Home Health News Covid-19 Live Updates: Cuomo Threatens Hospitals With Fines in Bid to Speed Up Vaccinations – The New York Times

Covid-19 Live Updates: Cuomo Threatens Hospitals With Fines in Bid to Speed Up Vaccinations – The New York Times

108 min read

Alex Welsh for The New York Times

California’s daily coronavirus case tallies remain around four times what they were during the state’s summer surge, and officials predict that the aftereffects of a December surge linked to holiday gatherings will worsen as the winter drags on.

After new infections — driven by Thanksgiving travel and gatherings, then Christmas festivities — resulted in a surge unlike any the state had yet seen, the trajectory of its new cases has leveled off somewhat in the early days of 2021.

But there are more than twice as many Covid-19 patients in California hospitals now as there were a month ago, and many intensive care units in the state have been overflowing. At least six people in the state have also been found to be infected with the new, more transmissible variant of the virus first identified in Britain.

In the pandemic’s brutal logic, more cases inevitably translates to more suffering and deaths. As of Monday night, 4,258 people with Covid-19 had died in the preceding two weeks, compared with 3,043 in the two weeks before that.

“This is a deadly disease, this is a deadly pandemic,” Gov. Gavin Newsom told reporters on Monday. “It remains more deadly today than at any point in the history of the pandemic.”

There has been some progress. California’s daily average of 38,086 cases per day over the past week represents a decrease of 11 percent from the average two weeks earlier, for example. And although Covid-19 hospitalizations have increased by 18 percent over the past two weeks, to 20,618, Governor Newsom said that represents a slight flattening of the curve.

But the state’s last major Covid-19 surge, over the summer, only produced around 10,000 infections on its worst days. And in Los Angeles County, the latest crisis has stretched the health care system so thin that incoming patients at one hospital were recently being instructed to wait in an outdoor tent.

Mayor Eric Garcetti of Los Angeles said on Sunday that the county’s latest surge was infecting a new person every six seconds, and that many transmissions were occurring in private settings.

“It’s a message for all of America: We might not all have the same density as L.A., but what’s happening in L.A. can and will be coming in many communities in America,” he said.

The worst of the state’s outbreak is concentrated in Southern California and the San Joaquin Valley, where intensive care units are at zero percent capacity. Officials are now working to bring in extra nursing staff to care for the flood of patients; Governor Newsom said that 90 patients were being kept at “alternate care sites” outside hospitals to help ease the burden.

The state is also facing an oxygen shortage for patients, and it has deployed the U.S. Army Corps of Engineers and the California Emergency Medical Services Authority to help deliver and refill oxygen tanks.

In a sign of how dire that shortage is, Marianne Gausche-Hill, the medical director for Los Angeles County’s E.M.S. agency, issued guidelines to emergency workers on Sunday for administering the “minimum amount of oxygen necessary” to keep patients’ oxygen saturation level at or just above 90 percent. (A level in the low 90s or below is a concern for people with Covid-19.)

More inoculations would help ease California’s burden, but Governor Newsom said vaccinations were only just ramping up after facing some early challenges. So far, he said, the state has only administered about 35 percent of the coronavirus vaccine doses it has received.

“That’s not good enough,” he said. “We recognize that.”

In the meantime, said Dr. Mark Ghaly, the state’s secretary of health and human services, Californians should be extra cautious about gathering with people outside their household now that the virus is so prevalent.

“The same activities that you did a month ago, today are just so much more risky than they were from a Covid transmission perspective,” he said.

Elected officials, prison rights advocates and inmates’ family members protested for better conditions outside San Quentin State Prison in July.
Jim Wilson/The New York Times

The number of inmates and guards known to have been infected with the coronavirus at American correctional institutions exceeded 500,000 on Monday, according to a New York Times database.

As correctional institutions have been battered by coronavirus infections and deaths, the number of cases reported in has risen by nearly 84 percent in the last two months, according to a Times analysis of the data from some 2,600 prisons, jails and immigration detention centers.

There are now 88 facilities that have had at least 1,000 infections, according to the database.

Local jails and state prison systems have been so devastated by the virus that they have resorted to the drastic strategy of shutting down completely and transferring inmates elsewhere. Experts say the jails and prisons that stay open will probably become even more crowded, unsanitary and disease ridden, and the transfers are likely to help the virus proliferate both inside and outside the walls.

At the same time, some states, like California and Washington, have begun vaccinating older and medically vulnerable prisoners. Even so, inmates and their families say that the crescendo of new cases has made incarcerated people more afraid of dying from the virus now than they have ever been.

“Five families called me on New Year’s Day,” said Beverly Brooks, who manages a prison advocacy program for the Covenant Fellowship of Churches International based in Florida. “They’re really scared for their loved ones. And the inmates are like, ‘OK, is this a way for me to die?’”

At Lumberton Correctional Institute in North Carolina, Shannon Nyamodi, an inmate, said he worried about prisoners with health issues sleeping an arm’s length from other inmates. More than 220 prisoners at Lumberton have tested positive, including a man Mr. Nyamodi knew who died over the summer.

“There’s a mass fear of contracting the virus for a big handful of prisoners,” he said. “They weren’t sentenced to death, they were just sentenced to do a few months or a few years here.”

A prisoner at the Allenwood federal complex in Pennsylvania, Aaron Kinzer, said he regularly watched staff members walk back and forth between his unit and a quarantine area without changing their protective gowns or masks.

Early in the pandemic last spring, he said, there were relatively few cases at Allenwood and prisoners worried mainly about loved ones on the outside. As illnesses inside the facility have piled up since then — nearly 700 inmates have tested positive — so has a sense of despair.

“The mood in here reflects the greater society’s mood, and has throughout the pandemic,” Mr. Kinzer said. “Early on, there was a lackadaisical approach — a belief that, you know, it was not going to touch us.” But after an inmate died of Covid-19 in August, he said, “hearing that it’s so close — just feet away, 100 yards away, 200 yards away — kind of drove it home.”

Ms. Brooks said her son Jonathan Brooks called her last week from Wake Correctional Center in Raleigh, N.C., after hearing rumors that a group of inmates would soon be transferred in. Similar transfers have touched off deadly outbreaks in prisons across the nation. Rumors like that, and of more inmates falling ill, can intensify the dread in the cell blocks.

“Every time this happens, they’re thinking, ‘Will I be next?’” Ms. Brooks said. “My son was like, ‘I just want to get out of here, Mama. I’ve got to get out of here.’”

Ann Hinga Klein and

Health workers and soldiers in lines for the Pfizer-BioNTech Covid-19 vaccine at a military base in Mexico City last week. Mexico has also approved the Oxford-Astra Zeneca vaccine for emergency use.
Marco Ugarte/Associated Press

Mexico approved the Oxford-AstraZeneca coronavirus vaccine for emergency use on Monday, the country’s top epidemiologist, Hugo López-Gatell, announced in a tweet on Monday evening. It is the fourth country to approve the vaccine.

Mexico’s foreign secretary, Marcelo Ebrard, had previously said the approval was “imminent.”

Mr. Ebrard celebrated the approval on Monday evening as “very good news,” tweeting that it would allow the country to start production “very soon.” AstraZeneca said in August it would work with the Mexican and Argentine governments to produce 150 million initial doses for distribution across Latin America, and later produce at least 400 million doses for the region.

Last week, Britain became the first country to grant emergency approval for the Oxford-AstraZeneca vaccine. Argentina soon followed suit. India on Sunday said it had also approved the Oxford-AstraZeneca vaccine.

On Monday, an 82-year-old dialysis patient in Oxford was the first person in the world to receive the clinically authorized, fully tested Oxford-AstraZeneca vaccine when Britain began administering the vaccine.

The Oxford-AstraZeneca shot is poised to become the world’s dominant form of inoculation. At $3 to $4 a dose, it is a fraction of the cost of some other vaccines.

And it can be shipped and stored in normal refrigerators for six months, rather than in the ultracold freezers required by the Pfizer-BioNTech and Moderna vaccines, making it easier to administer in poorer and harder-to-reach areas.

Mr. López-Gatell said he had incorrectly reported that a single-dose vaccine that had undergone phase three trials in Mexico by Chinese-Canadian firm CanSino was approved, according to The Associated Press.

The United States and the European Union have indicated that they are unlikely to authorize the Oxford-AstraZeneca vaccine until at least February.

When given in two full-strength doses, the regimen authorized by Britain, AstraZeneca’s vaccine showed 62 percent efficacy in clinical trials — considerably lower than the roughly 95 percent efficacy achieved by Pfizer and Moderna’s shots. No one who received the vaccine in the clinical trials developed severe Covid-19 or was hospitalized.

Much of the world is looking to AstraZeneca in part because it has set more ambitious manufacturing targets than other Western vaccine makers. It has said that it expects to make up to three billion doses this year — a haul that, at two doses per person, would be enough to inoculate nearly one in five people worldwide. The company has pledged to make the vaccine available at cost around the world until at least July 2021, and in poorer countries into perpetuity.

Mexico has the fourth-highest number of coronavirus deaths in the world, according to a New York Times database, and the 13th-highest number of coronavirus cases.

The country has reported nearly 1.5 million infections, and 127,213 Mexicans have died of the virus.

But Mexico’s transparency with the severity of the virus in the country has been spotty. Last month, federal officials told the public that the number of cases in the capital, Mexico City, had not reached a level requiring — per its own standards — a lockdown. A New York Times analysis using the government’s own official numbers found that the city had surpassed that level.

In the spring, The Times reported that the federal government was not reporting hundreds and potentially thousands of coronavirus deaths in the capital.

An earlier version of this item incorrectly stated when Mexico’s foreign secretary said the vaccine approval was “imminent.”

Jytte Margrete Frederiksen was vaccinated in Ishoej, Denmark, on Dec. 27, as Danish Prime Minister Mette Frederiksen watched the via videolink.
Mads Claus Rasmussen/Ritzau Scanpix, via Associated Press

As governments around the world rush to vaccinate their citizens, scientists and policymakers are debating whether to reserve the second doses everyone will need, or give as many people as possible just one shot now — potentially at the expense of giving second doses on schedule.

A number of countries in Europe are considering the options, or moving forward with the delay, despite a lack of evidence about how much protection a single dose of vaccine will provide and how long it will last.

Denmark on Monday approved a lag of up to six weeks between the first and second shots of the Pfizer-BioNTech vaccine, Reuters reported, although the vaccine is meant to to be given in doses three weeks apart. Germany and Ireland are considering similar moves.

Britain last week announced a plan to separate doses by up to 12 weeks. Britain has authorized Pfizer’s vaccine as well as the product developed by the University of Oxford and AstraZeneca, which is meant to be given in doses separated by four weeks.

So far, health officials in the United States have been adamantly opposed to the idea, saying it is not supported by the data gathered in clinical trials.

“The approach some countries are taking of delaying the booster shot could backfire and could decrease confidence in the vaccines,” Moncef Slaoui, scientific adviser of Operation Warp Speed, the federal effort to accelerate vaccines, said on Sunday night.

In the late-stage clinical trial that found the vaccine from Pfizer-BioNTech to be highly effective, participants generally received their seconds shots about three weeks after the first, although data were included from people who received the doses as far as seven weeks apart. In a statement on Monday, the European Union’s drug regulator, the European Medicines Agency, expressed support for sticking to the original plan for spacing the doses of the vaccine. “Any change to this would require a variation to the marketing authorization as well as more clinical data to support such a change,” said Monika Benstetter, an agency spokeswoman.

Since the United States began rolling out authorized vaccines from Pfizer-BioNTech and Moderna, second shots of the vaccines have been sequestered to guarantee that they will be available for people who have gotten their first injections.

Pfizer has also pushed back on the idea of additional lag time. “Two doses of the vaccine are required to provide the maximum protection against the disease,” said Steven Danehy, a spokesman for Pfizer. “There are no data to demonstrate that protection after the first dose is sustained after 21 days.”

The developers of authorized vaccines have reported that a degree of protection appears to kick in after the first shot of vaccine, although it’s unclear how quickly it may wane.

Still, despite a high-level repudiation of the U.K. strategy from Dr. Anthony S. Fauci, the nation’s top infectious disease expert, some scientists believe the United States should consider widening the gap between doses. Proponents of the idea argue that spreading vaccines more thinly across a population by concentrating on first doses may save lives.

On Sunday, Dr. Robert M. Wachter, the chair of the department of medicine at the University of California at San Francisco, and Dr. Ashish K. Jha, the dean of the Brown University School of Public Health, wrote in an opinion piece in The Washington Post that “it’s time to change the plan.”

“The biggest mistake you can make in medicine is anchoring bias,” Dr. Wachter told The New York Times. “You get stuck on what you thought, and you don’t shift with new information.”

The debate reflects frustration that so few Americans have gotten their first doses.

As of Monday morning, three weeks into the vaccination drive, 15.4 million doses of the Pfizer-BioNTech and Moderna vaccines had been shipped across the United States, but just 4.6 million people had gotten their first shots.

The rollout has been bumpy. In Houston, the Health Department phone system crashed on Saturday, the first day officials opened a free vaccination clinic. In Los Angeles, now a center of the pandemic, Mayor Eric Garcetti said that vaccine distribution was moving far too slowly. In New York, Gov. Andrew M. Cuomo said on Monday that hospitals in the state will now face fines and potentially lose the opportunity to distribute the vaccine if they do not step up the pace of inoculations.

But some experts are not convinced that increasing the gap between doses will solve the problems that have slowed the rollout of vaccines in the United States.

“We have an issue with distribution, not the number of doses,” said Saad Omer, a vaccine expert at Yale University. “Doubling the number of doses doesn’t double your capacity to give doses.”

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Prime Minister Boris Johnson addressing Britons on Monday.Paul Ellis/Agence France-Presse — Getty Images

Prime Minister Boris Johnson imposed a strict new national lockdown on Monday as Britain’s desperate race to vaccinate its population risked being overtaken by a fast-spreading variant of the coronavirus that was on track to overwhelm the nation’s beleaguered hospitals.

After several days of frighteningly high and escalating case numbers, Mr. Johnson ordered schools and colleges in England to shift to remote learning. He appealed to Britons to stay at home for all but a few necessary purposes, including essential work and buying food and medicine.

The decision was a fresh setback for Mr. Johnson, coming at a time when the arrival of two vaccines appeared to provide a route out of the crisis after nine fraught months and fierce criticism of his handling of the pandemic.

On the day that the first doses of a vaccine developed by AstraZeneca and the University of Oxford were administered, the good news was drowned out by the reintroduction of the type of sweeping restrictions used last spring when the pandemic first threatened to run out of control.

In recent weeks, a new, highly transmissible variant of the virus has taken hold in London and southeast England, prompting an alarming spike in case numbers and putting hospitals under acute pressure.

On Sunday, Mr. Johnson admitted that the current controls on daily life were insufficient. But the first announcement of a full-scale lockdown came not from him but from Scotland, where the first minister, Nicola Sturgeon, has consistently moved further and faster in efforts to tame the pandemic.

The first minister of Northern Ireland, Arlene Foster, said at a news conference on Monday evening that schools would remain closed as part of the restrictions, which she said could last through “the rest of January, probably into February.”

Students in primary school and some post-primary students in Northern Ireland had been set to return to school on Jan. 11. Ms. Foster said a more complete announcement would be made on Wednesday after the government had time to clarify some details, especially regarding vulnerable and special needs students.

Britain is now involved in a high stakes race to roll out its mass vaccination program before its country’s health service is overwhelmed by the new variant. Non-Covid treatment is again being postponed and pictures of ambulances stacking up in the parking lots of some hospitals last week illustrated the challenge faced by the country’s weary health workers.

In a sign of the threat faced by hospitals, the government raised its Covid alert to its highest level for the first time, one that warned of a “material risk of health care services being overwhelmed.” On Monday, there were more than 26,000 Covid-19 patients in hospitals, an increase of 30 percent from the previous week, Mr. Johnson’s office said.

New infections have surged to a rate of almost 60,000 a day, double the rate of a few weeks ago.

With 75,024 deaths, Britain already has the highest death toll in Europe, and medical experts warn that the toll, after growing more modestly over the summer, will begin spiking again.

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On Monday, Gov. Andrew M. Cuomo of New York threatened to fine hospitals if they don’t increase the pace of coronavirus vaccinations.Andrew Kelly/Reuters

Hospitals in New York State will now face fines and potentially lose the opportunity to distribute the coronavirus vaccine if they do not step up the pace of inoculations, Gov. Andrew M. Cuomo said on Monday.

The governor said hospitals could face fines of up to $100,000 if they did not use their current supplies of vaccine by the end of the week, and that facilities would be required to use future shipments within seven days of receipt, or face possible removal from distribution networks.

“We want those vaccines in peoples’ arms,” Mr. Cuomo said.

New York lags behind other large states in distributing the vaccine, and Mr. Cuomo is facing pressure to fast-track the vaccinations as deaths and hospitalizations continue to rise in the state.

Mr. Cuomo told reporters about the new penalties during a news conference at which he estimated that about 300,000 people in the state had been inoculated so far. In a call with reporters later on Monday, Mr. Cuomo announced that a case of a more contagious virus variant first identified in Britain had been found in New York State. Mr. Cuomo said the state had conducted about 5,000 tests for the British variant and that this was the first known case.

He also announced proposed legislation that would impose criminal charges on facilities and health care providers that ignore guidelines on who is eligible for the vaccine, and exhorted hospital administrators to dispense the vaccine faster, listing the 10 most and 10 least successful hospitals in the state side by side.

“This is a management issue of the hospitals,” Mr. Cuomo said, adding that “They have to move the vaccine faster.”

The announcements came after some health experts expressed concern about the slow pace of vaccinations in the city.

At an earlier news conference on Monday, Mayor Bill de Blasio said that New York City will double the number of coronavirus vaccination sites in the city and broaden the pool of people who are eligible to be inoculated in order to achieve his goal of administering one million doses in the city during January. He said that so far about 110,000 people in the city had received a first dose of the vaccine.

Mr. de Blasio said that New York State had added a number of categories of workers to the eligible list, including testing-site workers, contact tracers, dentists, physical therapists, police department medical staff, workers at specialized clinics, and outpatient and ambulatory care providers.

“We want to keep expanding those categories,” Mr. de Blasio said. “The more people that we can reach quickly, the better.”

In December, vaccines were reserved mainly for frontline medical workers and nursing home residents and staff, though some other health care workers and clinics have been accused of cutting the line.

There are currently about 125 vaccination sites in the city. Mr. de Blasio said he planned to open at least 125 more by the end of January. Dr. Dave A. Chokshi, the city health commissioner, said that the administration hoped to add at least 35 of the new sites by the end of this weekend.

“From this point on, seven days a week, 24/7, has to be the attitude and the approach,” Mr. de Blasio said.

Dr. Chokshi noted that some of the first health care workers to be vaccinated in the city would be receiving the required second dose this week.

The latest coronavirus statistics Mr. de Blasio offered were grim. New York City has been averaging 3,976 new cases a day over the past week, he said, with about 9 percent of tests coming back positive.

“We obviously want to get back below 5 percent,” Mr. de Blasio said. “We’re going to push hard to get this number back down in the days and weeks ahead. Nothing will be more important than the vaccination effort to help us get there.”

The case of the British variant found in the state was identified in a Saratoga Springs man in his 60s who had not traveled recently, suggesting community spread of the variant, Mr. Cuomo said.

Mr. Cuomo also appeared to effectively end the six-month battle over whether to reopen schools in New York City by announcing that the city and other regions of the state could keep schools open past the 9 percent positivity rate threshold he set over the summer. Schools can stay open as long as virus rates within school communities remain lower than the overall community average.

Mr. Cuomo said it would now be up to individual school districts, rather than his office, to decide whether to stay open.

In New York City, parents and educators had been nervously watching the local positivity rate climb for weeks, wondering if schools would close yet again. Mr. de Blasio said over the summer that schools would close if the citywide positivity rate reached 3 percent, according to the city’s metrics.

He closed schools when the city hit that threshold in the fall, but soon reopened elementary schools, saying there would no longer be a specific threshold for closing them citywide. On Monday morning Mr. de Blasio said he expected to keep primary schools open, along with classrooms for children with the most complex disabilities, and the governor had given him permission to do so.

But on Monday afternoon, the president of the city’s teachers’ union said it would push the mayor to close schools if the citywide positivity rate reaches 9 percent, according to the state’s metrics. The city could soon reach that number, setting up a potential battle between City Hall and the union. Middle and high schools have been closed since November, and appear likely to stay closed indefinitely.

Receiving a Covaxin shot in December, during Phase 3 trials. The vaccine, developed by the Indian company Bharat Biotech, was authorized on Sunday for emergency use.
Sanjeev Gupta/EPA, via Shutterstock

The government in India has defended regulators’ decision to approve a homegrown coronavirus vaccine that is still under trial after opposition lawmakers and health care monitors said the authorization was a political move to burnish the image of Prime Minister Narendra Modi.

The approval for the shot, called Covaxin, which has been developed by the Indian company Bharat Biotech, came on Sunday, along with authorization for the Oxford-AstraZeneca vaccine.

With the approvals, India, which has a population of about 1.3 billion, became the first country in South Asia to authorize shots. Government figures have celebrated the Covaxin approval as a triumph for India and for a stimulus package introduced by Mr. Modi with the aim of making the country more “self-reliant.”

However, All India Drug Action Network, an independent network of nongovernmental organizations, expressed shock over the Covaxin authorization because the shot was still in Phase 3 trials.

“The only human data available on safety and immunogenicity is on 755 participants in Phase 1 and 2 trials,” the network said in a statement. “Other than this, there is data from animal studies.”

Other experts have also raised concerns, pointing out disparities in publicly available data about the vaccine’s effectiveness.

Dr. Gagandeep Kang, a medical researcher, said that although Bharat Biotech had published some information, the Phase 3 trial of Covaxin had started only in November.

“There is absolutely no efficacy data that has been published,” she said.

Shashi Tharoor, an opposition politician, posted a series of messages on Twitter on Monday, criticizing what he called “chest-thumping ‘vaccine nationalism’” and saying that the desire to bolster Mr. Modi’s stimulus campaign had “trumped common sense and a generation of established scientific protocols.”

But Dr. Harsh Vardhan, the Indian health minister, said such comments were “disgraceful.”

Dr. Vardhan said that all those receiving the Covaxin shots would be tracked and monitored as if they were in a trial and dismissed concerns about the vaccine’s success rate.

“We will not compromise on any protocol before approving a vaccine,” Dr. Vardhan said.


Dan Eliasson, the head of the Swedish Civil Contingencies Agency, at a news conference in Stockholm in March.
Jonathan Nackstrand/Agence France-Presse — Getty Images

Weeks before Christmas, Dan Eliasson, the head of the Swedish Civil Contingencies Agency, sent a text message to all Swedes advising them to follow recommendations to stay home for the holidays.

A short time later, he packed his bags and flew off on a two-week trip to the Canary Islands.

Now Mr. Eliasson is under fire in Sweden, where obeying rules and recommendations — especially during the pandemic — is seen as one of the highest virtues.

Mr. Eliasson was photographed looking rather surprised while waiting at the airport in Las Palmas, the Swedish newspaper Expressen reported. He told the paper the trip had been essential, saying he had “given up a lot of trips during this pandemic” but deemed this one necessary because he had a daughter living in the Canaries.

“I celebrated Christmas with her and my family,” he said, adding that he had worked remotely while on the islands.

Many Swedes who did not get to see their families over the holidays were upset. “What were you thinking?” one man wrote on Twitter.

Sweden has avoided going into lockdown, and many public places continue to be open despite recent case rates that are among the highest in Europe. Compared to its Nordic neighbors, the country has recorded a high number of virus deaths, but the figure is on par with other larger European countries.

Mr. Eliasson’s trip comes on the heels of criticism leveled at the country’s prime minister, Stefan Lofven, who was caught on camera shopping at a mall in central Stockholm on Dec. 23, days after he criticized Justice Minister Morgan Johansson for going shopping in Lund.

Earlier in December, Finance Minister Magdalena Andersson was spotted renting ski boots in Salen, a ski resort area.

The Swedish Public Health Agency has urged people to stay home as much as possible and avoid gatherings.

International holiday travel also led to trouble for officials in Canada, where on Monday eight politicians resigned or were demoted following their excursions, Reuters reported.

A member of parliament resigned as the chair of an ethics committee after he traveled to the United States. The municipal affairs minister of Alberta, Tracy Allard, resigned after she went to Hawaii. A banner in front of a constituency office read, “Welcome Home, Aloha Allard.”

In other news from around the world:

  • The health minister of Lebanon, Hamad Hasan, announced that the country will lock down for three weeks, starting on Thursday until Feb. 1, Reuters reported. The shutdown, which includes an evening curfew, comes amid a financial crisis that has sent many Lebanese into poverty and unemployment — and the onslaught of coronavirus cases is being met with a health care system already running low on supplies.

  • The state health department of São Paulo, Brazil, said on Monday that it had identified the country’s first two confirmed cases of the virus variant first found in Britain. One case was a 25-year-old woman from São Paulo who had come into contact with people who had traveled to Europe. She began showing symptoms on Dec. 20. The other was a 34-year-old man, whose case was being investigated by health officials.

  • Slovakia became the latest European nation to confirm its first case of the variant, The Associated Press reported, after the country’s health minister, Marek Krajci, announced that the variant had been found in samples taken in the eastern county of Michalovce.

Seven people working on “The Kelly Clarkson Show,” which was being shot at an NBC Universal stage in Studio City, Calif., tested positive for the coronavirus this fall. So did nine people working on the Netflix series “Colin in Black & White” in Gardena. And the Los Angeles County Public Health Department reported that a dozen people working on the sitcom “Young Sheldon” in Burbank got the virus, too.

The entertainment industry is so vital to Los Angeles that film and television production were both allowed to continue even after outdoor dining was banned. But now, with the coronavirus surging across California and overwhelming hospitals, unions and industry groups are calling for in-person production to be suspended.

“Southern California hospitals are facing a crisis the likes of which we have never seen before,” Gabrielle Carteris, the president of SAG-AFTRA, the union representing 160,000 people who work in film, television and radio, said in a statement. “Patients are dying in ambulances waiting for treatment because hospital emergency rooms are overwhelmed. This is not a safe environment for in-person production right now.”

The union was joined in its call for a “temporary hold on in-person production in Southern California” by groups representing producers and advertisers.

The recommendation, which was announced on Sunday, came as officials said that major studios in the area had already extended a standard holiday-related pause in production until at least mid-January in the hope that the number of new cases would subside by then, freeing up space in hospitals and intensive care units.

By Monday night, “The Late Late Show” announced in a tweet that it had moved its production back into James Corden’s garage until it was “safe to return to our studio.” And a spokeswoman for “Jimmy Kimmel Live” confirmed a Deadline report that the Los Angeles-based late show would film remotely for the next two weeks.

Cleaning and disinfecting at a station in Bangkok on Monday. Health officials in Thailand announced on Monday that there had been 745 new coronavirus cases, the country's highest daily figure since the start of the pandemic.
Mladen Antonov/Agence France-Presse — Getty Images

Thailand, which had been among the most successful countries in containing the coronavirus, imposed wide-ranging new measures on Monday as infections hit a new daily high of 745.

The prime minister, Prayuth Chan-ocha, urged people to stay home but stopped short of calling the new measures a lockdown, which would have prompted government compensation for people put out of work.

In Bangkok, the capital, the government closed schools, bars, entertainment venues and gyms. Employers were urged to allow working from home, but malls and cinemas were permitted to stay open and restaurants were allowed to serve food indoors until 9 p.m.

“This is up to everyone,” Mr. Prayuth told reporters. “If we don’t want to get infected, just stay home for 14 to 15 days.”

The announcement came as Japanese officials considered declaring a state of emergency in Tokyo for the first time since April. The authorities on Monday requested that restaurants and bars close by 8 p.m. to prevent further spread of the virus.

The capital had recorded a record high of 1,337 cases in one day last week, and the local government had already asked residents to refrain from all but essential outings at night. Companies have been encouraged to allow employees to work from home, and universities have been asked to move classes online.

Japan has not yet approved any coronavirus vaccines, but it has contracts to buy doses from Pfizer, Moderna and AstraZeneca.

The country has reported a total of more than 240,000 cases and more than 3,500 deaths, with several record-setting days in recent weeks. Last month, as Japan detected cases of the more transmissible variant of the coronavirus that first emerged in Britain, the government closed the borders to foreign travelers.

Thailand had seen greater success in avoiding outbreaks: Until mid-December, the country recorded about 6,000 cases and 60 deaths. Nearly all new cases were detected in quarantine, which is required for anyone arriving from abroad.

But an outbreak last month at a seafood market in Samut Sakhon Province near Bangkok quickly spread among migrant workers living in close quarters and, from there, to much of the rest of the country.

Of the 745 new cases reported on Monday, 577 were found among undocumented workers.

In China, where life is largely back to normal, “wartime mode” measures have been imposed in several regions in the north of the country, where officials are conducting mass tests, sealing off villages where there have been confirmed infections and limiting entry into certain districts. The health authorities reported 33 new cases and 40 asymptomatic cases, which the country does not designate as confirmed cases, in mainland China on Monday. Beijing has begun vaccinating adults under 60, using the state-backed Sinopharm vaccine.

And on Saturday in South Korea, the government said it would extend until Jan. 17 restrictions in and around Seoul that had shuttered schools, gyms, karaoke rooms, bars and other high-risk facilities. Those restrictions are at the second-highest level of a five-tier system, in a country whose pandemic response was once held up as a model.

The NCAA Final Four college basketball tournament championship game in Indianapolis in 2015.
David J. Phillip/Associated Press

The N.C.A.A., in an attempt to limit the threat of coronavirus among teams, announced an agreement Monday to hold its signature men’s basketball tournament entirely in Indiana in March and early April.

The tournament includes 67 games and is usually held in numerous cities sprawled across the United States, culminating with the Final Four teams meeting in one city in April. This year’s Final Four — the tournament’s semifinals and final — was already scheduled for Indianapolis before the pandemic widely shut down American sports last year.

The N.C.A.A., which has its headquarters in Indianapolis, said the tournament would play out across six venues, detailing a plan it originally announced in November. The teams are scheduled to be selected on March 14, but the early rounds of the tournament have not been fully scheduled. With fewer courts, it will require some juggling to fit in all the games and practices.

The N.C.A.A. is working with local health officials in Marion County, where Indianapolis is, to determine safety protocols. Indiana has had a 17 percent decrease in new cases of the virus in the past two weeks, according to a New York Times database.

A limited number of family members for participating teams will be allowed at games, according to the announcement. However the organization said it would continue monitoring the pandemic before coming to a decision about allowing other spectators.

Teams will practice in the Indiana Convention Center and stay in hotels connected to the venue, with teams separated by hotel floors, unique dining and meeting rooms and “secure transportation to and from competition venues,” the N.C.A.A. said.

The 2021 women’s tournament is also set to play in one unique region, with the N.C.A.A. announcing in December that it was in preliminary discussions with officials in the San Antonio area to host. Both the 2020 men’s and women’s championships were among the first to be called off when the spread of the virus accelerated last March.

“The 2021 version of March Madness will be one to remember, if for no other reason than the uniqueness of the event,” Dan Gavitt, N.C.A.A.’s senior vice president of basketball, said in the announcement.

“This is going to be complicated and difficult; there’s no question about that,” he added.

Emilio Estefan, 67, receiving the vaccine at Jackson Memorial Hospital in Miami last week. About 80 percent of Florida’s vaccine doses have been distributed to hospitals.
Joe Raedle/Getty Images

Florida hospitals may have future supplies of coronavirus vaccine reduced if they do not administer doses quickly enough, Gov. Ron DeSantis warned on Monday.

“Hospitals that do not do a good job of getting the vaccine out will have their allocations transferred to hospitals that are doing a good job of getting the vaccine out,” Mr. DeSantis said at a news conference in Longwood, Fla., near Orlando. “We do not want vaccine to just be idle in some hospital system.”

So far, about 80 percent of Florida’s vaccine doses have been distributed to hospitals across the state, Mr. DeSantis said, adding that hospitals have the equipment, expertise and community relationships needed to get the vaccine to the people that Florida has given top priority: people 65 and older and health care workers.

But the governor acknowledged that the state needs to do more. “We need to add additional layers to the vaccination strategy,” Mr. DeSantis said.

Long lines have formed when some county health offices in the state opened vaccination sites on a first-come, first-serve basis. Appointment hotlines and websites have been overwhelmed with demand. In Jacksonville, about 4,000 people who filled out online forms incorrectly received confirmation emails and thought they had appointments to be vaccinated, when they actually did not. The Florida Department of Health’s own website crashed on Monday.

Demand for the vaccines in Florida has far exceeded supply, in part because Mr. DeSantis’s administration decided not to limit eligibility for the early wave of immunizations to people 75 and older, as the Centers for Disease Control and Prevention suggested. “We’ve made the decision in Florida: Our seniors come first,” he said. “We’re going to stand by that.”

Vaccination efforts were off to a slow start in part because of unfortunate timing, the governor said, since the Moderna vaccine arrived just before Christmas when many people were on vacation or busy with families. He said vaccines have now been delivered to health department offices in each of the state’s 67 counties, and to nearly every hospital.

He said his administration would identify state-run coronavirus testing sites that could be converted into vaccination sites, and would hire 1,000 nurses to assist in giving the shots at state sites or at short-handed hospitals.

And while the CVS and Walgreens drugstore chains have been taking the lead in vaccinating residents and employees at the nearly 4,000 long-term care facilities in Florida, the governor said the state would get more involved in assisting that effort. “We want to accelerate that pace,” Mr. DeSantis said.

Wall Street began the year with a tumble on Monday, with the S&P 500 suffering its steepest decline in more than two months as it retreated from record territory.

Analysts traced the sell-off to a number of factors, including political jitters stemming from Tuesday’s runoff election in Georgia — which will determine control of the U.S. Senate — concerns about a resurgent coronavirus, and the simple need for investors to take a breather after a stretch of sizzling gains.

It wasn’t clear that the slump would continue into Tuesday. Stocks in Asian markets were steady early on Tuesday, while futures markets suggested that Wall Street would stabilize when it opens.

The index fell 1.5 percent, its sharpest drop since late October. Stocks that have been most sensitive to investor sentiment about the coronavirus pandemic led the decline. Shares of Royal Caribbean Cruises, Wynn Resorts, Marriott International and Carnival were all down by 5 percent or more.

Major benchmarks in Europe also gave up most of their early gains on Monday, though they managed to stay in positive territory for the day. The Stoxx Europe 600 index rose 0.7 percent, and the FTSE 100 index in Britain gained 1.7 percent.

After Europe’s markets closed on Monday, Prime Minister Boris Johnson imposed a strict new national lockdown as a more contagious variant of the coronavirus threatened to overwhelm the nation’s beleaguered hospitals.

The variant is now present in the United States, where coronavirus cases and deaths have reached records in recent days.

Monday’s retreat also came after the S&P 500 rallied more than 16 percent in 2020, defying the economic crisis and the human catastrophe of the pandemic, as the Federal Reserve stepped in to support financial markets, Congress spent trillions on unemployment and business support programs, and vaccinations began, showing a sustainable way out of the pandemic.

But investors have always had to contend with the still-spreading coronavirus pandemic, the risk of new lockdowns and political turmoil in the United States.

On Tuesday, two runoff Senate elections in Georgia will settle control of the upper house of Congress, and finally determine how hard it will be for President-elect Joseph R. Biden Jr. to move forward on his agenda.

In the wake of the presidential election in November, investors had begun to anticipate that Republicans would retain control of the Senate, giving them the ability to limit the Biden administration’s ability to raise taxes or increase regulation.

That view had also helped lift stocks at the end of last year, but Monday’s trading showed investors had grown less confident in a Republican win on Tuesday.

“The market fears the Democrats taking both of those seats,” said Julian Emanuel, chief equity and derivatives strategist at the brokerage firm BTIG. He said that investors have been closely watching prediction markets give greater chances to that outcome in recent days. “It’s basically now a tossup as to what the outcome is going to be tomorrow, after the Republicans being heavily favored.”

Nurses attended to a Covid-19 patient in the intensive care unit at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, Calif., last month.
Apu Gomes/Agence France-Presse — Getty Images

Just over one-fifth of U.S. hospitals with intensive care units reported that at least 95 percent of their I.C.U. beds were full in the week ending Dec. 31. Nationwide, 77 percent of intensive care hospital beds were occupied. These numbers, which come from a dataset released weekly by the Department of Health and Human Services, show a continuation of the worrisome state of hospitalizations indicated by the previous week’s dataset. This week’s dataset may not yet capture the effect that holiday gatherings and travel have had on the number of U.S. residents who are very sick with Covid-19. For the last two weeks of 2020, the Transportation Security Administration said it screened an average of more than one million travelers per day.

The Genesis Church in Woburn, Mass., where a cluster of Covid-19 cases has been linked to Christmas gatherings.
Erin Clark/The Boston Globe

Genesis Community Church, outside of Boston, thought it was taking all the right safety precautions for its Christmas services: requiring an R.S.V.P. in case contact tracing was needed, limiting capacity and requiring masks.

But it was not enough. More than 40 people have tested positive for the coronavirus in cases that are believed to be connected to those gatherings.

The house of worship in Woburn, Mass., hosted a total of four Christmas celebrations on Dec. 23 and Dec. 24. Its lead pastor, Michael Davis, who declined to be interviewed, said in a series of emails that those who wanted to attend were required to essentially make reservations.

That allowed the church “to do accurate and complete contact tracing of everyone who was in the building,” Mr. Davis said. “The average attendance at each gathering was 105 per service, which is 35 percent of our building occupancy.”

But, he said, he knows of at least 44 people who were at those services who have tested positive. Tara Vocino, 32, a local photographer, is one of them. She said that she was tested on Dec. 29 and received her positive result two days later.

“It feels like there has been a knife in my mouth, and I’ve lost all sense of taste and smell,” Ms. Vocino said, adding that she feels so exhausted that she has been sleeping “about 16 hours a day.”

She said that she was at one of the services on Dec. 23, was in the front row at the church and was wearing a mask.

“When I saw there was the outbreak, I went out and got tested,” she added.

Ms. Vocino, who lives with her parents and suffers from asthma, said, “I’ve been in one room for the last couple of days, and I use a separate bathroom.”

Mr. Davis said that he has also tested positive for Covid-19 but is “almost back to full health.”

He added that the church is “working closely” with the Woburn Board of Health to help the agency with contact tracing. Mr. Davis said that within 24 hours of church officials learning of five of the Covid-19 cases, they contacted the health board.

Neither representatives from the health agency nor the mayor of Woburn responded to numerous calls and emails.

Susan Beachy contributed research.

Moncef Slaoui, the chief scientific adviser for Operation Warp Speed, outside the West Wing of the White House on Dec. 21.
Erin Scott for The New York Times

The Food and Drug Administration late Monday criticized an idea floated by one of the administration’s top vaccine officials for stretching the limited number of Covid-19 vaccine doses, saying that a proposal for half-doses of the Moderna vaccine was “premature and not rooted solidly in the available science.”

The agency’s statement, posted on its website Monday night, exposed a fissure between Trump administration officials about whether they can somehow economize vaccine supplies in order to inoculate more people quicker. Moderna and the Pfizer-BioNTech are the only companies so far whose vaccines are authorized for emergency use in the United States, and together they can deliver only enough doses to vaccinate 185 million Americans by the end of June.

On Sunday, Moncef Slaoui, the scientific leader of Operation Warp Speed, the administration’s vaccine development program, said that federal officials and Moderna were discussing possibly halving each of Moderna’s two doses — effectively giving recipients the equivalent of one full dose.

He said data from Moderna’s clinical trials demonstrated that people between the ages of 18 and 55 who received two 50-microgram doses showed an “identical immune response” to the two 100-microgram doses.

But the F.D.A., which would have to approve such a change in protocol, suggested in its statement that the available data was insufficient to justify that shift — or other proposed regimen changes designed to stretch out doses.

“We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19,” the statement said. Such changes should be researched in clinical trials before adopted, it said. Experts said such studies would take weeks, if not longer.

While some data already exists, clinical trial recipients of the Moderna or BioNTech vaccine who did not receive two doses at the proper time “were generally only followed for a short period of time,” the agency said. Therefore, “we cannot conclude anything definitive about the depth or duration of protection after a single dose of vaccine,” it said.

Changing the dosage could also complicate the vaccine effort just as the public is beginning to become more accepting of the program, according to Dr. Anthony S. Fauci, the government’s top infectious disease expert.

“One of the dangers of making a change in midstream is that it could confuse the public,” he said in an interview on Monday.

He also suggested that changing the vaccine dosage was “the right answer to the wrong question.” The current problem, he said, is not that there are not enough doses, but that state and local governments have been unable to vaccinate people with the doses they already have.

“At the present time we are not dealing with a shortage of doses — we are dealing with the need to increase our efficiency in getting people vaccinated,” he said. He suggested that changing the dosage “could become appropriate” if a shortage emerged.

Dining in Tokyo on New Year’s Eve. The Japanese government is to consider declaring a state of emergency in the capital and in three surrounding prefectures.
Noriko Hayashi for The New York Times

The authorities in Tokyo requested on Monday that restaurants and bars close by 8 p.m. to prevent further spread of the coronavirus, an announcement that came after the Japanese prime minister, Yoshihide Suga, said that the central government would consider declaring a state of emergency in the capital and in three surrounding prefectures for the first time since April.

With Tokyo recording a record high of 1,337 cases in one day last week, Governor Yuriko Koike said, “We should clearly recognize that the infection situation is in a completely different stage.” The metropolitan government has asked residents to refrain from all but essential outings after 8 p.m. Restaurants serving alcohol will be required to close at 8 p.m. starting on Jan 8; all other restaurants will have to follow suit on Jan. 12, with the restrictions in place through the end of the month. Ms. Koike said that the metropolitan government would also ask subway and train lines to end service earlier each evening.

Companies have been encouraged to allow employees to work from home, and universities have been asked to move classes online.

Mr. Suga said that the central government would consider declaring a state of emergency later this week. Japan has reported a total of more than 240,000 cases and more than 3,500 deaths.

Last month, as Japan detected cases of the more transmissible variant of the coronavirus that first emerged in Britain, the government closed the borders to foreign travelers. Mr. Suga also suspended government subsidies for a domestic travel program.

Legally, a state of emergency in Japan cannot mandate a lockdown but relies on voluntary compliance. Mr. Suga said that the government was considering punishments for businesses that do not comply with requests, as well as compensation for businesses that have to close early.

Japan has not yet approved any of the vaccines that are being rolled out in the United States, Europe and other parts of the world. But it has contracts to buy doses from Pfizer, Moderna and AstraZeneca, and Mr. Suga said he hoped that his country would start vaccinating medical workers and older adults by the end of February.

Brian Pinker, 82, receiving the vaccine developed by the University of Oxford and AstraZeneca at the Churchill Hospital in Oxford, England, on Monday.
Pool photo by Steve Parsons

An 82-year-old in Britain became the first person in the world to receive the clinically authorized, fully tested coronavirus vaccine developed by the University of Oxford and AstraZeneca, adding another shot to the global inoculation effort.

The 82-year-old, Brian Pinker, a retired maintenance manager, was injected with the first dose of the vaccine at a hospital in Oxford, where he is a dialysis patient. Mr. Pinker said he was proud to receive the vaccine linked to his hometown.

Prof. Andrew Pollard, who was the lead investigator on the trial, also received the shot on Monday. “It was an incredibly proud moment for me to have received the actual vaccine that the University of Oxford and the AstraZeneca teams have worked so hard to make available to the U.K. and the world,” he said.

The Oxford-AstraZeneca shot is expected to become one of the dominant forms of inoculation because it is cheaper and easier to store than the Pfizer-BioNTech and Moderna vaccines. After the health regulator in Britain became the first to grant emergency authorization to the Oxford-AstraZeneca vaccine last week, India followed suit and many other countries are counting on the shots to help tamp down the pandemic.

Although Britain was the first to authorize and administer the Oxford-AstraZeneca shot — as it was with the Pfizer-BioNTech vaccine early last month — the country is in the grip of a severe surge in coronavirus cases.

A new strain of the virus has pummeled the country, with 54,990 new cases and 454 deaths recorded on Sunday, taking the total number of people killed by the virus in Britain to more than 75,000.

Scotland’s leader, Nicola Sturgeon, announced that a new lockdown will go into effect at midnight on Monday and will remain in place until at least the end of the month. People will be ordered to stay home unless for essential reasons, such as for caregiving responsibilities or exercise, and most students will return to remote learning.

The new variant of the coronavirus accounts for almost half of new infections in Scotland, Ms. Sturgeon said, as the country recorded 1,905 new cases on Monday. “I am more concerned about the situation we face now than I have been at any time since March last year,” she said.

Prime Minister Boris Johnson is facing calls to implement a new national lockdown in England and for all schools to be closed. Mr. Johnson on Monday said there was “no question” the British government would announce stricter measures “in due course.”

Vice President-elect Kamala Harris received Moderna’s Covid-19 vaccine at United Medical Center in Washington last week.
Al Drago for The New York Times

For weeks, images of lawmakers from both parties getting their Covid-19 vaccinations have appeared on TV and across social media, in an effort to boost public confidence in the shots.

But there are now a few high-profile leaders who have chosen to forgo the early vaccines.

Gov. Andrew Cuomo of New York shared his stance on when he would get the vaccine sharply this week: “I’m not going to take the vaccine until the same people are eligible and it is available in the Black and Hispanic and poor communities in this state.”

Gov. Ron DeSantis of Florida said that he would wait until older Americans could get vaccinated. “It makes no sense for someone that’s 42 to jump ahead of someone that’s 70 years old,” he said.

President-elect Joseph R. Biden Jr., in his 70s, did not raise any eyebrows when he was inoculated. But other, younger politicians have chosen to be vaccinated, including Senator Marco Rubio in Florida, where the vaccine rollout is struggling.

The easy vaccine access for top elected officials, as regular Americans wait in long lines and distribution falls short of its goals, raises ethical questions: Should the nation’s leaders come before older Americans or those with severe health risks? On top of that, should their families and even congressional aides be at the front of the line? Republicans and Democrats alike have argued over the issue; Senator Rand Paul of Kentucky and Represenative Ilhan Omar of Minnesota both said it was not appropriate to jump the line.

“We have such a limited supply. There needs to be a decision made about priorities,” said Dr. Leana Wen, an emergency physician and Baltimore’s former health commissioner. “I understand at a certain level that elected officials need to be getting the vaccine for the purposes of continuity of government,” but, she added, “what is the most essential? Is it an I.C.U. physician or is it a congressional aide?”

She cited the guidelines from the Centers for Disease Control and Prevention, which prioritize high-risk and essential worker populations, and noted that many essential workers were less able to work remotely than politicians are.

“I think that really corrodes trust — when people don’t understand why the top-tier at-risk group isn’t the only group getting something,” said Arthur Caplan, the director of NYU Langone’s Division of Medical Ethics.

For other experts, though, the focus is on increasing public trust in the vaccine, and messiness in the priority groups is expected. “Trusted messengers” are key to vaccine confidence, said Lindsey Leininger, a Dartmouth professor who leads Dear Pandemic, a public education campaign about the pandemic.

There are also risks for the public perception in creating a “negative impression of people with influence and connections cutting in line, that undermines that whole notion of trust,” Dr. Caplan noted.

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