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‘We Are Not at the Finish Line,’ Newsom Says Despite Virus Vaccine

Gov. Gavin Newsom of California heralded the arrival of the coronavirus vaccine in his state, but he underscored the danger the state faces in the next few weeks.

We’re finally seeing the vaccine being utilized. We’re finally seeing those we value the most — we’ve celebrated since the beginning of this pandemic — get that support. Those emergency room docs and nurses, folks there on the front lines of this pandemic, and have been from the beginning, that are weary, worn out, worn thin. I was having these conversations about some of the work we’re doing, our mutual aid for morgues and working with coroners just a couple of days ago. And some hesitated to want to share that publicly. But I think I have an obligation to share publicly what we are doing on this issue. Here’s the numbers: 163 people we’ve lost on an average, every single day — 142 yesterday. We just had to order 5,000 additional body bags. They just purchased for the state. And we just distributed them down to San Diego, Los Angeles, Inyo counties. That should be sobering. I don’t say that, you know, I don’t want people to run with that. I don’t want people to scare folks. But, but this is a deadly disease, and we need to be mindful of where we are in this current journey together to the vaccine. We are not at the finish line yet.

Gov. Gavin Newsom of California heralded the arrival of the coronavirus vaccine in his state, but he underscored the danger the state faces in the next few weeks.CreditCredit…Pool photo by Jae Hong

With spiking coronavirus cases, hospitalizations and deaths all shattering records in recent weeks, Gov. Gavin Newsom of California said the state was preparing for bleak days to come: The state has ordered an extra 5,000 body bags, activated a mutual aid network for morgues and coroner’s offices, and stationed 60 refrigerated storage units in counties around the state to handle remains.

The governor heralded the arrival of the Covid-19 vaccine in his state as the starting gun for a final sprint to the end of the pandemic, but he underscored the danger the nation’s most populous state faces in the next few weeks.

The governor said he didn’t want the news of those preparations to cause panic, “but I think I have an obligation to share it.”

Over the past week, he said, California has reported an average of 163 deaths a day from Covid-19 — four times the average daily toll of a month ago. And the outlook is worsening.

Despite the start of vaccinations, deaths and disruptions in the United States are likely to persist for months, since virus cases have soared across the country and the vast majority of Americans will not be eligible for vaccinations until this spring or later. Even as applause rang out at hospitals as the vaccines arrived, many intensive care units remained near capacity and more than 110,000 Covid-19 patients are hospitalized, a record.

The country is averaging more than 2,400 deaths a day, even more than in the spring. Total deaths have surpassed 300,000, a toll larger than any other country.

More than 10 percent of coronavirus tests in California over the past two weeks have come back positive, the highest rate since April, when testing was not widespread. More than 260,000 people are now being tested for the virus in California on an average day.

Vaccination will soon allow the thousands of frontline health care workers to escape the stress hanging over every interaction with their loved ones, Mr. Newsom said, and those workers will have a crucial role to play as hospitals continue to fill.

“These are the folks we’re going to count on the most,” he said.

Across the country in New York, Gov. Andrew M. Cuomo has warned of another shutdown if hospitalizations continue to accelerate, and Mayor Bill de Blasio of New York City echoed concerns about a worsening situation at a news conference on Tuesday.

The mayor said that the virus data was “going in the wrong direction” and a shutdown after Christmas — similar to what the city experienced in the spring — would help curb the spread. However, Mr. Cuomo, not the mayor, has the power to impose a shutdown. Statewide, hospitalizations were at 5,982, the state reported on Tuesday.

“With some good luck and hard work and the vaccine starting to help us, we could be out of that in a matter of weeks,” Mr. de Blasio said.

In New York City, 40,950 doses are expected to be available at 42 hospitals, he said. After the first batch of vaccines arrived in the city, which was once the epicenter of the pandemic, 73 health care workers have already received their first dose, he said. On Monday, Mr. Cuomo said about 10,000 vaccine doses were to be administered throughout the day in hospital systems across the state.

Mr. de Blasio, who was still “feeling the glow from yesterday,” expressed his excitement for the vaccine’s long-awaited arrival. “It was really good to see that sense that we could actually have a positive moment together,” he said. “Didn’t matter which state you came from or what party you’re in, people were just working together.”

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, during President-elect Joseph R. Biden Jr.’s introduction of appointees to top health posts earlier this month.Credit…Hilary Swift for The New York Times

As the mass vaccination campaign entered its second day in the United States, Dr. Anthony S. Fauci, the nation’s top infectious disease expert, said it was his “strong recommendation” that President-elect Joseph R. Biden Jr. and Vice President-elect Kamala Harris receive a Covid-19 vaccine quickly.

“For security reasons, I really feel strongly that we should get them vaccinated as soon as we possibly can,” he said on “Good Morning America” Tuesday. “You want him fully protected as he enters into the presidency in January.”

Mr. Biden told reporters in Delaware on Tuesday that Dr. Fauci, who will be his chief medical adviser, “recommends I get the vaccine sooner than later.”

“I want to just make sure we do it by the numbers,” Mr. Biden said. “When I do it, you’ll have notice and we’ll do it publicly.”

A vaccine developed by Pfizer and BioNTech was given emergency use authorization by the Food and Drug Administration on Friday, and a second vaccine, made by Moderna, is expected to be authorized later this week. The first shots have generally gone to frontline health care workers.

Dr. Fauci said he would also recommend that President Trump and Vice President Mike Pence get the vaccine, even though the president has already had Covid-19.

“You still want to protect people who are very important to our country right now,” Dr. Fauci said. “Even though the president himself was infected and he has, likely, antibodies that likely would be protective, we’re not sure how long that protection lasts.

So to be doubly sure, I would recommend that he get vaccinated as well as the vice president.”

At a briefing on Tuesday, Kayleigh McEnany, the White House press secretary, said that the president would “receive the vaccine as soon as his medical team determines it’s best,” but that he was not yet scheduled to do so. She added that “some senior administration officials” would take the vaccine publicly in the coming days in order to “instill that confidence” in it, but she did not say who would do so.

Mr. Pence said he planned to get a vaccine, but he did not specify when, during a visit to a Catalent Biologics facility in Bloomington, Ind., on Tuesday. The company is working with Johnson & Johnson and Moderna to produce coronavirus vaccines. Mr. Pence may take a vaccine publicly in the coming days, an official said.

Ms. McEnany said that the number of White House staffers receiving the vaccine would be “a very limited group of people,” a shift that came after The New York Times reported on Sunday that there was a plan in place to try and vaccinate everyone who worked in the West Wing.

Mr. Trump said on Sunday night that he would delay the plan for senior White House staff members to quickly receive the vaccine.

“People working in the White House should receive the vaccine somewhat later in the program, unless specifically necessary,” Mr. Trump tweeted. “I have asked that this adjustment be made. I am not scheduled to take the vaccine, but look forward to doing so at the appropriate time.”

The acting secretary of the defense, Christopher C. Miller, received the vaccine at Walter Reed National Military Medical Center on Monday. The Defense Department is one of the agencies coordinating Operation Warp Speed, the Trump administration’s effort to distribute the vaccine as quickly as possible.

For some elected officials and public figures, getting vaccinated may be a damned-if-you-do, damned-if-you-don’t proposition. On the one hand, doing so publicly could be useful as a show of confidence to members of the public, and particularly to minority groups who can be especially wary of vaccination and of government-sponsored programs.

Dr. Fauci, who is 79, has said that he will be vaccinated publicly for those reasons. In an interview with NPR on Tuesday, he said that he had not yet scheduled his shot, but would do it “as soon as I possibly can, because I’ve always said I want people to understand that I am very confident in this vaccine.”

But there is a flip side to that argument, particularly for lawmakers on Capitol Hill. With the vaccine in scarce supply, some in positions of power do not want to be accused of jumping the line.

The issue came up on Capitol Hill last week when Senator Lamar Alexander, Republican of Tennessee and chairman of the Senate Health Committee, acknowledged to The Wall Street Journal that he had sought advice from Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention, about how lawmakers should handle vaccination.

“If they want public figures to take the vaccine early in order to reassure Americans that it’s safe, I’m sure many of us will do that,” Mr. Alexander said he told Dr. Redfield. But he added, “I’m not going to do that on my own. I’m going to do it when the public health officials tell me it’s my turn.”

Moderna’s headquarters in Cambridge, Mass. The company has said that its vaccine is 94.1 percent effective.Credit…Cody O’Loughlin for The New York Times

The coronavirus vaccine made by Moderna is highly protective for adults and prevents severe cases of Covid-19, according to data released on Tuesday by the U.S. Food and Drug Administration.

Based on the encouraging findings, the agency intends to grant emergency authorization for use of the vaccine on Friday, people familiar with the F.D.A.’s plans said. The decision would give millions of Americans access to a second coronavirus vaccine beginning as early as next week.

The review by the F.D.A. confirms Moderna’s earlier assessment that its vaccine had an efficacy rate of 94.1 percent in a trial of 30,000 people. Side effects, including fever, headache and fatigue, were unpleasant but not dangerous, the agency found.

The success of Moderna’s vaccine has become all the more crucial to fighting the pandemic as other vaccine efforts have faltered. The hopeful news arrives at a time of record-breaking numbers of new coronavirus cases in the United States, which are overwhelming hospitals, and of an ever-increasing total death toll, which reached a bleak milestone of 300,000 on Monday.

The data release is the first step of a public review process that will include a daylong meeting on Thursday by an independent advisory panel of experts. They will hear from Moderna, F.D.A. scientists and the public before voting on whether to recommend authorization. The panel is expected to vote in favor, and the F.D.A. generally follows the experts’ recommendations.

Distribution of about six million doses could then begin next week, significantly adding to the millions of doses already being shipped by Pfizer and BioNTech, the companies that developed the first coronavirus vaccine given emergency clearance last Friday. Health care workers received the first shots on Monday of the Pfizer-BioNTech vaccine, which has an efficacy rate of 95 percent.

The rollout of vaccines has been highly anticipated, and is one of the most ambitious immunization campaigns ever conducted in the United States.

The federal government signed deals last summer with Moderna and Pfizer to deliver a total of 200 million doses in the first quarter of 2021. Because both vaccines require two doses, those contracts guaranteed enough shots for 100 million people.

Last week, the U.S. government announced that it had purchased another 100 million doses from Moderna for the second quarter, increasing the number of Americans who could be vaccinated to 150 million. But that still leaves the question of how and when the roughly 180 million other Americans will be covered.

Dallas White, a UPS driver, wheeled a shipment of Covid-19 vaccine into UPMC Children’s Hospital of Pittsburgh on Monday.Credit…Kristian Thacker for The New York Times

A major winter storm is bearing down on the Northeast, from Virginia to New England, with the potential to snarl distribution of the Pfizer-BioNTech vaccine in the region.

The storm is expected to bring strong winds, more than six inches of snow and blizzard conditions in many areas on Wednesday and Thursday, threatening to hamper highway travel and knock out power, according to the National Weather Service. Some places may get two feet of snow; others may get freezing rain.

The same weather system is also producing snowfalls and slick conditions in parts of the Plains states on Tuesday as it moves eastward and gathers strength, the service said.

Two giant rivals, UPS and FedEx, are working side by side to deliver the Covid-19 vaccine to vaccination sites from Pfizer’s plants in Michigan and Wisconsin. A spokesman for UPS, Matthew O’Connor, said the company had a team of meteorologists monitoring the weather around the clock.

“We develop contingency plans based on weather forecasts and local conditions, enabling our employees to safely deliver what matters most,” Mr. O’Connor said in a statement. “Should roadways or airports be closed, we will observe all closures, and UPS will be ready to deliver as soon as it is safe.”

He added that UPS’s new health care command center, set up at its air hub in Louisville, Ky., was keeping track of the Covid-19 vaccine shipments, which must be kept frozen and require special handling. The command center “can step in with contingency plans should it appear that a package may be delayed,” he said.

Gen. Gustave F. Perna, who heads the operations of Operation Warp Speed, the federal vaccine distribution effort, told reporters on Monday that officials were ready to deal with any issues that could disrupt smooth deliveries, including wrong delivery addresses and truck or airplane accidents.

“I know you’ve seen the weather report,” General Perna said, noting that the storm “could be a problem.” He continued, “My responsibility to deliver safe and effective vaccines means get ahead of that problem.”

About 600 sites, many of them hospitals, were scheduled to receive the vaccine this week, nearly three million doses in all. Some 500,000 doses were delivered on Monday to 142 of the sites around the country.

In New York City, Mayor Bill de Blasio said at a Tuesday afternoon news conference that vaccine delivery and administration would continue despite the weather.

“There’s nothing about the storm at this point that should disrupt the supply of vaccine coming in,” he said.

But the city will close virus testing sites run by the city’s Health and Hospitals system from 2 p.m. on Wednesday to noon on Thursday, said Deanne B. Criswell, the commissioner of emergency management.

Restaurants have already been ordered by the city to close their roadway dining programs at 2 p.m. Wednesday. They were already grappling with the loss of indoor dining this week.

The closure order is temporary, and officials said it could be lifted by Thursday night. But the major snowstorm, expected to sweep into the area on Wednesday afternoon, will pose a significant test for restaurant owners and of how the city’s now-permanent outdoor dining program can withstand severe winter weather.

The city urges restaurants to remove the tops of their outdoor dining structures, but it will not require them to take those structures off the street.

Speaker Nancy Pelosi invited the leaders of the Senate and House to discuss a stimulus package on Tuesday.Credit…Anna Moneymaker for The New York Times

The top four congressional leaders are set to meet for a second time on Tuesday to discuss a stimulus package and a catchall omnibus bill that Congress is racing to agree upon and approve by week’s end, the first in-person talks for the bipartisan group on the issue since the election.

The invitation from Speaker Nancy Pelosi, Democrat of California, to meet with Senator Chuck Schumer of New York, the minority leader, and the top two Republicans on Capitol Hill, Senator Mitch McConnell of Kentucky and Representative Kevin McCarthy of California, came as lawmakers faced a Friday deadline when government funding is currently set to lapse.

Treasury Secretary Steven Mnuchin joined the meeting by phone, after speaking separately with Ms. Pelosi for more than an hour on the two funding issues. The group was expected to reconvene a second time Tuesday evening, after huddling for about 50 minutes in the afternoon, according to a person familiar with the plans. The meeting was reported earlier by Politico.

The Speaker and Secretary Mnuchin spoke at Noon by phone for 1 hour, 7 minutes and discussed the latest on COVID and Omni talks. The Secretary will join the Four Corners leadership meeting today at 4 p.m. by phone.

— Drew Hammill (@Drew_Hammill) December 15, 2020

In recent days, leaders in both parties have agreed that any additional pandemic aid should be wrapped into the year-end spending measure. But obstacles remain to an agreement, with millions of Americans at risk of losing jobless benefits next week in the absence of a deal.

Top Democrats previously rejected a $916 billion stimulus proposal from Mr. Mnuchin because it curtailed new funding for unemployment programs and did not revive the supplemental unemployment benefits that lapsed over the summer. And it was unclear whether leaders of either party would embrace a $748 billion version proposed on Monday by a group of moderates in both parties, which separated out the two most contentious items, money for state and local governments and coronavirus liability protections for businesses and other entities, into a separate bill.

Democrats were continuing to push to include the state and local government funding, which Republicans have opposed. Mr. McConnell and other Republicans have pressed for sweeping liability protections, to which many Democrats object.

Even if the four leaders were to reach an agreement, it would likely face hurdles among some rank and file lawmakers, as Republicans chafe at the prospect of spending billions of dollars in taxpayer funds and Democrats argue that an agreement amounting to less than $1 trillion would be insufficient.

Progressives in the House are pushing to include direct payments of at least $2,000 for all working Americans in the stimulus deal.

In a letter sent to the leaders, liberal lawmakers, led by Representatives Pramila Jayapal of Washington, and Ro Khanna and Katie Porter, both of California, argued that such payments “are a crucial part of any Covid relief package.” They also pressed for at least six months of unemployment benefits, including enhanced supplemental benefits that expired earlier this year.

“We’ve had this issue of direct payments on the table for months now, and we’re willing to look at different amounts,” Ms. Jayapal said. “There is absolutely no reason why we can’t put the direct payments in, and dare the Senate to take them out.”

Two senators, Josh Hawley, Republican of Missouri, and Bernie Sanders, Independent of Vermont, have threatened to hold up the broader government funding bill if Congress failed to ensure that Americans receive payments of $1,200 per adult and $500 per child in the stimulus measure.

Ellume’s test starts with a self-collected nasal swab, which is plugged into a cartridge and analyzed, and its data is transmitted to a smartphone via Bluetooth.Credit…Ellume, via Associated Press

The Food and Drug Administration on Tuesday issued an emergency authorization for the country’s first coronavirus test that can run from start to finish at home without the need for a prescription.

People as young as 2 are cleared to use the test, which takes just 15 to 20 minutes to deliver a result. Unlike many similar products, which are only supposed to be used by people with symptoms of Covid-19, this test is authorized for people with or without symptoms.

The test, developed by the Australian company Ellume, detects bits of coronavirus proteins called antigens. It’s slightly less accurate than gold standard laboratory tests designed to look for coronavirus genetic material using a technique called polymerase chain reaction, or P.C.R. But in a clinical study of nearly 200 people, Ellume’s product was able to detect 95 percent of the coronavirus infections found by P.C.R., regardless of whether the infected people felt sick. It also correctly identified 97 percent of the people who received negative laboratory test results.

Like other antigen tests that have received the F.D.A.’s emergency stamp of approval, Ellume’s test performs best within the first few days after a person starts experiencing Covid symptoms. In people without symptoms, the product found only 91 percent of the coronavirus infections discovered by P.C.R.

Dr. Valerie Fitzhugh, a pathologist at Rutgers University, noted that all of the study’s false positives occurred in the asymptomatic group. That “does make me a little nervous,” Dr. Fitzhugh said. False positives could send people into unnecessary periods of isolation or erode trust in testing.

Ellume, which was awarded a $30 million grant from the National Institutes of Health, plans to manufacture and deliver about 20 million home tests to the U.S. within the first half of 2021. The tests are expected to cost about $30 or less.

The test’s price tag — compared with some competitors that cost just $5 — and limited availability will likely restrict it from very frequent use.

But a test that can ping back immediate results could allow someone to promptly begin their isolation and break the chain of transmission. People carrying the virus are thought to be most contagious in the few days before and after their symptoms start, if they experience symptoms at all.

“I think this is hugely impactful, potentially,” Dr. Butler-Wu said.

Ellume’s test starts with a self-collected nasal swab. Plugged into a cartridge, the sample is analyzed, then the data is pinged to a smartphone via Bluetooth. The results go to the person taking the test, and can be shared with health care providers, as well as public health authorities.

Colorado lifted its restrictions on attendance at houses of worship after the Supreme Court ruled on a case from New York last month. Credit…Stephen Speranza for The New York Times

The Supreme Court on Tuesday ordered federal judges in New Jersey and Colorado to reconsider rulings allowing limits on attendance at indoor religious services in response to the coronavirus pandemic.

The court’s brief orders, which instructed the judges to take account of its decision last month lifting similar limits in New York, were unsigned and gave no reasons. The New Jersey ruling appeared to be unanimous, while the court’s three liberal justices dissented from the one concerning Colorado.

The Supreme Court has changed direction on how to balance public health and the free exercise of religion since Justice Amy Coney Barrett succeeded Justice Ruth Bader Ginsburg. While Justice Ginsburg was alive, the court upheld restrictions in California and Nevada by votes of 5 to 4. In the New York case, it struck down restrictions by the same margin.

In New Jersey, a priest and a rabbi sued over restrictions that limited attendance at indoor religious services to the lesser of 150 people or 25 percent of capacity.

In Colorado, a church and its minister sued to challenge 50-person limits on attendance at religious services, and lost in the lower courts. In the Supreme Court, state officials argued that the matter was moot, because the state removed the limits after the court issued its decision in the New York case.

Justice Elena Kagan, joined by Justices Stephen G. Breyer and Sonia Sotomayor, dissented from the order concerning Colorado on Tuesday, accepting the state’s argument that the case was moot and saying there was no prospect that the state would reimpose the capacity limits.

A vaccine protester among supporters of President Trump at a rally in Woodland Hills, Calif., in May.Credit…David McNew/Getty Images

As the United States begins the most ambitious vaccination drive in its history, with images of relieved health care workers getting a shot in the arm flashing across TV screens and news sites, fresh data revealed that more than one-quarter of Americans say they probably or definitely would not take a coronavirus vaccine.

That is according to a survey released on Tuesday by the Kaiser Family Foundation, which found that Republican, rural and Black Americans are among the most hesitant to be vaccinated.

The skepticism, while not totally unanticipated, still represents a challenge as the country tries to tamp down exploding infections, hospitalizations and deaths. On the same day as the first inoculations were administered, the United States passed 300,000 deaths — more than any other country.

The country is averaging more than 2,400 deaths a day, even more than in the spring. More than twice as many deaths are being announced each day than just a month ago.

The survey was conducted between Nov. 30 and Dec. 8 among a nationally representative random sample of 1,676 adults ages 18 and older (including interviews with 298 Hispanic adults and 390 non-Hispanic Black adults).

It is the first report from a new “Covid-19 Vaccine Monitor” that the Kaiser foundation has established to deeply examine the public’s views about coronavirus vaccination, and to track experiences in getting shots. Such information will be essential for public health experts who are trying to encourage vaccination.

Over all, 71 percent of respondents said they definitely would get a vaccine, an 8 percent increase from what Kaiser found in a September survey. Roughly a third (34 percent) now want the vaccine as soon as possible.

Another 39 percent said they would wait to see how the vaccine works out for other people before getting it themselves. Nine percent would get the vaccine only if it is required for work, school or another activity. Twelve percent said they would probably not take a vaccine, and 15 percent said they would definitely not get vaccinated — even if it was free and determined to be safe by scientists.

Different groups are hesitant for different reasons, the survey found. Black Americans appear most worried about side effects, or that they could get Covid-19 from the vaccine.

Nearly one in four Republicans “don’t want to get vaccinated because they don’t believe Covid poses a serious threat,” said Mollyann Brodie, the executive vice president of the foundation.

“It will be a real challenge to undo Covid denialism among this slice of President Trump’s political base,” she added.

Dr. Lyudmila Soboleva, 38, received the Sputnik V shot in Moscow last week. The government-funded coronavirus vaccine is based on genetically modified common cold viruses.Credit…Sergey Ponomarev for The New York Times

Russia has released additional results from a clinical trial of its leading coronavirus vaccine, called Sputnik V, showing an efficacy rate of 91.4 percent, similar to results obtained by Western vaccine makers.

Unlike in the West, the Russian authorities have taken a different path on vaccination, promoting the government-funded shot, which is based on genetically modified common cold viruses, before testing was complete. Moscow approved Sputnik V for emergency use in August, before wide-scale clinical trials to prove its efficacy and safety had even begun.

The World Health Organization and independent experts criticized the move as risky, noting that it undermined confidence in the vaccine, which Russia plans to market in more than 70 countries.

The financial company promoting the vaccine, the Russian Direct Investment Fund, released on Monday data from the interim result of its Phase 3 study, based on 22,714 participants receiving either the vaccine or a placebo. A total of 78 people across the two groups contracted Covid-19, the disease caused by the coronavirus.

It showed that among those who received the vaccine, none became severely ill with Covid-19 and that 91.4 percent were protected from mild or moderate cases. Twenty severe cases were recorded among the placebo group.

Kirill Dmitriev, the chief executive of the fund, praised the result as “astonishing” and said it would help Russia apply for registration for Sputnik V in potential export markets. He said the fund intended to apply in Argentina this month, and in other Latin American nations and countries in Asia and Africa in January.

So far, Russia has shipped about 320,000 doses of the vaccine and inoculated about 200,000 people outside of the clinical trials.

The vaccine this month received a vote of confidence from AstraZeneca, the British-Swedish pharmaceutical giant, when it opened talks with Russian vaccine scientists about combining efforts.

The AstraZeneca vaccine, developed at the University of Oxford, England, showed encouraging but perplexing results: Two doses of the vaccine provided stronger results (90 percent efficacy) when the first dose was only at half strength than when two full-dose shots were injected (a 62 percent efficacy). The joint efforts will explore whether that vaccine can be made more effective if recipients also receive a shot of Sputnik V.

The Russian trial is scheduled to continue until May, but Mr. Dmitriev said that regulators might halt it on ethical grounds as the vaccine had been proved effective. The efficacy rate was similar to what the Russian group had reported earlier but based this time on a larger, more statistically relevant sample. The results were comparable to those of the Pfizer vaccine, which reported a 95 percent efficacy and has already been approved for use in several countries, and of Moderna’s, which reported a 94.1 percent efficacy rate.

Gov. Chris Sununu of New Hampshire swore in the members of the New Hampshire House of Representatives outdoors on Dec. 2 for pandemic safety reasons. He urged residents on Tuesday not to let their guard down yet.Credit…CJ Gunther/EPA, via Shutterstock

It was not quite 30 degrees in Manchester, N.H. — with a wind chill of 19 — but Gov. Chris Sununu looked relieved and happy as the first few health care workers in the state were vaccinated against Covid-19 Tuesday morning outside the Elliot Hospital.

Even as he marked the occasion, though, the governor, a Republican, warned that it was far too soon for residents to let their guard down. And he dismissed the idea of elected officials like himself getting in the vaccine line ahead of the people most at risk.

“I think that’s ridiculous, frankly — I just completely disagree with that,” Sununu said.

Mr. Sununu, 46, noted that he has older parents (his father, John H. Sununu, was governor in the 1980s) and that he regularly picks up food at restaurants and goes grocery shopping. He said he was worried not just about keeping himself safe but also about unwittingly infecting others. Still, he said, he would wait his turn: “When it’s my time, I’ll be the first to step up.”

On Sunday, President Trump said he was reversing a directive to vaccinate top federal officials at a time when supplies are limited and public distribution of the shot is supposed to focus on frontline health workers and nursing home residents. News that White House staff members would receive the vaccine early had drawn sharp criticism on social media.

Governor Sununu urged residents to stay disciplined and keep making “small sacrifices,” including mask-wearing and social distancing. “It is going to take quite a few more months to get there,” he said.

Tuesday was the second day of Covid-19 vaccinations across the country. Lori Shibinette, the New Hampshire health commissioner, said the state had received more than 12,000 doses so far, and intended to use them all within the next two weeks. Vaccinations at the state’s hard-hit nursing homes, she said, would begin next week through a separate federal program.

The bulk of inoculations went to medical workers across the country on Monday, but they were not the only ones. Gov. Jim Justice of West Virginia was vaccinated as cameras rolled.

Police officers detained a woman taking part in an anti-vaccination and anti-lockdown protest in Parliament Square, London, on Monday.Credit…Stefan Rousseau/Press Association, via Associated Press

Prime Minister Boris Johnson was already facing a treacherous week as he weighs whether to strike a Brexit trade deal with the European Union. Now, he faces pressure on another front, after his government on Monday imposed tighter restrictions on London to curb a virus flare-up.

That abrupt decision, announced in Parliament by the health minister, Matt Hancock, will close pubs and restaurants in London, effective Wednesday. The move comes just 10 days before Christmas, and could drive away the shoppers who normally throng Oxford and Regent Streets at this time of the year.

Mr. Hancock said the British health authorities had identified a new, faster-growing variant of the virus, which he said might explain why the number of cases was rising so quickly in London, as well as in parts of southern and eastern England.

But that sobering news did not prevent grumbling from some members of Mr. Johnson’s Conservative Party, who warned that the new restrictions would deal another blow to the beleaguered hospitality and retail industries.

Medical experts said the discovery of a new variant was not, by itself, all that surprising. The variant, which has been found in roughly 1,000 people after first being detected in Kent, in southern England, is similar to that in other countries. Experts said that it served mainly to underscore the need for more robust border controls.

More baffling, they said, was the government’s on-again, off-again plan for dealing with the surge in cases. Under the new restrictions, pubs and restaurants in London will be closed, except for takeout service, while people from different households will be forbidden from socializing indoors.

Yet under a previously announced plan for Christmas, the government will temporarily lift the restrictions again a week later to allow up to three families to mix indoors. The break will begin Dec. 23 and last until Dec. 27 in most parts of Britain (those traveling to and from Northern Ireland can travel on Dec. 22 and 28). After that pause, London and the other affected regions would presumably go back under tighter restrictions.

Mayor Sadiq Khan of London has encouraged the government to rethink the holiday break, warning families, “This virus doesn’t respect Christmas.”

“We heard from Matt Hancock yesterday that it appears the government is looking at this again,” Mr. Khan told BBC Radio 4’s Today show on Tuesday morning. “I would encourage them to do so if they are.”

Two leading medical journals in a joint editorial published on Tuesday also criticized the British government’s decision to loosen measures over Christmas, warning that the move could lead to hospitals becoming overwhelmed by new cases.

The Institute of Contemporary Art in Boston in July.Credit…Steven Senne/Associated Press

Even as the first few days of mass vaccinations in the U.S. signaled what may be the beginning of the end of the coronavirus pandemic, officials in hard-hit areas were nonetheless imposing new restrictions this week to try to curb outbreaks.

In Boston, Mayor Martin J. Walsh announced the closure of museums, movie theaters and indoor fitness centers starting on Wednesday, among other measures. “Unfortunately, we are at the point where we need to take stronger action to control Covid-19 in Boston, and urgently, to ensure our health care workers have the capacity to care for everyone in need,” Mr. Walsh said in a statement. Several surrounding communities announced similar rules.

A few days earlier, Gov. Charlie Baker of Massachusetts had imposed other restrictions, including a 90-minute time limit on restaurant dining and fewer people per table.

New restrictions took effect in Delaware on Monday, limiting the capacity of various businesses and imposing a 10 p.m. curfew on restaurants and bars. Gov. John Carney also extended the state’s mask mandate to apply whenever Delaware residents or visitors are indoors with anyone from outside their households. Winter sports competitions are banned through Jan. 11, and restaurants must post signs requiring that patrons at individual tables all be from the same household.

In Virginia, new limits on social gatherings, a new curfew and a universal mask requirement took effect on Monday. With some exceptions, residents will be required to stay home from midnight until 5 a.m. Masks will be required outdoors when social distancing isn’t possible.

The new restrictions come as the coronavirus continues to surge across the country. On Monday, the United States announced nearly 1,700 newly reported deaths and surpassed 300,000 total deaths for the pandemic.

A doctor opened a box containing the Covid-19 vaccine after it arrived at the Jefferson Regional Medical Center in Pine Bluff, Ariz., on Tuesday.Credit…Andrea Morales for The New York Times

As a growing number of vaccines advance through clinical trials, wealthy countries are fueling an extraordinary gap in access around the world, laying claim to more than half the doses that could come on the market by the end of next year.

Many poor nations may be able to vaccinate at most 20 percent of their populations in 2021. But some of the world’s richest countries have reserved enough doses to immunize their populations multiple times.

With no guarantee that any particular vaccine will come through, these countries have hedged their bets on a number of candidates. But if all the doses they have claimed are fulfilled, the European Union could inoculate its residents twice, Britain and the United States could do so four times over, and Canada six times over, according to a New York Times analysis of data collected by Duke University, Unicef and Airfinity, a science analytics company.

The United States has provided billions of dollars to back the research, development and manufacturing of five of the most promising vaccines against Covid-19, pushing them forward at a speed and scale that would otherwise have been impossible. But the support came with a condition: that Americans would get priority access to doses made in their country.

Other wealthy countries joined the United States in placing large orders, often with clauses in their contracts that would allow them to acquire even more if they desired, undermining many other nations’ ability to make timely purchases.

How quickly the wealthy countries will achieve full coverage is uncertain, in large part because the candidates are in varied stages of progress. Pfizer’s vaccine, developed with BioNTech, is now authorized in countries including Bahrain, Britain, Canada, Mexico, Saudi Arabia and the United States. Moderna’s is expected soon.

AstraZeneca, which is developing its vaccine with the University of Oxford, is likely to seek approval in Britain, India and several other countries in the next few weeks, armed with data from outside the United States, where it has suffered setbacks with regulators. Valneva has not yet entered clinical trials. Sanofi, which is working with GlaxoSmithKline, recently changed its approval timetable to the end of next year after clinical results showed a poor performance in older people.

But the outlook for most of the developing world is dire. Because of manufacturing limits, it could be as late as 2024 before many low-income countries are able to obtain enough vaccines to fully immunize their populations.

Students arriving at a public school in Brooklyn last week.Credit…Victor J. Blue for The New York Times

In Arizona, where several schools have moved online in recent weeks amid a virus surge, Gov. Doug Ducey declared that teachers would be among the very first people inoculated. “Teachers are essential to our state,” he said. Utah’s governor, Gary Herbert, talked about possibly getting shots to educators this month. And Los Angeles officials urged prioritizing teachers alongside firefighters and prison guards.

But in districts where children have spent much of the fall staring at laptop screens, it may be too early for parents to get their hopes up that public schools will throw open their doors soon, or that students will be back in classrooms full time before next fall.

Given the limited number of vaccines available to states and the logistical hurdles to distribution, including the fact that two doses are needed several weeks apart, experts said that vaccinating the three million schoolteachers in the United States could be a slow process, lasting well into the spring.

And even once enough educators are inoculated for school officials and teachers’ unions — which hold considerable power in many large districts — to consider it safe to reopen classrooms, schools will most likely need to continue requiring masks and distancing students for many months, experts said, until community spread has sharply dropped, possibly by summer.

“I think some people have in their head that we’re going to start rolling out the vaccine and all this other stuff is going to go away,” said Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials, which represents public health agencies.

But in schools, as in daily life, he said, there will be no quick fix. “My feeling is that we’re all going to be wearing masks and keeping our distance and trying to be careful around each other for probably most of 2021.”

A Texas flag at an elementary school in Murphy, Texas, this month. Teachers in the state participated in a national sickout.Credit…LM Otero/Associated Press

More than 500 teachers in Georgia, Texas and other cities around the country called in sick on Tuesday as part of a nationwide protest against standardized testing during the pandemic, along with other policies that educators say are putting them at risk as coronavirus cases rise.

“This is legit just teachers who are just fed up across the nation and are saying this has to stop,” said Alfred Brooks, the founder of Teachers for Good Trouble, which organized the national sickout on Tuesday.

Teachers participated in at least seven cities including Houston, Atlanta, Los Angeles and St. Paul, Minn., said Mr. Brooks, a high school teacher near Atlanta, where more than 80 people rallied in front of the State Capitol building. Some participants with health concerns spoke out on Instagram in support of the sickout, Mr. Brooks said. Teachers at a school in Pensacola, Fla., came to work for in-person classes on Tuesday but wore yellow, the color associated with Teachers for Good Trouble, and taught the organization’s lessons on social justice and the racial context of standardized testing, he said.

In Texas, anger over a policy requiring teachers and students to take a state standardized test, with some districts requiring that students sit for the exam in school buildings, motivated some Houston-area educators to participate in the sickout, especially because a high school teacher died of the coronavirus earlier this month.

“They’re prioritizing testing over the safety of students, teachers and communities,” said Naseeb Gill, 32, a fifth-grade teacher in Houston, who called in sick on Tuesday.

Known as a Day Without Teachers, the sickout reflects an escalation in the contentious debate over the safety of in-person instruction that is playing out as the virus surges in many states.

Teachers at about 50 schools in Harris County, Texas, which includes Houston, were expected to participate, according to some who planned to take part. They are motivated by a range of policies, including requirements for teachers to use sick days to quarantine unless their absence is ordered by administrators. Many teachers in so-called right-to-work states have few labor protections.

Calling in sick has been a common method for teachers to express their concerns during the pandemic. About 100 teachers in Arizona’s third-largest school district staged a sickout on Friday, demanding that schools close after winter break and stay remote until the region’s infection rate declines.

A subway train in Beijing on Monday. Even though China has largely contained the coronavirus, small clusters of cases have continued to surface in the country.Credit…Andy Wong/Associated Press

The Chinese authorities on Tuesday were investigating a cargo pilot in a province in southwestern China who tested positive for the virus shortly after attending a 300-person wedding, just days after returning to the country from the United States.

His case added to fears about an outbreak in the province, Sichuan, where a few dozen cases — most of them imported — have been registered in recent days. Even though China has largely contained the virus since it emerged in the central city of Wuhan last year, small clusters of cases have continued to surface in the country.

And it is a stark reversal: Earlier this year, travelers from China were seen as posing a major risk of carrying the virus, but now, with the U.S. the center of the worst coronavirus outbreak in the world, the tables have turned.

It is unclear how the pilot, who was identified in Chinese news reports by his surname, Gao, had contracted the virus. Mr. Gao, 26, returned to the city of Chengdu from Los Angeles in late November and spent time in quarantine after testing negative for the virus, according to Chinese news media reports. The authorities have classified his case as an imported infection.

As news of the case spread on Chinese social media sites, many people expressed anger over Mr. Gao’s decision to attend the wedding, which took place in the city of Jiangyou on Saturday, 13 days after his return from the United States. He tested positive on Monday, according to Chinese news reports.

China has some of the strictest virus-control measures in the world, and the government typically mandates two weeks of quarantine for people returning to the mainland. But pilots are allowed exemptions. Some do not need to undergo quarantine if they test negative for the virus upon returning to China.

Here’s what else to know in coronavirus news from around the world:

  • At least 274 journalists around the world were in prison on Dec. 1, including some who had covered the pandemic, according to a report published early Tuesday by the Committee to Protect Journalists, an advocacy group in New York. Notably, at least three journalists in Egypt were arrested after covering their government’s response to the coronavirus, the report said. One of them, Mohamed Monir, contracted the coronavirus in custody and died a few days after his release. In Honduras, the journalist David Romero, who had been serving a 10-year defamation sentence when the pandemic started, died of Covid-19 complications in prison.

  • The European Medicines Agency has said in a statement that it will bring forward a meeting to decide whether to approve the Pfizer-BioNTech vaccine to Dec. 21. The meeting was originally planned for Dec. 29. The agency, which supervises drugs and vaccines for the European Union, said it had decided to expedite the meeting after receiving additional data from the pharmaceutical firm at the request of its experts.

  • Delivery workers in South Korea say they’re dying of “overwork.” More than a dozen couriers have died this year. Some died after complaining of unbearable workloads that kept them on the clock from dawn until past midnight.

  • Officials in the Philippines, fearing a surge in cases over the holiday season, said on Tuesday that anyone going out in public must wear a face shield on top of a face mask. Face shields had previously been required only on public transit and in enclosed spaces like malls and grocery stores, while masks have been mandatory since April. The Philippines, a country of more than 100 million people, has had a total of more than 450,000 cases, one of the worst outbreaks in Southeast Asia.

Lines, with little social distancing, outside a government office in Port Elizabeth, South Africa, last month.Credit…Theo Jeptha/Associated Press

President Cyril Ramaphosa of South Africa has announced a raft of new restrictions as the country enters a second coronavirus wave, with infections expected to rise further over the festive season.

Alcohol sales will be restricted, curfews will be in place from 11 p.m. to 4 a.m., and gatherings of more than 100 people indoors are banned across the country. In areas with the highest number of case, there will be even tighter restrictions, including the closing of beaches and public parks in some areas, Mr. Ramaphosa said in a televised address on Monday.

Four provinces are driving the surge in cases: Eastern Cape; Gauteng, the economic heart of the country; KwaZulu-Natal; and Western Cape, known for its wine routes and stunning beaches. Before the holiday season, when many gather at the seaside, beaches will be closed in Eastern Cape and along the Garden Route in Western Cape.

“The festive season now poses the greatest threat to the health and well-being of our nation,” Mr. Ramaphosa said in his broadcast.

The president warned that the resurgence threatened to overwhelm the South African health system, noting that, “if we do not act urgently and if we do not act together, the second wave will be more severe than the first wave.”

South Africa, the sub-Saharan region’s most developed economy, has recorded more than 866,000 coronavirus cases, according to a New York Times database. The average number of new daily cases has risen to more than 6,800, from around 3,800 a week ago, according to the database and government statistics. Officials said that another concern was the fact that new infections were highest among young people for the first time since the pandemic began.

The trend is being driven by student “rage” events — a series of alcohol-fueled parties, or gatherings at nightclubs and festivals, Dr. Zweli Mkhize, the South African health minister, said in a radio interview on Monday.

Dr. Mkhize said that the large number of these parties with “no adherence” to social distancing, adequate ventilation and other mitigation measures had led to several so-called superspreader events. After one big party in the southeastern coastal town of Ballito in KwaZulu-Natal Province this month, almost 1,000 students tested positive.

A nursing home resident in Miami got a drive-by visit from a friend in July.Credit…Wilfredo Lee/Associated Press

A handful of states are getting an early start on vaccinating some of their most vulnerable citizens, beginning with West Virginia, which began inoculating residents and staff at long-term care facilities on Tuesday, nearly a week before the majority of nursing homes around the United States are scheduled to get started.

The state expects to have 48 of its 214 facilities fully vaccinated by Friday, according to Marty Wright, chief executive of the West Virginia Health Care Association. Most of the country’s nursing homes will not begin vaccinations until Monday, when a major drive run by CVS and Walgreens will get underway in earnest. West Virginia is instead using local pharmacies.

West Virginia is one of four states — along with Florida, Ohio and Connecticut — that are getting an earlier start.

“We chose to not go along that time frame — to begin immediately, using the local pharmacies,” Mr. Wright said.

Covid-19 has ravaged the country’s nursing homes, despite an array of safety measures and bans on visitors, put in place months ago to slow the devastation. Deaths of residents of long-term care facilities have swelled to account for almost 40 percent of the country’s death toll, now over 300,000.

In Florida, Gov. Ron DeSantis announced a “strike force” that will distribute 21,450 doses this week at nursing homes in two counties, in advance of the pharmacy chains’ campaign next week. The strike force vaccinations are set to begin Wednesday or Thursday, according to Margarita Hall, a spokeswoman for the Florida Department of Health in Pinellas County.

Ohio expects to begin on Friday, with between five and 10 institutions giving hots that day, Gov. Michael DeWine announced. He said the Centers for Disease Control and Prevention had selected Ohio to start early.

Complicating the process at long-term care facilities is the need to obtain written consent for vaccination.

“When you have residents, many of whom are not capable of consent, you have find their guardian, their family, somebody else to consent for them,” said Peter Van Runkle, executive director of the Ohio Health Care Association, an organization of some 1,100 long-term care facilities. “That is challenging.”

There is also some hesitancy about the vaccine among both residents and staff members, he noted. Facilities in Ohio have so far not made vaccination mandatory; rather, administrators are hoping that briefings and educational materials will persuade most people to take the shot.

Mr. Van Runkle said it would probably take until early March to get all 200,000 to 300,000 people who either live or work in Ohio’s long-term care facilities inoculated.

In Florida, industry experts said that about 75 percent of nursing home employees had agreed to receive the vaccine.

Fernando Pires, who received a COVID-19 vaccination on Monday at Rhode Island Hospital in Providence, R.I., reported some soreness the day after.Credit…Cody O’Loughlin for The New York Times

The swamped intensive care units and emergency departments at many American hospitals have little flexibility these days for employees to be out sick. So it came as a relief that some of the hundreds of frontline health care workers who received their first dose of the coronavirus vaccine Monday were able to return to work the next day with just a bit of soreness at the injection site.

In interviews Tuesday, six vaccinated frontline workers said they had no significant side effects.

Fernando Pires, a 60-year-old maintenance worker who cleans rooms in the emergency department at Rhode Island Hospital in Providence, said he was not feeling anything other than a lot of pain in his arm. It was a small annoyance, he said, considering the peace of mind the vaccine gave him after months of coming to work despite being at risk himself, as someone with diabetes and asthma.

When his boss called him to ask if he wanted to be in the first round of vaccine recipients, Mr. Pires said, “I didn’t even think twice.”

At Ohio State University’s Wexner Medical Center, Dr. Mercy Dickson, a 35-year-old emergency medicine resident, said she was feeling good, even after working night shifts before and after receiving the vaccine.

“I have a little bit of soreness on my right arm where I got the shot,” she said. “But otherwise, I feel as I felt before.”

After months spent alongside Covid-19 patients who struggled to breathe, were isolated from family members, and died from the virus, Dr. Dickson said the vaccine was a first step for her toward healing. And as a Black doctor, she said, she especially hopes it will make a dent in the disproportionately deadly toll the virus has taken on Black Americans.

“Hopefully, someone sees me — someone who looks like them — and is encouraged to get their own vaccine, and we are able to change positively the trajectory of people’s lives and minimize the suffering and pain that families have to go through,” she said.

Luciana Thornton, a pharmacist at Ascension Via Christi St. Francis in Wichita, Kan., said she was surprised by how good she felt the day after receiving her shot, given what she had read about the vaccine’s potential side effects.

“Some people have fever or chills, and I have had none of that,” she said. “A lot of people I’ve talked to feel pretty good. Some people have had headaches. I feel a lot better than I expected to.”

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