Covid-19 Live Updates: Europe Begins Barring U.K. Travelers, Alarmed Over Virus Mutation

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Credit…Stefan Rousseau/Press Association, via Associated Press

European countries on Sunday began closing their borders to travelers from the United Kingdom, a day after Britain’s Prime Minister Boris Johnson ordered a wholesale lockdown on London and surrounding counties, citing concerns of a new fast-spreading variant of the coronavirus.

The new restrictions in England, which came into effect at midnight on Saturday and effectively quarantined the capital and other areas from the rest of the country, are the harshest measures to be taken since the country’s first lockdown in March. Train stations in London on Saturday night filled with crowds of people scrambling to leave the city.

Worried by the potential influx of travelers from Britain, the Netherlands said it would suspend flights from Britain from Sunday until Jan. 1, noting that the variant found in England “is thought to spread more easily and more quickly.”

Italy also suspended air travel, citing a duty to protect Italians, and Belgian officials on Sunday enacted a 24-hour ban on arrivals from the United Kingdom by air or train, which could be extended. Other countries are also considering similar bans, among them France and Germany, according to local media.

Transport officials in England said that they would increase the number of police officers monitoring hubs like railway stations to ensure only essential journeys were being taken.

Viral mutations are not uncommon, and British officials said this variant had been detected in a handful of other countries. And a similarly contagious version of the virus has emerged in South Africa, which seems to share some of the mutations seen in the British variant.

The estimate of greater transmissibility for the British variant — officials put the figure at 70 percent — is based on modeling and has not been confirmed by lab experiments, said Muge Cevik, an infectious disease expert at the University of St. Andrews in Scotland and a scientific adviser to the British government.

“Over all, I think we need to have a little bit more experimental data,” she said. “We can’t entirely rule out the fact that some of this transmissibility data might be related to human behavior.”

David Spicer prepares to conduct a coronavirus test on the first day of operation of their testing site adjacent to Terminal 1 of Manchester Airport in England earlier this month.
Credit…Oli Scarff/Agence France-Presse — Getty Images

Scientists say they are concerned but not surprised by variants in the coronavirus like the one that prompted officials in Britain to sound an urgent alarm on Saturday, declaring that a highly contagious new version of the virus had begun circulating in England.

Like all viruses, the coronavirus is a shape-shifter. Some variants become more common in a population simply by luck, not because the changes somehow supercharge the virus.

But scientists also are watching for mutations that enhance the virus. One concern is that the vaccination of millions of people and growing immunity in human populations may exert enormous pressure on the virus to evolve so-called escape mutations that evade the immune response, setting back the global fight by years.

Several experts urged calm, saying it would take years, not months, for the virus to evolve enough to render the current vaccines impotent.

“No one should worry that there is going to be a single catastrophic mutation that suddenly renders all immunity and antibodies useless,” said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.

“It is going to be a process that occurs over the time scale of multiple years and requires the accumulation of multiple viral mutations,” he added. “It’s not going to be like an on-off switch.”

In South Africa, where a similar variant has been found, scientists were also quick to note that human behavior was driving the epidemic, not mutations whose effect on transmissibility has yet to be quantified.

Escape from immunity requires that a virus accumulate a series of mutations, each allowing the pathogen to erode the effectiveness of the body’s defenses. Some viruses, like influenza, amass those changes relatively quickly. But others, like the measles virus, collect hardly any of the alterations.

Immunizing about 60 percent of a population within about a year, and keeping the number of cases down while that happens, will help minimize the chances of the virus mutating significantly, said Emma Hodcroft, a molecular epidemiologist at the University of Bern in Switzerland.

Patrick J. Toomey, Republican of Pennsylvania, departing a roll call vote at the Capitol on Saturday.
Credit…Stefani Reynolds for The New York Times

Lawmakers are on the brink of agreement on a $900 billion compromise relief bill after breaking through an impasse late Saturday night, with votes on final legislation expected to unfold as early as Sunday afternoon and very likely just hours before the government is set to run out of funding.

Senator Patrick J. Toomey, Republican of Pennsylvania, agreed Saturday night to narrow his effort to rein in the Federal Reserve and accepted an offer put forward by Senator Chuck Schumer, Democrat of New York and the minority leader, according to three aides familiar with the discussion. All three aides, speaking on the condition of anonymity, noted that the precise language was still being finalized.

The agreement was a critical breakthrough for lawmakers who have been racing to complete a package to rush direct payments, unemployment benefits and food and rental assistance to millions of Americans struggling financially during the coronavirus pandemic, as well as relief to businesses and funds for vaccine distribution. Although negotiators were still wrangling over smaller issues, the Federal Reserve language had emerged as the biggest impediment to a final agreement.

“If things continue on this path, and nothing gets in the way, we’ll be able to vote tomorrow,” Mr. Schumer told reporters as he left the Capitol shortly before midnight. “House and Senate.”

One of the potential remaining stumbling blocks is President Trump, who has largely been removed from the stimulus negotiations as he continues to attack the outcome of the Nov. 3 election and undermine President-elect Joseph R. Biden Jr.’s victory. Shortly after midnight on Sunday, he tweeted his frustration with Congress for not yet acting on a stimulus and signaled that he would want larger direct payments than the $600 payments currently under discussion.

“GET IT DONE, and give them more money in direct payments,” the president wrote on Twitter.

While Congress approved $1,200 direct payments in the $2.2 trillion stimulus law that passed in March, lawmakers are coalescing around $600 payments for this round in part to maintain Republican support and to keep the price tag of the measure under $1 trillion. The emerging deal would also provide enhanced federal jobless payments of $300 per week until early spring. It would also provide hundreds of billions of dollars to prop up small businesses, schools and other institutions struggling amid the pandemic, and fund the distribution of vaccines.

Congressional leaders plan to merge the $900 billion compromise measure with a catchall omnibus package that will keep the government funded for the remainder of the fiscal year. House leaders notified lawmakers to prepare for votes as soon as early Sunday afternoon. But lawmakers have yet to see the text for either legislative package, and, particularly in the Senate, a single senator could potentially delay passage past the midnight funding deadline.

Representative James E. Clyburn of South Carolina, the No. 3 Democrat in the House, said on MSNBC that he hoped the legislation could clear the House before midnight. Without that, he said, Congress would likely take up another stopgap spending bill to avoid a lapse in funding.

A nursing home resident in West Hartford, Conn., received a vaccination Friday. Connecticut was one of a handful of states to begin inoculating residents last week.
Credit…Stephen Dunn/Associated Press

A large swath of nursing homes in the United States are poised to receive Covid-19 vaccines beginning Monday, as the country pushes to inoculate some of its most vulnerable citizens and free them from months of confinement.

Nursing homes have felt the brunt of Covid-19’s severity in the United States. At least a third of the country’s more than 305,000 deaths have been reported among residents and employees of nursing homes and other long-term care facilities for older adults, while more than 787,000 staff members and residents have become infected. Most homes have been closed to visitors since the early days of the pandemic, leaving residents feeling lonely and isolated.

Vaccinations started in the United States last week, with health-care workers at the front of the line. The effort has expanded to long-term care facilities as conditions in them have deteriorated anew, with nearly 20,000 cases and an estimated 5,000 deaths reported per week, according to the American Health Care Association and National Center for Assisted Living.

Some states, including West Virginia, Connecticut, Delaware and Florida, began administering vaccines at long-term care facilities last week. The homes are expected to remain locked down until residents’ relatives have been vaccinated.

At The Cedars, a retirement community in Portland, Maine, pharmacists from Walgreens are expected to arrive at 8:30 a.m. Monday to administer vaccines to residents and staff members. “There will be much celebration in the air,” said Katharine O’Neill, the director of operations and communications.

In New York, the state health facilities association — which includes 425 skilled nursing homes and assisted living facilities — has been working with the state and federal governments for about two months to plan how the vaccine will be administered, said Stephen Hanse, the president and chief executive of the association.

Most homes will get the vaccine through CVS Pharmacy or Walgreens, part of a deal struck with the federal government, and residents will probably be vaccinated in their rooms, while staff will receive the doses in separate spaces, Mr. Hanse said.

There will be vaccination celebrations, probably mixed in with holiday festivities. Morale is higher than it has been throughout the pandemic, Mr. Hanse said, because the vaccines give residents hope that they will soon be able to see their loved ones in person after many months of solitude. “One of the things that’s really in play here. too, especially in New York, was the inability for family and loved ones to visit with their family,” he said.

In Fairborn, Ohio, at the Wright Rehabilitation and Healthcare Center, the first doses of the vaccine are scheduled to arrive in the first week of January, Greg Nijak, the executive director of the facility, said.

Preparations have centered on securing vaccine consent forms and disseminating information about the safety of the vaccine. “

Elsewhere, there is trepidation. At the Martha T. Berry Medical Care Facility outside Detroit, a recent survey found that less than half of the staff wanted to take the vaccine. “Our staff is mostly skeptical,” Kevin Evans, the executive director of the facility, said in an email.

The facility has started an information campaign for residents and staff members. Despite the apprehension among employees, residents are eager for the vaccines’ arrival, which the facility is planning to celebrate.

“Though we have multiple FaceTime and Skype and window visits,” Mr. Evans said, “it is not the same as a hug from a son, daughter, or grandchild.”

People handing out hand sanitizer on the streets in São Paulo, Brazil, on Friday.
Credit…Victor Moriyama for The New York Times

As the coronavirus continues its surge across the United States and Europe, where vaccinations recently began, total infections around the world have now topped 75 million.

In the United States, more than 128,000 people had been vaccinated as of Friday, according to a New York Times database tracking vaccinations. But that total is just slightly more than half the number of new cases reported across the country the same day.

The United States, the world’s largest coronavirus hot spot with more than 17.6 million people who have been infected over all, on Friday reported its first single-day caseload of more than 250,000 new infections.

In Sweden, there have been 66 new daily cases per 100,000 people over the past seven days, a rate nearly identical to that of the United States. Lithuania has the world’s highest current rate of spread, with a daily average of 98.6 new cases per 100,000 residents over the past week.

Over 15 million total cases have been reported in Europe, with the continent’s boundaries defined by the European Center for Disease Prevention and Control. India has reported more than 10 million infections, the second most of any country, followed by Brazil with more than seven million.

More than 1.6 million people around the world have died from Covid-19, according to a New York Times database. In the U.S. alone, more than 315,000 people have died — 3,611 of them on Wednesday, shattering the previous single-day record of 3,157 on Dec. 9.

Over 137,000 people in the United Kingdom have been vaccinated, according to Bloomberg, with 108,000 of those in England, where Prime Minister Boris Johnson on Saturday announced plans for a harsh lockdown on London and much of the country’s southeast. The U.K. reported 28,507 new cases on Friday.

China, which has reported only 96,400 cases total, says it has already administered more than a million doses, though its vaccines have not been fully tested. (Chinese officials have said that so far there have been no adverse reactions.)

On Friday, an international body established to promote global access to Covid vaccines, known as Covax, said it had reached deals with manufacturers to deliver a billion doses to low- and middle-income countries.

The announcement included news about a method for countries with excess doses to share them. Wealthy countries like the United Kingdom and the United States have secured a surplus of vaccines. Canada, which could receive as much as six times the amount needed to vaccinate its entire population, said it would contribute its extra doses through Covax. France made a similar commitment.

The sharing would be welcome help for lower-middle-income countries like India, Egypt and El Salvador, which have not secured enough doses to vaccinate their entire populations. Even upper-middle-income nations like Argentina, Turkey and Thailand have not met the 100 percent threshold.

Vaccine preorders as a percentage of population

Latin America

(excluding Brazil)

Vaccine preorders as a percentage of population

Latin America

(excluding Brazil)

Staff members who received the Covid-19 vaccine waited to make sure they did not experience an allergic reaction at Redlands Community Hospital in California on Friday.
Credit…Alex Welsh for The New York Times

An independent panel of experts advising the Centers for Disease Control and Prevention voted on Saturday to endorse a second coronavirus vaccine for use in adults 18 and older.

The committee’s recommendation, by a vote of 11 in favor and none against (with three recusals due to conflicts of interest), followed Friday’s announcement that the vaccine, made by Moderna, had been granted an emergency authorization by the Food and Drug Administration.

The advisory committee’s endorsement now awaits final approval from Dr. Robert R. Redfield, director of the C.D.C., which is expected shortly.

The committee’s vote signals to hospitals and doctors that they may proceed to inoculate patients with the Moderna vaccine. Some 5.9 million doses are scheduled to ship on Sunday, and the first vaccinations are expected to begin on Monday.

Unlike the Pfizer-BioNTech vaccine, which was authorized for use in people 16 and older, Moderna’s inoculations are intended for adults only. (Moderna did not begin its pediatric studies until Dec. 9 and did not expect to have a full set of data until sometime next year.)

In adults, Moderna’s vaccine was more than 94 percent effective at preventing symptomatic cases of Covid-19. It’s still unclear how well the two vaccines fare at curbing coronavirus transmission.

Much of the advisory committee’s deliberations centered on the severe allergic reactions reported after injections of the Pfizer-BioNTech vaccine, which contains ingredients similar to those in Moderna’s recipe.

Six cases of anaphylaxis have now been documented in the United States, as well as two in Britain. In addition, milder allergic reactions have been reported. Experts have said these cases shouldn’t deter a vast majority of people from getting the vaccine. More than 272,000 doses of Pfizer’s vaccine have already been doled out nationwide.

Half of the people who received Moderna’s vaccine in clinical trials also reported some uncomfortable symptoms, including fatigue, headaches and soreness, after their second shot, given about four weeks after the first. Some volunteers also developed fevers or rashes around injection sites.

Incidents like these appear to be much more common with Moderna’s vaccine than Pfizer’s, which contains a smaller dose of active ingredients. But most of the side effects disappeared within a day or so of the shot.

Neither Moderna nor Pfizer has yet collected data in people who are pregnant or breastfeeding. But none of the 13 volunteers who became pregnant while participating in Moderna’s clinical trials, six of whom received the vaccine, reported harmful effects.

Dr. Jacqueline Miller, Moderna’s senior vice president, also drew attention to the representation of people of varying races and ethnicities in Moderna’s trials — a nod to the disproportionate effect of the pandemic on communities of color.

In discussions this week, experts repeatedly noted the importance of partnering with representatives from communities of color to reaffirm vaccine safety and efficacy for people who might be skeptical of the shots.

On Sunday, C.D.C. officials will deliver more guidance about allocating the newly cleared vaccines.

State Sen. Jerry Relph was the first Minnesota lawmaker to succumb to the virus.
Credit…Glen Stubbe/Star Tribune, via Associated Press

A Republican state senator from Minnesota who tested positive for the coronavirus last month has died, his wife said in a written statement.

“I’m heartbroken to share that my husband, Jerry Relph, has passed away and entered his heavenly home,” his wife, Pegi Broker-Relph, said Friday. “Jerry dedicated his life to service and representing Senate District 14 was one of the highest honors he had.”

Mr. Relph, 76, represented a region that includes St. Cloud. He was a Marine Corps veteran who served in Vietnam and had worked as an attorney and businessman.

“He loved serving the people of St. Cloud in the Senate, and he cherished every minute of it,” she said.

Several state senators, including Mr. Relph, tested positive for the virus after attending a caucus leadership meeting on Nov. 5 and a post-election party that evening with more than 100 people present, local media outlets reported.

Mr. Relph began quarantining on Nov. 10, after being informed that he had been in close contact with someone who had the virus at the Senate, said Rachel Aplikowski, the communications director for the Senate Republicans. He received positive test results on Nov. 13, and went to the emergency room twice with symptoms but was not hospitalized, she said.

His condition had worsened in recent weeks, Minnesota Public Radio reported.

On social media, friends and colleagues poured out their condolences. “Covid-19 has claimed the life of Sen. Jerry Relph. I will remember him as a kind man and dedicated public servant,” Laurie Halverson, a member of the state House of Representatives, said on Twitter.

Tim Walz, the governor of Minnesota, called Mr. Relph’s passing “terrible news.” “Jerry lived his entire life in service to his community,” Mr. Walz wrote on Twitter.

In mid-November, Minnesota was announcing new single-day records of coronavirus cases, and daily new case reports in Minnesota had doubled in the time since Halloween, prompting the state health department to warn residents that even small gatherings pose risks of transmission.

Since then, new case numbers have declined. Over the past week, there has been an average of 2,989 cases per day — a decrease of 52 percent from the average two weeks earlier, while deaths have risen 17 percent.

Other state legislators have died from Covid, including New Hampshire’s new Republican speaker of the House of Representatives earlier this month. In North Dakota, David Dean Andahl, a Republican known as “Dakota Dave,” was elected posthumously to the state House of Representatives after dying from the virus.

New York’s largest transit union is lobbying to have its employees included in the next round of coronavirus vaccinations.
Credit…Gregg Vigliotti for The New York Times

Among state capitals, New York’s has long stood apart as a venue for favor trading and behind-the-scenes deals. Now, as the coronavirus rages and vaccines remain in short supply, the pandemic has been thrust squarely into the maw of Albany politics.

“Everyone is chasing the same thing now, and it really is remarkable,” said James E. McMahon, a veteran Albany lobbyist who represents a school bus company and other firms interested in early vaccination. “The need was there and then there’s the vaccine and all of a sudden, people are saying, ‘Oh Jesus, we’ve got to get in line now.’”

Apparently attuned to the atmosphere, Gov. Andrew M. Cuomo made several pronouncements this past week that his administration would not be swayed by interest groups.

“There will be no political favoritism,” the governor said in a news conference on Wednesday, a message he repeated on Friday.

The question of where groups of workers stand in the line for vaccines has yet to be resolved in New York or in a majority of other states, according to a review by the nonprofit Kaiser Family Foundation. The federal government is expected to issue final recommendations on who should be deemed essential soon. But it is largely up to states to prioritize vaccine distribution among those workers.

In New York, emergency responders like police officers, transit workers and those who maintain power grids and other critical infrastructure will almost certainly be part of the next wave, according to a state plan.

But the remaining uncertainty has led to clamoring for consideration in state capitols and in Washington from a wide array of businesses and workers. Tens of millions of Americans, designated as essential, continue to toil amid the pandemic’s dangers while others work from home.

The list of those who qualified as essential in New York stretched from chiropractors to landscapers to bicycle mechanics. That long list has allowed all sorts of industries to claim they should also be among the first for the vaccine.

Rich Maroko, president of the Hotel Trades Council, wrote a letter to state health officials in which he made the case for the 35,000 hotel employees the union represents in the city.

“These workers have continued to put themselves at risk and have worked throughout this pandemic performing services that are critical to the State of New York,” he wrote.

Stuart Appelbaum, the president of the Retail, Wholesale and Department Store Union, which represents 40,000 workers in New York, including grocery story workers, said he had reached out to state officials, but had yet to hear back.

Inside an Apple store in Santa Monica, Calif., last month. The company said it would close all of its California stores.
Credit…Philip Cheung for The New York Times

Apple is shuttering all 53 of its stores in California, as well as more than a dozen stores across Tennessee, Brazil, Mexico and the United Kingdom, because of a surge of coronavirus cases in those places, the company said.

“Due to current Covid-19 conditions in some of the communities we serve, we are temporarily closing stores in these areas,” Apple said in a statement. “We take this step with an abundance of caution as we closely monitor the situation and we look forward to having our teams and customers back as soon as possible.”

The closings began Saturday.

Even though Apple has an extensive online catalog, the closings come at a traditionally busy time of year for brick-and-mortar stores ahead of Christmas.

The closings in California were announced late Friday after the company had earlier said it would close stores in the Los Angeles area. California has been setting records for new virus cases in a single day, and reported just 2 percent availability of beds in its intensive care units on Saturday.

In Britain, Prime Minister Boris Johnson announced a strict lockdown on Saturday for London and southeastern England.

A national vaccination campaign in Israel began with Prime Minister Benjamin Netanyahu’s inoculation Saturday at Sheba Medical Center in Ramat Gan.
Credit…Amir Cohen/Reuters

Arriving at the hospital wearing a short-sleeved polo shirt under his jacket, Prime Minister Benjamin Netanyahu became the first Israeli to be inoculated against Covid-19 on Saturday night, saying he wanted to set an example and encourage all Israelis to get the vaccine.

“One small jab for man, and a huge step for all our health,” Mr. Netanyahu declared moments after receiving the Pfizer and BioNTech vaccination at the Sheba Medical Center in a Tel Aviv suburb at an event that was broadcast live on television.

His health minister, Yuli Edelstein, went next.

The pair kicked off a national vaccination campaign that prioritizes frontline health workers. Thousands of Israelis over age 60 have also received appointments to be vaccinated as early as this week.

Israel has experienced two major waves of coronavirus and, with numbers of infections on the rise again, may soon be facing a third lockdown.

The country has secured millions of vaccines from Pfizer and Moderna, potentially enough for the entire population of nine million, though it is not clear how many have arrived in the country.


In the days before Thanksgiving, infectious-disease experts and elected officials repeatedly warned Americans to limit their travel and family gatherings, fearing the holiday would turn into a nationwide super-spreader event.

But experts and data suggest what happened around the date, Nov. 26, was something like a micro-spreader, more a tornado picking its spots than a hurricane blowing down everything in its path.

Like much about the virus, exactly how much Thanksgiving gatherings spread it and why the effects seem to have varied so much from place to place remains unclear. But, with the virus surging as Christmas and New Year’s approach, epidemiologists and health officials across the country are picking apart the effects of Thanksgiving in search of lessons for the coming holidays.

Epidemiologists said coronavirus case numbers and other data show that in many parts of the country, Americans altered their routines during the holiday, staying home instead of traveling and canceling large family gatherings. But there have been regional and isolated surges that can be attributed in part to activity around those days in late November.

In California, for example, the worst days of the pandemic are hitting now, with a spike in new cases, hospitalizations and deaths that has shocked the state.

For a period last week in Los Angeles County, a coronavirus death was recorded every two hours. And infections have touched many families. On Thursday, Eric Garcetti, the mayor of Los Angeles, announced that his 9-year-old daughter had tested positive for the virus.

Cases in the region were spiking before the holiday, but the widespread transmission that occurred during Thanksgiving gatherings in Riverside, Los Angeles, Orange, Santa Barbara and other counties was contributing to the pace of spread, officials said.

The number of people hospitalized with Covid-19 in those four counties jumped 156 percent, from 3,400 to 8,687, in the three weeks from Thanksgiving to Dec. 17, according to data from the California Department of Public Health. In the three weeks preceding Thanksgiving, hospitalizations increased 108 percent.

“We had all these little fires going all throughout the county, and then someone with Thanksgiving just threw some gasoline — that’s what it kind of feels like,” said Wendy Hetherington, the chief of epidemiology for the public health department in Riverside County, where roughly one of five residents is testing positive.

Still, experts said that, in general, parts of the country that were improving pre-Thanksgiving continue to improve post-Thanksgiving, while other regions experiencing surges before the holiday continue to worsen, suggesting that any nationwide Thanksgiving effect was muted.

“The fact is, people took precautions, and those have helped to not make things worse — not enough to make things better, but enough to not make things worse,” said Ellie Murray, a professor of epidemiology at Boston University. “We probably have enough data to say that people didn’t do things completely as normal, and we are not in the worst-case scenario.”

Patients and their relatives rest on the sidewalk near Holy Family Hospital, one of the busiest government hospitals and a treatment center for Covid-19, in Rawalpindi, Pakistan.
Credit…Saiyna Bashir for The New York Times

As winter sets in, cold weather, pollution and public apathy to the coronavirus are weighing heavily on Pakistan’s limited health care system.

Pakistan’s Covid-19 positivity rate has rocketed up to about 7.7 percent of tests administered in recent weeks from only 2 percent in October, prompting a plea from health experts and doctors in Karachi for the government to impose a strict nationwide lockdown.

Despite the rise, people in Karachi show few signs of concern. Even as the positive testing rate topped 18 percent in the city of 20 million, markets were packed with shoppers not wearing masks. Buses were full. Overflow passengers rode on the roofs.

Prime Minister Imran Khan has closed schools but ruled out a second lockdown, saying it would decimate the economy.

By official figures, Pakistan is weathering the coronavirus better than the United States, Europe and neighboring India. Government restrictions on travel or the overall youth and resilience of Pakistan’s population may have contributed.

“Pakistanis remained safe during the first wave and didn’t face a serious situation like seen in other countries, mainly because of God’s special blessings,” said Dr. Qaiser Sajjad, a leader of the Pakistan Medical Association.

But the second wave is proving more lethal. Cases are surging, and limited testing compared with other countries suggests the virus could be racing through the country at an even higher rate.

Total infections have reached 448,522, according to researchers at Johns Hopkins University using official figures, and more than 9,000 people have died from the virus. Some hospitals are turning away patients. In Dr. Ruth Pfau Civil Hospital in Karachi, managers are scrambling for beds.

Health experts faulted the rising caseload on ineffective government limits on personal contact and widespread doubts — often fueled by conspiracy theories — that Covid-19 poses a threat.

A survey conducted in October by Gallup Pakistan showed that 55 percent of respondents in the country doubted that the virus was real and 46 percent believed it was a conspiracy. Those attitudes make it tougher to enforce mask-wearing and other preventive measures and could complicate the distribution of vaccines when they become widely available.

Children being vaccinated for smallpox at the New York Eye and Ear Infirmary in 1947.
Credit…The New York Times

In April 1947, New York City’s health commissioner, Israel Weinstein, had been on the job 10 months. He was a child on the Lower East Side when a smallpox outbreak brought the city to its knees in the early 1900s, killing 720 New Yorkers in a two-year period.

Most New Yorkers had been inoculated against smallpox. They’d been told the inoculation would protect them for life — but there was no guarantee. In some cases, the vaccine didn’t take. In others, the immunity wore off.

On Good Friday, April 4, some startling lab results reached Dr. Weinstein: An American businessman who arrived in New York from Mexico City by bus had tested positive for smallpox. In two days, New Yorkers would be gathering for the city’s annual Easter Parade. If only one of them had smallpox, even among a vaccinated population, the resulting outbreak could be devastating.

At 2 p.m. that day, Dr. Weinstein held a news conference, urging all city dwellers to get vaccinated immediately, even if they had been inoculated as children. Re-vaccinations were necessary, he said, in case people had lost immunity.

His decision was hardly without risk. Not only could the announcement cause mass hysteria, but vaccines then were not tested the way they are today. The smallpox vaccine available at the time could trigger rare but dangerous side effects, especially in people with weakened immune systems or particular skin conditions.

According to Dr. David Oshinsky, a professor of medicine at N.Y.U. Langone Health, Dr. Weinstein acted in line with the scientific knowledge of the era and made the right move.

In a series of daily radio addresses, Dr. Weinstein focused on transparency and a consistent message. The vaccine, he said, was free, and there was, in his words, “absolutely no excuse for anyone to remain unprotected.” In a calm, clear voice, he promoted the rallying cry that would appear on posters throughout the city: “Be Sure. Be Safe. Get Vaccinated!”

But the municipal stockpile contained nowhere near enough vaccine for all of the city’s 7.8 million residents.

With the cooperation of Mayor William O’Dwyer, Dr. Weinstein secured 250,000 units from the naval medical supply depot in Brooklyn. He had 780,000 doses flown in from military bases in California and Missouri. He purchased an additional two million from private manufacturers, and then he ordered more. And he began a tracing program to locate and vaccinate anyone exposed.

The vaccine rollout was remarkably swift and uncomplicated. In early May, Dr. Weinstein announced that the danger had passed.

Later that year, he summed up the case in The American Journal of Public Health. “In a period of less than a month, 6,350,000 people were vaccinated in New York City,” he wrote. “Never before had so many people been vaccinated in such a city and on such short notice.”

The final tally was 12 infections and two deaths.

James J. Florio and

People attended a vigil in Hong Kong in February, for the late Dr. Li Wenliang. Reports of Dr. Li’s death were squashed by the Chinese government in an effort to control news about the virus within the country.
Credit…Tyrone Siu/Reuters

In the early hours of Feb. 7, China’s powerful internet censors experienced an unfamiliar and deeply unsettling sensation. They felt they were losing control.

The news was spreading quickly that Li Wenliang, a doctor who had warned about a strange new viral outbreak only to be threatened by the police and accused of peddling rumors, had become one of its victims. Grief and fury coursed through social media. To people at home and abroad, Dr. Li’s death showed the terrible cost of the Chinese government’s instinct to suppress inconvenient information.

Yet China’s censors decided to double down. Warning of the “unprecedented challenge” Dr. Li’s death posed and the “butterfly effect” it might set off, officials got to work suppressing the inconvenient news and reclaiming the narrative, according to confidential directives sent to local propaganda workers and news outlets.

They ordered news websites not to issue push notifications alerting readers to his death. They told social platforms to gradually remove his name from trending topics pages. And they activated legions of fake online commenters to flood social sites with distracting chatter, stressing the need for discretion: “As commenters fight to guide public opinion, they must conceal their identity, avoid crude patriotism and sarcastic praise, and be sleek and silent in achieving results.”

The orders were among thousands of secret government directives and other documents that were reviewed by The New York Times and ProPublica. They lay bare in extraordinary detail the systems that helped the Chinese authorities shape online opinion during the pandemic.

Though China makes no secret of its belief in rigid internet controls, the documents convey just how much behind-the-scenes effort is involved in maintaining a tight grip on online discourse to enforce the Communist Party’s consensus: an enormous bureaucracy, armies of people, specialized technology , the constant monitoring — and, presumably, lots of money.

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