the dangers of hospitalization, death or other serious consequences from Covid-19 against the risk of side effects. That included myocarditis, a rare condition involving inflammation of the heart muscle that has been linked to the Pfizer-BioNTech and Moderna vaccines, especially among young men.

“The overall analysis predicted that the numbers of clinically significant Covid-19-related outcomes prevented would clearly outweigh the numbers of vaccine-associated excess myocarditis cases,” regulators wrote.

As is customary, the regulators took no stance on whether the new use of a vaccine should be authorized.

If the F.D.A. rules in favor of authorization and the Centers for Disease Control and Prevention and its own panel of vaccine experts agree, the 28 million children in that age group could become eligible for shots in the first week of November.

“There’s a lot of data to be encouraged by,” said Dr. Kathryn M. Edwards, a professor of pediatrics in the division of infectious diseases at Vanderbilt University School of Medicine. She said the results exceeded the protection offered by the best flu vaccine and could eventually lead to the easing of restrictions intended to prevent elementary school children from contracting the virus.

Gov. Philip D. Murphy of New Jersey, left, touring a coronavirus vaccination site earlier this month in Newark.Credit…Justin Lane/EPA, via Shutterstock

Now that federal regulators have cleared booster shots of all three coronavirus vaccines in use in the United States, state health authorities and pharmacies have begun rolling out plans to get even more shots in arms.

Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, recommended Moderna and Johnson & Johnson boosters on Thursday for tens of millions of Americans, a move that came nearly a month after many Pfizer-BioNTech recipients were cleared for boosters of that company’s vaccine.

The C.D.C. also gave a green light to a “mix-and-match” strategy so people who are eligible for boosters can decide to get a dose of a different type than the one they first received.

And as states, pharmacies and doctors began on Friday trying to get these shots into arms, they faced a variety of complex issues — they will have to help people understand whether they are eligible and answer questions about which booster to get.

According to the C.D.C., certain groups of people who received their second dose of an mRNA vaccine six or more months ago are now eligible for a booster. Those who qualify are people 65 and older, those 18 and older who live in long-term care, and those who have underlying medical conditions or work or live in settings placing them at high risk of infection.

For those who received the single-shot Johnson & Johnson vaccine, anyone 18 and older who was vaccinated two or more months ago is eligible. The Moderna booster, whether people originally got that company’s vaccine or either of the other two, will be a half-dose shot.

Limited evidence strongly suggests that booster doses of one of the two mRNA vaccines — Moderna or Pfizer-BioNTech — more effectively raise antibody levels than a booster dose of the Johnson & Johnson vaccine.

“Now with 10 months of vaccine experience, some may have an express preference for one booster type over another,” Dr. Walensky said on Friday, referring to the mix-and-match option, adding that it was “perfectly fine” for people to choose a booster of the same vaccine that they received initially.

Other challenges medical providers will contend with include reaching marginalized groups, including homeless people and migrant workers, who may have received the Johnson & Johnson vaccine when it was only meant as a single-dose option, and making sure that people receive the correct dose of a Moderna booster.

More than 120 million Americans will become eligible for a booster in the coming months, Jeffrey D. Zients, the White House coronavirus response coordinator, said at a news conference on Friday, adding that boosters were available at more than 80,000 locations across the country, including at least 40,000 local pharmacies. CVS and Walgreens said they expanded their booster offerings on Friday, and were able to provide “mix-and-match” doses.

State health departments generally follow the recommendations of the C.D.C., and many were prepared to begin moving ahead with boosters.

On Friday, Gov. Jared Polis of Colorado got a Moderna booster, after receiving his second Moderna shot six months earlier. Mr. Polis, 46, said he was eligible because his job puts him at high risk of exposure.

“Like most Coloradans and Americans, I am ready to put this pandemic behind us,” Mr. Polis said from behind a medical mask, adding. “I am excited to get this level of protection.”

In Maryland, Gov. Larry Hogan welcomed the C.D.C.’s guidance on Friday, saying in a statement that “Eligible Marylanders may now choose which vaccine they want for a booster, even if it is different from what they received initially.” Officials said that the state had been preparing for the decision for months, with more than 300 sites available since last month, including large and small pharmacies, hospitals, urgent care centers and mobile vaccination operations.

In Vermont, Gov. Phil Scott announced that eligible residents could receive the new boosters beginning on Friday.

In Oregon, the state health department has enrolled hundreds of providers to administer boosters, and will train them on giving different amounts of doses, according to Kristen Dillon, a senior adviser to the state’s Covid response and recovery unit.

Officials in New Jersey said they would open several state mass vaccination sites to handle the expected demand, in addition to offering shots at schools, pharmacies and large county sites.

Coral Murphy Marcos and Giulia Heyward contributed reporting.

A Covid patient in an intensive care unit at Providence Sacred Heart Medical Center in Spokane, Wash., in September.Credit…Grant Hindsley for The New York Times

Scientists from the Centers for Disease Control and Prevention on Friday took aim at the question of whether the Delta variant of the coronavirus causes more severe disease, finding no significant differences in the course of hospitalized patients’ illnesses during the Delta wave compared to earlier in the pandemic.

But larger and more detailed studies from a number of other countries have found that people with Delta infections were considerably more likely to be hospitalized in the first place — a trend that the C.D.C. study was unable to address because of limitations in its data. The C.D.C. study also said that the proportion of older hospitalized patients needing intensive care or dying had shown some signs of increasing during the Delta wave.

Delta’s higher level of infectiousness has made it a far greater challenge than earlier versions of the virus, but the question of whether it also causes more serious disease has loomed as it swept around the world. The Alpha variant, an earlier version first detected in Britain, appeared to be linked to a higher risk of death, though scientists have also tried to understand whether factors besides the variant were playing a role.

Studies in England, Scotland, Canada and Singapore suggested that the Delta variant was associated with more severe illness, a finding that scientists have said raises the risk that outbreaks of the variant in unvaccinated areas may put a bigger burden on health systems. Unlike the C.D.C. study, those studies drew on genomic sequencing, allowing researchers to distinguish infections with the Delta variant and to track patients from before they enter a hospital.

Without access to sequencing data, the C.D.C. researchers could not determine which variants the patients may have been infected with. It also examined patients already admitted to hospitals, making it impossible to determine whether they were at higher risk of needing hospital care in the first place.

The study, released on Friday, examined roughly 7,600 Covid hospitalizations, comparing July and August — when Delta dominated — to earlier months this year, and found no significant change in hospitalized patients’ outcomes.

The study said that the proportion of hospitalized patients aged 50 and older who died or were admitted to intensive care “generally trended upward in the Delta period,” though the differences were not statistically significant and further work was needed. At the hospitals included in the study, roughly 70 percent of Covid patients were unvaccinated.

The researchers said the findings matched those of other C.D.C. studies using similar methods that showed no significant differences in the outcomes of younger people hospitalized before and during the Delta surge.

Outside scientists questioned the reliability of the study.

Dr. David Fisman, an epidemiologist at the University of Toronto, ran a larger study that found that people infected with the Delta variant had roughly twice the risk of hospitalization as people infected with variants that had not been labeled a concern. He said that such analyses needed to control for the range of factors that affect the course of Covid patients’ illnesses, and that the availability of vaccines, testing and treatments had all been changing during the pandemic.

“As this is the U.S. C.D.C., I’m really surprised at the small sample sizes for individuals with more detailed clinical information, as well as the use of such rudimentary statistical methods to deal with these data,” he said.

Dr. Fisman’s study, drawing on 200,000 cases and published this month, also showed significantly increased risks of intensive care admission and death among those infected with the Delta variant, after accounting for their age, sex, vaccination status and other factors.

Roughly 70 percent of people with Delta infections in the study were unvaccinated, and 28 percent were partially vaccinated. Fully vaccinated people are heavily protected from Covid.

Similarly, a study in Scotland from June based on 20,000 Covid cases showed that Delta infections were associated with an 85 percent higher risk of hospitalization, though it allowed for a wide degree of uncertainty about the precise figure.

And data from England, drawn from 43,000 cases and published in August, found that people infected with the Delta variant were just over twice as likely to be hospitalized as people with the Alpha variant, though the researchers in that study, too, were unsure of the precise figure.

Roughly three-quarters of the patients in that study were unvaccinated, and most of the rest were only partially vaccinated.

Unloading vaccines distributed through Covax, the United Nations-backed vaccine program, in Nairobi, Kenya, in August.Credit…Daniel Irungu/EPA, via Shutterstock

As the United States began to offer Covid booster shots to tens of millions of people, representatives of the World Health Organization continued this week to sound the alarm over the disparity in vaccine access globally, with the world’s poorest countries struggling to get even a first dose into their citizens’ arms.

Gordon Brown, the former British prime minister who is now the W.H.O.’s ambassador for global health financing, said on Thursday that there was a shortfall of 500 million doses in the global South, while 240 million doses were lying unused in the West. The number of excess doses is projected to reach 600 million by the end of the year, Mr. Brown added.

Mr. Brown spoke on the same day the Centers for Disease Control and Prevention endorsed booster shots of the Moderna and the Johnson & Johnson Covid-19 vaccines for tens of millions in the United States.

In Africa, meanwhile, only nine countries had met a target of vaccinating 10 percent of their populations against Covid-19 by the end of September, the W.H.O. reported.

“Wealthy countries must let go of reserved doses and cede their place in the queue, allowing Covax and the African Union to buy the vaccines the continent seeks and stands ready to finance,” Dr. Matshidiso Moeti, the W.H.O. regional director for Africa, wrote in a Times guest essay last month, referring to the United Nations-backed program to inoculate the world against the coronavirus.

“Africa and other parts of the world need these vaccines. Now,” she added.

Mr. Brown called for military airlifts to help deliver unused doses to lower-income countries, particularly an estimated 100 million doses that had a use-by date before December and would otherwise end up being destroyed.

“We are talking about waste on a colossal scale if we don’t do something about this,” Mr. Brown said in an interview with BBC Newsnight on Thursday.

He and other health officials argue that low inoculation rates globally could undermine progress against the pandemic by creating room for the virus to mutate and spread.

“You can’t solve this problem without vaccinating the whole of the world, not half of the world,” Mr. Brown said.

The W.H.O. estimates that 11 billion Covid vaccine doses are needed worldwide to turn the tide of the pandemic, but so far production and distribution have been concentrated in Western countries.

Last month Covax slashed its forecast for the number of doses it expected this year, further undercutting a program that has been beleaguered by production problems, export bans and vaccine hoarding by wealthy nations.

According to government figures collated by the University of Oxford’s World in Data project, about 77 percent of shots administered worldwide have been in high- and upper-middle-income countries. Only about 0.5 percent of doses have been administered in low-income countries. Africa is the region with the lowest inoculation rate, with less than 8 percent of the population vaccinated.

The Biden administration has said that it can provide boosters to tens of millions of Americans while also donating vaccines to poorer nations. On Thursday, the White House announced that it had delivered more than 200 million doses of the Covid-19 vaccine to more than 100 countries, the most from any country in the world, according to the State Department.

“Doing more than everyone else shouldn’t be the bar,” said Craig Spencer, ​​director of global health in emergency medicine at NewYork-Presbyterian/Columbia University Medical Center. “It’s just not nearly enough.”

The approval of the mix-and-match approach for coronavirus vaccine booster shots left Americans with many questions.Credit…Jim Wilson/The New York Times

The Centers for Disease Control and Prevention said on Thursday that Americans could choose a booster dose of a vaccine different from the one they had initially received — the so-called mix-and-match strategy.

Preliminary evidence strongly suggests that mixing two Covid vaccine types produces a stronger immune response than matching the booster to the initial vaccine.

Booster doses of an mRNA vaccine (Pfizer-BioNTech or Moderna) seem to raise antibody levels higher than a booster dose of the Johnson & Johnson vaccine.

A pop-up vaccination clinic in West Palm Beach, Fla., in August. Vaccines remain highly protective against severe illness and death in the vast majority of people.Credit…Saul Martinez for The New York Times

Among Americans initially immunized with an mRNA vaccine, the following groups should receive a single booster dose six months or more after their second dose, the C.D.C. decided:

Adults ages 18 to 49 with certain medical conditions and those whose jobs regularly expose them to the virus may choose to get a booster. And recipients of the Johnson & Johnson vaccine should receive a booster shot at least two months after the first dose.

People who have received two mRNA vaccine doses or a single Johnson & Johnson dose should still consider themselves fully vaccinated.

Research indicates that, with the exception of adults over 65, the vaccines remain highly protective against severe illness and death in the vast majority of people.

There is not much information available on the safety of the boosters, but they may have some of the same side effects experienced with the initial doses.

It’s unclear how long protection from a booster shot might last, and whether people who receive them will need another booster in the future.

BioNet employees inspecting a vial-packing machine this month in a factory where mRNA Covid-19 vaccines will be produced in Ayutthaya, Thailand.Credit…Adam Dean for The New York Times

Across the developing world, hundreds of millions of people are unable to get a vaccine to protect themselves from the ravages of Covid-19, and millions of them have already become infected and died.

Depending on wealthy nations to donate billions of doses is not working, public health experts say. The solution, many now believe, is for the countries to do something that the big American mRNA vaccine makers say is not feasible: Manufacture the gold-standard mRNA shots themselves.

Despite mounting pressure, the chief executives of Moderna and Pfizer have declined to license their mRNA technology in developing countries, arguing it makes no sense to do so. They say that the process is too complex, that it would be too time- and labor- intensive to establish facilities that could do it, and that they cannot spare the staff because of the urgent need to maximize production at their own network of facilities.

“You cannot go hire people who know how to make mRNA: Those people don’t exist,” the chief executive of Moderna, Stéphane Bancel, told analysts.

But public health experts in both rich and poor countries argue that expanding production to the regions most in need is not only possible, it is essential for safeguarding the world against dangerous variants of the virus and ending the pandemic.

Setting up mRNA manufacturing operations in other countries should start immediately, said Tom Frieden, the former director of the Centers for Disease Control and Prevention in the United States, adding: “They are our insurance policy against variants and production failure” and “absolutely can be produced in a variety of settings.”

The vaccine needs of poorer countries were supposed to be met through Covax, a multinational body meant to facilitate global vaccine distribution — but donations have been slow and limited. Wealthier countries have locked up the supply. Just 4 percent of people in low-income countries are fully vaccinated.

Experts in both the development and production of vaccines say the mRNA vaccines involve fewer steps, fewer ingredients and less physical capacity than traditional vaccines. Companies in Africa, South America and parts of Asia already have much of what they would need to make them, they say; the technology specific to the mRNA production process can be delivered as a ready-to-use modular kit.

Most estimates put the cost of setting up production at $100 million to $200 million. A few large pharmaceutical producers in developing countries have these funds at hand; others would need loans or investors. The U.S. International Development Finance Corporation and the International Finance Corporation both have billions of dollars in funding available for this kind of project, as low-interest loans or a share of equity.

The New York Times interviewed dozens of executives and scientists at vaccine, drug and biotechnology companies across the developing world and from those conversations, found 10 strong candidates to produce mRNA Covid vaccines in six countries on three continents. The key criteria include existing facilities, human capital, the regulatory system for medicines and the political and economic climate.

Those companies include the Serum Institute of India, the world’s largest vaccine maker; Gennova Biopharmaceuticals in Pune, India; Biological E in Hyderabad, India; BioNet-Asia, a Thai drug maker; Aspen Pharmacare in Durban, South Africa; Biovac Institute of Cape Town; Bio-Manguinhos, the immunobiology arm of a venerated Brazilian public health research organization; Instituto Butantan, a renowned scientific research institute in São Paulo, Brazil; Singerium Biotech, based in Argentina; and BioFarma, a large state-owned company in Indonesia.

President Alexander G. Lukashenko of Belarus in Minsk, the capital, on Friday. His unconcerned attitude toward the pandemic has angered many Belarusians.Credit…Pool photo by Nikolay Petrov/via AP

Belarusian authorities on Friday horrified some of the country’s doctors by abolishing mask mandates, less than two weeks after their introduction during the pandemic and a day after the country registered a record number of new coronavirus infections.

The decision came after the nation’s authoritarian president, Alexander G. Lukashenko, dismissed the measures as unnecessary.

“It’s just over the top to send police to track down those who aren’t wearing masks,” Mr. Lukashenko said this week. “We aren’t the West.”

Dr. Nikita Solovei, a leading Belarusian infectious disease expert in the capital, Minsk, sharply criticized the decision. He described it as “madness” amid soaring contagion, and warned that “officials will bear responsibility.”

The mask mandates were introduced on Oct. 9, requiring Belarusians to wear masks in all indoor public areas, on public transportation and in stores.

On Thursday, the country officially reported 2,097 new Covid-19 infections, the highest number for the country so far. Many have criticized the official figures as an undercount.

When the pandemic struck, Mr. Lukashenko had dismissed concern over the coronavirus as “psychosis” and refused to impose any restrictions. The country was the only one in Europe to keep holding professional soccer games with fans in the stands while the outbreak was in full swing.

The 67-year-old former state farm director previously advised Belarusians to “kill the virus with vodka,” go to saunas and work in the fields to avoid infection. “Tractors will cure everybody!” he once proclaimed.

His attitude angered many Belarusians and contributed to the public outrage over Mr. Lukashenko’s victory for a sixth term in 2020 — an election the opposition and the West have rejected as a sham.

Belarusian authorities have registered a total of more than 580,000 Covid-19 infections and 4,482 deaths. Only about 20 percent of the population has been vaccinated, using vaccines made in Russia and China.

The authorities have stopped reporting daily deaths. Andrei Tkachev, the coordinator of Belarus’s Medical Solidarity Foundation — an association of volunteers and doctors that helps medical workers who faced reprisals from the government — and others have rejected the official statistics.

“Official statistics can’t be trusted,” Mr. Tkachev said. “Overcrowded hospitals are a testimony of that.”

Svetlana Tikhanovskaya, the main opposition challenger in the 2020 election, who was forced to move to neighboring Lithuania after the vote under official pressure, also dismissed the official numbers.

“People don’t believe the government and official statistics, and they see huge lines at clinics and hospitals,” Ms. Tikhanovskaya said during an online conference. “Belarus faces the worst wave of the coronavirus, and it’s not ready for that.”

HCA Healthcare was one of the larger chains that chose to return some of the federal funds.Credit…William DeShazer for The New York Times

A new analysis underscores concerns about how federal aid was allocated to health care institutions under the Provider Relief Fund, a $175-billion program that has drawn sharp criticism for giving so much money to the wealthiest U.S. hospitals.

The study, published Friday in JAMA Health Forum, shows that more money flowed to hospitals that were in a strong financial position before the pandemic than went to hospitals with weaker balance sheets and smaller endowments.

Small rural hospitals, called critical access hospitals, received lower levels of funding, according to the study, by researchers at the RAND Corporation, a nonprofit group. Those rural facilities often operate under extremely tight budget constraints, and some have closed or been acquired over the course of the pandemic.

More aid also flowed to those hospitals caring for the greatest number of Covid patients, many of which were large academic medical centers and big hospitals.

“There were large differences in how much each hospital got in funding,” Christopher M. Whaley, one of the study’s authors, said in an interview.

The analysis of 952 hospitals found that 24 percent received less than $5 million, while 8 percent got more than $50 million. Overall, the small rural hospitals received 40 percent less funding than their larger and more prosperous counterparts.

The researchers did not take into account $24 billion that was specifically targeted to rural and safety-net hospitals in underserved areas, which may have helped these organizations.

Congress authorized the aid to cushion losses sustained by hospitals during the pandemic, as patients stayed away and facilities could not perform lucrative surgeries and procedures.

But some of the hospitals that received hundreds of millions of dollars in federal funds went on buying sprees during the Covid crisis, gobbling up weaker hospitals and physician groups. A few large chains, including HCA Healthcare and the Mayo Clinic, chose to return at least some of the money.

The havoc caused by the Delta variant has further strained many hospitals, overwhelming intensive care units and forcing some to renew delays in elective treatments.

A September report commissioned by the American Hospital Association predicted a third of will have operating losses in 2021. Hospitals say they are treating sicker patients, many of whom delayed care earlier in the pandemic, and are paying more for staff, supplies and drugs.

Dr. Whaley said the larger flow of money to hospitals in strong financial shape calls into question “the purpose of having these financial resources,” noting some institutions have massive endowments and sizable assets. In contrast, rural hospitals receiving the least aid were already under financial strain when the pandemic hit.

“Policymakers should continue to ensure that these types of hospitals are sufficiently funded, potentially with additional rounds of funding,” the researchers wrote.





Melbourne Residents Celebrate Reopening

Residents of Melbourne flocked to cafes, swimming pools and hair salons as coronavirus restrictions began to ease. The Australian city had spent 262 days in lockdown, more than anywhere else in the world.

[cheering] “Today has been — is a great day. We’ve got out of jail. We are so, so happy. These last 11 weeks have been very, very hard on us.” “To all of those who are down there in Victoria today, enjoy the day. It’s going to be tremendous being reunited again and doing all the things you’ve been looking forward to doing. You’ve worked so hard for that, as they have here in New South Wales and the A.C.T. And together the country will open safely, and stay safely open.”

Residents of Melbourne flocked to cafes, swimming pools and hair salons as coronavirus restrictions began to ease. The Australian city had spent 262 days in lockdown, more than anywhere else in the world.CreditCredit…William West/Agence France-Presse — Getty Images

The residents of Melbourne have spent more days in lockdown — 262, to be precise — than people anywhere else in the world. And on Friday, they emerged from it with cheers, and a dose of caution, as restrictions began to ease.

During those lockdown days, residents in Australia’s second largest city were allowed to leave their homes to buy food and to exercise, and to do authorized work. For the past two and a half months, they have also been subject to a 9 p.m. curfew.

As the clock struck midnight on Friday and these restrictions were lifted, residents greeted their new freedoms with cheers and screams

It’s hoped that this will be Melbourne’s last lockdown — with 70 percent of residents age 16 and older now fully vaccinated, the government’s pandemic recovery plan envisages such restrictions becoming rare.

“I’m trying not to sound like some kind of soppy dad here, but I am proud, bloody proud of this state,” Daniel Andrews, the premier of Victoria, the state of which Melbourne is the capital, said on Twitter. “We’ve gone through such a hard time together, this pandemic has been exhausting in every sense of the word.”

But with case numbers still high — Victoria recorded 2,232 new infections on Thursday, its second highest daily total since the start of the pandemic — the city’s reopening is happening gradually.

Up to 10 vaccinated people can gather at home. Hairdressers, restaurants and bars can take in more customers. Retail stores can reopen — but only for outdoor business, a condition some business owners have labeled “ludicrous.”

Indoor retail outlets, gyms and entertainment venues will be able to reopen once 80 percent of the population is fully vaccinated.

On Friday morning, street musicians returned to Melbourne’s central business district, which had fallen silent during the pandemic. Most shops were still closed but long lines snaked out of cafes and hair salons.

“It’s nice to see everyone out and about again,” said Lionel Lam, 33, one of a dozen people waiting outside a barbershop. He’d bought clippers to cut his own hair during lockdown, he said, “but I’m excited to get the back done.”

On Friday, the authorities in Victoria announced that, starting Nov. 1, vaccinated Australian citizens returning to the state from overseas would not need to quarantine. That brought the state in line with the state of New South Wales, which made a similar announcement last week.

Beijing residents lining up for Covid booster shots on Friday. Credit…Andy Wong/Associated Press

Beijing began offering booster vaccinations against the coronavirus to residents 18 and older this week as China prepares to host the Winter Olympics in the capital early next year.

Several other parts of the country have also recently started administering third doses to people who had their second shot more than six months ago, according to reports in state-run news outlets. Beijing government notices said priority would be given to high-risk people, including those over 60 or in certain jobs, and to those organizing or attending “major events.”

More than 2.2 billion vaccine doses have already been administered in China, according to the government. Chinese health officials have maintained a zero-tolerance approach to the virus, even as other countries, such as New Zealand, have moved away from trying to eradicate infections using heavy restrictions.

China reported 28 locally transmitted coronavirus cases on Thursday, the highest one-day figure in a month. The authorities in the northern-central areas where the latest cases are concentrated have shut tourist sites, curbed travel and imposed neighborhood lockdowns.

On Friday, Beijing said it would conduct rapid testing for 34,700 residents of the capital after four new cases were discovered in the city’s Changping District.

The 2022 Beijing Olympics are poised to be the most restricted large-scale sporting event since the start of the pandemic. Athletes, officials, journalists, workers and more will have to spend all their time in a bubblelike environment and take daily coronavirus tests. Only residents of mainland China will be allowed as spectators.

Migrants were lined up and processed by Border Patrol north of the Roma–Ciudad Miguel Aleman International Bridge, which spans the Rio Grande border with Mexico, in Roma, Texas, U.S. October 1, 2021Credit…Jason Garza/Via Reuters

A record 1.7 million migrants from around the world, many of them fleeing pandemic-ravaged countries, were encountered trying to enter the United States illegally in the last 12 months. The tally capped a year of chaos at the southern border, which has emerged as one of the most formidable challenges for the Biden administration.

It was the highest number of illegal crossings recorded since at least 1960, when the government first began tracking such entries. The number was similarly high for the 2000 fiscal year, when border agents caught 1.6 million people, according to government data.

Single adults represented the largest group of those detained in the fiscal year that ended Sept. 30, at 1.1 million, or 64 percent of all crossers. There were also large numbers of migrant families — more than 479,000, which is about 48,000 fewer than during the last surge in family crossings in 2019.

But the nearly 147,000 children whom agents encountered without parents or guardians was the largest number since 2008, when the government started tallying unaccompanied minors.

The crossers hailed from around the globe, many of them seeking economic opportunity as the coronavirus pandemic erased hundreds of millions of jobs. Agents caught people from more than 160 countries in Asia, Africa and Latin America, with Mexico accounting for the largest share.

In addition to the pandemic, two hurricanes destroyed livelihoods and homes in Guatemala and Honduras, where extortion and violence from gangs have persisted in many communities, further fueling an exodus.

A public health rule, invoked by President Donald J. Trump at the beginning of the pandemic in 2020 to seal the border, has remained in place under the Biden administration. Over the last 12 months, the Border Patrol has carried out more than one million expulsions of migrants back to Mexico or to the migrants’ home countries.

President Biden has walked a fine line between trying to control the influx and put in place a more humane approach to border enforcement. Republicans have blamed Mr. Biden’s promises to reverse Trump-era immigration policies for fueling the surge, as word spread that the country’s borders had become easier to breach.

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