As governments around the world rush to vaccinate their citizens, scientists and policymakers are locked in a heated debate over a surprising question: Is it wisest to hold back the second doses everyone will need, or to give as many people as possible an inoculation now — and push back the second doses?
Since even the first shot appears to provide some protection, some experts believe that the shortest route to containing the virus is to disseminate the initial injections as widely as possible now.
Officials in Britain have already decided to delay second doses of vaccines made by the pharmaceutical companies AstraZeneca and Pfizer as a way of more widely distributing the partial protection afforded by a single shot.
Health officials in the United States have been adamantly opposed to the idea. “I would not be in favor of that,” Dr. Anthony S. Fauci, the nation’s top infectious disease expert, told CNN on Friday. “We’re going to keep doing what we’re doing.”
The debate reflects frustration that so few Americans have gotten the first doses. The public rollout remained bumpy over the weekend. Seniors lined up early for vaccinations in one Tennessee town, but the doses were gone by 10 a.m. In Houston, the Health Department phone system crashed on Saturday, the first day officials opened a free vaccination clinic.
Mayor Eric Garcetti of Los Angeles, now a center of the pandemic, said that vaccine distribution was moving far too slowly. Hospitalizations of Covid-19 patients during the past month have more than doubled in California.
All of them are intended to be delivered in two doses on a strict schedule. The first injection teaches the immune system to recognize a new pathogen by showing it a harmless version of some of the virus’s most salient features. After the body has had time to study up on this material, as it were, a second shot presents these features again, helping immune cells commit the lesson to memory.
Clinical trials run by Pfizer-BioNTech and Moderna showed the vaccines were highly effective at preventing cases of Covid-19 when delivered in two doses separated by three or four weeks.
Some protection appears to kick in after the first shot of vaccine, although it’s unclear how quickly it may wane. Still, some experts now argue that spreading vaccines more thinly across a population by concentrating on first doses may save more lives than making sure half as many individuals receive both doses on schedule.
That would be a remarkable departure from the original plan. Since the rollout began last month in the United States, second shots of the vaccines have been held back to guarantee that they will be available for people who have gotten their first injections.
But in Britain, doctors have been told to postpone appointments for second doses that had been scheduled for January, so that those doses can be given as first shots to others. Officials are pushing the second doses of vaccines as far back as 12 weeks after the first.
In a regulatory document, British health officials said that AstraZeneca’s vaccine was 73 percent effective in clinical trial participants three weeks after the first dose was given and before the second dose.
But some researchers fear the delayed-dose approach could prove disastrous, particularly in the United States, where rollouts are already stymied by logistical hurdles and a patchwork approach to prioritizing who gets the first vaccinations.
“We have an issue with distribution, not the number of doses,” said Saad Omer, a vaccine expert at Yale University. “Doubling the number of doses doesn’t double your capacity to give doses.”
Federal health officials said last week that some 14 million doses of the Pfizer-BioNTech and Moderna vaccines had been shipped across the United States. As of Saturday morning, just 4.2 million people had gotten their first shots.
That number is likely an underestimate because of reporting lags. Still, the figure falls far short of the goal that federal health officials set as recently as December to give 20 million people their first shots by the end of 2020.
New York City will double the number of coronavirus vaccination sites in the city and broaden the pool of people who are eligible to be inoculated, Mayor Bill de Blasio said on Monday, in order to achieve his goal of administering one million doses in the city during January.
Mr. de Blasio told reporters at a news conference that New York State had added a number of categories of workers to the eligible list, including testing-site workers, contact tracers, dentists, physical therapists, police department medical staff, workers at specialized clinics, and outpatient and ambulatory care providers.
“We want to keep expanding those categories,” Mr. de Blasio said. “The more people that we can reach quickly, the better.”
There are currently about 125 vaccination sites in the city. Mr. de Blasio said he planned to open at least 125 more by the end of January. Dr. Dave A. Chokshi, the city health commissioner, said that the administration hoped to add at least 35 of the new sites by the end of this weekend.
“From this point on, seven days a week, 24/7, has to be the attitude and the approach,” Mr. de Blasio said.
The announcement came after some health experts expressed concern about the slow pace of vaccinations in the city since the vaccines became available.
At a separate news conference, Gov. Andrew M. Cuomo announced new measures to speed up inoculations, like a potential $100,000 fine for hospitals that do not use up their current supplies of vaccine by the end of this week and a requirement that facilities use future shipments within seven days of receipt, or face possible removal from distribution networks.
“We want those vaccines in peoples’ arms,” Mr. Cuomo said.
Dr. Chokshi noted that some of the first health care workers to be vaccinated in the city would be receiving the required second dose this week.
The latest coronavirus statistics Mr. de Blasio offered were grim. New York City has been averaging 3,976 new cases a day over the past week, he said, with about 9 percent of tests coming back positive.
“We obviously want to get back below 5 percent,” Mr. de Blasio said. “We’re going to push hard to get this number back down in the days and weeks ahead. Nothing will be more important than the vaccination effort to help us get there.”
For weeks, images of lawmakers from both parties getting their Covid-19 vaccinations have appeared on TV and across social media, in an effort to boost public confidence in the shots.
But there are now a few high-profile leaders who have chosen to forgo the early vaccines.
Gov. Andrew Cuomo of New York shared his stance on when he would get the vaccine sharply this week: “I’m not going to take the vaccine until the same people are eligible and it is available in the Black and Hispanic and poor communities in this state.”
Gov. Ron DeSantis of Florida said that he would wait until older Americans could get vaccinated. “It makes no sense for someone that’s 42 to jump ahead of someone that’s 70 years old,” he said.
President-elect Joseph R. Biden Jr., in his 70s, did not raise any eyebrows when he was inoculated. But other, younger politicians have chosen to be vaccinated, including Senator Marco Rubio in Florida, where the vaccine rollout is struggling.
The easy vaccine access for top elected officials, as regular Americans wait in long lines and distribution falls short of its goals, raises ethical questions: Should the nation’s leaders come before older Americans or those with severe health risks? On top of that, should their families and even congressional aides be at the front of the line? Republicans and Democrats alike have argued over the issue; Senator Rand Paul of Kentucky and Represenative Ilhan Omar of Minnesota both said it was not appropriate to jump the line.
“We have such a limited supply. There needs to be a decision made about priorities,” said Dr. Leana Wen, an emergency physician and Baltimore’s former health commissioner. “I understand at a certain level that elected officials need to be getting the vaccine for the purposes of continuity of government,” but, she added, “what is the most essential? Is it an I.C.U. physician or is it a congressional aide?”
She cited the guidelines from the Centers for Disease Control and Prevention, which prioritize high-risk and essential worker populations, and noted that many essential workers were less able to work remotely than politicians are.
“I think that really corrodes trust — when people don’t understand why the top-tier at-risk group isn’t the only group getting something,” said Arthur Caplan, the director of NYU Langone’s Division of Medical Ethics.
For other experts, though, the focus is on increasing public trust in the vaccine, and messiness in the priority groups is expected. “Trusted messengers” are key to vaccine confidence, said Lindsey Leininger, a Dartmouth professor who leads Dear Pandemic, a public education campaign about the pandemic.
There are also risks for the public perception in creating a “negative impression of people with influence and connections cutting in line, that undermines that whole notion of trust,” Dr. Caplan noted.
An 82-year-old in Britain became the first person in the world to receive the clinically authorized, fully tested coronavirus vaccine developed by the University of Oxford and AstraZeneca, adding another shot to the global inoculation effort.
The 82-year-old, Brian Pinker, a retired maintenance manager, was injected with the first dose of the vaccine at a hospital in Oxford, where he is a dialysis patient. Mr. Pinker said he was proud to receive the vaccine linked to his hometown.
Prof. Andrew Pollard, who was the lead investigator on the trial, also received the shot on Monday. “It was an incredibly proud moment for me to have received the actual vaccine that the University of Oxford and the AstraZeneca teams have worked so hard to make available to the U.K. and the world,” he said.
The Oxford-AstraZeneca shot is expected to become one of the dominant forms of inoculation because it is cheaper and easier to store than the Pfizer-BioNTech and Moderna vaccines. After the health regulator in Britain became the first to grant emergency authorization to the Oxford-AstraZeneca vaccine last week, India followed suit and many other countries are counting on the shots to help tamp down the pandemic.
Although Britain was the first to authorize and administer the Oxford-AstraZeneca shot — as it was with the Pfizer-BioNTech vaccine early last month — the country is in the grip of a severe surge in coronavirus cases.
A new strain of the virus has pummeled the country, with 54,990 new cases and 454 deaths recorded on Sunday, taking the total number of people killed by the virus in Britain to more than 75,000.
Scotland’s leader, Nicola Sturgeon, announced that a new lockdown will go into effect at midnight on Monday and will remain in place until at least the end of the month. People will be ordered to stay home unless for essential reasons, such as for caregiving responsibilities or exercise, and most students will return to remote learning.
The new variant of the coronavirus accounts for almost half of new infections in Scotland, Ms. Sturgeon said, as the country recorded 1,905 new cases on Monday. “I am more concerned about the situation we face now than I have been at any time since March last year,” she said.
Prime Minister Boris Johnson is facing calls to implement a new national lockdown in England and for all schools to be closed. Mr. Johnson on Monday said there was “no question” the British government would announce stricter measures “in due course.”
Thailand, which had been among the most successful countries in containing the coronavirus, imposed wide-ranging new measures on Monday as infections hit a new daily high of 745.
The prime minister, Prayuth Chan-ocha, urged people to stay home but stopped short of calling the new measures a lockdown, which would have prompted government compensation for people put out of work.
In Bangkok, the capital, the government closed schools, bars, entertainment venues and gyms. Employers were urged to allow working from home, but malls and cinemas were permitted to stay open and restaurants were allowed to serve food indoors until 9 p.m.
“This is up to everyone,” Mr. Prayuth told reporters. “If we don’t want to get infected, just stay home for 14 to 15 days.”
The announcement came as Japanese officials considered declaring a state of emergency in Tokyo for the first time since April. The authorities on Monday requested that restaurants and bars close by 8 p.m. to prevent further spread of the virus.
The capital had recorded a record high of 1,337 cases in one day last week, and the local government had already asked residents to refrain from all but essential outings at night. Companies have been encouraged to allow employees to work from home, and universities have been asked to move classes online.
Japan has not yet approved any coronavirus vaccines, but it has contracts to buy doses from Pfizer, Moderna and AstraZeneca.
The country has reported a total of more than 240,000 cases and more than 3,500 deaths, with several record-setting days in recent weeks. Last month, as Japan detected cases of the more transmissible variant of the coronavirus that first emerged in Britain, the government closed the borders to foreign travelers.
Thailand had seen greater success in avoiding outbreaks: Until mid-December, the country recorded about 6,000 cases and 60 deaths. Nearly all new cases were detected in quarantine, which is required for anyone arriving from abroad.
But an outbreak last month at a seafood market in Samut Sakhon Province near Bangkok quickly spread among migrant workers living in close quarters and, from there, to much of the rest of the country.
Of the 745 new cases reported on Monday, 577 were found among undocumented workers.
In China, where life is largely back to normal, “wartime mode” measures have been imposed in several regions in the north of the country, where officials are conducting mass tests, sealing off villages where there have been confirmed infections and limiting entry into certain districts. The health authorities reported 33 new cases and 40 asymptomatic cases, which the country does not designate as confirmed cases, in mainland China on Monday. Beijing has begun vaccinating adults under 60, using the state-backed Sinopharm vaccine.
And on Saturday in South Korea, the government said it would extend until Jan. 17 restrictions in and around Seoul that had shuttered schools, gyms, karaoke rooms, bars and other high-risk facilities. Those restrictions are at the second-highest level of a five-tier system, in a country whose pandemic response was once held up as a model.
The government in India has defended regulators’ decision to approve a homegrown coronavirus vaccine that is still under trial after opposition lawmakers and health care monitors said the authorization was a political move to burnish the image of Prime Minister Narendra Modi.
The approval for the shot, called Covaxin, which has been developed by the Indian company Bharat Biotech, came on Sunday, along with authorization for the Oxford-AstraZeneca vaccine.
With the approvals, India, which has a population of about 1.3 billion, became the first country in South Asia to authorize shots. Government figures have celebrated the Covaxin approval as a triumph for India and for a stimulus package introduced by Mr. Modi with the aim of making the country more “self-reliant.”
However, All India Drug Action Network, an independent network of nongovernmental organizations, expressed shock over the Covaxin authorization because the shot was still in Phase 3 trials.
“The only human data available on safety and immunogenicity is on 755 participants in Phase 1 and 2 trials,” the network said in a statement. “Other than this, there is data from animal studies.”
Other experts have also raised concerns, pointing out disparities in publicly available data about the vaccine’s effectiveness.
Dr. Gagandeep Kang, a medical researcher, said that although Bharat Biotech had published some information, the Phase 3 trial of Covaxin had started only in November.
“There is absolutely no efficacy data that has been published,” she said.
Shashi Tharoor, an opposition politician, posted a series of messages on Twitter on Monday, criticizing what he called “chest-thumping ‘vaccine nationalism’” and saying that the desire to bolster Mr. Modi’s stimulus campaign had “trumped common sense and a generation of established scientific protocols.”
But Dr. Harsh Vardhan, the Indian health minister, said such comments were “disgraceful.”
Dr. Vardhan said that all those receiving the Covaxin shots would be tracked and monitored as if they were in a trial and dismissed concerns about the vaccine’s success rate.
“We will not compromise on any protocol before approving a vaccine,” Dr. Vardhan said.
The N.C.A.A., in an attempt to limit the threat of coronavirus among teams, announced an agreement Monday to hold its signature men’s basketball tournament entirely in Indiana in March and early April.
The tournament includes 67 games and is usually held in numerous cities sprawled across the United States, culminating with the Final Four teams meeting in one city in April. This year’s Final Four — the tournament’s semifinals and final — was already scheduled for Indianapolis before the pandemic widely shut down American sports last year.
The N.C.A.A., which has its headquarters in Indianapolis, said the tournament would play out across six venues, detailing a plan it originally announced in November. The teams are scheduled to be selected on March 14, but the early rounds of the tournament have not been fully scheduled. With fewer courts, it will require some juggling to fit in all the games and practices.
The N.C.A.A. is working with local health officials in Marion County, where Indianapolis is, to determine safety protocols. Indiana has had a 17 percent decrease in new cases of the virus in the past two weeks, according to a New York Times database.
A limited number of family members for participating teams will be allowed at games, according to the announcement. However the organization said it would continue monitoring the pandemic before coming to a decision about allowing other spectators.
Teams will practice in the Indiana Convention Center and stay in hotels connected to the venue, with teams separated by hotel floors, unique dining and meeting rooms and “secure transportation to and from competition venues,” the N.C.A.A. said.
The 2021 women’s tournament is also set to play in one unique region, with the N.C.A.A. announcing in December that it was in preliminary discussions with officials in the San Antonio area to host. Both the 2020 men’s and women’s championships were among the first to be called off when the spread of the virus accelerated last March.
“The 2021 version of March Madness will be one to remember, if for no other reason than the uniqueness of the event,” Dan Gavitt, N.C.A.A.’s senior vice president of basketball, said in the announcement.
“This is going to be complicated and difficult; there’s no question about that,” he added.
Coronavirus will not kill the office, Dror Poleg writes for The Upshot.
The ability to work remotely will not drive most people away from cities and offices, but it will enable many to live and work in new ways and places — while causing its fair share of disruption, he argues.
Even before the pandemic, there were signs of trouble with the office market in the handful of cities where the so-called creative class had been flocking. In 2018, net migration to New York, Los Angeles and San Francisco was negative, while the U.S. economy grew at a healthy 2.9 percent. Creative magnets like London and Paris were experiencing similar declines.
The explanation for the declines — mostly high housing costs because of limits on new construction — obscures other forces that were destabilizing the traditional office market. In the middle of the 2010s, Amazon, Facebook, Google, Apple and others started splitting their headquarters into multiple locations.
For the fastest-growing companies, being able to tap into talent anywhere became more important than having all their teams in one place. Smaller cities were good enough.
There were more specific signs that the office market was headed for a crisis. While employers were fighting over talent, many employees found traditional offices lacking. In 2019, Leesman, a firm that measures employee experiences, analyzed how the workplace affects employee productivity, pride and enjoyment. Leesman found that nearly 40 percent of employees thought their workplace did not enable them to work productively.
Still, this data tells us little about the post-Covid world. Those who thrived initially might burn out if they stayed home for a more extended period. Those who struggled might do much better once they’ve mastered new tools. And the technologies that allow us to work, learn and socialize remotely will only get better.
Steve Max usually spends his winters telling big crowds at basketball arenas to put their hands up and to touch their shoulders and to cover their eyes. He travels the country entertaining fans at halftime.
Or at least that was his line of work until March, when the pandemic emptied arenas and rendered his microphone silent.
Though a few N.B.A. teams began the season with limited numbers of spectators — and some are allowing their dance teams to perform in the aisles — none are hiring halftime entertainers. Contortionists, acrobats, Frisbee-catching dogs — they are all biding their time, waiting for the show to go on.
Beyond the financial impact — halftime entertainers typically make $1,500 to $5,000 a show — the effects of the pandemic have been felt within their community. David Maas, who had a popular act called Quick Change with his wife, Dania Kaseeva, died of Covid-19 in November.
“My heart goes out to all my friends who are in this business,” said Jon Terry, a booking agent for halftime performers who is based in Oklahoma. “These are creative people, and in many cases, it’s their sole income. Some of these guys were making six-figure incomes.”
And they all can recall in vivid detail the day that everything changed.
On March 11, Simon Arestov and Lyric Wallenda Arestov, who are both 36, were at home in Sarasota, Fla., preparing to travel to New York so they could perform at the Big East Conference men’s basketball tournament.
At the time, the couple had a long list of N.B.A. halftimes lined up for the rest of the season. They were also planning to bounce among festivals and circuses during the summer. On average, they do about 400 shows a year.
Since March, the couple has performed four times. Their return came in September at the Juniata County Fair in Port Royal, Pa. They both cried.
“I forgot what it was like to be in front of an audience,” Mr. Arestov said.