Vaccines Are a New Tool in Global Diplomacy

President Biden touring a lab at the National Institutes of Health on Thursday.
Credit…Pete Marovich for The New York Times

The Biden administration says it has now secured enough vaccine to inoculate every American adult, but President Biden warned that logistical hurdles would most likely mean that many Americans will still not have been vaccinated by the end of the summer.

Officials said Thursday that they had arranged to get 200 million more doses of vaccine by the end of summer, which amounts to a 50 percent increase. That should be enough vaccine to cover 300 million people.

But it will still be difficult to get those shots into people’s arms, and Mr. Biden lamented the “gigantic” logistical challenge his administration faces during an appearance at the National Institutes of Health.

“It’s one thing to have the vaccine, it’s another thing to have vaccinators,” Mr. Biden said.

Mr. Biden also expressed open frustration with the former administration.

“It was a big mess,” he said. “It’s going to take time to fix, to be blunt with you.”

He said, “While scientists did their job in discovering vaccines in record time, my predecessor — I’ll be very blunt about it — did not do his job in getting ready for the massive challenge of vaccinating hundreds of millions.”

Health officials in the Trump administration have pushed back on those suggestions, pointing to hundreds of briefings that officials at the Department of Health and Human Services offered the incoming health team, including on vaccine allocation and distribution.

The department said Pfizer and Moderna would each provide 300 million doses by the end of July in “regular increments.”

The deal for 200 million additional doses of vaccine announced Thursday helps fulfill a promise Mr. Biden made in January to ramp up supply to cover more of the population. He said then that the administration was closing in on that deal with the two manufacturers as part of his larger pledge that some 300 million Americans could receive a dose of the vaccine by the end of the summer or the beginning of the fall.

On Thursday, Mr. Biden said his administration had “now purchased enough vaccine to vaccinate all Americans.”

And earlier in the day, Dr. Anthony S. Fauci, the government’s top infectious disease expert, predicted that as early as April, any American could begin seeking a vaccine in an “open season” that would extend availability beyond priority categories.

Still, the issue might be getting doses to people who do not readily seek them.

“We’ll be reaching more and more of the population, and more of the population you’ll have to make an extra effort to reach,” said Dr. Nicole Lurie, who was the assistant health secretary for preparedness and response under President Barack Obama. “You have to hope that as the supply continues to open up, that the public still has a lot of demand for vaccines. That’s really the unknown.”

United States › United StatesOn Feb. 22 14-day change
New cases 59,462 –40%
New deaths 1,454 –28%

World › WorldOn Feb. 22 14-day change
New cases 287,166 –19%
New deaths 6,753 –25%

U.S. vaccinations ›

Where states are reporting vaccines given

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Los Angeles Temporarily Closes 5 Coronavirus Vaccination Sites

Mayor Eric Garcetti said on Wednesday the city would close five of its Covid-19 vaccination sites, including Dodger Stadium, because of a supply shortage.

We’re vaccinating people faster then new vials are arriving, here in Los Angeles, and I’m very concerned right now. I’m concerned as your mayor that our vaccine supply is uneven, it’s unpredictable and too often, inequitable. By tomorrow, the city will have exhausted its current supply of the Moderna vaccine for first-dose appointments. This is an enormous hurdle in our race to vaccinate Angelenos, and unfortunately, it means that we will have to temporarily close Dodger Stadium and the other four non-mobile vaccination sites for two days on Friday and Saturday. As soon as we receive more supply, and I hope that we get — I’d love a call tonight or tomorrow from some source at the state or national level, saying we found some more, but most likely, hopefully Tuesday or Wednesday, we will reopen and start the business up again.

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Mayor Eric Garcetti said on Wednesday the city would close five of its Covid-19 vaccination sites, including Dodger Stadium, because of a supply shortage.CreditCredit…Philip Cheung for The New York Times

Facing a shortage of coronavirus vaccine doses, Los Angeles will temporarily close five of its inoculation sites, including one of the country’s largest, at Dodger Stadium, raising new questions about the federal government’s handling of supplies and distribution.

By Thursday, the city will have exhausted its supply of the Moderna vaccine for first-dose appointments, Mayor Eric Garcetti said at a news conference. The centers will be closed on Friday and Saturday with plans to reopen by Tuesday or Wednesday of next week, he said.

“We’re vaccinating people faster than new vials are arriving here in Los Angeles,” Mr. Garcetti said. “I’m concerned as your mayor that our vaccine supply is uneven, it’s unpredictable and too often inequitable.”

The United States has struggled to mount a mass vaccination campaign in the face of limited supply and logistical hurdles. President Biden has promised to administer 100 million vaccines by his 100th day in office, which falls on April 30.

The Centers for Disease Control and Prevention said on Thursday that about 34.7 million people have received at least one dose of a Covid-19 vaccine, including about 11.2 million people who have been fully vaccinated.

The federal government has delivered about 68.3 million doses to states, territories and federal agencies, with many kept in reserve for second doses. State and federal officials have come under fire for their handling of vaccines, as demand far outpaces supply and health care providers struggle to predict how many doses they might receive.

About 10 percent of Californians have received a vaccine, according to C.D.C. data.

The city-run Dodger Stadium site opened on Jan. 15 and vaccinated more than 85,000 people in its first two weeks, despite waits that could sometimes last hours. Administrators have reduced wait times, and the site was averaging more than 6,000 shots a day last week, far more than the city’s other sites.

As of Wednesday, Los Angeles had received 316,947 doses, had administered 98 percent of those and had 5,201 on hand, according to city officials. The demand for the vaccine has only increased in recent days, with health care workers and residents aged 65 or older eligible to receive the shots.

The total number of shots given out on Wednesday was a daily record, with nearly 19,000 vaccinated at the five sites and at two mobile clinics. But Mr. Garcetti said Los Angeles had received only 16,000 new doses of the vaccine this week.

Starting in December, California faced a dramatic spike in virus cases concentrated in the southern part of the state and in its main agricultural region, the Central Valley, as well as the spread of a new local strain that may be more transmissible.

California now leads the nation in cases and deaths. Infections peaked around the holidays and have declined since mid-January, but deaths remain at record highs.

Mr. Garcetti said that hospitalizations in Los Angeles were down to about 3,700 on Wednesday, the lowest number in months.

City officials said one of the main issues that led to the shortage was the unpredictability of their allocation of doses. The city does not have its own public health department and receives doses from the county, but the uncertainty at the county, state and federal levels over how many doses are coming in per week has made long-term planning difficult.

“We don’t know what we’re going to get,” said Christopher Covino, who helps oversee vaccine distribution for Mr. Garcetti. “Think of it like income. If I don’t know how much money I’m going to make next week, what do I buy? If you’re planning your life around that, it’s impossible. And if you’re planning a whole massive vaccination program where you’re trying to vaccinate 20,000 people a day, it’s an issue.”

Dodger Stadium was one of several mass vaccination sites to open at stadiums and convention centers across the country. The sites typically give out doses by the thousands in a drive-through format, allowing people to remain in their vehicles. But the mass-vaccine model has run into supply, technical and logistical problems. In Dallas, city officials struggled with technical glitches in its appointment registration system that led to people being turned away at the Kay Bailey Hutchison Convention Center.

Two mass vaccine sites in Arizona, at State Farm Stadium and the Phoenix Municipal Stadium, were not in danger of running out of vaccine, but officials were limiting appointments at the sites based on the anticipated supply of the Pfizer vaccine, said a spokesman with the Arizona Department of Health Services.

Despite shortage concerns, Los Angeles will continue its mobile vaccination program, Mr. Garcetti said. “We can’t afford to see the outbreaks and, quite frankly, the unequal deaths that we’re seeing in communities of color,” he said.

An operator testing the straps of a N95 mask.
Credit…Scott McIntyre for The New York Times

The White House on Thursday stepped into the fragmented market for disposable, virus-filtering N95 masks, moving to connect medical supply companies with mask manufacturers who say they are loaded with inventory but can’t find buyers — even in the midst of a pandemic in which doctors and nurses are desperate for the protective gear.

President Biden’s coronavirus response coordinator, Jeffrey D. Zients, intervened after reading about the mask manufacturers’ dilemma on Thursday in an article in The New York Times.

“We will do all we can to get frontline workers the personal protective equipment they need, including breaking down barriers for N95 manufacturers,” Mr. Zients said in a statement, adding that he had already “reached out to all of the major medical distributors to start connecting them with these new N95 mask manufacturers.”

A senior administration official said members of Mr. Zients’ team had had conversations with three top medical suppliers: McKesson Corporation, Cardinal Health and AmerisourceBergen.

The Times reported that nearly two dozen small American companies have recently jumped into the business of making N95s but are sitting on extra supply, in part because of ingrained purchasing habits of hospital systems, competition from China and bans on mask advertising by companies like Facebook and Google, which were trying to thwart price gouging early in the pandemic.

Mr. Zients said the White House intends to work with “online retailers to ensure they are making more of these products available to their customers.”

One mask manufacturer, Luis Arguello Jr., said he has 30 million masks for sale. After the pandemic exposed a huge need for protective equipment, and China closed its inventory to the world, his family-run business DemeTech, began making masks in its factories in Miami. It invested tens of millions of dollars in new machinery and then navigated a nine-month federal approval process that allows the masks to be marketed.

“It’s insane that we can’t get these masks to the people who desperately need them,” he said.

The shortage of masks was one of the most visible failures of the federal response to the coronavirus pandemic. One mask company executive, Mike Bowen of Prestige Ameritech, testified on Capitol Hill last year that he has been warning for years that the United States was too dependent on China for mask supply.

He raised alarms again in a letter to a Trump administration official in February 2020, a month before President Donald J. Trump declared the coronavirus a national emergency. “Please ask your associates to convey the gravity of this national security issue to the White House,” he wrote.

Credit…John Moore/Getty Images

Officials in Michigan have confirmed the presence of a highly contagious coronavirus variant in one of its state prisons, the first such case documented in an American correctional facility — and a potential harbinger of even wider dispersion of the virus in prisons, public health officials said.

Michigan prison and health officials said Wednesday that an employee at the Bellamy Creek Correctional Facility, in Ionia, Mich., was found to have been infected with the B.1.1.7 variant. That strain was first detected in December in the United Kingdom. It has been found to spread more easily than other coronavirus variants.

The variant’s potential to disseminate rapidly in prisons and jails, which are typically overcrowded, unsanitary and have poor ventilation, has alarmed public health experts.

When we see increased levels of contagiousness in spaces that are overcrowded that really do not lend themselves to social distancing, what we know is going to happen is that there will just be really an explosion of cases,” said Lauren Brinkley-Rubinstein, an assistant professor at the University of North Carolina School of Medicine. “And so it just means more cases, more rapid transmission, and more devastation for incarcerated people and staff that work in jails and prisons.”

Correctional facilities and detention centers have already been devastated by Covid-19, with more than 600,000 infections and 2,700 dead among inmates and correctional officers, according to a New York Times database tracking infections in prisons, jails and detention centers.

Michigan prison officials said that once they had confirmed the presence of the variant, they ordered daily testing of all inmates and staff members in the prison, which has more than 1,600 inmates. As of Thursday, about 500 inmates and 100 correctional officers at the facility had been infected with the coronavirus, and one inmate had died.

As of Thursday morning, it was not clear whether anyone at the prison — aside from the staff member — had been infected by the new variant.

But prison authorities have expressed concern about the possible diffusion of the variant because inmates had been transferred from the Bellamy Creek Correctional Facility to two other prisons, the Duane Waters Health Center and the Macomb Correctional Facility, before officials were aware that the staff member had been sickened.

The Duane Waters facility, in Jackson, is reserved for some of the state prison system’s most severely ill inmates.

The prison system “will be taking extra steps to identify where this variant is present amongst staff and the prisoner population and we will continue to do everything we can to keep the prisoners, our staff and the community safe,” Heidi Washington, director of the Michigan prison system, said in a news release.

An earlier version of this item misspelled Lauren Brinkley-Rubinstein’s surname.

Maura Turcotte and

People waited in line to receive the Moderna vaccine in San Diego last month.
Credit…Ariana Drehsler for The New York Times

Dr. Anthony S. Fauci, President Biden’s chief medical adviser for Covid-19, said Thursday that most members of the general public could become eligible to get the coronavirus vaccine as soon as April.

“As we get into March and April, the number of available doses will allow for much more of a mass vaccination approach,” he said in an interview with the “Today” co-host Savannah Guthrie.

States have so far been prioritizing vaccines for older people and health care and essential workers, as well as residents of long-term care facilities. Dr. Fauci has said in the past that vaccine availability was likely to increase significantly through the spring.

“I would imagine by the time we get to April, that will be what I would call, for better wording, ‘open season,’” he said on Thursday. “Namely, virtually everybody and anybody in any category could start to get vaccinated.”

It would take “several more months” after that to get the vaccines into most people’s arms, he said, adding that he hoped the overwhelming majority of people in the United States could be vaccinated by mid- to late summer.

Although vaccine distribution in the United States has so far been plagued by confusion, difficulties and delays, the average number of shots administered daily has been increasing steadily since late December. The Centers for Disease Control and Prevention reported that 1.56 million doses were given on Wednesday, bringing the latest seven-day average to more than 1.5 million a day.

The supply of vaccines is also growing, though it is still well below demand. Moderna and Pfizer, whose vaccines have been approved by the U.S. Food and Drug Administration, have been gradually increasing production. The F.D.A. could authorize a one-dose vaccine from Johnson & Johnson later this month, and other vaccines from Novavax and AstraZeneca could also be authorized for U.S. use in the spring.

A nurse at a community health center in New York City preparing the Moderna vaccine.
Credit…James Estrin/The New York Times

Some people who have been fully vaccinated do not need to quarantine if they are exposed to the coronavirus, the Centers for Disease Control and Prevention said Thursday.

The advice, published in the C.D.C.’s revised Covid-19 guidelines, applies only to those who were vaccinated more than two weeks and less than three months ago, and who have shown no symptoms of Covid infection.

The new guidance covers those who have received both shots of a two-dose vaccine or one shot of a single-dose vaccine, should one be approved, the agency said. It effectively puts vaccinated people in the same category as people who have had Covid-19 and gained natural immunity, and also are not advised to quarantine.

The C.D.C. had previously recommended quarantine for any vaccinated person exposed, because of a fear they could still harbor low levels of the virus and spread it to others, even if they showed no signs of illness.

The new advisory plays down that risk, noting that people with symptoms of Covid-19 are more likely to spread infection than asymptomatic ones, and saying that the benefits of ending quarantine outweighed the downside.

Quarantines not only complicate family lives, forcing people to leave jobs and shifting household burdens to others, but they also divert health care resources needed to address higher-risk people, said John T. Brooks, the chief medical officer at the C.D.C.’s Covid-19 Response unit.

Health workers have to perform contact tracing on quarantined people, monitor their compliance with the sequester, monitor for signs of illness and certify an all-clear at the quarantine’s end. “It’s a lot of work, especially when public health resources are strained,” Dr. Brooks said.

But the new policy raised questions with one expert, who said it appeared to contradict other C.D.C. guidelines that advise fully vaccinated people to practice many of the same precautions recommended to those who lack immunity.

“It seems contradictory,” said Leana S. Wen, an emergency physician and public health professor at George Washington University in Washington, D.C. “It suggests that these individuals are not likely to be carriers, but we don’t know that that is true.”

A clear answer to that question, she said, would be a boon to many vaccinated people, most of them over 65, who long to travel to visit relatives but have no clear indication of whether that would be safe.

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‘We Need a Circuit Breaker’: Victoria Enters Lockdown

After multiple new cases of coronavirus were identified in Victoria, Australia, officials placed the region under lockdown, despite the tennis tournament currently taking place there.

I am sad to have to report it is the advice to me that we must assume that there are further cases in the community than we have positive results for, and that it is moving at a velocity that has not been seen anywhere in our country over the course of these last 12 months. Because this is so infectious and is moving so fast, we need a circuit breaker. Therefore, I’m announcing on advice from the chief health officer and after a meeting of relevant cabinet committees and the full cabinet, that from 11:59 p.m. tonight, Victoria, all of Victoria, will go to Stage 4. These restrictions are all about making sure that we respond appropriately to the fastest-moving, most infectious strain of coronavirus that we have seen. I know this is not the news that Victorians want to hear today. I know it’s not the place that we want it to be in. However, we’ve all given so much. We’ve all done so much.

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After multiple new cases of coronavirus were identified in Victoria, Australia, officials placed the region under lockdown, despite the tennis tournament currently taking place there.CreditCredit…Darrian Traynor/Getty Images

More than six million people in Victoria, Australia, will enter into a snap lockdown for five days in response to a coronavirus outbreak at a quarantine hotel.

The order came as the Australian Open was being held in Melbourne, Victoria’s capital, but the tennis tournament will continue — without spectators — the authorities said on Friday.

Victorians will be allowed to leave home only for essential shopping, work, exercise and caregiving, and must wear masks whenever they leave home.

But while sports and entertainment venues will be shut down, professional athletes like tennis players will be classified as “essential workers” and allowed to continue their matches.

“There are no fans; there’s no crowds. These people are essentially at their workplace,” Daniel Andrews, the premier of Victoria, told reporters on Friday. “It’s not like the only people that are at work are supermarket workers.”

Tennis Australia said in a statement that it would notify all ticket holders of the changes and continue “to work with the government to ensure the health and safety of everyone.”

The lockdown, which goes into effect at 11:59 p.m. on Friday, comes after an outbreak at a Holiday Inn near the Melbourne Airport that was being used to house returned travelers.

By Friday, 13 people linked to the hotel had tested positive with the new virus variant that first emerged in Britain. In the past 24 hours, five new cases have been identified, bringing the state’s total number of cases to 19.

Describing the lockdown as a “circuit breaker,” the authorities said it was critical to stopping the spread of the variant, which is highly infectious and has outwitted contact tracers before they can contain outbreaks. Similar snap lockdowns in Perth and Brisbane in recent months were successful in quashing infections.

“The game has changed,” Mr. Andrews said. “This is not the 2020 virus.”

He said he hoped Victorians, who endured among the longest lockdowns in the world last year, would work together to prevent the state from entering a third wave of the coronavirus. “We will be able to smother this,” he said.

The order had ripple effects in Australia’s other states, which all announced travel restrictions with Victoria. International flights, excluding freight, into Melbourne were also canceled.

A woman walking near Anichkov bridge in St. Petersburg, Russia.
Credit…Sergey Ponomarev for The New York Times

The coronavirus has been used as an excuse to restrict free speech in dozens of countries, according to a report released Thursday by Human Rights Watch, a New York-based advocacy organization.

Pointing to cases of censorship, arbitrary arrest and physical assault, the report found that at least 83 governments around the world have used the pandemic to justify silencing critics or preventing peaceful assembly.

It found that in at least 18 countries, military or police forces assaulted journalists, bloggers or critics of the government’s response to the pandemic, and that in at least 10 countries, officials used social distancing concerns to prevent or disband protests, even while allowing other large gatherings.

The findings expose a tension at the heart of coronavirus restrictions: Some of the same tools officials have used to save lives and slow the spread of Covid-19 — such as restricting large gatherings, countering misinformation or instituting lockdowns — can also be used by authoritarian governments as a pretext to monitor citizens or quash dissent.

China, Cuba, India, Egypt and Russia are among the countries where the restrictions on free speech have been felt most broadly, according to Human Rights Watch.

“The obligation of governments to protect the public from this deadly pandemic is not a carte blanche for placing a chokehold on information and suppressing dissent,” Gerry Simpson, associate crisis and conflict director at the organization, said in a news release.

The report relied on research from Human Rights Watch as well as data and reports from other nongovernmental organizations including the United Nations.

Tocilizumab, a drug used to treat arthritis, was recently approved for wider use to treat hospitalized Covid-19 patients in Britain.
Credit…Pascal Rossignol/Reuters

LONDON — An arthritis drug was found to reduce the risk of death for hospitalized Covid-19 patients in a large clinical trial in Britain, bolstering the prospects for widespread use of the drug after promising, but mixed, results in earlier and smaller studies.

The drug, tocilizumab, lowered the death rate in severely ill Covid-19 patients to 29 percent, compared with 33 percent in patients who were not given the treatment, according to a paper posted online on Thursday that has not yet undergone formal scientific review.

Those results translated to one life being saved for every 25 patients treated with the drug, a significant reduction in mortality that would also relieve pressure on overstretched health systems.

Desperate to combat a wave of infections and deaths, Britain encouraged doctors last month to begin using tocilizumab after a smaller study showed promising signs of its effectiveness. The British government said on Thursday that it would now make the drug available to thousands more patients.

“That’s good for patients and good for the health service,” said Martin Landray, a professor at the University of Oxford who helped lead the study, adding that it would pay dividends “not only here in the U.K., but internationally.”

Few drugs so far have been found to reduce Covid-19 deaths in large clinical trials. Steroids like dexamethasone, which was found to reduce deaths by one-third in patients on ventilators and by one-fifth in patients on oxygen, were identified by the same set of clinical trials in Britain, a testament to the role of the country’s centralized National Health Service in allowing researchers to identify Covid-19 treatments.

Drug studies in the United States have been comparatively poorly organized.

“After dexamethasone, this is the most significant advance in the treatment of Covid that has an impact in reducing deaths,” Athimalaipet Ramanan, a professor of pediatric rheumatology at the University of Bristol, said of the findings on tocilizumab.

The study included more than 4,000 patients, half of whom were given the drug on top of standard treatments like dexamethasone, and half of whom were not. Beyond reducing deaths, it also increased the chances of patients being discharged from the hospital within 28 days.

Tocilizumab, an anti-inflammatory drug, works to tamp down the immune system’s reaction to the coronavirus, which can go into overdrive in some instances and destroy the body’s own tissues. A few smaller studies earlier in the pandemic showed little to no benefit in people hospitalized for Covid-19, and doctors have said it may work on some, but not all, patients.

While dexamethasone is relatively cheap — about 5 pounds, or $7, per course — tocilizumab can cost roughly 500 pounds, or $700, per treatment, meaning that it may be less widely available. Even that price, though, is less than the cost per day of an intensive care bed in Britain.

Family skate night at an arena in Cleveland in November. Ohio has lifted a curfew in place since then.
Credit…Da’Shaunae Marisa for The New York Times

Two weeks, ago, Gov. Mike DeWine of Ohio said if the state’s hospitalization numbers continued to fall below 2,500 for seven straight days, he would lift a statewide late-night curfew.

On Thursday he offered a bit of good news: “We’ve blown through it,” Mr. DeWine said at a news conference where he announced the end of the curfew.

Hospitalizations in the state have decreased 34 percent over the past two weeks, down from a peak of 5,296 people on Dec. 15. On Wednesday, 1,922 people were hospitalized with Covid-19, according to a New York Times database.

Over the past week, there has been an average of 3,129 cases per day, a decrease of 39 percent from the average two weeks earlier.

Mr. DeWine cautioned that the more contagious variants that are gaining a foothold across the United States could land Ohio “back in a situation of climbing cases” — and in that case the curfew could be reinstated.

In the meantime, he said, there are small steps people can take to make that less likely.

“It’s very important for us to continue doing what we’ve been doing,” the governor said. “Get the vaccine into our arms as quick as we can, but at the same time we have to continue to wear a mask and continue to keep our distance.”

Mr. DeWine said a weekly survey of statewide mask use was holding steady at 93 percent. “It’s just part of what we’re going to have to do,” he said.

Mr. DeWine, an otherwise low-key career politician, became a household name during the pandemic as he took early and bold actions to lock down his state, even as the head of his party, President Donald J. Trump, dismissed the threat of the pandemic.

The curfew, first declared in November, required people to stay home during late evening and overnight hours with exceptions for emergencies, grocery shopping and other essential activities. The governor had considered closing bars, restaurants and fitness centers altogether at the time, but decided the economic impact would have been too damaging.

The lifting of the curfew also brings the end of a 10 p.m. “last call” order. Mr. DeWine said there are no plans to reinstate that order.

The state also expanded its coronavirus vaccine eligibility.

Starting next week, Ohioans with designated pre-existing conditions will be eligible for the vaccine. Early efforts to vaccinate residents of nursing homes and long-term care facilities have already shown great success. Coronavirus cases in those facilities have dropped 77 percent since November.

President Donald J. Trump leaving the hospital in October.
Credit…Doug Mills/The New York Times

Covid-19 took a worse toll on President Donald J. Trump last October than was publicly acknowledged at the time, according to four people familiar with his condition.

At one point, they said, the president had extremely depressed blood oxygen levels and a lung problem associated with pneumonia caused by the coronavirus.

His prognosis became so worrisome before he was taken to Walter Reed National Military Medical Center that officials believed he would need to be put on a ventilator, two of the people familiar with his condition said.

The people familiar with Mr. Trump’s health said he was found to have lung infiltrates, which occur when the lungs are inflamed and contain substances such as fluid or bacteria. Their presence, especially when a patient is exhibiting other symptoms, can be a sign of an acute case of the disease. They can be easily spotted on an X-ray or scan, when parts of the lungs appear opaque, or white.

Mr. Trump’s blood oxygen level alone was cause for extreme concern, dipping into the 80s, according to the people familiar with his evaluation. The disease is considered severe when the blood oxygen level falls to the low 90s.

The new revelations about Mr. Trump’s struggle with the virus underscore the limited and sometimes misleading nature of the information disclosed at the time about his condition.

The former president resisted being taken from the White House to Walter Reed, relenting when aides told him that he could walk out on his own or risk waiting until the U.S. Secret Service was forced to carry him out if he got sicker, two people familiar with the events said.

A dose of vaccine manufactured in India being administered in Colombo, Sri Lanka, in January.
Credit…Dinuka Liyanawatte/Reuters

It’s one of the world’s most in-demand commodities and has become a new currency for international diplomacy: Countries with the means or the know-how are using coronavirus vaccines to curry favor or thaw frosty relations.

India, the unmatched vaccine manufacturing power, is giving away millions of doses to neighbors friendly and estranged. It is trying to counter China, which has made doling out shots a central plank of its foreign relations. And the United Arab Emirates, drawing on its oil riches, is buying shots on behalf of its allies.

But the strategy carries risks.

India and China have vast populations of their own that they need to inoculate. Although there are few signs of grumbling in either country, that could change as the public watches doses be sold or donated abroad.

“Indians are dying. Indians are still getting the disease,” said Manoj Joshi, a distinguished fellow at the Observer Research Foundation, a New Delhi think tank. “I could understand if our needs had been fulfilled and then you had given away the stuff. But I think there is a false moral superiority that you are trying to put across where you say we are giving away our stuff even before we use it ourselves.”

For India, its soft-power vaccine drive has given it a rejoinder to China after years of watching the Chinese make political gains in its own backyard — in Sri Lanka, the Maldives, Nepal and elsewhere. Beijing offered deep pockets and swift answers when it came to big investments that India, with a layered bureaucracy and slowing economy, has struggled to match.

So India has sent vaccine doses to Nepal, a country that has fallen increasingly under China’s influence. And Sri Lanka, in the midst of a diplomatic tug of war between New Delhi and Beijing, is getting doses from both.

The donating countries are making their offerings at a time when the United States and other rich nations are scooping up the world’s supplies. Poorer countries are frantically trying to get their own, a disparity that the World Health Organization recently warned has put the world “on the brink of a catastrophic moral failure.”

With their health systems tested as never before, many countries are eager to take what they are offered — and the donors could reap some political good will in reward.

“Instead of securing a country by sending troops, you can secure the country by saving lives, by saving their economy, by helping with their vaccination,” said Dania Thafer, the executive director of the Gulf International Forum, a Washington-based think tank.

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