Gov. Gavin Newsom’s announcement on Wednesday seemed sweeping: California would open up eligibility for a coronavirus vaccine to anyone 65 or older, effectively abandoning a rollout plan that was meant to ensure that the most vulnerable would be first in line.
A day later, residents of the vast and varied state were trying to navigate what many described as vaccination chaos.
Some counties shifted gears immediately, among them Orange County, which said anyone 65 or older could book an appointment at the vaccination site it opened this week at Disneyland. But the scheduling website was quickly overwhelmed, making finding a shot seem like trying to score Taylor Swift concert tickets.
Neighboring Los Angeles County, however, stuck with its strict priority rules, and said that vaccines there would continue to be available only to health care workers.
The dueling approaches illustrate the tension across the country between two competing imperatives: getting as many doses as possible out quickly, and getting those who are at the most risk protected first.
As of Thursday, about 11.1 million people in the U.S. had received at least one dose of vaccine, according to the Centers for Disease Control and Prevention — a figure that is far short of the 20 million the Trump administration had hoped to reach by Dec. 31. Most have received only the first of the two necessary doses so far.
The confusion is hardly limited to California.
In New York City, a million residents who are over 65 became eligible to be vaccinated this week, but the reality of actually getting a shot has proved maddening, with buggy websites, multiple sign-up systems and a lack outreach.
California, with its decentralized public health system, is a microcosm of the many problems plaguing the national vaccination effort.
In Los Angeles, Mayor Eric Garcetti defended the decision to limit vaccinations for now to health workers, despite the state’s new directive.
“This is really about expectations,” he said Thursday. “Politically, it’d be easy to say, open it up to 65-plus.”
But he said that would mean that a senior citizen on the city’s wealthier west side, living in a large house, could easily take a spot from an essential worker who’s younger and living in a crowded home, with no room to isolate.
And so when health care workers in Los Angeles arrive at a vaccination site, like the one the city is set to open at Dodger Stadium on Friday, they’ll have to present either an employee badge with a photo or another form of documentation of their work.
California relies on county health departments like the one in Los Angeles to administer vaccines, and Dr. David Lubarsky, the chief executive of UC Davis Health, said the counties were up against the same problem they faced when trying to ramp up coronavirus testing: too little manpower.
Dr. Lubarsky suggested that the state should hand more vaccine doses over to health care providers, who already have the ability to reach out to patients selectively, including harder-to-reach patients like those with lower incomes or who are undocumented.
“We know who’s at risk,” he said.
Jonah Frohlich, a San Francisco-based health care consultant, said that a combination of factors had left county public health departments scrambling to cope with a deluge of monumental tasks.
“The same institutions that are trying to manage testing, contact tracing and supports for people,” Mr. Frohlich said, “are the same people who are managing the distribution of the vaccine.”
Worse, he said, they must work with often outdated and overwhelmed information systems, and organize it all on the fly.
“This is the kind of program and process that should take years to implement,” he said.
The counties are doing the best they can, Mr. Frohlich said, but “there is a real human cost to delaying the rollout of the vaccine.”
President-elect Joseph R. Biden Jr. on Thursday proposed a $1.9 trillion rescue package to combat the economic downturn and the Covid-19 crisis, outlining the type of sweeping aid that Democrats have demanded for months and signaling the shift in the federal government’s pandemic response as Mr. Biden prepares to take office.
The package includes more than $400 billion to combat the pandemic directly, including money to accelerate vaccine deployment and to safely reopen most schools within 100 days.
“The very health of our nation is at stake,” Mr. Biden said. “We have to act and we have to act now.”
Mr. Biden detailed his so-called American Rescue Plan in an evening speech in Delaware, effectively kicking off his presidency.
The Biden package, which would be financed entirely through increased federal borrowing, flows from the idea that the virus and the recovery are intertwined.
The $20 billion “national vaccine program” he announced envisions community vaccination centers around the country.
Mr. Biden also called for a “public health jobs program” that would address his goals of bolstering the economy and the Covid-19 response while also rebuilding the nation’s fragile public health infrastructure. The proposal would fund 100,000 public health workers to engage in vaccine outreach and contact tracing.
At the same time, Mr. Biden is keen on addressing the racial disparities in health that have been exposed by the pandemic, which has disproportionately claimed the lives of people of color. He pledged to increase funding for community health centers, and also intends to fund efforts to mitigate the pandemic in prisons and jails, where African-Americans and Latinos are overrepresented.
As New York City officials fight to control the coronavirus by this summer, it is becoming clear that the economic fallout will last far longer: The city’s property tax revenues are projected to decline by $2.5 billion next year, the largest such drop in at least three decades.
The anticipated shortfall, which Mayor Bill de Blasio announced on Thursday, is largely driven by a projected drop in the value of office buildings and hotel properties, which have all but emptied out since the pandemic began.
Roughly half of the city’s tax revenue comes from real estate, and the economic projections suggest the city’s budget will remain in a precarious position for the foreseeable future.
For now, the city will partially offset the loss with increased revenues from income taxes: The “rich got richer,” according to a slide from the mayor’s presentation.
But the city will still likely have to substantially cut spending elsewhere.
“This is just a total economic dislocation for certain industries,” the mayor said. “We’ve never seen anything like what’s happened to the hotel industry. We’ve never seen Midtown in the situation it is now.”
Mr. de Blasio and Gov. Andrew M. Cuomo, who have battled with the Trump administration for more federal aid, have expressed optimism that President-elect Joseph R. Biden Jr., together with a Democratic-led Congress, will bring substantial assistance.
Indeed, just before Mr. de Blasio’s expected announcement, the incoming Senate majority leader, Chuck Schumer, said that he and Mr. Biden had reached a deal for the federal government to cover the full costs of state and city expenses related to a disaster declaration from last March, when the virus was first discovered in New York.
The move is expected to save the state and city about $2 billion, money that Mr. Schumer’s office said can be used to “tackle Covid-related budget gaps.”
And on Thursday, Mr. Schumer was promising more to come.
“This is just prelude of better days ahead out of Washington for New York,” he said. “With Biden as president and me as majority leader, it’s going to get better.”
Still, few expect the federal government to be able to fully meet the budgetary needs of state and local governments.
Several states in the American South have been the slowest in the country to roll out Covid-19 vaccines.
Georgia has faced a raft of logistical and bureaucratic snags.
In South Carolina, the governor gave reluctant health care workers until Friday to get their shots or risk losing their priority status.
And Alabama has the distinction of administering the fewest vaccines per capita in the U.S., according to data from the Centers for Disease Control and Prevention.
“This was a herculean effort,” said Dr. Karen Landers, the assistant state health officer for the Alabama Department of Health. “It has been a challenge. And, of course, it’s disappointing that we’re not where we need to be.”
Alabama has stuck to vaccinating health care workers and nursing home residents and staff and will not officially start vaccinating people 75 and older until Monday, though some counties have started earlier.
South Carolina officials, too, have acknowledged disappointment.
“We are frustrated,” Gov. Henry McMaster said last week, giving health care workers 10 days to get their vaccine appointments. “And we are determined to eliminate the bottlenecks that are slowing this down.”
West Virginia, by contrast, has fared much better, administering the most vaccines per capita out of any state in the country. It began giving shots to people 80 and older a week ago and to people 70 and older on Wednesday. Teachers 50 and older are also getting vaccinated.
In Alabama and Georgia, state officials say they have administered more vaccines than the numbers indicate.
Officials in Georgia said part of the problem is the state’s 20-year-old database. It is “cumbersome and difficult” for providers to quickly enter information about administered doses, said Dr. Kathleen E. Toomey, the commissioner of the state Department of Public Health.
Some vaccine providers, particularly hospitals, also held back some of the state’s limited supply, to ensure that booster shots would be available, Gov. Brian Kemp and officials from his administration said on Tuesday.
They called that misguided.
“If this issue continues, the state will take possession of those doses and ensure that vaccinations continue,” the governor said. “If it takes me firing up my pickup truck and doing it myself, so be it.”
At first, Georgia also found a mismatch of vaccine supply and demand.
Vaccines went to rural parts of the state where 60 to 70 percent of nursing home workers did not want them, Mr. Kemp said, leaving those areas flush with doses while demand crushed supply in urban areas.
The governor said vaccinating all of Georgia’s nursing home residents should be completed by the end of the month. But he also acknowledged that the state still has “a long way to go.”
“Many local health departments are being inundated with calls,” Mr. Kemp said. “Yes, the phone lines will be busy. Yes, the websites will certainly crash. There are simply vastly more Georgians that want the vaccine than can get it today.”
People who received two shots of the Moderna Covid vaccine in its earliest, Phase 1 clinical trial are being offered a third shot, a so-called booster, as part of a continuing study to determine whether repeated vaccinations are needed, and whether they are safe and effective, the company said on Thursday.
The vaccines made by Moderna and Pfizer, both using genetic material called mRNA, were shown in clinical trials to be about 95 percent effective at preventing symptomatic cases of Covid-19 when administered as a two-shot regimen. But they have not been in use long enough to tell how long the immunity lasts, or whether additional booster shots will be needed.
“We anticipate that an additional dose could further boost the levels of neutralizing antibodies, should such a boost be required, and that this is expected to be an advantage of mRNA vaccines,” Colleen Hussey, a Moderna spokeswoman, said in a statement.
Neutralizing antibodies are made by the immune system in response to a virus or a vaccine and can block the virus from breaking into cells.
The company’s statement said the boosters were being offered to participants six to 12 months after their second shot. Volunteers in early trials received different doses of the vaccine, as part of the company’s attempts to calibrate the most effective amount of active ingredient to use.
The Moderna vaccine was ultimately given an emergency green light from the Food and Drug Administration as a two-dose vaccine of 100 micrograms of mRNA each. Trial volunteers who got lower doses might especially benefit from a third shot, said Akiko Iwasaki, an immunologist at Yale University.
In its statement, Moderna said that boosters might also be studied in people who took part in its later, Phase 3 study of 30,000 participants, “if accumulating antibody persistence data indicate that this is warranted.”
Company officials said at a conference this week that they thought protection should last at least a year, according to a report by CNBC. But Moderna’s chief executive, Stephane Bancel, also noted in an interview with CNBC that the vaccine might have to be adjusted in the future to immunize people against new coronavirus variants or strains, much like flu vaccines are regularly revamped.
Representative Adriano Espaillat, Democrat of New York, announced on Thursday he had tested positive for the coronavirus, as concerns continue to mount on Capitol Hill that efforts to corral lawmakers into secure locations during last week’s siege by Trump supporters may have led to a super-spreader event.
Mr. Espaillat, 66, who received his second dose of the Pfizer vaccine last week, said he was not experiencing any symptoms and that he was isolating at home. In a statement, he said he understood that it took time for the vaccine to be fully effective and that he had continued to take all necessary precautions. Guidelines from the Centers for Disease Control and Prevention state that people who test positive for the virus should isolate for at least 10 days after their symptoms start.
The two vaccines cleared for emergency use in the United States, made by Pfizer and Moderna, were shown in clinical trials to be about 95 percent effective at preventing symptomatic cases of Covid-19. But neither vaccine is perfect, and researchers remain unsure of how well the shots curb the ability of the virus to silently infect people. Both the Pfizer and Moderna vaccines require two injections, separated by three or four weeks, and they aren’t believed to fully kick in until about a week or two after a person receives the second shot.
Capitol Hill has long struggled to control the spread of the pandemic within its marble walls, a haphazard effort exacerbated last week as hundreds of maskless Trump supporters stormed the building and forced lawmakers to shelter in confined secure locations across the Capitol complex. Lawmakers, aides and reporters who took shelter in two separate rooms on both sides of the Capitol have been warned about possible exposure to the coronavirus.
Though cases have continued to emerge since the 117th Congress was sworn in nearly two weeks ago, House Democrats have blamed a group of their Republican colleagues who refused to wear masks during the attack while waiting in a secure location for law enforcement to regain control of the building.
Representatives Bonnie Watson Coleman, Democrat of New Jersey, Pramila Jayapal, Democrat of Washington, and Brad Schneider, Democrat of Illinois, have all tested positive in the aftermath of the attack and cited the Republican refusal to wear masks during the siege. Representative Ayanna S. Pressley, Democrat of Massachusetts, is in isolation after her husband, who was with her in the room, tested positive, and in a statement said the diagnoses were a consequence of “my callous Republican colleagues” who refused to wear masks.
In response to those accusations and concerns about the spread of the virus on Capitol Hill, the House earlier this week approved a fine system for members who refuse to adhere to a mask mandate on the floor.
It was unclear whether Mr. Espaillat took shelter in the secure room. But on Wednesday, he was among the lawmakers who spoke on the House floor — while wearing a mask — before voting to impeach President Trump for the second time.
Mr. Espaillat noted that the colleagues who had tested positive in recent days “collectively occupy a range of gender, ages, races and ethnicities.”
“Covid-19 does not discriminate,” he said. “It is incumbent on each of us to prioritize social distancing from one another — even if that poses a temporary inconvenience — and wear a face mask. There is no singular panacea and we must adjust our daily habits and practices for our own health and safety as well as the health and safety of those around us and throughout our communities.”
Airlines, workplaces and sports stadiums may soon require people to show their coronavirus vaccination status on their smartphones before they can enter.
A coalition of leading technology companies, health organizations and nonprofits — including Microsoft, Oracle, Salesforce, Cerner, Epic Systems and the Mayo Clinic — said on Thursday that they were developing technology standards to enable people to obtain and share their immunization records through health passport apps.
“For some period of time, most all of us are going to have to demonstrate either negative Covid-19 testing or an up-to-date vaccination status to go about the normal routines of our lives,” said Dr. Brad Perkins, the chief medical officer at the Commons Project Foundation, a nonprofit in Geneva that is a member of the vaccine credential initiative.
That will happen, Dr. Perkins added, “whether it’s getting on an airplane and going to a different country, whether it’s going to work, to school, to the grocery store, to live concerts or sporting events.”
Vaccine passport apps could fill a significant need for airlines, employers and other businesses. In the United States, the federal government has developed paper cards that remind people who receive coronavirus vaccinations of their vaccine manufacturer, batch number and date of inoculation. But there is no federal system that people can use to get easy access to their immunization records online and establish their vaccination status for work or travel.
A few airlines, including United Airlines and JetBlue, are trying Common Pass, a health passport app from the Commons Project. The app enables passengers to retrieve their virus test results from their health providers and then gives them a confirmation code that allows them to board certain international flights. The vaccination credentialing system would work similarly.
The U.S. vaccination program has been stymied by logistical hurdles as states scramble to set up new systems for booking appointments. Demand is high, but the rollout has been progressing far more slowly than hoped, marred by crashing servers, busy signals and confusion.
The federal Centers for Disease Control and Prevention said on Thursday that about 11.1 million people have received at least one dose of a Covid-19 vaccine, far short of the goal federal officials set to give at least 20 million people their first shots before the end of 2020.
At least 541,000 people in the United States have been fully vaccinated as of Jan. 12, according to a New York Times survey of all 50 states.
The U.S. secretary of health and human services, Alex M. Azar II, excoriated China on Thursday for its “bullying of international experts and scientists” and acknowledged for the first time that a top official at the Centers for Disease Control and Prevention was correct when she warned in February that the novel coronavirus might cause a severe disruption to American lives.
The official, Dr. Nancy Messonnier, was muzzled for nine months after issuing the Feb. 25 warning, which threw the stock market into a nosedive and infuriated President Trump, who was on his way back from India at the time. But she was merely repeating what she had learned from a White House Task Force meeting days earlier, Mr. Azar recalled.
“She got a little ahead of the briefing of the president and the official announcement,” Mr. Azar said. “But she and we were correct.”
Mr. Azar made his comments to the Heritage Foundation, during an online seminar that was billed as a talk about “lessons learned” from the pandemic. He spent much of it describing how China rebuffed offers of help from the United States — and thwarted American efforts to learn more about the virus that has now claimed more than 380,000 American lives.
The United States got its first hint of the novel virus — a case of an unusual pneumonia in Wuhan, China, on Dec. 30, 2019 — from monitoring news reports and through a notification from Taiwan. While American officials tried various tacks to get them to cooperate — including praising China in public as they “pressed them very hard and very firmly in private,” they were unsuccessful, he said.
“Our teams were also pressing for the Chinese government to send us viral isolates from patients there. And China has still, one year later, failed to provide the first-generation viral isolates,” Mr. Azar said, describing events in late January.
It was not until Feb. 16, he said, that an international team including American experts was allowed into China to investigate. “By this time,” he said, “Chinese intransigence meant that the window of opportunity had passed. Outbreaks had been seeded around the world.”
On Thursday, a team of experts from the World Health Organization finally arrived in the central city of Wuhan to begin hunting for the source of the coronavirus.
But in a sign of Beijing’s continuing efforts to control the investigation, the team of scientists and W.H.O. employees almost immediately ran into obstacles. Two scientists were unable to enter China at the last minute and remained in Singapore because they tested positive for coronavirus antibodies, the W.H.O. said. The Chinese authorities required the remaining 13 experts to undergo two weeks of quarantine in Wuhan.
The investigation is a critical step in understanding how the virus jumped to humans from animals so that another pandemic can be avoided. Getting answers will most likely be difficult.
More than a year after a new coronavirus first emerged in China, a team of experts from the World Health Organization arrived on Thursday in the central city of Wuhan to begin hunting for its source.
But in a sign of Beijing’s continuing efforts to control the investigation, the team of scientists and W.H.O. employees almost immediately ran into obstacles. Two scientists were unable to enter China at the last minute and remained in Singapore because they had tested positive for coronavirus antibodies, the W.H.O. said on Twitter.
The Chinese authorities required the remaining 13 experts to undergo two weeks of quarantine in Wuhan, where the virus first emerged in late 2019.
The investigation, which aims to gain an understanding into how the virus jumped to humans from animals, is a critical step so that another pandemic can be avoided. But getting answers is likely to be difficult.
Here’s what to know about the investigation.
China set up hurdles and pushed for control.
Apparently worried about drawing renewed attention to the country’s early mistakes in handling the pandemic, Chinese officials have used a variety of tactics over the past year to hinder the W.H.O. investigation.
After resisting demands from other countries that it allow independent investigators onto its soil to study the origin of the pathogen, China let two W.H.O. experts visit in July to lay the groundwork. They were not allowed to visit Wuhan, where the virus first emerged.
For months, China delayed approving a visit by a full team of experts, frustrating the health agency’s leaders. When the visit seemed to be finalized this month, it fell apart when Beijing declined to provide visas for the visitors, according to the health agency.
Now that the investigators have arrived, critics say Beijing’s desire for control means the inquiry will probably be more political than scientific.
Tracing the virus will be a painstaking task.
The team that has come to Wuhan will face a city radically transformed from when the virus first emerged, in late 2019. The city, which went into lockdown on Jan. 23 last year and became a symbol of the virus’s devastation, has since been held up by Chinese officials as a success story in vanquishing the virus.
The W.H.O. experts have decades of experience plumbing the depths of viruses, animal health and disease control. But tracing the source of the virus that as of Thursday had killed almost two million people worldwide and infected more than 92 million will be painstaking. While experts believe the virus originated naturally in animals, possibly bats, little else is known.
How much access the team gets in China will be critical, public health experts say.
The team will have to sidestep attempts to politicize its inquiry.
The pandemic has hurt China’s reputation, with many foreign governments still angry that Beijing did not do more to contain the crisis in its earliest stages. So Chinese propagandists are trying to use the W.H.O. inquiry to help shore up China’s image and portray the country as a mature superpower.
Complicating that effort could be new virus flare-ups in recent weeks that have prompted fresh lockdowns in China. In all, more than 22 million people have been ordered to remain inside their homes — double the number affected a year ago in Wuhan. On Thursday, China’s National Health Commission reported a coronavirus death in the mainland for the first time since May.
“The major concern here is the origin of the outbreak has been so politicized,” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. “That has really narrowed the space for the W.H.O. to have an independent, objective and scientific investigation.”
When a more contagious coronavirus variant first surfaced in early December, some researchers initially suggested that unlike with previous versions of the virus, children might be just as susceptible to the new variant as adults.
Recent research from Public Health England may put those fears to rest.
Based on detailed contact-tracing of about 20,000 people infected with the new variant — including nearly 3,000 children under 10 — the report showed that young children were about half as likely as adults to transmit the variant to others. That was true of the previous iteration of the virus, as well.
“There was a lot of speculation at the beginning suggesting that children spread this variant more,” said Muge Cevik, an infectious disease expert at the University of St. Andrews in Scotland and a scientific adviser to the British government. “That’s really not the case.”
But the variant does spread more easily among children, just as it does among adults. The report estimated that the new variant is about 30 percent to 50 percent more contagious than its predecessors — less than the 70 percent researchers had initially estimated, but high enough that the variant is expected to pummel the United States and other countries, as it did Britain.
Adolescents and teenagers between ages 10 and 19 were more likely than younger children to spread the variant, but not as likely as adults. Over all, though, the variant was more contagious in each age group than previous versions of the virus. The mutant virus will result in more infections in children unless schools shore up their precautions, experts said.
“The variant is not necessarily affecting children particularly, but we know that it’s adding on more transmissibility to all age groups,” Dr. Cevik said. “We need to find ways to return these kids back to school as soon as possible; we need to use this time period to prepare.”
Prime Minister Boris Johnson of Britain had promised last year to do all he could to keep schools open. But he changed course in the face of soaring infections and buckling hospital systems, and ordered schools and colleges to move to remote learning. Other European countries put a premium on opening schools in September and have worked to keep them open, though the variant already has forced some to close.
In the United States, the mutant virus has been spotted only in a handful of states but is expected to spread swiftly, becoming the predominant source of infections by March. If community prevalence rises to unmanageable levels — a likely proposition, given the surge in most states — even elementary schools may be forced to close.
But that should be a last resort, after closures of indoor restaurants, bars, bowling alleys and malls, several experts said.
“I still say exactly what many people have said for the past few months — that schools should be the last thing to close,” said Helen Jenkins, an infectious disease expert at Boston University. Keeping schools open carries some risk, but “I think it can be reduced substantially with all the mitigations in place,” she said.
Britain said on Thursday that it would ban arrivals from Latin American countries and Portugal over fears of a coronavirus variant discovered in Brazil.
In recent weeks, British authorities have already struggled to contain the spread of a different coronavirus variant discovered in Britain that is more contagious than its predecessors.
At least two coronavirus variants are currently circulating in Brazil, and at least one has slipped its borders, traveling to Japan.
Japanese authorities found one of those variants in four people traveling from Brazil earlier this week. The variant contains a mutation that has been linked with higher contagiousness, similar to the variant found in Britain and another in South Africa.
Like the variant found in South Africa, the one exported from Brazil to Japan also carries a mutation that may weaken the efficacy of vaccines. This same mutation has also been identified in the other coronavirus variant recently discovered in Brazil.
Experts have cautioned, however, that it would be very difficult for new variants of the coronavirus to evade vaccines entirely.
The British ban is set to come into effect on Friday at 4 a.m., the transportation secretary Grant Shapps said on Twitter. “Travel from Portugal to the U.K. will also be suspended given its strong travel links with Brazil,” Mr. Shapps added, although truck drivers transporting essential goods from Portugal will be exempted.
Britain has already banned flights from South Africa. Brazil banned flights from Britain on Christmas Day.
British authorities have come under criticism from opposition lawmakers for delaying a travel ban from Latin America, but they have argued that implementing such measures takes time, and that travelers coming from these countries had to quarantine for 10 days upon arrival.
“What we need to ensure is that when we make these very, very important decisions that have a huge impact on people’s personal lives, but also businesses, we have got to have a little bit of time,” the Home Office junior minister Victoria Atkins said on Sky News.
In the past week, Britain has faced some of its deadliest days since the beginning of the pandemic, and health authorities have warned that the country’s health care system was on the brink of collapse. Authorities have warned that they may tighten nationwide lockdown measures if the public doesn’t stay at home.
Britain has reported nearly 85,000 deaths, the heaviest death toll in Europe.
Anxious about taking a new vaccine and scarred by a history of being mistreated, many frontline workers at hospitals and nursing homes are balking at being inoculated against the coronavirus.
But hospitals and nursing homes, worried about their patients’ health and scarred by many thousands of deaths in the past year, are desperate to have their employees vaccinated.
These opposing forces have led to unusual measures: In addition to educating workers about the benefits of the vaccines, employers are dangling incentives like cash, extra time off and even Waffle House gift cards for those who get inoculated, while, in at least a few cases, threatening to fire those who refuse.
Officials at two large long-term care chains in the United States, Juniper Communities and Atria Senior Living, said they were requiring their workers, with limited exceptions, to be vaccinated if they want to keep their jobs.
“For us, this was not a tough decision,” said Lynne Katzmann, Juniper’s chief executive. “Our goal is to do everything possible to protect our residents and our team members and their families.”
Critics say it is unethical to strong-arm low-paid workers into being vaccinated.
“This is a population of people who have been historically ignored, abused and mistreated,” said Dr. Mike Wasserman, a geriatrician and former president of the California Association of Long Term Care Medicine. “It is laziness on the part of anyone to force these folks to take a vaccine. I believe that we need to be putting all of our energy into respecting, honoring and valuing the work they do and educating them on the benefits to them and the folks they take care of in getting vaccinated.”
A survey of about 5,900 employees at Jackson Health System in Miami found that only half wanted to get a vaccine immediately, a hospital spokeswoman said. Others said they would consider it later.
In Ohio, Gov. Mike DeWine said last month that roughly 60 percent of nursing home workers had declined vaccination. In New York City, at least 30 percent of health care workers said no to the shot in the first round, Mayor Bill de Blasio said on Monday.
Europe has reached a tipping point as it grapples with the spread of new coronavirus variants, the World Health Organization’s top official in the region said on Thursday, calling for tighter public health controls to slow their transmission.
The new variants have been identified in 25 of the European region’s 53 nations, Hans Kluge, the W.H.O.’s regional director, told a virtual news conference.
“We were prepared for challenging times in 2021, and it has been just that,” he said.
The region had 26 million confirmed coronavirus infections last year and more than 580,000 related deaths, he said, and in the past week alone recorded 1.8 million new cases.
He said that the health authorities could not yet assess the full extent of a surge in infections resulting from increased social gatherings and relaxed precautions over the year-end holidays, because testing and reporting also dropped.
But he said that the availability of vaccines offered hope for the months ahead. “2021 will be another year with the virus, but it will be more manageable and more predictable,” Mr. Kluge said.
As the year began, over 280 million people in Europe were living under national lockdowns, and several countries are set to add new measures in the hope of reducing new infections and easing the pressure on strained health facilities.
In Switzerland, where the number of new Covid-19 infections has fallen in recent days, the authorities announced new restrictions that take effect next week because of the threat posed by the highly transmissible variants.
Restrictions on businesses and social life in the country had been limited, and ski resorts have been allowed to remain open in a bid to minimize the impact on the economy.
Switzerland is also keeping its schools open. But starting Monday, all shops selling nonessential goods will have to close, the limit on private gatherings has been cut to five people from 10, and the required closing of bars, restaurants, cultural centers and sports facilities has been extended until the end of February.
Deaths from all causes rose sharply during the second quarter of 2020 as the pandemic took hold in the United States, reaching levels last seen 75 years ago, according to provisional figures released on Thursday by the National Center for Health Statistics.
Over all, the unadjusted death rate for all Americans rose to 1,033.7 per 100,000 in the second quarter of 2020, up from 850.8 per 100,000 Americans during the second quarter of 2019.
The last time the death rate exceeded that figure was in 1945, the year World War II ended, when there were 1,058 deaths for every 100,000 Americans. Rates had steadily declined since then, said Robert Anderson, chief of the mortality statistics branch of the center.
The overall death rate attributed specifically to Covid-19, the disease caused by the coronavirus, was 136.2 deaths per 100,000 Americans during the three months of April, May and June of 2020.
But deaths from several other leading causes, including diabetes, stroke, heart disease and hypertension, also increased. Since March, at least 400,000 more Americans have died than would have in a normal year. Deaths related to cancer, which have been declining for some time, continued to drop.
The new figures also highlight the unique threat that Covid-19 poses to men. Men died of Covid-19 at far higher rates than women during the second quarter of last year, with 148.1 deaths per 100,000, compared to 124.6 per 100,000 for women.
When the figures were adjusted to account for the age differences between the sexes, the disparities were even more stark: the Covid-19 death rate for men was 133.9 per 100,000 during the second quarter of 2020, compared with 86.9 per 100,000 for women.
The center has collected data on racial and ethnic disparities in death rates, but has not yet published the research. Another paper published on Thursday, in the Proceedings of the National Academy of Sciences, calculated that Covid-19 has reduced life expectancy for all Americans by about a year on average, but found that the impact differs dramatically by race.
While the life expectancy of white Americans has been shortened by less than a year, to 77.84 years on average, life expectancy among Black and Hispanic Americans has been reduced by two years and three years, respectively, to 72.7 years and to 78.7 years. (Hispanic Americans live longer on average than white or Black people.) The reduction represents the single largest single drop in life expectancy in 40 years.
The N.C.H.S. report is not the first to show that the pandemic has increased deaths from a variety of causes. In addition to the nearly 200,000 American deaths caused directly by Covid-19 from Jan. 26 to Oct. 3, another roughly 100,000 so-called excess deaths from other causes were recorded, the Centers for Disease Control and Prevention recently reported. The greatest rate of excess deaths was found among young adults and people of color.
Calculations of the death toll from injuries — a category that includes suicide, homicide, drug overdoses and firearm deaths — were not included in the new data, as reporting on these deaths frequently lags.
But a separate N.C.H.S. provisional report on drug overdose deaths during the 12-month period ending in June 2020 found an 18 percent increase over the previous year to 79,251 deaths, up from 67,821 deaths during the previous 12-month period ending in June 2019.
In total, there have been more than 384,000 known virus-related deaths in the United States. As of Wednesday, the seven-day average was 3,346 deaths a day, according to a New York Times database.
Laura Engle, 78, lives alone in an apartment in Midtown Manhattan. She uses a walker and has a chronic lung disease. She is exactly the kind of person who most needs a coronavirus vaccine.
Yet she has found it impossible to make an appointment and has become lost in the confusing system set up by the city and the state.
Computer-literate, she navigated New York City’s vaccine finder page on Monday, found the closest provider and sent an email with her name and phone number to set up an appointment. When no one called, she reached out to the urgent care’s corporate office, which told her to wait.
She wanted to register at the new Javits Center megasite, which she had heard about on the news, but couldn’t figure out how.
“I’m willing to wait my turn,” she said, frustrated, “but I would like to have some feeling that I have a turn.”
Millions of older New Yorkers started the week with optimism that they would finally gain access to a vaccine after months of fearing they would fall victim to the coronavirus. But the reality of actually getting the shots has proved maddening.
Buggy websites, multiple sign-up systems that act in parallel but do not link together and a lack of outreach is causing exasperation and exhaustion among older New Yorkers and others trying to set up vaccination appointments. It is also stymying New York’s efforts to get the vaccine to many of the city’s most vulnerable, creating a situation that risks exacerbating the inequalities that Covid-19 has already laid painfully bare.
The race to vaccinate millions of New Yorkers has reached a critical point, as officials on Wednesday announced that two cases of a more contagious variant of the virus first detected in Britain had been found in New York City, one in Manhattan and one in Queens.
The state has used 35 percent of its available vaccine, in line with the national average in a rollout that has gone far slower than expected nationwide. New York City has distributed 38 percent of its shots, with 491,000 available doses as of Thursday.
But in the race to get shots in arms, some say the bigger picture about exactly whose arms should be prioritized has been lost.
“Here we are, facing a global pandemic, with thousands of New Yorkers who have lost their lives, and who is again the forgotten group of people? The very people who need help the most,” said Mark Treyger, a city councilman from Brooklyn who said his office had been inundated with calls from family members trying to get appointments for their parents.
Lebanon began its strictest lockdown of the pandemic on Thursday, imposing a 24-hour curfew, shutting nearly all businesses and allowing grocery stores to serve customers only by delivery.
The lockdown, scheduled to last until Jan. 25, is intended to curtail a sharp rise in infections since the holidays that has outstripped the abilities of the health sector in the small Mediterranean country.
Thirty-five people died on Wednesday after falling ill with Covid-19, a new daily record, and nearly 5,000 new cases were reported. Lebanon, with a population of nearly six million, has recorded more than 231,000 infections and 1,740 deaths since the start of the pandemic, according to a New York Times database.
The caretaker health minister, Hamad Hassan, tested positive on Wednesday and was taken to a hospital. The state-run news media said his condition was “good.”
Lebanon’s response to the pandemic has been hampered by an acute economic crisis. The country’s currency has fallen in value by about two-thirds. On top of that, a huge explosion in the port of Beirut in August killed about 200 people, destroyed four hospitals and damaged a large swath of the city.
To leave home during the lockdown, people must obtain a one-hour permit — even to buy bread or medicine or go to the airport, hospital or doctor’s office — or risk a fine. The caretaker prime minister, Hassan Diab, has called on the security forces to be strict with violators.
In other developments around the world:
President Recep Tayyip Erdogan of Turkey received a Covid-19 vaccination in Ankara on Thursday, hoping to alleviate public concerns as the country’s mass vaccination program gets started. Photos of Mr. Erdogan receiving the shot were posted on social media, instead of him getting inoculated on live television, as expected. Senior members of Mr. Erdogan’s political party have also received vaccines. Turkey is currently using the vaccine developed by Sinovac, a Chinese company, but it expects shipments of the vaccine developed by Pfizer and BioNTech, a German company owned by two Turkish emigrants. The country is concentrating first on health care workers; the health ministry reported that almost 300,000 had received shots the first day.
King Abdullah II of Jordan and two other members of the Jordanian royal family received coronavirus vaccines on Thursday. The country also began the first vaccination campaign for a major refugee operation against the virus, drawing praise from the United Nations. At the Zaatari refugee camp, home to around 120,000 fugitives from the war in Syria, 43 refugees were vaccinated Thursday. Jordan had shown “exemplary leadership” integrating refugees into its public health response to the pandemic, the U.N. refugee agency chief Filippo Grandi said, “proving how it should be done if we are to keep everyone safe.”
Regulators in the Philippines granted emergency use authorization to the Pfizer-BioNTech coronavirus vaccine on Thursday, making Pfizer the first foreign company to receive permission to distribute its Covid-19 vaccine in the country.
One region of Spain — Castile and León, north and west of Madrid — asked the national government on Thursday to put it under a stay-at-home order, and the leader of another region — Andalusia, the country’s most populous — asked residents to stay home voluntarily. The national health ministry reported more new coronavirus cases on Wednesday than on any previous day since the pandemic began, and hospitalizations in the country are rising sharply.
The Vatican said on Thursday that Pope Francis, 84, and Pope Emeritus Benedict XVI, 93, had each received the first dose of a coronavirus vaccine “as part of the vaccination program of the Vatican City State.” Francis has called being vaccinated “an ethical action.”
New Zealand, which has kept its borders tightly controlled while largely vanquishing the coronavirus, will let 1,000 international students back into the country starting in April, Chris Hipkins, the education minister, announced on Thursday. The move applies to students already enrolled in an undergraduate or postgraduate course who were locked out of New Zealand when border restrictions were imposed.
Andy Murray, the former top-ranked tennis player, has reportedly tested positive for the virus, putting in doubt his participation in next month’s Australian Open. He had planned to fly to Melbourne this week to begin a two-week quarantine required by the tournament, which begins Feb. 8, three weeks later than usual because of the pandemic.