Congressman-Elect From Louisiana Dies of Virus

A congressman-elect from Louisiana died from Covid-19 complications.

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Luke Letlow in July. He said on Dec. 18 that he was isolating at home after testing positive for the coronavirus.Credit...Melinda Deslatte/Associated Press

Luke Letlow, a Republican who was elected to the House of Representatives this month to represent Louisiana’s Fifth Congressional District, died Tuesday evening of complications from Covid-19, a spokesman said. He was 41.

Mr. Letlow was set to take office on Sunday. His death was confirmed by several politicians, including Representative Garret Graves of Louisiana, who said in a Facebook post that the death of his friend and “former co-worker” was “a huge loss to Louisiana and America.” Mr. Letlow died at the Ochsner L.S.U. Health medical center in Shreveport, La., said the spokesman, Andrew Bautsch.

Mr. Letlow said on Dec. 18 that he was isolating at home after testing positive for the coronavirus. He was hospitalized a day later in Monroe, La., before being transferred to the hospital in Shreveport on Dec. 22. Mr. Bautsch said on Dec. 23. that Mr. Letlow had been receiving the antiviral drug remdesivir and steroids to treat his infection.

On Dec. 21, while he was hospitalized in Monroe, Mr. Letlow urged people who had recovered from Covid-19 to donate plasma. “Your plasma is ESPECIALLY needed by those who are suffering,” he wrote in a tweet. “I cannot stress this enough. Please consider saving lives by going out and donating at your local blood bank.”

He did not have any underlying conditions that would have increased his chances of dying from Covid-19, Dr. G.E. Ghali, a doctor at the Shreveport hospital, told The Advocate in Baton Rouge, La.

In a runoff this month against another Republican, Mr. Letlow was elected to succeed Representative Ralph Abraham, whom Mr. Letlow had served as chief of staff.

Mr. Letlow is survived by his wife, Julia, and their two children, Jeremiah and Jacqueline.

Speaker Nancy Pelosi said in a statement, “Tonight, the United States House of Representatives sadly mourns the passing of Congressman-elect Luke Letlow.

“Congressman-elect Letlow was a ninth-generation Louisianian who fought passionately for his point of view and dedicated his life to public service,” she said.

Kevin McCarthy, the House minority leader, said, “Our hearts break tonight as we process the news of Congressman-elect Luke Letlow’s passing.”

Gov. John Bel Edwards of Louisiana said Tuesday evening that Covid-19 had “taken Congressman-elect Letlow from us far too soon.” Mr. Edwards, a Democrat, said he had ordered flags to be flown at half-staff on the day of Mr. Letlow’s funeral.

Representative Mike Johnson, a Republican who represents the state’s Fourth Congressional District, issued a statement on behalf of the state’s six-member Congressional delegation: “We are devastated to hear of Luke Letlow’s passing. Luke had such a positive spirit, and he had a tremendously bright future ahead of him. He was looking forward to serving the people of Louisiana in Congress, and we were excited to welcome him to our delegation where he was ready to make an even greater impact on our state and our nation.”

Bobby Jindal, the former governor of Louisiana whom Mr. Letlow had previously worked for when Mr. Jindal was a congressional candidate, representative and governor, said the congressman-elect “had talked in recent days about his excitement about the opportunity to serve” his district.

“I first met Luke when he was still a college student, and spent countless hours with him in his truck driving the back roads of Louisiana,” Mr. Jindal said. “His passion for service has been a constant throughout his life.”

According to Ballotpedia, Mr. Letlow is the first elected federal official to die from the coronavirus; the first member of the federal government to die from it was a judge.

Other elected officials to die from Covid-19 include several state legislators: a Republican state senator from Minnesota, New Hampshire’s new Republican speaker of the House of Representatives, and in North Dakota, David Dean Andahl, a Republican known as Dakota Dave, who was elected posthumously to the State House of Representatives after dying from the virus.

Vaccine announcements from Britain, China and other countries bolster the push for inoculations.

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A volunteer in the Oxford-AstraZeneca vaccine trial getting a shot in Oxford, England, in November.Credit...Andrew Testa for The New York Times

A global push to accelerate vaccinations gathered steam on Wednesday, with new developments from Britain, China and Russia.

Britain became the first country to give emergency authorization to the coronavirus vaccine developed by AstraZeneca and the University of Oxford. The approval opens a path for a cheap and easy-to-store shot that much of the world will rely on to help end the pandemic. Indian officials met on Wednesday and were set to meet again on Friday to consider vaccine applications.

For Britain, where hospitals are overwhelmed by a new, more contagious variant of the virus, the regulator’s decision offered some hope of a reprieve. The health service is preparing to vaccinate a million people per week at makeshift sites in soccer stadiums and racetracks.

The Oxford-AstraZeneca shot is poised to become the world’s dominant form of inoculation. At $3 to $4 a dose, it is much less expensive than some other vaccines. And it can be shipped and stored at normal refrigeration temperatures for six months, rather than in the ultracold freezers required by the Pfizer-BioNTech and Moderna vaccines, making it easier to administer to people in poorer and hard-to-reach areas.

In a bold departure from prevailing strategies around the world, the British government also decided to begin giving as many people as possible a first vaccine dose, rather than holding back supplies for quick second shots, greatly expanding the number of people who will be inoculated. Clinicians in Britain will wait as long as 12 weeks to give people second doses, the government said.

The effects of delaying second doses as a way of giving more people the partial protection of a single dose are not fully known. Britain, which experts believe is the first country to undertake such a plan, will also delay second doses of the Pfizer-BioNTech vaccine, which has been in use in the country for several weeks and has been shown in clinical trials to have considerable efficacy after a single dose. Some participants in the clinical trial of the Oxford-AstraZeneca vaccine were given the two doses several months apart.

When given in two full-strength doses, AstraZeneca’s vaccine showed 62 percent efficacy in clinical trials — considerably lower than the roughly 95 percent efficacy achieved by Pfizer’s and Moderna’s shots. For reasons scientists don’t yet understand, AstraZeneca’s vaccine showed 90 percent efficacy in a smaller group of volunteers who were given a half-strength initial dose.

Here are other vaccine developments from around the world:

  • China said on Thursday that it had approved a homegrown coronavirus vaccine after an early analysis of clinical trial results showed that it was effective. The announcements sent a positive signal for the global rollout of Chinese vaccines but lacked crucial details.

    The manufacturer, a state-controlled company called Sinopharm, said a vaccine candidate made by its Beijing Institute of Biological Products arm had an efficacy rate of 79 percent based on an interim analysis of Phase 3 trials. Sinopharm said it had filed an application with Chinese regulators to allow the vaccine to be used broadly, and on Thursday the government said the vaccine had been granted conditional approval.

  • Russia secured an important outside vote of confidence in the safety of its vaccine, Sputnik V, with the start of mass inoculations in Belarus and Argentina. The vaccine had been dogged by criticism since President Vladimir V. Putin announced in August that it was ready for use even though clinical trials had not been completed.

    Large-scale clinical trials carried out since then have shown the vaccine, developed by the Gamaleya National Research Institute of Epidemiology and Microbiology, to be more than 91 percent effective, according to its Russian backers. A voluntary vaccination program using Sputnik V began in Russia this month, but a recent survey found that only 38 percent of Russians intended to get the vaccine.

  • Hungary, whose leader, Viktor Orban, has pointed to Russia as a beacon of his model of so-called illiberal democracy, was the first member of the European Union to receive a delivery of the Russian vaccine, though the shipment it received on Monday was only 6,000 vials. Doses of the Russian vaccine also arrived in Serbia, which is outside the union, on Wednesday.

  • Prime Minister Giuseppe Conte of Italy said on Wednesday that the country was aiming to immunize 10 million to 15 million people by late spring but that it would not make the vaccine obligatory.

Tracking the Coronavirus ›

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A Chinese coronavirus vaccine has proved effective, its maker said.

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A volunteer receiving a Sinopharm Covid-19 vaccine at a trial in Lima, Peru, this month.Credit...Ernesto Benavides/Agence France-Presse — Getty Images

A Chinese pharmaceutical company on Wednesday said late-stage drug trials showed that one of its coronavirus vaccines was effective, delivering positive results that could pave the way for the global rollout of hundreds of millions of Chinese vaccine doses in the coming months.

The company, a state-controlled firm called Sinopharm, said that a vaccine candidate made by its Beijing Institute of Biological Products arm had proved to be 79 percent effective in interim Phase 3 trials. Sinopharm said it applied with Chinese regulators to allow the vaccine to be used broadly.

A full breakdown of results was not immediately available. If supported, the results will bolster claims that Chinese officials have made in recent days that the country’s vaccines are safe and effective. The authorities have already moved ahead with plans to vaccinate 50 million people in China by mid-February, when hundreds of millions are expected to travel for the Lunar New Year holiday, according to a Chinese vaccine expert.

China’s drive to develop a homegrown vaccine speaks to the country’s technological and diplomatic ambitions. If Chinese vaccines stand up to global scrutiny, they would support the country’s claim as a peer and rival to the United States and other developed countries in biomedical sciences.

The Sinopharm vaccine’s results show that it is less effective than others that have been approved in other countries. Still, the results are well above the 50 percent threshold that makes a vaccine effective in the eyes of the medical establishment.

Two other coronavirus vaccines, made by Moderna and Pfizer-BioNTech, have already been shown to have an efficacy rate of about 95 percent. The Pfizer-BioNTech vaccine has received authorization in more than 40 countries. Moderna’s vaccine has been authorized in the United States, while other countries are evaluating its trial results. Russia has announced that its Sputnik V vaccine has an efficacy rate of 91 percent and has begun a mass vaccination campaign. A vaccine made by AstraZeneca and Oxford University was approved early Wednesday in Britain.

Beijing has leaned heavily on the promise of its vaccines to strengthen ties with developing countries deemed vital to China’s interests. Officials have toured the world pledging to provide Chinese vaccines as a “global public good,” a charm offensive that the United States may seek to counter, particularly when the campaign encroaches on its backyard.

The political stakes in the race for a vaccine are particularly high for China’s ruling Communist Party, whose authoritarian rule has been criticized for stifling information and playing down the virus when it first emerged in the city of Wuhan late last year. A successful vaccine, if quickly made available to the world, could help repair the party’s image globally and that of its leader, Xi Jinping.

California extends stay-at-home orders in two regions into 2021.

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A boarded up beauty salon in San Bernardino, Calif., this month.Credit...Alex Welsh for The New York Times

Stringent, contested stay-at-home orders have been extended in California’s vast southern region and Central Valley, state health officials announced on Tuesday, because new coronavirus cases and hospitalizations are continuing to surge in those regions.

Hospitals in the state have been flooded with patients, to the point that some facilities have resorted to treating them in hallways, gift shops and tents. And in the wake of the holiday season, the hospital situation is expected to worsen, according to California’s secretary of health and human services, Dr. Mark Ghaly.

“We are essentially projecting that I.C.U. capacity is not improving in Southern California and the San Joaquin Valley, with demand exceeding capacity,” he said in a news conference on Tuesday.

The orders require residents of the two regions not to leave their homes except for certain essential activities, like shopping or working at grocery stores. Restaurants may stay open only for takeout, and stores must operate at reduced capacity, although indoor shopping malls have been allowed to remain open.

Southern California and the San Joaquin Valley were the first parts of the state to undergo the restrictions about three weeks ago, after available space in intensive care units dipped perilously low. The orders could have expired on Monday if the crowding was expected to ease soon.

But neither region now has any I.C.U. space available, and Dr. Ghaly said that hospitals were being stretched to a breaking point. Hospitals in Los Angeles County, now the hardest hit area in the state, have had to turn away ambulances. Care is suffering because health care providers are overwhelmed.

Dr. Ghaly said that hospitals and officials have been having urgent discussions aimed at preventing the need to ration care.

Daily reports of new cases remain alarmingly high across the United States, and officials worry that holiday travel and social gatherings will only accelerate the spread. More than 121,000 patients with Covid-19 are hospitalized across the country, according to the Covid Tracking Project.

Dr. Ghaly did not give a new expiration date for the extended restrictions, saying that I.C.U. conditions would be evaluated day by day.

Two other regions — Greater Sacramento and the Bay Area — are also under the restrictions, but those orders were imposed later and are not yet eligible to expire. Hospitals across the Sacramento area have 19.1 percent of their I.C.U. capacity available, while those in the Bay Area have 10.4 percent, officials said. The state has said it would lift restrictions once a region’s hospitals are expected to soon have at least 15 percent of capacity free.

Experts have said that the prevalence of the virus in so many communities in the state has made the stay-at-home orders a necessary last resort. But California’s restrictions, among the strictest imposed in the nation since the spring, have met with considerable resistance. Many residents and businesses have openly defied the regulations, and the sheriffs of Orange and Riverside Counties have said they would not enforce them.

Even so, Gov. Gavin Newsom said on Monday that “people have been in compliance — overwhelmingly so.”

And although the state has said it would withhold money from counties where local officials have declined to enforce the orders, officials said on Monday that the state had not yet taken any steps to do so.

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The first confirmed U.S. case of the more contagious British variant has been found in Colorado.

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The variant was detected in a man in his early 20s who is in isolation in Elbert County, southeast of Denver.Credit...David Zalubowski/Associated Press

A case of the more contagious coronavirus variant first discovered in Britain was found in Colorado on Tuesday, Gov. Jared Polis said. It is the first confirmed case of the variant in the United States.

The variant was detected in a man in his 20s with no travel history, Mr. Polis said. The man was in isolation in Elbert County, southeast of Denver, he said.

“There is a lot we don’t know about this new Covid-19 variant, but scientists in the United Kingdom are warning the world that it is significantly more contagious,” Mr. Polis said in a statement. “The health and safety of Coloradans is our top priority and we will closely monitor this case, as well as all Covid-19 indicators, very closely.”

Scientists are worried about these variants but not surprised by them. It is normal for viruses to mutate, and most of the mutations of the coronavirus have proved minor.

“This should not be cause for panic,” said William Hanage, an epidemiologist at Harvard University. “But it is cause to redouble our efforts at preventing the virus from getting the opportunity to spread.”

Earlier this month, British researchers observed that the variant was becoming more prevalent in parts of Britain. Their subsequent investigations suggest that the variant — known as B.1.1.7 — spreads more readily than others in circulation.

It’s not yet clear why B.1.1.7 transmits more easily. The lineage has accumulated 23 mutations since it split off from other coronaviruses. Researchers are investigating some of the mutations to see if they allow the viruses to invade cells more readily or make more copies of themselves.

There’s no evidence that an infection with B.1.1.7 is more likely to lead to a severe case of Covid-19 or increase the risk of death. But the speed at which the variant seems to spread could lead to more infections — and therefore more hospitalizations.

The British government has responded to the emergence of B.1.1.7 by enforcing stronger restrictions on people’s movements and the size of gatherings. In a preliminary study, British researchers found that schools may need to be closed and vaccination programs aggressively accelerated to prevent a huge surge in cases.

Cases of the variant have been found in several countries, including Japan, Spain, France and Canada. Officials in India said on Tuesday that they had found six cases of the virus variant first detected in Britain.

Countries around the world have implemented stricter protocols for travelers entering from the United Kingdom. A new rule in the United States mandating that incoming travelers from the U.K. — including American citizens — show proof of a negative coronavirus test upon entry went into effect on Monday.

How much coronavirus a person carries could predict how sick they’ll get.

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Health care workers treating a Covid-19 patient at Providence St. Mary Medical Center in Apple Valley, Calif., this month.Credit...Ariana Drehsler for The New York Times

Dozens of research papers published over the past few months have found that people whose bodies were teeming with the coronavirus more often became seriously ill and were more likely to die, compared with those who carried much less virus and were more likely to emerge relatively unscathed. Now that information could help hospitals.

The results suggest that knowing the so-called viral load — the amount of virus in the body — could help doctors distinguish those who may need an oxygen check just once a day, for example, from those who need to be monitored more closely, said Dr. Daniel Griffin, an infectious disease physician at Columbia University in New York.

Tracking viral loads “can actually help us stratify risk,” Dr. Griffin said. The idea is not new: Managing viral load has long formed the basis of care for people with H.I.V., for example, and for tamping down transmission of that virus.

Little effort has been made to track viral loads in Covid-19 patients. This month, however, the Food and Drug Administration said clinical labs might report not just whether a person is infected with the coronavirus, but also an estimate of how much virus is in their body.

This is not a change in policy. Labs could have reported this information all along, according to two senior F.D.A. officials who spoke on condition of anonymity because they were not authorized to speak publicly about the matter.

Still, the news came as a welcome surprise to some experts, who have for months pushed labs to record this information.

“This is a very important move by the F.D.A.,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. “I think it’s a step in the right direction to making the most use of one of the only pieces of data we have for many positive individuals.”

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Hospital and case numbers in England surpass the first peak, despite lockdowns.

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People outside a Covid-19 testing center in Islington, north London, on Tuesday.Credit...Andrew Testa for The New York Times

Nearly half of England is under the nation’s strictest lockdown measures, and people have been ordered to stay at home, but the coronavirus is still spreading at an alarming rate. Hospitals are treating more patients than at any time during the pandemic, and there is a growing debate about allowing tens of thousands of students to return to classrooms after the holiday break.

The nation’s scientists have said that a more contagious variant of the virus is driving the rise in cases and, having already imposed severe restrictions on more than 48 million people, it remains unclear what other tools the government has at its disposal to get the outbreak under control.

There were 53,135 new lab-confirmed cases reported on Tuesday, the highest figure yet on a single day. The National Health Service said there were now over 20,000 people in the hospital there, more than at the peak of the pandemic in April.

With the government scheduled to meet to evaluate the current restrictions on Wednesday, Prime Minister Boris Johnson is under pressure to impose another national lockdown and shift students — especially older ones in colleges and secondary schools, who may be more easily infected by the new virus variant — to remote learning.

The government said that it would rely on mass testing to keep the virus from spreading in schools, with military help. Some 1,500 soldiers are being dedicated to providing schools with the “guidance, materials and funding they need to offer rapid testing to their staff and students from the start of term,” according to the education secretary, Gavin Williamson.

But two teachers’ unions have said that staff has not been given adequate time to set up mass testing and the country’s board of scientific advisers, known as SAGE, has recommended against allowing classrooms to reopen, according to British media reports.

Even as the country’s health workers find themselves under growing pressure to treat the influx of patients, they are also being asked to speed up the largest mass vaccination program in the nation’s history.

Around 200,000 people are getting their first shot of the Pfizer-BioNTech vaccine every week. Ursula von der Leyen, the European Commission’s president, wrote on Twitter on Tuesday that the European Union would take an additional 100 million doses of that vaccine, bringing the total to 300 million doses.

With the approval of a vaccine from AstraZeneca and the University of Oxford expected in coming days, the number of doses available will expand drastically. The AstraZeneca vaccine, which comes without the stringent temperature requirements of Pfizer’s, should also be easier to distribute.

There is no evidence that the vaccines are any less effective against the variant of the virus spreading in Britain, and they remain the best chance for the country to break the spread of the current wave of infections.

Joe Biden says vaccine distribution ‘is not progressing as it should.’

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Biden Criticizes Coronavirus Vaccine Distribution

President-elect Joseph R. Biden Jr. on Tuesday criticized the Trump administration’s speed in distributing the coronavirus vaccine, and promised that once in office, he would increase the pace of distribution.

The next few weeks and months are going to be very tough, a very tough period for our nation — maybe the toughest during this entire pandemic. I know it’s hard to hear, but it’s the truth. We might not see improvement until we’re well into March, as it will take time for our Covid response plan to begin to produce visible progress. So the Trump administration’s plan to distribute vaccines is falling behind — far behind. We’re grateful to the companies, the doctors, the scientists, the researchers, the clinical trial participants in Operation Warp Speed for developing the vaccines quickly. But as I long feared and warned, the effort to distribute and administer the vaccine is not progressing as it should. A few weeks ago, Trump administration suggested that 20 million Americans, could be vaccinated by the end of December. With only a few days left in December, we’ve only vaccinated a few million so far, and the pace of vaccination, the vaccination program, is moving now — as it continues to move as it is now — it’s going to take years, not months, to vaccinate the American people. This is going to be the greatest operational challenge we’ve ever faced as a nation. But we’re going to get it done.

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President-elect Joseph R. Biden Jr. on Tuesday criticized the Trump administration’s speed in distributing the coronavirus vaccine, and promised that once in office, he would increase the pace of distribution.CreditCredit...Amr Alfiky/The New York Times

President-elect Joseph R. Biden Jr. on Tuesday criticized the speed of vaccine distribution under the Trump administration and promised to step up the pace when he takes office, while offering a sobering warning about the continuing toll of the pandemic.

“As I long feared and warned, the effort to distribute and administer the vaccine is not progressing as it should,” Mr. Biden said in Wilmington, Del., adding that at the current pace, “It’s going to take years, not months, to vaccinate the American people.”

Mr. Biden promised a “much more aggressive effort” under his administration.

“This is going to be the greatest operational challenge we’ve ever faced as a nation,” Mr. Biden said, “but we’re going to get it done.”

The president-elect will take office in just over three weeks amid a crisis that has already killed more than 335,000 people in the United States. He has vowed to get at least 100 million vaccine shots into the arms of Americans in his first 100 days in office.

The administration of vaccines has gotten off to a slower start than federal officials had hoped. As recently as earlier this month, federal officials had said their goal was for 20 million people to get their first shots by the end of the year. As of Monday morning, 11.4 million doses of the Pfizer and Moderna vaccines had been distributed across the country, but just 2.1 million people in the United States had received their first dose, according to a dashboard maintained by the Centers for Disease Control and Prevention that most likely reflects a reporting lag of several days.

Earlier Tuesday, Vice President-elect Kamala Harris received her first dose of the coronavirus vaccine. She got her shot on live television, just as Mr. Biden did last week. Ms. Harris’s husband, Douglas Emhoff, was also vaccinated on Tuesday.

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China is set to vaccinate millions, but without much proof that its vaccines work.

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Sinovac, a private Beijing-based vaccine maker, has produced millions of doses of its vaccine but has yet to receive government approval.Credit...Thomas Peter/Reuters

Hospitals all over China have almost everything necessary for a mass vaccination drive. Millions of doses. Refrigerators to store them. Health care workers trained to administer them.

Everything, that is, except much proof that any of their vaccines work.

Unlike their Western competitors, most Chinese companies have not disclosed data from late-stage clinical trials that would show whether their vaccines are effective; just one, the state-owned Sinopharm, has released findings, which it did on Wednesday. Regulators in China have not officially approved any of them.

That has not deterred local governments across the country, which have begun an ambitious vaccination campaign. The goal is to inoculate 50 million people — roughly the population of Colombia — by the middle of February, before the Lunar New Year holiday, when hundreds of millions of people are expected to travel.

China, where the virus first emerged a year ago, is going to great — and scientifically unorthodox — lengths to prevent a resurgence of the outbreak. While Beijing has not officially announced the vaccine target, the government has signaled that the rollout will be managed in much the same way as the outbreak, through a top-down approach that can mobilize thousands of workers to produce, ship and administer the shots.

Chinese officials have issued broad statements with few details, assuring the public that the vaccines are safe and effective. Three of the vaccines have been approved only for emergency use. Last month, Liu Jingzhen, the chairman of Sinopharm, a state-owned vaccine maker that has two vaccines in late-stage trials, said that none of the roughly one million people vaccinated so far had any adverse reactions and that “only a few had mild symptoms.”

On Wednesday, Sinopharm said that one of its vaccine candidates, made by its Beijing Institute of Biological Products arm, had proved to be 79 percent effective in interim Phase 3 trials. Sinopharm said it had applied for Chinese regulatory approval for the vaccine to be used en masse.

China could have problems persuading people to get inoculated because of the lack of transparency about the vaccines.

Tao Lina, a vaccine expert and a former immunologist at the Shanghai Center for Disease Control and Prevention, said he knew of several health care workers who had declined the shots.

He got a Sinopharm vaccine on Monday, and said he felt confident that the vaccines were safe and effective. But he added that the companies could do better in their messaging.

“If you say that it’s safe, then you should show all kinds of evidence to show that it’s safe,” Mr. Tao said.

Liu Yi, Amber Wang and Elsie Chen contributed research.

Moderna will give its Covid-19 vaccine to its workers, board members and some relatives.

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The Moderna company headquarters in Cambridge, MA. in November, 2020.Credit...Cody O'Loughlin for The New York Times

Moderna will make its Covid-19 vaccine available to its workers, on-site contractors and board members in the United States, as well as to adults in their household, the company said in a statement on Tuesday afternoon.

The Massachusetts firm, which developed one of two vaccines that received emergency use authorization this month from the Food and Drug Administration, justified the move on the basis that its workers are conducting “essential services in developing, manufacturing and delivering a Covid-19 vaccine.” The decision to include adult household members was made to “reduce the risk of absenteeism and disruption due to a Covid-19 infection,” the statement said.

Moderna has about 1,200 full-time employees, a figure that does not include on-site contractors. A spokesman for the company, Ray Jordan, said the firm did not have a specific estimate of how many people would be vaccinated through the program, noting that participation would be voluntary. Mr. Jordan said that the program began with vaccinating on-site manufacturing workers and is expanding through the rest of Moderna’s population.

Moderna said it will pay for the costs of the doses given to its workers and for administering them. They will be given separately from Moderna’s deal to supply the United States with 200 million doses of the vaccine, with the first half to come by the end of March and the second half to come by the end of June.

Most of the people who have been vaccinated in the United States so far — over 2 million, according to a New York Times database — have been health care workers and residents of nursing homes and other long-term care facilities. In the coming weeks, vaccines are expected to increasingly be given to other high-risk groups, including older people and frontline workers.

At Pfizer, the maker of the other coronavirus vaccine that has received authorization so far, chief executive Dr. Albert Bourla told CNBC earlier this month that he had not yet received his company’s vaccine and that he and other executives and board members would not “cut the line.”

A spokeswoman for Pfizer, Amy Rose, said that Pfizer plans to vaccinate its employees in the order that groups of them become eligible under guidelines from the Centers for Disease Control and Prevention. She said the first group is expected to be the company’s essential workers, especially in manufacturing. “There are no plans to prioritize the vaccination of our executives or board members ahead of other high-risk groups,” Ms. Rose said.

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New data triples Russia’s death toll.

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Fresh graves at the Butovskoye cemetery, which serves as one of the burial grounds for those who died from the coronavirus, in Moscow, in June.Credit...Dmitry Serebryakov/Associated Press

MOSCOW — After months of questions over the true scale of the coronavirus pandemic in Russia and the efficacy of a Russian-developed vaccine, the state statistical agency in Moscow has added to the uncertainty with new figures indicating that the death toll from Covid-19 is more than three times as high as officially reported.

From the start of the pandemic early this year, the health crisis has been enveloped and, critics say, distorted by political calculations as President Vladimir V. Putin and Kremlin-controlled media outlets have repeatedly boasted of Russian successes in combating the virus and keeping the fatality rate relatively low.

Russia has reported more than three million cases of infection, making it the world’s fourth-hardest-hit country, and 55,827 deaths, which ranks it No. 8 worldwide for the highest number of deaths from the virus. A demographer at a government agency who questioned the official fatality figures, dismissing them as far too low, was fired over the summer.

New data issued on Monday by Rosstat, the state statistics agency, however, indicated that the demographer was right and that the real number of fatalities was far higher than previously reported. The agency reported that the number of deaths from January to November was 229,732 higher than over the same period last year, an increase that a senior official blamed largely on the coronavirus.

Tatiana Golikova, a deputy prime minister leading Russia’s efforts to combat the pandemic, told a government briefing on Monday that more than 81 percent of the increased number of deaths in 2020 was “due to Covid,” which would mean that the virus had killed more than 186,000 Russians so far this year.

This is still far fewer than the more than 334,000 deaths caused by Covid-19 in the United States but means that Russia has suffered more fatalities as a result of the pandemic than elsewhere in Europe like Italy, France and Britain, whose poor record has been regularly cited by Russian state media as proof of Russia’s relative triumph.

McConnell blocks immediate vote on $2,000 stimulus checks, leaving their fate in limbo.

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McConnell Blocks Vote on $2,000 Stimulus Checks

After Senator Chuck Schumer, the minority leader, tried to force an immediate vote on increasing the size of the stimulus checks, Senator Mitch McConnell, the majority leader, blocked the measure, leaving its fate unclear.

“A vast majority of the public, Republican and Democrat, strongly support $2,000 checks. An overwhelming bipartisan majority in the House supports $2,000 checks. Senate Democrats strongly support $2,000 checks. Even President Trump supports $2,000 checks. There’s one question left today: Do Senate Republicans join with the rest of America in supporting $2,000 checks? Would the senator modify his request to include a unanimous consent request that the Senate — to include unanimous consent that the Senate proceed to the immediate consideration of H.R. 9051, a bill received from the House to increase recovery rebate amounts to $2,000 per individual, that the bill be read a third time and passed, the motion to reconsider be considered made, laid upon the table with no intervening action or debate?” “Is there objection to the modification?” Sen. McConnell: “I object.” “Objection is heard.”

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After Senator Chuck Schumer, the minority leader, tried to force an immediate vote on increasing the size of the stimulus checks, Senator Mitch McConnell, the majority leader, blocked the measure, leaving its fate unclear.CreditCredit...Al Drago for The New York Times

Senator Mitch McConnell of Kentucky, the majority leader, on Tuesday blocked an effort to hold an immediate vote to increase stimulus checks to $2,000, saying instead that the Senate would “begin a process” to consider bigger payments, along with other demands issued by President Trump, leaving the fate of the measure unclear as more Republicans clamored to endorse it.

Mr. McConnell did not elaborate further on how — or when — the Senate would move to consider Mr. Trump’s demands, which the president made on Sunday after finally agreeing to sign a $900 billion stimulus package and government spending bill into law. Mr. Trump had held the package hostage for days, insisting that lawmakers increase the direct payments to $2,000 from $600, remove a legal shield for companies like YouTube and Facebook and investigate “very substantial voter fraud.”

The president relented only after Republican lawmakers persuaded him to sign the legislation, saying on Sunday that he had been promised that Congress would take up his demands.

Mr. McConnell’s decision to block a vote on increasing the stimulus payments came as a growing number of Republican senators voiced support for the larger checks, and as pressure mounted on the Senate to vote on the measure.

Senator Chuck Schumer of New York, the minority leader, tried to force an immediate vote on increasing the size of the checks using a procedural tactic that allows senators to advance legislation unless another senator objects. Mr. McConnell blocked the measure.

“Senate Democrats strongly support $2,000 checks. Even President Trump supports $2,000 checks,” Mr. Schumer said. “There’s one question left today: Do Senate Republicans join with the rest of America in supporting $2,000 checks?”

A growing number of Republican senators have endorsed higher stimulus payments, including Senators Kelly Loeffler and David Perdue, both Georgia lawmakers facing tight runoff elections next week, who announced on Tuesday that they supported larger stimulus checks.

They joined a handful of others, including Senator Marco Rubio of Florida, Senator Josh Hawley of Missouri and Senator Lindsey Graham of South Carolina, who have backed increasing the checks to $2,000. But the majority of Senate Republicans have so far remained opposed to the plan.

Mr. McConnell’s decision to link all of Mr. Trump’s demands could doom any chance of passage. While Democrats all support larger checks, they are unlikely to endorse a hasty overhaul of the legal shield currently in place for social media companies, especially measures put forward by Republican senators aimed at confronting what they believe is anti-conservative bias.

Democrats are also likely to resist anything that could be seen as trying to undermine the outcome of the 2020 presidential election, as Mr. Trump has suggested. Mr. McConnell, who has privately urged his members not to object to the election results when Congress meets on Jan. 6 to ratify them, portrayed the president’s request as “exploring further ways to protect the sanctity of American ballots.” But Mr. Trump has been laser-focused on getting Congress to investigate “the very substantial voter fraud which took place,” an assertion he has repeated contrary to considerable evidence.

The House voted on Monday evening to increase the size of the checks to $2,000, daring Senate Republicans to either approve the heftier sum or defy Mr. Trump. The president kept up his campaign for the measure on Tuesday, demanding in a tweet “$2000 for our great people, not $600!”

The House vote, which just reached the two-thirds majority needed to pass, came a day after Mr. Trump finally signed off on a $900 billion pandemic relief package he initially denounced as a “disgrace” and refused to sign. The legislation, which passed by a vote of 275 to 134, was supported by 44 Republicans.

In signing the relief bill on Sunday night, Mr. Trump claimed in a statement that the Senate would “start the process for a vote” on legislation that would increase direct payments and pledged that “much more money is coming.”

Republican lawmakers in the House were visibly frustrated with Mr. Trump’s demand. Some of the president’s closest allies, including Representatives Steve Scalise of Louisiana, the No. 2 Republican, and Jim Jordan of Ohio, voted against the measure, and Representative Kevin Brady of Texas, the top Republican on the Ways and Means Committee, complained on the House floor that the proposal had been “hastily dropped on us at the last minute” and wouldn’t assist those who needed it most.

“I worry that this whopping $463 billion won’t do what’s needed — stimulate the economy or help workers get back to work,” Mr. Brady said.

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Kamala Harris gets the coronavirus vaccine and urges others to do the same.

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‘That Was Easy’: Harris Receives Covid-19 Vaccine

Vice President-elect Kamala Harris received the Moderna Covid-19 vaccination on Tuesday at United Medical Center in southeast Washington, and urged the public to get vaccinated as well.

“Let’s do it.” “All righty. Ready?” “Yeah, I’m ready. That was easy. [laughing] Thank you. I have now been vaccinated — as Joe likes to say, there’s a big difference between the vaccine and vaccinations. I want to encourage everyone to get the vaccine. It is relatively painless. It happens really quickly. It is safe. Literally, this is about saving lives. It’s literally about saving lives. I trust the scientists, and it is the scientists who created and approved this vaccine. So I urge everyone, when it is your turn, get vaccinated. It’s about saving your life, the life of your family members and the life of your community.”

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Vice President-elect Kamala Harris received the Moderna Covid-19 vaccination on Tuesday at United Medical Center in southeast Washington, and urged the public to get vaccinated as well.CreditCredit...Al Drago for The New York Times

Vice President-elect Kamala Harris received the first dose of the coronavirus vaccine on Tuesday and urged the public to get vaccinated as well, declaring, “Literally this is about saving lives.”

Ms. Harris received the Moderna vaccine at United Medical Center, a public hospital in Southeast Washington, where she rolled up her sleeve and received the shot in her left arm.

“That was easy,” she said when it was over. “Thank you. I barely felt it.”

Ms. Harris appeared on live television to receive her shot, just as President-elect Joseph R. Biden Jr. did last week when he received the Pfizer-BioNTech vaccine at a hospital in Delaware. Ms. Harris’s husband, Douglas Emhoff, was also vaccinated on Tuesday.

After getting the vaccine, Ms. Harris urged Americans to get vaccinated as well, saying: “It is relatively painless. It happens really quickly. It is safe.”

“I trust the scientists, and it is the scientists who created and approved this vaccine,” she added. “So I urge everyone, when it is your turn, get vaccinated. It’s about saving your life, the life of your family members and the life of your community.”

Two million children in the U.S. have tested positive.

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Taamisha Meyers, left , a nurse at NYC Health +Hospitals/Harlem, performing a Covid-19 test, on Babacar Campbell, 5 as his mother Isseu Diouf Campbell comforting him last week.Credit...James Estrin/The New York Times

Two million children in the United States had tested positive for infection with the coronavirus as of Dec. 24, one million of them just since Nov. 12, according to data gathered by the American Academy of Pediatrics.

Severe illness among children is still rare, but the numbers indicate a worrying trend in the proportion of children becoming infected. Children now make up 12.4 percent of the total cases in the country, based on age distributions of diagnoses in 49 states, the District of Columbia, Puerto Rico and Guam. In 11 states, children account for 15 percent or more of total cases.

But states define a child in various ways. The upper limit for a child’s age varies from 14 to 20 years, and some states have adjusted the ranges during the course of the pandemic, making direct comparisons difficult.

Nearly 400,000 children were diagnosed in the two weeks leading up to Dec. 24. It’s unclear why the number has risen so sharply over the past few weeks. Family gatherings during the Thanksgiving holiday and increased testing among children may have contributed.

The new viral variant reported in Britain, B117, is thought to be more transmissible among children, raising concerns that they may become more vulnerable as the pandemic expands.

The report did not include details on testing, hospitalizations and deaths, but the academy plans to release those data next week.

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The grandmother who was the first to get the vaccine in Britain gets her second dose.

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Margaret Keenan, shown leaving the hospital in Coventry, in central England, on Dec. 9, received her second dose of the Pfizer-BioNTech vaccine on Tuesday.Credit...Pool photo by Jonny Weeks

Margaret Keenan, the first patient in Britain to receive the coronavirus vaccine on Dec. 8, received her second injection on Tuesday, making her the first publicly known person to be fully vaccinated against the virus outside a clinical trial.

Ms. Keenan made headlines this month when she became the first person in the world to receive a clinically authorized, fully tested coronavirus vaccine, wearing a Christmas penguin T-shirt and saying she felt privileged to be vaccinated. At the time, she said, “If I can have it at 90, then you can have it, too!”

The second injection given to Ms. Keenan, now 91, provided some good news in Britain as the country reported 53,135 new lab-confirmed cases on Tuesday, its highest daily number since the start of the pandemic.

Although nearly half of England is under lockdown, the virus is spreading at an alarming rate, and hospitals are treating more patients than at any time during the health crisis.

Over 600,000 people have received the first dose of the coronavirus vaccine in Britain, but scientists at the London School of Hygiene and Tropical Medicine said that two million people needed to be vaccinated every week to avoid hospitals being overwhelmed like they were during the first wave.

Since the beginning of the pandemic, over 71,000 people in Britain have died from the coronavirus, the second highest death toll in Europe after Italy.

Covid-19 may have claimed a death row inmate who survived a botched execution attempt in 2009.

Romell Broom, a death row inmate in Ohio whom the state attempted and failed to execute by lethal injection in 2009, died on Monday. The cause was probable Covid-19, officials said.

Technicians tried and failed for two hours on Sept. 15, 2009, to maintain an IV connection in order to inject Mr. Broom with lethal drugs. As the process continued, Mr. Broom covered his face and cried from the pain; at one point, he screamed when the needle struck bone. It was the first time an execution by lethal injection had failed and been rescheduled.

Mr. Broom, 64, was convicted of abducting, raping and killing Tryna Middleton, 14, who had been walking home from a football game with two friends in Cleveland in 1984.

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Romell Broom, an Ohio death row inmate who survived a botched execution attempt in 2009, died on Monday.Credit...Ohio Department of Rehabilitation and Correction, via Associated Press

Mr. Broom’s lawyers fought unsuccessfully to prevent the state from attempting to execute him again, arguing that doing so would constitute cruel and unusual punishment. He was scheduled to be executed in March 2022.

The spokeswoman for the Ohio Department of Rehabilitation and Correction said that as of Tuesday his death was listed as a probable Covid-19 related death, pending his death certificate. At the time of his death he was incarcerated at the Franklin Medical Center in Columbus.

In a statement, Mr. Broom’s lawyers, Adele Shank and Tim Sweeney, said that Mr. Broom had survived his first attempted execution “only to live with the ever-increasing fear and distress that the same process would be used on him at his next execution date, March 16, 2022. Let his passing in this way, and not in the execution chamber, be the final word on whether a second attempt should ever have been considered.”

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An account of the ‘yearlong catastrophe’ of Covid-19 in the U.S. fills The New Yorker’s latest issue.

The New Yorker did something on Monday that had few precedents in the magazine’s 95-year history: It published an issue devoted to a single feature article. The topic was, of course, the coronavirus.

“The Plague Year,” by Lawrence Wright, examines how the United States permitted the virus to become the “yearlong catastrophe” he identifies in the opening sentence. It includes interviews with Dr. Deborah L. Birx; Dr. Anthony S. Fauci; and Dr. Barney S. Graham, an immunologist whose research aided the development of several early vaccines and a monoclonal antibody treatment.

The article also includes fly-on-the-wall descriptions of White House meetings and the experiences of Dr. Ebony Hilton, a Virginia anesthesiologist who witnessed firsthand how the virus worsened racial disparities in health.

At roughly 31,000 words, the article is as long as a novella, roughly five times the length of a typical major magazine article.

Mr. Wright, a staff writer at The New Yorker for nearly three decades, initially turned in 76,000 words. “I have an appetite to go into depth,” he said in an interview. (He added, with a laugh: “I get paid by the word.”)

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Credit...The New Yorker

“The Plague Year” occupies the issue’s entire “feature well” — the heart of the magazine, typically occupied by three or four long feature articles. The New Yorker had done that only a handful of times before, notably for John Hersey’s “Hiroshima” in 1946, for the first installment of Hannah Arendt’s “Eichmann in Jerusalem” in 1963 and for Mark Danner’s “The Truth of El Mozote,” a report on an atrocity in El Salvador, in 1993.

“You really needed the real estate to do what he was out to do,” said David Remnick, the editor of The New Yorker.

Mr. Wright won the Pulitzer Prize in 2007 for his nonfiction book on Al Qaeda, “The Looming Tower.”His novel “The End of October,” published last April, tells the story of a new strain of influenza breaking out. Mr. Wright did extensive research and reporting for his work of fiction; Dr. Graham, the National Institutes of Health immunologist featured in the New Yorker article, is thanked in the book’s acknowledgments.

Global Roundup

The Netherlands sees its highest number of excess deaths since World War II.

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Medical staff treating a patient with Covid-19 in the intensive care unit at Maastricht University Medical Center+ in Maastricht, Netherlands, last month.Credit...Piroschka Van De Wouw/Reuters

The pandemic has caused the highest number of excess deaths in the Netherlands since World War II, the CBS, the country’s independent national statistics bureau, said on Tuesday.

Up to last week, the Netherlands — which has a population of roughly 17 million people — reported 162,000 deaths, about 13,000 more than usual, according to the CBS, the statistics bureau, whose figures are used by the government and businesses in the Netherlands. During both waves of the virus, when European countries struggled to contain cases, the number of excess deaths in the country was notable. All excess deaths during the first wave in the spring were caused by the coronavirus, according to the statistics bureau, and an August heat wave also caused some excess deaths this year.

Over the summer, the country had barely any lockdown measures in place, and some people were able to go on vacation. But over the past few months, as the country has been facing and trying to fight a brutal second wave of the pandemic, 6,100 more people died than would have been expected. The Netherlands has also found cases of the British variant in the past week.

The pandemic has hit the Netherlands particularly hard. Earlier this month, Prime Minister Mark Rutte announced harsh new lockdown measures — the strictest of the pandemic — until at least Jan. 19 because of “a dramatic increase in the number of infections, with figures up to around 9,000 per day,” according to the government.

In other developments from around the globe:

  • A woman in hotel quarantine in Queensland, Australia, is the first person in the country found to have a new South African strain of the coronavirus that is thought to be more contagious, health officials said on Tuesday. The woman had traveled from South Africa and has been transferred to a hospital north of Brisbane.

  • The United States on Tuesday began vaccinating its 28,500 troops in South Korea, as the government there reported a single-day record for coronavirus deaths. Service members are receiving the Moderna vaccine, though it is not mandatory, U.S. Forces Korea said in a statement. There have been more than 450 coronavirus cases tied to U.S. forces serving in South Korea. The country, which is struggling to contain a third wave of infections, has had a total of 58,725 cases and 859 deaths, with 40 reported on Tuesday. South Korean officials say vaccinations for the public will begin in February.

  • Denmark’s prime minister, Mette Frederiksen, said on Tuesday she would extend its lockdown for two weeks, until Jan. 17, Reuters reported. The restrictions, which were originally announced on Dec. 16, shuttered schools, malls, restaurants, bars and other nonessential stores. Denmark has seen a rise in cases over recent weeks: Its daily average of new cases over the last week — 2,600 — is the 16th highest in the world when adjusted for population.

  • The Philippines on Tuesday banned foreign travelers from 19 countries and territories until Jan. 15 in an effort to keep out a more virulent strain of the coronavirus that was first detected in Britain.

  • Venezuela signed a contract with Russia to begin a mass vaccination campaign using Russia’s Sputnik V vaccine, according to the main government-run television network, VTV. President Vladimir V. Putin announced in August that Russia had developed the world’s first coronavirus vaccine, even though it had not been tested in a major clinical trial, and Russia has offered it in recent weeks to teachers, medical workers, and others. This has led to widespread distrust of the vaccine among the Russian public.

Jason Gutierrez, Jennifer Jett, Livia Albeck-Ripka and Sameer Yasir contributed reporting.

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Bulgaria uses hot dog trucks to deliver its first shipment of the vaccine.

Over the weekend, Bulgaria received its first shipment of 9,750 doses of the coronavirus vaccine. Before the vaccination rollout on Sunday, Bulgarian authorities turned to hot dog trucks to deliver the vaccine to different locations across the country.

Escorted by the police, several refrigerated vans initially delivered the doses to at least a couple of cities. The Pfizer-BioNTech vaccine must be stored at extreme temperatures of minus 70 degrees Celsius to remain effective, and it can be kept at temperatures of 2 degrees to 8 degrees Celsius for up to only five days.

News about the unorthodox choice of transportation prompted a wave of mockery on social media.

Hot dog-themed memes, bearing the logo of Pfizer, with Photoshopped images and frankfurter-related puns and jokes, have flooded Facebook and Twitter. One Facebook post included a picture of frankfurters stamped with the Pfizer logo.And an old, popular ad for this particular hot dog brand — showing a shopkeeper in a butcher’s store holding a string of hot dogs — was being shared online, but, this time, with an updated tagline: “The vaccines are here.”

The vaccination campaign begins at a time when Bulgaria has one of the highest Covid-19 death rates in the E.U., with more than 25 people per 100,000 dying from the virus over 14 days, according to the European Center for Disease Prevention and Control, and its health system has been struggling to cope with the surge of virus patients.

While some Bulgarians have mocked the creative mode of transportation, others have expressed concern that it signals that the state is not well prepared to receive and store the first batch of the vaccines.

“It doesn’t matter if the trucks have images of hot dogs or Black Angus beef plastered on them,” Mariya Sharkova, a lawyer specializing in health care, said. “What matters is for the government to strictly follow the distribution and storage regulations.”

She is concerned that the delivery of vaccines in food trucks may make the country legally liable, she said, since “the vaccine manufacturer cannot be held responsible” if “transport and distribution protocols are not observed properly.”

“Bulgarian authorities knew, for a while now, exactly when the first vaccines were arriving,” said Desislava Nikolova, a health editor at the Bulgarian newspaper Capital Weekly. “It perplexes me why the government needed to use a hot dog truck instead of a vehicle licensed for distribution of thermolabile medicines.” Bulgaria has strict laws about the proper transportation of pharmaceuticals, and each vehicle needs to be licensed and registered with health authorities.

Kostadin Angelov, the health minister, assured Bulgarians that the hot dog trucks had met all of the requirements needed for storage of the vaccine, and said that he found the hot dog-inspired jokes “inappropriate.”

“Seeking to exploit that aspect is unacceptable,” he told reporters on Sunday shortly after becoming the first Bulgarian to be inoculated. “Bulgaria is not the only country where private logistics companies provide transportation.”

Mr. Angelov vowed that this first batch was an exception and the next deliveries of the vaccine would be distributed using transportation provided by the manufacturer.

Ms. Sharkova worries that the delivery incident might further worsen vaccine skepticism among some Bulgarians.

“There are many people outside of the anti-vax movement who are hesitant to get vaccinated,” she said. “Instead of using the vaccine arrival to defuse their fears, the state has become a target of ridicule.”

Coronavirus: Then & Now

An ordeal on a virus-stricken cruise ship didn’t extinguish a couple’s wanderlust.

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CreditCredit...Jim Wilson/The New York Times

As 2020 comes to a close, we are revisiting subjects whose lives were affected by the pandemic. When Thomas Fuller first spoke with the Clarks in March, they were passengers trapped on a cruise ship that was being kept at sea because of a coronavirus outbreak onboard.


OAKLAND, Calif. — Never again! So said Cookie Clark, a retired real estate agent, as her Hawaiian cruise on the Grand Princess came to an end in San Francisco Bay in March.

With more than 20 people infected with the coronavirus onboard, the ship was a floating symbol of the nation’s disjointed reaction to the pandemic reaching American shores. President Trump had said he didn’t want the ship to dock because it would increase the tally of infected people in the country. So the ship was kept circling for days off the California coast, while the authorities on shore debated what to do and the passengers and crew grew increasingly frustrated.

“I’m ready to get the hell off this ship,” Ms. Clark said from her cabin.

The Grand Princess finally got clearance to dock on March 9, and sailed under the Golden Gate Bridge to a pier in the port of Oakland. When Ms. Clark and her husband, Joe, disembarked, they were taken to Travis Air Force Base along with other passengers, to be quarantined for two weeks in rudimentary conditions.

The ordeal might have been enough to make homebodies out of anyone, and that’s the way Ms. Clark, 76, was feeling in March. But nine months later, she and her husband, 82, are itching to travel again.

The couple has been strict about social distancing during the pandemic. When they take walks outside their home in Oakdale, Calif., at the foot of the Sierra Nevada, they give neighbors and fellow pandemic hikers a wide berth. Ms. Clark lamented that they weren’t able to attend her granddaughter’s graduation from the University of California, Berkeley. And they have sworn off visits to the mall for the duration. But they are getting antsy.

“We’re older and we’re retired, and it’s just like we’ve lost the whole year,” Ms. Clark said by telephone from her home.

Another cruise?

“We would do it again,” she said. “I’m sure.”

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Even though cases are exploding in Mexico City, Americans are pouring in.

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Mexico has seen an increase in American tourists despite mounting coronavirus cases that have swamped the health care system throughout the country.Credit...Alfredo Estrella/Agence France-Presse — Getty Images

In November, more than half a million Americans came to Mexico — of those, almost 50,000 arrived at Mexico City’s airport, according to official figures, less than half the number of U.S. visitors who arrived in November last year, but a surge from the paltry 4,000 who came in April, when much of Mexico was shut down. Since then, numbers have steadily ticked up: From June to August, U.S. visitors in Mexico more than doubled.

It’s unclear how many are visiting and how many are permanently relocating — or even just taking advantage of the six-month tourist visa that Americans are granted on arrival. Some may be Mexicans who also have American passports and are visiting family.

But on the streets of Mexico City’s hipster neighborhoods these days, it sometimes seems as if English has become the official language.

The surge in visitors, however, comes as Mexico City enters a critical phase of the pandemic; cases have increased, and hospitals are stretched so thin that many sick people are staying home. The U.S. Centers for Disease Control and Prevention have also advised Americans to avoid all travel to Mexico.

Mexico City’s health care system “is basically overwhelmed,” Xavier Tello, a Mexico City health policy analyst, said via WhatsApp message. “The worst is yet to come.”

In mid-December, the authorities escalated Mexico City’s alert system to the highest level, which requires an immediate shutdown of all but essential businesses. But the lockdown came weeks after numbers had already reached the critical level of contagion, according to the government’s own figures.

As in much of the world, the most affluent are often the least affected. In Roma Norte, on one street corner, working-class Mexicans lined up for hours to buy oxygen tanks for their relatives who were sick at home with Covid-19, while just blocks away well-off young people lined up for croissants.

The pandemic has been devastating for children from low-income families.

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Loretta Jones with her children, from left, Grenderline, 11, Christopher Michael, 4, and Frederick, 12. “By the grace of God, we’re making it through,” Ms. Jones said.Credit...Cheriss May for The New York Times

Since the first coronavirus case was recorded in her neighborhood in Southeast Washington in the spring, 11-year-old Grenderline Etheridge has burst into tears many times for reasons she cannot explain. She has crawled into bed with her mother, something she had not done for a very long time.

Her siblings have also had trouble dealing with the pandemic: Her brothers, who are 12 and 4, have joined her in their mother’s bedroom, and the little one, who was nearly potty trained before his school shut down in March, recently went back to wearing diapers.

Grenderline’s mother, Loretta Jones, has tried over the past 10 months to keep the children focused on their studies and entertained with games, books and handprint art activities. In the early days of the pandemic, Ms. Jones often drove the family to a nearby park for exercise, but they stopped going once virus cases began rising again. A surge in gunfire this year in the neighborhood has also caused the family to stay mostly inside, confined to a crowded, three-bedroom apartment.

“By the grace of God, we’re making it through,” said Ms. Jones, 34, who has bipolar disorder and has had difficulty finding steady work.

As the virus advanced on the nation and spared not a single community, it also inflamed the difficulties that many families were already enduring in pre-pandemic times: gun violence, hunger, poverty.

The disruptions to daily life — and the associated stresses of lives on pause — have been perhaps most acutely felt by children from low-income families, experts said, many of whom live in predominantly Black and Latino neighborhoods that have been plagued by a rise in gun violence and disproportionately high coronavirus infection rates.

The pandemic has inflicted so much upheaval in Grenderline’s life — and the lives of many young people — that experts worry the devastating effects will be felt long after vaccines are distributed and some semblance of normalcy returns.

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Prisoners in Oregon can sue state officials in federal court over their handling of the pandemic.

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Prisoners affected by the coronavirus in facilities like the Eastern Oregon Correctional Institution in Pendleton have the right to sue Oregon state officials over their handling of the pandemic, a federal judge has ruled.Credit...Ricardo Nagaoka for The New York Times

Inmates in Oregon’s prisons, where coronavirus infections and deaths have been rising for months, have the legal right to sue state officials over their handling of the outbreaks, a federal court judge has ruled.

The ruling this month by Stacie Beckerman, a magistrate judge, is believed to be the first in the nation to allow state officials — including the governor and top prison officials — to be held accountable in court for failing to adequately protect prisoners from the virus.

If such lawsuits succeed, Oregon may ultimately be forced to pay damages, and prisoners in other states may follow the same legal road.

State prison officials around the nation have acknowledged that they have taken a trial-and-error approach to the pandemic, one that has failed to stop the virus from penetrating any state prison system in the nation, according to a New York Times database. As of Tuesday, there had been almost 265,000 confirmed infections and more than 1,600 Covid-19 deaths among inmates in state prisons, according to the database.

Indications that a prison took inadequate precautions might include anything from not requiring guards to wear masks to testing too few inmates, according to the court ruling.

In May, the Supreme Court denied a request from two inmates in a Texas geriatric prison to reinstate a trial judge’s order instructing officials to take steps to protect them from the coronavirus. But Juan Chavez, one of the lawyers representing prisoners in the Oregon lawsuit, said the Texas case was different.

The Texas prisoners were asking the court to order officials to act to prevent the spread of the virus, Mr. Chavez said. The Oregon lawsuit, however, includes a claim for money damages because the prisoners believe state leaders did too little to protect their health.

The Oregon Department of Corrections declined to comment on the lawsuit on Tuesday.

Advocacy groups and prisoners’ families have pressed the state to release many inmates to slow the spread of the virus, as some other states have done. But since March, only 247 people have had their sentences commuted, according to the department.

Bonnie Grady, whose son, Matthew Yurkovich, is incarcerated at the Snake River Correctional Institution in Ontario, Ore., said that prisoners slept within a few feet of one another and had limited access to cleaning supplies, and that guards did not always wear masks.

Ms. Grady said that in the spring, her son lost his sense of smell and taste, a symptom associated with the coronavirus, but that he was never tested. “If I did my job as poorly as the prison did their job with the virus, then I would have lost my job,” she said.

Nearly 2,200 prisoners and 500 correctional officers have been infected in Oregon state prisons, including more than 460 inmates at Snake River, according to state records. Twenty-one prisoners statewide have died. Coronavirus cases surged in the state prison system after wildfires in September forced the evacuation of several prisons.

Long-term symptoms can send virus patients back to overburdened hospitals.

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Chris Long of Clarkston, Mich., has been in the hospital seven times since contracting the coronavirus.Credit...Emily Rose Bennett for The New York Times

Nearly a year into the pandemic, it is clear that recovering from Covid-19’s initial onslaught can be an arduous, uneven journey. Now, studies reveal that a significant subset of patients are having to return to hospitals, sometimes repeatedly, with complications triggered by the disease or the body’s battle against it.

The routine of Chris Long, 54, used to include biking 30 miles three times a week and taking courses toward a Ph.D in eight-week sessions. But since getting sick with the coronavirus in March, Mr. Long has fallen into a distressing new cycle — one that so far has landed him in the hospital seven times.

Every few weeks since his initial five-day hospitalization, his lungs begin filling, he starts coughing uncontrollably and runs a low fever. Roughly 18 days later, he spews up greenish-yellow fluid, signaling yet another bout of pneumonia.

Soon, his oxygen levels drop and his heart rate accelerates to compensate, sending him to a hospital near his home in Clarkston, Mich., for several days, sometimes in intensive care.

Data on rehospitalization of coronavirus patients is incomplete, but early studies suggest that in the United States alone, tens or even hundreds of thousands could ultimately return to the hospital.

“It’s an urgent medical and public health question,” said Dr. Girish Nadkarni, an assistant professor of medicine at Mount Sinai Hospital, who, with another assistant professor, is studying readmissions of Covid-19 patients.

A study by the Centers for Disease Control and Prevention of 106,543 coronavirus patients, initially hospitalized between March and July, found that one in 11 was readmitted within two months of being discharged, with 1.6 percent of patients readmitted more than once.

Readmissions strain hospital resources, and patients can be exposed to new infections and develop muscle atrophy from being bedridden.

Some research suggests implications for hospitals currently overwhelmed with cases. A Mount Sinai Hospital study of New York’s first wave found that patients with shorter initial stays and those not sick enough for intensive care were more likely to return within two weeks.

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