Covid-19: Some U.S. Vaccination Sites Will Close as Demand Drops – The New York Times

Heres what you need to know:Medical students and physician assistants from Touro University Nevada waiting to screen people in Las Vegas last month.Credit...Steve Marcus/Reuters

Some county health departments that couldnt keep up with vaccine demand a month ago have now started closing some of their mass vaccination sites for lack of customers, and some counties are declining vaccine shipments.

Now that more than half of adults in the United States have received at least one Covid-19 vaccine dose and the country has surpassed 200 million administered doses, demand for shots appears to be slowing in many areas.

White House and health officials are comparing the next phase of the vaccination campaign to a get-out-the-vote effort. Officials in many states are looking beyond mass vaccination sites and focusing on having patients vaccinated at their doctors offices, where they are more at ease a shift that will require the Biden administration to ship vaccines in much smaller quantities.

The seven-day average of vaccinations has declined somewhat in recent days, to 2.86 million doses a day as of Friday, from a high point of 3.38 million last week, according to a New York Times analysis of data from the Centers for Disease Control and Prevention.

What is emerging is an unequal landscape in which some places have more supply than demand and others have more demand than supply. In Seattle, for example, more than 200,000 people are on a waiting list for vaccines at city-run sites. Local officials have requested and are now receiving additional doses through a federal program.

At a news conference on Friday, Jeffrey D. Zients, the White Houses Covid-19 response coordinator, acknowledged that the pace of vaccinations nationally would ebb. We expect daily vaccination rates will moderate and fluctuate. Weve gotten vaccinations to the most at risk and those most eager to get vaccinated as quickly as possible, he said. And we will continue those efforts, but we know reaching other populations will take time and focus.

Mr. Zients said two new federally run vaccination sites would open Friday in Kentucky, with a combined capacity of 7,000 shots each week.

Even with persistent vaccine hesitancy, the reasons for the dip in vaccination rates are still not entirely clear. Injections of Johnson & Johnsons vaccine were halted last week as federal health officials investigated a potential rare side effect, and this may have had some effect on daily tallies, with millions of doses now sitting on shelves and yet to be allocated. On Friday, a panel of C.D.C. advisers recommended lifting the pause on the vaccine for all adults and adding a label about an exceedingly uncommon, but potentially dangerous, blood clotting disorder.

While every person 16 and older in the country became eligible for a coronavirus vaccination on Monday, falling demand has pushed Mercer County, Ohio where 27 percent of adults have at least one dose to announce the closing of its mass vaccination site on May 7.

In the first few months of the year, the site in the county, which has 41,000 residents and borders Indiana, would fill up its 400 appointments in an hour or two, said Jason Menchhofer, the county health administrator. But demand has fallen precipitously in the last several weeks, and last week the county ended up wasting two doses, which was a first.

We no longer have a reserve of people who want to be vaccinated to reach into to show up and take those doses, Mr. Menchhofer said.Officials in Palm Beach County, Fla., said that the county would shut its three mass vaccination sites, which are operating at about half capacity, by the end of May. Of 16,000 appointment slots available this week, only 6,000 were filled, according to health officials. Instead, three mobile units will each aim to give 500 doses a day.

In Galveston County, Texas, a mass drive-through clinic at a county park wont operate after May 1. The park has been administering 5,000 doses per day, including on Thursday. But demand for appointments has dampened in the last three weeks, according to the countys chief public health officer, Dr. Philip Keiser. He also asked the state to pause vaccine shipments.

Were concerned that some of it may expire before we use it, if we keep getting it, Dr. Keiser said.

There will be much more targeted outreach, down to the census tract level, Dr. Keiser said, and there might be 100 or 200 injections per day rather than thousands.

We got about 50 percent of our people vaccinated, he said, and we recognize that next 25 percent is going to be a lot harder than the first.

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 agencys 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 companys 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 Fridays 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 countrys vaccine demand. Emergent BioSolutions, the plants operator, has produced tens of millions of doses of Johnson & Johnsons 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.

With the decision by the Food and Drug Administration on Friday to lift its recommended pause on administration of the Johnson & Johnson vaccine, many states are likely to start using it again in short order.

Several states, including Texas, Arizona, Alabama, Utah and Wisconsin, had said they expected to follow the recommendations of the F.D.A. and the Centers for Disease Control and Prevention once the decision was made. (The F.D.A. issued its new guidance after advisers to the C.D.C. voted to lift the pause.) Other states, including Washington State, had said they would wait until the conclusion of the C.D.C. meeting and then formulate their plans.

Dr. Karen Landers of the Alabama Department of Public Health said the state would follow the guidance of the committee and C.D.C. if there is guidance to resume use of Johnson & Johnson.

Shelby Anderson, a spokeswoman for the Washington State Department of Health, said the Western States Scientific Safety Review Workgroup was scheduled to convene after the C.D.C. meeting. Right now, its too soon to say when a decision could be made, she said.

Elizabeth Goodsitt, a spokeswoman for the Wisconsin Department of Health Services, said that the state would follow the federal recommendation, and that its plan was to allocate doses of the Johnson & Johnson vaccine primarily to local health departments, as well as smaller providers, to offset the hub deliveries and storage challenges of Pfizer.

In a statement, the Minnesota Department of Health said the vote underscores the importance that is placed on vaccine safety.

Just before the rollout was halted last week, Minnesota had distributed 9,600 Johnson & Johnson doses to providers, officials said, adding, Those doses have been stored by the providers who received them, and we expect them to be available in the coming days along with any updated information to provide to those getting the vaccine.

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The situation right now here is really, really worst, critical and out of control. The staff is really cooperative, but due to the overcrowding, all through the main hall of the walk-in casualty, it is difficult to provide equal treatment to all the patients. Thats why there is a highly casualty rate inside, and theres a very negative environment inside. The situation in India is a devastating reminder of what this virus can do and why we must marshal every tool against it in a comprehensive and integrated approach. This is a scenario thats playing out around the world and will continue to play out unless we ensure equitable access to the tools needed to save lives. The solution is straightforward. We need countries and companies that control the resources that could save lives to share.

The Timess Emily Schmall reports from New Delhi on the desperate situation in India. The following is an excerpt from her article.

NEW DELHI A catastrophic second wave of the coronavirus is battering India, which is reporting the worlds highest number of new infections as hospitals and patients beg for fast-diminishing oxygen supplies and other emergency aid.

India recorded more than 330,000 coronavirus cases in 24 hours, the health ministry said on Friday, the second consecutive day that the country has set a global record for daily infections.

Canada has joined Britain, Hong Kong, Singapore and New Zealand in barring travelers coming from India. And the U.S. State Department advised people against going to India after the Centers for Disease Control raised the risk level to its highest measure.

Even as cases have climbed, Prime Minister Narendra Modis governing Bharatiya Janata Party and other parties have continued to hold mass rallies with thousands of people unmasked. The government has also allowed an enormous Hindu festival to draw millions of pilgrims despite signs that it has become a superspreader event.

The catastrophe in India is playing out vividly on social media, with Twitter feeds and WhatsApp groups broadcasting hospitals pleas for oxygen and medicines, and families desperate searches for beds in overwhelmed Covid-19 wards. With many hospitals short of ventilators, television reports have shown patients lying inside ambulances parked outside emergency rooms, struggling to breathe.

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All city-run sites, as of now, will be open to all New Yorkers, regardless of any geographic restrictions that existed previously. We want to make it simple. You can go to any city-run site Health and Hospitals, Department of Health, any site you can go there and get a shot. Doesnt matter where you live. Second, all city-run sites will be open for walk-ins as of today, for all sites, for all age levels. So you can just walk up and get vaccinated. If youre 16 years old or older for the sites using Pfizer, 18 years old and older at the sites using Moderna. We did a walk-up pilot project focusing on the oldest New Yorkers. We saw really good results. A lot of people said it was the reason they came and got vaccinated, that it was a lot simpler for them. And we did not have the kinds of lines we were worried about that might be a problem. So were quite confident we could accommodate a much higher volume of walk-ins. So were going to make that universal at all the city-run sites, again, for all ages.

New York City is now allowing any eligible New Yorker to get vaccinated at city-run sites without an appointment, an attempt to simplify the inoculation process and expand access, Mayor Bill de Blasio said on Friday.

We want to make it simple, Mr. de Blasio said at a news conference. We want to encourage people. And lets face it, convenience matters to New Yorkers.

The city had begun allowing walk-in vaccinations for people older than 50 last week. Fridays expansion to all eligible New Yorkers is limited to sites run by the citys health department and its public hospital system, but as of Friday, New York State has also begun allowing walk-in vaccinations to anyone older than 60 at 16 of its vaccination sites, including five in New York City.

Being able to walk into a vaccine site will simplify a process that had confounded many New Yorkers desperately seeking vaccines. Appointments at all vaccination sites, including those run by the city, were elusive for months. New Yorkers often had to check dozens of websites, each with a different sign-up protocol. In some cases, appointments seemed to disappear as residents were trying to book them.

Officials had long worried that navigating the complex system was a major barrier to the equitable distribution of the vaccines in New York.

As the supply of vaccines increased, appointments became far less scarce. Mr. de Blasio said that the city was now confident enough in its continued supply to eliminate the need for appointments.

Mr. de Blasio also said the city was eliminating rules that had restricted appointments to residents of neighborhoods surrounding certain sites.

The requirements were initially meant to address inequitable distribution of the vaccine and ensure that residents in harder-hit neighborhoods or boroughs had access.

As of Friday, more than six million doses have been administered in New York City. According to the citys data, 50 percent of residents over 18 have received at least one dose.

But inequity remains: 60 percent of eligible adults have received one dose of the vaccine in Manhattan, compared with 41 percent in the Bronx and 45 percent in Brooklyn.

Black and Latino residents are also being vaccinated at a slower pace than white residents. Of the city residents who had received one dose and whose race was recorded, about 34 percent were white, 21 percent were Asian, 20 percent were Latino and 13 percent were Black. The citys population is roughly 29 percent Latino and 24 percent Black.

The new walk-in policy does not expand eligibility requirements for the vaccine: Only those ages 16 and older can receive the Pfizer-BioNTech vaccine, and only those 18 and older can receive the Moderna vaccine.

Mr. de Blasio said the city was pressing community health centers to adopt similar policies. Officials were also urging private doctors to call their patients and urge them to get vaccinated.

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 states 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 wouldnt 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 Illinoiss 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 dont 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 viruss 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 systems 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.

Perth, Australias fourth-largest city, began a three-day lockdown on Saturday after a coronavirus case was discovered outside quarantine.

Health officials believe that the virus passed from a man who left a two-week hotel quarantine on April 17 to a woman he later stayed with in Perth. The man tested positive on Friday after flying to Melbourne, officials said.

The lockdown bars the citys two million residents from leaving their homes except to buy groceries, exercise, work or seek medical care. It has also forced the cancellation of public events in Perth on Sunday for Anzac Day, which celebrates military veterans of Australia and New Zealand.

New Zealand, which days ago opened a long-awaited travel bubble with Australia, said it had paused flights to and from Western Australia State, of which Perth is the capital. New Zealands government said in a statement that the pause was an example of the type of scenario both countries have planned for.

Australia has all but eliminated local transmission of the virus, in part by imposing swift, short-term lockdowns any time new infections are found. In February, when one coronavirus case was detected outside quarantine for the first time in 10 months, Perth was locked down for five days.

The premier of Western Australia, Mark McGowan, said that more than 2,500 people underwent coronavirus tests at public clinics on Friday, and that more than 300 people who are believed to have come into contact with the infected man had been placed into quarantine and were being tested.

No additional infections have been found, Mr. McGowan said, but he urged residents to get tested if they believe they could be at risk.

We need many more tests to be done, Mr. McGowan told a news conference on Saturday. This is crucial to get us the data and certainty to look beyond this lockdown.

SAN JUAN, P.R. Throughout the pandemic, Dr. Vctor Ramos, a pediatrician, had not seen more than two Covid-19 patients hospitalized at the same time at San Jorge Children & Womens Hospital in San Juan, the Puerto Rican capital, where he works nights. When he left after one of his shifts a few days ago, the hospitals pediatric patient count had grown to 10.

We had never seen that, he said.

Puerto Rico has experienced its worst coronavirus outbreak of the pandemic over the past five weeks, with an explosive growth in cases exceeding records that had been set in December. Only this week did the numbers stop rising, giving the territory its first respite since the surge began in mid-March.

Behind the rise, experts say, was a confluence of factors, including the arrival of variants that probably made the virus more contagious right when people weary of staying home and hopeful about vaccines began to let their guard down, returning to work in person and shopping and dining indoors. Tourists poured in for spring break season. People gathered to celebrate Holy Week, a time when many are off work.

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Covid-19: Some U.S. Vaccination Sites Will Close as Demand Drops - The New York Times