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Crowds gathering in stadiums, pubs and bars to watch the European Championship soccer games have driven a rise in coronavirus cases across Europe, the World Health Organization said on Thursday, raising concerns about another virus wave even though vaccination campaigns have made progress.
“We need to look much beyond just the stadiums themselves,” said Catherine Smallwood, the W.H.O.’s senior emergency officer. “We need to look at how people get there: Are they traveling in large, crowded convoys of buses? And when they leave the stadiums, are they going into crowded bars and pubs to watch the matches?”
In Scotland, more than 2,000 people tested positive after watching a Euro 2020 game either at a stadium, a fan zone or at a pub, according to National Health Scotland. (Nearly two-thirds of those cases were linked to a Euro 2020 game in London in mid-June.) At least 120 fans from Finland were infected after traveling to St. Petersburg, Russia, to watch their team play.
After months of virus restrictions, and with the European Championships postponed for a year, soccer fans have been eager to travel across borders to watch the games in person. Finnish tourists attended games in Russia, French fans traveled to Romania, and Welsh ones supported their team in the Netherlands. In countries like Belgium, Britain and France, bars had reopened just weeks before the tournament began.
But given that most European countries have fully vaccinated less than a third of their populations, the risks are high. Experts say that the lax restrictions imposed on travel for the soccer championship may have serious consequences later in the summer or in the fall.
The rise in cases linked to the tournament comes more than a year after soccer games hosted early last year led to some of the first outbreaks in Europe.
Germany’s interior minister, Horst Seehofer, called the decision by European’s soccer governing body, UEFA, which runs the tournament, to allow large crowds in stadiums “utterly irresponsible.”
Despite the warnings by the W.H.O., British officials are allowing 60,000 fans to attend each of the tournament’s three final games in London next week.
Portugal’s government on Thursday announced that it would reintroduce nighttime curfews in municipalities where the coronavirus case rate has risen fastest, in another sign that the country is struggling to cope with the spread of the Delta variant.
In the past 14 days, the average number of daily cases in the country has nearly doubled to over 1,600, according to a New York Times database, though they remain far below their January peak of over 12,000 per day. Over 55 percent of the population is has gotten at least one Covid vaccine dose, compared to about 54 percent in the United States, according to Our World In Data.
The curfews are designed to discourage “risky behaviors” and particularly gatherings of younger people at night, said Mariana Vieira da Silva, the cabinet minister who presented the measures on Thursday. “This is a time to follow the rules, avoid gatherings, avoid parties, and seek to contain the numbers,” she added.
The curfew will come into force from 11 p.m. on Friday and will apply in 19 municipalities that are now ranked as having a “very elevated risk” of Covid-19, and a further 26 with an “elevated risk.” Portugal reported almost 2,500 new coronavirus cases on Thursday, which was the highest daily rise since February.
Among the 45 municipalities that will have a curfew from 11 p.m. to 5 a.m. are Lisbon, the capital, Porto, the second-largest city, and Albufeira, a tourism hub in the southern region of Algarve. Two weeks ago, authorities locked down Lisbon for the weekend after the country registered its highest number of new cases since March, with residents prohibited from traveling outside their home area.
Three days before she was arrested by soldiers, Myanmar’s civilian leader, Daw Aung San Suu Kyi, received her first dose of a coronavirus vaccine. Her high-profile inoculation was part of a nationwide campaign to combat the virus through testing, mask-wearing, lockdowns and vaccination.
But like the civilian government that Ms. Aung San Suu Kyi headed, her program to contain Covid-19 was cast aside by the military when it seized power in the Feb. 1 coup.
“There had been a real push toward testing, surveillance and vaccination and all of that just crumbled after the first of February,” said Alessandra Dentice, the head of Myanmar’s UNICEF office.
Now, the country, reeling from a brutal military crackdown and crippled by a monthslong national strike, is paying the price for the junta’s neglect of the pandemic. According to data reported by the regime’s health ministry, the number of daily reported Covid cases has risen sharply, and with limited testing underway, the positivity rate jumped to nearly 22 percent on Thursday. Health experts believe many more cases are going undetected.
Most worrisome are outbreaks in the three largest communities near the border with India, the country where the highly contagious Delta variant was first identified. The variant has been detected among the cases.
As of Thursday, 20 townships in six states and regions have been placed under pandemic-related stay-at-home orders by the military. Outbreaks have also been reported in Yangon, the largest city, and Naypyidaw, the capital. In Mandalay, the second-largest city, all seven townships were placed under stay-at-home orders on Thursday. The six hospitals in the city that accept coronavirus patients have been filled to capacity since last week, according to a local medical charity.
The ousted government in the Southeast Asian nation had acquired 3.5 million vaccines from India before the coup. The junta commandeered most of the shots, but ignored plans to prioritize vaccinations for the elderly. Some shots went to vaccinate soldiers, according to a doctor at a Yangon military hospital. In protest, many doctors refused to get a second dose from the regime.
The military’s unwillingness to provide details about its vaccination program prompted Covax, the global vaccine-sharing program, to delay a shipment of 5.5 million doses in March, said Dr. Stephan Paul Jost, the World Health Organization’s representative for Myanmar. No new shipment has been scheduled.
With doctors and other health care workers on strike against the coup, Myanmar’s health care system may buckle under the outbreak.
NAIROBI, Kenya — The African Union’s special envoy on Covid-19 urged Europe to relax restrictions on vaccine makers’ exports so that African countries could buy more doses and try to stem a fast-surging third wave of the pandemic driven mainly by the more contagious Delta variant.
Speaking in an online news conference on Thursday, the envoy, Strive Masiyiwa, criticized wealthy nations for giving short shrift to Africa’s needs while monopolizing manufacturers’ vaccine output for their own citizens. If Europe can lift lockdowns to let soccer fans throng its stadiums, he said, it is time to open up and let African countries buy more vaccine doses from Europe.
Mr. Masiyiwa spoke about a number of issues related to vaccines, including the European Union’s decision not to recognize Covishield — the India-made version of the AstraZeneca vaccine that most African countries are relying on — in its digital travel pass, which went into use on Thursday.
Just over 1 percent of Africa’s 1.3 billion people have been fully vaccinated so far, according to the World Health Organization, while nearly every country in Europe has surpassed 25 percent. Some are over 45 percent.
To get vaccine supplies, African nations are relying largely on the global purchasing and distribution mechanism known as Covax. It was not immediately clear whether European-made vaccine doses donated through Covax had reached any African countries. European states like France and Denmark have separately donated hundreds of thousands of vaccine doses to African countries like Senegal, Rwanda and Kenya.
The European Union began exerting control on vaccine exports in January, as the virus surged in its member nations, and may consider extending that control through September.
Mr. Masiyiwa said that access, not charity, was the main need now. “We are not asking for donations — in fact, we have money to buy vaccines,” he said. “Vaccines are not expensive, certainly when it comes to the lives of our people.”
The European Union did not immediately respond to a request for comment.
At a separate news conference on Thursday, an official with European Medicines Agency noted that vaccination with our vaccines the agency had authorized for use in the European Union — those made by Pfizer-BioNTech, Moderna, AstraZeneca and Johnson & Jonson — all seem to protect against the Delta variant. Those are the vaccines accepted in the E.U.’s digital travel pass.
So far, there is no comparable data on the efficacy of the Covishield against Delta.
On Thursday, Covax urged “all regional, national and local government authorities to recognize as fully vaccinated” people who received any vaccine approved by the W.H.O., which include the four accepted in the E.U.’s travel pass, Covishield, and two Chinese-made vaccines, Sinopharm and Sinovac-CoronaVac.
Africa is experiencing its steepest Covid surge yet, with more than 200,000 new cases reported in the past week. The continent is on “the verge of exceeding its worst week ever in this pandemic,” said Dr. Matshidiso Moeti, the W.H.O.’s regional director for Africa, adding that “the speed and scale of Africa’s third wave is like nothing we’ve seen before.”
South Africa alone reported more than 105,000 cases in the week ending June 27, according to the Africa Centers for Disease Control and Prevention. Daily death reports in the Democratic Republic of Congo have more than doubled over the last month. In Kenya, more than a dozen counties have been placed in a partial lockdown.
Mr. Masiyiwa said on Thursday that the first consignment of donated American vaccines, including Pfizer-BioNTech and Johnson & Johnson doses, were due to arrive in the next few days. .
Dr. John Nkengasong, head of the Africa C.D.C., said that if vaccinations in Africa did not accelerate soon, the consequences would be catastrophic. “We don’t want to be the continent of Covid,” he said.
The Delta variant, which is now responsible for most coronavirus infections in England, is not driving a surge in the rate of hospitalizations there, according to data released by Public Health England on Thursday.
Although the number of coronavirus infections has risen sharply in recent weeks, hospitalization rates remain low. Between June 21 and June 27, the weekly hospitalization rate was 1.9 per 100,000 people, the same as it was the previous week.
The hospitalization rate has increased slightly over the past month, rising from 1.1 admissions per 100,000 people in early June, according to the agency’s data. But it remains considerably lower than during England’s surge last winter, when the hospitalization rate peaked at more than 35 admissions per 100,000 people.
The data suggest that countries with high vaccination rates are unlikely to see major surges in hospitalization rates from Delta. Nearly 75 percent of adults in England — including 95 percent of those who are 80 or older — have had at least one shot, according to the agency’s numbers.
Earlier this month, England had delayed its plans to reopen after Delta caused a spike in new cases.
Case rates are highest among young adults, who are the least likely to be vaccinated, Public Health England reported. (Among those under 40, just 34 percent have been at least partially vaccinated.) Young people are less likely to develop severe Covid-19, which could explain why the spread of Delta has not resulted in a wave of hospitalizations.
Breakthrough infections, or those that occur in people who are fully vaccinated, tend to cause mild or no symptoms.
At a separate news conference on Thursday, the European Medicines Agency noted that vaccination should provide good protection against Delta.
“We are aware of the concerns that are caused by the rapid spread of the Delta variant and all the variants,” Marco Cavaleri, the head of biological health threats and vaccine strategy at the agency, said at the briefing. Given the research that has been done so far, the four vaccines that are approved in the European Union — Pfizer-BioNTech, Moderna, AstraZeneca and Johnson & Jonson — all seem to protect against the Delta variant, he said.
In one recent study, for instance, researchers found that the Pfizer vaccine was 88 percent effective at protecting against symptomatic disease caused by Delta, a performance that nearly matches its 95 percent effectiveness against the original version of the virus. A single dose of the vaccine, however, is much less effective.
“Expediting vaccination and maintaining public health measures remain very important tools to fight the pandemic,” Dr. Cavaleri said. “In particular, making sure that vulnerable and elderly people complete their vaccination course as soon as possible is paramount.”
Indonesia’s president, Joko Widodo, announced new restrictions on Thursday for parts of Java and Bali islands to contain the rapidly spreading Delta variant, including closing mosques, schools, shopping malls and sports facilities.
The measures will take effect on Saturday and last until July 20, encompassing the Muslim holiday Eid al-Adha, a major event in Indonesia that falls on July 19 and is usually celebrated with large gatherings and the sacrifice of goats and cows.
“As we all know, the Covid-19 pandemic has been growing rapidly in the last few days because of the new variant, which is also a serious problem in many countries,” Mr. Joko said in an address to the nation. “This situation requires us to take more resolute steps so that together we can curb the spread of Covid-19.”
The number of reported cases has been rising daily, reaching a record 24,836 on Thursday, along with 504 deaths, another high. Just six weeks ago, it appeared that the vast Southeast Asian archipelago was making progress against the virus, with fewer than 2,500 daily cases reported.
The Delta variant, first detected in India, is driving a surge of the coronavirus in many parts of the world. In Indonesia, health experts say that the variant has led to the recent rise in cases, which has swamped hospitals and cemeteries, especially in the capital, Jakarta.
The Delta variant makes up 87 percent of the cases in Jakarta, the governor, Anies Baswedan, said earlier this week.
“Hospitals are overflowing, around one in five tests in Indonesia are reportedly coming back positive, and we’re experiencing more deaths now than at any point of the pandemic so far,” said Ade Soekadis, Mercy Corps’ country director for Indonesia.
The new measures stop short of the complete lockdown urged by some health experts.
All places of worship will be closed, workers in nonessential jobs must work from home, restaurants can provide only takeout food, local transit will operate with reduced capacity and public parks will be closed. Weddings with up to 30 attendees will still be allowed.
The measures will apply to nearly all of Java, which includes Jakarta and has a population of about 140 million, and to the most heavily populated parts of Bali, where tourism officials had been hoping to reopen to foreign tourists.
Most hospitals on Java are already over capacity and some are turning away patients, said Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia. According to his projections, the current surge would not peak until at least the end of July and could reach 500,000 cases and 2,000 deaths a day if tougher measures are not adopted.
“The government should do a lockdown,” he said. “Now we are facing our most serious and critical time. If we don’t respond to this situation in a serious way, then we will lose many lives.”
Digital Covid-19 certificates aimed at facilitating free movement in the European Union came into force across the bloc on Thursday, a long-awaited milestone for countries hoping to boost their ailing tourism industries — but also a point of friction over the number of vaccines that do not qualify.
Free movement is a key pillar of European integration, and E.U. officials said last month that the certificates would “again enable citizens to enjoy this most tangible and cherished of E.U. rights.”
So far, the European Union lists four vaccines as qualifying for the certificate, all of which have been authorized for use across the bloc. They are the vaccines made by Pfizer-BioNTech, Moderna, Johnson & Johnson and AstraZeneca.
That leaves out a vaccine that the international Covax mechanism has distributed across Africa: Covishield, a version of the AstraZeneca vaccine that is manufactured in India. It is, however, accepted in a handful of E.U. member nations.
Without naming the E.U., the Covax facility on Thursday urged “all regional, national and local government authorities to recognize as fully vaccinated” all people who have received a vaccine approved by the W.H.O. when easing travel restrictions, warning that not doing so would create a two-tiered system.
Through a Q.R. code issued by their country of residence, certificate holders will be able to show that they have been either fully vaccinated, tested negative or have immunity after a recent recovery. That will exempt them from most travel or quarantine restrictions.
Many European governments have already eased such rules, and each member nation can still revive protective measures if a country’s health situation deteriorates. Germany, for instance, has imposed restrictions on travelers coming from Portugal, which has faced a surge of new cases driven by the spread of the Delta variant.
While countries have agreed that national health authorities will issue the certificates — most E.U. countries have already been doing so — they are divided over who should check them, where and when.
Citing privacy concerns, Germany and Austria have not given airlines access to verification devices that they would need to scan the Q.R. codes. France has distributed such tools in airports, and Spain has built a system whereby Q.R. codes can be checked before passengers travel to the airport.
And one country, Ireland, has yet to set up a verification system for the digital certificates, after its national health system was recently targeted by cyberattacks, according to E.U. officials.
The divergences have highlighted the challenges that the E.U. faces in allowing free movement across the bloc.
This week, a group of airlines and airport representatives urged member states to set up verification systems before departure — alongside online check-ins, for instance — to avoid chaotic situations at airports upon arrival.
Echoing some concerns shared by the travel industry, the European Commission, the bloc’s executive arm, noted that the 27 E.U. member states had planned more than 10 verification processes.
“The digital Covid-19 certificate is an important tool that ideally will give people confidence in the easing of travel restrictions,” said Thomas Reynaert, the managing director of Airlines for Europe, an organization based in Brussels that represents the bloc’s largest carriers. “But this can only work for travelers if member states implement it in a harmonized way.”
While many countries are desperately trying to get their hands on coronavirus vaccines, others are now finding their supply outstripping demand because of low uptake — to the extent that they are seeking ways to reduce their stockpiles.
Romania is a case in point.
On Tuesday, the Danish government said it had bought more than a million doses of the Pfizer vaccine from Romania. “We can do this deal because Romania is experiencing low vaccination backing and therefore wants to sell excess vaccines which they won’t be able to use,” Denmark’s health minister, Magnus Heunicke, said in a statement. The vaccines were sold at cost.
Last week, Valeriu Gheorghita, the head of Romania’s national coronavirus vaccination campaign, said that 35,000 doses of the AstraZeneca vaccine would probably need to be destroyed because they were set to expire at the end of June. In a news conference on Thursday, he said he had asked AstraZeneca whether the doses’ shelf life could be extended.
Despite a promising start this year to its vaccine rollout, Romania has seen a considerable decline in recent months in the number of people getting vaccinated.
In early May, the country was administering more than 100,000 doses a day, but the number has since dropped significantly. In a 24-hour period ending Wednesday, 20,800 doses were administered, and most of those were the second of the two doses that many vaccines require.
Overall, 4.7 million people in Romania, which has a population of about 19 million, have received one or both doses.
“We had a fraction of the population, maybe 30 percent, who were eager to get the vaccine, and that was very clear from December when they ran the first opinion polls,” said Sorin Ionita, a policy analyst at the Expert Forum, a Bucharest-based research group. “You absorb this fraction of the population, and then everything stops because there was no proper campaign to inform, to change the profound attitudes in the population.”
Romania is one of the most rural countries in the European Union, he said, and that adds to the challenge.
“Even if you get to the village and you organize a vaccine center in the town hall,” Mr. Ionita said, “it doesn’t necessarily mean that people who are 85 can get there easily from the margins of the village.”
The drop in vaccination uptake in Romania also comes as infection rates have fallen sharply: Sunday was the first day in more than a year that the capital, Bucharest, did not record a single new case. But there are concerns about a potential new wave later in the year, especially if vaccination rates remain sluggish.
To date, there have been more than a million confirmed cases in Romania and more than 33,000 related deaths.
New Jersey’s yearlong ban on smoking inside casinos in Atlantic City will end on Sunday as the state continues to relax its coronavirus-related mandates.
But even as Gov. Philip D. Murphy acknowledged an end to the safety rule he implemented when casinos reopened a year ago, he strongly suggested that he supported efforts to make Atlantic City’s nine remaining casinos smoke free permanently.
Of the states with legalized gambling, nine, including New York and Massachusetts, bar smoking inside casinos, and many others permit it only within designated areas, according to the Centers for Disease Control and Prevention.
When asked Wednesday about the Fourth of July end to smoke-free casino floors, Mr. Murphy, a Democrat running for re-election, volunteered that he was “open-minded” to a pending legislative effort to end smoking inside gaming facilities.
“Would I be constructive on legislation?” Mr. Murphy said during a news briefing, adding, “I would be very constructive on that.”
Casinos, one of the state’s most powerful economic drivers, were among the first businesses to close in March 2020, as New Jersey became an early center of the virus, thrusting thousands of employees out of work over night.
An estimated 15.8 percent of workers in and around the seaside gaming hub lost jobs during the pandemic — the third-largest metropolitan decline nationwide, according to a recent study by the William J. Hughes Center for Public Policy at Stockton University.
When casinos reopened last July, smoking, which health officials warned could quickly spread the virus through exhaled vapor, was outlawed.
Some groups, including Smoke Free Atlantic City, a nonprofit funded by the state, have pressed to make the ban permanent even as officials with a casino trade association warned that would drive gamblers away and hurt the region’s recovery.
Bills that would bar smoking have not advanced in the State Legislature.
Although the White House recently acknowledged that President Biden did not expect to meet his self-imposed deadline of 70 percent of U.S. adults at least partly vaccinated by July 4, Anheuser-Busch still plans to offer to buy much of the United States a beer.
As the pool of the Americans most eager to get vaccinated has shrunk in recent months, the Biden administration has shifted its focus from prioritizing the benefits of mass vaccination sites to a persuasion campaign that highlights incentives to encourage hesitant or disinterested people to get vaccinated.
In early June, the brewing giant announced that it would offer free beer, contingent on the country reaching the president’s goal by the holiday. On Wednesday, the company said that it is still offering adults a $5 virtual credit card for beverages this weekend, whether or not they had been vaccinated.
Beginning at noon on Friday, and ending on Monday night, U.S. adults of legal drinking age can log on to a company website, provide personal information like their email address and ZIP code, and receive a gift card redeemable for an Anheuser-Busch beverage at bars, restaurants and other retailers.
“As people get back together with friends and family for Independence Day, we are celebrating the progress we’ve made together the best way we know how — over a beer — and are delivering on our promise of beer for America,” Michel Doukeris, the chief executive of Anheuser-Busch, said in a statement.
There are a variety of measures being tried across the United States in hopes that people will get vaccinated, like free rides from Uber or Lyft or free child care, and prizes like state-sponsored lotteries, free tickets for airplanes and sporting events, gift cards, joints, guns and, of course, beer.
“That’s right, get a shot and have a beer,” Mr. Biden said recently, noting the brewer’s move. “Free beer for everyone 21 years and over to celebrate the independence from the virus.”
Still, if the rate of adult vaccinations continues on the seven-day average, as of Wednesday, the country will come in just shy of his target, with about 67 percent of adults having at least one shot by July 4, according to a New York Times analysis.
Lazaro Gamio and Daniel E. Slotnik contributed reporting.
The Biden administration is expected to take its first steps on Thursday toward finalizing the details of a ban on surprise medical bills that Congress passed and President Donald J. Trump signed into law last winter. Some experts see the policy as the most important consumer protection legislation regarding health care to come out of Washington in more than a decade.
Surprise medical bills can arise when a doctor or other provider who isn’t in a patient’s insurance network becomes unexpectedly involved in a patient’s care. Patients may go to a hospital in their network, for example, but get treatment from emergency room physicians or anesthesiologists who are not — and who then send patients big bills directly.
Millions of Americans get such bills each year, and the pandemic highlighted the scope of the problem. Those hospitalized with Covid-19 sometimes found themselves facing thousands of dollars in medical debt from bills they could never have prevented.
One Covid patient in Philadelphia ended up with a $52,112 bill for an air ambulance transfer between hospitals while she was unconscious and on a ventilator. A woman in Texas was charged $4,000 by out-of-network doctors who cared for her during a 10-day hospitalization.
The new law, which goes into effect in 2022, would have prevented bills like those. The law was created in late 2020, but Congress gave regulators about a year to write more specific rules about how the policy will work. On Thursday, federal officials are expected to publish the first major regulation interpreting the plan.
“This law represents the single greatest patient protection since Obamacare,” said Adam Buckalew, who worked as a Republican staff member on the committees that wrote the bill in both the House and the Senate. “And it’s solidly bipartisan,” he added. Mr. Buckalew, now a consultant, is advising some health insurance groups interested in the details of the regulation.
Americans can now vacation in France and Spain, where roughly half the people have had at least one dose of a Covid-19 vaccine. But with limited exceptions, they still cannot travel to Canada.
In mid-June, to the frustration of many on both sides of the U.S. border, Canada announced that it was extending restrictions on nonessential travel until at least July 21. The ban includes travel by land, air and sea.
Canada lagged behind the United States in distributing vaccines, but has quickly caught up. According to the government’s health database, 65 percent of the population has received at least one vaccine dose and 19 percent were fully vaccinated as of June 19, the latest date for which figures are available.
The government has cited the spread of more transmissible coronavirus variants, such as Delta, as a reason for its caution.
“Even a fully vaccinated individual can pass on Covid-19 to someone who is not vaccinated,” Prime Minister Trudeau said during a virtual news conference on June 18.
The Canadian government plans to reopen the U.S. border in phases. On Monday, it will ease entry requirements for fully vaccinated Canadians, permanent residents and some eligible foreign nationals.
But discretionary travel, including tourism, remains prohibited. Before the pandemic, Americans accounted for about 15 million of the 22 million overnight international visitors to Canada. They spent an estimated 11 billion Canadian dollars of the 23 billion dollars spent by all international visitors in 2019.
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