Covid Live Updates: Pregnant Women With Covid Have Greater Risk for a Stillbirth, C.D.C. Study Finds

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Credit…Charles Krupa/Associated Press

Pregnant women who had Covid-19 when they delivered their babies were almost twice as likely to have a stillbirth as healthy women who did not have Covid, according to a new Centers for Disease Control study released Friday that examined more than 1.2 million deliveries in the U.S. between March 2020 and September 2021.

While stillbirths were rare overall, representing fewer than 1 percent of all births, 1.26 percent of the 21,653 women with Covid experienced a stillbirth, compared with 0.64 percent of women without Covid. Even after adjustments were made to control for differences between the groups, women with Covid were 1.9 times as likely as healthy women to have a stillbirth.

The risk of stillbirth has been even higher for women with Covid since the Delta variant has been dominant: while the risk of stillbirth for women with Covid was 1.5 times as high as that of healthy women before July, when Delta became dominant, it was 4 times as high between July and September. As many as 2.7 percent of deliveries to women with Covid were stillbirths during the period studied while Delta was dominant.

“There had been reports suggesting an increased risk, but stillbirths are hard to study, because luckily they are uncommon,” said Dr. Denise Jamieson, chief of gynecology and obstetrics at Emory Healthcare. “This is some of the strongest evidence of the increased risk, and probably the strongest data pointing to the risks specifically tied to Delta.”

“The take home message is the importance of vaccination for pregnant women, particularly at this point in the pandemic with Delta circulating,” she said.

The CDC strongly encourages pregnant and breastfeeding women and women planning or trying to become pregnant to be vaccinated against Covid, but resistance has been strong, even though pregnancy is on the C.D.C.’s list of health conditions that increase the risk of severe disease.

Studies have shown that pregnant patients who are symptomatic are more than twice as likely as other symptomatic patients to require admission to intensive care or interventions like mechanical ventilation, and they may be more likely to die. They are also more likely to experience a preterm birth.

Another CDC study issued Wednesday described the cases of 15 pregnant women in Mississippi who died of Covid during their pregnancy or shortly afterward, including six who died before the Delta variant became dominant and nine who died between July and October, while Delta was dominant.

Of the women who died, nine were Black women, three were white women and three were Hispanic women. The median age was 30. Fourteen of the women had underlying medical conditions, and none were vaccinated. Five of the deaths occurred before vaccinations were available.

The study concluded that the risk of death for a pregnant woman with Covid is nine deaths per 1,000 infections, while the risk of death from Covid for other women of reproductive age is only 2.5 deaths per 1,000 infections.

A third study by CDC researchers found that pregnant women with Covid faced a more than 60 percent higher risk of being admitted to intensive care, needing a ventilator or special equipment to breathe, and even of dying during the period that Delta was dominant, compared to pregnant women during the period before the variant was dominant.

Credit…Stefani Reynolds for The New York Times

Scientific advisers to the Centers for Disease Control and Prevention on Friday unanimously endorsed booster shots of the Pfizer-BioNTech and Moderna coronavirus vaccines for all adults, a move that brings tens of millions fully vaccinated adults a step closer to a third shot.

Boosters would be recommended six months after the second shot of the Pfizer or Moderna vaccines. If Dr. Rochelle Walensky, the agency’s director, formally accepts the recommendation, as she typically does, boosters would be available this weekend, allowing many Americans who want one to get the shot before the Thanksgiving holiday.

The new recommendations say everyone 50 and older — most of whom have other risk factors — as well as those 18 and older living in long-term care facilities “should” get a booster. Others who are 18 and older “may” opt for one if they wish, based on individual risk and benefit. Several advisers said at the meeting that they hoped the simpler age-based guidelines would ease some of the confusion around who is eligible for the extra shots.

These recommendations align with President Biden’s promise that all adults would be eligible for extra doses.

Desperate to dampen even a dim echo of last winter’s horrors, the Biden administration is betting that booster shots will shore up what some have characterized as waning immunity among the fully vaccinated. The Food and Drug Administration authorized boosters of the Pfizer-BioNTech and Moderna vaccines for all adults on Friday.

In recent days, several states have broadened booster access to all adults on their own. Addressing the panelists, Dr. Sam Posner, the acting director of the National Center for Immunization and Respiratory Diseases, acknowledged that previous eligibility categories “were complicated to implement,” and hoped that simplifying it to all adults “will reduce confusion.”

Research suggests that the shots may help forestall at least some infections, particularly in older adults and those with certain health conditions.

After an all too brief respite, coronavirus infections are inching up again, particularly in parts of the country where cooler weather is hustling people indoors.

At the C.D.C. panel meeting, Dr. Doran Fink, a key F.D.A. regulator, said that the impact of broadening booster eligibility would be clear “on the individual level,” offering protection against breakthrough cases of Covid-19. But he said the “greatest impact on a population level is still dependent on increasing vaccine uptake among” the unvaccinated.

The C.D.C.’s decision will land just as Americans are preparing to spend the holidays with family and friends. Given the roughly 100 million Americans who have yet to receive a single dose of vaccine, holiday travel and get-togethers could send cases skyrocketing, as they did last year.

During a presentation, Dr. Sara Oliver, a C.D.C. scientist, said that while protection from a booster against asymptomatic infection may not be permanent, even temporary protection might help contain the virus ahead of the winter holidays, increased travel and indoor gatherings.

At a news conference as the C.D.C. panel meeting got underway, Jen Psaki, the White House press secretary, praised the moves “to further protect Americans, especially as we enter the winter months.”

With the virus still spreading, she acknowledged that many are exhausted by the pandemic. “What we can do is encourage action,” she said, urging eligible Americans to get their boosters.

Several European countries are also offering boosters to all adults in a bid to contain fresh waves of infections. France has gone so far as to mandate booster shots for those over age 65 who wish to get a health pass permitting access to public venues.

“Look what other countries are doing now about adopting a booster campaign virtually for everybody,” Dr. Anthony S. Fauci, the Biden administration’s top Covid adviser, said at a conference on Tuesday. “I think if we do that, and we do it in earnest, I think by the spring we can have pretty good control of this.”

But many experts, including some who advise federal agencies, are skeptical that boosters alone can turn the tide. While the extra shots can strengthen immunity in older adults, they are unlikely to offer much benefit to adults under 65, who remain protected from severe illness and hospitalization by the initial immunization, the experts said.

It is also unclear whether booster shots can significantly slow the spread of the virus. The limited evidence available suggests that vaccines can blunt transmission, but only to a limited extent and for a limited period.

Many pandemic-weary Americans, too, seem unmoved by the administration’s push for boosters. More than 85 percent of the adult population is already eligible, but only about 17 percent has chosen to get them. And those may not be the people most in need of extra protection.

As with the initial shots, fully vaccinated white people are more likely to have lined up for a booster shot, compared with other racial and ethnic groups, according to data compiled by the Kaiser Family Foundation.

Dr. Oliver later noted that recommendations that are complex, or hard to communicate or implement could exacerbate disparities in booster rates.

So far, the people who have opted for boosters “tend to be of higher socioeconomic status and more highly educated, and have more access in general to medical care,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center.

“That’s not necessarily who’s actually at risk of severe disease, hospitalization or death, and so I think you’re going to have limited public health impact.”

Noah Weiland and Dan Levin contributed reporting.

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The country became the first Western democracy to announce that it would require Covid vaccinations for its entire adult population.CreditCredit…Leonhard Foeger/Reuters

Austria on Friday became the first Western democracy to announce that it would mandate Covid vaccinations for its entire adult population as it prepared for a nationwide lockdown starting Monday.

The extraordinary measure by Austria, which only days ago separated itself from the rest of Europe by introducing a lockdown for the unvaccinated, who are driving a surge of infections, made for another alarming statement about the severity of the fourth wave of the virus in Europe, now the epicenter of the pandemic.

But it also showed that increasingly desperate governments are losing their patience with vaccine skeptics and shifting from voluntary to obligatory measures to promote vaccinations and beat back a virus that shows no sign of waning, rattling global markets at the prospect that still tentative economic recoveries will be undone.

Some European countries, including Germany, which once seemed a model of how to manage the virus, are now facing their worst levels of infections in the nearly two years since the pandemic began. The surge, health authorities say, is being driven by stubborn resistance to getting vaccinated in deep pockets of the population, cold weather driving people indoors, loosened restrictions and possibly waning immunity among those previously vaccinated.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

“For a long time — maybe too long — I and others assumed that it must be possible to convince people in Austria to voluntarily get vaccinated,” Chancellor Alexander Schallenberg of Austria said on Friday. “We therefore have reached a very difficult decision to introduce a national vaccine mandate.”

With its latest move, Austria significantly moved ahead of other European countries that have inched up to, but not crossed, a threshold that once seemed unthinkable. The announcement drew an immediate threat of violent protest this weekend by leaders of anti-vaccine movements and the far-right Freedom Party, which compared the government’s latest mandates with those of a dictatorship.

Many European countries have already instituted mandates in all but name only — requiring strict health passes as proof of vaccination, recovery from infection or a negative test to partake in most social functions, travel or to go to work. Many already require children to be vaccinated against measles and other illnesses to attend school.

The notion of requiring vaccination in adults against Covid was a line that Europe had seemed unwilling to cross, however, with leaders often contrasting their respect for civil liberties with authoritarian-styled countries.

But just as lockdowns have become a fact of life, vaccine mandates are increasingly becoming plausible. German lawmakers in Parliament voted on Thursday to force unvaccinated people going to work or using public transit to provide daily test results. The country’s vaccination rate among adults is about 79 percent, one of the lowest in Western Europe.

On Friday, Jens Spahn, the acting health minister in Germany, was asked whether a general lockdown was possible for the country. “We are in a position where nothing should be ruled out,” he said.

The specter of a lockdown in Germany, Europe’s largest economy, sent jitters through European markets hungering for economic recovery and sales during the Christmas shopping season.

Austria’s new vaccine mandate will take effect in February, in the hopes that as many people as possible will be motivated to sign up for their initial inoculations, but also booster shots, Austria’s health minister, Wolfgang Mückstein, said.

It also gave leaders time to formalize legal guidelines for the mandate, he said, adding that there would be exceptions for people who are not able to be vaccinated.

Correction: 

An earlier version of this briefing item incorrectly described the nature of Austria’s planned nationwide lockdown. It will be among the first in Europe since the spring, not the first.

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As coronavirus cases in Germany continue to reach record levels, officials warned of a possible nationwide lockdown. “With vaccinations and boosters alone, we will not be able to break the wave quick enough,” said Germany’s health minister.CreditCredit…Christof Stache/Agence France-Presse — Getty Images

As Austria prepares to go into a national lockdown next week, the health minister in neighboring Germany suggested on Friday that a similar measure remained an option for his far larger country as coronavirus cases there continue to reach record levels.

“We are in a position where nothing should be ruled out,” the minister, Jens Spahn, told a news conference in response to a reporter’s question about a lockdown for both vaccinated and unvaccinated people.

His remarks came one day after lawmakers in Parliament voted to force unvaccinated people going to work or using public transit to provide daily test results. The country’s vaccination rate among adults is about 79 percent.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

Chancellor Angela Merkel and state governors also agreed on Thursday night to require proof of vaccination or recovery from coronavirus infection for people entering restaurants, bars and hair salons or attending events in states where hospital beds are becoming scarce.

But some German states are going it alone.

On Friday, the governor of Bavaria, which has some of the country’s worst hot spots, announced measures including the cancellation of all Christmas markets and the closing of bars, clubs and nightclubs until at least Dec. 15. The celebrated Christmas market in the state’s capital, Munich, was canceled earlier this week.

Theaters, cinemas, operas and spectator sports will be allowed to remain open at 25 percent capacity for people who are vaccinated or who have recovered from the virus and show a negative test result. Restaurants will close at 10 p.m.

Districts with high infection rates will close down completely, leaving only essential shops, day cares and schools open.

“We are facing a corona drama,” the state’s governor, Markus Söder, said. “The numbers are exploding in the shortest time span and the beds are full,” he added, referring to overwhelmed hospitals. Some patients there are being moved to less crowded hospitals in northern Germany.

The governor of Saxony also announced new restrictions on Friday. Starting on Monday, a ban will be introduced on some events and larger gatherings regardless of the inoculation status of those attending.

Credit…David Ryder/Reuters

With the holiday travel season nearing, Canadian officials announced several measures on Friday meant to standardize international travel and make it easier for Canadians taking short trips to re-enter the country.

Travelers who are fully vaccinated with the shots from Sinopharm, Sinovac and Covaxin will be allowed to enter Canada starting Nov. 30, opening the door wider to people from countries like India, Brazil and China, where those vaccines are more frequently administered.

Currently, Canada only accepts travelers who have received the Pfizer-BioNTech, Moderna, Oxford-AstraZeneca or Johnson & Johnson vaccines, the four shots approved in the country. The expanded list will align with the vaccines cleared for use by the World Health Organization.

Dr. Theresa Tam, Canada’s chief public health officer, said that the case rates associated with each of the vaccines were about the same.

“All that is very reassuring,” Dr. Tam said. She added that although Sinopharm, Sinovac and Covaxin “are not authorized in Canada, because they’ve gone through the W.H.O. process in terms of evaluation of safety, of efficacy and of quality, we’ve taken that into account as we increase the list of vaccines for Canadian border measures.”

Additionally, people leaving Canada by land or by air for less than 72 hours will no longer be required to provide proof of a negative Covid-19 test to re-enter the country. The price and processing time of P.C.R. tests — which can cost more than $100 and take longer than a day for results — were widely seen as deterrents to travel.

This change applies only to Canadians, permanent residents and Indigenous people registered under the Indian Act. It also takes effect Nov. 30.

The government will take a firm stance against unvaccinated travelers entering and leaving the country beginning on that date as well, with “very few exemptions,” said Omar Alghabra, Canada’s transport minister. He added that only fully vaccinated travelers would be able to fly from a Canadian airport or board a Via Rail or Rocky Mountaineer train.

Starting Jan. 15, Canada will also phase out most previously granted travel exemptions for those who are unvaccinated. This will affect professional and amateur athletes, foreign students, truck drivers and other essential workers who cross the border, and adults over 18 traveling to reunite with a family member.

Other categories of unvaccinated or partly vaccinated travelers — such as refugees, marine crews and agricultural workers — will be able to enter only with limited approval.

Credit…Merck & Co Inc/Via Reuters

BRUSSELS — The European Union’s drug regulator on Friday recommended the use of a pill, developed by Merck, that was found in a clinical trial to halve the rate of hospitalizations and deaths in high-risk Covid patients who took it soon after infection.

The drug, molnupiravir, has yet to be authorized by E.U. countries, but in recommending its administration, the European Medicines Agency paved the way for its use within the next few months.

Several E.U. countries, including France and Italy, have already placed orders for supplies of the drug.

Britain became the first country this month to authorize the use of the pill. Its regulator authorized it for vaccinated and unvaccinated people who have Covid, and are at high risk of becoming severely ill. The treatment could be authorized in the United States as soon as early December.

The European Medicines Agency said the drug could be taken by adults who do not require supplemental oxygen and who are at increased risk of developing severe coronavirus cases. The pill “should be administered as soon as possible after diagnosis of Covid-19 and within five days of the start of symptoms,” the agency said in a news release.

The agency also said on Friday that it had begun reviewing a similar drug developed by Pfizer, called Paxlovid.

Scientists and government leaders have called the drugs game changers in the fight against the pandemic if their efficacy in clinical trials holds up in the real world. Unlike monoclonal antibodies, which are typically administered by health care professionals at a hospital or clinic, the pills would be dispensed at pharmacies and taken at home, providing a cheaper and easier way to treat coronavirus infections, including in poorer countries.

Merck has agreed to let other manufacturers make and sell its pill in 105 developing nations, including many where vaccination rates are critically low. It has also licensed eight large Indian drug makers to produce generic and cheaper versions of Merck’s pill.

In the United States, Pfizer applied to the Food and Drug Administration this week to authorize Paxlovid, and the Biden administration plans to buy a stockpile of the pill that could be administered to as many as 10 million people.

Credit…Carlos Osorio/Reuters

Canada approved the use of Pfizer-BioNTech’s coronavirus vaccine for children ages 5 to 11 on Friday, adding more than 2.8 million young people to those eligible for a shot.

Some provinces, including Ontario and Saskatchewan, have already announced plans to start scheduling appointments for young children as soon as the doses arrive. Canada’s first order — enough for all eligible children to receive one dose — is expected to begin arriving on Sunday, Filomena Tassi, Canada’s minister of public services and procurement, said at a news conference. She added that the government was working with Pfizer on a second order.

“Overall, this is very good news for adults and children alike,” Dr. Supriya Sharma, chief medical adviser at Health Canada, the agency responsible for drug authorization in the country, said at another news conference. “It provides another tool to protect Canadians and, to the relief of many parents, will help bring back a degree of normality to children’s lives, allowing them to more safely do the things that they have missed during the last 20 months.”

Pfizer’s is the first coronavirus vaccine to be approved in Canada for children ages 5 to 11. Health Canada based its approval on a clinical trial comprising 4,600 children, Dr. Sharma said, with 3,100 children receiving two doses of the vaccine spaced three weeks apart and 1,500 receiving a placebo.

There were four adverse reactions unconnected to the vaccinations, and none of the children experienced heart inflammation or severe allergic reactions.

The pediatric doses — each one-third of the adult dose — will be stored in vials with an orange cap, and the cartons’ labels will have orange borders, to differentiate them from the adult vials, Christina Antoniou, a spokeswoman for Pfizer Canada, said in an email.

The reduced dose for children results in antibody levels comparable to those from the larger dose in adults, said Dr. Jeffrey Pernica, an infectious diseases specialist at McMaster Children’s Hospital in Hamilton, Ontario. For parents wondering if they should wait until their child turns 12 to get the larger dose, Dr. Pernica noted, the immune response produced by the pediatric vaccine is just as strong.

“I don’t think waiting would have any significant benefit,” he said.

Nearly 75 percent of all Canadians, or more than 28.5 million people, are fully vaccinated.

More than 16,800 coronavirus cases have been reported in Canada in the past seven days, according to national public health data, with the highest per capita rates in Yukon and the Northwest Territories. First Nations reserves are also experiencing high per capita infection rates.

While the number of severe cases has declined nationwide, hospitals in some areas are inching closer to capacity limits, said Dr. Theresa Tam, Canada’s chief public health officer. She added that newly reported cases were highest among children.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

Credit…Emily Elconin for The New York Times

As Michigan confronts the most severe rise in recent coronavirus cases per capita in the United States, the state’s health officials announced on Friday that they will issue a face mask advisory in an effort to hamper the virus’s spread ahead of the holidays.

The Michigan Department of Health and Human Services recommended that all residents older than the age of 2 should wear a face mask at indoor gatherings, and urged businesses to implement a mandatory mask policy.

The advisory comes as Michigan tackles its highest surge of virus cases since the pandemic began, outpacing a jump that ravaged the state in the spring.

As of Thursday, the daily average of new cases increased 83 percent and the average number of hospitalizations increased 40 percent over the past two weeks, according to a New York Times database. The seven-day average of new cases was 8,393, and the average number of daily deaths was 67. The average number of hospitalizations, 3,224, remained lower than those in the spring.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

“The increases in case counts, percent positivity and hospitalizations have us very concerned,” Elizabeth Hertel, director of the Michigan health department, said in a statement. “We are issuing the face mask advisory and are looking to Michiganders to do their part to help protect their friends, their families and their communities by wearing a mask in indoor settings and getting vaccinated for Covid-19 and flu as soon as possible if they have not already done so.”

With airline travel this Thanksgiving season expected to approach prepandemic levels, according to Transportation Security Administration officials, Michigan’s chief medical executive, Dr. Natasha Bagdasarian, urged residents to abide by a range of mitigation measures as holiday season approaches.

“The holidays can be a time to spread great cheer and we recommend taking measures including wearing a mask indoors to not spread Covid-19 to loved ones,” she said in a statement.

Credit…Tang Chhin Sothy/Agence France-Presse — Getty Images

Cambodia reopened for fully vaccinated tourists from overseas this week without quarantine after a nationwide campaign succeeded in achieving one of the world’s highest vaccination rates.

The move was welcomed by desperate tourism operators and workers, who have struggled to make a living since the start of the pandemic.

“I rejoice at and fully support the news of reopening the country to vaccinated tourists without quarantine,” said Chhay Sivlin, the president of the Cambodia Association of Travel Agents. Tourism directly accounted for more than 12 percent of the country’s economy in 2019 and provided jobs to 630,000 people, she said.

Last month, the Southeast Asian nation of about 16 million announced plans to let fully vaccinated foreign tourists begin entering the country at the end of November if they first quarantined in selected areas for five days.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

But citing the rapid pace of inoculations and a vaccination rate of 88 percent, Prime Minister Hun Sen accelerated that plan and said that fully vaccinated tourists could arrive without quarantine, effective on Monday.

“This is a big step towards reopening the entire country,” said Mr. Hun Sen, an authoritarian leader who came to power in 1984. “I hope our compatriots enjoy our reopening. It is widely due to the country having achieved such an outstanding rate of vaccination.”

While the prime minister put the fully vaccinated rate at 88 percent based on a population of 16 million, The New York Times database puts the rate at 80 percent, based on a population of nearly 16.5 million.

More than two million people have received a third dose.

About 90 percent of Cambodia’s vaccines came from China, including more than nine million doses of Sinovac and nearly four million doses of Sinopharm.

Under the new rules, travelers arriving from abroad can skip quarantine if they are fully vaccinated, test negative for the virus before departure and test negative again on arrival. Travelers who are not vaccinated must still spend 14 days in quarantine.

Ms. Sivlin said that tourist bookings were beginning to pick up and that airlines were working to increase the number of flights to Cambodia.

Some flights are scheduled to the capital, Phnom Penh, but none for Siem Reap, the town near the ancient city of Angkor that is one of the most popular destinations in Southeast Asia.

Like many of its neighbors, Cambodia reported relatively few virus cases in 2020 but faced a deadly surge this year. Still, its overall numbers have remained relatively low, with about 120,000 total cases and 2,900 deaths.

Credit…Chang W. Lee/The New York Times

About a third of people in the United States and Britain think their countries have suffered damage to their global reputations over their responses to the pandemic, according to a survey released on Friday, while Canadians rated their country’s response more positively.

Respondents to the poll, which was conducted by the Policy Institute at King’s College London, were split in the United States and Britain on whether their countries should cooperate internationally to quash the virus moving forward or whether they should work independently.

“The public in the U.K. and the U.S. seem in two minds on whether each country should hunker down and protect themselves or reach out to the rest of the world,” said Bobby Duffy, the director of the institute that conducted the survey.

“But it’s actually an understandable response,” he added. “People feel like we should think of ourselves first in the current crisis but work with others to help prevent future global health challenges.”

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

The United States and Britain have experienced two of the worst Covid outbreaks among wealthy nations.

New cases have been rising in the United States as colder winter temperatures and the holiday season approach, with nearly 95,000 additional infections recorded daily.

Britain is reporting an average of nearly 40,000 daily virus cases. And despite a surge in cases this fall, Prime Minister Boris Johnson has opposed introducing preventive measures such as mask mandates and health passes.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The survey, an online poll conducted in October and November, found that about 38 percent of respondents in the United States believed the country’s handling of the pandemic has damaged its global reputation, 21 percent said its impact had been positive and 25 percent said they felt it had no effect.

In Britain, about 36 percent said the government’s mishandling of the health crisis had damaged the country’s global standing, 21 percent said it had improved it, and 31 percent said they considered the impact insignificant.

Only 19 percent of people in Canada said their country’s reputation had taken a hit, while 33 percent said it had improved amid the government’s pandemic response and 37 percent said it had made no difference.

The poll included 1,099 adults in the United States, 1,129 people aged 16 to 75 in Britain, and 1,088 adults in Canada.

It follows a highly critical 151-page parliamentary inquiry into Britain’s initial response to the coronavirus, which ranked it as “one of the most important public health failures the United Kingdom has ever experienced” and charged that it had cost thousands of lives.

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