Early in the pandemic, there was hope that the world would one day achieve herd immunity, the point when the coronavirus lacks enough hosts to spread easily. But over a year later, the virus is crushing India with a fearsome second wave and surging in countries from Asia to Latin America.
That means if the virus continues to run rampant through much of the world, it is well on its way to becoming endemic, an ever-present threat.
Virus variants are tearing through places where people gather in large numbers with few or no pandemic protocols, like wearing masks and distancing, according to Dr. David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.
While the outbreak in India is capturing the most attention, Dr. Heymann said the pervasive reach of the virus means that the likelihood is growing that it will persist in most parts of the world.
As more people contract the virus, developing some level of immunity, and the pace of vaccinations accelerates, future outbreaks won’t be on the scale of those devastating India and Brazil, Dr. Heymann said. Smaller outbreaks that are less deadly but a constant threat should be expected, Dr. Heymann said.
“This is the natural progression of many infections we have in humans, whether it is tuberculosis or H.I.V.,” said Dr. Heymann, a former member of the Epidemiology Intelligence Service at the Centers for Disease Control and Prevention and a former senior official at the World Health Organization. “They have become endemic and we have learned to live with them and we learn how to do risk assessments and how to protect those we want to protect.”
Vaccines that are highly effective against Covid were developed rapidly, but global distribution has been plodding and unequal. As rich countries hoard vaccine doses, poorer countries face big logistical challenges to distributing the doses they manage to get and vaccine hesitancy is an issue everywhere. And experts warn the world is getting vaccinated too slowly for there to be much hope of ever eliminating the virus.
Only two countries have fully vaccinated more than half of their populations, according to the Our World in Data project at the University of Oxford. They are Israel and the East African nation of the Seychelles, an archipelago with a population of fewer than 100,000. And just a handful of other countries have at least partially vaccinated nearly 50 percent or more, including Britain, tiny Bhutan, and the United States.
Less than 10 percent of India’s vast population is at least partly vaccinated, offering little check to its onslaught of infections.
In Africa, the figure is slightly more than 1 percent.
Still, public health experts say a relatively small number of countries, mostly island nations, have largely kept the virus under control and could continue keeping it at bay after vaccinating enough people.
New Zealand, through stringent lockdowns and border closures, has all but eliminated the virus. Dr. Michael Baker, an epidemiologist at the University of Otago who helped devise the country’s coronavirus response, said New Zealand would likely achieve herd immunity by immunizing its population, but it has a long way to go with only about 4.4 percent of New Zealanders at least partially vaccinated.
“All of the surveys show there is a degree of vaccine hesitancy in New Zealand, but also a lot of people are very enthusiastic,” Dr. Baker said. “So I think we will probably get there in the end.”
While new daily cases have remained at near-world record levels, the number of deaths has dropped from a peak in February, going against the normal pattern of high cases followed eventually by high deaths. If that trendline continues, it could offer a glimmer of hope for a future scenario that scientists are rooting for: Even as the virus spreads and seems to be hurtling toward becoming endemic, it could become a less lethal threat that can be managed with vaccines that are updated periodically to protect against variants.
“It may be endemic, but not in a life-threatening way,” Dr. Michael Merson, a professor of global health at Duke University and former director of the World Health Organization’s Global Program on AIDS said. “It may be more like what we see with young kids, a common cold like disease.”
Madeleine Ngo contributed reporting.
Dr. Anthony S. Fauci said on Sunday that he was open to relaxing indoor masking rules as more Americans are vaccinated against the virus, just two days after the Centers for Disease Control and Prevention belatedly emphasized the danger of airborne transmission.
Dr. Fauci, President Biden’s chief medical adviser for the pandemic, said that as vaccinations climb, “we do need to start being more liberal” in terms of rules for wearing masks indoors, though he noted that the nation was still averaging about 43,000 cases of the virus daily. “We’ve got to get it much, much lower than that,” he said.
On Friday, the C.D.C. updated its guidance about how the coronavirus spreads, stating explicitly that people could inhale airborne virus even when they were more than six feet away from an infected individual. Previously, the agency had said that most infections were acquired through “close contact, not airborne transmission.”
The update brought the agency in line with evidence of the danger from airborne droplets that epidemiologists had noted as the pandemic unfolded last year. According to some experts, it also underscored the urgency for the federal Occupational Safety and Health Administration to issue standards for employers to address potential airborne hazards in the workplace.
Dr. Fauci’s comments on Sunday came in response to a question about comments that Dr. Scott Gottlieb, the former head of the Food and Drug Administration, made last week on CNBC. Dr. Gottlieb said that relaxing indoor mask mandates now — “especially if you’re in environments where you know you have a high level of vaccination” — would give public health officials “the credibility to implement them” again in the fall or winter if cases surge.
Dr. Fauci, asked by George Stephanopoulos on ABC’s Sunday program “This Week” whether he agreed, said: “I think so, and I think you’re going to probably be seeing that as we go along, and as more people get vaccinated.”
“The C.D.C. will be, almost in real time, George, updating their recommendations and their guidelines,” Dr. Fauci continued. “But yes, we do need to start being more liberal as we get more people vaccinated.”
Over a third of the U.S. population — more than 112 million people — is fully vaccinated and another 40 million people have received the first dose of a two-dose protocol.
The C.D.C., which issues national guidance on masking, says that even vaccinated people should continue to wear masks in indoor public spaces, including restaurants when they are not actively eating and drinking. In many places across the country, it is clear that the guidance is not being followed.
In a separate interview on Sunday, on CNN’s “State of the Union,” Jeffrey Zients, Mr. Biden’s Covid response coordinator, was somewhat more circumspect than Dr. Fauci when asked about Dr. Gottlieb’s comments.
“I think everyone is tired, and wearing a mask is — it can be a pain,” Mr. Zients said. “But we’re getting there. And the light at the end of the tunnel is brighter and brighter. Let’s keep up our guard. Let’s follow the C.D.C. guidance. And the C.D.C. guidance across time will allow vaccinated people more and more privileges to take off that mask.”
Mr. Zients also suggested that instead of reaching herd immunity — the point when enough people are immune to the virus that it can no longer spread through the population — the goal should be to achieve some sense of normalcy by getting 70 percent of Americans immunized. President Biden has called for 70 percent to have at least one dose by July 4.
Reaching 70 percent will create “a pattern of decreasing cases, hospitalizations and deaths and take us down to a sustainable low level,” Mr. Zients said, pointing to Israel, a world leader in vaccinations, as a model.
In that country, vaccinations have reached almost 60 percent of the population since they began on Dec. 19 last year, and the seven-day average of new cases has dropped from a high of more than 8,600 on Jan. 17 to fewer than 60 as of Saturday.
China said on Sunday that it had taken steps to prevent coronavirus cases from entering the country — over the top of the world’s tallest mountain.
Nyima Tsering, head of the Tibet Sports Bureau, told the state-run Xinhua News Agency that control measures would be put in place on Mount Everest, including the installation of a dividing line on the summit to prevent climbers from the Chinese side and the Nepal side from coming into contact.
Last week, a team of Sherpa guides affixed a rope to the summit of Mount Everest from the Nepal side, allowing expeditions to resume for the first time since the pandemic forced a cancellation of attempts last year.
Nepal has this year approved a record 408 permits to climb Everest, even as coronavirus cases have surged in the country and several climbers have been flown from base camp with symptoms of Covid-19.
China, which has approved just 21 permits to climb the mountain from its side this year, has expressed concern about the risk of coronavirus transmission on the mountain. Since the coronavirus first emerged in China in 2019, the country has carried out strict measures to prevent its spread internally and reintroduction from abroad.
The border between Nepal and China crosses the peak of Everest, a small area where a handful of climbers can stand after making a successful ascent. At the summit, 29,031.7 feet above sea level, most climbers already wear masks to supply oxygen and protect themselves from the cold. But China will implement additional steps to reduce the risk of transmission.
In addition to restrictions on the summit, a checkpoint has been installed outside the Chinese base camp. People returning from the Chinese side will have to undergo disinfection, temperature checks and potentially isolation, Xinhua reported.
NEW DELHI — Doctors in India are concerned about an increasing number of potentially fatal fungal infections affecting either people who have Covid-19 or those who have recently recovered from the disease.
The condition, known as mucormycosis, has a high mortality rate and was present in India before the pandemic. It is caused by a mold that thrives in wet environments and can attack through the respiratory tract, potentially eroding facial structures and harming the brain.
The condition is relatively rare, but doctors and medical experts say it seems to be infecting some Covid patients whose weakened immune systems and underlying conditions, particularly diabetes, leave them vulnerable.
Some experts attribute the fungal infections to an increased use of steroids to treat hospitalized patients. Another factor could be that, with hospitals overwhelmed in this second wave of the pandemic, many families are self-medicating and applying oxygen therapy at home without the proper hygiene, experts say.
In the western state of Maharashtra, which includes the commercial hub of Mumbai and has been badly devastated by the pandemic, local news media reported that around 200 patients who had recovered from Covid were being treated for mucormycosis and that eight had died.
In Gujarat, a western state north of Maharashtra, the state government ordered the allocation of separate wards in hospitals for the treatment of the infection, and said it had put purchase orders for 5,000 doses of amphotericin B, a medicine used to treat it. Infections have also been reported in hospitals in the country’s capital, New Delhi.
Health experts are keeping close tabs on the situation. “We have heard that in some areas, people who are Covid-infected or recovered suffer from mucormycosis, but there is not a big outbreak of it,” Dr. V.K. Paul, who heads India’s Covid task force, said last week. “We are watching and monitoring.”
“It is a fungus that has a strong relation to diabetes,” he added. “If the person is not diabetic, it is very uncommon that the person would have mucormycosis.”
Many less-populous countries have higher percentages of diabetes, but only one — China, with a population even larger than India’s 1.38 billion — has a higher raw number of diabetics. In India, more than 10 percent of the adult population has the condition, or 77 million people. China has more than 116 million adult diabetics, or 9 percent, according to the 2019 International Diabetes Foundation Atlas.
Dr. K. Srinath Reddy, who leads the Public Health Foundation of India, said a large number of the recent reported mucormycosis cases were of hospitalized coronavirus patients who had been discharged after their recovery.
“You are using steroids to reduce the hyperimmune response, which is there in Covid,” Dr. Reddy said. “But you are reducing the resistance to other infections.”
European soccer’s governing body will hold talks with the British government on Monday about moving this month’s Champions League final to London. Travel restrictions related to the coronavirus pandemic have made it almost impossible for domestic fans of the finalists — the Premier League rivals Chelsea and Manchester City — to attend the match at its scheduled site in Istanbul.
The final, which is planned for May 29, is the biggest day on the European club soccer calendar; like the Super Bowl and the Wimbledon final, the Champions League decider is one of the tent-pole events in global sports every year.
Questions about where to hold the match have been growing since Turkey announced a lockdown late last month. They intensified on Friday, days after Chelsea and City clinched their places in the final, when the British government announced that Turkey was among the countries to which Britons should avoid all but essential travel.
Officials from the Football Association in England have opened talks with Europe’s governing body, UEFA, about moving the game, and they will be present at Monday’s meeting, when UEFA will outline its requirements for relocation. A decision will most likely be announced within 48 hours.