Billions spent on coronavirus fight, but what happens next?

Congress has poured tens of billions of dollars into state and local public health departments in response to the coronavirus pandemic, paying for masks, contact tracers and education campaigns to persuade people to get vaccinated.

Public health officials who have juggled bare-bones budgets for years are happy to have the additional money. Yet they worry it will soon dry up as the pandemic recedes, continuing a boom-bust funding cycle that has plagued the U.S. public health system for decades. If budgets are slashed again, they warn, that could leave the nation where it was before the coronavirus: unprepared for a health crisis.

“We need funds that we can depend on year after year,” said Dr. Mysheika Roberts, the health commissioner of Columbus, Ohio.

When Roberts started in Columbus in 2006, an emergency preparedness grant paid for more than 20 staffers. By the time the coronavirus pandemic hit, it paid for about 10. Relief money that came through last year helped the department staff up its coronavirus response teams. While the funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.

After the pandemic is over, public health officials across the U.S. fear, they’ll be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after the Sept. 11 attacks and the SARS and Ebola outbreaks.

When the mosquito-borne Zika virus tore through South America in 2016, causing serious birth defects in newborn babies, members of Congress couldn’t agree how, and how much, to spend in the U.S. for prevention efforts, such as education and mosquito abatement. The Centers for Disease Control and Prevention took money from its Ebola efforts, and from state and local health department funding, to pay for the initial Zika response. Congress eventually allocated $1.1 billion for Zika, but by then, mosquito season had passed in much of the U.S.

“Something happens, we throw a ton of money at it, and then in a year or two we go back to our shrunken budgets and we can’t do the minimum things we have to do day in and day out, let alone be prepared for the next emergency,” said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments.

Funding for Public Health Emergency Preparedness, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Even the federal Prevention and Public Health Fund, which was established with the Affordable Care Act to provide $2 billion a year for public health, was raided for cash over the past decade. If the money hadn’t been touched, eventually local and state health departments would have gotten an additional $12.4 billion.

Several lawmakers, led by Democratic U.S. Sen. Patty Murray of Washington, are looking to end the boom-bust cycle with legislation that would eventually provide $4.5 billion annually in core public health funding. Health departments carry out essential government functions — such as managing water safety, issuing death certificates, tracking sexually transmitted diseases and preparing for infectious outbreaks.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, KHN and The Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

Compounding those losses, the coronavirus pandemic has prompted an exodus of public health officials because of harassment, political pressure and exhaustion. A yearlong analysis by the AP and KHN found at least 248 leaders of state and local health departments resigned, retired or were fired between April 1, 2020, and March 31, 2021. Nearly 1 in 6 Americans lost a local public health leader during the pandemic. Experts say it is the largest exodus of public health leaders in American history.

Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health, calls Congress’ giant influx of cash in response to the crisis “wallpaper and drapes” because it doesn’t restore public health’s crumbling foundation.

“I worry at the end of this we’re going to hire up a bunch of contact tracers — and then lay them off soon thereafter,” Castrucci said. “We are continuing to kind of go from disaster to disaster without ever talking about the actual infrastructure.”

Castrucci and others say they need dependable money for high-skill professionals, such as epidemiologists — data-driven disease detectives — and for technology upgrades that would help track outbreaks and get information to the public.

In Ohio, the computer system used to report cases to the state predates the invention of the iPhone. State officials had said for years they wanted to upgrade it, but they lacked the money and the political will. Many departments across the country have relied on fax machines to report COVID-19 cases.

During the pandemic, Ohio’s state auditor found that nearly 96% of local health departments it surveyed had problems with the state’s disease reporting system. Roberts said workers interviewing patients had to navigate several pages of questions, a major burden when handling 500 cases daily.

The system was so outdated that some information could be entered only in a non-searchable comment box, and officials struggled to pull data from the system to report to the public — such as how many people who tested positive had attended a Black Lives Matter rally, which last summer was a key question for people trying to understand whether protests contributed to the virus’ spread.

Ohio is working on a new system, but Roberts worries that, without a dependable budget, the state won’t be able to keep that one up to date either.

“You’re going to need to upgrade that,” Roberts said. “And you’re going to need dollars to support that.”

In Washington, the public health director for Seattle and King County, Patty Hayes, said she is asked all the time why there isn’t a central place to register for a vaccine appointment. The answer comes down to money: Years of underfunding left departments across the state with antiquated computer systems that were not up to the task when the coronavirus hit.

Hayes recalls a time when her department would conduct mass vaccination drills, but that system was dismantled when the money dried up after the specter of Sept. 11 faded.

Roughly six years ago, an analysis found that her department was about $25 million short of what it needed annually for core public health work. Hayes said the past year has shown that’s an underestimate. For example, climate change is prompting more public health concerns, such as the effect on residents when wildfire smoke engulfed much of the Pacific Northwest in September.

Public health officials in some areas may struggle to make the case for more stable funding because a large swath of the public has questioned — and often been openly hostile toward — the mask mandates and business restrictions that public health officials have imposed through the pandemic.

In Missouri, some county commissioners who were frustrated at public health restrictions withheld money from the departments.

In Knox County, Tennessee, Mayor Glenn Jacobs narrated a video posted in the fall that showed a photo of health officials after referencing “sinister forces.” Later, someone spray-painted “DEATH” on the department office building. The Board of Health was stripped of its powers in March and was given an advisory role. A spokesperson for the mayor’s office declined to comment on the video.

“This is going to change the position of public health and what we can and cannot do across the country,” said Dr. Martha Buchanan, the head of the health department. “I know it’s going to change it here.”

A KHN and AP investigation in December found at least 24 states were crafting legislation that would limit or remove public health powers.

Back in Seattle, locally based companies have pitched in money and staff members for vaccine sites. Microsoft is hosting one location, while Starbucks offered customer service expertise to help design them. Hayes is grateful, but she wonders why a critical government function didn’t have the resources it needed during a pandemic.

If public health had been getting dependable funding, her staff could have been working more effectively with the data and preparing for emerging threats in the state where the first U.S. COVID-19 case was confirmed.

“They’ll look back at this response to the pandemic in this country as a great example of a failure of a country to prioritize the health of its citizens, because it didn’t commit to public health,” she said. “That will be part of the story.”

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KHN senior correspondent Anna Maria Barry-Jester and Montana correspondent Katheryn Houghton contributed to this report.

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Follow Michelle R. Smith on Twitter @MRSmithAP, Lauren Weber @LaurenWeberHP and Hannah Recht @hannah—recht.

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This story is a collaboration between The Associated Press and KHN (Kaiser Health News), which is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Brazil's hospitals running out of sedatives as COVID-19 rages

RIO DE JANEIRO (Reuters) – Hospitals in Brazil were running out of drugs needed to sedate patients on Thursday, with reports of the seriously ill being tied down and intubated without effective sedatives.

FILE PHOTO: Medical workers take care of patients in the emergency room of the Nossa Senhora da Conceicao hospital that is overcrowding because of the coronavirus outbreak, in Porto Alegre, Brazil, March 11, 2021.  REUTERS/Diego Vara

The scenes playing out across Brazil, one of the countries hardest hit by the COVID-19 pandemic, are placing growing international pressure on President Jair Bolsonaro.

Aid group Médecins Sans Frontières (MSF) said Brazil’s “failed response” had led to thousands of avoidable deaths and created a humanitarian catastrophe that could still get worse.

Brazil has recorded a total of 361,884 coronavirus deaths – only the United States has more – and 13,673,507 confirmed cases.

More Brazilians are currently dying of the virus each day than anywhere else in the world. Bolsonaro has opposed lockdowns and held large events in which he often does not wear a mask. He has only recently embraced vaccines as a possible solution.

Brazil’s hospitals are struggling to cope.

Rio de Janeiro and Sao Paulo have both sounded the alarm over shortages of sedatives, with Sao Paulo’s Health Secretary saying the city’s ability to care for seriously ill COVID-19 patients is on the verge of collapse.

“I never thought that I would be living through something like this after 20 years working in intensive care,” Aureo do Carmo Filho, an ICU doctor in Rio, told Reuters.

“Using mechanical restraints without sedatives is bad practice…the patient is submitted to a form of torture,” he said.

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Seriously ill COVID-19 patients struggling for breath are sedated in order to put them on ventilators, an intrusive practice the body can naturally resist.

With ICU beds at or near capacity across the country, hospitals are being forced to create improvised intensive care beds which often lack equipment or professional expertise.

Globo television network on Wednesday reported cases from a Rio hospital in which patients were intubated with a lack of sedatives, tied to beds.

The Albert Schweitzer hospital, through the press office of the city of Rio which runs it, said there was a shortage of intubation drugs but that substitutes were being used to ensure medical assistance was not compromised. It said mechanical restraints were only used when prescribed by a doctor.

The city of Rio added that a batch of intubation drugs was set to arrive on Thursday.

“FAILED RESPONSE”

Médecins Sans Frontières said Bolsonaro’s government had not done enough to prevent the tragedy.

“More than one year into the COVID-19 pandemic, the failed response in Brazil has caused a humanitarian catastrophe,” said Christos Christou, a medical doctor and president of MSF, called Doctors Without Borders in English.

“Each week there is a grim new record of deaths and infections – the hospitals are overflowing and yet there is still no coordinated centralized response,” Christou said in a briefing with reporters, adding that the situation was expected to become even worse in the weeks ahead.

Bolsonaro has openly fought against state and local governments seeking to institute lockdowns, saying Brazilians need to get on with normal life and that job losses are more dangerous than the virus.

MSF Director-General Meinie Nicolai said the surge in cases cannot be blamed only on the contagious Brazilian COVID-19 variant, known as P.1.

“The P.1 variant is certainly a problem, but this doesn’t explain the situation in Brazil,” she said.

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German government seeks more powers to set pandemic rules

BERLIN — Chancellor Angela Merkel said Tuesday her government wants clear rules that include nighttime curfews imposed in all regions with high numbers of COVID-19 infections, ending the patchwork of measures that have characterized the pandemic response across Germany’s 16 states.

“The uniform, nationwide emergency brake is overdue because even though it’s difficult to hear this again, the situation is serious,” Merkel told reporters in Berlin after her Cabinet approved the plan.

Many Germans have expressed frustration and confusion in recent months as governors interpreted rules agreed with the federal government in different ways, despite having similar infection rates.

Merkel warned that Germany remains “firmly in the grip of the third wave” of infections, citing figures from the country’s disease control agency that showed 10,810 newly confirmed cases in the past 24 hours, and 294 deaths.

Since the start of the pandemic, Germany has registered more than 3 million infections and 78,746 deaths from COVID-19.

“If we were to wait until all the intensive care beds were occupied, then it would be too late,” Merkel said, adding that governments and citizens need to help doctors and nurses tackle the surge in cases.

The emergency brake, proposed in a bill that will be submitted to Parliament, will apply in regions with more than 100 new weekly cases per 100,000 inhabitants. It entails the closure of stores, cultural and sports facilities, limits on personal contacts and nighttime curfews.

States would be free to set more flexible rules in regions with fewer than 100 new cases each week per 100,000 inhabitants.

Merkel said she hoped Parliament would swiftly debate and pass the bill.

She again asked for Germans to show patience and noted that the country’s sluggish vaccine program had picked up with the recent start of vaccinations in GP practices. Last week, some 3.2 million shots were administered in Germany, compared with 1.9 million the previous week.

The Cabinet also agreed that companies will need to offer all employees who aren’t working from home at least one coronavirus test each week, and that parents will get more paid leave to care for children who cannot go to school due to the pandemic.

Separately, Germany’s top security official ordered an end to temporary border controls along with frontier with the Czech Republic. The checks, which caused lengthy tailbacks along the border and were a headache for commuters, had been in place for two months due to the high rate of infection in Germany’s eastern neighbor.

Interior Minister Horst Seehofer said the spot checks would continue to take place to ensure that people have a negative coronavirus test when entering Germany from the Czech Republic.

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Follow all of AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic, https://apnews.com/hub/coronavirus-vaccine and https://apnews.com/UnderstandingtheOutbreak

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The Latest: S Korea to resume AstraZeneca jab for ages 30-60

SEOUL, South Korea — South Korea says it will resume administrating AstraZeneca’s coronavirus vaccine to all eligible people between the ages of 30 and 60.

Last week, South Korea suspended the use of AstraZeneca vaccines for those 60 years old or younger while awaiting the outcome of the European Medicine Agency’s review.

The Korea Disease Control and Prevention Agency said Sunday it will restart the use of AstraZeneca vaccine beginning Monday, citing studies showing that the vaccine’s benefits outweighs the risk of side effects.

An agency statement said those aged 30 or younger will be excluded, as U.K. authorities have recommended they take alternative vaccines.

It says it’s found three cases of blood clots from vaccinated people in South Korea — but none belong to the type of side effects determined by European authorities.

Those who would get AstraZeneca vaccines from Monday include medical workers and people in long-term care facilities, those at special schools and welfare centers for disabled people and homeless people.

In recent days, South Korea has been experiencing a steady increase in new coronavirus infections. Earlier Sunday, South Korea reported 677 new confirmed cases, raising the total to 109,559 with 1,768 deaths.

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THE VIRUS OUTBREAK:

— More Black Americans say they are open to taking vaccine

— Delayed vaccine shipments could stall progress against COVID-19 in some of world’s poorest countries

— Iran enforces 10-day lockdown amid fourth wave of pandemic

— Nearly one-third of Texans have received virus vaccine

— Ecuador, Peru head to polls under strict virus measures

— Follow AP’s pandemic coverage at https://apnews.com/hub/coronavirus-pandemic and https://apnews.com/hub/coronavirus-vaccine

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HERE’S WHAT ELSE IS HAPPENING:

BEIJING — China has reported 10 new confirmed coronavirus cases and no deaths.

All the new infections were believed have been acquired abroad, the National Health Commission announced Sunday.

China’s death toll stood at 4,636 out of 90,410 confirmed cases.

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ISLAMABAD— Pakistan has reported it’s highest single-day death toll from COVID-19.

The National Command and Control Center announced Sunday that 114 deaths from coronavirus had been confirmed, as well as more than 5,000 new cases.

A weekend ban on inter-city transport has been extended until mid-April, as part of measures to control a surge in virus infections and deaths. The ban will not apply on freight, ambulance services and supplies of medical equipment.

Pakistan, with a population of 220 million people, has vaccinated more than a million people using the Chinese Sinopharm vaccine since February.

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COLOMBO, Sri Lanka — Sri Lankan health authorities have imposed tough restrictions ahead of this week’s New Year festival in a bid to contain the spread of COVID-19.

Health officials on Sunday banned musical shows and many other traditional games, including the tug-of-war, for the April 14 holiday.

They’ve also ordered other gatherings not to exceed 100 people, and asked that gatherings for rituals be limited to immediate family members and close relatives.

The country’s New Year festival typically involves large-scale events, games, competitions and musical shows.

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BUCHAREST — Marchers have taken to the streets of the Romanian capital of Bucharest to protest restrictive measures to fight the spread of COVID-19 even as new daily infections and deaths rise in the European Union nation.

About 1,000 people converged Saturday on Victory Square and University Square, expressing frustration with an earlier curfew and shop closures that took effect at the end of March. Many demonstrators waved tri-color Romanian flags and chanted “Freedom!” and “Down with the government!”

“We came to fight against this state of alert that buries all our rights and freedoms,” Dumitru Balan, leader of the civic movement Action for the Nation, told The Associated Press.

The protest was held on the same day that Romania passed 1 million confirmed COVID-19 cases. Hospital intensive care units are struggling to cope with the record demand of just under 1,500 COVID-19 patients; 12,000 others are in other wards.

“There are now very severe patients admitted in our clinical ward that normally would require intensive care … we don’t have enough ICU beds available and patients are waiting with sub-optimal care,” Dragos Zaharia, a pneumologist at Marius Nasta Institute, told the AP. “We are at risk of being accused of malpractice.”

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NEW YORK — State lawmakers across the U.S. are taking actions to limit the emergency powers of governors — not just in the current coronavirus pandemic, but for any future emergencies.

The pushback is coming primarily from Republican lawmakers but is not entirely partisan. GOP lawmakers are targeting both Democratic and Republican governors.

When the pandemic hit a year ago, many governors and their top health officials temporarily ordered residents to remain home, limited public gatherings, prohibited in-person schooling and shut down dine-in restaurants, gyms and other businesses. Many governors have been repealing or relaxing restrictions after cases declined from a winter peak and as more people get vaccinated.

The potential remains in many states for governors to again tighten restrictions if new variants of the coronavirus lead to another surge in cases.

The U.S. has recorded 31 million coronavirus cases and more than 561,000 confirmed deaths, the most in the world.

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LONDON — As many as 60 countries might be stalled at the first shots of their coronavirus vaccinations because nearly all deliveries through the global program are blocked until as late as June.

The COVAX initiative is designed to provide vaccines to countries lacking the clout to negotiate on their own for scarce supplies. In the past two weeks, only 2 million doses were cleared for shipment to 92 countries through the program, the same amount injected in Britain alone.

Internal World Health Organization documents obtained by The Associated Press say uncertain deliveries are causing some countries to lose faith in COVAX.

The vaccine shortage stems mostly from India’s decision to stop exporting vaccines from its Serum Institute factory because of a surge of coronavirus cases in that country. The factory produces the majority of the AstraZeneca doses that COVAX counted on to supply about a third of the global population.

WHO Director General Tedros Adhanom Ghebreysus says while one in four people in rich countries had received a vaccine, only one in 500 people in poorer countries had received a dose.

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Italy reports 296 coronavirus deaths on Monday, 10,680 new cases

A Venice resident receives a coronavirus disease (COVID-19) vaccine on board a traditional ‘vaporetto’, a ferry normally used for public transportation in Venice, Italy, April 5, 2021. REUTERS/Manuel Silvestri

MILAN (Reuters) – Italy reported 296 coronavirus-related deaths on Monday against 326 the previous day, the health ministry said, while the daily tally of new infections decreased to 10,680 from 18,025.

Italy has registered 111,326 deaths linked to COVID-19 since its outbreak emerged in February last year, the second-highest toll in Europe after Britain and the seventh-highest in the world.

The country has reported about 3.6 million cases to date.

Patients in hospital with COVID-19 – not including those in intensive care – totalled 28,785 on Monday, slightly up from 28,432 a day earlier.

There were 192 new admissions to intensive care units, from 195 on Sunday. The total number of intensive care patients rose to 3,737 from a previous 3,703.

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Ontario to enter third COVID-19 lockdown as cases, hospital rates rise

Nurses from Humber River Hospital’s mobile vaccine clinic administer the Moderna COVID-19 vaccine at Toronto and Region Islamic Congregation Centre as part of the coronavirus disease (COVID-19) vaccination campaign, in Toronto, Ontario, Canada April 1, 2021. REUTERS/Carlos Osorio

TORONTO (Reuters) – The Canadian province of Ontario will enter lockdown for at least four weeks on Saturday as COVID-19 cases and hospital intensive care unit occupancy rises, Premier Doug Ford said on Thursday.

The third such lockdown in Canada’s most populous province will shutter all indoor and outdoor dining but allow retailers to remain open with capacity limits, Ford said.

Schools will remain open, the province’s education minister said on Twitter.

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More under-30 Americans report anxiety, depression during pandemic – CDC

(Reuters) – More young adults in the United States reported feeling anxious or depressed during the past six months of the COVID-19 pandemic, and fewer people reported getting the help they needed, according to a U.S. government study released on Friday.

The percentage of adults under age 30 with recent symptoms of an anxiety or a depressive disorder rose significantly about five months after the U.S. imposed COVID-19 related lockdowns, and reported rising deaths from the fast-spreading virus.

Between August 2020 and February 2021, this number went up to 41.5% from 36.4%, as did the percentage of such people reporting that they needed, but did not receive, mental health counseling.

The study suggests that the rise in anxiety or depressive disorder symptoms reported correspond with the weekly number of reported COVID-19 cases.

The findings are based on a Household Pulse Survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) and the Census Bureau to monitor changes in mental health status and access to care during the pandemic.

“Trends in mental health can be used to evaluate the impact of strategies addressing adult mental health status and care during the pandemic,” the authors of the study wrote in the CDC’s Morbidity and Mortality Weekly Report released on Friday.

The study also found those with less than a high school education were more at risk, though it did not provide an explanation for it.

Even with more vaccines gaining authorization beginning late 2020, the effects of the pandemic on mental health continued into 2021.

During Jan. 20, 2021 through Feb. 1, 2021, about two in five adults aged over 18 years experienced recent symptoms of an anxiety or a depressive disorder, the survey found.

Demand for mental health and meditation apps, and investments in tech startups building these apps have also risen during this period.

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Brazil registers second deadliest day in COVID pandemic, with 2,724 deaths

FILE PHOTO: Family members attend the burial of a loved one who died from the coronavirus disease (COVID-19), at the Campo da Esperanca cemetery in Brasilia, Brazil, March 11, 2021. REUTERS/Ueslei Marcelino

RIO DE JANEIRO (Reuters) – Brazil registered its second deadliest day in its COVID pandemic, with 2,724 deaths, according to the Health Ministry on Thursday.

The country had 86,982 new COVID cases.

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Italy announces plan to vaccinate at least 80% of population by September

People queue to receive a coronavirus disease (COVID-19) vaccine at Fiumicino Airport in Rome, Italy March 8, 2021. REUTERS/Guglielmo Mangiapane

ROME (Reuters) – Italy said on Saturday it aims to vaccinate at least 80% of its population by September through ramping up the daily vaccination campaign.

Francesco Paolo Figliuolo, the new special commissioner for coronavirus, released a national plan to issue 500,000 vaccine doses a day, according to a statement released by the cabinet office.

Italy has registered 101,881 deaths since the outbreak emerged in the country in February last year, the second-highest toll in Europe after Britain and the seventh-highest in the world. The country has reported 3.2 million cases of infection to date.

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Alaska opens vaccine to residents age 16 and up as more U.S. states reopen

ANCHORAGE, Alaska (Reuters) – Alaska, one of the most successful U.S. states in inoculating its residents, has become the first to make COVID-19 vaccines available to anyone age 16 or older, eliminating eligibility requirements for people who work or live there.

FILE PHOTO: Alaska Governor Mike Dunleavy speaks at the Petroleum Club in Anchorage, Alaska, U.S. January 15, 2020. REUTERS/Yereth Rosen/File Photo

Governor Mike Dunleavy, a Republican, announced the new rules on Tuesday for his state of about 730,000 people. More than one quarter of Alaskans have received least one vaccine shot, second only to New Mexico, according to data from the U.S. Centers for Disease Control and Prevention (CDC).

Certain regions of Alaska are nearing a 90% vaccination rate among elderly people, officials said.

Many states are struggling to meet the vast demand for vaccines. Differing eligibility requirements have created a patchwork system, with certain states still restricting vaccines to adults 65 or older, along with people in high-risk groups.

The COVID-19 vaccines developed by Moderna and Johnson & Johnson are approved only for people age 18 and older, but younger Alaskans can receive the Pfizer vaccine.

Officials hope that making vaccinations widely available will boost the crucial tourism industry ahead of the summer.

“Alaska’s also somewhat of a seasonal state with regard to aspects of the economy,” Dunleavy said at a news conference. “We’re hoping that we can get the cruise ships back there, the tourism industry back here.”

As of Tuesday morning, more than 123 million doses of the COVID-19 vaccines had been distributed in the United States and 93.7 million shots had been administered, according to the CDC.

REOPENINGS ACCELERATE

Nonetheless, as the pace of inoculations picks up, several states have moved to relax COVID-19 restrictions.

North Carolina Governor Roy Cooper on Wednesday announced an agreement reached with legislative, health and education leaders to reopen many schools in the state for full in-person learning.

Under the plan, all elementary schools would return to in-person education full-time while districts would choose whether middle schools and high schools are to reopen their classrooms or offer hybrid learning, officials said. The new legislation is expected to move through the legislature this week.

In California, the Los Angeles Unified School District and its teachers’ union on Tuesday reached a tentative deal for students to return to school in April. The agreement is contingent on teacher vaccinations against COVID-19, extensive health measures and the county’s impending exit from California’s most restrictive tier of health regulations.

Earlier this week, New York City’s public school system — the nation’s largest — said it would welcome high school students back to the classroom on March 22 as part of its gradual reopening.

The city also welcomed back movie fans to theaters last week, nearly a year since cinemas went dark.

Texas and Mississippi have taken bolder actions, lifting statewide mask mandates and most restrictions on businesses.

Maryland Governor Larry Hogan took similar action on Tuesday when he removed several mitigation measures, including limits on outdoor and indoor dining.

In another move toward recovery, Governors Andrew Cuomo and Phil Murphy announced on Wednesday that restaurants in New York City and New Jersey will be able to expand indoor dining capacity to 50% beginning March 19. Restaurants in the rest of New York state will expand to 75% capacity.

(This story has been refiled to add dropped word to headline)

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