Short on vaccines, Asia grapples with Delta-driven outbreaks.

https://www.nytimes.com/live/2021/07/11/world/covid-coronavirus-updates

Graveyard workers taking a rest from burying coronavirus victims at a cemetery in Surabaya, Indonesia, on Friday.
Credit…Juni Kriswanto/Agence France-Presse — Getty Images

In recent days, Indonesia has reported nearly twice as many coronavirus cases as the United States. Malaysia’s per capita caseload is roughly on par with those of Brazil and Iran. And the latest Covid surges in Japan and South Korea have prompted harsh new restrictions on movement there, effective Monday.

Across the Asia-Pacific region, the Delta variant is driving new outbreaks in places where transmission was once kept relatively low, but where the pace of vaccination has been too slow to contain the latest outbreaks. One result is that everyday activities are again being restricted, just as they were in the anxious, early days of the pandemic — even as the West edges back to normalcy.

Indonesia, the world’s fourth most populous country, is a case in point. Its government once hoped that its archipelagic geography and youthful population would spare it a debilitating outbreak. But only about 13 percent of its 270 million people have received at least one dose of a Covid-19 vaccine, and the rise of Delta is pushing its health system to the brink and forcing some patients to hunt for oxygen.

On July 3, the government closed mosques, schools, shopping malls and sports facilities on two of Indonesia’s major islands for two weeks. But the daily average of new cases — more than 33,000 as of Sunday — has continued to climb. Officials said on Friday that they would extend the same emergency rules to other islands.

Intensive care wards in and around the capital, Jakarta, have been operating at full capacity, and doctors who received the vaccine made by the Chinese company Sinovac have been falling ill or dying. The government has said it will administer a third dose, of the Moderna vaccine, to about 1.5 million health workers starting this week.

In other Southeast Asian countries, too, the percentages of populations that have gotten even one shot are in the single or low double digits. And as variant-driven infections proliferate, some are seeing their worst outbreaks yet.

In Myanmar, where health workers have been striking to protest the military’s February coup, cases are sharply rising and schools have been closed until July 23. People in several Malaysian cities are chafing under strict lockdowns as the country reports the region’s highest per capita caseload. Vietnam is restricting movement in its two major cities and scrambling to import vaccines. And a terminal at Thailand’s largest international airport is being converted into a field hospital.

Richer countries in the region have more resources to throw at the virus. But they, too, are vulnerable because they have made little progress in their vaccination drives. In Australia, Japan, New Zealand and South Korea, less than one person in three has had a shot, according to a New York Times tracker.

New South Wales, Australia’s most populous state, reported its largest daily increase in cases this year on Sunday, as well as Australia’s first coronavirus-related death this year, a woman in her 90s. Sydney, the state capital, has already been under a stay-at-home lockdown, and the authorities have warned that it could be extended past July 17, when it is set to expire.

South Korea reported 1,378 new cases on Saturday, its third consecutive daily record. The government plans to raise restrictions to the highest level in Seoul, the capital, and some neighboring regions as of Monday. Schools will be closed, bars and nightclubs will be shut, and no more than two people will be allowed to meet in public after 6 p.m.

And in Japan, Tokyo’s fourth state of emergency will take effect on Monday, less than two weeks before the Summer Olympics begin there. Restaurants, department stores and other businesses will be asked to close early, and organizers of the Summer Games have said they will bar spectators from most events in Tokyo and its surrounding areas. A ceremony marking the Olympic torch’s arrival in the city late last week was held in a nearly empty park.

On Saturday, Fukushima Prefecture said that it would also ban spectators from Olympic events because of the surging caseload, reversing a position announced two days earlier by Olympic organizers.

People, mostly residents of Iran, waited in line to receive Covid-19 vaccines in Yerevan, Armenia, on Friday. Armenia’s offer of free vaccines to any foreign visitor has drawn many people from neighboring countries.
Credit…Lusi Sargsyan/PHOTOLURE, via Associated Press

Thousands of Iranians frustrated with the government’s chaotic vaccine rollout and desperate for protection after enduring wave after wave of the coronavirus are flocking by air and land to neighboring Armenia to be vaccinated against Covid-19.

Iran is enduring a fifth wave of the pandemic, with Tehran and 143 cities declared high-risk “red” zones and the highly contagious Delta variant of the virus spreading quickly. Over the past two weeks, Iran’s average daily caseload has risen by 62 percent, to more than 16,000, according to a New York Times database.

Only about 2 percent of Iran’s 84 million people been fully vaccinated, according to the Our World in Data project at the University of Oxford. With U.S.- and British-made vaccines banned by Ayatollah Ali Khamenei, Iran’s top leader, the country is waiting for shipments of vaccines made by China and Russia.

Across the border in Armenia, a country of three million, there are more vaccine doses than people willing to take them, largely because of widespread conspiracy theories and misinformation. Officials there announced in May that they would provide free vaccines to foreigners without registration. Mobile clinics were set up in the streets to make them easily accessible to tourists and visitors. Iranians don’t need a visa to travel to Armenia, and the drive from the border to the capital, Yerevan, is about seven hours.

Based on Iran’s vaccine eligibility chart, Parvin Chamanpira, 53, and her husband calculated that it would be months before they qualified, so they traveled from Tehran to Yerevan last week and received their shots from an ambulance parked on the side of the road. She said it took about five minutes, requiring only a blood pressure check and no paperwork. They will return in a few weeks for their second shots.

“This is not an ideal choice for Iranians to be forced to travel and spend a lot of money and be stressed out for getting a vaccine,” Ms. Chamanpira said. “We would not do it if we didn’t have to.”

Armenian officials have not said how many foreign nationals have received vaccinations, but the number of flights between Tehran and Yerevan has been increased to meet the demand. Tickets are sold out until late August, travel agents said. Bus tours centered around vaccinations are also booked. Some Iranians are chartering their own buses and vans or driving their own cars across the border, according to several people organizing the trips.

In a social media group dedicated to planning vaccination trips to Armenia, Iranians at the border posted videos on Friday showing lines of cars and people stretching for miles, saying the wait was at least 13 hours.

Among ordinary Iranians and medical workers facing the surge in cases, anger at the government is mounting. Some prominent physicians have called for the health minister to be prosecuted for his mishandling of the pandemic and the vaccine rollout.

“Our only weapon is immediate and fast vaccination of the public,” Dr. Saeedreza Mehrpour, the head of Shariati Hospital in Tehran, said on his Instagram page on Thursday, criticizing the country’s leaders for putting defiant ideology over public health. “I wish we had better relations with the worlds.”

President Hassan Rouhani said this month that Iran would expand its vaccine distribution effort in the coming weeks by importing more foreign vaccines and producing domestic ones. So far it has received more than 2.1 million doses of the AstraZeneca vaccine through Covax, the global vaccine-sharing program.

In the meantime, Iranians seeking vaccination have been largely left on their own, including those in higher-risk groups. Fahimeh Hosseini, 72, a retired banker, said she recently waited for four hours with dozens of other older people outside a clinic in Tehran for a second dose of the vaccine, only to be told there were no more. The clinic told them appointments for a second dose could not be scheduled because there was no predicting when the vaccine would be in stock.

“They told us to keep coming back until you get lucky,” she said.

The lack of vaccines has led some Iranians to turn to the black market. One 37-year-old manager of a trade company, who declined to use his name because he had acted illegally, said he was told he was buying the AstraZeneca vaccine but had no way to know if that was true.

Iran’s intelligence ministry announced this week that it had made arrests among several networks illegally selling and distributing Covid vaccines.

Emily Robart, a clinical research coordinator at the University of Ohio, demonstrated the Covid-19 breathalyzer test that is currently under review by the F.D.A.
Credit…Maddie McGarvey for The New York Times

Scientists have long been interested in creating portable devices that can quickly and painlessly screen a person for disease simply by taking a whiff of their breath. But delivering on this dream has proved to be a challenge. Different diseases may cause similar breath changes. Diet can affect the chemicals someone exhales, as can smoking and alcohol consumption, potentially complicating disease detection.

Still, scientists say, advances in sensor technology and machine learning, combined with new research and investment spurred by the pandemic, mean that the moment for disease-detecting breathalyzers may have finally arrived.

“I’ve been working in the area of breath research for almost 20 years now,” said Cristina Davis, an engineer at the University of California, Davis. “And during that time, we’ve seen it progress from a nascent stage to really being something that I think is close to being deployed.”

In May, when musicians from dozens of countries descended on Rotterdam, the Netherlands, for the Eurovision Song Contest, they had to pass a breath test before they were allowed onstage. The musicians were asked to exhale into a device the size of a water bottle called the SpiroNose, which analyzed the chemical compounds in their breath to detect signatures of a coronavirus infection. If the results came back negative, the performers were cleared to compete.

The SpiroNose, made by the Dutch company Breathomix, is just one of many breath-based coronavirus tests under development across the world. In May, Singapore’s health agency granted provisional authorization to two such tests, made by the domestic companies Breathonix and Silver Factory Technology. And researchers at Ohio State University say they have applied to the U.S. Food and Drug Administration for an emergency authorization of their coronavirus breathalyzer.

“It’s clear now, I think, that you can detect this disease with a breath test,” said Paul Thomas, a chemist at Loughborough University in England. “This isn’t science fiction.”

GLOBAL ROUNDUP

Auckland, New Zealand, in June. The country, which closed its borders early in the pandemic, has all but eliminated the coronavirus.
Credit…Sylvie Whinray/New Zealand Herald, via Associated Press

Strict lockdowns in New Zealand last year appear to have contributed to a recent outbreak in children of respiratory syncytial virus, or R.S.V., a highly contagious, flulike illness whose symptoms include a runny nose, coughing, sneezing and fever.

Children in New Zealand were mostly stuck indoors amid lockdowns last autumn, which runs from March to May in the Southern Hemisphere. After the country reopened last winter, health officials say, few of them contracted seasonal viruses and infections, probably because they had been underexposed to germs.

In a typical year, New Zealand sees a peak of cases of respiratory infections from June to September. But in 2020, the country experienced “the complete absence of an annual winter influenza epidemic,” with a 99.9 percent reduction in flu cases and a 98 percent reduction in R.S.V., according to a study published in Nature in February.

This year, however, the same children have been more vulnerable than usual to those same ailments.

Since the start of winter five weeks ago, during which there have been no coronavirus restrictions, children’s wards in New Zealand have seen dozens of patients, many of them infants, battling the sometimes deadly disease, while some elementary schools have reported having as many as half their students absent because of respiratory illnesses.

The country has reported 969 cases of R.S.V. in five weeks, compared with an average of 1,743 cases over the entire 29-week winter season in the five years before the pandemic, according to New Zealand’s Institute of Environmental Science and Research.

The recent surge has yet to reach a plateau, said Dr. Sue Huang, a virologist at the Institute of Environmental Science and Research and the lead author of the Nature study.

“The exponential increase is very sharp,” she said in a statement. “The absence of R.S.V. last winter meant there is a young cohort of children from last year, plus a new cohort this year, who have not been exposed to the seasonal virus.”

Doctors around the world have warned of the risk of “immunity debt,” when a decline in the number of viral and bacterial infections during lockdowns is followed by more sickness once restrictions are lifted.

In a paper published in May in the journal Infectious Diseases Now, a team of French medical researchers suggested that less exposure to microbial agents could create a lack of “immune stimulation” for susceptible people, particularly in children. “The longer these periods of ‘viral or bacterial low-exposure’ are, the greater the likelihood of future epidemics,” they wrote.

New Zealand closed its borders early in the pandemic, unveiling stringent lockdown measures that were lifted last April and May and have allowed the country to all but eliminate coronavirus transmission. No community cases have been reported for more than four months.

In other developments around the world:

  • Spain is facing a further hit to its summer tourism season after Germany classified the entire country as a “risk area.” As of Sunday, travelers entering Germany from anywhere in Spain, including its Balearic and Canary archipelagoes, will have to provide a negative coronavirus test or proof of vaccination or recovery to avoid quarantine. The Italian government also warned on Saturday that it was considering greater restrictions on travelers from Spain as well as Portugal. Both countries have been grappling with a surge in coronavirus cases fueled by the highly contagious Delta variant, particularly among unvaccinated young people.