More U.S. Pharmacies to Start Vaccinating High-Risk Groups

The next phase of the U.S. vaccine rollout will expand the number of pharmacies distributing coronavirus vaccines to high-risk groups.
Credit…Jeenah Moon for The New York Times

As the lagging rollout of coronavirus vaccines begins to pick up its pace in its fourth week, the Trump administration this week will launch a federal program to give out vaccines at pharmacy stores to high-risk groups, including older people and frontline workers, federal health officials said at a news conference on Wednesday.

“The next big push is to bring those online and make sure the governors have those available really to hopefully expand out to much larger swathes of individuals,” said Alex M. Azar II, the secretary of health and human services.

Some states have already begun using their pharmacies to give out vaccines, mainly to health care workers and older people. The program being activated this week, which was announced in November without a time table for its launch, is a partnership with 19 pharmacy chains and associations, including Walmart, CVS, Walgreens and Costco.

States will be able to allocate doses of vaccines directly to these pharmacies, which can then give out the vaccines to high-risk groups designated by each state. Across the country, 40,000 pharmacy locations have enrolled to participate in the program, although in the first days of the program, only a few thousand pharmacies are expected to begin giving out vaccines.

Even as the vaccines have started becoming available, the virus continues to spread at an alarming pace. More than 21 million coronavirus cases and more than 357,000 virus-related deaths have been reported in the United States.

So far, most vaccines have been given out at hospitals and other health care settings, such as clinics and nursing homes. But pharmacies are increasingly entering the mix.

In Louisiana, about 100 pharmacies across the state this week will start to give doses of the Moderna vaccine to people over 70, health care workers, and patients on dialysis, Gov. John Bel Edwards announced on Monday. In Florida, seniors will be able to start making appointments on Thursday to get the Moderna vaccine at 22 Publix Supermarkets pharmacy locations across the state, Gov. Ron DeSantis announced on Tuesday.

As of Wednesday morning, nearly 17.3 million doses of vaccines from Pfizer and Moderna had been shipped out across the country. But according to data from the Centers for Disease Control and Prevention,, only 5.3 million people have received their first shots.

The rollout is beginning to accelerate: More first shots were reported given in the third week of the vaccine drive than in the first two combined, and the C.D.C.’s count increased by 470,000 between Tuesday and Wednesday. Still, the number of vaccinations is far fewer than the 20 million people that the Trump administration hoped would get their first shots by the end of 2020.

Pharmacies in the program will face the challenge of verifying that the people they give vaccines to are eligible to receive them because of their age, job or medical conditions. Mr. Azar said on Wednesday that verification is a less urgent concern than getting out doses quickly.

“We need to not be overly prescriptive in that, especially as we see governors who are leaving vaccines sitting in freezers rather than getting it out into people’s arms,” Mr. Azar said. “The perfect cannot be the enemy of the good here.”

Other vaccines nearing the final stages of development could increase the supply of vaccines and help accelerate their distribution.

Johnson & Johnson is on track to file by the end of this month for emergency authorization for its vaccine, said Moncef Slaoui, the chief scientific adviser for Operation Warp Speed, the federal effort to fast-track vaccines. That vaccine only involves a single dose, which will be easier to deliver than all the other leading vaccines, which require two shots.

Another vaccine, developed by AstraZeneca and the University of Oxford, is being tested in a late-stage trial in the United States that is nearing its final stages. It is right around its goal of recruiting 30,000 participants, though a few sites are still recruiting minority populations, Dr. Slaoui said. He said AstraZeneca could seek emergency authorization as early as the first week of March. Dr. Slaoui said last month that the AstraZeneca vaccine — which has been authorized in Britain, India, Mexico and several other countries — likely will not be available in the United States until at least April.

Dr. Slaoui confirmed on Wednesday that he will stay on as a consultant under the new Biden administration, though he suggested the role would be more limited than his current position.

With no robust system to identify genetic variations of the coronavirus, experts warn that the United States is woefully ill-equipped to track a dangerous new mutant, leaving health officials blind as they try to combat the grave threat.

The variant, which is now surging in Britain and burdening its hospitals with new cases, is rare for now in the United States. But it has the potential to explode in the next few weeks, putting new pressures on American hospitals, some of which are already near the breaking point.

The United States has no large-scale, nationwide system for checking coronavirus genomes for new mutations, including the ones carried by the new variant. About 1.4 million people test positive for the virus each week, but researchers are only doing genome sequencing — a method that can definitively spot the new variant — on fewer than 3,000 of those weekly samples. And that work is done by a patchwork of academic, state and commercial laboratories.

Scientists say that a national surveillance program would be able to determine just how widespread the new variant is and help contain emerging hot spots, extending the crucial window of time in which vulnerable people across the country could get vaccinated. That would cost several hundred million dollars or more. That may seem like a steep price tag, but it’s a tiny fraction of the $16 trillion in economic losses that the United States is estimated to have sustained because of Covid-19.

“We need some sort of leadership,” said Dr. Charles Chiu, a researcher at the University of California, San Francisco, whose team spotted some of the first California cases of the new variant. “This has to be a system that is implemented on a national level. Without that kind of dedicated support, it’s simply not going to get done.”

With such a system in place, health officials could warn the public in affected areas and institute new measures to contend with the variant — such as using better masks, contact tracing, closing schools or temporary lockdowns — and do so early, rather than waiting until a new surge flooded hospitals with the sick.

The incoming Biden administration may be open to the idea. “The president-elect supports a national testing program that can help stop the spread of Covid-19 and find variants,” said T.J. Ducklo, a spokesman for the transition. “That means more tests, increased lab capacity and genome sequencing. This is vital to control Covid-19 and to prepare the United States to detect and stop future disease threats.”

Experts point to Britain as a model for what the United States could do. British researchers sequence the genome — that is, the complete genetic material in a coronavirus — from up to 10 percent of new positive samples. Even if the U.S. sequenced just one percent of genomes from across the country, or about 2,000 new samples a day, that would shine a bright light on the new variant, as well as other variants that may emerge.

Any site that administers the currently authorized vaccines must be prepared to recognize and treat a severe allergic reaction that may occur, though it is “a rare outcome,” federal health officials said.
Credit…Adriana Zehbrauskas for The New York Times

Of the nearly 2 million Americans who received coronavirus vaccinations developed by Pfizer and BioNTech during a 10-day stretch last month, 21 experienced a serious and potentially life-threatening allergic reaction called anaphylaxis, federal health officials said Wednesday.

Although the risk is ten times higher than the risk for anaphylaxis after a seasonal flu vaccine, officials described the reaction as “a rare outcome.”

The rate of anaphylaxis following vaccination was estimated to be 11.1 per million doses administered, compared with 1.3 cases of anaphylaxis per million doses of influenza vaccine administered, officials said.

“We know that safety is one of the public’s biggest concerns about the Covid vaccine,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“The anaphylaxis rate may seem high compared to the flu vaccine, but I want to reassure you: This is still a rare outcome.”

Any site that administers the vaccine must be prepared to recognize and treat a severe allergic reaction that may occur, federal health officials said. And though there is less information about reactions to the Moderna vaccine than to the Pfizer-BioNTech vaccine, Dr. Messonnier said, “At this point we really don’t have enough data to say there’s any difference in the risks, so the recommendations apply to both.” Recipients who experience anaphylaxis after receiving the first dose of the vaccine should not receive the second dose, officials said.

Other than the anaphylaxis reactions, which occurred shortly after vaccination, “Our vaccine safety systems haven’t picked up any worrisome signals,” Dr. Messonnier added. “The known and potential benefits of the Covid vaccine outweigh the risk of getting Covid-19.”

The C.D.C.’s analysis of adverse reactions, published on Wednesday, included only those to the Pfizer-BioNTech vaccine administered between Dec. 14 and Dec. 23.

One case of anaphylaxis was reported among the first 224,322 recipients of the Moderna vaccine, which became available later, between Dec. 21 and Dec. 23, the report said.

The vast majority of anaphylaxis reactions — 90 percent — occurred in women, who made up slightly more than half of vaccine recipients. A surprising number of those who went into anaphylaxis — 14 of the 21 — had never experienced an anaphylactic reaction prior to receiving the vaccine, and four had no known allergies at all.

Of the 21 who had reactions, 20 had recovered or been discharged home, and information was lacking on one individual. Nineteen were treated with epinephrine, and four were hospitalized, including three in intensive care. Seventeen were treated in an emergency department.

The C.D.C. said it was still investigating another seven reports of anaphylaxis following the vaccine, which have not been confirmed. The Vaccine Adverse Event Reporting System also identified 83 cases of nonanaphylaxis allergic reactions after the Pfizer-BioNtech vaccination; these people developed symptoms like rash and mild respiratory symptoms within a day of receiving the vaccine.

Among the 21 vaccine recipients who experienced anaphylaxis, 17 were known to have allergies to a variety of triggers, including foods, insects, pets and medications. The median time for anaphylactic reaction was 13 minutes after immunization, but one patient developed the reaction two and a half hours afterward.

Patients with known allergies have been warned to bring an epinephrine injector when they get vaccinated, and providers have been advised to keep patients with allergies for observation for 30 minutes following inoculation.

The new information is disconcerting, said Diana Zuckerman, president of the National Center for Health Research.

“The flaw in the system is that there was a small number of people who had a reaction 30 minutes or later,” she said. “It’s one thing to say everybody should hang around for 15 minutes. But the range was up to 150 minutes, and people aren’t going to hang around that long.”

Banner Health personnel prepare doses of the Pfizer-BioNTech Covid-19 vaccine during a vaccination drive held at the Arizona State Fairgrounds, in Phoenix on Monday.
Credit…Adriana Zehbrauskas for The New York Times

The summer surge that raged across the Sun Belt started in Arizona. For more than a month, from early June until mid July, the state added cases at the highest per capita rate in the country. Thousands died. Hospitals were stretched thin. At the peak, more than 3,800 cases were emerging each day.

As a new year begins, Arizona is again in dire shape, with a higher rate of new cases than any other state. Hospitalizations and deaths have surpassed records. Over the last week, the state has averaged more than 8,000 cases a day, more than double the summer peak.

“It shouldn’t have to have taken this amount of destruction for folks to take it seriously,” said Kristin Urquiza, who spoke of losing her father to the coronavirus at the Democratic National Convention last summer. In recent months, she said, she has been in Phoenix, helping her mother but also watching the city around her be overtaken by the virus that killed her father in June.

“There might be some hope that people will begin to think about it differently if they see it take hold of people they love,” she said.

Yet the cases keep pouring in, with no sign of slowing and little indication, some Arizona health care leaders say, of the kind of widespread public vigilance that might bring the outbreak under control. At the same time, vaccines in the state are being administered at among the lowest rates in the country.

“Most Americans don’t want to know, don’t want to acknowledge, don’t really want to recognize and certainly — even as it’s descending upon us — do not appear to understand the dire circumstances that we are facing,” said Dr. Marjorie Bessel, the chief clinical officer at Banner Health, Arizona’s largest hospital network.

Arizona is by no means alone in its struggle. Nationally, it has become routine for more than 200,000 infections and more than 2,500 deaths to be announced in a single day. California, Rhode Island, Tennessee and Oklahoma are all identifying cases at extraordinarily high rates.

The outlook is especially alarming in Southern California. In just two weeks, more than 240,000 cases had been identified in the Los Angeles metropolitan area. That is more cases than at least 19 entire states have identified over the entire pandemic. Hospitals have become so crowded that the Los Angeles County emergency medical services agency directed ambulances not to transport patients who cannot be resuscitated by emergency responders out in the field.

The hospital system in Arizona is not at that point yet, but it is close.

More than 4,600 coronavirus patients are currently hospitalized, forcing multiple hospitals to operate at over 120 percent of licensed bed capacity, send new emergency patients elsewhere and put a halt to elective surgeries.

Only 136 intensive care unit beds are available out of nearly 1,800 statewide, according to state data, but beds are not the most pressing issue, Dr. Bessel said. Staff and resources are. Nurses are being quickly trained in new skills and hundreds of health care workers are being flown in from other states.

Still, Dr. Bessel acknowledged, there comes a point when resources can be stretched no thinner and more drastic measures, such as rationing care, might have to be considered.

New York City police officers are next in line to receive the Covid-19 vaccine.
Credit…Hiroko Masuike/The New York Times

The pool of people eligible for vaccination in New York City in the first phase expanded to include about 25,000 eligible Police Department employees, Mayor Bill de Blasio said on Wednesday

Mr. de Blasio said that the state had approved vaccines for some home care workers, Department of Corrections employees and other city staff members in emergency response or medical roles. He said that he hoped to vaccinate 10,000 Police Department employees by Sunday.

“All of Phase 1A is now eligible,” Mr. de Blasio said, adding, “we want to go further.”

Mr. de Blasio’s announcement came after days of pushing the state to expand the group of people who could be vaccinated. New York City only gave the vaccine to about 10,000 people on Tuesday, which was about the same number of doses that the city provided on Monday. The mayor has pledged to accelerate the slow rollout of the vaccine and to deliver 100,000 doses this week, but the city will not likely reach that goal at the current pace.

Mr. de Blasio has also pushed for the state to allow people over 75 to receive the vaccine, a group designated in Phase 1B, the next stage of the state’s vaccine rollout. In that phase, Gov. Andrew M. Cuomo has said roughly five million essential workers across the state, including more than 800,000 education workers and about 200,000 public safety and public transit workers would be eligible for vaccination, along with about 1.3 million people over 75.

On Tuesday, Mr. Cuomo declined to immediately expand the pool beyond Phase 1A. “There isn’t supply,” he reiterated on Wednesday, adding that only 950,000 doses had been distributed so far, and there were more than 2.1 million health care workers in the highest priority group.

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

At Mr. de Blasio’s news conference on Wednesday, Dr. Dave A. Chokshi, the city’s health commissioner, said that “each of us knows and has worried about an aging parent or grandparent during this pandemic. We must do everything that we can for them.”

Mr. de Blasio described a preregistration system that would allow older New Yorkers to reserve a time to get vaccinated, reducing the risk of long lines that could spread the virus, like those that bedeviled inoculation efforts for older people in Florida. He said that seniors would be able to register by phone, a method that many of them prefer.

The mayor also said that the city would open two mass vaccination sites that will operate seven days a week, day and night, in Brooklyn and the Bronx on Sunday. Dr. Chokshi said the city was “pulling out all the stops” to open new vaccination sites and speed up the process. The city opened 25 sites so far this week, he said.

The positive test rate in the city also continued to climb to a seven-day average of 9.25 percent, the mayor said.

On Wednesday, Mr. Cuomo continued to raise concerns about the pace of vaccination and need to keep the virus in check. A man in his 60s became the state’s first confirmed case of a more contagious variant of the virus, which was initially found in the United Kingdom. Mr. Cuomo said that public health officials had discovered that the man had been in contact with an individual who had traveled to the United Kingdom, though he did not offer additional details.

Mr. Cuomo said he had sent a letter to U.S. Customs and Border Protection on Wednesday, asking that all travelers flying into state airports from abroad provide proof that they were tested for the virus before leaving the airport.

“We don’t want tens of thousands of people coming to our airports everyday from countries around the world who were not tested,” Mr. Cuomo said.

A takeoff at Dubai International Airport last April.
Credit…Karim Sahib/Agence France-Presse — Getty Images

An outbreak of at least four new coronavirus infections occurred on a September flight from Dubai to Auckland, New Zealand, despite numerous containment measures, researchers reported on Wednesday, suggesting that airlines may need to tighten their precautions still further to prevent in-flight transmission.

The new infections were detected after the plane landed in New Zealand, which requires incoming travelers to quarantine for 14 days before entering the community. The analysis, led by researchers at the New Zealand Ministry of Health, found that seven of the passengers tested positive during their quarantine, and at least four appeared to have been newly infected on the flight.

The passengers came from five countries, and five had tested negative at different points before boarding. They were seated within four rows of each other for the 18-hour duration of the flight, and the viruses they carried were virtually identical genetically — a strong indication that one person initiated the outbreak.

The findings are not definitive, cautioned the authors, led by Tara Swadi of the health ministry. But, they wrote, they “underscore the value of considering all international passengers arriving in New Zealand as being potentially infected, even if pre-departure testing was undertaken, social distancing and spacing were followed, and personal protective equipment was used in-flight.”

The new report comes at a moment when airlines are increasingly requiring pre-trip negative test results and requiring some social distancing between passengers and mask wearing. In this case, two of the people who tested positive acknowledged not wearing a mask during the flight, and two did not get a Covid test before boarding.

Previous analyses of the infection risk of air travel had produced mixed results, and airlines’ air filtration systems are thought to reduce risk even when a flight includes an infected person or persons. But at least two recent reports strongly suggest that in-flight outbreaks are a risk: one, of a flight from Boston to Hong Kong in March; the other of a flight from London to Hanoi, Vietnam, also in March.

But the new report is the first of an in-flight outbreak late in the year, when both airlines and passengers were being far more cautious than in the spring.

Gov. Gavin Newsom in July.
Credit…Pool photo by Hector Amezcua

Calling on state lawmakers to fast-track pandemic relief to Californians, Gov. Gavin Newsom proposed on Wednesday that the state send $600 checks to an estimated four million low-income families in the state, including undocumented immigrants who file state tax returns.

If the Legislature approves the idea, the state payments will roughly equal the federal ones established in the stimulus package Congress approved last month. It provides individual adults with an adjusted gross income of up to $75,000 for 2019 with a $600 payment. There is also a $600 federal payment for each child under 17 in families who meet those requirements.

The state money would go to households that qualify for California’s earned-income tax credit, meaning that they earn less than $30,000 annually. Some undocumented families and those with mixed immigration status would benefit.

The governor’s $2.4 billion pandemic relief plan, which also includes an extension of the state’s soon-to-expire moratorium on evictions, is among several emergency measures he is proposing to buttress the economy of the state, where small businesses and low-income workers, in particular, have suffered during the pandemic.

Mr. Newsom also has proposed speeding up about $1 billion in help for small businesses and $2 billion in spending to help schools reopen sooner for in-person instruction.

“Californians who have been impacted by this pandemic will get help to provide for their families and keep a roof over their heads,” Mr. Newsom said in a statement.

The Legislature, which is scheduled to reconvene next week, normally passes the state budget in June. The proposed emergency spending proposals are highly unusual, according to H.D. Palmer, the spokesman for the state Department of Finance, said, “but these are unusual times.”

Property owners, who have been restricted from evicting tenants for nonpayment of rent, have also called for financial assistance. California and some local governments in the state are expecting to receive some $2.6 billion in federal money to help low-income renters and small-property owners, and the governor proposed expediting use of those funds. He did not say how long he hoped to extend the protection for tenants.

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.

The European Medicines Agency has come under criticism for taking too long to authorize vaccines.
Credit…Cooper Neill for The New York Times

The European Union drug regulator approved the Moderna coronavirus vaccine on Wednesday after moving up a decision that had been scheduled for later in January.

The regulator, the European Medicines Agency, approved the Pfizer-BioNTech vaccine in late December after coming under criticism for being too slow, as Britain and the United States began rolling out vaccination campaigns before the European Union had even granted the drugs authorization.

The bloc, which is home to about 450 million people in 27 countries, has taken the lead in approving and ordering the vaccines on behalf of its members. The Pfizer vaccination was introduced in the final days of 2020 in most European Union countries, a few weeks behind Britain and the United States, but criticism has been growing that the process is taking too long and that there are not enough doses to go around yet.

The European Union has said that the availability of shots will pick up, along with production. The European Medicines Agency, which is based in Amsterdam, has also been criticized for not yet having started a review of the University of Oxford-AstraZeneca vaccine which has recently been approved for use in Britain and in India.

The European Union agency said that it needed more information to reach a decision of its own on the Oxford-AstraZeneca vaccine and that it expected the developers to share more data in January. The makers of the vaccine have not yet formally submitted a request to the European Union for approval.

Both the Pfizer-BioNTech decision in December and the Moderna decision on Wednesday were moved forward by the European Medicines Agency, reflecting the political and economic pressure on developed countries that have multibillion-dollar contracts with the pharmaceutical companies not to be seen as falling behind their peers in mass immunization campaigns.

The European Commission, the executive arm of the European Union, will need to formalize the regulator’s approval before the Moderna vaccine is rolled out, a process that can take up to two days.

Scottish First Minister Nicola Sturgeon delivered a statement at Holyrood, Edinburgh, announcing that Scotland will be placed in lockdown on Monday. Sturgeon said President Trump is not welcome to visit Scotland during lockdown.
Credit…Pool photo by Andrew Milligan

President Trump has not said where he plans to go after leaving the White House on Jan. 20. But the leader of Scotland made clear on Tuesday that Mr. Trump is not welcome in her country.

Nicola Sturgeon, Scotland’s first minister, said that under newly imposed virus restrictions, which prohibit all but essential travel, a visit by the president to one of his Scottish golf resorts, Trump Turnberry, would not be acceptable.

Rumors that Mr. Trump would head for Scotland flared after a Scottish paper reported that an American military version of a Boeing 757 — sometimes used by Mr. Trump — was scheduled to land at a nearby airport on Jan. 19, the day before Joseph R. Biden Jr. is to be sworn in as president.

“We are not allowing people to come into Scotland,” Ms. Sturgeon told reporters in Edinburgh, “and that would apply to him just as it applies to anybody else — and coming in to play golf is not what I would consider to be an essential purpose.”

A plain-spoken politician, Ms. Sturgeon said she did not know what Mr. Trump’s travel plans were, but that she hoped his immediate plan was to exit the White House. On Monday, she imposed a lockdown on Scotland, which, like England, is battling a surge in coronavirus cases because of a rapidly spreading new variant.

Under the new rules, people are required to stay at home and to work from there, where possible. Places of worship have been closed, and schools will operate by remote learning. Scotland has frequently moved faster and further than England to impose restrictions during the pandemic.

The White House initially declined to comment on the report, first published in Scotland’s Sunday Post paper, but later denied it.

“This is not accurate,” the press secretary, Kayleigh McEnany, said on Tuesday. “President Trump has no plans to travel to Scotland.”

Two White House officials said that while there’s been almost no concrete discussion of what Mr. Trump will do on Jan. 20 because he is so focused on trying to overturn the election results, they do not believe he is considering Scotland.

Mr. Trump has owned the Trump Turnberry resort since 2014 and has long thought of it as an escape. In November 2016, according to Anthony Scaramucci, the former White House communications director, he had planned on flying to the resort if, as he then expected, he lost the presidential race to Hillary Clinton.

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.”


Administering a vaccine in Montpellier, France, on Monday. The first wave of inoculations in the country has concentrated on residents of retirement or nursing homes.
Credit…Pascal Guyot/Agence France-Presse — Getty Images

Many countries in Europe and elsewhere have been criticized for rolling out Covid-19 vaccinations too slowly. And then there is France.

Only about 7,000 people have been vaccinated in France, the authorities said on Tuesday — a tiny fraction of the number in Germany (more than 316,000) or in Italy (more than 178,000).

The French government says it is following the strategy set out by the country’s top health authority, focusing the first wave of inoculations almost exclusively on residents of retirement or nursing homes.

But critics say the process is bogged down by red tape, preventing those who want a shot from getting one, while doing little to reassure those who are skeptical about the inoculations. One poll this week found that nearly 60 percent of respondents in France did not want a Covid-19 vaccine, up 8 percentage points from last month.

President Emmanuel Macron has privately vented to his staff that the pace of inoculations was like a “family stroll,” according to the Journal du Dimanche.

Jean Rottner, a doctor and center-right politician who is the regional president of Grand Est, in eastern France, said on the television channel France 2 this week that getting vaccinated was “becoming more complicated than buying a car.”

Jérôme Goeminne, who manages a group of hospitals in that region, said in an interview that it made sense to prioritize retirement and nursing homes to keep older and more vulnerable patients from overwhelming hospitals. And he said that some of the delays were inevitable.

Still, Mr. Goeminne said that the government had not given the local health authorities enough flexibility.

“Once it’s launched, things will roll ahead, but the execution is long,” he said. “There is a cultural aversion to risk in France,” he added.

Responding to the criticism, officials are speeding up their timetable. Health workers, firefighters and home-based care givers over the age of 50 are now able to get their shots — ahead of schedule.

Olivier Véran, the French health minister, also announced on Tuesday that anyone over 75 would be eligible for vaccination by the end of January, that hundreds of vaccination centers would open by the end of the month and that any French person who wanted a shot would soon be able to sign up for an appointment.

“We are now going to amplify, accelerate and simplify our vaccination strategy,” Mr. Véran told RTL radio on Tuesday, vowing that France would catch up with its European neighbors in the coming days.

More than 66,000 people have died in France so far because of the virus, and the number of hospitalized patients is stuck at about 25,000. Museums and movie theaters are closed, as are bars and restaurants.

In other global news:

  • BioNTech, the German vaccine maker working with Pfizer, is aiming to have a second production site in Germany up and running by the end of next month, the country’s health minister, Jens Spahn, said on Wednesday. The plant in Marburg, north of Frankfurt, will concentrate on producing more Covid-19 vaccine doses for Europe. German officials have been criticized for not distributing the vaccine more quickly. So far, only 367,331 of the country’s initial supply of 1.3 million doses have been administered, mostly to nursing home residents and health care workers.

The largely deserted Horse Guards Parade in central London on Tuesday. England has been forced into a new national lockdown to try to combat a more infectious variant of the coronavirus.
Credit…Andrew Testa for The New York Times

ROME — People around the world counted down to the end of 2020 with relish, pegging their hopes on the idea that the new year would bring vaccines and something that felt like normalcy.

But the coronavirus keeps no calendar. The bad news rolled in during the first days of 2021, including about the virus variant that has sent Britain into a desperate lockdown, serving notice that tougher times could be ahead. More than ever, hope is riding on the vaccine rollouts that have been fumbled and slower than promised around the world.

So far, the new year doesn’t look, or feel, so different.

“It’s OK to be upset and feel down right now,” Joe Wicks, a British fitness instructor whose online sessions last year drew millions of views, said as he broke down in a Monday night video reacting to England’s new restrictions.

Even places that much of the world looked to with admiration for their response to the pandemic have stumbled into the new year. In South Korea, infections soared to the largest daily increases yet during Christmas week. In Japan, a looming state of emergency for Tokyo is dashing long-harbored hopes.

The pandemic has warped notions of national identity, truth and time itself, but it has also created a shared vulnerability. The whole world seems to be alone together, cut off from the pre-Covid conceptions of what life was supposed to look like.

“It’s been tough,” said Fabrizio Topi, a cafe owner in Rome struggling to make ends meet. “But it’s the same the world over.”

That search for unity in itself is something. Taking lessons from natural disasters, charity groups and mental health advocates have emphasized the importance of staying connected and fostering communities that recognize that many are in a similar situation. Other people are looking within themselves for resilience and even improvement to beat back despondency.

But nearly a year into the crisis, after any New Year’s buzz has worn off, talk of common fragility and self-actualization can feel like whistling in the dark.

Students arrived for in-person learning at Public School 93, William Prescott, in Brooklyn’s Bedford Stuyvesant neighborhood, on Tuesday.
Credit…Andrew Seng for The New York Times

New York City’s rising coronavirus numbers are once again forcing high-stakes decisions about whether to keep schools open, leaving students, parents and educators with newfound uncertainty.

The United Federation of Teachers has warned the city that it believed all schools should close if the positivity rate reached a certain threshold.

But the mayor’s office has said it is determined to keep schools open.

Mayor Bill de Blasio has said the roughly 190,000 children in lower grades and those with complex disabilities who are back in classrooms should have the option to stay there, even as positivity rates top 9 percent citywide and individual school buildings are closing at an accelerating rate because of positive test results among staff or students.

Gov. Andrew M. Cuomo appeared to support Mayor Bill de Blasio in his desire to keep schools open, announcing on Monday that the state would not stick with its plan to close schools if the positivity rate hit 9 percent by the state’s metrics, and would instead leave the decision to local leaders. (Because of the difference in how the state and city tabulate virus test results, the state’s metrics have New York City at more than 6 percent positivity.)

But the teachers’ union quickly poured cold water on that plan by saying it wanted schools closed if the city hit the 9 percent state mark.

The renewed tension over opening schools makes it even less likely that the city’s middle and high schools will reopen in the next few months. Those schools were open for just a few weeks last fall before the mayor closed them again. The city does not yet have the testing capacity to open those schools, officials have said, and the teachers’ union has said it would oppose plans to reopen middle and high schools this winter.

As the city’s positivity rate has climbed over the last few weeks, educators have expressed incredulity that elementary schools and classrooms for children with the most complex disabilities would remain open in the new year.

One faction of the United Federation of Teachers called on the union and the city to immediately close all schools for in-person learning, rather than waiting to see if the numbers worsen. “Too many students, families and staff will become sick,” if schools remain open, U.F.T. Solidarity, a left-leaning caucus within the union, said in a recent statement.