Covid-19 Live Updates: C.D.C. Warns Against Holiday Travel

The number of Covid-19 patients in American hospitals has surpassed 100,000 for the first time, nearly double the number from spring during the coronavirus’s deadly first wave, according to the Covid Tracking Project.

The Tracking Project on Wednesday put the number of patients at 100,226.

The relentless rise in hospitalizations follows a rapid climb in new cases, which now number more than one million every week. And deaths, a so-called lagging indicator that tends to spike after a rise in hospitalizations, have also been rising fast. They have now passed 270,000 in the U.S.

The numbers paint a sobering picture of what the next few weeks may look like, experts said. Hospitals in some places are nearing capacity, and if states are unable to curb the surge of new cases, those systems could soon become overwhelmed, as New York was in the spring.

“Any thinking person has to be worried,” said Philip Landrigan, the director of a global public health program at Boston College. “That we have so many hospitalizations speaks to the fact that we have done a very poor job of controlling this pandemic. It is spreading very rapidly, and in many places, it is basically spreading out of control.”

Still, the situation today is different from the spring.

Hospitalizations are climbing steadily, but they are not keeping pace with the soaring number of cases. The share of people infected with the coronavirus who are admitted to hospitals has actually been shrinking, a twist in the data for which experts offer different theories.

One explanation is testing. Many more people today are getting tested than at the start of the pandemic and that is turning up many more mild cases. And many of those who do contract the virus become far less sick, said Dr. Caitlin Rivers, an epidemiologist at Johns Hopkins University, meaning they are less likely to need hospitalization.

But Dr. Rivers does not believe that the share of people who are sick enough to need hospitalization has changed that much. It is just that now they are spread across the United States, unlike the spring, when they were concentrated in New York and New England.

“Now we can see more of the iceberg,” she said. “This spring, you got a test because you were in the hospital and you were already sick. Now you can get tested even if you don’t have symptoms. We are adding to the denominator, but many of those people were never really destined for the numerator.”

But others said the shift was more than just increased testing.

Dr. Michael Osterholm, an infectious diseases expert at the University of Minnesota, who is on President-elect Joseph Biden’s advisory panel for the pandemic, said that he had seen a downturn in hospitalizations over the past few weeks, but that he suspected it reflected an attempt by hospitals to manage rising caseloads.

“Patients that would have been hospitalized last month today are being sent home and watched closely,” Dr. Osterholm said. “Many of our health care systems are literally on the edge. They are in a sense triaging, keeping only the most severely ill patients.”

Complicating the situation for hospitals is the fact that with cases now exploding in nearly all parts of the country, health care workers cannot be brought from other states to help, he said.

The next two weeks will be critical, Dr. Osterholm said.

“If we get this Thanksgiving surge, we will have hospitals hit their case cliff,” he said. “Then you can’t have more hospitalizations because there won’t be enough health care professionals to care for them.”

Hospital administrators said their staffs were already stretched.

Marvin O’Quinn, president and chief operating officer of CommonSpirit Health, which runs hospitals in 21 states, said his system had been drawing from its own outpatient facilities as well as outside companies to meet the growing need for hospital workers.

“There just aren’t enough nurses or doctors,” said Mr. O’Quinn. “This has escalated around the last two or three weeks.”

He said his hospital system is now treating 2,056 Covid-19 patients, the highest number to date and about 65 percent more than a month ago. About 100 new cases a day are being admitted. He said hospitals in Omaha, Los Angeles and Phoenix had seen substantial increases in caseloads.

“I’m concerned,” he said, adding that he believed the hospitals were as prepared as they could be.

“We took the summer to get ready. We knew the fall was coming.”




C.D.C. Director Warns of High Winter Death Toll

Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, urged Americans to practice precautions, especially wearing masks.

We are at a very critical time right now about being able to maintain the resilience of our health care system. In the spring, we were dealing with New York, Detroit, you know, New Orleans, Los Angeles. We could shift health care capacity from one part of the country to another. We saw similar when we had the Southern wave. We could shift health care capacity from the heartlands and from the northern Plains. Right now, we unfortunately have a pandemic. It’s really throughout the nation. The reality is December and January and February are going to be rough times — I actually believe they’re going to be the most difficult time in the public health history of this nation, largely because of the stress that’s going to put on our health care system. We’re in that range potentially now starting to see 1,500 to 2,000 to 2,500 deaths a day from this virus. So yeah, the mortality concerns are real. And I do think, unfortunately, before we see February we could be close to 450,000 Americans have died from this virus. But you know that’s not a fait accompli. If the American public really embraces social distancing, wearing masks, not letting your guard down in family gatherings, limiting crowds, maintaining ventilation, doing events outdoors rather than indoors, making sure you’re vigilant in hand hygiene; and that, coupled with some strategies that we’re pushing states to do to begin to diagnose through surveillance, the asymptomatic infections will begin to help us.

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Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, urged Americans to practice precautions, especially wearing masks.CreditCredit…Stefani Reynolds for The New York Times

The director of the Centers for Disease Control and Prevention warned on Wednesday that the nation is facing a devastating winter, predicting that total deaths from Covid-19 could reach “close to 450,000” by February unless a large percentage of Americans take more precautions.

“The reality is, December and January and February are going to be rough times,” said Dr. Robert Redfield, the head of the C.D.C., in an address to the Chamber of Commerce Foundation. “I actually believe they’re going to be the most difficult time in the public health history of this nation.”

The C.D.C. has been posting aggregate forecast models of the potential for a mounting death toll as the pace of the coronavirus outbreaks in various states has accelerated.

“We’re in that range potentially now, starting to see 1,500 to 2,000 to 2,500 deaths a day from this virus,” Dr. Redfield said. “The mortality concerns are real, and I do think, unfortunately, before we see February, we could be close to 450,000 Americans” dead from the virus.

Dr. Redfield said the death toll could be held down if the public embraced practices like mask wearing.

“It’s not a fait accompli,” he said. “We’re not defenseless. The truth is that mitigation works. But it’s not going to work if half of us do what we need to do. Probably not even if three-quarters do.”

The death toll in the United States is also approaching another set of dire milestones: The country has reported nearly 275,000 total deaths, and came closer on Tuesday to the single-day death record of 2,752, set in April.

In his address, Dr. Redfield indirectly criticized President Trump and Scott Atlas, the president’s recently departed coronavirus adviser, both of whom have questioned the value of masks. The C.D.C. was blocked from its plan to require masks on all public transportation, and Dr. Redfield was publicly skewered by the president after saying, at a congressional hearing, that masks might be as protective as a vaccine.

“When you really want to get everybody on board, you’ve got to have clear, unified, reinforced messaging,” Dr. Redfield said on Wednesday. “The fact that we were still arguing in the summer about whether masks work,’’ he said, “was a problem.”

“The time for debating whether or not masks work or not is over,” he said. “We clearly have scientific evidence.”

Dr. Redfield also recommended that more schools reopen, and said that the C.D.C. would issue guidelines later this week on routine Covid screening for teachers.

“I was very disappointed in New York when they closed schools,” he said, adding that he had not seen evidence of clusters of infections from open schools. He said most teachers’ infections can be traced to a spouse or community exposure.

A student under quarantine in a dorm at Ohio State University last month.
Credit…Maddie McGarvey for The New York Times

Citing the spiraling rise in coronavirus cases nationwide, the Centers for Disease Control and Prevention on Wednesday warned Americans not to travel over the holidays, and outlined two ways to shorten the recommended quarantine times for people who may have been exposed to the coronavirus, especially those who may choose to travel anyway.

“The best thing for Americans to do during the holiday season is to stay at home and not travel,” said Dr. Henry Walke, who oversees day to day management of pandemic response for the agency.

Dr. Walke and other officials also outlined two ways to shorten the recommended quarantine times for people who may have been exposed to the coronavirus, among them Americans who choose to travel despite the agency’s advice.

Previously, the C.D.C. had recommended a 14-day quarantine period following potential exposure, and officials said they still supported the longer period as the safest option. But officials also recommended two alternatives.

Those without symptoms may end quarantine after seven days, followed by a negative test for the virus, or after 10 days without a negative test, agency officials said at a news briefing. P.C.R. or rapid tests are acceptable, the agency said, and should be taken within 48 hours of the end of the quarantine period.

“We can safely reduce the length of quarantine, but accepting that there is a small residual risk that a person who is leaving quarantine early could transmit to someone else if they became infected,” said Dr. John Brooks, the C.D.C.’s chief medical officer for the Covid-19 response.

(Quarantine refers to people who are well but may become ill; isolation refers to those known to be ill.)

Agency officials also recommended that Americans who are traveling get tested for the infection one to three days before the trip and again three to five days after returning. Returnees should eliminate nonessential activities for seven days.

A shortened quarantine period may be more palatable to people, with reduced economic impact, and may improve compliance, officials said. But the more relaxed guidance may lead to some infections being missed.

Studies have found that the median incubation period for the virus is five days. But symptoms do not develop in a few patients until nearly two weeks after exposure.

C.D.C. officials also warned strongly against travel over the holidays.

Dr. Cindy Friedman, chief of the travelers health branch at the C.D.C., reiterated that with cases rising, “the safest thing to do is to postpone travel and stay home,” saying that even a small percentage of infected travelers could “translate into hundreds of thousands of additional infections.”

“Travel is a door-to-door experience that can spread the virus during the journey and into communities where travelers visit or live,” she said. “We know it’s a hard decision, and people need time to prepare and have discussions with family and friends and to make these decisions.”

“Our recommendations are trying to give them the tools they need to make these tough choices,” she said, adding that people should take the time before the holidays to “think about the safest option for them and their families.”

On Capitol Hill, Representative Steny H. Hoyer of Maryland, the majority leader, emphasized on Wednesday that he wanted lawmakers to leave by Dec. 11 — the same day government funding is set to expire — because of Congressional quarantine requirements ahead of the holidays, and the ongoing surge in coronavirus cases.




‘We Can Get Started’: Britain to Begin Vaccine Campaign

Matt Hancock announced Wednesday that the National Health Service would start administering doses of a coronavirus vaccine as early as next week.

What we do know is that we can get started next week with that first load, and then several millions will be coming throughout December. And people will get — be contacted by the N.H.S. when it’s their turn. And I urge you very strongly to come forward because obviously being vaccinated is good for you. It’s approved as clinically safe by the regulator, and it’s good for your community, as well, to help keep — get this virus finally, under control once and for all. You know, 2020 has been just awful. And 2021 is going to be better, and help is on its way. Help is on its way with this vaccine, and we can now say that with certainty rather than with all the caveats that I normally have to put around that. This will take time to roll out. You’ve got to have that 21 days in between the jabs anyway. And we’ve got to get this rolled out at the speed of which it could be manufactured. But I’m confident now with the news today that from spring, from Easter onwards, things are going to be better.

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Matt Hancock announced Wednesday that the National Health Service would start administering doses of a coronavirus vaccine as early as next week.CreditCredit…Andrew Testa for The New York Times

Britain gave emergency authorization on Wednesday to Pfizer’s coronavirus vaccine, leaping ahead of the United States to become the first Western country to allow mass inoculations against a disease that has killed more than 1.4 million people worldwide.

The decision kicked off a vaccination campaign with little precedent in modern medicine, encompassing not only ultracold dry ice and trays of glass vials but also a crusade against anti-vaccine misinformation.

Britain beating the United States to authorization — on a vaccine codeveloped by the American pharmaceutical giant Pfizer, no less — may intensify pressure on U.S. regulators, who are already under fire from the White House for not moving faster to get doses to people. And it has stirred up a global debate about how to weigh the desperate need for a vaccine with the imperative of assuring people that it is safe.

“Help is on its way with this vaccine — and we can now say that with certainty, rather than with all the caveats,” the British health secretary, Matt Hancock, said on Wednesday, as the government exulted in the authorization.

While the go-ahead bodes well for Britain, it will have no effect on the distribution of the hundreds of millions of doses that other wealthy countries have procured in prepaid contracts.

It also offers little relief to poorer countries that could not afford to buy supplies in advance and may struggle to pay for both the vaccines and the exceptional demands of distributing them.

The Pfizer vaccine, developed with BioNTech, a smaller German firm, must be transported at South Pole-like temperatures, a requirement that could dictate who will be vaccinated first in Britain: Nursing-home residents were supposed to be the top priority under an advisory committee’s plans, but efforts to limit transportation of the vaccine and ensure it remains cold may mean that National Health Service staff will receive the shots first.

The government said on Wednesday that 800,000 doses would be available by next week for health workers to begin administering. For Britain, which has suffered one of Europe’s highest per capita death tolls from the virus, the decision by its drug regulator testified to a vaccination strategy that has been the most aggressive in the West.

After the government strengthened an old law that allows Britain to step out from under the European Union’s regulatory umbrella in public health emergencies, its Medicines and Healthcare Products Regulatory Agency fast-tracked a review of the Pfizer vaccine, which was 95 percent effective in a late-stage trial.

The White House, concerned that Britain would approve a vaccine first, summoned Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, for a meeting on Tuesday. A panel of outside advisers to the F.D.A. is scheduled to meet on Dec. 10 to decide whether the agency should grant emergency authorization to the Pfizer vaccine.

American regulators pore over raw data from vaccine makers to validate their results, an approach they say ensures safety. Their counterparts in Britain and elsewhere in Europe lean more heavily on companies’ own analyses. However, British regulators seek opinions from a specialist committee, similar to the outside panel of experts the Food and Drug Administration uses to assess vaccine candidates. And while the F.D.A.’s panel is being convened on Dec. 10, Britain’s committee has met as it needed to about the Pfizer vaccine, for more than 40 hours, its chairman said on Wednesday.

The European Union is set to conduct its own review of the Pfizer and BioNTech vaccine, after the companies submitted their final application to the bloc’s health authorities on Tuesday.

The global race to develop a vaccine is poised to shatter records for time to market. Around the world, researchers are testing 57 vaccines in clinical trials, and nearly 100 others are being tested in animals or cells. China and Russia have approved vaccines without waiting for the results of late-stage trials, known as Phase 3, which experts say raises serious risks.

In Russia, President Vladimir V. Putin announced on Wednesday that mass vaccinations of the general public would begin by the end of next week. In televised remarks, Mr. Putin said that more than two million doses of the Sputnik V vaccine had been produced. The health minister, Mikhail Murashko, said that more than 100,000 people had already received the vaccine.

“I trust this science,” said former President Barack Obama.
Credit…Scott McIntyre for The New York Times

Former President Barack Obama said on Wednesday that he plans to take a coronavirus vaccine, going as far as to suggest he would get his vaccination on film to amplify public awareness.

“If Anthony Fauci tells me this vaccine is safe and can immunize you from getting Covid, absolutely I’ll take it,” Mr. Obama said during an interview with SiriusXM’s Joe Madison, set to air Thursday.

In November, Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said Pfizer and Moderna’s success in creating vaccines that are over 90 percent effective based on the rate in vaccine trials, gave him hope. However, it would still take considerable time for the public to return to its pre-pandemic behaviors.

During the interview, Mr. Obama said he understood why some members of minority groups might be skeptical of being vaccinated, pointing to the history of medical abuse and the mistrust it has engendered among Black people. Among the abuses was the 40-year-long Tuskegee study in which officials from the U.S. Public Health Service allowed Black men infected with syphilis to go untreated.

Mr. Obama also discussed the disproportionate number of coronavirus cases and deaths among Black, Hispanic and Native American people. Black and Latino residents are about three times as likely to be infected with the coronavirus and about twice as likely to die from it.

It could take until May or June, according to federal officials, for a vaccine to become more widely available to the general public beyond those who are most at-risk and certain priority groups such as health care workers.

“I promise you that when it’s been made for people who are less at risk, I will be taking it,” Mr. Obama said. “I may end up taking it on T.V. or having it filmed, just so that people know that I trust this science, and what I don’t trust is getting Covid.”

Dr. Jacob Keeperman took a photo of himself in the Renown Medical Center’s alternative care site in Reno, Nev., on opening day in November, before the center’s first patients arrived. 
Credit…Jacob Keeperman/Renown Regional Medical Center, via Associated Press

In the latest example of misinformation about the coronavirus ricocheting across social media, a Nevada doctor’s selfie has been used to spread false claims that downplay the severity of the pandemic.

In the picture posted to Twitter on Sunday, the doctor, Jacob Keeperman, is standing at the Renown Regional Medical Center’s alternate care site in Reno, Nev. In the background, empty hospital beds covered in plastic stand in a vacant parking area. The photo was taken on Nov. 12, the day the site opened, so patients had not yet arrived, Renown Health said.

“I want to thank all the incredible staff who are Fighting the Good Fight to help all those suffering from COVID-19,” Dr. Keeperman, the medical director for Renown’s Transfer and Operations Center, wrote. “With 5 deaths in the last 32 hours, everyone is struggling to keep their head up. Stay strong.”

His photograph was then used by the account @Networkinvegas to erroneously claim that it showed a “fake hospital” that had “never seen a single patient.”

On Tuesday, President Trump brought that falsehood to a wider audience, retweeting the @Networkinvegas post with the comment: “Fake election results in Nevada, also!” Twitter flagged the president’s tweet, noting that the claim about election fraud was “disputed.”

In fact, the alternate care site in Reno has cared for a total of 219 Covid patients in the three weeks it has been open. And across Nevada, hospitalizations have risen 43 percent in the last 14 days, with a 55 percent increase in deaths, according to a New York Times database.

Dr. Keeperman said in an interview on Wednesday that he was “sad and disappointed” to see the attacks surrounding his post on social media. “I sent that tweet to recognize and to thank all of our health care teammates that often go unrecognized,” he said. “My greatest wish is that I never have to tell another family that their loved one won’t be coming home.”

He has received an outpouring of support from local, state and national leaders, from health care colleagues, and from many in the general public — but he has also received some “less than savory messages,” he said. “I have chosen to ignore those and to keep hope.”

In response to the president’s tweet, Gov. Steve Sisolak of Nevada, a Democrat, said, “His consistent misleading rhetoric on Covid-19 is dangerous and reckless, and today’s implication that Renown’s alternate care site is a ‘fake hospital’ is among the worst examples we’ve seen.”

Addressing those who maintain that the pandemic is some kind of hoax, Dr. Keeperman said in the interview: “Covid is real. I sure hope that you don’t get sick, but when you do, we’re going to be here to care for you. And we’re going to have a bed for you, and we’re going to do our best. And then you’ll know just how real it is.”

Residents of a nursing home playing bingo outside in Georgia this summer. 
Credit…John Bazemore/Associated Press

The pharmacy chain CVS has reached a deal with the federal government to give out a Covid-19 antibody treatment in patients’ homes and in long-term care facilities, the company announced on Wednesday, providing a new way for certain high-risk patients to get a drug that aims to keep them out of the hospital.

The intravenous treatment, called bamlanivimab and developed by Eli Lilly, has been administered mainly at hospitals since it received emergency authorization from the Food and Drug Administration less than a month ago. Since then, the federal government has distributed to state health departments nearly 170,000 doses of the treatment — over half its supply for the rest of this year.

The deal with CVS involves just 1,000 doses of the treatment, enough to treat 1,000 Covid-19 patients over a three-month pilot period. The program will be limited for now to seven metropolitan areas — Boston, Chicago, Cleveland, Los Angeles, Milwaukee, Minneapolis and Tampa. It is not clear how much impact that will have as the virus is spreading rapidly and demand for treatments is surging.

“Even with this partnership, we’re talking about a very limited resource,” said Dr. Robert Goldstein, an infectious disease physician at Massachusetts General Hospital. “We still don’t have a way to deliver it equitably, and I’m not sure that the CVS partnership is necessarily going to improve equity in distribution.”

Still, giving the treatment in residential settings could help avoid the logistical challenges involved in infusing it at hospitals.

“We believe that this is a much more patient-friendly way to treat, in the comfort of someone’s own home or without having to be transferred,” said Dr. Sree Chaguturu, the CVS executive who is helping to lead the planning for the pilot.

A technician sorting blood samples during a Covid-19 vaccine study in Florida over the summer.
Credit…Chandan Khanna/Agence France-Presse — Getty Images

The drugmaker Moderna said on Wednesday that it would soon begin testing its coronavirus vaccine in children aged 12 to 17. The study, listed Wednesday on the website, will include 3,000 children, with half receiving two shots of vaccine four weeks apart, and half getting placebo shots of salt water.

But the posting says the study is “not yet recruiting,” and Colleen Hussey, a spokeswoman for Moderna, said the company was not certain when the testing sites would be listed or start accepting volunteers. A link on the website to test centers is not yet working and may not become active until Monday, Ms. Hussey said.

Moderna announced on Monday that data from its study in 30,000 adults had found its vaccine to be 94.1 percent effective, and that it had applied to the Food and Drug Administration for emergency authorization to begin vaccinating adults. If approval is granted, certain groups of high-risk adults, including people in nursing homes, could receive shots in late December.

But no vaccine can be widely given to children until it has been tested in them. Vaccines meant for both adults and children are generally tested first in adults to help make sure they are safe for pediatric trials.

Moderna’s vaccine has not yet been studied in children or pregnant women. In the new clinical trial in adolescents, girls past puberty will be tested before each injection to make sure they are not pregnant.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University and an adviser on vaccines to the Centers for Disease Control and Prevention, said, “Everyone anticipates that when we test this first in adolescents, then older children, then the real small kids, that the Covid vaccine will work.”

But children have more active immune systems than adults and may have stronger reactions, including more fever, fatigue and muscle and joint aches, Dr. Schaffner said.

“They may be more out of sorts than adults for a day or two,” he said. “You really do want to know, if it’s given in adolescents, what can parents expect? You really want to be able to tell them clearly how you might feel for 24 or 48 hours after you receive the vaccine. And, obviously, we really want to be able to tell parents it works.”

If a child had intense side effects and parents were not prepared for it, they might be reluctant to go back for the second shot, Dr. Schaffner said.

Dr. Paul A. Offit, a vaccine expert at Children’s Hospital of Philadelphia, said that vaccines “for the most part” work equally well in children and adults. Occasionally, as with the Hepatitis B vaccine, different doses are required, he said. Moderna will study the same dose in children that it has tested in adults.

Pfizer began testing its coronavirus vaccine in children as young as 12 in October. A large clinical trial found its vaccine to be 95 percent effective in adults, and the company has requested emergency authorization from the F.D.A. Britain approved the Pfizer vaccine for adults on Monday, becoming the first country to do so.

AstraZeneca has also tested its vaccine in children, but not in the United States.

As vaccine studies have moved forward, rumors have spread on social media, particularly among people who oppose vaccines in general, that President-elect Joseph R. Biden Jr. plans to require vaccination for everyone, including children. His team has denied those claims, and Mr. Biden has said that he will rely on scientists’ advice for the best way to end the pandemic.




New York’s First Vaccine Shipment Expected Dec. 15, Cuomo Says

Gov. Andrew M. Cuomo said New York’s first batch of Pfizer Covid-19 vaccine is expected to arrive on Dec. 15, containing enough doses for 170,000 people. The Food and Drug Administration has not yet approved the vaccine for use.

The first vaccine delivery to New York will be 170,000. The federal government distributes the vaccine by percentage of population of that state. So state’s population divided by available dosages is what the state gets. There’s no discretion in how much the state gets. It’s purely percent of population, which is what they say at least. We expect, if all safety and efficacy approvals are granted, those doses will arrive on Dec. 15. By the end of December, the administration suggests that there’ll be enough to vaccinate 20 million people with two dosages, which is 40 million dosages. That means 6 percent of Americans — gives you an idea of where we’re going to be coming into January — and those 6 percent will be prioritized as the health care workers, seniors in congregate facilities, etc. But 6 percent of Americans having available dosages by the beginning of January, you see how far we have to go. New York State also expects additional allocation of the Pfizer vaccine and the Moderna vaccine, which has also been approved, and we expect them later this month.

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Gov. Andrew M. Cuomo said New York’s first batch of Pfizer Covid-19 vaccine is expected to arrive on Dec. 15, containing enough doses for 170,000 people. The Food and Drug Administration has not yet approved the vaccine for use.CreditCredit…Dave Sanders for The New York Times

If authorized by federal regulators, the first batch of Pfizer’s Covid-19 vaccine is expected to arrive in New York on Dec. 15 and contain enough doses for 170,000 people, Gov. Andrew M. Cuomo said on Wednesday. He outlined how quickly the state could work to vaccinate vulnerable people, including nursing home residents and health care workers.

The Food and Drug Administration must first approve Pfizer’s application to authorize its vaccine for emergency use before the doses can be administered. Mr. Cuomo’s announcement came as he warned this week about the dangers hospitals are facing across the state, and as he and other officials, including those from the Centers for Disease Control and Prevention on Tuesday, warn against holiday travel.

“The vaccination program is really the end game here,” Mr. Cuomo said.

Pfizer’s vaccine requires two doses taken three weeks apart, and Mr. Cuomo said he expects the second set of doses to be available on time.

He said the state is also expecting another batch of vaccines from Moderna, which has also submitted an application to the F.D.A., although it was not immediately clear when that would arrive or how many people it could cover.

To grant emergency approval, the F.D.A. will review the data for a vaccine and share it with its advisory committee. The committee will meet publicly — in the case of the Pfizer vaccine, on Dec. 10, and Moderna, on Dec. 17 — and make a recommendation to the agency. The F.D.A. will then decide whether to approve a vaccine for emergency use.

After the initial shipments from Pfizer and Moderna, vaccine doses would then continue arriving in the state on a rolling basis, Mr. Cuomo said. Between them, there should be more than enough doses to cover people prioritized by the state to receive the vaccine first: approximately 210,000 individuals living and working in nursing homes. The overflow will go to the most at-risk health care workers.

“If you are an I.C.U. worker, emergency room worker, you’re at the top of the health care queue,” he said.

The state’s priorities essentially mirror those put forth by a panel of independent experts advising the C.D.C., which voted Tuesday to recommend that health care workers most at risk of contracting Covid-19 and residents of nursing homes and other long-term care facilities be the first Americans to receive the vaccinations.

A disproportionate number of U.S. deaths — about 39 percent nationwide — have occurred in nursing homes and other long-term care facilities, according to an analysis by The New York Times. In New York, about 20 percent of deaths have been linked to long-term care facilities.

Mr. Cuomo said he expects some people to be skeptical and initially resist taking the vaccine. But he said the state has its own panel that will be reviewing the F.D.A.’s approval of the vaccine “to help build confidence and to counter that existing cynicism” about a vaccine. Mr. Cuomo has said that the review will not delay the vaccine’s distribution.

The governor’s announcement comes against a troubling backdrop in New York and across the country. Hospitalizations across the state continue to rise, with 3,924 reported on Wednesday, up from 3,774 reported the day before, and Mr. Cuomo called this week for hospitals to prepare for worsening conditions. He has said many new infections were being traced to small gatherings and households.

Also on Wednesday, New York City reported a seven-day average positive test rate of 4.8 percent, its highest rate since May 29, when testing was less widespread and nonessential businesses in the city were shut down.

“These numbers have changed a lot, very rapidly,” Mayor Bill de Blasio said at a news conference.

The numbers would likely continue to worsen through at least January, Mr. Cuomo said, adding that he would start next week holding regular news briefings three times a week.

Face masks are required on the boardwalk at Rehoboth Beach in Delaware as the state is experiencing a surge of coronavirus cases.
Credit…Mark Makela/Getty Images

The pandemic is accelerating in Delaware, the state newly thrust into the limelight as President-elect Joseph R. Biden Jr. builds his administration from his home in Wilmington. Daily reports of new Covid-19 cases in Delaware are up 50 percent from two weeks ago, according to a New York Times database.

The state saw relatively few cases through much of the year, but that has changed in the last month.

Delaware had 682 new cases on Tuesday, a record, said Jennifer Horney, the founding director of the epidemiology program at the University of Delaware. The state has averaged about 500 cases a day over the last week, more than triple the average in late October, according to the Times database.

“I think it is sort of like everywhere — people are fatigued and letting down their guard,” Dr. Horney said. “There is more community transmission among people of all ages.”

The number of Covid-19 patients in the state’s hospitals has doubled since the end of October, she said, and the state is bracing for even more patients once the lag time for infections over Thanksgiving has passed.

As of Wednesday morning, there had been at least 36,343 cases in Delaware and 777 deaths since the beginning of the pandemic, according to the Times database.

The state has been fairly consistent from the beginning of the pandemic in asking its residents to follow mitigation methods, including face masks and social distancing. Some of its regulations were tightened right before Thanksgiving, including capping gatherings in homes at 10 people, limiting indoor dining at restaurants to 30 percent of capacity and banning youth sports teams from leaving the state or playing opponents from out of state.

Given Delaware’s small size, residents often travel to the surrounding states — Maryland, Pennsylvania and New Jersey — all of which are seeing increasing cases. Still, the infection rates in the Mid-Atlantic states, relative to population, are still far below those in the upper Midwest.

In Delaware, previous outbreaks had been concentrated among the state’s large chicken farms and around the beach resorts in the southern part of the state. But these days, current cases are less linked to specific clusters and are spread more generally among people in the more populous north, Dr. Horney said.

A virus testing site in Los Angeles on Tuesday. A C.D.C. committee has recommended that front-line medical workers and people in long-term care facilities be first in line for vaccines.
Credit…Jenna Schoenefeld for The New York Times

A Centers for Disease Control and Prevention committee met Tuesday and voted on guidance about who should get the vaccine first. Their recommendation: Health care workers should receive the first doses, along with residents of nursing homes and of long-term care facilities. The C.D.C. director will decide by Wednesday whether to accept the recommendation.

But the agency does not have the final say. The distribution of the vaccine is up to individual states, and they don’t have to follow C.D.C. advice (as we’ve seen with masks or travel restrictions). Still, experts say that most states probably will.

For insight into the vaccine rollout, and when you might get the vaccine, Jonathan Wolfe, who writes our Coronavirus Briefing newsletter, did a quick interview with Carl Zimmer, a science writer for The Times.

We now know who the C.D.C. says should get the vaccine first, but who’s next in line?

We won’t know until the advisory committee votes again later this month. But it’s likely that the next group in line will be essential workers — firefighters, police and so on. And then after that, it may be people over 65, and people with comorbidities like diabetes, obesity, cancer that put them at high risk of death or severe disease.

When should the general public expect a vaccine?

Nobody should be marking their calendar with “Vaccine Day.” But I think it would be reasonable to expect that the general public would be getting vaccines in May or June.

Is that the time frame without other vaccines entering the market?

It will definitely take longer to vaccinate the U.S. with just Pfizer and Moderna than with Pfizer, Moderna, Johnson & Johnson and AstraZeneca. But there are also two other vaccines that are going to go into late-stage clinical trials probably this month. One is from Sanofi, one is from Novavax. If their results come through quickly, and if everything looks good to the F.D.A., they could be also adding their vaccines to the supply, that would speed things up as well.

So after I’m vaccinated, can I just return to normal life?

No. Sorry. You can’t. First of all, you’re going to need two shots. After your first shot, you’re not fully vaccinated. Second of all, after your second shot it’s going to take awhile for you to get maximum immunity. Third of all, we don’t know yet if these vaccines simply prevent people from getting the symptoms of Covid or actually stop the spread of the virus from one person to the next. They might, but we don’t know. So you do not want to be walking around feeling fine and breathing viruses all over people who haven’t gotten vaccinated yet, or people who can’t get vaccinated.

Any thoughts, then, on when normal life will return?

This is an experience that none of us has gone through before, so we’re not going to get the kind of precise timetable that we might want. But Tony Fauci has talked about life getting back to normal by late 2021. But that comes with a big asterisk — that timetable will depend on at least 75 percent of the country getting vaccinated promptly.

Sandra Guató Silva, a leader of the Guató indigenous people in Brazil, in October. The country’s health ministry said Indigenous people and the elderly will be prioritized when distributing coronavirus vaccines. 
Credit…Maria Magdalena Arrellaga for The New York Times

Brazil’s Health Ministry said Tuesday that it would give Indigenous people and the elderly priority when a vaccine for the coronavirus becomes available, but it remains unclear how soon the first Brazilians will be immunized.

The ministry presented its preliminary vaccination plan after weeks of pressure from critics who say the government of President Jair Bolsonaro has led a reckless, haphazard response to the crisis, which made Brazil one of the epicenters of the epidemic.

When the first doses of a vaccine become available, the government intends to vaccinate people who are 75 or older, elderly people in nursing homes and other long-term care facilities and Indigenous people.

The next groups who will have preferential access to the vaccine include people who are 60 or older, people with certain chronic conditions, teachers, security forces, penitentiary workers and prisoners.

The government expects to cover those vulnerable groups with the roughly 109 million doses of vaccine it has negotiated access to. Brazil expects to get its first doses of the vaccine from AstraZeneca, a pharmaceutical company that developed a vaccine in partnership with the University of Oxford and has conducted trials in Brazil.

Health Minister Eduardo Pazuello said Wednesday that he expects Brazil will receive the first 15 million doses of a vaccine during the early months of 2021. Yet Anvisa, the country’s health regulator, has yet to authorize the use of any vaccine. Mr. Pazuello said he hopes Brazil will have 100 million doses in hand during the first six months of the year.

Weill Cornell Medicine saw a 10 percent increase in applications this year. 
Credit…Stephen Speranza for The New York Times

As the coronavirus gripped the globe, doctors and other health care workers have been hailed as heroes, cheered nightly with songs and pot-banging in cities across the world.

That enthusiasm appears to be reflected now in a surge of applications to American medical schools, which are up 18 percent over last year. Experts are calling it the “pandemic effect.”

“The pandemic has really motivated folks to pursue medicine,” said Geoffrey Young, senior director for student affairs and programs at the Association of American Medical Colleges.

“For this generation, this might be their 9/11,” Dr. Young said, comparing the interest in medicine now to the rush by some young people to join the military after the 2001 terror attacks.

Other pandemic-related factors may also be playing a role, admissions officers said. In an uncertain job market, people often look for refuge in stable professions like medicine. And the lockdowns gave students more time to reflect on their futures —  and to fill out medical school applications.

Some medical schools have made it easier to apply. They extended their application deadlines, shifted to virtual interviews and waived the usual standardized test requirement for portions of their admissions review. They also waived application fees for more students.

At New York University, applications to the Grossman School of Medicine are up 4 percent this year, to about 9,600 applications for 102 spots, said Dr. Rafael Rivera, the associate dean for admission and financial aid.

“The pandemic has clearly put health care in a positive spotlight,” Dr. Rivera said. “Medicine has always been a calling for people, and that call has grown stronger this year.”

At Weill Cornell Medicine, applications are up 10 percent, according to the dean, Dr. Augustine M.K. Choi. He attributed the rise in part to the debt-free policy for financial aid students that the school introduced last year. But he said that Covid-19 also played a role.

“For decades, there has been a correlation between the number of medical school applicants and how well the economy is doing,” Dr. Choi said, meaning a negative correlation — that applications tend to go up when the economy goes down.

Tulane University School of Medicine has seen one of the sharpest rises, with applications up by 35 percent. Along with the “call of service,” Mike Woodson, director of admissions, also connects the increase to an awareness that Black communities were hit hard by the virus. He credits a Black medical student at Tulane, Russell Ledet, for helping boost interest in the school among young Black people: A year ago, he organized a photo of himself and 14 Black classmates in their white coats in front of the slave quarters of a former plantation, to demonstrate progress, unity and resiliency.

“In Louisiana, we don’t like perfect storms,” Mr. Woodson said, “but if you want to call it a perfect storm, it all kind of snowballed into this.”


Pakistan’s cricket team during a match against England in September. Eight players tested positive after arriving in New Zealand.
Credit…Pool photo by Jon Super

When Pakistan’s 53-member national cricket squad arrived last week in New Zealand, where strict controls have helped make the country one of the world’s biggest coronavirus success stories, they were hoping to receive an exemption from the country’s 14-day quarantine requirement to train.

Instead, six players tested positive shortly after arrival, even though they had tested negative before leaving Lahore. And an eighth member of the cricket squad tested positive for the coronavirus while in an isolation facility in Christchurch, health officials said on Wednesday, making him the day’s only new case in the nation.

The team has not only been unable to train ahead of their scheduled matches, set to begin in late December, but their behavior led to an official warning from New Zealand’s Ministry of Health after C.C.T.V. footage revealed the squad breached quarantine requirements.

“Rather than being in their own rooms, which is a requirement for the first three days, until that first test comes back, there was some mingling in the hallways, chatting, sharing food, and not wearing masks,” Dr. Ashley Bloomfield, the country’s Director-General of Health, told Radio New Zealand last week.

The decision to warn the players has sparked anger from many in Pakistan, who felt New Zealand officials had disrespected the players and nation. But the team’s chief executive, Wasim Khan, took a more measured approach, urging the players to follow the rules.

“They have told me straight away that one more breach and they will send the whole team back,” Mr. Khan said in a recorded WhatsApp message to players last week, according to a report from The Associated Press.

While New Zealand has been among the countries least affected by the pandemic, with a total of 2,059 cases and 42 deaths, according to a New York Times database, Pakistan has experienced more than 400,000 cases, with 8,166 lives lost.

Here’s what else is happening across the world:

  • An Olympic committee in Japan unveiled a preliminary coronavirus safety plan for the Tokyo 2020 games, which were postponed to July 2021, that would allow overseas spectators without requiring two-week quarantines upon arrival. Specific countermeasures for visitors, which could include negative tests before arrival and the use of tracking smartphone apps, will be determined by the spring as the plan solidifies. The guidelines call for athletes to comply with a range of safety measures, including testing every four to five days.

  • Disagreements over how to deal with Europe’s ski season amid the pandemic have left the continent divided, with some countries like Austria and Switzerland choosing to open while others, like Italy, Germany and France have either vowed to remain shut or have put in place significant restrictions. Ski resorts played a major role in the first wave of pandemic cases, experts said.

  • New South Wales, the Australian state that includes Sydney, will ease capacity limits as of Monday after going nearly four weeks without a local infection. The new guidelines will lift caps on weddings, funerals and religious services, and allow up to 50 people in gyms and on dance floors, provided they are spaced two square meters apart. Up to 5,000 people will be permitted at ticketed outdoor events.

  • The International Federation of Red Cross and Red Crescent Societies reported that hundreds of thousands of new volunteers around the world have signed up to help support Covid-19 relief efforts. The American Red Cross saw 78,000 new sign-ups this year; Italy saw 60,000 new volunteers, and Kenya gained 35,000. Even the small Pacific island nation of Tuvalu, which has no reported coronavirus cases, welcomed 130 new volunteers.

Women working at a pasta factory in Gragnano, Italy, earlier this year.
Credit…Gianni Cipriano for The New York Times

Women and the lowest-paid workers in Europe have taken the biggest hit in earnings as a result of the Covid-19 pandemic, the United Nations labor organization said on Wednesday, urging governments to keep in place measures to protect jobs and wages.

Unlike 2009, when the impact of the financial crisis was felt across all sectors of employment, the pandemic has struck hardest at the lowest end of the job market, the International Labour Organization found in an analysis of data for the first half of 2020, mostly from European countries.

“The growth in inequality created by the Covid-19 crisis threatens a legacy of poverty and social and economic instability that would be devastating,” Guy Ryder, the organization’s director general, said in a statement.

Without a significant injection of funds in government job furlough and wage protection schemes, earnings by the lowest half of the work force would have dropped by 17 percent in the first half of the year, Mr. Ryder said.

Those plans absorbed much of the loss of earnings, he said. But in the second quarter of the year, women had still lost a little over 8 percent of their earnings, compared with around 5.4 percent for men.

Mr. Ryder warned against an early exit from wage subsidy and employment protection plans, in which governments have invested an estimated $11 trillion to $12 trillion. As these programs came to an end there would be further downward pressure on wages, he said.

The looming availability of Covid-19 vaccines would provide conditions for people to work with greater confidence, Mr. Ryder said, but it would “not solve the economic and social condition we are in.”

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