As the United States welcomed the news Friday that a second vaccine, by Moderna, had been authorized by the federal government for emergency use, the country confronted another stark reminder of how desperately vaccines are needed: a single-day caseload of over 251,000 new coronavirus cases, a once-unthinkable record.
It’s been only a week since the Food and Drug Administration first approved a Covid-19 vaccine, the one created by Pfizer and BioNTech. As trucks have carried vials across the country and Americans began pulling up their sleeves for inoculations, more ominous numbers have piled up:
Monday: 300,000 total dead in the United States.
Wednesday: 3,611 deaths in a single day, shattering the previous record of 3,157 on Dec. 9.
Thursday: Over 1 million new cases in just five days, pushing the country’s total of confirmed cases past 17 million.
Three months ago, new cases were trending downward and death reports were flat, but those gains have been lost. Now there are nearly six times as many cases being reported each day, and three times as many deaths, according to a New York Times database.
The South is on a particularly worrisome trajectory. Georgia, Arkansas and South Carolina have all set weekly case records. Tennessee is confirming new cases at the highest per capita rate in the country.
As cases continue to spike, officials are warning that hospitals, which now hold a record of nearly 115,000 Covid-19 patients, could soon be overwhelmed. More than a third of Americans live in areas where hospitals are running critically short of intensive care beds, federal data show. A recent New York Times analysis found that 10 percent of Americans — across a large swath of the Midwest, South and Southwest — live in areas where I.C.U.s are either completely full or have less than 5 percent of beds available.
In California, hospitals are especially stretched. The state reported just 2.1 percent availability of I.C.U. beds on Friday, after the number of available beds fell by 37 percent over the past month. In Los Angeles County, officials say, an average of two people are dying of Covid-19 every hour, and I.CU. capacity could be exceeded within the month.
There has been rapid improvement in much of the Midwest and Mountain West. Iowa is adding fewer than half the cases it was at its November peak. South Dakota, Montana, Nebraska, Colorado and Wyoming are all seeing sustained declines in cases.
But because deaths are a lagging indicator, North Dakota still has the nation’s highest daily death rate for its size, despite progress in slowing new cases after the governor reversed months of resistance and announced a mask mandate and restrictions on businesses in mid-November.
As Christmas approaches, American families will be tempted again to gather indoors, as many did for the Thanksgiving holiday, despite a torrent of warnings from public health officials and elected leaders. And whatever progress is being made now in some places could, once again, be negated.
“There’s no need for that many to have died,” David Hayes-Bautista, a professor of medicine at the University of California, Los Angeles, said after the country’s pandemic death toll hit 300,000 on Monday. “We chose, as a country, to take our foot off the gas pedal. We chose to, and that’s the tragedy.’’
Mitch Smith, Julie Shaver, John Eligon, Amy Harmon, Remy Tumin and Jill Cowan contributed.
The Food and Drug Administration on Friday authorized the Covid-19 vaccine made by Moderna for emergency use, allowing the shipment of millions more doses across the nation and intensifying the debate over who will be next in line to get inoculated.
The move will make Moderna’s vaccine the second to reach the American public, after the one by Pfizer and BioNTech, which was authorized just one week ago.
It comes as the virus continues to rage across the United States, which set another record for daily cases on Friday with over 251,000 and has surpassed a total of 17 million known cases, according to a New York Times database.
The F.D.A.’s decision sets the stage for a weekend spectacle of trucks rolling out as expert committees begin a new round of discussions weighing whether the next wave of vaccinations should go to essential workers, or to people 65 and older, and people with conditions that increase their risk of becoming severely ill from Covid-19.
Jockeying for the next shots in January and February has already begun, even though there is still not enough of the two vaccines for all the health care workers and nursing home staff members and residents given first priority. Uber drivers, restaurant employees, morticians and barbers are among those lobbying states to include them in the next round along with those in the more traditional categories of the nation’s 80 million essential workers, like teachers and bus drivers.
The rapid progress from lab to human trials to public inoculation has been almost revolutionary, spurred by the nation’s urgent need to blunt the pandemic that has broken record after record in U.S. deaths, hospitalizations and economic losses. In the past week alone, there has been an average of more than 218,000 cases per day, an increase of about 18 percent from the average two weeks earlier. And at least 2,800 new deaths were reported on Friday.
Dr. Anthony S. Fauci, the nation’s top infectious disease expert, called the advent of two vaccines “an historic moment.”
“This to me is a triumph of multiyear investment in biomedical research that culminated in something that was not only done in record time, in the sense of never before has anybody even imagined you would get vaccines to people in less than a year from the time that the sequence was made known,” Dr. Fauci said.
“This is an example of government working. It worked really well,” he added.
Moderna, a company based in Cambridge, Mass., worked with Dr. Fauci’s agency at the National Institutes of Health to create a vaccine that, along with Pfizer-BioNTech’s, shepherds in a new technology based on genetic material called messenger or mRNA. In clinical trials in tens of thousands of volunteers, the vaccines proved 94 to 95 percent effective. Each requires two shots.
Both products are reaching an anxious public before vaccines made with traditional approaches, and have become even more critical as other companies’ efforts have faltered in recent months.
The emergency authorization kicks off a swift and complex drive to distribute some 5.9 million doses of the Moderna vaccine around the country, with shipping to begin on Sunday and deliveries starting on Monday. The first Moderna vaccinations could then be given hours later.
Because Moderna’s vaccine, unlike Pfizer-BioNTech’s, does not need extreme-cold storage and is delivered in smaller batches, states are hoping to provide it to less populated areas, reaching rural hospitals, local health departments and community health centers that were not at the top of the distribution list.
Three places that did not receive the Pfizer-BioNTech vaccine — the Marshall Islands, Micronesia and Palau — will receive the Moderna vaccine for that reason, according to a federal health official familiar with the government’s distribution plans.
And in contrast to Pfizer’s rollout last week, the Moderna vaccine deliveries will be managed by the federal government under the funding of Operation Warp Speed, the administration’s program to develop and distribute vaccines as fast as possible.
David Gelles, Katherine J. Wu, Sharon LaFraniere and Reed Epstein contributed reporting.
This week, some 5,000 doses of Pfizer’s newly authorized coronavirus vaccine arrived on the grounds of Stanford Medical Center in Palo Alto, Calif. — a windfall for frontline health workers eager to receive their first dose of the lifesaving injection.
But a flawed prioritization plan failed to include the vast majority of the hospital’s medical residents and fellows, instead opting to give many of the first jabs to employees who don’t interact heavily with sick patients.
On Friday morning, scores of masked clinicians gathered on the hospital campus to protest being passed over. By the afternoon, the hospital had buckled to their demands and begun vaccinating some of those left off the list — but the system rapidly devolved into a first-come, first-serve situation.
Of the 5,000 people tapped by the hospital to receive the first injections, only seven were medical residents — a paltry fraction of the more than 1,300 in the institution’s cohort. Also left out were many fellows and nurses who have spent countless shifts attending to people hospitalized with Covid-19. (Pfizer’s vaccine requires two doses, three weeks apart, to take full effect. The hospital had banked on receiving a second batch to complete the process.)
“I have done Covid-positive intubations, I have done Covid-positive procedures,” said Dr. Anna Frackman, a medical resident specializing in anesthesia. “We have put ourselves and our loved ones at risk. We think we should have been included.”
The prioritization plan, designed by researchers and ethicists, meant to list hospital personnel by highest risk of getting the virus and becoming seriously sick. It used an algorithm that assigned each person a crude risk score, taking into account factors such as age, job description and the number of coronavirus cases that had been detected in their hospital department. That resulted in personnel like environmental services workers, food service workers and older employees being shuttled to the front of the line.
Residents, who are early in their careers and tend to be young, rotate throughout the hospital to train with various teams of physicians, making them difficult to place in a designated unit. “So in that, it sounds like we all got zero points,” said Dr. Frackman, who had not seen the algorithm. (ProPublica also reported on the problems with the list.)
In an internal memo sent to a small group of Stanford Hospital administrative staff, hospital employees described the algorithm-based process as being carried out under pressure and time constraints. The Times obtained a copy of the memo.
The system also differs drastically from those used at other hospitals around the country to determine who gets injected first. Many other institutions have been able to prioritize environmental and food services workers as well — but not at the expense of health care providers treating Covid patients on a daily basis.
Hospital administrators were supposed to review the algorithmically generated list before distribution began, but “leadership review and revisions did not occur,” according to the memo, because of the fast-paced turnaround of the list and the amount of email and text messaging being sent back and forth between harried, overwhelmed hospital administrators.
“People are worn-out and frustrated by everything that is 2020,” the internal memo said. “The vaccination rollout, all well-intentioned, hit the perfect storm.”
Many attending physicians, who outrank residents and fellows, made it onto the hospital’s original list. In many cases, Dr. Frackman noted, their exposure is higher than those of their trainees. “Our attendings have made an effort to try to shield us from some of the risk,” she said. “But in all honesty, there is just too much Covid to shield us from the risk.”
In a statement released to hospital personnel on Friday, the Stanford Health Care executives David Entwistle, Paul King, Dr. Lloyd Minor, Dr. Niraj Sehgal and Dr. Dennis Lund acknowledged the “significant concerns” raised by the protests.
“We fully recognize we should have acted more swiftly to address the errors that resulted in an outcome we did not anticipate,” the statement said. “We recognize that the plan had significant gaps.”
The hospital executives also said they were “working quickly to address the flaws” in the plan and promised transparency during the modification process.
In a statement, Lisa Kim, a spokeswoman for Stanford Health Care, echoed these sentiments. “We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response,” the statement said. “We are immediately revising our plan to better sequence the distribution of the vaccine.”
Executives at the Brazilian steakhouse chain Fogo de Chão thought they had seen the worst of it.
Earlier in the year, when seemingly each hour brought news of another city or state shutting down because of the pandemic, executives switched from email to the messaging system WhatsApp to communicate in real time with the general managers of their 43 locations scattered across the United States.
“The first time we heard a state issue a stay-at-home order we were like, ‘What does that mean? What are they talking about?’” Barry McGowan, the company’s chief executive, said. “Then it was like dominoes falling. Boom. Boom. Boom.”
Communicating with vendors was a hit or miss. Trucks full of food pulled up to restaurants that had been closed.
The restaurant chain created a takeout menu in three days. It reached out to landlords to negotiate breaks on its leases. And as mandates to stay closed were lifted, it spent about $1 million renting tents and other equipment to set up outdoor dining in places where indoor dining was still restricted.
For a while, it worked. Diners flocked to the restaurants and spent lavishly. Before the pandemic, Fogo de Chão sold about 500 premium steaks, like Wagyu and Tomahawk rib-eyes, per week. That shot up to 1,300 per week by July.
But with virus cases rising again across the country, new restrictions have been placed on indoor and outdoor dining — no indoor dining in Philadelphia, Chicago and New York City; indoor dining curfews in New Jersey and Massachusetts; no restaurant dining at all in much of California.
For larger dine-in chains like Fogo de Chão, the ever-changing patchwork of rules poses a particular logistical challenge: How do you come up with a companywide approach when different locations are dealing with their own specific regulations?
“What you have is a massive deviation from standard in terms of how a chain is operating restaurant locations in different states, which then requires a whole set of processes and management to make sure that you comply with the regulations,” said Sean Ryan, a partner at Kearney, a consulting firm. “It’s costly and time consuming.”
They were educators, music teachers and community activists who served those living in poverty tirelessly.
In less than two weeks this month, eight Roman Catholic nuns died of illnesses related to Covid-19 at a Wisconsin retirement home, a gut-wrenching loss that highlighted the risks of infection in communal residences, even as administrators said they took precautions against infection.
The deaths took place at Notre Dame of Elm Grove, about eight miles west of Milwaukee, in Waukesha County. Like most of the United States, Wisconsin is struggling to contain the spread of the coronavirus, and it has recorded 486,364 cases and 4,635 deaths since the beginning of the pandemic, according to a New York Times database. There have been 34,478 cases in Waukesha.
The retirement home, historically used as an orphanage for children, was converted into a residence for elderly and sick nuns in 1859. The first of the eight women died on Dec. 9, and the others in the days that followed, through Tuesday, according to Trudy Hamilton, a spokeswoman for the School Sisters of Notre Dame Central Pacific Province, which established the home.
Sisters Rose M. Feess, 91, and Mary Elva Wiesner, 94, a religious educator and liturgist, died on Dec. 9, according to the home’s site. Sister Dorothy MacIntyre, 88, died two days later, and Sister Mary Alexius Portz, 96, died two days after that, on Sunday. Sisters Joan Emily Kaul, 95, Lillia Langreck, 92, and Michael Marie Laux, 90, died on Monday. Sister Cynthia Borman, 90, died on Tuesday.
The military judge overseeing the Sept. 11 case at Guantánamo Bay in Cuba delayed litigation deadlines again on Friday, postponing the start of the trial of the accused mastermind Khalid Shaikh Mohammed and four accused co-conspirators until after the 20th anniversary of the attacks next year.
The death penalty case, in its eighth year of pretrial proceedings, was already complicated by its remote location, procedural issues, legal challenges and the control of classified evidence by different elements of the U.S. government.
“The coronavirus Covid-19 pandemic has continued to worsen,” the judge, Col. Douglas K. Watkins of the Army, wrote in a two-page order that extended deadlines for another 30 days, for a total of 300 days of delay since the start of the pandemic.
Based on the timetable toward trial set by a previous judge, the selection of the military officers for the jury will now start on Nov. 7, 2021, at the earliest.
The pandemic has paralyzed much of the work of the court, whose participants commute from the mainland to the military commissions courtroom in Cuba for each session. The last hearing in the case was held in February.
The pandemic has also forced cancellation of all hearings in the case, which recessed in the midst of the judge taking extensive testimony on the question of whether key interrogations of the prisoners at Guantánamo in 2007 are inadmissible at trial because they are tainted by C.I.A. torture.
When it came time to crack down on Mac’s Public House, the Staten Island bar that has notoriously defied Covid-19 restrictions, New York City sent in law enforcement officers from the Sheriff’s Office, a relatively tiny force that relies on 150 deputies and remains unknown even to most New Yorkers.
But the obscure sheriff’s office has moved into the spotlight as a surprising and highly visible frontline enforcement unit in the city’s ongoing battle to maintain its coronavirus restrictions.
The deputies have cracked down on restaurants that disobey curfews and indoor-dining rules. They have become staples at bridge and tunnel checkpoints watching for visitors from high-infection states.
Most prominently, they have been the city’s chief party crashers.
The designation of the sheriff’s office as a primary enforcer of restrictions reflects the scramble of states and localities around the country to figure out how they should police a pandemic.
In New York, whether it was the crowded sex club in Queens, the raging Halloween warehouse parties in Brooklyn and the Bronx, or nightclubs with bottle service and D.J.s performing in vacant commercial spaces in midtown Manhattan, it fell to the sheriff’s office to shut them down.
But the deputies are also vigilant about pursuing tips about large gatherings in private homes. They show up and inform hosts that big get-togethers are not permitted.
Though sheriffs in other parts of the country are leading officials with a major role in public safety decisions, the New York City sheriff’s office has long been overshadowed by the New York Police Department.
That changed with the pandemic.
Early on, the police department was carrying out social distancing and lockdown regulations. It generally handles criminal enforcement while the sheriff’s office carries out civil and court orders.
But sheriff’s deputies took on more of those duties as complaints mounted that police officers were discriminating against poor people of color. The N.Y.P.D. was enforcing restrictions more frequently in neighborhoods that had more households that were Black and Hispanic and had lower incomes. The police also had to pivot to address rising crime and to patrol Black Lives Matter protests.
With her semester at Mercer University in Georgia complete, Skylar Mack, 18, flew down to the Cayman Islands in late November to watch her boyfriend compete in the islands’ jet ski racing national championship.
When she arrived, however, there was a problem.
She got there on a Friday; the championship was on Sunday. And per the country’s laws, she was required to remain in her hotel room for 14 days before going anywhere on the islands.
To elude the restrictions, Ms. Mack, after receiving a negative coronavirus test, slipped an electronic monitoring bracelet from her wrist and escaped to a beach on Grand Cayman’s South Sound, where she saw her boyfriend, Vanjae Ramgeet, 24, win first place.
But the authorities found out, and Ms. Mack and Mr. Ramgeet were sentenced this week to four months in prison for the quarantine breach.
“This was as flagrant a breach as could be imagined,” Justice Roger Chapple said in court during the sentencing, according to the Cayman Compass. “It was borne of selfishness and arrogance.”
The islands, a British territory of nearly 65,000 residents, have reported 310 infections and two deaths.
Ms. Mack’s relatives in suburban Atlanta are now scrambling to pull together letters from friends and family attesting to her character in an effort to get the sentence overturned on appeal, said Jeanne Mack, Ms. Mack’s grandmother.
Jeanne Mack has even written to President Trump for help. She received a response from the Office of Presidential Correspondence, dated Thursday, stating that her correspondence had been forwarded “to the appropriate federal agency for further action.”
The family and Skylar, a junior pre-med student, make no illusions about what happened, Jeanne Mack said: What she did was wrong.
“I’ll do everything to get you home, and when I get you here, I’m going to kick your butt,” Ms. Mack, 68, said of her sentiment toward her granddaughter. “We’re not saying, ‘poor, innocent Skylar.’ We’re simply saying the punishment does not meet the crime.”
Skylar Mack pleaded guilty to breaking the quarantine rules and was initially sentenced to 40 hours of community service and a fine. But the punishment was increased after the prosecutor appealed.
She and her boyfriend were the first to be sentenced under a new law that allows for up to two years in prison and a $12,000 fine for quarantine violations, according to The Associated Press.
Jeanne Mack said that her granddaughter was scheduled to appear before a panel of judges on Tuesday that will decide whether her appeal can proceed. If it can, then the family hopes that she will be released on bond pending the appeal.
More than a million doses of untested Covid-19 vaccines have so far been administered in China to people most at risk of contracting the coronavirus, officials said on Saturday, weeks before a travel rush begins ahead of the Lunar New Year holiday.
Even as governments in Europe, North America and elsewhere approve vaccines, China is still awaiting the results of clinical trials for its unproven homegrown candidates. In the meantime, the government has worked outside traditional testing protocol to inoculate government workers, teachers and hospital workers with three homegrown varieties.
Two of those vaccine candidates are made by Sinopharm; a third is made by Sinovac.
While experts have warned that the untested vaccines could pose safety hazards, Chinese officials said Saturday that so far, there had been no adverse reactions. More than 60,000 people who received the vaccines have traveled to high-risk areas overseas and have not come down with a serious infection, Zheng Zhongwei, a top official at China’s National Health Commission, told reporters in Beijing on Saturday.
“Research shows that there are no serious safety hazards,” Mr. Zheng said, speaking about the overseas trials.
Still, Chinese officials have said they are awaiting results from overseas trials for several leading vaccine candidates before starting distribution on a larger scale.
The government is under pressure to do just that. While the virus is largely under control in China, hundreds of millions of people are expected to travel domestically in the coming weeks for the Lunar New Year, which will be celebrated in February. The fear is that the mass travel could turn isolated Covid-19 clusters into much larger ones, as it did last winter.
In rolling out the untested coronavirus vaccines, the government said it is prioritizing health care professionals, pilots and others at an elevated risk for contracting the virus. People who work in the food import industry are also being given priority.
The government has pushed the idea, without evidence, that the virus has spread on a large scale in China from meat, seafood and other products imported from overseas.
Employers can require workers to get a Covid-19 vaccine and bar them from the workplace if they refuse, the federal government said in guidelines issued this week.
Public health experts see employers as playing an important role in vaccinating enough people to reach herd immunity and get a handle on a pandemic that has killed more than 300,000 Americans. Widespread coronavirus vaccinations would keep people from dying, restart the economy and usher a return to some form of normalcy, experts say.
Employers had been waiting for guidance from the U.S. Equal Employment Opportunity Commission, the agency that enforces laws against workplace discrimination, because requiring employees be tested for the coronavirus touches on thorny medical and privacy issues covered by the Americans With Disabilities Act of 1990.
The guidance, issued on Wednesday, confirmed what employment lawyers had expected.
Businesses and employers are uniquely positioned to require large numbers of Americans who otherwise would not receive a vaccination to do so because their employment depends on it.
The disabilities act limits employers’ ability to require medical examinations like blood tests, breath analyses and blood-pressure screening. These are procedures or tests, often given in a medical setting, that seek information about an employee’s physical or mental conditions.
“If a vaccine is administered to an employee by an employer for protection against contracting Covid-19, the employer is not seeking information about an individual’s impairments or current health status,” it stated, “and, therefore, it is not a medical examination.”