The United States is poised to reach a once-unthinkable number of 600,000 Covid-19 deaths. And had it not been for the removal of hundreds of deaths from official tallies in Northern California, the country would have surpassed the mark already.
More than 1,600 deaths had been tied to the coronavirus in Alameda County, Calif., which includes Oakland, when June began. But by this week, the county had reported fewer than 1,300 deaths linked to the virus.
The sudden drop had to do with longstanding questions about which deaths count as coronavirus deaths and which do not. Health departments routinely add or subtract deaths, sometimes by the dozens or even hundreds, as information becomes available about a patient’s residence or the circumstances of their death.
Alameda County, which had previously included in its tally any resident who died while they happened to be infected with the virus, recently tightened its rules to include only those for whom Covid-19 was identified as a cause of death, or for whom the virus could not be ruled out as a cause of death.
“It is important to accurately report deaths due to Covid-19 so that residents and health officials have a more precise understanding of the impact of the pandemic and response actions in our community,” county officials said in a news release. “Using the older definition of Covid-19 deaths, a resident who had Covid-19 but died due to another cause, like a car accident,” would still have been counted.
Public health officials across the United States had identified more than 599,860 coronavirus deaths through Tuesday, according to New York Times data, a figure that dropped after The Times adjusted its data to match the Alameda revision. Many experts say they believe the national total to be an undercount. Data on excess deaths, the number of deaths beyond what would be expected based on historical trends, has suggested that the official statistics may not capture the pandemic’s full toll.
As the pace of infection and death slows, public health agencies continue to revisit their death totals.
On Monday, officials in Washington State removed around 30 deaths, some dating back to April 2020, that they said were determined not to be related to Covid-19. On Tuesday, Missouri officials said they were adding 25 deaths, mostly from May, after conducting a weekly sweep of death certificates.
Over the course of the pandemic, the counting of coronavirus deaths has become more standardized. In the last year, many states, including Washington and Ohio, have adjusted their tallies to align with federal guidance, based on death certificates, which calls for counting deaths where the virus was determined to be a factor.
Oklahoma added about 1,800 deaths to its total in April as it worked to implement the federal guidance. Later that month, West Virginia removed 162 deaths because Covid-19 was not listed on the death certificate.
But death certificates, often filled out by a family doctor or county coroner, are subjective by nature and can vary widely in their content, leading to borderline cases.
Adding to the confusion, testing was scarce at the start of the pandemic, meaning many people died with coronavirus symptoms but without any confirmation of infection. Some places, including New Jersey and New York City, have classified those people as probable deaths and included them in their totals.
The European Union is expected to recommend lifting the ban on nonessential travel for visitors from the United States on Friday, opening for American tourists just in time for the summer season, which is crucial to the economy of many members of the bloc.
On Wednesday, ambassadors of the E.U. countries indicated their support for adding the United States to the list of countries considered safe from an epidemiological point of view, a bloc official confirmed. The decision is expected to be formally adopted on Friday and would come into effect immediately.
In principle, all travelers from countries on the safe list, not just citizens or residents, would be allowed to enter the bloc for nonessential reasons, such as tourism or visiting family, even if they are not vaccinated, without any further restrictions. The European Commission, the European Union’s executive arm, recommended that a PCR test should be required, but it is ultimately up to national governments to set out the specific rules, including any need to quarantine.
The move is part of a broader attempt to restore tourism flows within and from outside the European Union. Travel from outside the bloc was practically suspended last year to limit the spread of the coronavirus, with the exception of a handful of countries that fulfilled specific criteria, such as low infection rates, number of tests performed, and their overall response to Covid-19.
Until today, the list, which has been updated on a regular basis, contained a relatively small number of nations, including Australia, Japan and South Korea. China fulfilled the quantitative criteria, but the lifting of entry restrictions is subject to reciprocity. Albania, Lebanon, North Macedonia, Serbia and Taiwan would also be added to the list, and the requirement for reciprocity dropped for the Chinese territories of Hong Kong and Macau.
The European Commission recommended last month that all travelers from third countries who were fully vaccinated with shots approved by the European Medicines Agency or by the World Health Organization should be allowed to enter without restrictions, a policy switch that was first reported by The New York Times.
The loosening of travel measures was enabled by the fast pace of vaccination in the United States and by the acceleration of the inoculation campaign in Europe, and bolstered by advanced talks between the authorities on how to make vaccine certificates acceptable as proof of immunity from visitors.
But health policy in the European Union is ultimately the province of the national member governments, so each country has the right to tailor the travel measures further, including possibly adding more stringent requirements, regardless of the decision on Friday.
Some countries that are heavily dependent on tourism, such as Greece and Spain, did not wait for a continentwide policy and moved in March to reopen to external travelers.
The further opening of the European Union comes as the bloc finalizes work on a Covid certificate system, which is supposed to become operational on July 1. Seven member countries started issuing and accepting the certificate ahead of schedule at the beginning of this month. The document records whether people have been fully vaccinated against the coronavirus, recovered from illness or tested negative within the past 72 hours, and it would eventually allow those that meet one of the three criteria to move freely across the 27 member countries.
Travelers coming from outside the bloc would have the opportunity to obtain a Covid certificate from an E.U. country, the European Commission said. That would facilitate travel between different countries inside the bloc, but would not be a prerequisite for entering the European Union.
Study after study has built a consensus around monoclonal antibody drugs for Covid-19: They work best when given early, long before a patient is admitted to the hospital.
But clinical trial data released on Wednesday offered the strongest evidence to date that at least one of the available treatments can sometimes help later in the progression of the disease. Results from a large study in Britain indicated that Regeneron’s antibody treatment can reduce deaths in a subset of hospitalized patients: those whose immune systems are unable to mount a natural response to the virus.
Regeneron, which has emergency authorization for its drug to be given to high-risk patients who are not yet sick enough to be hospitalized, said it plans to ask the Food and Drug Administration to expand its approval to allow the drug to be given to appropriate hospitalized patients.
That could eventually give doctors another tool to help some of the sickest Covid patients. Although the widespread availability of vaccines has sent infection rates plummeting, unvaccinated Americans are still getting seriously ill from the virus. Close to 20,000 patients remain hospitalized with Covid in the United States.
The study enrolled nearly 9,800 hospitalized Covid patients beginning last September. Among those who had not mounted their own natural antibody response when they joined the trial, the group randomly assigned to receive Regeneron’s antibody on top of standard care had a 20 percent reduced risk of death after 28 days, compared with the group that received only standard care. The usual treatment for such patients has typically involved the steroid dexamethasone or the antiviral drug remedesivir.
Regeneron’s drug provided no such statistically meaningful benefit for patients who had mounted their own immune response. “If you already have antibodies, giving you more may not make much difference,” Peter Horby, a University of Oxford researcher who co-led the trial, said at a news conference.
The results, which have not yet been peer-reviewed and are expected to be posted on a preprint server on Wednesday, came from the Recovery trial, a nationwide effort in Britain to evaluate Covid-19 therapies that has been praised for its rigor and simplicity.
Like other such treatments, Regeneron’s monoclonal antibody is a cocktail of two lab-made drugs designed to mimic the antibodies generated naturally when the immune system fights the virus. Although it is one of three such drugs authorized in the United States, it is the only one currently in use nationwide.
Another cocktail, from Eli Lilly, is no longer being distributed in eight states because of the high prevalence there of the Beta and Gamma variants first seen in South Africa and Brazil, respectively. (Lab experiments indicate that those variants can evade Lilly’s drug.) A third, from GlaxoSmithKline and Vir, has not been ordered by the federal government since being authorized last month.
Federal health officials have classified the Delta variant of the coronavirus now circulating in the United States as a “variant of concern,” sounding the alarm because it spreads rapidly and may partially sidestep certain antibody treatments.
Officials with the Centers for Disease Control and Prevention on Tuesday emphasized that the authorized vaccines are highly effective against the variant, however, and urged all Americans who have not yet been inoculated to get fully vaccinated as soon as possible.
In England, the swift spread of Delta variant has forced government officials to postpone the lifting of pandemic restrictions, called Freedom Day, which was to be June 21. Now the government will maintain some restrictions for four additional weeks.
Reports from Britain indicate that single doses of the Pfizer-BioNTech or AstraZeneca vaccine are only 33 percent effective at preventing symptomatic Covid-19 caused by the Delta variant.
In the United States, about 44 percent of citizens are fully vaccinated, according to a database maintained by The Times. In California and New York, states in which vaccination rates are higher, governors are moving to lift restrictions altogether.
“Even though our case counts are declining and people are getting vaccinated, we still have roughly half our population that is unvaccinated,” said Summer Galloway, a Covid-19 adviser to the C.D.C. and executive secretary of the SARS-CoV-2 Interagency Group, which characterizes emerging variants for the U.S. government.
“We have circulation of a more transmissible variant that is definitely a concern, and our bottom line message here is we want to make sure people are taking this seriously and are getting vaccinated as soon as they’re eligible and it’s available to them.”
The Delta variant, also known as B.1.617.2, is now one of six variants of concern. The virus first was identified in India in December, and by June was found in 54 countries. It was detected in Britain in late March. Public Health England called it a variant of concern on April 28, and the World Health Organization followed suit in May.
In the United States, the proportion of coronavirus infections attributed to the Delta variant has increased rapidly, from 2.7 percent during the two-week period ending May 22 to nearly 10 percent of cases during the two-week period ending June 5, according to modeling studies used by the C.D.C.
The rapid rise is “the number one driver for classifying this as a variant of concern,” Dr. Galloway said. Data from Britain suggest that the Delta variant is at least 50 percent more transmissible than the Alpha variant, also called B.1.1.7, she added.
There is still uncertainty about whether the Delta variant causes more severe disease, increasing the risk of hospitalization and death, Dr. Galloway said: “We don’t have hard data to say there is a definitive increase in disease severity, but there is potential for that and we don’t want to rule that out.”
The Delta variant “has rapidly become the dominant variant in England,” accounting for more than 90 percent of new infections, scientists recently reported. The variant contains a mutation in the viral genes that direct production of its spike protein, called the L452R substitution. That mutation is shared by other variants and may make monoclonal antibody treatments less effective.
Scientists determined that the odds of the Delta variant spreading among members of a household was 64 percent greater than that of the B.1.1.7 variant first identified in Britain, which itself is considered both more contagious and more deadly than other variants.
The trajectory of the Delta variant in the United States is unpredictable, but it could present serious challenges, particularly in regions like the South, where vaccination rates are low, and in the more than 100 U.S. counties where fewer than 20 percent of the population is vaccinated, said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“This virus continues to throw curveballs at us,” he said.
Japan’s leaders are racing to lift Covid-19 vaccination rates at home, but that hasn’t stopped them from donating doses in the Asia Pacific region as part of a wider geopolitical strategy.
Foreign Minister Toshimitsu Motegi of Japan said this week that the country would send a million doses of the AstraZeneca vaccine to Vietnam on Wednesday. The shots are among the 120 million doses that Japan expects to obtain as part of a deal it struck with the British-Swedish manufacturer.
Japan also donated more than a million AstraZeneca shots to Taiwan this month, and Mr. Motegi said this week that it planned to donate vaccines to Indonesia, Malaysia, the Philippines and Thailand.
Japan is donating vaccines to Taiwan and Vietnam directly rather than through Covax, the global vaccine-sharing program. That suggests geopolitics are a motivating factor, experts say.
China has been promoting its self-made vaccines in Southeast Asia and beyond in a charm offensive that has clear diplomatic overtones. Stephen Nagy, a political scientist at International Christian University in Tokyo, said that Japan appeared to see its own vaccine diplomacy as a counterweight.
“Watching what China has done, delivering a lot of Sinovac in particular countries, Japan does not want to fall behind,” he said, referring to the manufacturer of one of China’s main vaccines.
China has been asserting its geopolitical muscle in the region for years, flying warplanes over Taiwan and fortifying artificial islands in parts of the South China Sea that are also claimed by Malaysia, the Philippines and Vietnam. Japan has often found ways to gently push back.
In Vietnam, Japan has invested in large infrastructure projects and supplied the country’s navy with coast guard vessels for patrolling the South China Sea. After Prime Minister Yoshihide Suga of Japan took office last year, he made Vietnam his first overseas stop.
Vietnam could use more vaccines. It kept infections low until recently through rigorous quarantining and contact tracing, but is now experiencing its worst outbreak yet. Only about 1.5 percent of the country’s 97 million people have received even one shot, according to a New York Times tracker.
Japan’s health authorities have authorized the AstraZeneca vaccine for emergency use, and about 90 million of its 120 million doses will be manufactured domestically. But the government has held off administering that vaccine locally because of concerns over very rare complications involving blood clots.
Japan’s inoculation campaign has also been held up by strict rules that allow only doctors and nurses to administer shots, and by a requirement that vaccines be tested on people in Japan before being approved for use.
Only about 25 million vaccine doses have been administered in Japan and 15 percent of the population has received at least one shot. That percentage is about the same as in India, and far below that of most richer countries.
The government wants to speed up vaccines in part so that it can allow domestic spectators when the Tokyo Olympics begin in July. The news agency Kyodo reported on Tuesday that officials are considering allowing up to 10,000 fans or half of a venue’s capacity — whichever is smaller — at Olympic events.
For now, Tokyo and nine other prefectures remain under a state of emergency that has been in effect since late April. The order is scheduled to expire on June 20, barely a month before the Olympics start.