Home / World News / Covid-19: F.D.A. Authorizes Moderna Vaccine for Emergency Use, Adding Millions of Doses to U.S. Arsenal

Covid-19: F.D.A. Authorizes Moderna Vaccine for Emergency Use, Adding Millions of Doses to U.S. Arsenal

Beginning Sunday, shipments totaling 5.9 million doses of the Moderna vaccine may be sent to rural areas, smaller hospitals and local health departments. The first shots are expected to be given Monday.
Beginning Sunday, shipments totaling 5.9 million doses of the Moderna vaccine may be sent to rural areas, smaller hospitals and local health departments. The first shots are expected to be given Monday.Credit…Andrew Kelly/Reuters

The Food and Drug Administration on Friday authorized the Covid-19 vaccine made by Moderna for emergency use, allowing the shipment of millions more doses across the nation and intensifying the debate over who will be next in line to get inoculated.

The move will make Moderna’s vaccine the second to reach the American public, after the one by Pfizer and BioNTech, which was authorized just one week ago.

It comes as the virus continues to rage across the United States, which set another record for daily cases on Friday with over 251,000 and has surpassed a total of 17 million known cases, according to a New York Times database.

The F.D.A.’s decision sets the stage for a weekend spectacle of trucks rolling out as expert committees begin a new round of discussions weighing whether the next wave of vaccinations should go to essential workers, or to people 65 and older, and people with conditions that increase their risk of becoming severely ill from Covid-19.

Jockeying for the next shots in January and February has already begun, even though there is still not enough of the two vaccines for all the health care workers and nursing home staff members and residents given first priority. Uber drivers, restaurant employees, morticians and barbers are among those lobbying states to include them in the next round along with those in the more traditional categories of the nation’s 80 million essential workers, like teachers and bus drivers.

The rapid progress from lab to human trials to public inoculation has been almost revolutionary, spurred by the nation’s urgent need to blunt the pandemic that has broken record after record in U.S. deaths, hospitalizations and economic losses. In the past week alone, there has been an average of more than 218,000 cases per day, an increase of about 18 percent from the average two weeks earlier. And at least 2,800 new deaths were reported on Friday.

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, called the advent of two vaccines “an historic moment.”

“This to me is a triumph of multiyear investment in biomedical research that culminated in something that was not only done in record time, in the sense of never before has anybody even imagined you would get vaccines to people in less than a year from the time that the sequence was made known,” Dr. Fauci said.

“This is an example of government working. It worked really well,” he added.

Moderna, a company based in Cambridge, Mass., worked with Dr. Fauci’s agency at the National Institutes of Health to create a vaccine that, along with Pfizer-BioNTech’s, shepherds in a new technology based on genetic material called messenger or mRNA. In clinical trials in tens of thousands of volunteers, the vaccines proved 94 to 95 percent effective. Each requires two shots.

Both products are reaching an anxious public before vaccines made with traditional approaches, and have become even more critical as other companies’ efforts have faltered in recent months.

The emergency authorization kicks off a swift and complex drive to distribute some 5.9 million doses of the Moderna vaccine around the country, with shipping to begin on Sunday and deliveries starting on Monday. The first Moderna vaccinations could then be given hours later.

Because Moderna’s vaccine, unlike Pfizer-BioNTech’s, does not need extreme-cold storage and is delivered in smaller batches, states are hoping to provide it to less populated areas, reaching rural hospitals, local health departments and community health centers that were not at the top of the distribution list.

Three places that did not receive the Pfizer-BioNTech vaccine — the Marshall Islands, Micronesia and Palau — will receive the Moderna vaccine for that reason, according to a federal health official familiar with the government’s distribution plans.

And in contrast to Pfizer’s rollout last week, the Moderna vaccine deliveries will be managed by the federal government under the funding of Operation Warp Speed, the administration’s program to develop and distribute vaccines as fast as possible.

David Gelles, Katherine J. Wu, Sharon LaFraniere and Reed Epstein contributed reporting.

An emergency room triage tent in Colton, Calif., on Friday.
An emergency room triage tent in Colton, Calif., on Friday.Credit…Alex Welsh for The New York Times

As the United States welcomed the news Friday that a second vaccine, by Moderna, had been authorized by the federal government for emergency use, it confronted another stark reminder of how desperately vaccines are needed: A single-day caseload of over 251,000 new coronavirus cases, a once-unthinkable record.

It’s been only a week since the Food and Drug Administration approved a Covid-19 vaccine for the first time, the one by Pfizer and BioNTech. As trucks have carried vials across the country and Americans began pulling up their sleeves for inoculations, more ominous numbers have piled up:

  • Monday: 300,000 total dead in the United States.

  • Wednesday: 3,611 deaths in a single day, shattering the previous record of 3,157 on Dec. 9.

  • Thursday: More than 17 million total confirmed cases; over 1 million new cases in just five days.

Three months ago, new cases were trending downward and death reports were flat. But those gains have been lost: Now there are nearly six times as many cases being reported each day, and three times as many deaths, according to a New York Times database.

The South is on a particularly worrisome trajectory. Georgia, Arkansas and South Carolina have all set weekly case records. Tennessee is confirming new cases at the highest per capita rate in the country.

As cases continue to spike, officials are warning that hospitals, which now hold a record of nearly 115,000 Covid-19 patients, could soon be overwhelmed. More than a third of Americans live in areas where hospitals are running critically short of intensive care beds, federal data show. A recent New York Times analysis found that 10 percent of Americans — across a large swath of the Midwest, South and Southwest — live in areas where I.C.U.s are either completely full or have under 5 percent of beds available.

In California, hospitals are especially stretched: The state reported just 2.1 percent availability of I.C.U. beds on Friday, after the number of available beds fell by 37 percent over the past month. In Los Angeles County, officials say, an average of two people are dying of Covid-19 every hour and I.CU. capacity could be exceeded within the month.

There has been rapid improvement in much of the Midwest and Mountain West. Iowa is adding fewer than half the cases it was at its November peak. South Dakota, Montana, Nebraska, Colorado and Wyoming are all seeing sustained declines in cases.

But, because deaths are a lagging indicator, North Dakota, where the governor announced a mask mandate and restrictions on businesses in mid-November after months of resistance, still has the nation’s highest daily death rate for its size, despite progress in slowing new cases.

As Christmas approaches, American families will be tempted again to gather indoors, as many did for the Thanksgiving holiday, despite the torrent of warnings from public health officials and elected leaders. And whatever progress is being made now in some places could, once again, be negated.

“There’s no need for that many to have died,” David Hayes-Bautista, a professor of medicine at the University of California, Los Angeles, said after the country’s pandemic death toll hit 300,000 on Monday. “We chose, as a country, to take our foot off the gas pedal. We chose to, and that’s the tragedy.’’

Mitch Smith, Julie Shaver, John Eligon, Amy Harmon, Remy Tumin and Jill Cowan contributed.

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‘Didn’t Feel a Thing’: Pence Receives Coronavirus Vaccine

Vice President Mike Pence and his wife, Karen Pence, received a coronavirus vaccine on Friday.

I didn’t feel a thing. Well done, and we appreciate your service to the country. Today, Karen and I wanted to step forward and take this vaccine to assure the American people that while we cut red tape, we cut no corners.

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Vice President Mike Pence and his wife, Karen Pence, received a coronavirus vaccine on Friday.CreditCredit…Doug Mills/The New York Times

It’s yet another paradox of the pandemic: The vaccine may be President Trump’s greatest legacy. But many of his supporters do not want to take it.

Like everything else about the coronavirus pandemic, and the United States writ large, vaccine hesitancy — the public health term for delaying to accept or refusing to take a vaccine even when it is available — has become deeply partisan. The “anti-vaxxer movement” is not new, and it typically cuts across political parties. But partisanship plays a major role in how people view the coronavirus vaccine.

A recent survey by the Kaiser Family Foundation found that Republicans were the group most likely to be hesitant about the coronavirus vaccine, with 42 percent saying they would probably not or definitely not be vaccinated. Democrats were the least likely, with 12 percent saying they would probably or definitely not be vaccinated.

In any other era, the vaccination on live television of Vice President Mike Pence, at the Eisenhower Executive Office Building, administered by technicians from Walter Reed National Military Medical Center in Bethesda, Md., would have been a moment to bring the nation together. (An earlier version of this item misstated the location.) Mr. Pence used it as a way to promote both the vaccine while also hailing the work of the White House Coronavirus Task Force, which he leads.

He took the shot in front of a giant blue poster declaring in block white letters: SAFE and EFFECTIVE. His wife, Karen Pence, and Surgeon General Jerome Adams were also vaccinated. As they took their seats on high stools, a technician asked if any were “pregnant or breastfeeding” or immunocompromised, which prompted a laugh.

“I didn’t feel a thing — well done,” the vice president said minutes after the vaccine was administered to him by a technician. He called it a “truly inspiring day.”

But Mr. Trump was notably absent. One reason for the partisan divide over vaccination, experts say, is the president himself; his repeated denigration of scientists and insistence that the pandemic is not a threat have contributed to a sense among his followers that the vaccine is either not safe or not worth taking.

“We need him taking a proactive role,” said Matthew Motta, a political scientist at Oklahoma State University who studies politics and vaccine views, adding, “The single best person to convince you to change your mind about something is somebody who agrees with you, somebody who you trust on other issues.”

President-elect Joseph R. Biden Jr. and his wife, Jill, are scheduled to receive an injection on camera on Monday, transition officials said on a conference call with reporters on Friday afternoon. Jen Psaki, a spokeswoman for the transition and the incoming White House press secretary, said Vice President-elect Kamala Harris and her husband would receive the vaccine after Christmas.

Ms. Psaki said the vaccinations were staggered based on medical recommendations “that they should not do doses at the same time.”

Members of Congress and the Supreme Court will begin receiving vaccinations in the coming days, in an effort to safeguard the functioning of the government. It was not immediately clear how many doses will be sent to Capitol Hill, but all 535 members of Congress and the nine justices are eligible under plans circulated on Thursday by Dr. Brian P. Monahan, the Capitol’s attending physician.

Speaker Nancy Pelosi of California was among the first lawmakers to receive a vaccine. Ms. Pelosi, 80, would be second in line to the presidency if the president or vice president were unable to serve.

On Friday, Ms. Pelosi posted photos of herself receiving the shot inside the Capitol on Twitter. “Today, with confidence in science and at the direction of the Office of the Attending Physician, I received the Covid-19 vaccine,” she wrote.

Senator Mitch McConnell, Republican of Kentucky, the majority leader, received the shot a short time later, writing on Twitter, “vaccines are how we beat this virus.”

Mr. McConnell, 78, a polio survivor, shared an image of himself receiving a card marking his vaccination from Dr. Monahan.

The C.I.A. plans to shortly begin offering vaccines to its work force, as well as other intelligence officials, according to four people familiar with the matter who were not authorized to speak publicly.

It was not clear how many doses of the vaccine the agency will receive to start. Government plans call for the C.I.A. to eventually offer vaccines to its roughly 20,000 employees. (The precise size of the agency is classified.)

The White House approved the decision, according to two of the people. Giving priority for the C.I.A. was a matter of national security, said one government official. The C.I.A. declined to comment. The White House did not respond to a request for comment.

Other national security officials are also beginning to get vaccinated. Some of the Defense Department’s medical personnel began receiving doses of the Pfizer vaccine this week. Other service members, including senior military leaders and troops deploying overseas, could begin to get doses of the Moderna vaccine as soon as next week, according to an American official.

Gov. Gavin Newsom with a vial of the Pfizer-BioNTech coronavirus vaccine in Los Angeles on Monday. Mr. Newsom has said he will wait his turn for the vaccine.
Gov. Gavin Newsom with a vial of the Pfizer-BioNTech coronavirus vaccine in Los Angeles on Monday. Mr. Newsom has said he will wait his turn for the vaccine.Credit…Jae Hong/Agence France-Presse — Getty Images

On Monday, the very first day that Covid-19 vaccines were administered in the United States, Gov. Jim Justice of West Virginia rolled up his right sleeve and became one of the first top elected officials in the country to receive one. He touted the achievements of medical professionals and cheerily joked with the health care worker jabbing him with the needle.

“It’s as safe as it can be,” he said as cameras rolled. “I promise you, if I can make it through it, you can too.”

Mr. Justice, 69, wanted to show West Virginians that the vaccine is essential to fighting the virus. But so far, few other high-level government officials have done so.

Governors nationwide, along with top health officials, are the ones signing off on vaccine prioritization decisions. At the same time, they are considering their own timelines for vaccination.

In Utah, Gov. Gary Herbert will wait his turn in line, behind health care professionals and those most at risk for serious complications from the virus, according to his spokeswoman, Anna Lehnardt. “The current plan is for him to get the vaccine when it is administered to other Utahns in his same age group/risk category,” she said in an email, adding that the governor had complete trust in the safety and efficacy of the vaccine and “encourages everyone to get it as soon as it is available to them.”

In California, where I.C.U.s statewide are almost filled, and officials say an average of two people are dying every hour, Gov. Gavin Newsom said on Monday during a news conference that he would take the vaccine when it was available to someone in his “position.”

“I’m not cutting a line,” he said. “I’m not going to get in the way of any of the critical workers I see in front of me,” he added. “I will not get in the way of that.”

It’s a tricky political balance. Some believe that government leaders should take the vaccine as soon as possible to project public confidence in a medical advance that could signal the beginning of the end of the pandemic. Vaccine skepticism is rampant, and health officials are working to ease public doubts about the safety of the injections.

Others see top government leaders taking the vaccine first as unfair, especially when supplies are still limited.

Gov. Chris Sununu of New Hampshire scoffed at the notion that elected officials like himself should get the vaccine before people who are more at risk. “I think that’s ridiculous, frankly — I just completely disagree with that,” he said.

Just two weeks ago, Gov. Gavin Newsom warned Californians that the state’s intensive care beds might be full before Christmas.

Now, it appears that his dire projection is being borne out.

How bad is the coronavirus surge in California?

In Los Angeles County, officials say, an average of two people are dying every hour. And one in every 80 people there is thought to be infected.

“Our hospitals are under siege, and our models show no end in sight,” Dr. Christina Ghaly, the director of health services in Los Angeles County, said on Thursday.

Statewide, California reported 2.1 percent availability of I.C.U. beds on Friday.

But the problem is most severe in the southern part of the state. Within the month, Dr. Ghaly said, the number of patients requiring I.C.U. care in Los Angeles County “could easily exceed” the 2,500 licensed adult beds by 1,000 or more.

California continues to shatter records. On Thursday, the state reported more than 45,000 new cases and over 260 deaths. That made it the second-worst day in terms of daily reported cases and the third-worst for a single-day death toll.

And it is hardly alone. More than a third of Americans live in areas where hospitals are running critically short of intensive care beds, federal data show. A recent New York Times analysis found that 10 percent of Americans — across a large swath of the Midwest, South and Southwest — live in areas where I.C.U.s are either completely full or have under 5 percent of beds available.

The total number of confirmed infections in the United States since the pandemic began passed 17.2 million on Thursday, just five days after eclipsing the 16 million mark. There have been at least 310,900 deaths. On Thursday alone, there were at least 238,100 new cases and at least 3,290 new deaths reported.

In California, the authorities have ordered an extra 5,000 body bags, activated an aid network for morgues and coroners’ offices, and stationed 60 refrigerated storage units in counties around the state to handle remains. Health officials in Orange County said they would roll out three field hospitals.

Hospitals are particularly overwhelmed in the San Joaquin Valley, where many low-wage essential workers live without good access to health care even in the best of times.

Even the Bay Area, which for a time managed to stave off the worst of the surge, has not been spared. I.C.U. capacity there has dropped below 15 percent, leading to a new regional stay-at-home order.

The ever-climbing numbers are all the more demoralizing for Californians, because they have endured some of the most stringent pandemic restrictions in the country. But health officials said that now more than ever, they need to keep hunkering down.

“It’s going to be a wild ride probably for another four, five or six weeks,” said Dr. Nancy Gin, a regional medical director for Kaiser Permanente in Southern California. She urged Californians to stay home and not give in to temptation to travel as the holidays near.

The arrival of vaccinations has buoyed people’s spirits, but many health care workers are exhausted.

“It’s really hard to put all of it into words,” said Helen Cordova, an I.C.U. nurse who was the first person in California to receive a vaccine shot. “This is a very real disease — those images of inside of hospitals, that’s very accurate.”

Covid-19 vaccines at the Sinovac factory in Beijing in September.
Covid-19 vaccines at the Sinovac factory in Beijing in September.Credit…Ng Han Guan/Associated Press

More than a million doses of untested Covid-19 vaccines have so far been administered in China to people most at risk of contracting the coronavirus, officials said on Saturday, weeks before a travel rush begins ahead of the Lunar New Year holiday.

Even as governments in Europe, North America and elsewhere approve vaccines, China is still awaiting the results of clinical trials for its unproven homegrown candidates. In the meantime, the government has worked outside traditional testing protocol to inoculate government workers, teachers and hospital workers with three homegrown varieties.

Two of those vaccine candidates are made by Sinopharm; a third is made by Sinovac.

While experts have warned that the untested vaccines could pose safety hazards, Chinese officials said Saturday that so far, there had been no adverse reactions. More than 60,000 people who received the vaccines have traveled to high-risk areas overseas and have not come down with a serious infection, Zheng Zhongwei, a top official at China’s National Health Commission, told reporters in Beijing on Saturday.

“Research shows that there are no serious safety hazards,” Mr. Zheng said, speaking about the overseas trials.

Still, Chinese officials have said they are awaiting results from overseas trials for several leading vaccine candidates before starting distribution on a larger scale.

The government is under pressure to do just that. While the virus is largely under control in China, hundreds of millions of people are expected to travel domestically in the coming weeks for the Lunar New Year, which will be celebrated in February. The fear is that the mass travel could turn isolated Covid-19 clusters into much larger ones, as it did last winter.

In rolling out the untested coronavirus vaccines, the government said it is prioritizing health care professionals, pilots and others at an elevated risk for contracting the virus. People who work in the food import industry are also being given priority.

The government has pushed the idea, without evidence, that the virus has spread on a large scale in China from meat, seafood and other products imported from overseas.

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Protest at Hospital That Left Frontline Workers Off Vaccine List

Healthcare workers at Stanford Medical Center in Palo Alto, Calif., protested a Covid-19 vaccine prioritization plan that left out the majority of the hospital’s medical residents and fellows.

[chanting] “First in the room!” — “back of the line!”

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Healthcare workers at Stanford Medical Center in Palo Alto, Calif., protested a Covid-19 vaccine prioritization plan that left out the majority of the hospital’s medical residents and fellows.

This week, some 5,000 doses of Pfizer’s newly authorized coronavirus vaccine arrived on the grounds of Stanford Medical Center in Palo Alto, Calif. — a windfall for frontline health workers eager to receive their first dose of the lifesaving injection.

But a flawed prioritization plan failed to include the vast majority of the hospital’s medical residents and fellows, instead opting to give many of the first jabs to employees who don’t interact heavily with sick patients.

On Friday morning, scores of masked clinicians gathered on the hospital campus to protest being passed over. By the afternoon, the hospital had buckled to their demands and begun vaccinating some of those left off the list — but the system rapidly devolved into a first-come, first-serve situation.

Of the 5,000 people tapped by the hospital to receive the first injections, only seven were medical residents — a paltry fraction of the more than 1,300 in the institution’s cohort. Also left out were many fellows and nurses who have spent countless shifts attending to people hospitalized with Covid-19. (Pfizer’s vaccine requires two doses, three weeks apart, to take full effect. The hospital had banked on receiving a second batch to complete the process.)

“I have done Covid-positive intubations, I have done Covid-positive procedures,” said Dr. Anna Frackman, a medical resident specializing in anesthesia. “We have put ourselves and our loved ones at risk. We think we should have been included.”

The prioritization plan, designed by researchers and ethicists, meant to list hospital personnel by highest risk of getting the virus and becoming seriously sick. It used an algorithm that assigned each person a crude risk score, taking into account factors such as age, job description and the number of coronavirus cases that had been detected in their hospital department. That resulted in personnel like environmental services workers, food service workers and older employees being shuttled to the front of the line.

Residents, who are early in their careers and tend to be young, rotate throughout the hospital to train with various teams of physicians, making them difficult to place in a designated unit. “So in that, it sounds like we all got zero points,” said Dr. Frackman, who had not seen the algorithm. (ProPublica also reported on the problems with the list.)

In an internal memo sent to a small group of Stanford Hospital administrative staff, hospital employees described the algorithm-based process as being carried out under pressure and time constraints. The Times obtained a copy of the memo.

The system also differs drastically from those used at other hospitals around the country to determine who gets injected first. Many other institutions have been able to prioritize environmental and food services workers as well — but not at the expense of health care providers treating Covid patients on a daily basis.

Hospital administrators were supposed to review the algorithmically generated list before distribution began, but “leadership review and revisions did not occur,” according to the memo, because of the fast-paced turnaround of the list and the amount of email and text messaging being sent back and forth between harried, overwhelmed hospital administrators.

“People are worn-out and frustrated by everything that is 2020,” the internal memo said. “The vaccination rollout, all well-intentioned, hit the perfect storm.”

Many attending physicians, who outrank residents and fellows, made it onto the hospital’s original list. In many cases, Dr. Frackman noted, their exposure is higher than those of their trainees. “Our attendings have made an effort to try to shield us from some of the risk,” she said. “But in all honesty, there is just too much Covid to shield us from the risk.”

In a statement released to hospital personnel on Friday, the Stanford Health Care executives David Entwistle, Paul King, Dr. Lloyd Minor, Dr. Niraj Sehgal and Dr. Dennis Lund acknowledged the “significant concerns” raised by the protests.

“We fully recognize we should have acted more swiftly to address the errors that resulted in an outcome we did not anticipate,” the statement said. “We recognize that the plan had significant gaps.”

The hospital executives also said they were “working quickly to address the flaws” in the plan and promised transparency during the modification process.

In a statement, Lisa Kim, a spokeswoman for Stanford Health Care, echoed these sentiments. “We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response,” the statement said. “We are immediately revising our plan to better sequence the distribution of the vaccine.”

A Pittsburgh Veterans Authority Medical Center worker received a Covid-19 vaccine on Thursday. Employers are uniquely positioned to require large numbers of Americans who otherwise would not receive a vaccination to do so.
A Pittsburgh Veterans Authority Medical Center worker received a Covid-19 vaccine on Thursday. Employers are uniquely positioned to require large numbers of Americans who otherwise would not receive a vaccination to do so.Credit…Jeff Swensen/Getty Images

Employers can require workers to get a Covid-19 vaccine and bar them from the workplace if they refuse, the federal government said in guidelines issued this week.

Public health experts see employers as playing an important role in vaccinating enough people to reach herd immunity and get a handle on a pandemic that has killed more than 300,000 Americans. Widespread coronavirus vaccinations would keep people from dying, restart the economy and usher a return to some form of normalcy, experts say.

Employers had been waiting for guidance from the U.S. Equal Employment Opportunity Commission, the agency that enforces laws against workplace discrimination, because requiring employees be tested for the coronavirus touches on thorny medical and privacy issues covered by the Americans With Disabilities Act of 1990.

The guidance, issued on Wednesday, confirmed what employment lawyers had expected.

Businesses and employers are uniquely positioned to require large numbers of Americans who otherwise would not receive a vaccination to do so because their employment depends on it.

The disabilities act limits employers’ ability to require medical examinations like blood tests, breath analyses and blood-pressure screening. These are procedures or tests, often given in a medical setting, that seek information about an employee’s physical or mental conditions.

“If a vaccine is administered to an employee by an employer for protection against contracting Covid-19, the employer is not seeking information about an individual’s impairments or current health status,” it stated, “and, therefore, it is not a medical examination.”

President Emmanuel Macron of France spoke to the press in Paris on Wednesday, a day before the announcement that he had tested positive for the virus.
President Emmanuel Macron of France spoke to the press in Paris on Wednesday, a day before the announcement that he had tested positive for the virus.Credit…Thomas Coex/Agence France-Presse — Getty Images

President Emmanuel Macron of France said on Friday that he felt mostly fine but was working more slowly after being infected with the coronavirus, as he pleaded with the French to remain vigilant and warned that “no one is sheltered from this virus.”

“I am doing well,” Mr. Macron said in a video posted on Twitter that he appeared to have recorded on a hand-held smartphone. “I have the same symptoms as yesterday — that is to say fatigue, headaches, a dry cough.”

The video broke with France’s decades-old tradition of secrecy around the health of its presidents, whose medical histories and conditions are rarely aired in public.

Mr. Macron, who is isolating at an official presidential residence in Versailles, west of Paris, wore a black turtleneck and stood in an office with a desk and the French and European flags in the background. His wife, Brigitte Macron, has tested negative, and was expected to remain at the Élysée Palace in Paris.

He did not appear overtly sick, with no signs of difficult breathing, but he seemed less energetic and spoke more slowly than usual. He said he was continuing to handle important day-to-day affairs.

But he acknowledged that he was “a bit slowed down because of the virus.”

Mr. Macron said he would give daily updates on his condition, although he did not specify whether he would do so by video.

“There is normally no reason that things would take a turn for the worse, but I am closely monitored medically and I will update you in a totally transparent way,” he said.

He added a warning that the country had recorded more than 18,000 new infections on Thursday, saying, “We must remain vigilant.”

Mr. Macron did not say how he might have been infected. French officials have raised the possibility that he was exposed at a meeting of top European Union officials last week in Brussels.

“I am very protected, I am very careful, I follow distancing rules, I wear the mask, I use hydro-alcoholic gel regularly — and despite all that I caught the virus,” he noted. “Probably a moment of negligence, a moment of bad luck, too.”

Prime Minister Igor Matovic of Slovakia, who also attended the meeting, has also tested positive for the coronavirus, the government said Friday, offering no further details.

Some other officials who had been in proximity to Mr. Macron are taking extra precautions. Prime Minister Pedro Sánchez of Spain, who had lunch with Mr. Macron on Monday, suspended his official activities until Dec. 24. Portugal’s prime minister, António Costa, who lunched with Mr. Macron on Tuesday, planned to quarantine and get tested. Charles Michel, a top European Union official, went into quarantine after meeting with Mr. Macron on Monday, a spokesman said.

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Virus Shutdown ‘Totally Avoidable,’ Cuomo Says

At a Friday news conference, Gov. Andrew M. Cuomo of New York said that a coronavirus shutdown was avoidable if New Yorkers continued to take precautions.

Big question: Will we have shutdowns? It’s a question everybody asks me. Nobody can answer that question today — people can have opinions, but it is purely up to us because it is a question of future actions. It will be determined by us, by what we do over the coming weeks. I do not believe that we are destined to have a shutdown. There is no destiny here — destiny is what we make it. The future is what we make it. It is totally in our control and a shutdown is totally avoidable. Totally — I believe New Yorkers can slow the spread, and that hospitals can manage the increase. Those are the two variables.

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At a Friday news conference, Gov. Andrew M. Cuomo of New York said that a coronavirus shutdown was avoidable if New Yorkers continued to take precautions.CreditCredit…Spencer Platt/Getty Images

New York State broke its record for most positive tests reported on a single day on Friday, according to a New York Times database and analysis.

Officials in New York State announced 12,606 new cases on Friday, The Times found, a single-day record that exceeds a previous high of 12,274 cases recorded on April 4, when testing was less widely available and significantly fewer tests were being conducted.

But there was also a rare bit of good news: The number of people hospitalized with the virus in the state decreased on Thursday for the first time since late October, Gov. Andrew M. Cuomo said on Friday.

It was unclear whether the decrease — a drop of 66 patients from a day earlier — was a single-day dip or the beginning of a larger trend. Hospitalizations in the state have increased steadily since late September, and occasional drops have been followed by prolonged increases.

For weeks, Mr. Cuomo has offered dire warnings that parts of New York could be headed for new restrictions on businesses if sustained increases in hospitalizations continued. In an interview with The New York Times last week, the governor said that New York City could be shut down “within a month” if its growth in hospitalizations continued at its current pace.

On Friday, Mr. Cuomo sounded more optimistic, at one point telling a reporter that he “would wager” the state would not shut down. So far, no hospital in the state had told officials that it was on track to reach 85 percent of its maximum capacity in three weeks, the threshold at which Mr. Cuomo has said he would consider enacting restrictions on businesses and activities.

“I believe we can avoid a shutdown,” he said at a news conference. “I believe we will avoid a shutdown, I’ll go that far.”

The governor also said that 19,000 people in New York had received the Pfizer-BioNTech vaccine so far. The state has also approved the use of extra doses of the vaccine that had been found by pharmacists in hospitals around the country.

“This is now a footrace between the vaccine and Covid,” Mr. Cuomo said.

Later, health officials in New York City said that 11,152 people there had received their first dose of the vaccine.

But Mayor Bill de Blasio also warned of troubling increases in the number of cases, people hospitalized and the positive-test rate in the city.

On Friday, he reported that the city’s latest seven-day average positive-test rate was 6.16 percent, while the seven-day average of new probable and confirmed cases had climbed “through the roof, honestly,” to 2,805.

A United Airlines airplane takes off over a plane on the runway at San Francisco International Airport.
A United Airlines airplane takes off over a plane on the runway at San Francisco International Airport.Credit…Jeff Chiu/Associated Press

United Airlines said on Friday that it was working with health officials to contact passengers who might have been exposed to the coronavirus by a male passenger who died after a medical emergency on a recent flight.

The four flight attendants who responded to the emergency on board the flight, United 591, also went into quarantine for 14 days after the plane landed at its destination in Los Angeles, the flight attendants’ union said.

The flight, which took off from Orlando, Fla., and was diverted to New Orleans, prompted widespread alarm on social media after reports indicated that the man’s wife had told emergency medical workers that he had tested positive for the virus.

United Airlines said on Friday that the man’s wife was overheard telling an emergency medical worker that her husband had symptoms of Covid-19, including loss of taste and smell.

But United officials said medical professionals did not confirm at the time that the man had tested positive for the virus, and they are still not sure if he was infected. When the flight was diverted to New Orleans, the airline said, it was told that the passenger had experienced cardiac arrest.

It was only after the plane continued on to Los Angeles that the officials learned that the man’s wife had expressed concern that he had symptoms of Covid-19.

United Airlines said it had been contacted by the Centers for Disease Control and Prevention. “We are sharing requested information with the agency so they can work with local health officials to conduct outreach to any customer the C.D.C. believes may be at risk for possible exposure or infection,” the airline said.

With her semester at Mercer University in Georgia complete, Skylar Mack, 18, flew down to the Cayman Islands in late November to watch her boyfriend compete in the islands’ jet ski racing national championship.

When she arrived, however, there was a problem.

She got there on a Friday; the championship was on Sunday. And per the country’s laws, she was required to remain in her hotel room for 14 days before going anywhere on the islands.

To elude the restrictions, Ms. Mack, after receiving a negative coronavirus test, slipped an electronic monitoring bracelet from her wrist and escaped to a beach on Grand Cayman’s South Sound, where she saw her boyfriend, Vanjae Ramgeet, 24, win first place.

But the authorities found out, and Ms. Mack and Mr. Ramgeet were sentenced this week to four months in prison for the quarantine breach.

“This was as flagrant a breach as could be imagined,” Justice Roger Chapple said in court during the sentencing, according to the Cayman Compass. “It was borne of selfishness and arrogance.”

The islands, a British territory of nearly 65,000 residents, have reported 310 infections and two deaths.

Ms. Mack’s relatives in suburban Atlanta are now scrambling to pull together letters from friends and family attesting to her character in an effort to get the sentence overturned on appeal, said Jeanne Mack, Ms. Mack’s grandmother.

Jeanne Mack has even written to President Trump for help. She received a response from the Office of Presidential Correspondence, dated Thursday, stating that her correspondence had been forwarded “to the appropriate federal agency for further action.”

The family and Skylar, a junior pre-med student, make no illusions about what happened, Jeanne Mack said: What she did was wrong.

“I’ll do everything to get you home, and when I get you here, I’m going to kick your butt,” Ms. Mack, 68, said of her sentiment toward her granddaughter. “We’re not saying, ‘poor, innocent Skylar.’ We’re simply saying the punishment does not meet the crime.”

Skylar Mack pleaded guilty to breaking the quarantine rules and was initially sentenced to 40 hours of community service and a fine. But the punishment was increased after the prosecutor appealed.

She and her boyfriend were the first to be sentenced under a new law that allows for up to two years in prison and a $12,000 fine for quarantine violations, according to The Associated Press.

Jeanne Mack said that her granddaughter was scheduled to appear before a panel of judges on Tuesday that will decide whether her appeal can proceed. If it can, then the family hopes that she will be released on bond pending the appeal.

GLOBAL ROUNDUP

Medical workers prepare to administer coronavirus tests at a theater in Le Havre, France, on Monday. France is a member of Covax, an international group that has negotiated for vaccine doses, including for low- to middle-income countries.
Medical workers prepare to administer coronavirus tests at a theater in Le Havre, France, on Monday. France is a member of Covax, an international group that has negotiated for vaccine doses, including for low- to middle-income countries.Credit…Andrea Mantovani for The New York Times

Leaders of an international body established to promote global access to coronavirus vaccines, known as Covax, announced on Friday that the effort had reached additional deals with manufacturers that would allow it to access nearly two billion doses of candidate vaccines, more than half of them intended to be delivered to low- and middle-income countries.

The effort’s goal is to ensure vaccination for a fifth of the population of its 190 participating countries and economies before the end of next year.

The new deals involve vaccines that are still being studied for effectiveness and safety, one made by AstraZeneca and the University of Oxford and another by Johnson & Johnson. While discussions have been underway, no arrangements have yet been finalized to procure the FDA-approved BioNTech-Pfizer vaccine that is already being administered in countries including the United States and Britain.

The international effort has been led by the public-private health partnership known as Gavi, the Vaccine Alliance, as well as the Coalition for Epidemic Preparedness Innovations and the World Health Organization.

Friday’s announcement included the news that a mechanism had been developed so that countries with excess doses could share them.

Many high-income nations have made arrangements with multiple manufacturers that could result in significantly more doses than needed to vaccinate their entire populations. Officials from Canada and France announced that they intended to contribute their extra doses through Covax, although they did not specify a timeline, or say whether they would vaccinate their entire populations first.

France will “start sharing vaccines as early as possible,” Stephanie Seydoux, the country’s ambassador to global health, said at a news conference.

  • In other developments around the world:

  • In South Africa, scientists and health officials announced on Friday the discovery of a new lineage of the coronavirus that has quickly come to dominate samples of virus tested in the country. The variant, named 501.V2, has also been associated in a preliminary analysis with faster spread and a higher load of virus found in swabs. Scientists are examining it closely because the variant includes several changes in the part of the virus that allows it to attach to human cells, which is a key target for antibody therapies and vaccines.

  • In Europe, a patchwork of policies are in place across the continent in the lead-up to Christmas as deaths pass 500,000. . Germany has introduced a strict lockdown for Christmas week, and the Netherlands and Italy will have more stringent measures in place over the holiday. France and Spain have some restrictions in place, but have resisted full new national lockdowns. In Britain, Prime Minister Boris Johnson has been criticized for lifting restrictions on Christmas gatherings even as new infections spike. The World Health Organization’s regional director Dr. Hans Henri P. Kluge said in a statement on Friday that now was not the time for Europeans to loosen restrictions.

  • As coronavirus cases and hospitalizations continue to rise in Sweden, the government issued several new recommendations Friday, including the use of face masks. “We need to do more now because the medical system is strained,” Prime Minister Stefan Lofven said. Included in the new recommendations is a four-person per table limit in restaurants, cafés and bars and a ban on the sale of alcohol after 8 p.m. Stores, shopping centers and gyms are asked to further limit the number of customers.

U.S. roundup

At least two federal prisoners on death row have tested positive for the coronavirus.
At least two federal prisoners on death row have tested positive for the coronavirus.Credit…Ting Shen for The New York Times

A second federal inmate scheduled for execution next month has tested positive for the coronavirus, according to his lawyers.

Corey Johnson, 52, is scheduled for execution by lethal injection at the federal prison complex in Terre Haute, Ind., on Jan. 14. As of Friday afternoon, 177 inmates at U.S. Penitentiary Terre Haute, the high-security prison that houses Mr. Johnson and much of the federal death row, had “active cases” of the virus, according to the Bureau of Prisons.

Another inmate at the penitentiary who is scheduled for execution the next day, Dustin John Higgs, has also tested positive.

“Not surprisingly, given the growing outbreak on federal death row, Corey Johnson also has now tested positive for Covid-19,” Donald P. Salzman and Ronald J. Tabak, lawyers for Mr. Johnson, said in a statement. “The government must stop conducting executions during a Covid-19 outbreak in the facility, and we have called on the Department of Justice to withdraw Mr. Johnson’s execution date.”

The lawyers said that their client’s infection would interfere with their ability to have meaningful contact with him in the critical days before his scheduled execution and that they intended to ask the courts to intervene if the government did not withdraw his execution date. They also contended that the outbreak on federal death row confirmed the “reckless disregard for the lives and safety of staff, prisoners, and attorneys alike.”

The inmates who have tested positive account for about 14 percent of the penitentiary’s population, and an additional 206 inmates have contracted the virus and recovered.

Mr. Higgs and Mr. Johnson are far from the first individuals close to the executions to contract the coronavirus. After the government put Orlando Hall to death in November, eight members of the execution team tested positive, five of whom intended to travel to Terre Haute for the December executions, according to a court declaration from a bureau official.

Two lawyers for a woman who was scheduled for execution in December also contracted the virus after visiting their client. After a court order, the government rescheduled her execution for January.

If the federal government were to postpone Mr. Higgs’s and Mr. Johnson’s executions more than a few days, it is unlikely they would be put to death in the near future. President-elect Joseph R. Biden Jr., whose inauguration is scheduled for Jan. 20, has pledged to work to end the federal death penalty as part of his criminal justice platform.

Mr. Johnson was convicted of seven counts of murder in 1993. Prosecutors said the murders were connected to drug-trafficking activity. Two of his co-conspirators remain on death row without scheduled execution dates.

Lawyers for Mr. Johnson have claimed that he has an intellectual disability, and the federal government is therefore barred from executing him under Supreme Court precedent.In other developments around the United States:

  • Officials around the country are tightening restrictions ahead of expected Christmas and New Year holiday gatherings. In the latest example, Muriel E. Bowser, the mayor of the Washington, D.C., said in an order on Friday night that indoor dining would be suspended for three weeks from the evening of Dec. 23. Restaurants will still be allowed to deliver and to offer outdoor dining. Mayor Bowser’s order said that the number of people hospitalized in Washington in mid-December had doubled from a month earlier, to 246, with 80 of those patients in intensive care units. The city has reported 728 deaths and more than 26,000 cases during the pandemic.

  • The sheriff of Wayne County, Mich., died from the coronavirus on Thursday, becoming the latest and one of the most prominent members of law enforcement to succumb to the pandemic. Benny Napoleon, 65, had been the sheriff of the county, which includes Detroit, since 2009. He is the third known member of the sheriff’s office to die from the virus.

  • Penn State, one of the nation’s largest universities, announced Friday that it would delay returning students to campus for the spring semester by at least four weeks, requiring them to take classes remotely during that time. The news came just two days after state officials advised colleges to delay in-person classes. The announcement signals that some colleges could have second thoughts about bringing more students back to campus.

Sophia Allan, right, a licensed vocational nurse, preparing a Pfizer vaccine shot for Monica Escopete, a registered nurse at Providence St. Mary Medical Center in Apple Valley, Calif. 
Sophia Allan, right, a licensed vocational nurse, preparing a Pfizer vaccine shot for Monica Escopete, a registered nurse at Providence St. Mary Medical Center in Apple Valley, Calif. Credit…Ariana Drehsler for The New York Times

Allergic reactions reported in two health workers who received a dose of the Pfizer-BioNTech vaccine in Alaska this week have reignited concerns that people with histories of extreme immune flare-ups might not be good candidates for the newly cleared shots.

The two incidents follow another pair of cases in Britain. Three of the four were severe enough to qualify as anaphylaxis, a severe and potentially life-threatening reaction. But all four people appear to have recovered.

Health officials in both countries are vigilantly monitoring vaccinated people to see if more cases emerge. On Thursday, Dr. Doran Fink, deputy director of the Food and Drug Administration’s clinical division of vaccines and related products applications, addressed the issue during a meeting about the vaccine made by Moderna, which contains similar ingredients and is expected to soon receive emergency use authorization from the agency.

“We anticipate that there may be additional reports, which we will rapidly investigate,” Dr. Fink said, adding that robust surveillance systems were in place to detect these rare events.

Still, Dr. Fink said that “the totality of data at this time continue to support vaccinations under the Pfizer E.U.A., without new restrictions.”

Health officials are investigating, but no direct link to the vaccine so far has been identified publicly.

There’s no evidence that people with mild allergies, which are quite common, need to avoid the vaccine. On Monday, the American College of Allergy, Asthma and Immunology released guidance stating that people with common allergies “are no more likely than the general public to have an allergic reaction to the Pfizer-BioNTech Covid-19 vaccine.”

Even most people with a history of severe allergies should be good to go, too, said Dr. Eun-Hyung Lee, an allergy and immunology expert at Emory University.

People with a history of anaphylaxis to any other substance, including other vaccines or injectable drugs, can still get the vaccine, but should consult with their health care providers and be monitored for 30 minutes after getting their shots. Everyone else, like people with mild or no allergies, need to wait 15 minutes before leaving the vaccination site.

Guidelines released by the Centers for Disease Control and Prevention identified one group of people who might not want to get the Pfizer vaccine: those with a known history of severe allergic reactions to an ingredient in the injection.

Many people with allergies have asked questions about whether they should get the vaccines and what is known about them.

For more information on the allergic reactions documented so far, and what advice experts offer on the matter, here is our explainer.

Senator Mitch McConnell, the majority leader, in the Capitol on Friday.
Senator Mitch McConnell, the majority leader, in the Capitol on Friday.Credit…Anna Moneymaker for The New York Times

The House and Senate on Friday night passed a two-day temporary spending bill to stave off a weekend government shutdown and buy lawmakers more time to strike a sweeping year-end deal as negotiations over another stimulus package dragged on.

President Trump was expected to sign the short-term spending bill, punting the threat of a government shutdown until midnight on Sunday.

Negotiators in both chambers insisted they were still optimistic about reaching a stimulus deal in the coming days and talks are expected to continue through the weekend. But negotiations over the $900 billion proposal were snagged by a Republican attempt to curb the Federal Reserve’s emergency lending powers, and rank and file lawmakers began to grow antsy late Friday as their leaders continued to fight over details in the coronavirus package.

“We are hopeful that they will reach agreement in the near future,” Representative Steny H. Hoyer of Maryland, the majority leader, said after the vote, referring to stimulus talks. “They have not reached one yet. There are still some significant issues outstanding.”

In a sign of the growing discontent, Senator Bernie Sanders, independent of Vermont, had threatened to object to the must-pass short-term government funding measure as leverage to secure an additional $600 in direct payments in the final stimulus package that lawmakers are haggling over, which would bring the total to $1,200.

The scramble came as President-elect Joseph R. Biden Jr. pushed back on a Republican effort to use the emerging stimulus deal to bar the Fed from restarting a series of pandemic relief programs, weighing in on a last-minute dispute that was hampering final agreement on the $900 billion package.

The proposal, which would bar the central bank from reviving emergency lending efforts that expire at year’s end and potentially limit its ability to fight future financial crises, emerged on Friday as perhaps the thorniest point of contention holding up the stimulus agreement. It could take away some of the Fed’s power as a “lender of last resort,” and curtail Mr. Biden’s latitude in dealing with the continuing economic fallout from the pandemic.

[Read more about the fight over the Fed’s programs.]

In a statement, Brian Deese, whom Mr. Biden has selected to chair the National Economic Council, argued that the measure “could put our future financial stability at risk.”

“The package should not include unnecessary provisions that would hamper the Treasury Department and the Federal Reserve’s ability to fight economic crises,” Mr. Deese said. “As we navigate through an unprecedented economic crisis, it is in the interests of the American people to maintain the Fed’s ability to respond quickly and forcefully.”

Senator Patrick J. Toomey, the Pennsylvania Republican who was spearheading the effort to rein in the Fed, dismissed the Democrats’ criticism, arguing in a statement that his proposal “affects a very narrow universe of lending facilities and is emphatically not a broad overhaul of the Federal Reserve’s emergency lending authority.”

A senior Democratic aide said that an agreement had been in sight before Mr. Toomey moved to insert a measure to bar a future Treasury secretary from restarting Fed emergency loan programs. The programs have kept credit flowing to medium-sized businesses, state and local governments and corporations amid the pandemic. Concern centered on the breadth of Mr. Toomey’s proposal: It would prohibit both those programs and any “similar” one, which could curb the Fed’s future ability to keep credit flowing to states and businesses.

The plan under discussion would provide a dose of badly needed relief after months of stalled negotiations and amid a national public health crisis that has killed more than 307,000 people.

That includes a new round of stimulus payments, probably $600, to American adults; a temporary infusion of enhanced federal jobless aid of around $300 per week; and rental and food assistance. It would also revive a loan program for struggling small businesses and provide funding for schools, hospitals and the distribution of the vaccine.

With 43 locations scattered across the United States, Fogo De Chão has been dealing with a patchwork of pandemic regulations. At this location, in Rosemont Ill., only two panels of an outdoor structure must be kept open.
With 43 locations scattered across the United States, Fogo De Chão has been dealing with a patchwork of pandemic regulations. At this location, in Rosemont Ill., only two panels of an outdoor structure must be kept open.Credit…Lyndon French for The New York Times

Executives at the Brazilian steakhouse chain Fogo de Chão thought they had seen the worst of it.

Earlier in the year, when seemingly each hour brought news of another city or state shutting down because of the pandemic, executives switched from email to the messaging system WhatsApp to communicate in real time with the general managers of their 43 locations scattered across the United States.

“The first time we heard a state issue a stay-at-home order we were like, ‘What does that mean? What are they talking about?’” Barry McGowan, the company’s chief executive, said. “Then it was like dominoes falling. Boom. Boom. Boom.”

Communicating with vendors was a hit or miss. Trucks full of food pulled up to restaurants that had been closed.

The restaurant chain created a takeout menu in three days. It reached out to landlords to negotiate breaks on its leases. And as mandates to stay closed were lifted, it spent about $1 million renting tents and other equipment to set up outdoor dining in places where indoor dining was still restricted.

For a while, it worked. Diners flocked to the restaurants and spent lavishly. Before the pandemic, Fogo de Chão sold about 500 premium steaks, like Wagyu and Tomahawk rib-eyes, per week. That shot up to 1,300 per week by July.

But with virus cases rising again across the country, new restrictions have been placed on indoor and outdoor dining — no indoor dining in Philadelphia, Chicago and New York City; indoor dining curfews in New Jersey and Massachusetts; no restaurant dining at all in much of California.

For larger dine-in chains like Fogo de Chão, the ever-changing patchwork of rules poses a particular logistical challenge: How do you come up with a companywide approach when different locations are dealing with their own specific regulations?

“What you have is a massive deviation from standard in terms of how a chain is operating restaurant locations in different states, which then requires a whole set of processes and management to make sure that you comply with the regulations,” said Sean Ryan, a partner at Kearney, a consulting firm. “It’s costly and time consuming.”

Women watched U.S. troops patrol  the roads of the northeastern Syrian town of Al Jawadiyahin, near the border with Turkey, on Thursday. The coronavirus is surging in Syria, which has little capacity to cope with another crisis.
Women watched U.S. troops patrol  the roads of the northeastern Syrian town of Al Jawadiyahin, near the border with Turkey, on Thursday. The coronavirus is surging in Syria, which has little capacity to cope with another crisis.Credit…Delil Souleiman/Agence France-Presse — Getty Images

Syrians living in bomb-scarred cities have long had to deal with a kneecapped health system that can barely handle the basic needs of the country’s exhausted population. Now, like the rest of the world, Syrians are facing the coronavirus. And detected cases are skyrocketing.

The U.N. Security Council, which met on Wednesday to discuss the humanitarian situation in Syria, reported that cases had more than quadrupled in October and November compared with the previous two months.

Syria has no organized independent data collection, and government data and propaganda tend to obscure the country’s difficulties. For instance, the Syrian Ministry of Health reported a total of 8,580 infections as of Dec. 9, while the Security Council, relying on reports from inside the country, counted at least 30,000 at the start of the month. Many say the true numbers are likely far greater.

“There is no doubt the Covid-19 infection and mortality rates for Syria are vastly undercounted and underreported,” said Dr. Michele Heisler, medical director at the nonprofit Physicians for Human Rights and a professor of internal medicine and public health at the University of Michigan.

The undercounts, coupled with the disastrous state of Syria’s hospitals after a decade of civil war and a severe lack of medical professionals, leave millions of people at risk of grave consequences if they become infected. Emergency doctors make up just 0.3 percent of the country’s public hospital workers, according to the World Health Organization.

“For years, the Syrian government and its Russian allies have attacked health workers and facilities as a strategy of war, resulting in a battered health system ill equipped to respond to the pandemic,” Dr. Heisler said.

Since the beginning of the conflict in 2011, Physicians for Human Rights has documented 595 attacks on health facilities in Syria. The group attributed about 90 percent of them to the Syrian government or its Russian allies, and has also recorded the killing of 923 medical professionals.

Some parts of Syria do not have access to clean water, sanitation or power. Widespread privation means that masks and soap come last on shopping lists. Conditions in camps for Syrians displaced by the war are often even worse, with open sewage and overcrowding fostering the spread of disease.

“Social distance is a fantasy in a camp, but if we’re going to prevent a massive outbreak, we need to make it a reality,” Kieren Barnes, the Mercy Corps country director for Syria, said in March.

In order to receive care, many coronavirus patients have had to pay bribes for hospital admission and oxygen supplies, according to a Physicians for Human Rights report released on Wednesday.

Dr. Heisler pointed to the stoppage of cross-border aid, inequitable access to health care and severe disparities in the government’s distribution of humanitarian supplies to explain why the health system’s “ability to respond to the pandemic as well as to other diseases is tremendously compromised.” There is also little testing capacity and a shortage of personal protective equipment.

“I don’t know that we’ll ever know the true scale of it,” a humanitarian worker focused on southern Syria told the group’s researchers. “The toll has got to be in the tens of thousands, if not higher. Every bed is full.”

A vaccination center in Frankfurt, Germany.
A vaccination center in Frankfurt, Germany.Credit…Ralph Orlowski/Reuters

A Belgian government minister released, and then quickly deleted, a Twitter post late Thursday containing prices that the European Union has negotiated to pay pharmaceutical companies for coronavirus vaccines.

The prices had been kept secret by the European Commission, the bloc’s executive, which is negotiating on behalf of its 27 member states and ordering doses for the 410 million people living in the vast region.

The new information comes days before the bloc is expected to approve its first vaccine for use across the region, which will set off an ambitious and logistically challenging inoculation campaign, as cases surge across much of the European Union.

The price list, briefly released by Belgium’s budget state secretary, Eva De Bleeker, showed that the Pfizer-BioNTech vaccine, which is set for approval on Monday in the bloc and is being administered in the United States and Britain, will cost 12 euros, or $14.70, per dose, bringing the cost per person to €24, as each person is supposed to receive two doses.

That is markedly lower than the company’s official price, which has been announced at $19.50 per dose.

The Moderna vaccine, which is the next in line for E.U. approval, on Jan. 6, and is expected to receive authorization from the U.S. Food and Drug Administration for emergency use on Friday, is costing the E.U. $18 per dose, the table showed. The company had said it was looking to charge $25 to $37 per dose.

A European Commission spokesman declined to comment on the price list, saying that the negotiated agreements were “covered by confidentiality,” but did not dispute the pricing.

A spokesman for Ms. De Bleeker said that she had tweeted the details to settle a political debate in Belgium, where opposition politicians are accusing the government of not setting aside enough money to buy the vaccines.

“We were trying to be transparent, but it seems we were a bit too transparent,” Bavo De Mol, the spokesman, said.

Global Roundup

In Berlin this week. Germany’s health authorities registered 33,777 new coronavirus infections on Thursday, a daily record.
In Berlin this week. Germany’s health authorities registered 33,777 new coronavirus infections on Thursday, a daily record.Credit…Lena Mucha for The New York Times

Chancellor Angela Merkel of Germany paid a virtual visit on Thursday to the headquarters of BioNTech, the German company behind the mRNA vaccine created in partnership with Pfizer. Their coronavirus vaccine is the first to be approved for emergency use in countries including the United States, Britain and Canada.

“We are incredibly proud to have such researchers in our country,” Ms. Merkel, herself a quantum chemist by training, said in opening remarks delivered by video. She also congratulated Ugur Sahin and Ozlem Tureci, the husband-and-wife founders of BioNtech, and their team.

The event was a point of light on an otherwise somber day in Germany, as the health authorities registered 33,777 new coronavirus infections, a daily record. There were also 813 daily deaths recorded, the second worst daily toll since the pandemic began.

The European Union is expected to approve the Pfizer-BioNTech vaccine next week, officials said on Thursday.

Germany expects to receive 11 million to 13 million doses of the vaccine once it is approved and will begin administering doses on Dec. 27, the country’s health minister, Jens Spahn, said on Friday. The first to receive it will be people over 80 and residents of nursing homes, followed by the nurses and doctors who care for them, Mr. Spahn said.

Vaccinations will be voluntary, and Mr. Spahn said that officials would like to see as many people as possible accept the shots. He urged people to be patient, however, and to continue following regulations on wearing masks, washing hands and keeping a safe distance from others.

Other coronavirus news from around the world:

  • India was about 20,000 cases away on Friday from recording its 10 millionth coronavirus infection. The country’s total caseload is the world’s second-largest after the United States. Tens of millions of migrant workers were stranded after Prime Minister Narendra Modi imposed a national lockdown in March, and the emergency trains that carried them back to their villages spread the coronavirus across the country. India has reported 144,789 Covid-19 deaths, the third-largest toll after the United States and Brazil.

  • Spain’s northeastern region of Catalonia on Friday announced a tightening of lockdown restrictions as infections skyrocket. The rules, which will be in effect from Monday through at least Jan. 11, limit the size of groups allowed to gather and tighten restrictions on restaurants and bars. Several other Spanish regions have also introduced new measures in recent days. On Thursday, Valencia limited family gatherings to six people, while the Balearic archipelago said it would require visitors from the Spanish mainland to produce a negative coronavirus test result before arrival.

An emergency worker speaking with a 77-year-old woman with Covid-19 symptoms before she was taken to a hospital in Yonkers, N.Y., on Thursday.
An emergency worker speaking with a 77-year-old woman with Covid-19 symptoms before she was taken to a hospital in Yonkers, N.Y., on Thursday.Credit…John Moore/Getty Images

After accelerating through the fall, the coronavirus is spreading in the United States at a consistently rapid rate, with each day bringing an average of more than 200,000 new reported cases. Progress in some regions is roughly counteracted by deterioration in others. And while the rate seems to have steadied, ominous milestones are flying by.

The total number of confirmed infections surpassed 17 million on Thursday, five days after eclipsing the 16-million mark.

The increased availability of testing and growing public awareness have undoubtedly contributed to the pace at which cases are being confirmed. But testing doesn’t cause Covid-19 cases — it merely detects them. And the velocity of the pandemic that tests are detecting now continues to be high.

After the country’s first case was confirmed on Jan. 21, it took more than three months to reach a million cases. Even at the previous peak in July, when testing had become more readily available, it took 16 days to go from three million confirmed cases to four million.

The progress that the nation as a whole made by late summer in slowing the virus’s spread has been wiped out, and then some. Three months ago, new cases were trending downward and death reports were flat. But now there are nearly six times as many cases being reported each day, and three times as many deaths.

The virus has spread so widely now that in some communities nearly one in five residents has tested positive.

One state that has been through the wringer, North Dakota, had the highest Covid-19 mortality rate in the world at one point. After resisting doing so for months, Gov. Doug Burgum announced a mask mandate and restrictions on businesses in mid-November, and new cases have started ticking downward, although deaths have yet to subside.

Eddy and Foster counties, neighbors in the rural east central part of the state, are among the places where the pandemic is highly pervasive. Choose six people in those counties, and the odds are that at least one has tested positive.

“It’s terrifying,” said Tanis Walch, an associate professor of public health education at the University of North Dakota.

Dr. Walch said her students tallied how many people wore masks into grocery stores in a study over the summer, when the state had no mask requirement. They found that 34 percent of people did so — but the proportion almost doubled when the grocery chain said it would start requiring masks, even before the rule took effect.

More recently, the students have been monitoring mask wearing at gas stations. Many more people are wearing them now, she said, but compliance remains spotty.

Dr. Walch said she still heard a sentiment among fellow North Dakotans that they do not want anything to impinge on their personal freedom. She said a friend of hers had ignored warnings and held a Thanksgiving gathering with 22 family members. Eighteen have since tested positive, she said.

Now Dr. Walch is worried about Christmas. “It’s not a good time in North Dakota right now,” she said.

A subdued holiday spirit in Milan last week.
A subdued holiday spirit in Milan last week.Credit…Alessandro Grassani for The New York Times

With more than 500,000 people across Europe dead as a result of the coronavirus, and a growing mental health crisis on the continent, a World Health Organization official had a message for Europeans on Friday ahead of the Christmas holiday time: Stay home.

Dr. Hans Henri P. Kluge, the agency’s regional director for Europe, reflected on the “far-reaching and relentless fallout from the pandemic” and said in a statement that now was not the time to loosen restrictions.

“While families debate how to spend their holidays, I have a final appeal to make. There remains a difference between what you are being permitted to do by your authorities and what you should do,” he said. “The safest thing right now is to remain at home.”

He also addressed concerns around mental health during the pandemic, emphasizing that the psychological impact of lockdowns and the knock-on effects of unemployment and financial worries would be “long-term and far-reaching.”

“The mental health toll of Covid-19 will be compounded by anxieties that often present during the winter and holiday season,” he said. “We cannot underestimate the impact this can have on our friends, our families and our own mental health.”

A patchwork of policies are in place across Europe in the lead-up to Christmas as nations struggle to cope with a surge of new coronavirus infections while also contending with a two-week period that is traditionally a time for large family gatherings, travel and celebrations. Germany has introduced a strict lockdown for Christmas week, and the Netherlands and Italy will have more stringent measures in place over the holiday.

France and Spain have some restrictions in place, but have resisted full new national lockdowns. In Britain, Prime Minister Boris Johnson has been criticized for lifting restrictions on Christmas gatherings even as new infections spike.

Looking ahead to 2021, Dr. Kluge said there was “much to look forward to” with the early stages of vaccine rollout on the horizon, although he said that there would be “a few more months of sacrifice ahead.”

“When we look back on these unprecedented times,” he said, “I hope we all feel that we acted with a spirit of shared humanity to protect those in need.”

Prudence Dudu Khumalo had her nose swabbed before taking part in a Novavax vaccine trial in Johannesburg earlier this month. South African health officials have discovered a new variant of the coronavirus.
Prudence Dudu Khumalo had her nose swabbed before taking part in a Novavax vaccine trial in Johannesburg earlier this month. South African health officials have discovered a new variant of the coronavirus.Credit…Joao Silva/The New York Times

South African scientists and health officials announced on Friday the discovery of a new lineage of the coronavirus that has quickly come to dominate samples of virus tested in the country.

Scientists are examining this particular variant closely because it includes several changes in the part of the virus that allows it to attach to human cells, which is a key target for antibody therapies and vaccines.

The variant, named 501.V2, has also been associated in a preliminary analysis with faster spread and a higher load of virus found in swabs. It has not yet been linked to any difference in disease severity, and the findings have not yet been reviewed by other scientists or published in a journal.

“There is reason for concern that we have a virus that seems to be spreading rapidly,” Dr. Salim Abdool Karim, co-chair of the country’s ministerial advisory committee on Covid-19, said at a national news conference. He emphasized that public behavior was a major factor in driving the uptick in cases.

It is normal for viruses to collect tiny changes in their genetic sequences as they move through populations. Typically these changes, known as mutations, have little significance, and certain lineages can become more common by chance. But scientists across the world track them to assess whether they affect characteristics such as transmissibility, disease severity and the response to treatments and vaccines.

One of the mutations in the new South African variant, known as N501Y, is on the part of the sequence coding for the virus’s spike protein. It has been found in other countries, including Australia, which was able to control its spread, and Britain, which this week made a similar announcement that its new variant was most likely associated with faster spread in London, though a causal link has not yet been proven.

The new South African lineage now accounts for 90 percent of sequences analyzed in the country, an effort led by the Kwazulu-Natal Research Innovation and Sequencing Platform in Durban. “Clearly there’s still a lot of work to be done ahead,” Dr. John Nkengasong, director of the Africa Centers for Disease Control and Prevention, said at the news conference.

The police monitored a protest in Lansing, Mich., last month. Law enforcement officers are especially susceptible to contracting the coronavirus.
The police monitored a protest in Lansing, Mich., last month. Law enforcement officers are especially susceptible to contracting the coronavirus.Credit…Emily Elconin for The New York Times

The sheriff of Wayne County, Mich., died from the coronavirus on Thursday, becoming the latest and one of the most prominent members of law enforcement to succumb to the pandemic.

Benny Napoleon, 65, had been the sheriff of the county, which includes Detroit, since 2009. The sheriff announced on Nov. 19 that he had tested positive for the virus and was hospitalized the next day. He is the third known member of the sheriff’s office to die from the virus.

“I cannot think of a leader in this town who has been more loved and admired than Benny,” Mayor Mike Duggan of Detroit, who defeated Sheriff Napoleon in the 2013 election, said in a statement. “He was born in the city, served our community courageously his entire adult life, and loved Detroit as much as anyone I’ve ever known.”

Since the earliest weeks of the pandemic, law enforcement officials have expressed great concern that, as emergency responders who regularly interact with the public, their ranks were particularly susceptible to infection. And indeed, the virus has taken its toll on law enforcement.

More than 300 law enforcement employees in the United States have died of Covid-19, according to a list compiled from media reports by the Fraternal Order of Police. The Officer Down Memorial Page, a nonprofit that memorializes law enforcement officers, has tallied 164 coronavirus-related deaths.

Sheriff Napoleon’s own brother, the police chief in Highland Park, Mich., overcame a severe bout of Covid-19, which had him in the hospital for about two and a half months and on a ventilator for part of that time.

Law enforcement agencies throughout the country have struggled with outbreaks that have sidelined hundreds of officers, with Detroit especially hard hit.

The Detroit Police Department, where Sheriff Napoleon was once the chief, had at least 180 infections in April, leading more than 1,000 officers to have to quarantine at some point. Even the department’s current chief, James Craig, tested positive.

The department has had to combat another outbreak more recently, with 62 police employees testing positive in the middle of last month and 92 in quarantine, according to The Detroit Free Press.

Penn State will start its spring semester classes online, delaying the return of students to campus amid rising coronavirus caseloads and hospitalizations in the state.
Penn State will start its spring semester classes online, delaying the return of students to campus amid rising coronavirus caseloads and hospitalizations in the state.Credit…Jeff Swensen for The New York Times

Penn State, one of the nation’s largest universities, announced Friday that it would delay returning students to campus for the spring semester by at least four weeks, requiring them to take classes remotely during that time. The news came just two days after state officials advised colleges to delay in-person classes.

“Students are strongly discouraged from returning to campus, off-campus locations and group dwellings” during the remote learning period, which will begin on Jan. 19, and residence halls and campus dining facilities will be closed, except in extenuating circumstances, the university’s announcement said.

In-person classes could resume on Feb. 15, Penn State said, depending on health and safety conditions and guidance from the state.

The university, a sprawling system with nearly 90,000 students on campuses statewide, said it was taking the action because officials watching the trajectory of the pandemic were “very concerned with the current outlook across the country and the commonwealth.” Its main campus in State College, Pa., has reported more than 5,000 coronavirus cases since the pandemic began, according to a New York Times tracking effort — one of the largest campus-based clusters in the country.

On Wednesday, Pennsylvania’s health and education departments advised colleges across the state to delay the return of students to campus and start the spring semester virtually. The state said cases and hospitalizations are expected to peak in January or February, just as students would normally be returning, and could overwhelm the hospital system.

The shift in Pennsylvania comes even as many colleges say that they have learned lessons from the fall term, including the need for more robust testing, and feel confident about bringing more students back to campus than they did in the fall, and offering more face-to-face classes.

But the announcement by Penn State signals that some colleges could have second thoughts. The university said its decision was “in alignment” with the recommendation from state health and education authorities.

Penn State students returning to off-campus housing before Feb. 15 would have to be tested before their arrival, officials said, and the university plans an “augmented testing strategy,” including random daily surveillance testing, for the spring.

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