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President-Elect Joseph R. Biden Jr. plans to release nearly all available coronavirus vaccine doses “to ensure the Americans who need it most get it as soon as possible,” a sharp break from the Trump administration’s practice of holding back some of the vaccine, the Biden transition team said Friday.
“The president-elect believes we must accelerate distribution of the vaccine while continuing to ensure the Americans who need it most get it as soon as possible,” T.J. Ducklo, a spokesman for the transition team, said.
“He supports releasing available doses immediately, and believes the government should stop holding back vaccine supply so we can get more shots in Americans’ arms now. He will share additional details next week on how his Administration will begin releasing available doses when he assumes office on January 20th.”
Because both of the vaccines that have emergency approval require two doses, the Trump administration has been holding back roughly half of its supply to ensure those already vaccinated receive the booster dose. But the vaccine rollout has been troubled from the start.
As of Thursday, the Trump administration had shipped more than 21 million vaccine doses, and millions more were already in the federal government’s hands. Yet only 5.9 million people had received them. State and local public health officials, already overwhelmed with rising infections, have been struggling to administer the vaccine to hospital workers and at-risk older Americans while most people remain in the dark about when they might be protected.
Releasing the vast majority of the vaccine doses goes against the recommendation of officials from the Food and Drug Administration — experts whose advice Mr. Biden has pledged to follow. But a transition official, speaking anonymously to provide insight into the president-elect’s thinking, said would use the Defense Production Act, if needed, to ensure that enough doses are available.
Thursday began with a warning, and it was soon borne out.
“We believe things will get worse as we get into January,” Dr. Anthony S. Fauci, the United States’ top infectious disease specialist, said in a radio interview at the start of the day.
It didn’t take long for him to be proved right: Things immediately got worse.
For the second day in a row, the United States set a record for daily reported deaths: at least 4,111. And public health officials recorded a new daily case record, too: at least 280,028 new infections. (That excludes two days with figures driven up by reporting anomalies, and it is possible that the new highs in deaths and cases may reflect reporting lags tied to the holidays.)
The figures were an uncomfortable reminder that while many Americans were fixated on the political events roiling Washington, the pandemic hadn’t ceased wreaking havoc across the country.
With hopes buoyed by the arrival of a vaccine, and then dimmed by the delays in rolling it out, Dr. Fauci urged Americans to be patient. In his interview with NPR, he said that any program so large in scale would hit stumbling blocks. And the holiday timing of the rollout may have added to the delays, he said.
“I think it would be fair to just observe what happens in the next couple of weeks,” Dr. Fauci said. “If we don’t catch up on what the original goal was, then we really need to make some changes about what we’re doing.”
Dr. Francis S. Collins, director of the National Institutes of Health, also said it was not surprising that the vaccine drive had gotten off to a “rocky” start.
“That’s a lot of logistics,” he told The Washington Post. “So maybe we shouldn’t be too shocked that it didn’t go like clockwork.”
And, in fact, after a lagging start, vaccinations were beginning to speed up.
In the third week of the drive, more people were reported to have received their initial shots than in the first two weeks combined. The government count rose by 470,000 from Tuesday to Wednesday, and then by another 612,000 from Wednesday to Thursday.
The European Commission, the executive arm of the European Union, announced on Friday that it had secured a contract for an additional 200 million doses of the Pfizer-BioNTech vaccine, with an option to add another 100 million, in an apparent response to the growing criticism that the bloc had ordered too little and too late.
“Europe will have more than enough vaccines in a reliable time frame,” Ursula von der Leyen, the commission’s president, said during a news conference on Friday, stressing that the combined orders of Pfizer-BioNTech and Moderna vaccines would be sufficient to inoculate 80 percent of the European Union’s population of about 450 million.
Defending the commission’s actions on ordering doses, Ms. von der Leyen said that in the summer it had been impossible to know “which vaccines would have made it,” but that the expansion of Pfizer’s production capacity “illustrates it was right to bet on this particular horse.”
The new contract could double the number of Pfizer-BioNTech doses secured by the European Union from 300 million to 600 million, with the first 75 million ready for dispatch in the spring, though it is now up to member countries to place their individual orders. The original contract, finalized in November, secured 200 million doses with the option for an additional 100 million, which was triggered by the commission in late December.
The bloc also ordered 160 million doses of the Moderna vaccine, which was approved by the European Union drug regulator on Wednesday, moving up a decision that had been scheduled for later in January.
The European Commission has come under fire for not ordering a sufficient number of vaccines, and has been blamed for the slow rollout in its 27 member countries. The European Medicines Agency, the regulator, has also been denounced for not yet having started a review of the University of Oxford-AstraZeneca vaccine, which has recently been approved for use in countries including Britain and India.
The commission has taken the lead in approving, negotiating and securing the vaccines on behalf of its members, and it has pushed back against the criticism, highlighting that the decision on how many doses to buy was made by national governments, and that the rollout itself was strictly national business.
“All the members do their utmost to move forward with the vaccination plan,” Ms. von der Leyen said on Friday. “The beginning is always difficult, it is a logistical challenge.”
The British government on Friday issued new guidance encouraging health care providers to use two arthritis drugs to treat severely sick Covid-19 patients, after the release of encouraging data from a clinical trial that has not yet been published in a scientific journal.
The paper reported that treatment regimens that included the drugs tocilizumab or sarilumab reduced the death rate among Covid patients in intensive care to about 27 percent, compared with 36 percent among patients who did not take the drugs. Based on those results, about one death would be prevented for every 12 I.C.U. patients treated early with the drugs. All of the patients in the trial received the drugs within 24 hours of entering intensive care.
“As far as interventions go, that’s really good,” said Dr. Ilan Schwartz, an infectious-disease physician at the University of Alberta, Canada.
The findings make the pair of drugs, which act on the immune system, some of the only treatments — apart from steroids like dexamethasone — that have reduced Covid deaths in a rigorously designed clinical trial. (Most of the new study’s participants also took steroids during their hospital stay.)
The big dip in mortality shown in the trial of about 800 patients has caught some experts by surprise. Other studies testing the effects of tocilizumab and sarilumab have ended in disappointment, showing little to no benefit in people hospitalized for Covid-19.
Because all treatment trials are run with their own quirks and patient populations, “it’s difficult to compare across different studies,” said Dr. Emma Kaplan-Lewis, an infectious-disease physician at NYC Health + Hospitals who has helped to conduct trials on tocilizumab, including one that showed no improvement in patient survival. She was not involved in the new study.
“My general impression is that tocilizumab and sarilumab do work for some patients,” Dr. Kaplan-Lewis added. “But there is a sweet spot — it’s not for everybody, at all times.”
While many treatments for Covid-19 target the coronavirus itself, drugs like tocilizumab and sarilumab work to quiet the immune system which, when triggered by an infection, can overreact and start to destroy the body’s own tissues. This immunological “friendly fire” is thought to fan the flames of many of the most serious cases of Covid-19.
Although the new study has not yet been vetted by experts for formal publication, its findings were compelling enough to prompt a shift in guidance in Britain, where officials have partnered with Roche, a manufacturer of tocilizumab, to keep hospitals stocked with the drug.
Edward Goldberg’s phone would not stop ringing. Not only was the concierge doctor on Manhattan’s Upper East Side fielding calls from patients who went to St. Bart’s or Aspen — the wisdom of public-health officials be damned — and came back with Covid, he was hearing from healthy people too. They had an urgent desire for the coronavirus vaccine, and surely there was a way to gain access to it immediately.
Another contingent was calling Dr. Goldberg’s office inquiring about membership in his practice, assuming that they would then be fast-tracked for the vaccine. Concierge medicine involves the payment of annual fees — in Dr. Goldberg’s case, $20,000 a year — for what is essentially unlimited access to a doctor’s care. When asked how quickly someone might receive a vaccine, Dr. Goldberg explains that New York State is levying huge penalties against any medical outfit that tries to game the protocols for distribution.
It was inevitable that in an era marked by inequity and radically conflicting interpretations of truth that the rollout of the Covid-19 vaccine would be marked by so much delusion on multiple fronts. On the one hand are the rich, who are accustomed to finding workarounds whenever they want something that is in short supply and see little need for a different approach when it comes to protecting themselves from a disease that has largely devastated the underclass.
And then there are the skeptics who believe that the vaccine is trouble. In a survey of 1,117 Americans, conducted in early December, a quarter of respondents said they would not take the vaccine when it became available to them, while another quarter said that they were not sure.
A little over a week ago, Lara Devgan posted a video of herself getting the vaccine on Instagram. A Park Avenue plastic surgeon, she’d been hearing from some of her patients — those who have had cosmetic fillers — that they were worried the vaccine would cause temporary facial swelling.
“As someone who performs injectable facial fillers — who likes them and uses them myself — I believe the vaccine is safe,’’ Dr. Devgan said, “and the concept about worrying about how your face looks is not a reason not to get the vaccine.”
In a boost to Israel’s vaccination campaign, Prime Minister Benjamin Netanyahu announced on Thursday that he had reached an agreement with Pfizer that will enable all Israelis above age 16 to be inoculated against Covid-19 by the end of March.
Mr. Netanyahu made the remarks hours before Israel was set to tighten its current lockdown. Health experts believe the new highly transmissible variant of the virus has fueled a rising infection rate.
“We are going to be the first country to beat the coronavirus,” Mr. Netanyahu declared in a statement at his office in Jerusalem.
The vow came after days in which health officials warned that Israel’s supply of vaccines was dwindling.
He said planes carrying the vaccine would be arriving soon and boasted that he had spoken to Albert Bourla, Pfizer’s chief executive, 17 times in the past several weeks.
More than 18 percent of Israel’s population has already received the first dose of the vaccine, a rate that has far outstripped the rest of the world and buoyed Mr. Netanyahu’s battered domestic image.
As part of the agreement with Pfizer, Mr. Netanyahu said that Israel would be an “international model for quickly vaccinating an entire country” and that Israeli authorities would share data with the pharmaceutical giant to help “develop strategies to defeat” the virus.
The Israeli health minister, Yuli Edelstein, said the government would give priority to a broader swath of its population to receive the vaccine starting next week. He did not give specifics.
As of Thursday, Israel was permitting people 60 and older to be inoculated, as well as a number of other target groups. It has also provided them to members of the broader public under some circumstances.
Despite his optimism about the vaccines, Mr. Netanyahu was adamant that Israelis abide by the lockdown. “It is forbidden to forget for a moment that the pandemic is raging around the world,” he said.
Israel has averaged 6,695 cases per day over the past week, a substantially higher number than the previous seven days, according to a New York Times database.
Concerns about the rapidly transmissible variants of the coronavirus found in Britain and South Africa have prompted a number of countries to introduce a requirement for passengers to test negative for the virus before they travel.
Australia and Canada will begin requiring negative tests from all travelers this week, while Ireland will begin requiring proof of a negative result for travelers just from Britain or South Africa.
Some of the world’s strictest entry requirements, those in Hong Kong, recently got tougher, with the territory now requiring not only a negative test result but also extending its mandated quarantine at a government-designated hotel to three weeks.
Many countries within the European Union, such as Greece, the Netherlands and Spain, require travelers from countries deemed high-risk to provide a negative test result before or on arrival, and Brazil and Russia have also made a negative test a requirement for entry.
Britain, for its part, said on Friday that it would also require proof of negative tests from international travelers, aiming to prevent infections from abroad from adding to the drastic rise in its domestic cases. Since early December, the country’s seven-day average of new daily infections has quadrupled, growing from around 14,000 to more than 57,000.
Deaths are also on the rise, with a toll of 1,162 announced on Thursday. And the National Health Service’s hospitals in London are under such strain that the mayor, Sadiq Khan, on Friday put some responding agencies on emergency footing.
Almost all inbound passengers, including Britons, who arrive by boat, plane or train will be required to have a test in the 72 hours before departing for the country, British officials said on Friday, with a fine of 500 pounds, or about $680, for those who fail to comply. The new rules are expected to come into force next week.
Even with a negative test, those arriving in Britain will still need to quarantine unless they have come from a country judged to be low-risk. Travelers can shortening the period of self-isolation by taking another test at least five days after arrival.
GLOBAL ROUNDUP
Officials in Hong Kong on Friday reversed a contentious pandemic restriction that had barred birth partners from delivery rooms in public hospitals, forcing women to give birth alone.
Announcing the change, Dr. Au Yeung Kam-chuen, chairman of the Hong Kong Hospital Authority’s coordinating committee for obstetrics and gynecology, said, “We consider the accompanying person can help soothe the emotions and reduce painkilling needs for pregnant women during delivery, and will not affect the operation of the labor ward too much.”
Officials said the restriction had been lifted in response to feedback from women and their partners, many of whom were prevented from meeting their children until several days after they were born.
“Everyone is just absolutely overjoyed at the news, and honestly a little bit stunned that all our campaigning has worked,” said Lindsey Ford, an expectant mother who had drawn attention to the issue.
Under the new rules, which take effect next week, birth partners will be allowed if they have tested negative for the coronavirus within the past 72 hours. Women in labor were already required to be tested upon arrival at the hospital.
Hong Kong’s ban on birth partners had been in place off and on for most of last year, and was most recently reintroduced over a month ago amid a fourth wave of infections. It went against a recommendation by the World Health Organization that all pregnant women, including those suspected or confirmed to have the coronavirus, have access to the companion of their choice during labor and childbirth. Experts have also warned against such restrictions in the British Medical Journal and elsewhere.
“I still feel robbed,” said Emma Whetnall, whose husband was not allowed to be present for the birth of their first child last May. “I feel like that experience was stolen from us.”
The pandemic has complicated pregnancy and childbirth for women around the world, with many reporting negative experiences including nonconsensual procedures and forced separation from newborns. Researchers have estimated that pandemic-related disruptions could result in tens of thousands of additional maternal deaths.
Hong Kong was among the only places in the world where hospital restrictions still extended even to the delivery room. In March, Gov. Andrew Cuomo of New York issued an executive order requiring all hospitals in the state to allow birth partners in delivery rooms after they were barred by two major hospital systems in New York City.
In other developments across the world:
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Britain granted emergency approval to the coronavirus vaccine developed by Moderna on Friday, making it the third shot approved for use there. The 17 million doses ordered from the Massachusetts-based company are not expected to arrive until spring. Doses of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines are already being administered to thousands of people a day. In the face of skyrocketing infections, Prime Minister Boris Johnson has set a goal of vaccinating 13.9 million of the nation’s most vulnerable people by mid-February.
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Indonesia’s influential council of Muslim clerics announced on Friday that a coronavirus vaccine made by the Chinese company Sinovac was acceptable under Islamic law, removing a potential obstacle to its use. The Indonesian government is expected to issue an emergency authorization soon that would permit use of the vaccine, with inoculations beginning as soon as next week. The Indonesian Ulema Council, as the body of clerics is known, said it had concluded that the vaccine was free of pork material and therefore halal.
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Brisbane, Australia’s third-biggest city, is heading into a three-day lockdown after reporting its first case of a highly transmissible coronavirus variant that was not in a quarantined international traveler. A cleaner working at a quarantine center tested positive for the variant first identified in Britain on Thursday. Officials say they believe the cleaner had been infectious but asymptomatic from Jan. 2, during which time she had been on public transport and visited shops. Annastacia Palaszczuk, the state premier of Queensland, which includes Brisbane, said that residents would not be allowed to leave home except to get groceries, exercise, work or provide care, starting on Friday at 6 p.m. until Monday night.
The list of states to identify the dangerous new coronavirus variant is growing.
Texas, Connecticut and Pennsylvania confirmed their first cases on Thursday, joining California, Colorado, Georgia, Florida and New York.
Florida has at least 22 confirmed cases, according to the Centers for Disease Control and Prevention. California has reported at least 26.
Experts have warned that the United States is woefully ill-equipped to track the rapidly transmissible variant. Without a robust, national system to identify genetic variations of the coronavirus, states are left on their own to identify the variant.
The Texas Department of Health and Human Services said an adult male resident of Harris County, which includes Houston, with no history of travel tested positive for the coronavirus. Genetic sequencing this week showed that the infection was caused by the variant.
“The fact that this person had no travel history suggests this variant is already circulating in Texas,” Dr. John Hellerstedt, the commissioner of state health services, said in a statement. “It’s not surprising that it showed up here given how rapidly it spreads.”
Dr. Hellerstedt urged Texans to “redouble our commitment” to social distancing and public health measures.
In Connecticut, Gov. Ned Lamont said two individuals between 15 and 25 years old had tested positive for the variant. Both had traveled outside of the state, he said, one to Ireland and the other to New York. Genetic sequencing showed the cases are unrelated.
Pennsylvania also reported that its case was because of international exposure.
Last month, Britain became the first country to identify the new variant, which is now surging there and burdening its hospitals with new cases. Now, the variant has been identified in at least 33 countries, including Britain. Dr. Hans Kluge, the World Health Organization’s regional director for Europe, called the spread of the variant across the continent “an alarming situation.”
“Without increased control to slow its spread, there will be an increased impact on already stressed and pressurized health facilities,” Dr. Kluge said at a briefing on Thursday, warning that the variant may, over time, “replace other circulating lineages” as it has in Britain.
Dr. Kluge urged countries to continue to investigate transmission, increase genetic sequencing and to share data.
The already sputtering economic rebound went into reverse in December, as employers laid off workers amid rising coronavirus cases and waning government aid.
U.S. employers cut 140,000 jobs in December, the Labor Department said Friday. It was the first net decline in payrolls since last spring’s mass layoffs, and though the December loss was nowhere near that scale, it represented a discouraging reversal for the once-promising recovery. The U.S. economy still has about 10 million fewer jobs than before the pandemic began.
The December losses were heavily concentrated in leisure and hospitality businesses, which have been hit especially hard by the pandemic. The industry cut nearly half a million jobs in December, while sectors less exposed to the pandemic continued to add workers.
The unemployment rate was unchanged at 6.7 percent, down sharply from its high of nearly 15 percent in April but still close to double the 3.5 percent rate in the same month a year earlier.
“We’re losing ground again,” said Diane Swonk, chief economist at the accounting firm Grant Thornton. “Most notably, this is still very much a low-wage recession, and the losses were where we first saw them when the pandemic hit.”
Unemployment rate
By Ella Koeze·Seasonally adjusted·Source: Bureau of Labor Statistics
Hiring has slowed every month since June, and the economy lost more than nine million jobs in 2020 as a whole, the first calendar-year decline since 2010 and the worst on a percentage basis since the aftermath of World War II.
Congress last month passed a $900 billion relief package that will provide temporary support to households and businesses and could give a boost to the broader economy. And in the longer run, the arrival of coronavirus vaccines should allow the return of activity that has been suppressed by the pandemic.
But the vaccine and the aid came too late to prevent a sharp slowdown in growth.
“We did have a pullback in the economy,” said Michelle Meyer, head of U.S. economics at Bank of America. “If stimulus was passed earlier, maybe that could have been avoided.”
Amid surging coronavirus cases, the top U.S. testing official on Thursday announced another scale-up in the country’s diagnostic efforts, touting the importance of tests that can run from start to finish outside the lab.
The government will allocate an additional $550 million to community-based testing programs across all 50 states, said Adm. Brett Giroir, the assistant secretary for health. The government will also put $300 million toward 60 million kits for federal distribution to nursing homes and other vulnerable communities.
Dr. Giroir projected that the country’s capacity for non-laboratory testing could more than double by June.
In a video livestream, Dr. Giroir held up three new at-home testing kits, designed by Ellume, Abbott and Lucira Health, that recently received emergency green lights from the Food and Drug Administration. All can deliver results in a matter of minutes after a quick nasal swab, though only Ellume’s product can be purchased without a prescription.
The Abbott and Ellume tests search for bits of coronavirus proteins called antigens. Lucira’s test, like most laboratory-based tests, hunts for genetic material.
Dr. Giroir, who will depart his position on Jan. 19 as part of the transition to the Biden administration, praised the tests as “sophisticated” but cautioned that none were yet in widespread use. Production ramp-ups are in progress, he noted, but might not alter the market for a few months.
Ellume’s test, for example, while it will be sold over the counter in a few weeks, will still be available in only very limited quantities.
Experts have repeatedly cautioned that rapid tests are not as accurate or consistent as tests that route people’s samples through a laboratory, where they are typically processed with a technique called polymerase chain reaction, or P.C.R.
Rapid tests, which can run from start to finish in a matter of minutes, may also falter more often when used on people without symptoms. Even so, they are often used — as a way to frequently screen some populations like nursing home residents and schoolchildren.
But rapid tests typically have cost and convenience on their side — benefits that Dr. Giroir repeatedly underscored in a call with reporters. He noted the slow and bumpy rollout of testing in the United States, where speedy tests results are still a relative rarity.
Dr. Giroir said it was “not yet obvious” whether widespread at-home testing would be successful.
Susan Butler-Wu, a clinical microbiologist at the University of Southern California’s Keck School of Medicine, said at-home testing might streamline the testing process. People who feel sick could test themselves and determine whether they need to isolate or seek treatment in a matter of minutes.
But outsourcing testing to the general public also carries risks.
Incorrect results, for example, could be tougher to catch, interpret and act on when people test themselves at home. False negatives might embolden people to mingle with others, hastening the spread of the virus, while false positives could unnecessarily keep people out of work or school.
And both types of errors could erode public trust in testing.
Dr. Butler-Wu also noted that rapid test results might not make it to the right care providers and to public health officials when collected at home.
If results aren’t properly reported, she said, “you’re flying blind — you don’t know the prevalence in your community.”
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