Editor’s note: This is a live account of COVID-19 updates from Friday, April 23, as the day unfolded. It is no longer being updated. Click here to see all the most recent news about the pandemic, and click here to find additional resources.

Washington state has entered its fourth wave of the COVID-19 pandemic as cases continue to rise, Gov. Jay Inslee said Thursday. In a news conference where he was joined by health care officials from Pierce County and Spokane, Inslee pointed to data showing an increase in cases, a rise in hospitalizations and the spread of new virus variants. Calling the situation “simply too dangerous to persist,” Inslee called on people to get vaccinated, wear masks and keep their distance.

The health effects of COVID-19 not only can stretch for months but appear to increase the risk of death and chronic medical conditions, even in people who were never sick enough to be hospitalized, a large new study finds. In the study, published Thursday in the journal Nature, researchers looked at medical records of more than 73,000 people across the United States whose coronavirus infections did not require hospitalization. Between one and six months after becoming infected, those patients had a significantly greater risk of death — 60% higher — than people who had not been infected with the virus.

We’re updating this page with the latest news about the COVID-19 pandemic and its effects on the Seattle area, the U.S. and the world. 

Click here to see previous days’ live updates and all our other coronavirus coverage, and here to see how we track the daily spread across Washington and the world.

Puerto Rico experiences its worst surge in coronavirus cases

Puerto Rico in the last five weeks has experienced its worst surge of coronavirus since the pandemic began.  

In early April, the island went from averaging about 200 new cases a day to about 800, according to a New York Times database, and at one point the positivity rate reached about 14%. The rise leveled finally off this week.  

Several factors were to blame for the rise, including the spread of coronavirus variants, tourists on spring break and gatherings to celebrate Holy Week. The government had relaxed restrictions in January and February to open up the economy. 

Some 1.65 million people in Puerto Rico — 31% of the population — have received a dose of the vaccine. 

“So much public attention turned to vaccination,” said Mónica Feliú-Mojer, director of communications at Ciencia Puerto Rico, a nonprofit group that supports scientists and their research. 

“The moment you stop hearing about all the cases, you stop hearing about the importance of preventing contagion. The numbers have been worrying for more than a month, epidemiologists were sounding the alarm, and nobody was paying attention.” 

—The New York Times

State reports 1,801 new coronavirus cases and 6 new deaths

The state Department of Health (DOH) reported 1,801 new coronavirus cases and six new deaths on Friday.

The update brings the state's totals to 393,594 cases and 5,434 deaths, meaning that 1.4% of people diagnosed in Washington have died, according to the DOH. The data is as of 11:59 p.m. Thursday.

The new cases may include up to 130 duplicates, according to DOH.

In addition, 21,772 people have been hospitalized in the state due to the virus — 29 new hospitalizations. In King County, the state's most populous, state health officials have confirmed a total of 99,085 COVID-19 diagnoses and 1,504 deaths.

Since vaccinations began in mid-December, the state and health care providers have administered 4,919,206 doses and 26.82% of Washingtonians have been fully vaccinated against COVID-19, according to vaccination data, which the state updates on Mondays, Wednesdays and Fridays. Providers are currently giving an average of about 61,184 vaccine shots per day.

The DOH says its daily case reports may also include duplicate test results, results assigned to the wrong county, results that are reported for today but are actually from a previous day, occasional false positive tests and other data discrepancies. Because of this, the previous day’s total number of cases plus the number of new daily cases does not add up to the new day’s total number of cases. State health officials recommend reviewing the dashboard's epidemiologic curves tab for the most accurate representation of the state's COVID-19 spread.

—Evan Bush

Seattle will have 52,000 COVID-19 vaccination doses to administer next week

The city of Seattle and its partners will have more than 52,000 COVID-19 vaccination doses to administer next week, up from a previous weekly high of about 30,000, Mayor Jenny Durkan’s office announced Friday.

The batch for next week will include 38,600 first doses and 13,700 second doses, thanks to a larger allocation from the federal government, Durkan’s office said.

The city and its partners are operating vaccination hubs in North Seattle, Rainier Beach and West Seattle and at the Lumen Field Event Center in Sodo.

Anyone 16 and older can join the city’s vaccination appointment notification list here to receive email notifications when appointments become available. You can call 206-684-2489 for help joining the list.

More than 50,000 doses have been administered to date at the Lumen Field Event Center, which can handle up to 22,000 doses each day.

People 60 and older can be vaccinated without an appointment at the Rainier Beach and West Seattle hubs. The Rainier Beach site at the Atlantic City Boat Ramp (8702 Seward Park Ave. S.) and the West Seattle site at the Southwest Athletic Complex (2801 S.W. Thistle St.) are open Monday to Saturday from 9 a.m. to 4 p.m.

—Daniel Beekman

Canada reaches deal with Pfizer for vaccines in future years

Prime Minister Justin Trudeau said Friday Canada has reached an agreement with Pfizer for 35 million booster shots next year and 30 million in 2023 in case the effectiveness of COVID-19 vaccines fades with time and need to be reinforced.

“Canadians expect us to be ready for whatever happens. There is certainly a hope that booster shots might not be necessary, but we are much better to ensure that we are prepared in case they are,” Trudeau said at news conference in Ottawa.

Trudeau made the announcement shortly before he and his wife Sophie were scheduled to receive the AstraZeneca vaccine that some people have been reluctant to get because of reports of rare blood clots.

Read the story here.

—Rob Gillies, The Associated Press

UW study finds coronavirus antibodies in dogs

A University of Washington study of household pets has found nearly two dozen dogs with antibodies for SARS-CoV-2.

The antibodies that are generated to fight off a coronavirus infection have been found in other dogs and household pets across the country. The threat to the public isn't significant, according to researchers and public-health officials.

"While there is no significant public health risk, we would advise pet owners who are COVID-positive to take measures to protect their pets from the virus," said Dr. Brian Joseph, Washington state veterinarian, in a press release from the state Department of Agriculture.

Read the full story here.

—Ryan Blethen

CDC advisory panel: Time to restart vaccinations with J&J

An expert advisory panel to the Centers for Disease Control and Prevention urged the federal government to resume vaccinations with the Johnson & Johnson vaccine, saying on Friday that the vaccine's benefits outweigh the serious but very small risk of blood clots.

About 15 cases of unusual blood clots in the brain have been identified in people after receiving the J&J shot. All of these cases were in women, most younger than 50. Nearly 8 million people have been vaccinated with the J&J inoculation so far.

Federal regulators will weigh the panel's recommendation and decide soon on next steps.

Read more.

—Associated Press and Seattle Times staff reporter Evan Bush

CDC recommends pregnant women get coronavirus vaccine

Pregnant women confused by conflicting recommendations regarding coronavirus vaccination over the past few months now have clear guidance from the Centers for Disease Control and Prevention: Get the shots.

At a White House briefing on the coronavirus Friday, CDC Director Rochelle Walensky said that vaccination surveillance systems showed “no safety concerns” for more than 35,000 women in their third trimester or for their babies.

The CDC had previously suggested that pregnant women make their decisions in consultation with their doctors. The American College of Obstetricians and Gynecologists said coronavirus vaccines “should not be withheld from pregnant individuals” but stopped short of explicitly recommending the shots for that population.

Read the story here.

—Ariana Eunjung Cha, The Washington Post

Family indicted, accused of selling bleach as COVID cure

A family accused of selling a toxic industrial bleach as a coronavirus cure through their Florida-based church has been indicted on federal charges.

A federal grand jury in Miami returned an indictment Thursday charging Mark Grenon, 62, and his sons, Jonathan, 34, Jordan, 26, and Joseph, 32, with one count each of conspiracy to commit fraud and two counts each of criminal contempt, according to court records.

Mark Grenon is the archbishop of the Genesis II Church of Health and Healing, based in Bradenton, Florida. The church sells chlorine dioxide as a “Miracle Mineral Solution,” officials said. The Grenons claim the solution can cure a vast variety of illnesses ranging from cancer to autism to malaria to COVID-19. A Miami federal judge last April ordered the church to stop selling the substance, but the order was ignored.

—The Associated Press

NY won’t say what it told DOJ about nursing home outbreaks

Gov. Andrew Cuomo’s office said it won’t reveal what it told the U.S. Justice Department about COVID-19 outbreaks in nursing homes, partly because doing so would be an “invasion of personal privacy.”

The Justice Department last year asked the governors of several states, including New York, to turn over certain, basic statistics related to deaths and infections inside nursing homes.

That federal request, initially made in August and later expanded in October, followed reports by The Associated Press and other news organizations that the state’s official nursing home death toll was likely a significant undercount.

Cuomo’s began sending records to federal investigators last year. But his office has now denied a request from The Associated Press for copies of those documents.

Read the story here.

—The Associated Press

Canada bans flights from India, Pakistan

Canada on Thursday said it is banning all flights from India and Pakistan for 30 days due to the growing wave of COVID-19 cases in that region.

Transport Minister Omar Alghabra said the ban would start late Thursday, speaking hours after India reported a global record of more than 314,000 new infections in the previous 24-hours. Cargo flights from India and Pakistan will continue.

Health Minister Minister Patty Hajdu said half the people who are testing positive for the coronavirus after arriving in Canada by airplane came from India. Flights from India account for about one fifth of the country’s air traffic.

There also a disproportionate higher number of positive cases among those travelling on flights from Pakistan, she said.

“It makes sense to pause travel from that region while our scientists and researchers better understand the variants of interest,” Hajdu said.

Read the story here.

—The Associated Press

Donor fatigue and desperate need at Seattle's Bloodworks Northwest

Bloodworks Northwest said donor fatigue and the most sustained no-show rate since the coronavirus pandemic began led to a severe blood shortage with less than a 24-hour supply in the blood bank's inventory.

In a statement Friday, the local nonprofit declared it a "Code Red" emergency.

Bloodworks said donor fatigue from warm weather and a feeling that the pandemic may almost be over has led to a significant drop in the number of people making and keeping their appointments. Donations are short about 700 units a week compared to the need.

“Blood is being shipped to hospitals faster than it’s being collected,” said Executive Vice President Vicki Finson. “We’re actively communicating with hospitals to conserve blood and appealing to donors to book appointments so that doctors don’t need to make difficult decisions like canceling surgeries or postponing treatments based on the blood supply. And because donation is by appointment-only, if you cannot make your appointment, it’s critical to cancel so others can fill in for you.”

Types O and A are in critically short supply, the statement said.

Washington and Oregon residents can book appointments here.

—Christine Clarridge

EU agency says people should get 2nd dose of AstraZeneca too

The European Medicines Agency said Friday that people who have received a first dose of AstraZeneca’s COVID-19 vaccine should also get the second one despite the rare risk of blood clots that have been linked to the shot.

In new guidance, the European Union’s drug regulator said people should still get a second AstraZeneca dose four to 12 weeks after their first shot and that the benefits of immunization far outweighed the risks of the unusual clotting disorder.

Earlier this month, the Amsterdam-based drug regulator for the 27-nation EU said there was a “possible link” between the AstraZeneca vaccine and rare blood clotting disorders, but that the vaccine dramatically reduced the risk of being hospitalized or killed by COVID-19.

Read the story here.

—Maria Cheng, The Associated Press

Sen. Johnson on others getting shots: ‘What do you care?’

Republican Sen. Ron Johnson, of Wisconsin, questioned the need for widespread COVID-19 vaccinations, saying in a radio interview “what do you care if your neighbor has one or not?”

Johnson, who has no medical expertise or background, made the comments Thursday during an interview with conservative talk radio host Vicki McKenna. Contrary to what medical experts advise, Johnson has said he doesn’t need to be vaccinated because he had COVID-19 in the fall. On Thursday, he went further, questioning why anyone would get vaccinated or worry about why others have not.

“For the very young, I see no reason to be pushing vaccines on people.” Johnson said. “I certainly am going to vigorously resist any kind of government use or imposing of vaccine passports. … That could be a very freedom-robbing step and people need to understand these things.”

Johnson’s comments come as health officials in the U.S. and around the world urge people to get vaccinated for COVID-19 as soon as possible, saying that reaching herd immunity is the best shot at stopping the uncontrolled spread of the virus.

Read the story here.

—Scott Bauer, The Associated Press

What immunosuppressed patients should know about the coronavirus vaccines

Cancer patients. Organ transplant recipients. Individuals with HIV. Those with autoimmune or chronic inflammatory conditions such as lupus, multiple sclerosis and rheumatoid arthritis.

An estimated 10 million people in the United States are considered immunocompromised, including those who were born with immune-system deficiencies. It often makes them more susceptible to infections and puts them at a higher risk of experiencing a more severe outcome when they get sick.

So it makes sense why many would want to inoculate themselves against COVID-19, the illness caused by the coronavirus — and public health authorities have advised them to do it.

But even though the coronavirus vaccines authorized for emergency use by the Food and Drug Administration are considered safe for people with compromised immune systems, some of them may not produce protective antibodies after vaccination, or any antibodies at all.

That’s why researchers are working to understand more about vaccines’ effectiveness within the immunocompromised community and how to protect the most vulnerable.

Read the story here.

—Lindsey Bever, The Washington Post

Indian hospitals plead for oxygen, country sets virus record

India’s underfunded health system is tattering and hospitals are begging for oxygen as the world’s worst coronavirus surge wears out the nation, which set a global record in daily infections for a second straight day with 332,730.

India has confirmed 16 million cases so far, second only to the United States in a country of nearly 1.4 billion people. India has recorded 2,263 deaths in the past 24 hours for a total of 186,920.

Read the story here.

—The Associated Press

Thailand’s new cases set record

Thailand’s health authorities announced Friday they have confirmed 2,070 new COVID-19 cases, a new daily record that brings the country’s total to 50,183.

The rising numbers are severely straining the supply of hospital beds and ICU capacity.

At the beginning of March, Thailand had 26,031 cases with double-digit daily increases, but a new outbreak sent the numbers skyrocketing.

Read the story here.

—The Associated Press

FDA: N95 masks, now plentiful, should no longer be reused

The Biden administration has taken the first step toward ending an emergency exception that allowed hospitals to ration and reuse N95 medical masks, the first line of defense between frontline workers and the deadly coronavirus.

Thousands of medical providers have died in the COVID-19 pandemic, many exposed and infected while caring for patients without adequate protection.

Critical shortages of masks, gowns, swabs, and other medical supplies prompted the Trump administration to issue guidelines for providers to ration, clean, and reuse disposable equipment. Thus, throughout the pandemic, once a week many doctors and nurses were issued an N95 mask, which is normally designed to be tossed after each patient.

Now U.S. manufacturers say they have vast surpluses for sale, and hospitals say they have three to 12 month stockpiles.

In response, the government says hospitals and healthcare providers should try to return to one mask per patient.

Read the story here.

—Martha Mendoza and Juliet Linderman, The Associated Press

Tokyo under ’emergency orders’ with Olympics 3 months away

Only three months before the postponed Olympics are set to open, Tokyo and Japan’s second largest metropolitan area of Osaka have been placed under the nation's third set of emergency orders aimed at stemming surging cases of the coronavirus.

The measures, which take place during Japan’s “golden week” holiday period, are meant to limit travel and keep people out of public places. They are to end on May 11, just ahead of a widely reported visit to Hiroshima by International Olympic Committee President Thomas Bach whose presence was immediately criticized by opposition lawmakers who say the Olympics are being prioritized ahead of public safety.

Japan has attributed about 10,000 deaths to COVID-19, good by global standards but poor by standards in Asia. It has vaccinated less than 1% of the population and has not enforced lockdowns with people becoming impatient and less cooperative as cases have again accelerated.

Read the story here.

—The Associated Press

Topless clubs among businesses that can reopen in Vegas

Topless dancers can shed coronavirus restrictions next weekend in Las Vegas and get face-to-face with patrons again, under rules accepted Thursday by a state COVID-19 task force.

But masks still will be required for adult entertainment employees and recommended for customers.

Sin City strip clubs that went dark when Nevada Gov. Steve Sisolak ordered casinos, clubs and nonessential businesses closed in March 2020 will be able to open May 1 at 80% of fire code capacity under strict social distancing guidelines.

The rules will allow strip club entertainers to get closer than 3 feet (0.9 meters) to patrons if the entertainer received at least a first dose of a COVID-19 vaccine at least 14 days earlier, according to county rules, or if the dancer tests negative in a weekly COVID-19 test.

Read the story here.

—Ken Ritter, The Associated Press

Norwegian climber 1st to test positive on Mount Everest

The coronavirus has conquered the world’s highest mountain.

A Norwegian climber became the first to be tested for COVID-19 in Mount Everest base camp and was flown by helicopter to Kathmandu, where he was hospitalized.

Erlend Ness told The Associated Press in a message Friday that he tested positive on April 15. He said another test on Thursday was negative and he was now staying with a local family in Nepal.

An ace mountain guide, Austrian Lukas Furtenbach, warned that the virus could spread among the hundreds of other climbers, guides and helpers who are now camped on the base of Everest if all of them are not checked immediately and safety measures are taken.

Any outbreak could prematurely end the climbing season, just ahead of a window of good weather in May, he said.

Read the story here.

—Binaj Gurbacharya, The Associated Press

Catch up on the past 24 hours

Put on the life jacket and mask: Washington is officially riding the fourth wave of COVID-19 as dangerous variants spread, and younger people are getting hit harder. This doesn't bode well for the state's upcoming decision on whether to tighten restrictions.

Avoid those unusual coronavirus test sites that have been popping up, King County health officials are warning. They're not operating safely, and they're not necessarily free, according to Public Health — Seattle & King County. Here's what to watch for and where to get tested without worrying about that possible hinkiness.

The Johnson & Johnson vaccine could get the go-ahead todaybut with a new warning about rare blood clots, U.S. officials say. The decision will come as the CDC investigates the death of an Oregon woman who had the J&J shot.

What are the odds you’ll need a vaccine passport? Our FAQ Friday breaks down how they might work and why they’re meeting stiff resistance.

Two alarming new studies on COVID-19's effects: Even people who were never hospitalized after falling ill ended up with a significantly higher risk of death and chronic medical conditions, according to a study that stunned researchers. And pregnant women with COVID-19 were 20 times more likely to die than those who didn't get the virus, UW researchers have found.  

Hundreds of Mount Everest climbers may be at risk after the first coronavirus case arrived at base camp. 

—Kris Higginson