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UK Lockdown: Colleges, Schools to Shut as Coronavirus Variant Rages

LONDON – Prime Minister Boris Johnson imposed a tough new national lockdown on Monday as the UK’s desperate race to vaccinate its population could be overtaken by a fast-spreading variant of the coronavirus that was on track to overwhelm the country’s beleaguered hospitals .

After several days of alarmingly high and escalating case numbers, Mr Johnson ordered schools and colleges in England to close their doors and switch to distance learning. He appealed to the British to stay home for all but a few necessary purposes, including essential work and the purchase of food and medicine.

The nationwide restrictions, officials warned, will remain in place until at least mid-February.

The decision was a new setback for Mr Johnson as the arrival of two vaccines after nine months and severe criticism of his handling of the pandemic appeared to offer a way out of the crisis.

On the day the first doses of a vaccine developed by AstraZeneca and Oxford University were given, the good news was drowned out by the reintroduction of the kind of sweeping restrictions put in place last spring when the pandemic first threatened to spiral out of control.

In the past few weeks, the new, highly transmissible variant of the virus has caught on in London and the south-east of England, causing the number of cases to rise alarmingly to nearly 60,000 a day and putting hospitals under acute pressure.

On Sunday, Mr Johnson admitted that current controls of daily living were inadequate. However, the first announcement of a full lockdown came not from England but from Scotland, where the first minister, Nicola Sturgeon, has consistently moved further and faster to tame the pandemic.

In Edinburgh, Ms Sturgeon said that mainland Scotland people must be required to stay at home and work from wherever possible, while places of worship would be closed and schools were largely operated by distance learning.

Mr Johnson followed on Monday evening to announce the lockdown in England that many predicted.

“It is clear that we must do more together to get this new variant under control while our vaccines are rolled out,” Johnson said in a televised address.

While the coming weeks may be some of the toughest, he believed Britain “is entering the final phase of the struggle because with every push that goes into our arms we tilt the odds against Covid and in favor of the British people. ”

The people of England have been encouraged to comply with the new rules immediately, although some of the new restrictions won’t take effect until Wednesday morning and a vote in Parliament will likely take place, specifically recalled on the same day.

Ministers had celebrated the deployment of the AstraZeneca vaccine, which is not only cheaper than Pfizer-BioNTech’s but also much easier to store. They said it could help turn the tide in Britain’s fight against the virus.

However, the UK is in a race to roll out its mass vaccination program before its overloaded health service is overwhelmed by the new variant. Covid-free treatment is already being postponed again, and pictures of ambulances piling up in some hospitals’ parking lots last week highlighted the challenge facing the country’s tired health workers.

Updated

Jan. 6, 2021, 3:48 p.m. ET

The government has raised its Covid warning for the first time and warns of a “material risk that health services will be overwhelmed”. There were more than 26,000 Covid-19 patients in hospitals as of Monday, up 30 percent from the previous week, Johnson’s office said. And cases are increasing rapidly across the country, it said.

Mr Johnson has set an ambitious goal for the country’s vaccine campaign: to have a first dose of the vaccine to the most vulnerable populations by mid-February. If the government does this, the restrictions could be lifted.

Most Britons are already exposed to severe restrictions in everyday life. Non-essential shops, pubs and restaurants are already closed in much of England, where those who live by the strictest rules in the areas are not allowed to mix between households.

Now all parts of England will be under these curbs and schools will be closed to most students.

However, some restrictions will be a little less onerous than those imposed last March when the virus marched relentlessly across Europe and the country was first put into lockdown.

This time around, people in England are still allowed to meet someone else to exercise together outside, and the places of worship remain open, as are the playgrounds. Elite professional football games continue, although some games had to be canceled recently after players became infected.

For critics, developments on Monday showed Mr Johnson’s tendency to postpone decisions until the last moment, in part to balance public health issues with concerns of many of his ruling Conservative Party about the devastating economic impact.

On Sunday, after Mr Johnson used a BBC interview to warn that new restrictions were likely, opposition Labor Party leader Keir Starmer called for immediate new national restrictions.

But on Monday morning, Mr Johnson initially appeared to be resisting being forced to take a quick decision, insisting that the government still measure the impact of the toughest restrictions already in place on a hospital visit. He acknowledged that “tough” weeks were ahead and said there was “no question” that tougher measures would be announced “in due course”.

Even within his own Conservative Party, pressure mounted when a senior lawmaker and former health minister, Jeremy Hunt, wrote on Twitter that it was “time to act” and “schools, close borders and immediately ban any confusion. ”

The main lesson from dealing with the pandemic was that “Countries that act early and act decisively save lives and quickly get their economies back to normal,” Hunt said.

Medical experts said that given the rapid spread of the new variant, Mr Johnson had no choice but to take more draconian measures. Some said the prime minister was already behind the curve given the number of cases and hospital admissions skyrocketed over the past week.

“He’s running late,” said Devi Sridhar, director of the global public health program at the University of Edinburgh. “The situation is bad with the new variant. You have to manage boundaries, pause schools, and stop mixing between households. “

The government’s scientific advisory body known as SAGE recommended on December 22nd that the UK consider a national lockdown and close schools and universities. The variant is on the way to become dominant in many parts of the country.

New infections have risen to almost 60,000 per day, twice as many as a few weeks ago.

Hospital admissions in London have doubled every week since early December, wrote Christina Pagel, director of clinical operations at University College London, on Twitter. The UK already has the highest death toll in Europe, with 75,024 deaths, and medical experts are warning that it will rise again after more modest growth in the summer.

Others expressed concern about the constant changes in the message of a government that often seemed to respond to fast-moving events rather than anticipating them.

After the national lockdown last year, the government promised to do everything possible to keep schools open. However, the return of students on Monday after the winter break was confusing as some schools had to close in areas with high infections while some school principals decided to do it themselves. In some cases it was because too many employees were sick, in others it was reports that children might be more susceptible to the new variant than to the original virus.

A teachers’ union called on all elementary schools to switch to distance learning in the first two weeks of January, with the exception of classes aimed at vulnerable children and the families of key workers.

After days of chaos over school policy, Mr Johnson reluctantly and belatedly agreed to the proposal on Monday.

“Parents whose children were in school today reasonably wonder why we didn’t make that decision sooner,” he said, adding, “the answer is simply that we have done everything in our power to make schools keep open. “

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Health

India coronavirus vaccine candidate from Cadila Healthcare

SINGAPORE – Indian drug maker Cadila Healthcare is about to start a phase 3 clinical trial for a potential coronavirus vaccine, its chairman told CNBC.

“We are now entering the third phase, which will begin very, very soon,” Pankaj Patel told CNBC’s “Street Signs Asia” on Tuesday.

He said the process will involve around 30,000 volunteers and take around three to three and a half months.

The pharmaceutical company, also known as Zydus Cadila, announced on Sunday that it had received approval from India’s Medicines Agency to begin its Phase 3 clinical trial after previous studies found its DNA vaccine candidate was “safe, well tolerated and immunogenic “.

“We saw that the antibody response was very, very good, in the range of 20 to 80-fold increases in antibodies after the vaccine was given,” said Patel, adding studies that so far indicated that the volunteers the vaccine responded well to it. “We also saw good virus neutralization with it and we didn’t see any side effects to be concerned about.”

“Overall we have very good results and we believe that phase three should actually show us the exact effectiveness of the vaccine,” said Patel. Cadila’s candidate will likely become India’s second domestically developed Covid-19 vaccine when it receives regulatory approval following its phase three study.

Ground staff walk past a container that is being held at Freight Terminal 2 at Indira Gandhi International Airport and will be used as a COVID-19 center for vaccine handling and distribution on December 22, 2020 in New Delhi, India, according to officials becomes.

Anushree Fadnavis | Reuters

Unlike some other Covid-19 vaccines that require extremely cold storage temperatures, Cadila’s candidate can be kept stable at room temperature, according to Patel. That would make it easier to distribute to remote parts of India.

Patel stated that the company already has a distribution system in India and has invested in expanding its manufacturing capacity. He added that the company is also in advanced talks with several other countries to deliver the potential vaccine once it’s ready, but declined to name the nations.

South Asia’s largest country currently has more than 10.35 million reported cases of coronavirus infection, second only to the US. According to the Johns Hopkins University, almost 150,000 people in India are said to have died of Covid-19. However, official figures suggest that the number of cases of active infections is decreasing.

The Indian Medicines Agency on Sunday approved the restricted use of two coronavirus vaccines in emergency situations. One of them is a vaccine developed by AstraZeneca and Oxford University and made locally by the Serum Institute of India. The other was developed by India’s Bharat Biotech in partnership with the Indian State Council for Local Medical Research and received emergency approval if clinical trials continue.

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World News

Britain, Trump, Coronavirus: Your Tuesday Briefing

There are many more ideas at home about what to read, cook, see, and do while being safe at home.

Steve Kenny, the Times’ senior editor for nights, briefs the newsroom about what happened while many of us were asleep. Five evenings a week, Mr. Kenny sends an email to editors and reporters around the world, summarizing the news and preparing others for the day ahead. Here are some of his “late notes” telling the story of 2020.

THURSDAY, JAN. 9, 2020. 2:08 pm

Sui-Lee Wee and Donald McNeil gave us the latest news that researchers in China have identified a new virus that is behind a mysterious pneumonial disease that has caused panic in the central China region. “There is no evidence that the virus, a coronavirus, is easily spread by humans and is not tied to death,” they write. “But health officials in China and internationally are watching it closely.”

THURSDAY, MARCH 12, 3:52 am

Within five minutes tonight, President Trump concluded his coronavirus speech. Tom Hanks announced on Instagram that he and his wife Rita Wilson had tested positive, and the NBA said it would put their season on hold until further notice.

TUESDAY, JUNE 23rd, 12:40 am

White House Trade Advisor Peter Navarro raised the alarm tonight when he told Fox News the trade deal with China was “over”. He took it back pretty quickly – or rather said that what he said had been “wildly out of context” – but not before Asian stock markets began to plunge.

TUESDAY, OCT. 6. 01:58 am

We got off to a hectic start with Trump’s return to the White House and his dramatic maskless salute on the balcony overlooking the South Lawn. Then he released a video recorded in the White House telling Americans that Covid-19 was nothing to fear.

That’s it for this briefing. Until next time.

– Victoria

Many Thanks
To Theodore Kim and Jahaan Singh for the break from the news. You can reach the team at briefing@nytimes.com.

PS
• We listen to “The Daily”. Our last episode is about the Georgia runoff elections.
• Here is our mini crossword puzzle and a clue: pond foam (five letters). You can find all of our puzzles here.
• Jeffrey Henson Scales spoke to ABC News about the Times year in photos.

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Health

Coronavirus surge hits Los Angeles

Los Angeles County, already in a devastating spike in coronavirus cases after Thanksgiving trips and gatherings, is hit by a surge in Christmas festivities.

The weekly average of new cases per day in the county, the largest in the United States, is highest at 16,193.

That’s roughly 12 times the November 1st weekly average, which was 1,347.

Though the spate of coronavirus cases has overwhelmed hospitals across the state, and Los Angeles County in particular, some Angelenos tried to celebrate the New Year at secret parties. Police dispersed more than a thousand people who attended a camp party, the Los Angeles Times reported.

According to a New York Times database, more than 21,000 people were hospitalized in California on New Year’s Day, up 26 percent from two weeks earlier.

Many intensive care units in Southern California and the San Joaquin Valley have been at full or almost at full capacity for weeks. At a Los Angeles hospital late last month, arriving patients waited outside in a tent – the lobby was used to treat patients and stretchers were placed in the gift shop.

Governor Gavin Newsom said Monday the state of the virus in California had made it “natural” that orders would remain in place for the southern and central regions of the state that were due to expire.

“Unfortunately, it gets worse before it gets better,” he said, adding that emergency room care for non-Covid patients has been slowed as intensive care units struggle to cope with the onslaught caused by the wave of coronavirus cases .

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Health

What Scientists Know About How the Coronavirus Variant Spreads

A more contagious form of the coronavirus has entered the United States.

In the UK, where it was first identified, the new variant became the predominant form of the coronavirus in just three months, accelerating that nation’s rise and filling its hospitals. It could do the same thing in the United States, exacerbating an unstoppable surge in deaths and overwhelming the already strained health system, experts warned.

One variant that is spreading more easily also means that people must follow religious precautions such as social distancing, mask-wearing, hand hygiene, and improved ventilation – undesirable news for many Americans who are already scrubbing against restrictions.

“The bottom line is that everything we do to reduce transmission is reducing transmission of all variants, including this one,” said Angela Rasmussen, a Georgetown University virologist. But “it may mean that the more targeted measures that aren’t like a full lockdown aren’t as effective.”

What does it mean for this variant to be transferable? What makes this variant more contagious than previous iterations of the virus? And why should we worry about a variant that spreads more easily but doesn’t seem to make anyone sick?

We asked experts to weigh the evolving research on this new version of the coronavirus.

Many variants of the coronavirus have emerged since the beginning of the pandemic. However, all evidence so far suggests that the new mutant, named B.1.1.7, is more transmissible than previous forms. It first appeared in the UK in September, but already accounts for more than 60 percent of new cases in London and neighboring areas.

The new variant appears to infect more people than previous versions of the coronavirus, even if the environments are the same. It is not clear what gives the variant this advantage, although there is evidence that it could infect cells more efficiently.

It’s also difficult to say exactly how much more transmissible the new variant can be, as scientists haven’t yet done the necessary laboratory experiments. Most of the conclusions were drawn from epidemiological observation and “there are so many possible biases in all the data available,” warned Muge Cevik, an infectious disease expert at the University of St Andrews in Scotland and a scientific advisor to the UK government.

Scientists initially estimated that the new variant was 70 percent more transferable, but a recent model study put that number at 56 percent. Once the researchers sift through all of the data, the variant may only be 10 to 20 percent more transmissible, said Trevor Bedford, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.

Still, said Dr. Bedford, it is likely to catch on quickly and become the predominant form in the United States by March. Scientists like Dr. Bedford closely follows all known variants to determine any further changes that could change their behavior.

The new mutant virus can spread more easily, but in every other way it seems little different from its predecessors.

At least so far, the variant does not seem to make people sick or lead to more deaths. Still, there is cause for concern: a more transmissible variant increases the death toll just because it spreads faster and infects more people.

“With that in mind, it’s just a numbers game,” said Dr. Rasmussen. The effect is amplified “in countries like the US and UK where the health system is really at its breaking point”.

The routes of transmission – through large and small droplets and tiny aerosolized particles floating in crowded interiors – have not changed. This means that masks, limiting time with others, and improving indoor ventilation will all help contain the spread of the variant, as it does with other variants of the virus.

Updated

Apr. 31, 2020, 10:44 am ET

“By minimizing exposure to viruses, you reduce the risk of infection and overall transmission,” said Dr. Rasmussen.

Some preliminary evidence from the UK suggests that people infected with the new variant tend to have greater amounts of the virus in their nose and throat than people infected with previous versions.

“We’re talking in the 10-fold to 10,000-fold range,” said Michael Kidd, clinical virologist for Public Health England and clinical advisor to the UK government who has investigated the phenomenon.

There are other explanations for the finding: Dr. Kidd and his colleagues did not have access to information about when, for example, people were tested for their disease, which could affect what is known as their viral load.

However, the finding offers a possible explanation for why the new variant is spreading more easily. The more viruses infected people have in their noses and throats, the more they are expelled into the air and onto surfaces when they breathe, speak, sing, cough or sneeze.

As a result, situations where people are exposed to the virus are more likely to develop new infections. Some new data suggests that people infected with the new variant spread the virus to more of their contacts.

For previous versions of the virus, contact tracing suggested that about 10 percent of those who are in close contact with an infected person – for at least 15 minutes within six feet – inhaled enough virus to become infected.

“With the variant we could expect 15 percent of it,” said Dr. Bedford. “Right now, risky activities are getting riskier.”

The variant has 23 mutations compared to the version that broke out a year ago in Wuhan, China. But 17 of those mutations appeared suddenly after the virus deviated from its youngest ancestor.

Every infected person is a melting pot that gives the virus the opportunity to mutate as it reproduces. With more than 83 million people infected worldwide, the coronavirus is accumulating mutations faster than scientists expected at the start of the pandemic.

The vast majority of mutations offer no benefit to the virus and die out. However, mutations that improve the fitness or transmissibility of the virus have a greater chance of prevailing.

At least one of the 17 new mutations in the variant contributes to their greater contagion. The mechanism is not yet known. Some data suggest that the new variant may bind more tightly to a protein on the surface of human cells and infect them more easily.

It is possible for the variant to bloom in the nose and throat of an infected person, but not, for example, in the lungs. This may explain why patients are more likely to spread it but not develop more serious diseases than from previous versions of the virus. Some influenza viruses behave similarly, experts say.

“We must view this evidence as preliminary and accumulative,” said Dr. Cevik on the growing data on the new variant.

However, the studies to date indicate that the transmission of the variant must urgently be restricted. She added: “Overall, we need to be much more careful and investigate the gaps in our mitigation efforts.”

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Why Coronavirus Vaccine Distribution is Taking Longer Than Anticipated

In Florida, less than one-quarter of delivered coronavirus vaccines have been used, even as older people sat in lawn chairs all night waiting for their shots. In Puerto Rico, last week’s vaccine shipments did not arrive until the workers who would have administered them had left for the Christmas holiday. In California, doctors are worried about whether there will be enough hospital staff members to both administer vaccines and tend to the swelling number of Covid-19 patients.

These sorts of logistical problems in clinics across the country have put the campaign to vaccinate the United States against Covid-19 far behind schedule in its third week, raising fears about how quickly the country will be able to tame the epidemic.

Federal officials said as recently as this month that their goal was to have 20 million people get their first shot by the end of this year. More than 14 million doses of the Pfizer and Moderna vaccines had been sent out across the United States, federal officials said on Wednesday. But, according to the Centers for Disease Control and Prevention, just 2.8 million people have received their first dose, though that number may be somewhat low because of lags in reporting.

States vary widely in how many of the doses they’ve received have been given out. South Dakota leads the country with more than 48 percent of its doses given, followed by West Virginia, at 38 percent. By contrast, Kansas has given out less than 11 percent of its doses, and Georgia, less than 14 percent.

Compounding the challenges, federal officials say they do not fully understand the cause of the delays. But state health officials and hospital leaders throughout the country pointed to several factors. States have held back doses to be given out to their nursing homes and other long-term-care facilities, an effort that is just gearing up and expected to take several months. Across the country, just 8 percent of the doses distributed for use in these facilities have been administered, with two million yet to be given.

The holiday season has meant that people are off work and clinics have reduced hours, slowing the pace of vaccine administration. In Florida, for example, the demand for the vaccines dipped over the Christmas holiday and is expected to dip again over New Year’s, Gov. Ron DeSantis said on Wednesday.

And critically, public health experts say, federal officials have left many of the details of the final stage of the vaccine distribution process, such as scheduling and staffing, to overstretched local health officials and hospitals.

In one notable blunder, forty-two people in Boone County, W.Va., who were scheduled to receive the coronavirus vaccine on Wednesday instead were mistakenly injected with an experimental monoclonal antibody treatment.

The West Virginia National Guard, which is leading the state’s vaccine distribution effort, called the error “a breakdown in the process.” None of the recipients has developed any adverse effects so far.

“We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health.

Federal and state officials have denied they are to blame for the slow rollout. Officials behind Operation Warp Speed, the federal effort to fast-track vaccines, have said that their job was to ensure that vaccines are made available and get shipped out to the states. President Trump said in a tweet on Tuesday that it was “up to the States to distribute the vaccines once brought to the designated areas by the Federal Government.”

“Ultimately, the buck seems to stop with no one,” Dr. Jha said.

These problems are especially worrisome now that a new, more contagious variant, first spotted in Britain and overwhelming hospitals there, has arrived in the U.S. Officials in two states, Colorado and California, say they have discovered cases of the new variant, and none of the patients had recently traveled, suggesting the variant is already spreading in American communities.

The $900 billion relief package that Mr. Trump signed into law on Sunday will bring some relief to struggling state and local health departments. The bill sets aside more than $8 billion for vaccine distribution, on top of the $340 million that the C.D.C. sent out to the states in installments in September and earlier this month.

That infusion of money is welcome, if late, said Dr. Bob Wachter, a professor and chair of the department of medicine at the University of California, San Francisco. “Why did that take until now when we knew we were going to have this problem two months ago?”

Michael Pratt, a spokesman for Operation Warp Speed, said that there will always be lags between the number of doses that have been allocated, shipped, injected and reported. “We’re working to make those lags as small as possible,” Mr. Pratt said.

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:

    • If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
    • When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
    • If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
    • Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
    • Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

The task of administering thousands of vaccines is daunting for health departments that have already been overburdened by responding to the pandemic. In Montgomery County, Maryland, the local health department has recruited extra staff to help manage vaccine distribution, said Travis Gayles, the county health officer.

“While we’re trying to roll out vaccinations, we’re also continuing the pandemic response by supporting testing, contact tracing, disease control and all of those other aspects of the Covid response,” Dr. Gayles said.

Complicating matters, the county health department gets just a few days of notice each week of the timing of its vaccine shipments. When the latest batch arrived, Dr. Gayles’s team scrambled to contact people eligible for the vaccine and to set up clinics to give out the doses as fast as possible.

Over all, Maryland has given nearly 17 percent of its vaccine doses. In a Wednesday appearance on CBS, Gov. Larry Hogan attributed the slow process to challenges across the board — from the federal government not sending as many doses as initially predicted, to the lack of logistical and financial support for local health departments.

In Texas, Gov. Greg Abbott and top state health officials say vaccines are available in the state but are not being distributed quickly enough to deal with a critical surge of Covid-19 cases that is pushing hospital capacity to the breaking point.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” the governor tweeted Tuesday.

In California, Gov. Gavin Newsom on Wednesday encouraged people to be “humble” in the face of such a complicated task and said that the pace of vaccination would accelerate. California has administered 20 percent of the doses it’s received.

Hesitancy among people offered the vaccine may also be slowing the rollout. Gov. Mike DeWine of Ohio said in a news conference on Wednesday that roughly 60 percent of nursing home staff members offered the vaccine in the state had declined it. In Florida, some hospital workers offered the vaccine declined it, and those doses are now designated for other vulnerable groups like health care workers in the community and the elderly, but that rollout has not quite begun, said Justin Senior, chief executive officer for the Safety Net Hospital Alliance of Florida, a hospital consortium.

There are bright spots. Some states and hospitals are finding ways to speedily administer the vaccines they have received. West Virginia said on Wednesday that it had finished giving the first round of vaccine doses to willing residents and workers at all of the state’s 214 long-term-care facilities — putting the state far ahead of most other states that began vaccinating at these facilities under a federal program with CVS and Walgreens.

In Los Angeles, Cedars-Sinai Medical Center, which employs some 20,000 people at several facilities, was vaccinating about 800 people a day, said Dr. Jeff Smith, Cedars-Sinai’s chief operating officer. He said Cedars-Sinai expected to vaccinate all of its staff members who have opted for the vaccine within a couple of weeks.

But other communities are falling short of that rapid clip. Dr. Smith said the medical community is worried about staffing shortages when hospitals have to both administer vaccines and treat Covid-19 patients.

In a news conference on Wednesday, Operation Warp Speed officials said they expected the pace of the rollout to accelerate significantly once pharmacies begin offering vaccines in their stores. The federal government has reached agreements with a number of pharmacy chains — including Costco, Walmart, and CVS — to administer vaccines once they become more widely available. So far, 40,000 pharmacy locations have enrolled in that program.

Most vaccines administered across the country to date have been given to health care workers at hospitals and clinics, and to older adults at nursing homes. Gen. Gustave F. Perna, the logistics lead of Operation Warp Speed, on Wednesday described them as “two very difficult, challenging groups” to immunize.

But public health officials warned that reaching these initial groups, who are largely being vaccinated where they live or work, is a relatively easy task. “This is the part where we’re supposed to know where people are,” said Dr. Saad B. Omer, the director of the Yale Institute for Global Health.

It may be more difficult, public health officials say, to vaccinate the next wave of people, which will most likely include many more older Americans as well as younger people with health problems and frontline workers. Among the fresh challenges: How will these people be scheduled for their vaccination appointments? How will they provide documentation that they have a medical condition or a job that makes them eligible to get vaccinated? And how will pharmacies ensure that people show up, and that they can do so safely?

“In the next phase,” said Dr. Jha of Brown University, “we’re going to hit the same wall, where all of a sudden we’re going to have to scramble to start figuring it out.”

Lucy Tompkins and David Montgomery contributed reporting.

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Health

Extra Contagious Coronavirus Variant Present in Colorado

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

The variant was discovered in a man in his twenties with no travel history, Mr Polis said. The man was isolated in Elbert County, southeast of Denver, he said.

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

Scientists are concerned about these variants, but not surprised by them. It is normal for viruses to mutate, and most of the mutations in the coronavirus have been shown to be minor.

“This shouldn’t be a cause for panic,” said William Hanage, an epidemiologist at Harvard University. “But it is an occasion to redouble our efforts to prevent the virus from getting a chance to spread.”

Earlier this month, British researchers observed that the variant was becoming more common in parts of the UK. Your subsequent research suggests that the variant known as B.1.1.7 spreads more easily than others in circulation.

It is not yet clear why B.1.1.7 transmits more easily. The line has accumulated 23 mutations since splitting off from other coronaviruses. The researchers are studying some of the mutations to see if the viruses can enter cells more easily or make more copies of themselves.

There is 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. However, the speed at which the variant appears to be spreading could lead to more infections – and therefore more hospitalizations.

The UK government reacted to the emergence of B.1.1.7 by restricting the movement of people and the size of the gatherings. In a preliminary study, UK researchers found that schools may need to be closed and vaccination programs aggressively accelerated to prevent a huge surge in cases.

Countries around the world have introduced stricter protocols for travelers entering from the UK. A new rule in the United States requiring incoming travelers from the UK – including American citizens – to provide proof of a negative coronavirus test upon entry went into effect on Monday.

It is not clear where B.1.1.7 originated. The UK has the largest system for sequencing the coronavirus genomes, which is why the variant may have been found there first. Cases of the variant have also been identified in France, Spain and other European countries, as well as Lebanon and Singapore. Health officials in Ontario, Canada, said Saturday that they had identified two cases of the variant in a couple with no known travel history or exposure.

With the United States sequencing far fewer genomes than the UK, American scientists suspected that the variant may already have been undetected in the country. It seems they were right.

The fact that the Colorado man identified on Tuesday had no travel history raises the worrying possibility that B.1.1.7 is already well established in his community – and perhaps elsewhere as well. “It didn’t teleport across the Atlantic,” said Dr. Hanage.

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Health

You’re Contaminated With the Coronavirus. However How Contaminated?

With Covid-19 patients flocking to hospitals across the country, doctors face an impossible question. Which patients in the emergency room are more likely to get worse quickly and which are most likely to fight the virus and recover?

As it turns out, there may be a way to differentiate these two groups, although it’s not yet widely used. Dozens of research published in the past few months found that people with bodies full of coronaviruses were more likely to get seriously ill and die more often, compared to people who carried much fewer viruses and were more likely to be relatively unharmed.

The results suggest that knowing what is known as viral load – the amount of virus in the body – could help doctors predict a patient’s course and more accurately distinguish those who may only need an oxygen check once a day from those who need it monitored, said Dr. Daniel Griffin, an infectious disease doctor at Columbia University in New York.

Tracking viral load “can actually help us stratify risk,” said Dr. Griffin. The idea is not new: viral load management has long been the foundation of caring for people living with HIV and stopping the transmission of this virus.

Little effort has been made to track viral loads in Covid-19 patients. However, earlier this month the Food and Drug Administration announced that clinical laboratories may report not only whether a person was infected with the coronavirus, but also how much virus was transmitted in their body.

This is not a change in policy – laboratories could have reported this information all along, according to two senior FDA officials, who spoke on condition of anonymity for not having the authority to speak publicly on the matter.

Still, the news came as a welcome surprise to some of the experts who have spent months pushing laboratories to record this information.

“This is a very important step by the FDA,” said Dr. Michael Mina, epidemiologist at Harvard TH Chan School of Public Health. “I think it’s a step in the right direction to make the most of one of the little pieces of data we have for a lot of positive people.”

The FDA change followed a similar move by the Florida Department of Health to require all laboratories to report this information.

Omitting viral load from test results was a missed opportunity not only to optimize strained clinical resources but also to better understand Covid-19, experts say. For example, an analysis of viral load shortly after exposure could reveal whether people who die of Covid-19 are more likely to have high viral loads at the onset of their illness.

And a study published in June showed that the viral load decreased as the immune response increased, “just as you would expect from an old virus,” said Dr. Alexander Greninger, a virologist at the University of Washington in Seattle. who directed the study.

An increase in the average viral load across communities could indicate an increasing epidemic. “We can get an idea of ​​whether the epidemic is growing or decreasing without relying on the number of cases,” said James Hay, postdoctoral fellow in Dr. Mina’s laboratory.

Fortunately, viral load data – or at least a rough approximation of it – is readily available to feed into the results of the PCR tests that most laboratories use to diagnose coronavirus infection.

A PCR test is performed in “cycles”, doubling the amount of viral genetic material originally taken from the patient sample. The higher the initial viral load, the fewer cycles the test takes to find genetic material and generate a signal.

A positive result at a low cycle threshold or Ct implies a high viral load on the patient. If the test is positive after completing many cycles, the patient is likely to have a lower viral load.

Researchers at Weill Cornell Medicine in New York recorded the viral load of more than 3,000 hospitalized Covid-19 patients on the day they were admitted. They found that 40 percent of patients with high viral loads – whose tests were positive at a Ct of 25 or less – died in the hospital, compared with 15 percent of those who tested positive at higher Ct and presumably lower viral loads.

In another study, the Nevada Department of Health found an average Ct of 23.4 in people who died from Covid-19 compared to 27.5 in people who survived their diseases. People who were asymptomatic had a mean of 29.6, suggesting they carried much fewer viruses than the other two groups.

These numbers seem to vary very little, but they represent millions of virus particles. “These are not subtle differences,” said Dr. Greninger. A study from his lab showed that patients with a Ct less than 22 were more than four times as likely to die within 30 days as compared to those with a lower viral load.

However, using Ct values ​​to estimate viral load is a difficult practice. Viral load measurements for HIV are highly accurate because they are based on blood samples. Tests for the coronavirus rely on wiping your nose or throat – a process that is subject to user error and the results of which are less consistent.

The amount of coronavirus in the body changes drastically as the infection progresses. The levels go from undetectable to positive test results in just a few hours, and the viral load continues to rise until the immune response sets in.

Then the viral load decreases rapidly. However, viral fragments can remain in the body and produce positive test results long after the patient is no longer infectious and the disease has resolved.

Given this variability, capturing viral load at a given point in time may not make sense if there is no more information about the progression of the disease, said Dr. Celine Gounder, Infectious Disease Specialist at Bellevue Hospital Center and a member of the Coronavirus Inbound Management Advisory Group.

“When do you measure the viral load on this curve?” Asked Dr. Gounder.

The exact relationship between a Ct value and the corresponding viral load can vary between tests. Instead of validating this quantitative relationship for each machine, the FDA authorized the tests to provide diagnoses based on a limit value for the cycle threshold.

Most manufacturers conservatively set the thresholds for diagnosing their machine between 35 and 40. These values ​​generally correspond to an extremely low viral load. However, the exact threshold for a positive result or for a certain Ct as an indication of infectivity depends on the instrument used.

“So I’m very concerned about many of these Ct-based ratings,” said Susan Butler-Wu, director of clinical microbiology at the University of Southern California.

“Of course it is a value that can be useful in certain clinical circumstances,” said Dr. Butler-Wu, “but the idea that you can have a unicorn Ct that correlates perfectly with an infectious or non-infectious condition makes me very nervous.”

Other experts recognized these limitations, but said that the benefits of collecting Ct values ​​outweighed the concerns.

“All of these are valid points when looking at the test results of an individual patient, but they don’t change the fact that, on average, looking at the results of the admission tests of these Ct values, actually identifies patients at high risk of decompensation will and die, “said Dr. Michael Satlin, an infectious disease physician and lead researcher on the Weill Cornell Study.

Dr. Satlin said adjusting his team’s results for duration of symptoms and various other variables did not change the high risk of death in high viral load patients. “Regardless of how you try to statistically adjust, that association is extremely strong and won’t go away,” he said.

At the population level, too, Ct values ​​can be valuable during a pandemic, said Dr. Hay. High viral loads in a large group of patients may indicate recent exposure to the virus, suggesting an incipient increase in community transmission.

“This could be a great monitoring tool for less well-equipped facilities that need to understand the course of the epidemic but are unable to conduct regular, random tests,” said Dr. Hay.

Overall, information on the viral load is too valuable to be ignored or discarded without analysis.

“One of the things that has been difficult with this pandemic is that everyone wants to do evidence-based medicine and do it at the right pace,” said Dr. Greninger. “But we should also expect certain things to be true, like that more viruses are usually not good.”

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Health

Coronavirus Variant Is Certainly Extra Transmissible, New Research Suggests

A team of British scientists published a worrying study on Wednesday of the new variant of coronavirus sweeping the UK. They warned that the variant was so contagious that new control measures, including closing schools and universities, may be required. Even that might not be enough, they said, saying, “It may be necessary to speed up the introduction of vaccines significantly.”

Nicholas Davies, lead author of the study, said the model should also serve as a warning to other countries where the variant may have already spread.

“The preliminary results are pretty convincing that faster vaccination is going to be a really important matter for any country dealing with this or similar variants,” said Dr. Davies, an epidemiologist at the London School of Hygiene and Tropical Medicine, in an interview.

The study, published by the Center for Mathematical Modeling of Infectious Diseases at the London School of Hygiene and Tropical Medicine, has not yet been reviewed by a scientific journal. The study compares a number of models as predictors of data on infection, hospital stays, and other variables. Other researchers are testing the variant in laboratory experiments to see if it is biologically different.

The study found no evidence that the variant was more deadly than others. However, the researchers estimated that it was 56 percent more contagious. On Monday the British government released an initial estimate of 70 percent.

Bill Hanage, an epidemiologist at Harvard TH Chan School of Public Health who was not involved in the study, said it provided a compelling explanation of the variant’s past and possible future.

“The overall message is solid and in line with what we’ve seen from other sources of information,” he said in an interview. “Is that important? Yes. Is there any evidence of increased transmission? Yes. Will that have an impact in the next few months? Yes. These are all pretty solid. “

The variant, which British researchers became aware of earlier this month, has spread rapidly in London and eastern England. It contains 23 mutations, some of which can be more contagious.

Dr. Davies and colleagues found more evidence that the variant actually spreads faster than others. For example, they ruled out the possibility that it was becoming more common in some regions of the UK because people in those places were more moving and more likely to come into contact with one another. Data recorded by Google showing the movements of individual cell phone users over time showed no such difference.

The researchers built various mathematical models and tested each one as an explanation for the spread of the variant. They analyzed which model of spread best predicted the number of actually confirmed new cases, as well as hospitalizations and deaths.

The researchers concluded that the variant can, on average, spread to more people than other variants. Dr. Davies warned that their estimate of 56 percent more contagious is still crude as they are still collecting data on the recent spread of the variant. “I think if we get more of that corner we will be safer,” he said.

Despite the data he and his colleagues have so far, he is confident that the new variant must be taken very seriously. “I think that given all the evidence, it is a strong case,” he said.

Updated

Apr. 27, 2020, 6:19 am ET

Dr. Davies and his colleagues then predicted what the new variant would do over the next six months and built models that took different constraints into account. Without a broader roll-out of vaccines, they warned, “Cases, hospitalizations, ICU admissions and deaths in 2021 could exceed those in 2020.”

Closing schools through February could buy the UK some time, the researchers noted, but lifting those additional restrictions would then result in a significant recovery in cases.

Dr. Davies and his colleagues also considered the protection vaccines offer. Vaccine experts are confident that coronavirus vaccines can block the new variant, although this needs to be confirmed by laboratory experiments that are currently being carried out.

To study the effects of the current vaccination rate, the researchers created a model that vaccinated 200,000 people each week. This pace was too slow to have much of an impact on the outbreak. “That kind of pace wouldn’t really help loosen control measures,” said Dr. Davies.

When they increased the vaccinations to 2 million a week, they saw a decrease in the peak load for intensive care units. Whether the UK can increase vaccinations by a factor of 10 is unknown.

As of Tuesday, the variant had not been identified in the United States, according to the Centers for Disease Control and Prevention. “Given the low proportion of US infections sequenced, the variant could already be in the US without being detected,” they warned.

The United States is vaccinating its citizens more slowly than expected. This could potentially become a problem if the variant spreads in the UK to the US.

“You need to be able to remove any obstacles to transmission as quickly as possible,” said Dr. Hanage.

Dr. Davies warned that the model he and his colleagues analyzed, like any model, was based on a number of assumptions, some of which could prove to be incorrect. For example, the rate at which infected people die from Covid-19 may continue to decline as doctors improve care for hospital patients. There are still uncertainties as to whether and by how much the new variant is more contagious in children.

They also didn’t consider other tools to stop the spread of the variant, such as an aggressive program to test people and isolate those infected. “That’s a limitation of the paper,” said Dr. Davies. Researchers are now starting to analyze new possibilities like this.

Nevertheless, Dr. Davies and his colleagues in the conclusion of their study: “There is an urgent need to examine which new approaches may be necessary in order to sufficiently reduce the ongoing transmission of SARS-CoV-2.”

Commenting on the new estimates, Alessandro Vespignani, director of the Network Science Institute at Northeastern University in Boston, who was not involved in the study, said: “Unfortunately, this is another turn in the plot.”

“While we were all excited about the vaccine,” he added, “there is a potential for a change in the epidemiological context that will make our next few months much more complex and dangerous to navigate.” Evidence is mounting that the variant is more transmissible, and this implies that even greater efforts are likely to be needed to keep its spread under control. “

Dr. Hanage warned that the model had some flaws. The researchers assumed that anyone under the age of 20 had a 50 percent chance of spreading the disease. Although this might be true for younger children, Dr. Hanage, it’s not for teenagers. “That’s the weakest part of their model,” he said.

Nevertheless, the study offers an important insight into the possible future of the country. “It’s not a forecast, it’s not a prediction, it doesn’t mean this is going to happen,” he said. “They say that if you don’t take it seriously, it can happen very easily.”

Benjamin Mueller contributed to the reporting.

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Business

Scenes From Gallup, N.M., The place the Coronavirus Has Hit Onerous

December 27, 2020

Gallup’s hospitals are almost full. Most of the stores are empty. The unemployment rate in the county where the city is located is one and a half times the national average. Earlier this month, according to a New York Times database, the highest number of cases per capita in any subway area were in the United States.

With the pandemic marching steadily across the country in recent months, places like Gallup have been hardest hit.

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According to census data, nearly half of Gallup’s residents are between the Navajo Nation in the north and the Zuni Nation in the south.

Native American communities were particularly vulnerable to the virus, accounting for nearly 40 percent of all cases in New Mexico at one point, although these communities make up less than a tenth of the state’s population. And some who have so far been spared the virus are still affected by the consequences of the economic slowdown.

Eric-Paul Riege, a 26-year-old artist, is the son of a veteran hotel manager and a Navajo mother who taught him the art of weaving. His work has been published in galleries and collections across the country. But paid projects almost dried up this year.

When I met Mr. Riege, he was working shifts at a restaurant called Grandpa’s Grill, processing orders for take-away groceries.

Route 66 runs through Gallup. The city has relied on tourism to fuel its economy. She expects visitors to shop and sell trading posts in local galleries that sell Native American arts and crafts. But the limits of activity in the region made that difficult.

When the region saw an extreme wave of virus cases in May, the city was on lockdown and state police and the National Guard barricaded highway exits to prevent people who did not live in Gallup from entering the city unless they did so an emergency.

Last month, long after the barricades fell, trading posts were open for indoor shopping but closed, reducing the chances of anyone stopping and browsing.

The legendary El Rancho Hotel, where John Wayne, Katharine Hepburn and other Hollywood stars once lived, was about a quarter full.

Gallup is in many ways a relic of conquered indigenous lands and American expansion. For example, many of the trading posts are owned and operated by whites. These little shops are overshadowed by McDonald’s, Walmart, and other large American franchises where cars and people often end up in parking lots these days.

Bill Lee, head of the Gallup Chamber of Commerce, said there has been a growing economic divide due to restrictions imposed by local and state officials. Smaller businesses often have to adhere to stricter guidelines, including rules that prevent in-store shopping, while larger stores, especially those deemed essential, can operate with fewer restrictions. “The governor picked winners and losers,” Mr. Lee told me.

Updated

Apr. 26, 2020 at 6:29 am ET

When the barricades were erected earlier this year, Walmart was inundated with shoppers stocking up on weeks of supplies, especially as there are few grocery stores in indigenous lands. However, the barricades also had the effect of preventing members of Indian groups from coming into town to shop.

Indigenous groups in the region have long suffered from a lack of information and resources.

Even before the pandemic, the Indian Health Service, the government program that provides medical care to the country’s 2.2 million members of the country’s tribal communities, faced a significant shortage of funding and care in addition to a lack of doctors and aging facilities.

The virus made these weaknesses all the more evident.

Amid the devastation of the pandemic, some people have gotten lucky. Dan Bonaguidi, the son of the city’s mayor who owns Michelle’s Ready Mix Rock and Recycle with his wife Michele, is one of them. Its business flourished as government grants resulted in greater demand for building materials for home renovations and projects such as new or expanded healthcare facilities during the pandemic.

But even with Lichtblicke there are many more stories of companies that are empty or closed – small and large.

After an oil and natural gas boom in New Mexico and Texas in recent years, the pandemic has lowered oil demand and prices. Marathon Petroleum announced plans in August to cease operations in the area and lay off more than 200 workers – roughly 1 percent of the city’s population.

Operations like marathons are vital to Gallup’s economy, and job losses contributed to the region’s unemployment rate rising to 10.6 percent in October. Raul Sanchez is one of the workers who lost his job.

One afternoon, two days before Thanksgiving, as I was driving past his house on the hill overlooking the western part of town, Mr. Sanchez was working on a red pickup truck. He had worked at Marathon for 10 years. “No other jobs in this city are paying off,” said 39-year-old Sanchez.

“It will have an impact on us,” said the city’s mayor, Louis Bonaguidi, earlier this year about the closure of the marathon plant. “It will surely affect the real estate market. But it will also affect all companies. “

As I drove through Gallup the day before Thanksgiving, the last few minutes of sun lit the rails of the Atlantic and Pacific Railroad. Despite the fighting in the city, I could still feel a pride in the community as I drove around.

But the feeling of vulnerability was just as evident. Even before the pandemic, more than a quarter of the city’s residents were living in poverty, and that number has increased this year.

Shortly after my visit to Rehoboth Medical Center, I watched a group of Navajo men lower a bronze-colored coffin into a grave in a cemetery 50 miles north of Gallup. It wasn’t the only virus-related funeral scheduled there this week.

Production by Renee Melides