Coronavirus Has Recently Infected 1 in 50 in England

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Britain Scrambles to Battle the Virus

Speaking at a news conference, Prime Minister Boris Johnson of Britain said that 1.3 million people had already been vaccinated, and that he hoped that the most vulnerable could be protected by the vaccine within about six weeks.

I can tell you that this afternoon — with Pfizer and Oxford-AstraZeneca combined — as of this afternoon, we’ve now vaccinated over 1.1 million people in England and over 1.3 million across the U.K. Then we think that by the middle of February, when a very considerable portion of the most vulnerable groups will have been vaccinated, or so we hope and believe, that’s the top four of the J.C.V.I. cohorts, then, you know, there really is the prospect of beginning the relaxation.

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Speaking at a news conference, Prime Minister Boris Johnson of Britain said that 1.3 million people had already been vaccinated, and that he hoped that the most vulnerable could be protected by the vaccine within about six weeks.CreditCredit…Andrew Testa for The New York Times

As England re-entered lockdown on Tuesday, new figures showed that one in 50 people had recently been infected with the virus, and officials warned that some restrictions on daily life could still be needed next winter.

Speaking at a news conference, Prime Minister Boris Johnson promised to focus government efforts on rolling out its strained mass vaccination program intended to prevent a surge in infections of a highly transmissible variant of the virus from overwhelming the health service.

With more than a million confirmed cases in the week ending Jan. 2, or 2 percent of England’s population, Britain is in a race against time to distribute vaccines.

Mr. Johnson was speaking on a day when the government said more than 60,000 new cases were recorded for the first time. Standing alongside him, Professor Chris Whitty, England’s chief medical officer, said that the number of daily deaths, now averaging around 530, was expected to rise and that if people did not observe a lockdown order to stay at home, the risk was “extraordinarily high.”

He also warned that Britons might face some restrictions well into the future.

“We might have to bring a few in, in the next winter for example — that is possible — because winter will benefit the virus,” Professor Whitty said.

Mr. Johnson said that 1.3 million people had already been vaccinated and that he hoped that the most vulnerable, a group including the elderly and numbering around 13 million, could be protected by the vaccine within about six weeks, turning the tide in the battle against the virus.

“We in government are now using every second of this lockdown to put that invisible shield around the elderly and the vulnerable in the form of vaccinations,” he said.

Mr. Johnson said that England would be locked down until inoculations reached the four most vulnerable groups: residents in nursing homes and those who care for them, everyone over the age of 70, all frontline health and social care workers, and everyone who is clinically extremely vulnerable.

“If we succeed in vaccinating all those groups, we will have removed huge numbers of people from the path of the virus,” he said.

That goal, he added, could be achieved by the middle of February.

But to do that, the pace of vaccinations will need to increase drastically.

The four groups that the prime minister cited include 13.9 million people in England, according to Nadhim Zahawi, the minister overseeing the vaccine effort.

Since the campaign started on Dec. 8, fewer than 800,000 people in England had been vaccinated as of Dec. 27, the last date when data was available.

But with the introduction on Monday of the first doses of a vaccine developed by the University of Oxford and AstraZeneca — shots that are easier to transport and do not need to be stored at very cold temperatures — British officials said that the campaign could now be ramped up.

To meet Mr. Johnson’s target, some two million doses need to be given every week.

Mr. Johnson also said he was planning a new system to ensure that those traveling to Britain had a negative coronavirus test before arrival. But he was forced to defend himself against charges that he moved too slowly to order the lockdown, and showed poor judgment by insisting over the weekend that many schools in England should reopen after the winter holiday on Monday — only to reverse that decision on Monday night.

Patients were lined up outside the emergency room at the LAC USC Hospital in Los Angeles, on Tuesday, after they were brought to the hospital by ambulance and the fire department.
Credit…Etienne Laurent/EPA, via Shutterstock

Officials in California have painted an increasingly catastrophic picture of the state’s Covid-19 crisis over the past several days, precisely what they had warned was coming, as the state faces an oxygen shortage.

California has deployed the U.S. Army Corps of Engineers and the California Emergency Medical Services Authority to deliver and refill oxygen tanks.

In Los Angeles County, emergency workers have been told to conserve oxygen and administer the minimum amount of oxygen to keep patients’ oxygen saturation level at or just above 90 percent. (A level in the low 90s or below is a concern for people with Covid-19.)

Officials in the most populous U.S. county have said a person is being infected every six seconds in the county and one in five residents currently tested was infected with Covid-19. “Your bubble is not as safe as you think it is,” the department tweeted.

Gov. Gavin Newsom has warned that the worst was somehow yet to come: a “surge on top of a surge” driven by post-holiday infections.

As of Tuesday evening, 4,374 people with Covid-19 had died in the preceding two weeks, compared with 3,202 in the two weeks before that.

In some cases, there will be nowhere for the victims of that surge to go.

Health authorities in Los Angeles County have directed ambulance crews not to transport some cardiac arrest patients whose survival is unlikely. At some hospitals, patients are being lined up outside while workers try to find bed space.

California was already short on hospital beds before the pandemic, and I.C.U. capacity in a large swath of the state has been nonexistent for weeks.

The surge in Southern California has been so severe that industry groups themselves have called for film and television production, which had been allowed to continue even after outdoor dining was banned, to pause. SAG-AFTRA, the union representing 160,000 industry workers, was joined by groups representing producers and advertisers in calling for an in-person production halt on Sunday.

Their statement noted that even if workers do not contract the virus, they are still at risk of injury from stunts, equipment failures, or falls.

“With few if any hospital beds available, it is hard to understand how a worker injured on set is supposed to seek treatment,” said David White, SAG-AFTRA’s national executive director.

The Grammy Awards, one of the entertainment industry’s biggest nights, were postponed on Tuesday from Jan. 31 to March 14. A statement from the Recording Academy, which presents the awards, and CBS, its longtime broadcast partner, cited the “deteriorating” situation in Los Angeles.

Sandra Lindsay received her second dose of the Covid-19 Pfizer-BioNTech coronavirus vaccine on Monday, three weeks after the first dose. 
Credit…Shannon Stapleton/Reuters

After Sandra Lindsay became the first person in the United States to receive a Covid-19 vaccination outside a clinical trial, something unexpected happened: She acquired a fan club.

Half a dozen inspired youngsters in Lee, N.H., ranging in age from 8 to 12, each sent Ms. Lindsay a letter praising her for leading the way.

“I would like to thank you for taking the first vaccine in the U.S.A.,” 12-year-old Finley wrote. “I have had a hard time in this era. What you did was incredibly brave.” He added, “You helped everyone who was unsure, and you gave hope to those who are lonely and felt unsafe.”

On Monday, Ms. Lindsay, 52, the director of critical care nursing at Long Island Jewish Medical Center in Queens, was in the vanguard again. The requisite 21 days had passed, so it was time for her, and hundreds of other health care workers and long-term care patients at the head of the line, to receive the second half of the two-dose Pfizer-BioNTech vaccine.

By the end of the day, 118,304 people in the city had gotten a first dose of coronavirus vaccinations, and 756 had gotten a second, according to the New York City Department of Health and Mental Hygiene. Across the country, other early recipients were getting shot No. 2 as well.

Nearly all states have made getting health care workers and nursing home residents immunized a top priority. But the effort, now three weeks old, has been slower than many governors and public health officials hoped.

The federal government has shipped more than 15 million vaccine doses to states, but only 4.5 million people have received them so far. There are 21 million health care workers nationwide, and three million residents of nursing homes and other long-term care facilities.

Dr. Mark P. Jarrett, chief quality officer for Northwell Health, which operates Long Island Jewish, 22 other hospitals and 800 ambulatory care sites in the New York metropolitan area, said his organization has vaccinated about 27,000 employees with either the Pfizer or the Moderna vaccines. The Moderna recipients will get their second shot after 28 days.

The two-stage nature of the vaccines will affect how fast the vaccination program progresses, Dr. Jarrett noted. “I would expect that general public inoculations could start in late February, and it will take a long time to complete,” he said. “You’re talking about millions of people, and they have to come back for second shots.”

Ms. Lindsay said on Tuesday that she had experienced no side effects from the vaccine, and that she was touched by the children’s letters, which left her “very, very emotional.”

She said she had been sure since the early days of the pandemic that she would get vaccinated as soon as she could: “Given my experiences on the front lines, and seeing the hard work of my colleagues and the suffering and death of patients, I knew back then that when it was developed, I wanted to take the vaccine.”

But even with the two shots now safely in her arm, she still worries about going to work.

“I have been a nurse for more than 26 years, and I’ve never been more scared than I am right now, even with the vaccine, because this virus is so erratic, unpredictable and does not discriminate,” she said. “You never know what you are walking into.”

A medical worker receiving one of the first doses of the Moderna Covid-19 vaccine at Christ Hospital in Jersey City, N.J., last month.
Credit…Bryan Anselm for The New York Times

Scientists at the National Institutes of Health and the drugmaker Moderna are analyzing vaccine research data to see if they can double the supply of the company’s coronavirus vaccine by cutting doses in half, a move that would help alleviate vaccine shortages as the country surpassed more than 21 million virus cases.

The research, which also involves scientists from Operation Warp Speed, the government’s vaccine initiative, could take about two months, Dr. John Mascola, the director of the Vaccine Research Center at the N.I.H., said in an interview Tuesday.

The data analysis, which Dr. Mascola said has been long planned as part of the vaccine research effort, comes amid a broader scramble to increase vaccine supply. Late last month, the Trump administration sealed a deal with Pfizer to increase that company’s vaccine supply by 100 million doses.

“It’s important to do these analyses that we’re doing, and have all that data in our pocket in the event that there’s a need to use it,” Dr. Mascola said.

The vaccine rollout has been troubled from the start. For the moment, the problem is not a shortage of vaccine, but rather that state and local governments are having trouble distributing the vaccine doses they already have.

As of Tuesday, at least 4.8 million people in the United States have received a Covid-19 vaccine dose. The federal government — which had earlier set a goal of giving at least 20 million people their first dose by the end of 2020 — said on Tuesday that it had delivered more than 17 million doses to states, territories and federal agencies.

The prospect of doubling the supply of Moderna doses was first raised on Sunday by Dr. Moncef Slaoui, the head of Operation Warp Speed, who said on the CBS program “Face the Nation” that data from Moderna’s clinical trials demonstrated that people between the ages of 18 and 55 who received two 50-microgram doses showed an “identical immune response” to the two 100-microgram doses.

That is true, said both Dr. Mascola and Dr. Anthony S. Fauci, the director of the National Institute for Allergy and Infectious Diseases, which includes the vaccine research center. But Dr. Slaoui also went one step farther, and said federal officials and Moderna were discussing possibly halving each of Moderna’s two doses — a remark that prompted pushback from the Food and Drug Administration, which would have to approve any change in the dosing regimen.

In a statement posted on its website Monday night, the F.D.A. said a proposal for half-doses of the Moderna vaccine was “premature and not rooted solidly in the available science.” The finding Dr. Slaoui cited came from an early Phase II clinical trial, which involved hundreds of people and was designed to test only for immune response, and not for the effectiveness of the vaccine, Dr. Fauci said. It compared the immune response in people given 50 micrograms against those given 100 micrograms.

The larger Phase III trial that found the vaccine effective involved 30,000 people, half of whom were given the 100-microgram dose and half of whom were given placebo.

In order to provide the F.D.A. with the kind of data it would need to approve a change in dosing, scientists must first study blood samples from patients who participated in the Phase III trial to determine precisely what immune response correlates with protection against Covid-19.

Then, Dr. Mascola said, researchers would have to either look back at patients from the Phase II trial, or conduct a new one, to demonstrate that patients who received the 50 milligram dose developed the threshold immune response. If the results looked promising, he said, “all this then needs to be put together as a data package for review and discussion with F.D.A.”

On Tuesday, Dr. Jerome Adams, the U.S. surgeon general, urged states not to stick rigidly to the Centers for Disease Control and Prevention guidelines about whom to vaccinate first. He said states should “move quickly to other priority groups” if fewer health care workers agree to be vaccinated.

Asked about Dr. Adams’s remarks, a C.D.C. spokeswoman said the agency had made clear in written guidance that states did not need to vaccinate everyone in a priority group before moving on to the next group.

Lining up for Covid-19 testing outside a Beijing hospital on Tuesday. The Beijing area has reported new cases in recent days. 
Credit…Greg Baker/Agence France-Presse — Getty Images

The World Health Organization has criticized China for not authorizing a team of international experts to enter the country to investigate the origins of the coronavirus pandemic, a highly anticipated trip that has been months in the making.

Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, said at a Tuesday news conference that two members of the U.N. agency’s 10-person team were already in transit to China when they were informed that the necessary visa permissions had not yet been granted. The team had been expected to go to Wuhan, the city where the virus first emerged.

Dr. Tedros, who has been criticized for praising China despite the country’s early mishandling of the outbreak, said he was “very disappointed” by the news and was in touch with “senior Chinese officials” to resolve the issue.

Michael Ryan, the head of the emergencies program at the W.H.O., said that one of the experts in transit had already returned home, while the other was staying in a third country awaiting further instructions. The rest of the team, consisting of experts from the Netherlands, Japan, the United States and elsewhere, had not yet left for China when news of the visa delays came through.

Hua Chunying, a spokeswoman for China’s Ministry of Foreign Affairs, said at a regularly scheduled briefing on Wednesday that the government was doing its best to resolve the issue but that “the question of the virus investigation is very complicated.”

It appeared to be the latest example of China’s efforts to stymie an independent investigation into the origins of the virus, which has infected more than 86 million people and killed 1.8 million around the world since the initial outbreak in Wuhan more than a year ago.

The W.H.O. has discussed sending an investigative team to Wuhan since last January, but the Chinese government has delayed those plans while promoting flimsy theories that the outbreak started outside of China. Last summer, two W.H.O. experts were allowed into China to negotiate the terms of the investigation, but they did not go to Wuhan.

The Chinese government has yet to release crucial information about its own internal investigations into the virus’s origins, including data from animal samples taken in and around Wuhan.

Most scientists say the virus probably jumped to humans from an animal, probably a bat. They say that solving the mystery of its origin is critical to preventing future pandemics and helping to develop vaccines and treatments. In the absence of more solid information, numerous conspiracy theories about the virus have flourished.

China has largely, but not entirely, subdued the virus within its borders. In Hebei Province near Beijing, a small flare-up in infections led the local authorities to declare “wartime” mode this week. After Hebei reported 63 new cases in a day, officials in Shijiazhuang, the provincial capital, on Wednesday imposed tougher travel controls, barred gatherings and moved elementary and middle schools to online learning.

The W.H.O.’s criticism of China marks a rare public fissure in what has otherwise been a close relationship.

For months, the W.H.O. has publicly praised China for its response to the coronavirus, in the hope that such a soft-handed approach would yield crucial access and information. Critics say that in doing so, the organization allowed the Chinese government to whitewash its mistakes and portray itself as a transparent and cooperative global partner in the pandemic response.

Some have expressed concern that by now, the inquiry has become so politicized it is unlikely to yield concrete findings. But one thing is almost certain: if and when the W.H.O. team does arrive in China, another delay is expected. Like all other Chinese citizens and foreign visitors, the investigators will be required to quarantine for 14 days.

Curative’s walk-up kiosk testing site for Covid-19 in Seattle on Saturday.
Credit…Ted S. Warren/Associated Press

The Food and Drug Administration has raised concerns about the accuracy of a coronavirus test used by lawmakers, congressional staff and reporters, potentially muddling the already fraught effort to stem the spread of the virus on Capitol Hill.

In a notice published on Monday, the F.D.A. warned of the risk of false results, particularly false negative results, with the Curative SARS-Cov-2 test, which in the Capitol is a self-administered nasal swab and typically produces a result within 12 hours. The warning outlined multiple risks to a patient with a false negative result, including “delayed or lack of supportive treatment, lack of monitoring of infected individuals and their household or other close contacts for symptoms resulting in increased risk of spread of Covid-19 within the community.”

Curative’s test is based around a laboratory technique called polymerase chain reaction, or P.C.R. — typically considered the gold standard of coronavirus diagnostics. P.C.R.-based tests carry a reputation for high accuracy, making the problems with Curative’s product somewhat unusual. Other tests, such as rapid antigen tests, which can run in just minutes, are typically more prone to returning incorrect results.

The F.D.A. notice did not specify the rate at which Curative’s test was delivering false negatives. It did, however, note that samples that come from nasal swabs and oral fluid specimens should only be taken from people with Covid-19 symptoms.

“We have been working with the agency to address their concerns and these limitations, and we will continue to work interactively with F.D.A. through the Emergency Use Authorization process,” said Amy VandenBerg, a senior vice president of Curative.

After months without testing on Capitol Hill, Curative has been providing the tests to hundreds of lawmakers and staff who work in the building since at least November. The testing was implemented in part to help lawmakers who travel across the country twice a week comply with Washington’s quarantine requirements after travel.

Dr. Brian P. Monahan, Congress’s attending physician, acknowledged the warning about the test in a memo, which was first obtained by Politico, but wrote that it was “the most accurate available” and that all tests carry the risk of a false result.

“This is not unique to this test,” Dr. Monahan wrote. “It is a problem for all the coronavirus tests. We expect to have additional information in the coming days from the FDA and our expert consultants with regard to any concerns about the ongoing use of this test for the Capitol community.”

The warning about the tests, which are used by several lawmakers, aides and reporters, on days when Congress is in session, comes as lawmakers are still struggling to implement coronavirus protocols and prevent the virus from spreading through their ranks. Congressional leaders initially resisted providing testing in the Capitol despite the amount of traveling lawmakers do to vote in person because of a nationwide shortage and concerns about appearing to jump the line.

Representative Kay Granger, Republican of Texas, reported a positive test after spending time on the House floor Sunday for the swearing-in of the 117th Congress, where hundreds of lawmakers had to vote in person. It is unclear whether any lawmakers are quarantining as a result of that exposure.

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Experts advising the World Health Organization have recommended that the Pfizer-BioNTech Covid-19 vaccine be administered as recommended by its manufacturer, adding that countries with limited supplies of the vaccine could delay the second dose.CreditCredit…Adriana Zehbrauskas for The New York Times

A group of international experts advising the World Health Organization has recommended that the Pfizer-BioNTech Covid-19 vaccine be administered as recommended by its manufacturer, in two doses given three to four weeks apart. However, it concluded that countries that have limited supplies of the vaccine and are concerned about the level of transmission of the virus could delay the second dose for up to six weeks.

That delay would help “maximize the number of individuals benefiting from a first dose,” the group’s chairman, Dr. Alejandro Cravioto, said at a news conference on Tuesday.

“We have to be a bit open to these types of decisions that countries need to make according to their own epidemiological situations,” he added.

The decision followed what Katherine O’Brien, director of the W.H.O.’s Department of Immunization, Vaccines and Biologicals, referred to as a “very robust discussion” about the trade-offs between risks, including the risk that the vaccine may not work as well as anticipated if it is not given in the way it was tested.

The group, known as the Strategic Advisory Group of Experts on Immunization, also recommended that the vaccine be given only in situations where health workers are able to treat rare severe allergic reactions, known as anaphylaxis.

The experts also concluded that while there is not yet enough safety data to be able to recommend the Pfizer vaccine for pregnant women, there are “situations where the benefit of vaccination of a pregnant woman outweighs the potential risks, such as health workers at high risk of exposure,” Dr. Cravioto said.

He also said that the vaccine should be offered regardless of whether a person has previously been infected by the virus. However, in situations of limited vaccine supply, people whose infections have been documented may choose to delay getting vaccinated until close to six months after their infections, in order to make the vaccine more available to others.

At the news conference, the W.H.O.’s director general, Tedros Adhanom Ghebreyesus, also revealed that a separate team of international experts who were expected to go to Wuhan, China this week to conduct a long-awaited investigation into the origins of the pandemic had been delayed; two of the members had already departed their home countries.

“Today we learned Chinese officials have not yet finalized the necessary permissions for the team’s arrival in China,” he said. “I’m very disappointed with this news.”

He added that he had been in contact about the matter with senior Chinese officials who assured him, he said, that the country “is speeding up internal procedures for the earliest possible deployment.”

U.S. ROUNDUP

Chicago has been wrestling for months over plans to reopen its public schools, including Frederic Chopin Elementary on the city’s West Side. 
Credit…Taylor Glascock for The New York Times

Just over half of the teachers who were expected to report to school buildings in Chicago on Monday, as the first step in the district’s reopening plan, did not show up, the district said on Tuesday. The absences were part of a long-running clash between teachers and administrators that is complicating the district’s efforts to resume in-classroom instruction for the first time since March 2020.

Chicago Public Schools, the nation’s third largest district with some 340,000 students, is planning to welcome prekindergarten students and some special education students back to schools next week, followed by kindergarten through eighth-grade students on Feb. 1. The students’ families can choose to have them return or to continue with remote learning; about 37 percent have chosen to return.

The district’s plan has run into relentless opposition from the Chicago Teachers Union, which argues that virus transmission remains too high in many neighborhoods and that the district’s safety measures are inadequate. A majority of the City Council signed a letter opposing the plan and demanding that the district negotiate with the union over the conditions for reopening.

The district, which is under the control of Mayor Lori Lightfoot, indicated on Tuesday that it was determined to press forward with its reopening plans.

The district’s chief executive, Janice K. Jackson, said that overall, some 60 percent of school-based employees — including teachers and paraprofessionals — who were expected to return to schools on Monday did so, “which is significant,” she said, “considering the fact that they were pressured by the union not to return.”

For comparison, she said, about 83 percent of employees reported for work in the first two days following winter break last year, “which is what we typically expect around this time.”

In other news from around the country:

  • The Mississippi Department of Corrections has reported that 108 people died in its prisons in 2020, a toll that was significantly higher than a year earlier. But as of Monday, the department had not disclosed whether any of those deaths were caused by the coronavirus, though more than 1,400 inmates have been infected since the pandemic’s start, according to state data.

  • Workers in meat processing plants in Nebraska are prioritized in the state’s vaccine distribution. But Nebraska’s governor, Pete Ricketts, said this week that he did “not expect any” undocumented workers to receive the vaccine as part of that priority group.

  • In Georgia on Tuesday, baseball Hall of Famer Hank Aaron, former U.N. Ambassador and civil rights leader Andrew Young and former U.S. Health and Human Services Secretary Louis Sullivan got the vaccine, hoping to send a message to Black Americans that the shots are safe, The Associated Press reported.

    Rebecca Griesbach and Bryan Pietsch contributed reporting.

The head coach of the Cleveland Browns, Kevin Stefanski, during an game against the Pittsburgh Steelers on Sunday.
Credit…David Richard/Associated Press

Cleveland Browns head coach Kevin Stefanski, two other coaches and two players tested positive for Covid-19, the team said on Tuesday, putting the team’s championship aspirations in doubt.

All five people will miss the Browns matchup against the Pittsburgh Steelers on Sunday night, Cleveland’s first postseason game in nearly two decades. Special teams coordinator Mike Priefer will take over as head coach in Stefanski’s absence.

The N.F.L. said there was no change to the status of the game, and the league and team continue “to conduct standard contact tracing to identify any possible high-risk close contacts.”

Stefanski and the other coaches and players must be isolated from the team for a minimum of 10 days. If any players or personnel are found to have had close contact with them, they would need to remain apart from the team for five days, after which they would be eligible to return to the team and play in the game.

Offensive lineman Joel Bitonio is one of the two players who tested positive. Bitonio has been with the Browns his entire seven-year career, which has included the 2016 and 2017 seasons, when the team went 1-15 and 0-16.

Stefanski gave Bitonio, the longest tenured player on the team, the game ball after Sunday’s win. Now Bitonio will miss his first chance to play in a postseason game.

During their 24-22 victory on Sunday over the Steelers, the Browns had six players on the Covid-19 reserve list who had either tested positive or had close contact with someone who had. The previous week, the Browns had played without any of their best wide receivers because of an outbreak on the team.

The number of N.F.L. players, coaches and staff who tested positive picked up noticeably starting in November as the virus raged through communities around the country.

In the week that ended Jan. 2, the N.F.L. said there were 34 new confirmed positive tests among players and 36 new confirmed positives among other personnel. The 70 combined cases was up from 58 positive tests the week before and 45 cases the week before that.

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Chancellor Angela Merkel of Germany announced on Tuesday that the country would extend the nationwide lockdown until the end of January amid the surge of coronavirus cases and the fear that the more contagious variant of the virus could spread.CreditCredit…Lena Mucha for The New York Times

Chancellor Angela Merkel and state governors in Germany agreed on Tuesday to extend the nationwide lockdown by three weeks, until at least the end of January, and to tighten restrictions amid high rates of coronavirus cases and deaths and the fear that a more contagious variant of the virus could spread in Germany.

“The measures we have adopted today are drastic,” Ms. Merkel said in a news conference after the meeting. “They are not just a continuation of what we did before Christmas. Given the situation, they are tougher.”

Under the extended lockdown rules, members of a household cannot meet more than one person from another household; schools, child care centers, cultural sites and all but essential shops are closed. Ms. Merkel and the governors also agreed to limit movement to 15 kilometers from home for people living in areas in which there are more than 200 new infections a week per 100,000 people. It is the first such rule in effect across Germany since the pandemic began.

After the failure of lighter lockdown measures in November — under which both schools and most shops had remained open — the German authorities had set stricter rules in mid-December. Those restrictions, which were set to expire Jan. 10, cut short the pre-Christmas shopping period, discouraged family gatherings over the festive season and curtailed celebrations for New Year’s Eve.

In a recent YouGov poll, two thirds of German respondents said that they approved of an extension to the lockdown. About 24 percent also said that they thought the restrictions should be tightened, according to the poll, commissioned by the German news service DPA.

On Monday, the health authorities in Germany registered 11,897 new infections and 944 deaths. According to a New York Times database, there were 17,526 new infections per day on average during the last seven days, comparable to the number of daily infections registered at the beginning of November, when authorities started the lockdown.

A woman wearing a protective face mask passed shuttered shops in Jerusalem’s Old City during Israel’s third national lockdown to fight coronavirus.
Credit…Ronen Zvulun/Reuters

JERUSALEM — The Israeli government announced on Tuesday that it would tighten its lockdown as coronavirus cases in the country have climbed rapidly over the past week.

In late December, Israel entered into its third nationwide lockdown, but much of the public has since flouted restrictions, prompting health experts to call for tougher enforcement.

The government still has not published a comprehensive list of the newest restrictions, but cabinet ministers confirmed that it decided to shutter schools except for those that provide special education and serve youth at risk.

In a short joint statement, the prime minister’s office and the Health Ministry said the new measures would take effect on Friday and would remain in place for two weeks. They also said that access to flights abroad would be limited.

The government still needs to formally approve the measures, but it is expected to do so in the coming 24 hours.

In addition, Israel’s Parliament, the Knesset, is required to vote on the restrictions. A controversial law passed in July, however, allows them to come into effect before it deliberates on the matter.

Earlier on Wednesday, Prime Minister Benjamin Netanyahu cited the new, highly transmissible variant of the virus that was first identified in the United Kingdom as a reason why Israel needed to stiffen its lockdown.

“We are at the height of a global pandemic that is spreading at record levels with the British mutation,” Mr. Netanyahu said in a recorded statement. “It arrived in Israel and it will claim many lives.”

As of Monday, there were 30 known cases of the variant in Israel, the Health Ministry said. Israel has averaged 5,841 virus cases per day over the past week — a significantly higher number than the preceding seven days, according to a New York Times database.

GLOBAL ROUNDUP

An employee in December at the Global Halal Center near Jakarta, Indonesia, where the coronavirus vaccine made by the Chinese company Sinovac was analyzed.
Credit…Ulet Ifansasti for The New York Times

The one-sentence letter didn’t say much. The coronavirus vaccine was “manufactured free of porcine materials,” Sinovac, the Chinese vaccine maker, wrote to Indonesia’s state-owned vaccine manufacturer in July.

While the letter was promising, Indonesian clerics needed more details. A vaccine laced with the smallest amount of pork DNA could dissuade some followers of Islam from inoculation in Indonesia, the country with the world’s largest Muslim population. Sinovac took months to provide more information, which came only this week.

The Chinese company’s delayed response has been yet another challenge in Indonesia’s already fragile vaccine rollout. With the highest number of coronavirus infections in Southeast Asia, the country is eager to drum up support for its goal of inoculating 181.5 million adults within 15 months. But looming questions about the safety of the Sinovac vaccine and whether it is halal, or allowed under Islam, are complicating the government’s efforts.

“There shouldn’t be any concern about whether this vaccine is halal or not halal,” President Joko Widodo has said. “We are in an emergency situation because of the Covid pandemic.”

Indonesia has recorded nearly 800,000 infections and more than 23,000 deaths, staggering numbers in a region where virus cases have remained relatively low. Inoculations are set to begin with health workers, soldiers and police officers in the coming weeks, once the health authorities are satisfied that the Sinovac vaccine is safe and effective.

Islamic authorities in other countries where Muslims make up a sizable share of the population, including Malaysia and the United Arab Emirates, have already ruled that coronavirus vaccines are permissible, even if they contain pork gelatin, which is used to stabilize many inoculations.

The Ulema Council, an influential group of Muslim clerics that decides which products are halal in Indonesia, is expected to issue a decree, or fatwa, authorizing the use of the Sinovac vaccine in the coming weeks. But the nature of its findings could affect how widely it is accepted in Indonesia, especially among the country’s many conservative Muslims.

In other developments across the world:

  • A senior official in Singapore said on Monday that the country’s police force could legally use data from the government’s coronavirus contact-tracing program for criminal investigations. A privacy statement on the program’s website had said that the information would be used only for contact tracing, local news media reported. But Desmond Tan, the home affairs minister, said in Parliament on Monday that officers could use the data for criminal investigations “and for the purpose of the safety and security of our citizens.”

  • Japan’s top-ranked sumo wrestler, Hakuho, has tested positive for the virus after losing his sense of smell, the country’s national broadcaster reported on Tuesday. The Mongolian-born athlete had been scheduled to compete next week in the New Year Grand Tournament, a major sumo event.

N.Y. roundup

Eric Ettinger was first on line before a pop-up vaccination site opened in Manhattan, New York, on Tuesday morning.
Credit…James Estrin/The New York Times

As New York tries to confront lagging coronavirus vaccinations, Gov. Andrew M. Cuomo on Tuesday said that he would not immediately expand the pool of people eligible to receive the vaccine in the state, after repeated pleas from Mayor Bill de Blasio of New York City to do just that.

Mr. Cuomo maintained that health care workers should be the first to receive the vaccine, and that the state’s supply was not yet sufficient to expand distribution to other categories. He said that only 900,000 doses had been distributed so far, and there were 2.1 million health care workers in the state’s highest priority group.

At the rate the state was receiving vaccine shipments it would be about four weeks before the vaccination effort could move on from health care workers, the governor said.

Mr. Cuomo’s comments came on the same day Dr. Jerome Adams, the U.S. surgeon general, urged states not to stick rigidly to the Centers for Disease Control and Prevention guidelines about whom to vaccinate first. He said that states should “move quickly to other priority groups” if fewer health care workers agree to be vaccinated.

Asked about Dr. Adams’s remarks, a C.D.C. spokeswoman said the agency had made clear in written guidance that states did not need to vaccinate everyone in a priority group before moving on to the next group.

City officials said that at least a third of health care workers in city hospitals were hesitant about receiving the vaccine because they were concerned about its safety and efficacy.

Mr. Cuomo blamed hospital management for the slow pace of vaccine distribution and said he doubted that health care workers were not agreeing to be vaccinated in large numbers. He noted out of the 194 public and private hospitals statewide distributing the vaccine, some were working quickly. And he said for those that were not, the state could take back the doses and instead use hospitals that are moving faster.

“Why are they slow? A variety of reasons,” he said. “These are 194 hospitals, some of them frankly operate better than others. It’s like anything else in life.”

Mr. de Blasio had asked to add people over 75 years old and essential workers to those in the pool approved for vaccinations. As of Tuesday morning, New York City data showed that just over 118,000 people had been vaccinated, a sliver of a population of more than 8 million.

Mr. Cuomo said the state was also looking to ramp up vaccination from places other than hospitals. He said essential workers like police officers, firefighters and transit workers should look to use their own networks to distribute the vaccine, once they are eligible to do so.

He said there would eventually be more than 3,700 sites across the state, including pharmacies and urgent care clinics, where people could get a vaccine.

Statewide, there were 8,590 reported hospitalizations, he said Tuesday, up from around 400 in early September.

In the city, Mr. de Blasio said five new vaccination centers, one in each of the five boroughs, will operate day and night with the aim of distributing 100,000 doses of the vaccine per week. He said that virus statistics for the city remained discouraging, with a seven-day average positive test rate of 9.03 percent.

In other news from around New York:

  • The state’s largest health system, Northwell Health, sued more than 2,500 patients last year over unpaid medical bills, even as the pandemic has led to widespread job losses and economic uncertainty. After a Times article about the lawsuits was published on Tuesday morning, Northwell abruptly announced it would stop suing patients during the pandemic and would rescind all legal claims it filed in 2020.

  • The pandemic’s effect on home sales in Manhattan was predictably grim, even though there have been recent signs of improvement, according to new industry statistics. There were 7,048 sales of co-ops and condos in Manhattan in 2020, compared with 10,048 in 2019, representing a nearly 30 percent drop, according to the brokerage Douglas Elliman. Affluent buyers continued to snap up expensive apartments, while entry-level buyers, who are more likely to be unemployed because of Covid-19, were practically absent.

  • Across New York City, free street parking has become increasingly scarce after people who drove away for the summer returned, outdoor dining took over roughly 10,000 parking spaces and car ownership soared. “It’s like the Hunger Games for parking,” one Brooklyn resident said.

A doctor tending to patients suffering from Covid-19 in an intensive care unit at Long Island Jewish Medical Center in Queens, New York, in April.
Credit…Victor J. Blue for The New York Times

When the coronavirus began spreading through New York, Gov. Andrew M. Cuomo ordered state-run hospitals to stop suing patients over unpaid medical bills, and almost all of the major private hospitals in the state voluntarily followed suit by suspending their claims.

But Northwell Health, which is the state’s largest health system and is run by one of Mr. Cuomo’s closest allies, sued more than 2,500 patients last year, records show.

The lawsuits each sought an average of $1,700 in unpaid bills, plus large interest payments. They hit teachers, construction workers, grocery store employees and others, including some who had lost work in the pandemic or gotten sick themselves.

“My salary was cut in half. I’m now working only two days a week. And now I have to deal with this,” said Carlos Castillo, a hotel worker in New York City who was sued for $4,043 after being hospitalized with a seizure at Long Island Jewish Medical Center, which is part of the Northwell system. Mr. Castillo, 37, said he was worried the hospital would seize his paychecks and leave him unable to pay rent.

After a New York Times article was published Tuesday morning about the lawsuits, Northwell abruptly announced it would stop suing patients during the pandemic and would rescind all legal claims it filed in 2020.

The Northwell system brings in about $12.5 billion in annual revenue and received $1.2 billion in emergency funding through the stimulus package in the federal CARES Act last year.

It has sued over unpaid bills as small as $700, records show.

Northwell’s chief executive officer, Michael Dowling, was the state health director and deputy secretary to former Gov. Mario Cuomo, the current governor’s late father, and he is a close friend to the younger Mr. Cuomo.

During the pandemic, Mr. Dowling has served as the governor’s closest ally in the hospital industry. Both men wrote books this year, and Mr. Cuomo wrote a blurb promoting Mr. Dowling’s writing.

A Northwell spokeswoman declined to say whether Mr. Dowling had discussed the lawsuits with Mr. Cuomo. A spokesman for the governor did not respond to requests for comment.

Richard Miller, Northwell’s chief business strategy officer, defended the cases, saying Northwell had the right to collect what it was owed. He said that Northwell has a financial-assistance program for low-income patients that is more generous than required by the government, and he said the system sues only employed patients that it believes have the ability to pay and who do not respond to outreach attempts.

Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, a nonprofit that advocates anti-poverty policies, criticized hospitals for suing patients during the pandemic.

She said that a few hundred dollars may not mean much to a hospital chain but can be a significant burden for a low-income patient. “It means someone is going hungry,” Ms. Benjamin said. “It means a kid is not getting a winter coat.”

Since the pandemic began, only one in five prisoners in Mississippi’s correctional facilities has been tested, according to state records.
Credit…Rogelio V. Solis/Associated Press

The Mississippi Department of Corrections has reported that 108 people died in its prisons in 2020, a toll that was significantly higher than a year earlier. But as of Monday, the department had not disclosed whether any of those deaths were caused by the coronavirus, though more than 1,400 inmates have been infected since the pandemic’s start, according to state data.

Grace Fisher, a spokeswoman for the prison system, did not respond to email and phone inquiries about how the state prison system determines, records and makes public the causes of inmate deaths. A spokeswoman for Gov. Tate Reeves did not respond to an email and phone call seeking comment.

Many states report Covid-19 cases and deaths in online dashboards. Others report them in news releases or when requested.

Mississippi’s prison system has touted its handling of the virus, saying in a news release in December that its prisons “remain among the safest in the nation from the Covid-19 virus.”

Burl Cain, the state’s prison commissioner, said in May that the prison system had successfully managed the virus by restricting inmate transfers, suspending family visits and using increased cleaning and disinfection practices.

Advocates of greater transparency from prison authorities say it is unclear whether Mississippi’s prisons are opting not to disclose coronavirus deaths or if officials are uncertain of a full count because deaths are not being fully investigated.

Cliff Johnson, the director of the University of Mississippi School of Law’s MacArthur Justice Center — which filed a Freedom of Information request to obtain the number of prison deaths — said the lack of information about the causes of prison deaths represented a public safety threat.

All but three states have reported Covid-19 deaths in their prison systems. Vermont has recorded no prisoner deaths from the virus, a representative for that system said. Wyoming has not disclosed any deaths. But Mississippi’s prison system is far larger, with about 16,350 inmates, compared with just 3,200 in Wyoming and Vermont combined.

In New Jersey, whose prisons house about 15,000 inmates, at least 53 have died from Covid-19, according to state data.

The rate of coronavirus testing in Mississippi’s prisons is among the lowest in the nation. Since the pandemic began, only one in five prisoners has been tested, according to state records.

Prime Minister Boris Johnson of Britain watches as Jennifer Dumasi receives a dose of the Oxford-AstraZeneca vaccine in London’s Chase Farm Hospital on Monday.
Credit…Pool photo by Stefan Rousseau

As England enters a strict new national lockdown and other European nations extend restrictions to try to slow the spread of the coronavirus, political leaders have pointed to the promise of mass vaccination campaigns to bring an end to the suffering.

But in the race to beat the virus, the virus is still way out in front.

Around the world, inoculation efforts in many countries are rolling out slower than promised, even as the count of new infections soars and record numbers flood hospitals, placing a double burden on health care providers who have also been tasked with leading the vaccination push.

And a more contagious variant spreading widely in England and detected in dozens of other countries threatens to give the virus an even greater advantage.

Prime Minister Boris Johnson said that England would be locked down until inoculations reached the four most vulnerable groups: residents in nursing homes and those who care for them, everyone over the age of 70, all frontline health and social care workers, and everyone who is clinically extremely vulnerable.

“If we succeed in vaccinating all those groups, we will have removed huge numbers of people from the path of the virus,” he said.

That goal, he added, could be achieved by the middle of February.

But to do that, the pace of vaccinations will need to increase drastically.

The four groups that the prime minister cited include 13.9 million people in England, according to Nadhim Zahawi, the minister overseeing the vaccine effort.

Since the campaign started on Dec. 8, fewer than 800,000 people in England had been vaccinated as of Dec. 27, the last date when data was available.

But with the introduction on Monday of the first doses of a vaccine developed by the University of Oxford and AstraZeneca — shots that are easier to transport and do not need to be stored at very cold temperatures — British officials said that the campaign could now be ramped up.

To meet Mr. Johnson’s target, some two million doses need to be given every week.

According to Mr. Johnson, England is outpacing many countries in the European Union, where vaccination campaigns did not kick off until just before Christmas.

Data from 19 of the bloc’s 27 member states, including France, Germany and Italy, show that about 500,000 vaccinations have been carried out so far.

In Germany, where the government was poised to extend lockdown measures through January, nearly 265,000 people received a first shot as the nationwide drive entered its second week, according to health officials. At the moment, Germany and other European Union countries are relying on the BioNTech-Pfizer vaccine, which requires another booster shot weeks later to reach full efficacy. England has decided to delay that second shot and other countries are exploring doing the same.

The Italian government said that as of Monday, 151,606 people had been vaccinated. A majority, 134,255, were health care professionals.

The vaccination drives in Germany and Italy are moving much faster than in France, where only about 500 people received the vaccine during the previous week.

And the campaign in the United States, the world’s leader in new infections, is off to a much slower start than promised.

About 4.5 million people in the United States have received a dose of a Covid-19 vaccine, according to the Centers for Disease Control and Prevention, far short of the goal that federal officials set to give at least 20 million their first shots before the end of December.

The small number of vaccine recipients is particularly striking in New York City, where roughly 110,000 people — in a city of more than eight million — have received the first of two doses necessary to help prevent serious cases of the disease. That is about a quarter of the total number received by the city.

The Genesis Church in Woburn, Mass., where a cluster of Covid-19 cases has been linked to Christmas gatherings.
Credit…Erin Clark/The Boston Globe

Genesis Community Church, outside of Boston, thought it was taking all the right safety precautions for its Christmas services: requiring an R.S.V.P. in case contact tracing was needed, limiting capacity and requiring masks.

But it was not enough. More than 40 people have tested positive for the coronavirus in cases that are believed to be connected to those gatherings.

The house of worship in Woburn, Mass., hosted a total of four Christmas celebrations on Dec. 23 and Dec. 24. Its lead pastor, Michael Davis, who declined to be interviewed, said in a series of emails that those who wanted to attend were required to essentially make reservations.

That allowed the church “to do accurate and complete contact tracing of everyone who was in the building,” Mr. Davis said. “The average attendance at each gathering was 105 per service, which is 35 percent of our building occupancy.”

But, he said, he knows of at least 44 people who were at those services who have tested positive. Tara Vocino, 32, a local photographer, is one of them. She said that she was tested on Dec. 29 and received her positive result two days later.

“It feels like there has been a knife in my mouth, and I’ve lost all sense of taste and smell,” Ms. Vocino said, adding that she feels so exhausted that she has been sleeping “about 16 hours a day.”

She said that she was at one of the services on Dec. 23, was in the front row at the church and was wearing a mask.

“When I saw there was the outbreak, I went out and got tested,” she added.

Ms. Vocino, who lives with her parents and suffers from asthma, said, “I’ve been in one room for the last couple of days, and I use a separate bathroom.”

Mr. Davis said that he has also tested positive but is “almost back to full health.”

He added that the church is “working closely” with the Woburn Board of Health to help the agency with contact tracing. Mr. Davis said that within 24 hours of church officials learning of five of the cases, they contacted the health board.

Neither representatives from the health agency nor the mayor of Woburn responded to numerous calls and emails.

Susan Beachy contributed research.