President Trump signed a $900 billion pandemic relief bill on Sunday and funded the government through September. The measure restarts unemployment benefits that had lapsed on Saturday, extends an eviction moratorium, provides money to states for vaccine distribution and replenishes a loan program for small businesses.
It will also provide stimulus checks of $600 for most Americans, a bit of welcome news in a tough holiday season. For months, Americans, like people everywhere, have had to make difficult choices about where to go and whom to see, as the coronavirus pandemic rages across the globe. Those narrowing choices, hard even during times of lower infection rates, have been especially amplified as the holidays have coincided with record-shattering numbers.
Adding to the physical toll of the virus are the economic repercussions, as the millions who lost their jobs this year can so readily attest. Mr. Trump had withheld his support of the bill in part because he said the direct payments to many Americans should be $2,000, and not the $600 provided in the legislation.
The United States reported 225,930 new cases on Dec. 26, according to a New York Times database, continuing a slight downward trend in the numbers, but still a staggering figure. As case counts remained steady, and hospitalizations increased, California’s worsening outbreak muffled progress in other parts of the country. In parts of the state — the wealthiest and most populous in the country — every I.C.U. bed is filled.
Dr. Anthony Fauci warned again of especially challenging months ahead. “We very well might see a post-seasonal — in the sense of Christmas, New Year’s — surge,” Dr. Fauci said on the CNN program “State of the Union.”
“We’re really at a very critical point,” he said. “If you put more pressure on the system by what might be a post-seasonal surge because of the traveling and the likely congregating of people for, you know, the good warm purposes of being together for the holidays, it’s very tough for people to not do that.”
And while many people reduced the size of their gatherings or gave up travel this year, others defied the pleas of public health experts and the Centers for Disease Control and Prevention.
Several days around the Christmas holiday saw some of the busiest air travel of the pandemic, according to data from the Transportation Security Administration. More than one million people passed through T.S.A. checkpoints each day of the weekend before Christmas, and again on Dec. 23 and the day after Christmas — a number reached only a few times since March, including during the Thanksgiving holiday week.
The coronavirus did not start Turkey’s economic ails, but it greatly worsened them.
The country had been grappling with a falling currency and double-digit inflation for two years when the pandemic hit in March, adding to a deep recession. Nine months in, as a second wave of the virus sweeps through Turkey, there are signs that a significant portion of the population is overwhelmed by debt and increasingly going hungry.
For President Recep Tayyip Erdogan, who drew attention this year at home and abroad with an aggressive foreign policy and military interventions, things suddenly came to a head in November.
The government admitted that it had been understating the extent of Turkey’s coronavirus outbreak by not recording asymptomatic cases, and new data revealed record infection levels in the country.
Hacer Foggo, founder of the Deep Poverty Network, a group that helps street traders and informal workers, said that in her nearly 20 years of working to alleviate urban poverty in Turkey she had never seen such distress.
Ms. Foggo laid the blame squarely on local and national governments for their lack of strategy for confronting growing poverty and failing to improve social services.
Indeed, the economic tailspin came after Mr. Erdogan tightened his reins on the country, including over the economy, by acquiring sweeping powers under a new presidential system inaugurated in 2018. International monitors cite those changes as a main reason for their alarm about the country’s economic plunge.
As tens of millions of Americans await their turn for a shot, many are hungering for details about what to expect. Some who have been part of the biggest vaccination program in U.S. history spoke to The New York Times.
They recounted a wide spectrum of responses, from no reaction at all — “Can’t even tell I had the shot,” said a hospital worker in Iowa City — to symptoms like uncontrolled shivering and “brain fog.” A nurse assistant in Glendora, Calif., wondered whether the fever he ran was a side effect of the vaccine or a sign that he had been infected by one of his patients.
And there was a dizzying variety of sore arms. Some likened the pain to that from a flu shot; for others, it was considerably worse.
Dr. Matthew Harris, 38, an emergency medicine doctor in Great Neck, N.Y., was up all night with a fever, shivering underneath a blanket, after receiving the first shot. He had joint pain in his wrists and shoulders that lasted into the next day.
The next day, he posted about his reaction, with the hashtag #stillworthit. “Everyone has read, ‘This is the light at the end of the tunnel,’” Dr. Harris said in an interview. “But are people going to feel great 100 percent of the time after this vaccine? No. And if we’re not honest with them, how can we expect them to trust us?”
Most vaccine recipients who spoke to The Times for this article stressed that they had no regrets about getting the shot. The Food and Drug Administration has found the vaccines to be safe and remarkably effective. And public health leaders say mass vaccination is the only hope for controlling the virus that is now claiming the lives of close to 3,000 Americans a day.
But in these first weeks of vaccination, there is an inescapable element of suspense.
For infectious disease experts, a nation down for the count with post-vaccine malaise would be the best news in a long time. The side effects dissipate within a few days, and they are a signal, the experts say, that the vaccine is working.
The Maryland biotech Novavax is starting a final, so-called Phase 3 clinical trial in the United States and Mexico for its experimental coronavirus vaccine, the company announced on Monday.
The little-known firm, which has never brought a vaccine to market before, received up to $1.6 billion from the federal government’s Operation Warp Speed this summer to expedite development. The company reported robust results in earlier phases of its trial, showing that the vaccine prompted strong immune responses in monkeys and people.
The company began a Phase 3 trial of 15,000 people in Britain in September and expects to report preliminary results from that study in the first quarter of next year. It had intended to start its U.S. trial in October but delayed the launch because of manufacturing problems.
The Novavax vaccine, known as NVX-CoV2373, works differently than the ones by Pfizer and other companies that have already been shown to be effective. It contains artificially produced viral proteins, along with an immune-boosting compound derived from the soapbark tree.
The vaccine, given in two doses, three weeks apart, is designed to teach the immune system to recognize the protein. Later, if vaccinated people get infected with coronaviruses, their antibodies can attack them, while immune cells can destroy virus-harboring cells.
NVX-CoV2373 must be kept refrigerated but does not require freezing, making its storage easier than the vaccines from Moderna and from Pfizer and BioNTech, which have to be transported at ultracold temperatures.
Three other protein-based coronavirus vaccines are also in Phase 3 trials in Australia, Canada and India.
Novavax will run its trial at 115 sites in the United States and Mexico, enrolling as many as 30,000 people. Two-thirds will receive the experimental vaccine, and the rest a placebo. Novavax said it would recruit a diverse group, including Black and Latino volunteers. They plan for one-quarter of their participants to be over 65.
“With the COVID-19 pandemic raging around the globe, this trial is a critical step in building the global portfolio of safe and effective vaccines to protect the world’s population,” Stanley C. Erck, president and chief executive officer of Novavax, said in a statement.
GLOBAL ROUNDUP
On Sunday, reported coronavirus infections in South Africa surpassed one million since the start of the pandemic.
The country has now recorded 1,004,413 cases and 26,735 deaths.
With one of the strictest initial lockdowns in the world, South Africa avoided the high death toll that many experts feared. As restrictions eased in the last quarter of the year, however, the death toll climbed steadily, beginning to spike as the holiday season approached.
Many South Africans also traveled from cities to more rural provinces to celebrate the holidays. Officials recorded a daily increase of more than 14,000 cases on Christmas Day and the two days before, though the number fell to 9,502 on Sunday.
Physicians and nurses described overwhelmed hospitals. “For many of the young doctors at the front line, it’s an incredibly traumatic experience, the moral trauma of having to, if you will, decide who lives and dies,” said Dr. Ntobeko Ntusi, chair and head of medicine at Groote Schuur Hospital, a large public institution in Cape Town.
Dr. Ntusi said there had been some patients who were “28, 32 years old” without other health conditions who had extremely low oxygen levels from Covid-19 pneumonia. But because of the overwhelming demand for resources, “We are not able to offer them the treatment that we know can save their lives.”
Some medical professionals urged the government to return to stricter lockdown measures and restrict gatherings. “There’s a huge problem regarding adequate staff, nurses as well as doctors,” Dr. Angelique Coetzee, the president of the South African Medical Association, told SABC News, the public broadcaster, on Sunday.
As the number of infections climbed, President Cyril Ramaphosa held an emergency meeting with the National Coronavirus Command Council and would be submitting their proposals to the country’s Cabinet, according to local news reports. Mr. Ramaphosa is expected to announce new measures soon.
Early in December, South Africa tried to curb the spread of infections in hot spots by imposing a curfew, banning the sale of alcohol on weekends and closing beaches. Masks were made mandatory at all gatherings.
Scientists from the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal discovered a variant of the virus that accounts for the vast majority of samples tested in the current wave. It has one change in common with a distinct variant recently discovered in Britain that has led to travel bans; scientists believe both new lineages may be more easily transmissible. So far there is no evidence that they are associated with more severe disease.
Doctors began noting an increased number of younger patients who had no vulnerabilities, or comorbidities, Zweli Mkhize, the minister of health, said in a statement announcing the discovery earlier this month. That may be at least in part related to large gatherings of young people, including student parties, that officials say have been amplifying the spread of the virus.
South Africa does not have access to any vaccines yet, but Mr. Ramaphosa has said that the country will have soon enough vaccines for 10 percent of the population. They will arrive via an agreement with Covax, an international body established to promote equitable access to vaccines. Unlike 92 low- and middle-income countries, which will be receiving support to make their purchases, as a higher-middle income country, South Africa will finance its doses.
In other developments around the world:
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Indonesia will bar entry to international visitors for two weeks from New Year’s Day to stem the spread of new, potentially more contagious strains of the coronavirus, Reuters reported, with an exemption only for high-level government officials. The country barred travelers from Britain a few days ago, and tightened rules for those arriving from Europe and Australia, expanding on an earlier tourism ban.
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South Korea has discovered three cases of the variant first detected in Britain, officials said on Monday. All were in members of a family who arrived in the country from London on Dec. 22, Agence France-Presse reported, citing the Korea Disease Control and Prevention Agency. All three have been in isolation since testing positive on arrival. South Korea, which is struggling to contain a third wave of infections, is among dozens of countries that have temporarily banned flights from Britain in response to the new variant. The country of about 50 million people reported 808 new cases on Monday, bringing the national total to 57,680, with 819 deaths.
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Frontline workers in Sydney, Australia, will not be allowed to watch the New Year’s Eve firework display from the harbor as planned, Gladys Berejiklian, premier of the state of New South Wales, said Monday, citing a growing coronavirus outbreak in the city’s northern suburbs. “We’ll find another opportunity during the year to recognize what you’ve done,” Ms. Berejiklian said to the workers, about 5,000 of whom would have been invited. Other restrictions announced for Dec. 31 include lowering a limit on outdoor gatherings to 50 from 100 and barring people who live outside the central business district from entering unless they have a venue booking and an entry permit. The city reported five locally transmitted cases on Monday, bringing the total in the cluster to 126.
This has been an ugly year for Italy.
The first wave of the coronavirus took the country by surprise and killed tens of thousands. The second wave somehow took the government by surprise and has killed thousands more. Italians, who have been under tough restrictions this holiday season, have struggled to get their hands on simple flu shots, let alone a Covid vaccine, which just began being administered in the country.
To brighten things, the government has turned to the urban planner and architect Stefano Boeri. Mr. Boeri has sought to help his country with architectural flower power, designing 1,500 pavilions with a primrose theme where the vaccine will be distributed when the mass inoculation campaign begins.
“The primrose is the first flower after the winter, it’s something even a child knows,” Mr. Boeri said in an interview, calling his vision for the building design “a strong message that everyone can understand.”
Italy has run with the proposal. Its official Italian slogan for vaccination is: “With a flower, Italy comes back to life.”
So have the critics, many of whom found the government’s emphasis on Milanese design a little misplaced in a pandemic. “Idiots,” one prominent commentator offered. “I don’t want a primrose,” said a top Italian economist, Carlo Cottarelli. “I want an anti-Covid vaccine!”
But Mr. Boeri rejects the cynicism. “Flowers are serious,” he wrote on Twitter, and in the interview he explained why the primrose was the ideal image for Italy’s vaccination program, which started on Sunday. “It’s one thing to go get vaccinated in a container or in a military field hospital, and it’s another to go into a luminous space in the form of a flower,” he said.
He and his team sought an image, he said, that could be universally understood as positive “by a 4-year-old or an intellectual in the North or a young migrant.”
The federal Centers for Disease Control and Prevention recommends that the first shots of the coronavirus vaccines go to people in nursing homes and other long-term care facilities as well as to doctors, nurses and frontline health care workers, and there has been little disagreement over that guidance.
But who should get vaccinated next?
“There is a consensus of what we call the A1 group,” Ohio Gov. Mike DeWine said on CBS’s “Face the Nation” on Sunday. “People who are risking their lives every single day, as well as where we have taken the most losses, and that is in our nursing homes.”
“I think there will probably be more lack of consensus among people in general when you get beyond that first group,” Mr. DeWine said.
In guidelines based on recommendations from an expert panel, the C.D.C. lays out the next two rounds of vaccination, known as Phase 1b and Phase 1c. Phase 1b would include people 75 years and older and essential frontline workers not in health care, such as firefighters, police officers, postal workers, grocery store employees, public transit workers and teachers.
Phase 1c would include people from 65 to 74 years old, people 16 to 64 with underlying medical conditions and other essential workers in jobs like food service, construction and public health.
But not all governors are following along. Some have put a higher priority on certain people in the Phase 1c group and a lower priority on those in Phase 1b.
“The next wave is going to be different by state,” Adm. Brett P. Giroir, an assistant secretary for the Department of Health and Human Services who serves as the administration’s testing coordinator, said during an appearance on “Fox News Sunday.”
He noted that Gov. Greg Abbott of Texas planned to give priority to people over 65. “Because those are the people will go to the hospitals,” Adm. Giroir said. “It’s not the frontline 24-year-old worker who is at low risk of getting the infection and at very, very low risk of getting serious results from that, but over 65.”
Gov. Ron DeSantis of Florida is similarly giving priority to people over 70, Admiral Giroir said.
”I think that variability is critically important because as the hospitals fill up, the first priority really needs to be to save lives and to reduce the burden on hospitals,” the admiral said. “You’re seeing that in Texas and Florida, and you will probably see that in many other states.”
The C.D.C. places teachers and others working in education in Phase 1b, but Admiral Giroir suggested that most states would move them down unless they suffer from underlying health conditions.
“Young healthy teachers should be at no more risk than young healthy individuals in any other profession,” he said. “They’re probably going to be further down the priority scale, because we need to take care of those who are vulnerable — who will die, who will be hospitalized — first.”
Last January, when the government of China imposed an unprecedented lockdown on the city of Wuhan in a belated effort to contain the spread of the coronavirus, it was right before the start of the Lunar New Year, the country’s most important holiday. Soon the shutdown was extended to encompass all 60 million people in the surrounding province of Hubei, and fear of the virus led millions more to cancel their holiday plans. Now the virus is likely to disrupt the holiday for a second year, with officials advising the public not to travel as they battle outbreaks in two major cities.
After months of near-zero case numbers that have allowed life in China to largely return to normal, the country of 1.4 billion people has recorded 42 locally transmitted cases in the past week, many of them of unknown origin. Most appeared in Dalian, a northern port city, but there have also been a few in Beijing, the capital.
In line with the government response to previous outbreaks this year, officials have been testing hundreds of thousands of people in Beijing and millions in Dalian, and residents of Dalian have been advised not to leave the city.
Officials in Beijing are looking even further ahead to the Lunar New Year, during which hundreds of millions of Chinese travel to their hometowns in what has been called the world’s largest annual human migration. Citing concerns that holiday travel could spread the virus, the government is discouraging Beijing residents from traveling and gathering for the holiday, especially the elderly, pregnant women and people with chronic conditions. Travel companies have also been told not to organize any group tours to Beijing during the holiday, which this year falls on Feb. 12.
Other parts of the country are taking precautions as well. Anhui Province, home to many of China’s migrant workers, plans to test and monitor all those who return for the holiday. The governments of Anhui Province and Shanxi Province have also advised residents to limit private gatherings to 10 people during the holiday period.
Chinese officials and health experts say they are confident that China will not have a major outbreak in the new year, citing plans to vaccinate 50 million people before the Lunar New Year as well as the greater experience they have in testing and contact tracing compared with a year ago.
Since the pandemic began, China has reported almost 97,000 coronavirus cases and 4,634 deaths.
The delivery of a small number of vaccine doses from Pfizer to several countries in the European Union suffered a minor delay after concerns about the temperature controls being used to keep the doses super cold. The issue forced shipments from a factory in Belgium to be pushed back a day, according to the Spanish health authorities.
Pfizer’s factory in Puurs, Belgium, told the company’s Spanish division on Monday night that shipments to eight European countries would be delayed “because of a problem in the process of loading and sending,” the Spanish ministry said in a news release.
The release did not specify which countries beside Spain were affected. When asked about the delay on the Spanish radio broadcaster Ser, Salvador Illa, the health minister, said that the problem was linked to the “control of the temperature” of the shipments and had been resolved.
The doses, he said, should arrive on Tuesday, one day late.
The delay underscored the logistical challenges of speeding millions of doses of vaccine that need to be kept at minus 70 degrees Celsius around the world as fast as possible.
On Sunday, the first day of the vaccination campaign in Europe, there was also a minor problem with the cold-chain process in Germany: Concerns about 1,000 shots not being cold enough delayed efforts around Lichtenfels, in Bavaria.
“When reading the temperature loggers that were enclosed in the cool boxes, doubts arose about the compliance with the cold chain requirements,” the district of Lichtenfels said in a statement.
By late Sunday, the problems were resolved and the campaign commenced.