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Covid-19 Vaccine, Instances Reside Updates: The Newest International Information

Here’s what you need to know:

Credit…Christopher Occhicone for The New York Times

The Trump administration, in a major policy shift aimed at accelerating lagging distribution of the coronavirus vaccine, announced on Tuesday that it would release all available doses and instructed states to immediately begin vaccinating every American 65 and older, as well as tens of millions of adults with health conditions that put them at higher risk of dying from the virus.

The announcement, by Health Secretary Alex M. Azar II and other top federal health officials, came amid continuing complaints about the pace of the vaccine rollout. Mr. Azar warned that states will lose their allocations if they don’t use up doses quickly, and that starting in two weeks, how many each state receives will be based on the size of its population of people 65 and older.

Precisely how that will work is unclear; in two weeks, President-elect Joseph R. Biden Jr. will already have been sworn in as president. Mr. Azar said the incoming Biden administration would be briefed on the changes, though he added that Americans “operate with one government at a time, and this is the approach that we believe best fulfills the mission.”

The new distribution plan, first reported Tuesday morning by Axios, is a reversal for the administration, which had been holding back roughly half of its vaccine supply — millions of vials — to guarantee that second doses would be available. Mr. Azar said the administration always expected to make the shift when it was confident in the supply chain. Both vaccines authorized in the United States so far require two doses: 21 days apart for the one developed by Pfizer and BioNTech, and 28 days apart for the one from Moderna.

“This next phase reflects the urgency of the situation we face,” he said.

Just days ago, Mr. Azar and officials from Operation Warp Speed, the administration’s fast-track vaccine initiative, criticized aides to Mr. Biden for announcing a similar plan. Mr. Azar said at the time that releasing nearly all of the doses, as the Biden team proposed, would jeopardize the “system that manages the flow, to maximize the number of first doses, but knowing there will be a second dose available.”

He called any proposed changes an “untenable position.”

Health officials also recommend that the vaccines be given to all adults with pre-existing conditions that make them more likely to develop serious illness from the virus, such as diabetes, chronic lung or heart disease, high blood pressure and cancer. Before the change, the vaccines were largely being distributed to people in the highest-risk categories, including frontline health care workers and older people in nursing homes.

In addition to the eligibility changes, health officials are also adding more community centers and pharmacies to the list of places where people can be vaccinated.

Mr. Azar’s new directive threatens to create more confusion in states that had already articulated different plans for who should receive the vaccine next. As of Monday, about 9 million people have received at least one dose of a Covid-19 vaccine, according to the Centers for Disease Control and Prevention, far short of the federal government’s original goals. At least 151,000 people in the United States have been fully vaccinated, as of Jan. 8, according to a New York Times survey of all 50 states. More than 375,000 people have died related to the virus and in recent days, the number of daily deaths in the country has topped 4,000.

Instead of holding back vaccine doses all existing doses will be now sent to states to provide initial inoculations. Second doses are to be provided by new waves of manufacturing.

The idea of using existing vaccine supplies for first doses has raised objections from some health workers and researchers, who worry that frontloading shots will raise the risk that second injections will be delayed. Clinical studies testing the vaccines showed the shots were effective when administered in two-dose regimens on a strict schedule. And while some protection appears to kick in after the first shot, experts remain unsure of the extent of that protection, or how long it might last without the second dose to boost its effects.

But others have vocally advocated for explicit dose delays, arguing that more widely distributing the partial protection afforded by a single shot will save more lives in the meantime.

The new recommendations come after some states have already begun vaccinating people 65 and older, leading to long lines and confusion over how to get a shot. Health experts and officials have faced difficult choices as they decided which groups would be prioritized in the vaccine rollout. While the elderly have died of the virus at the highest rates, essential workers have borne the greatest risk of infection, and the category includes many poor people and people of color, who have suffered disproportionately high rates of infection and death.

Despite the bumpy rollout, Gov. Ron DeSantis of Florida, who prioritized people 65 and older from the start, said he believed making all older people eligible was always the right thing to do.

The initial guidelines “would have allowed a 20-year-old healthy worker to get a vaccine before a 74-year-old grandmother,” he said on Tuesday at a news conference in the sprawling retirement community of The Villages. “That does not recognize how this virus has affected elderly people.”

In New York, which began vaccinating people 75 and older and more essential workers this week, Gov. Andrew M. Cuomo said that the state will accept the new federal guidance to prioritize those 65 and older, though he criticized the administration for not clearly defining who should be considered “immunocompromised.”

The new guidance will make more than 7 million New Yorkers eligible for the vaccine, Mr. Cuomo said, though the state only receives 300,000 doses a week.

“The federal government didn’t give us an additional allocation,” he said. “At 300,000 per week, how do you effectively serve 7 million people, all of whom are now eligible, without any priority?”

New Yorkers 65 and older are immediately able to schedule appointments on the state’s website, according to Melissa DeRosa, a top Cuomo aide, who added that the state was working with the C.D.C. on who is considered immunocompromised.

New guidelines released on Monday by the Centers for Disease Control and Prevention now note that while people should get their second shots “as close to the recommended 3-week or 1-month interval as possible,” there is “no maximum interval between the first and second doses for either vaccine.”

The update perplexed experts, who said that while other, previously licensed vaccines that involve multiple doses can be administered months or even years apart, no evidence yet exists to clearly support this strategy for Covid-19. “They will need to back this up with data,” said Marion Pepper, an immunologist at the University of Washington.

Dr. Leana Wen, an emergency physician at the George Washington School of Public Health, echoed the call for an explanation. With skepticism of vaccines already hindering the rollout of some shots, “the last thing we want to do is give the impression that there are shortcuts being taken in the approval process.”

Health officials in Britain are now allowing intervals between the first and second doses of Pfizer’s vaccines of up to 12 weeks. Last week, the World Health Organization said the injections could be given up to six weeks apart. The agency’s Strategic Advisory Group of Experts on Immunization “considers the administration of both doses within 21 to 28 days to be necessary for optimal protection,” said Saad Omer, a vaccine expert at Yale University who helped draft the WHO’s position on the matter.

In response to queries about dose delays, representatives from Pfizer and Moderna have repeatedly pointed to the company’s clinical trials, which tested dosing regimens of two shots, separated by 21 days for Pfizer, and 28 days for Moderna.

“Two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95 percent,” Steven Danehy, a spokesman for Pfizer, said earlier this month. “There are no data to demonstrate that protection after the first dose is sustained after 21 days.”

United States › United StatesOn Jan. 11 14-day change
New cases 222,902 +37%
New deaths 2,048 +48%
World › WorldOn Jan. 11 14-day change
New cases 625,815 +32%
New deaths 10,307 +28%

Where cases per capita are
highest

A coronavirus testing site in a shopping center parking lot in southern Los Angeles last week.Credit…Philip Cheung for The New York Times

California is trying to speed up its vaccination efforts, which have lagged amid the state’s struggle with a weekslong deluge of coronavirus cases that has led to some of the most dire consequences in the country.

Emergency rooms have had to shut their doors to ambulances for hours at a time. Nearly one in 10 people has tested positive for the virus in Los Angeles County, the nation’s most populous. And a surge of hospitalizations has caused problems for the oxygen delivery and supply system used by medical facilities.

Over the past week, an average of 480 people daily have died of Covid-19 in the state, according to a New York Times database.

Gov. Gavin Newsom said on Monday that California would employ an “all-hands-on-deck approach” to ramp up vaccinations.

The approach includes transforming Dodger Stadium from one of the nation’s biggest and most visible Covid-19 testing sites into a mass vaccination center. Petco Park, where the San Diego Padres play, and the state fairgrounds in Sacramento are also being set up as vaccination sites, the governor said.

The Orange County board of supervisors said on Monday that the county’s first of five planned “super” vaccination sites would open this week at the Disneyland Resort in Anaheim, which has been closed for much of the pandemic. Vaccinations will be available by appointment to everyone in “Phase 1a,” which includes frontline health care workers, paramedics, dentists and pharmacists.

Los Angeles County opened vaccine eligibility to a wider group of health care workers on Monday, allowing workers in facilities like primary care clinics, Covid-19 testing centers, laboratories, pharmacies and dental offices, as well as those who work with people who are homeless, to be vaccinated.

Previously, workers in hospitals and long-term-care facilities were prioritized. But as The Los Angeles Times reported, large numbers of health care workers in Los Angeles and Riverside Counties were declining to be inoculated.

And relatively few people in California have gotten vaccine doses, compared with other places: Only 2 percent of the state’s population has received a vaccine, according to a New York Times database; 782,638 doses out of the more than 2.8 million that the state has received have been administered.

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Newsom Broadens Who Can Administer Vaccines

Gov. Gavin Newsom of California described an “all-hands-on-deck approach” that will allow a wider range of health care workers, including pharmacists and dentists, to administer the coronavirus vaccine.

We are sending an urgent call across the spectrum, our health care partners, our legislative partners, as well as labor and business partners up and down the state, this notion of an all-hands-on-deck approach to accelerate the equitable and safe distribution of vaccines. Again, we’re not losing sight of the issue of equity. We’re not losing sight of the imperative to prioritize the most vulnerable and the most essential. So that’s why we talk about our special efforts to vaccinate the vaccinators as part of an all hands on deck — the slide that represents the number of categories of individuals and groups that can currently vaccinate. And you can see the myriad of different registered nurses, physician assistants and the like. But we recognize more folks need to have that ability. And that’s why you recall a week or so ago, we talked about our efforts on pharmacists and pharm techs. We’re seeing more and more paramedics partnering with the counties. Local health officers are encouraging this and we are very supportive of EMTs as this local option for additional vaccinators to help administer these vaccines faster.

Video player loadingGov. Gavin Newsom of California described an “all-hands-on-deck approach” that will allow a wider range of health care workers, including pharmacists and dentists, to administer the coronavirus vaccine.CreditCredit…Alex Welsh for The New York Times

Dr. Mark Ghaly, California’s secretary of health and human services, said at a news conference on Monday that the state was working to distribute vaccines to those who need them and want them — without allowing wealthy people to cut the line.

Mr. Newsom said the state was allowing a broader range of workers to administer vaccines, including pharmacists and dentists, and was rolling out a public awareness campaign in 18 languages.

“People have said, ‘Well, what about sending in the National Guard?’” he said of the groups administering vaccines. “Well, we have the National Guard out there.”

He also said there were urgent efforts to “vaccinate the vaccinators.”

Representative Brad Schneider, Democrat of Illinois, speaking in Washington last year.Credit…Samuel Corum/Getty Images

Three Democratic members of Congress have tested positive for the coronavirus, and say they believe their infections are linked to their time spent in a secure location with colleagues who did not wear masks during last week’s siege of the U.S. Capitol.

Representative Brad Schneider, Democrat of Illinois, said he received a positive test result Tuesday morning after driving home to Illinois, and that he did not have symptoms. Like Representatives Bonnie Watson Coleman of New Jersey and Pramila Jayapal of Washington, two Democrats who had announced positive tests on Monday, he directly blamed a group of House Republicans who refused to wear masks while sheltering in a secure location during the Capitol siege.

“Today, I am now in strict isolation, worried that I have risked my wife’s health and angry at the selfishness and arrogance of the anti-maskers who put their own contempt and disregard for decency ahead of the health and safety of their colleagues and our staff,” Mr. Schneider said.

He called for lawmakers who ignore public health guidance to be sanctioned “and immediately removed from the House floor by the Sergeant-at-arms for their reckless endangerment of their colleagues.”

Capitol Hill has long struggled to contain the spread of the virus, and within hours of the beginning of the 117th Congress on Jan. 3, lawmakers began announcing positive test results.

Now lawmakers, aides, police officers and reporters who fled to secure locations during the siege have been warned that they might have been exposed to the virus while sheltering from the mob.

On Sunday, Representative Chuck Fleischmann, Republican of Tennessee, who was also in protective isolation at the Capitol during the siege, said that he had tested positive for the virus after being exposed to his roommate, Representative Gus Bilirakis of Florida, also a Republican.

Mr. Fleischmann told the local news station WRCB that he was notified Wednesday that Mr. Bilirakis had tested positive, but did not receive the notification amid the riot. He said he did not know how many other lawmakers he had come in contact with.

Democrats, already frustrated by resistance from their Republican colleagues to wearing masks, accused maskless Republicans in the secure House location of reckless indifference.

“It angers me when they refuse to adhere to the directions about keeping their masks on,” Ms. Watson Coleman said in an interview. “It comes off to me as arrogance and defiance. And you can be both, but not at the expense of someone else.”

Ms. Jayapal said on Twitter that she had tested positive “after being locked down in a secured room at the Capitol where several Republicans not only cruelly refused to wear a mask but recklessly mocked colleagues and staff who offered them one.”

Ms. Jayapal, who said she had begun quarantining immediately after the siege on the Capitol, also said that any member of Congress who did not wear a mask should be removed from the floor by the sergeant-at-arms and fined.

“This is not a joke,” she said in a statement. “Our lives and our livelihoods are at risk, and anyone who refuses to wear a mask should be fully held accountable for endangering our lives because of their selfish idiocy.”

Dustin Johnson teeing off the 17th tee during round two at the Masters golf tournament in Augusta, Ga., in November.Credit…Doug Mills/The New York Times

This year’s Masters tournament in April will be attended by a limited number of spectators, the Augusta National Golf Club announced Tuesday. The club, which prohibited fans from the event two months ago, did not specify how many fans would be allowed in 2021, adding that spectators would be permitted if “it can be done safely.”

The 2020 Masters was postponed from its usual April date to November because of the coronavirus pandemic and was contested with protocols that included virus testing before the event for all players, caddies, club members, staff and other personnel, including a reduced number of media members.

Fred Ridley, the club chairman, said in a statement issued Tuesday that similar health standards would be instituted for this year’s tournament, which is scheduled to be contested from April 8 to 11. The club, based in Augusta, Ga., made the announcement as the state reported 16 new coronavirus deaths and 7,957 new cases on Jan. 11. Over the past week, there has been an average of 9,604 cases per day, an increase of 55 percent from the average two weeks earlier.

“Following the successful conduct of the Masters Tournament last November with only essential personnel, we are confident in our ability to responsibly invite a limited number of patrons to Augusta National in April,” Ridley said. “As with the November Masters, we will implement practices and policies that will protect the health and safety of everyone in attendance.”

The Augusta National statement said the club was in the process of communicating with all ticket holders and that refunds will be issued to those patrons not selected to attend.

Commuters at Shinjuku station in Tokyo last week.Credit…Noriko Hayashi for The New York Times

Another new coronavirus variant has been detected in four people who traveled to Japan from Brazil.

Japan’s health ministry said that the people who arrived this month at Tokyo’s Haneda Airport had tested positive for the coronavirus and that it was a separate variant with similarities to those detected in Britain and South Africa. It is also distinct from another variant recently identified in Brazil, according to experts who have analyzed the data.

Makoto Shimoaraiso, an official with Japan’s Cabinet Secretariat and Office for Covid-19 Preparedness and Response, said on Tuesday that the country was consulting with the World Health Organization.

It is not unusual for viruses to accumulate mutations or for new variants to emerge. But scientists are calling for greater surveillance of variants, particularly after those from Britain and South Africa proved to be more contagious.

Mr. Shimoaraiso said epidemiologists were not sure whether the variant identified in Japan was more infectious or likely to cause more severe illness.

According to Japan’s health ministry, one of the passengers infected with the new variant, a man in his 40s, was admitted to a hospital after having breathing difficulties. Of the other cases, a woman in her 30s and a teenage boy are experiencing sore throats and fever, and a teenage girl is asymptomatic.

London last week. A coronavirus variant that emerged in Britain has been found in about 50 countries.Credit…Andrew Testa for The New York Times

In recent weeks, scientists have raised concerns about a coronavirus variant first detected in December in South Africa, noting that this version of the virus may spread more quickly than its cousins, and perhaps be harder to quash with current vaccines.

Their worries are compounded by skyrocketing Covid-19 cases in the United States and another highly infectious new variant that is driving a surge in Britain.

Scientists still have a lot to learn about these variants, but experts are concerned enough to warn people to be extra-vigilant in masking and social distancing. Here’s what you need to know:

  • The British variant has been found in about 50 countries, including the United States, where dozens of cases have been identified. The South African variant has spread to about 10 countries but has yet to be detected in the United States.

  • Both variants carry genetic changes in the virus’s spike protein — the molecule used to unlock and enter human cells — that could make it easier to establish an infection. Researchers estimate that the British variant is about 50 percent more transmissible than its predecessors. Julian Tang, a virologist at the University of Leicester, said that researchers didn’t yet have a good estimate for how much more contagious the South African variant is.

  • There is no evidence that any of the new variants are more deadly on their own, but an uptick in the spread of any virus creates ripple effects as more people become infected and ill. That can strain already overstretched health care systems and undoubtedly lead to more deaths.

  • It is unlikely that either variant will completely evade the protective effects of the new Covid vaccines. A recent study, not yet published in a scientific journal, found that the Pfizer-BioNTech vaccine is still effective against a virus carrying a mutation common to both new variants.

    The South African variant does carry genetic changes that could make vaccines less effective: One mutation appears to make it harder for antibodies produced by the immune system to recognize the coronavirus, which means they may be less effective at stopping the variant. But it is “important to note that doesn’t mean vaccines won’t be functionally protective,” said Angela Rasmussen, a virologist affiliated with Georgetown University.

    Vaccines use multifaceted immune responses, and while some antibodies may be confused by the variant, others probably won’t be. In addition, antibodies are only one sliver of the complex cavalry of immune cells and molecules that battle infectious invaders.

    Also, if the virus accumulates more genetic changes, many of the authorized vaccines, including Pfizer’s and Moderna’s, can be adjusted fairly quickly.

Transportation emissions dropped sharply in 2020 as millions of people stopped driving to work and lockdowns were in place.Credit…Lucy Nicholson/Reuters

America’s greenhouse gas emissions from energy and industry plummeted more than 10 percent last year, reaching their lowest levels in at least three decades as the pandemic slammed the brakes on the nation’s economy, according to an estimate published Tuesday by the Rhodium Group.

The steep drop was the result of extraordinary circumstances, however, and experts say the United States still faces enormous challenges in getting its planet-warming pollution under control.

“The most significant reductions last year were around transportation, which remains heavily dependent on fossil fuels,” said Kate Larsen, a director at Rhodium Group, a research and consulting firm. “But as vaccines become more prevalent, and depending on how quickly people feel comfortable enough to drive and fly again, we’d expect emissions to rebound unless there are major policy changes put in place.”

Transportation, the nation’s largest source of greenhouse gases, saw a 14.7 percent decline in emissions in 2020 as millions of people stopped driving to work and airlines canceled flights. Although travel started picking up again in the second half of the year as states relaxed lockdowns, Americans drove 15 percent fewer miles last year than in 2019.

Over all, the fall in emissions nationwide was the largest one-year decline since at least World War II, the Rhodium Group said. It put the United States within striking distance of one of the major goals of the Paris climate agreement, a global pact by nearly 200 governments to address climate change.

As part of that agreement, President Barack Obama had pledged that U.S. emissions would fall 17 percent below 2005 levels by last year. President Trump withdrew the country from the Paris accord, and before last year, it appeared that the United States would miss the emissions target. But America’s industrial emissions are now roughly 21.5 percent below 2005 levels.

Scientists say that even a big one-year drop is not enough to stop climate change. Until humanity’s emissions are essentially zeroed out and nations are no longer adding greenhouse gases to the atmosphere, the planet will continue to heat up. As if to underscore that warning, European researchers announced last week that 2020 was probably tied with 2016 as the hottest year on record.

Global roundup

Coronavirus testing at a clinic outside Kuala Lumpur, Malaysia, on Monday.Credit…Fazry Ismail/EPA, via Shutterstock

Malaysia’s king declared a national state of emergency on Tuesday to stem a surge in coronavirus cases, suspending Parliament, closing nonessential businesses and locking down several states and territories, including the largest city, Kuala Lumpur.

The emergency declaration could last until Aug. 1, and some critics said the main beneficiary would be the prime minister, Muhyiddin Yassin, the head of an unelected government who for months has barely maintained his hold on power.

Mr. Muhyiddin, who asked the king to issue the declaration, went on television to assert that the emergency measure was necessary to contain the virus — and that it was not about extending his political career.

“Let me assure you, the civilian government will continue to function,” he said. “The emergency proclaimed by the king is not a military coup.”

Mr. Muhyiddin promised to hold a general election after the virus was brought under control.

Malaysia was mostly successful in containing the virus for much of last year, but the number of infections began rising in October and reached a daily peak of more than 3,000 new cases on Thursday. The surge was caused in part by an election campaign in the state of Sabah and by an outbreak among migrant workers. The government reported a total of more than 141,000 cases and 559 deaths as of Tuesday.

Mr. Muhyiddin came to power in March after the previous government collapsed. He formed a new coalition and the king appointed him prime minister without a parliamentary vote. Opponents have since questioned whether he has the support of a majority of Parliament’s 222 members.

Now, the king’s declaration means that no parliamentary vote or general election can be held for more than six months, as long as the virus persists.

James Chin, professor of Asian studies at the University of Tasmania, said the declaration gave Mr. Muhyiddin extraordinary powers, including the authority to pass laws that override existing ones and to use the military for police work.

“Politically he will benefit the most from this Covid emergency,” he said. “This will give him what he wants without any scrutiny from Parliament.”

Other global developments:

  • Taiwan on Tuesday reported two locally transmitted coronavirus infections: a doctor and a nurse at a hospital in the northern part of the island that treats coronavirus patients. They are Taiwan’s first locally transmitted cases since Dec. 22, when it reported the first such case since April.

  • The European Union’s top drug regulator said it would assess the coronavirus vaccine developed by AstraZeneca and Oxford University “under an accelerated timeline,” after receiving an application for emergency authorization of the drug.

  • The leader of the German state of Bavaria has urged health care workers to do their “civic duty” by getting vaccinated, and called on the government to consider making coronavirus vaccinations for medical personnel mandatory in some cases. And about half of the staff at Charité, Germany’s largest research hospital, has refused to receive vaccine shots, according to Dr. Andrej Trampuz, a department head at the facility.

  • Because of high infection numbers, Berlin residents will be restricted from traveling more than about 9 miles outside the city, under new rules agreed to by German lawmakers. The distance of travel within Berlin is not being limited.

  • A couple who were out walking on Saturday night in Sherbrooke, Quebec, told the police that they were in compliance with a new overnight curfew because the wife was walking her crawling husband on a leash like a dog, CTV News reported. People walking their dogs are excluded from the province’s curfew, which is in effect from 8 p.m. to 5 a.m., as are essential workers and those seeking medical care. The pair were fined 1,500 Canadian dollars each. The province’s leader, François Legault, said on Monday that 740 people were fined over the weekend for violating the curfew, the first of its kind in Canada.

Dr. Rochelle P. Walensky is President-elect Joseph R. Biden Jr.’s nominee to lead the Centers for Disease Control and Prevention.Credit…Hilary Swift for The New York Times

Dr. Rochelle P. Walensky, chief of the infectious diseases division at Massachusetts General Hospital and a professor at Harvard, has been nominated by President-elect Joseph R. Biden Jr. to be director of the Centers for Disease Control and Prevention. In a column for The New York Times Opinion section, excerpted here, she writes about her plans for the agency.

On Jan. 20, I will begin leading the C.D.C., which was founded in 1946 to meet precisely the kinds of challenges posed by this pandemic. I agreed to serve as C.D.C. director because I believe in the agency’s mission and commitment to knowledge, statistics and guidance. I will do so by leading with facts, science and integrity — and being accountable for them, as the C.D.C. has done since its founding 75 years ago.

I acknowledge that our team of scientists will have to work very hard to restore public trust in the C.D.C., at home and abroad, because it has been undermined over the last year. In that time, numerous reports stated that White House officials interfered with official guidance issued by the C.D.C.

As chief of the infectious diseases division at Massachusetts General Hospital, I and many others found these reports to be extremely disturbing. The C.D.C.’s science — the gold standard for the nation’s public health — has been tarnished. Hospitals, doctors, state health officials and others rely on the guidance of the C.D.C., not just for Covid-19 policies around quarantine, isolation, testing and vaccination, but also for staying healthy while traveling, strategies to prevent obesity, information on food safety and more.

Restoring the public’s trust in the C.D.C. is crucial. Hospitals and health care providers are beyond tired, beyond stretched. I know because I have stood among them, on the front lines of the Covid-19 response in Massachusetts. We also face the need for the largest public health operation in a century, vaccinating the population — twice — to protect ourselves and each other from a surging pandemic. Because the impact of Covid-19 does not fall equally on everyone, we must redouble our efforts to reach every corner of the U.S. population.

The research and guidance provided by the civil servants at the C.D.C. should continue regardless of what political party is in power. Novel scientific breakthroughs do not follow four-year terms. As I start my new duties, I will tell the president, Congress and the public what we know when we know it, and I will do so even when the news is bleak, or when the information may not be what those in the administration want to hear.

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Gorillas Test Positive for Coronavirus at San Diego Zoo

Officials at the zoo’s Safari Park said that several gorillas had tested positive for the virus and that they believed an asymptomatic staff member infected the animals.

They’re doing OK, they’re experiencing some mild symptoms. And we continue to observe them. But they’re drinking, they’re eating and they’re interacting with one another. So we suspect that the gorillas got this virus from an asymptomatic team member. And that’s despite all of the precautions that we take. We follow C.D.C. guidelines. We follow San Diego County health guidelines. The team wears P.P.E. around all of our wildlife. And so even with all those precautions, we still have an exposure that we think happened with that team member. This virus has been very, very tricky. We’ve done everything we can to respond to it and make sure that we’re taking all the precautions and following all the guidelines that we can. But as we see it evolving everywhere around the world right now, we know that it is, it is, it’s evolving. It’s changing. And the best that we can do for humans and wildlife is just to ensure that we stay up to date on any protocols, that we remain nimble so that we can respond accordingly and make sure that we’re doing the very best we can to protect both our team, our guests and wildlife.

Video player loadingOfficials at the zoo’s Safari Park said that several gorillas had tested positive for the virus and that they believed an asymptomatic staff member infected the animals.CreditCredit…Ken Bohn/San Diego Zoo Global/Via Reuters

Several gorillas at the San Diego Zoo Safari Park have tested positive for the coronavirus, becoming what federal officials say are the first known apes in the United States to be infected.

Zoo officials said on Monday that they believed the gorillas were infected by an asymptomatic staff member who had been following safety recommendations, including wearing personal protective equipment when near animals.

Veterinarians are closely monitoring the troop, which is made up of eight western lowland gorillas. The infected animals are expected to make a full recovery, officials said.

“Aside from some congestion and coughing, the gorillas are doing well,” Lisa Peterson, the Safari Park’s executive director, said in a statement.

Three animals are exhibiting symptoms, officials said. And because gorillas live together in troops, “we have to assume,” the zoo said, “that all members of the family group have been exposed.”

The total number of western lowland gorillas, which can be found in central Africa, has declined more than 60 percent over the past two decades, according to the World Wildlife Fund.

Zoo officials learned that at least two gorillas had been infected with the coronavirus after the animals were observed on Wednesday “coughing and showing other mild symptoms,” the zoo said in the statement.

The zoo’s Safari Park has been closed since Dec. 6 amid a lockdown, and the primate habitat where the gorillas are housed poses “no public health risk,” officials said. Last year, as the pandemic spread across the country, the zoo installed additional barriers to ensure that more than six feet of space separated visitors from “susceptible species,” officials said.

The gorillas are among the latest animals in the country to become infected with the coronavirus. In April, the first case of human-to-cat transmission was detected in a tiger at the Bronx Zoo in New York City. In August, minks on two farms in Utah tested positive. In December, a coronavirus infection in a snow leopard was detected at the Louisville Zoo in Kentucky.

VideoVideo player loadingMayor Bill de Blasio of New York City announced on Tuesday that CitiField, the Mets’ home stadium in Queens, will be a “24/7 mega-vaccination site” starting the week of Jan. 25.CreditCredit…Ryan Christopher Jones for The New York Times

Mayor Bill de Blasio of New York City announced on Tuesday that CitiField, the Mets’ home stadium in Queens, will be a mass vaccination site starting the week of Jan. 25. The site will operate around the clock, seven days a week, with the capacity to vaccinate 5,000 to 7,000 people a day, Mr. de Blasio said. The location is ideal, the mayor said, because it is right next to a subway and railroad station and has plenty of parking.

“It’s going to be big, and it’s going to be a game changer,” Mr. de Blasio said at a news conference on Tuesday.

Large sports venues across the country have been used as sites for mass coronavirus testing, and more recently for vaccination, including the home stadiums of the Los Angeles Dodgers and San Diego Padres baseball teams, the Arizona Cardinals of the N.F.L. and the San Antonio Spurs of the N.B.A. Testing and vaccination efforts at Hard Rock Stadium in Miami were temporarily suspended on Monday to allow the college football championship game between Alabama and Ohio State to be played there.

The pool of people eligible for the vaccine in New York has recently expanded to include teachers and a range of other essential workers, as well as any resident who is 65 or older. At first, the vaccine was limited to frontline health care workers and nursing home residents.

The CitiField location is part of New York City’s initiative to establish mass inoculation sites in each of the city’s five boroughs. Vaccination centers opened in Brooklyn and the Bronx this week; locations in Manhattan and Staten Island have not yet been announced.

More than 26,000 vaccine doses were administered in the city on Monday, according to Mr. de Blasio, who is trying step up the pace of inoculations. The mayor has said his goal is to have one million doses administered by the end of January.

Mr. Cuomo, a third-term Democrat, said on Tuesday that the state intended to set up a series of rapid testing sites in areas where restrictions have closed indoor dining and arts events, and closed offices. Some of these sites would be located in vacant retail spaces or shuttered businesses, he said, promising hundreds of “pop-up” testing sites.

At the same time, Mr. Cuomo wants to reopen office buildings — a major element of New York City’s economy, both for their tenants and developers — saying he had received assurances from their owners that they could ramp up testing for workers. “Bringing workers back safely will boost ridership on our mass transit, bring customers back to restaurants and stores, and return life to our streets,” he said.

A coronavirus testing site in Los Angeles on Monday. The United States was one of the poorest-performing countries in a study of responses to the pandemic.Credit…Alex Welsh for The New York Times

How well a country has responded to Covid-19 is not explained by the country’s economic power or scientific capacity, but by how its people relate to one another and their government, according to preliminary findings of a research study.

“Countries with traditions of acting in concert against social problems, and countries with histories of deference to public authorities, fared better on compliance than countries lacking either or both,” the researchers wrote.

Investigators compared characteristics of 23 countries on six continents, considering outcomes related to disease burden, economic impact and disparities. In the United States, rated as one of the poorest-performing countries, “the virus ‘exploited’ pre-existing weaknesses” in public health, the economy and politics.

Before the pandemic, numerous reports and congressional testimony “recognized vulnerabilities that became apparent during Covid-19,” another study found, including threats of viruses emerging from animals, economic disruption, inadequate stockpiles and vulnerability to global supply shortages. For that study, researchers compiled more than 1,200 pre-pandemic records in an expanding online library that was introduced on Tuesday — Health Security Net — in the hopes that it will “inform future planning and response efforts.”

Another team, studying five countries in Africa, found that national leaders there had quickly recognized the threat from the virus and imposed measures to limit its importation and spread. “That managed to at least curtail the outbreak,” said Wilmot James, a Columbia University research scholar who was one of the study’s principal investigators, “but the impacts on the economies were quite devastating.”

The Africa Centers for Disease Control and Prevention, a four-year-old institution modeled in part on its U.S. counterpart, was unique in providing technical assistance for an entire continent.

The research reports were released Tuesday in conjunction with a two-day symposium, the Futures Forum on Preparedness, supported by Schmidt Futures and the Social Science Research Council.

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Research Says Blood Plasma Reduces Threat of Extreme Covid-19 if Given Early

It will be difficult “to find and diagnose them in this vanishingly small window,” said Dr. Ilan Schwartz, an infectious disease doctor at the University of Alberta who was not involved in the study. “The study looks solid, but it isn’t exactly practical in the real world.”

Plasma has additional logistical hurdles, said Dr. Titanji from Emory University. Treatment is given as an intravenous infusion – a process that requires skilled hands – and patients must be monitored afterward. That might be easier in long-term care facilities, but far more difficult for the general population, she said.

And plasma may not work as well as monoclonal antibody therapy – a synthetic preparation that is made en masse in the laboratory and not drawn from human blood, and that focuses on only one or two types of antibody at a time, rather than the total amount produced naturally by the immune system. Two types of monoclonal antibody treatments have been approved for emergencies in Covid patients.

But plasma has some advantages over monoclonal antibody treatments, emphasized Dr. Polack.

Because monoclonal antibodies are synthetic and tedious to make, they come at a high price, sometimes costing thousands of dollars (although the US government has prepaid some doses). The limited supply chain of treatment, as well as unexpectedly low demand, have made it inaccessible to many patients in need in the US and abroad.

In countries like Argentina, plasma could be one of the best treatment options available, said Dr. Polack. Plasma infusions in Buenos Aires cost less than $ 200 per patient. “It’s more accessible, cheaper, more universal,” he said.

Even in the United States, plasma “really is the only game in town that is widely available in terms of antibody therapy,” said Dr. Wang from Stanford.

Instead of viewing monoclonal antibodies as an upgrade for convalescent plasma, “they each have a different place in the armory,” said Dr. Pirofski. “Anything this virus can control is really an incredible benefit at this point.”

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India Approves Oxford-AstraZeneca Covid-19 Vaccine and 1 Different

NEW DELHI – India announced on Sunday that it has approved two coronavirus vaccines, one made by AstraZeneca and Oxford University and the other developed in India for emergency use. This is an important step in stopping the coronavirus from spreading in one of the toughest in the world. countries hit.

The permits were announced at a press conference in New Delhi on Sunday. Dr. VG Somani, the Indian drug control officer, said the decision to approve the Oxford-AstraZeneca vaccine and a local vaccine developed by Bharat Biotech was made after “careful review” of both by the Central Drugs Standard Control Organization, India’s Indian medicines agency .

Indian regulators are still considering approvals for other vaccines. One made by Pfizer and BioNTech has already been approved in the US and Europe. Another, Russia’s Sputnik V, seems less far away.

The UK became the first country to issue emergency approval for the Oxford-AstraZeneca vaccine on Wednesday. Argentina soon followed.

Officials in India moved quickly for several reasons. The country ranks number 2 in confirmed infections behind the United States, and the outbreak is widely believed to be worse than official numbers suggest. The pandemic has devastated the economy and the unemployment rate is at a 45-year high. Education has been disrupted, leading to concerns about the long-term impact on the country’s youth.

India is now facing major challenges. Cans for more than 1.3 billion people have to be paid for and distributed over a vast country. Government officials may also have public doubts about the vaccine’s safety and effectiveness, partly due to the government’s lack of transparency about clinical trial protocols.

Criticism of the ambiguity of the data examined by the regulator came quickly after the two emergency vaccines were approved.

All India Drug Action Network, a public health watchdog, immediately issued a statement requesting more information on the scope of clinical trials and dosage regimens for both vaccines.

Regarding the Bharat biotech vaccine called Covaxin, the group said it was “baffled to understand the scientific logic that motivated the top experts” to approve a vaccine that is still in clinical trials.

Dr. Somani, the regulator, said the vaccine had been given to 22,500 study participants and “found safe” to date.

Both the AstraZeneca vaccine and the Bharat Biotech vaccine require two doses, said Dr. Somani. He did not state whether participants in Bharat Biotech’s ongoing clinical trials received both doses.

The effort has already been fraught with setbacks. The Serum Institute, an Indian drug company that had an agreement to make the Oxford vaccine before it was proven to be effective, has managed to produce only about a tenth of the 400 million doses it promised to make before the end of the year.

The government says it’s ready. To get the vaccine to a country known for its size and sometimes unreliable roads, officials will leverage knowledge from nationwide campaigns against polio and newborn vaccinations, as well as the skills and flexibility used in India’s mammoth general election where ballot boxes are delivered to the US furthest from the country.

The Serum Institute says it is on the right track to ramp up production of the vaccine known in India as Covishield. With $ 270 million of its own funds and $ 300 million from the Bill and Melinda Gates Foundation, Serum plans to increase production capacity to 100 million doses per month by February, said Mayank Sen, a company spokesman.

First, the Serum Institute signed a pact with AstraZeneca to manufacture one billion doses of the vaccine for low and middle income countries. The vaccine is attractive to developing countries because it is cheaper to manufacture and easier to transport than those which require colder temperatures during storage and transportation.

The Serum Institute experienced production delays when it built new facilities to manufacture the vaccine. It is said to have produced between 40 and 50 million cans for the world. The company’s chief executive Adar Poonawalla told reporters on Monday that the majority of the cans will be given to India.

Indian officials were unsure of how many doses to receive and when. Mr Sen said the Serum Institute had no firm agreement with the Government of India, but had committed to reserve most of its existing inventory for India.

“The government has not yet signed the papers and the final dotted line, but this is based on initial discussions we had because we have always said India will be the priority,” said Sen.

Until the vaccine is approved by the World Health Organization, serum will begin shipping doses at manufacturing cost to other developing countries, Sen said.

India’s approval process has also been delayed. The Serum Institute filed for emergency approval earlier last month, but regulators requested additional details from clinical trials, including whether any person involved in the trials had had any medical complications.

The details of this claim are not clear. After receiving the Covishield vaccine on October 1, a 40-year-old volunteer from Chennai, India, publicly reported neurological symptoms to the Serum Institute in a legal notice. The company threatened defamation lawsuits and required volunteers to pay approximately $ 13.7 million. While negative health effects from vaccine trials are rare, health professionals risked the Serum Institute promoting misinformation by punishing someone for speaking up.

Mr Poonawalla said Monday that the Serum Institute had submitted the additional information that regulators had requested. It has denied that the problems reported by the Chennai trial participant had anything to do with Covishield but refused to comment on allegations of intimidation.

Indian officials have drawn up an ambitious plan to vaccinate the country’s huge population. This is the greatest effort of this kind in the country’s history.

India plans to launch a vaccination campaign in the first three months of the year that will cover about a quarter of the population by August. The first 30 million people vaccinated will be health care providers, then police and other frontline workers. For the remaining 270 million people, authorities will focus on those over 50 who are suffering from conditions that may make them more vulnerable.

The rest of the population will be immunized based on the availability of vaccines and the latest scientific knowledge.

India has a long history of vaccinating its people. India’s first mass vaccination took place in 1802 to combat smallpox. Subsequent efforts suffered from misinformation and slow adoption.

The country has made progress in recent years. In the fight against polio, government officials ran informational campaigns to religious leaders to almost eradicate the disease. According to a study, a mass measles vaccination campaign between 2010 and 2013 saved the lives of tens of thousands of children.

For the coronavirus campaign, the national government has asked the states to prepare vaccination strategies. Some have established task forces at the state, district and block levels. To date, more than 20,000 health workers in around 260 districts have been trained to administer the vaccine, according to the Indian Ministry of Health.

The government plans to use the framework of its universal vaccination program for pregnant women and newborns – one of the largest and cheapest public health interventions in the world.

Indian civil aviation minister Hardeep Singh Puri said Tuesday that airlines, airports and ground handlers have been asked to develop plans to transport vaccine bottles in cold temperatures.

This week, health workers in four Indian states conducted an exercise to iron out wrinkles. Health officials in various locations distributed over 100 doses of placebo vaccine to trainers. They then tracked the temperature of the cans on the way from the train depot to the vaccination site, as well as the time and whether they reached the intended patient.

India has yet to improve its ability to store and transport vaccines under temperature controlled conditions known as the cold chain network, as well as improve distribution methods and train new workers.

India may need to double its health care workforce from its current 2.5 million, said Thekkekara Jacob John, a senior virologist in southern Tamil Nadu state.

“This is a Herculean task,” said John of the vaccination effort. “And the challenge is not in densely populated cities, but in rural areas – home of real India.”

Government officials must also stop the rumor, he said. Chat groups on WhatsApp, Facebook’s widespread messaging service in India, have already become misinformation about side effects.

A month ago, Prime Minister Narendra Modi urged citizens to look out for those trying to spread rumors about the vaccine, which he called “anti-national and anti-human” and urged politicians to help raise awareness .

Mr Modi renewed that appeal on Thursday, throwing the continued fight against the virus as one against an unknown enemy.

“Be careful of rumors,” he said, “and as a responsible citizen, you must not post messages on social media without checking.”

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Why Covid-19 Vaccines Take a Whereas to Kick In

A barrage of headlines this week flooded social media, documenting a seemingly worrying case of Covid-19 with a San Diego nurse who fell ill about a week after his first injection of Pfizer’s coronavirus vaccine.

However, experts said the disease is not unexpected: it is known that vaccines take at least a couple of weeks to protect themselves. And getting sick before getting a two-dose vaccination shouldn’t affect the effectiveness of Pfizer’s product, which has blown away with flying colors through late-stage clinical trials.

Reporting that a half-vaccinated person has Covid-19 is “really the equivalent of saying someone went outside without an umbrella and got wet in the middle of a rainstorm,” said Dr. Taison Bell, an intensive care physician at the University of Virginia. Dr. Bell received his first dose of Pfizer’s vaccine on December 15th and will soon be receiving his second shot.

The California nurse, identified as Matthew W. (45) on an ABC10 news report, received his first dose of Pfizer’s vaccine on December 18. Six days later, he started experiencing mild symptoms such as chills and muscle pain and fatigue, according to news reports. He tested positive for the virus the day after Christmas.

Dr. Megan Ranney, an emergency doctor at Brown University, said this shouldn’t be a concern. “So what????” She tweeted Wednesday in response to a Reuters article about the nurse’s illness. “It’s a 2-shot vaccination.” Dr. Ranney received her first dose of Pfizer’s vaccine on December 18th.

Dr. Describing the nurse’s illness as news, Ranney said in an interview that this was a departure from expectations – and that there should be protection about a week after the first dose of vaccine. That is not the case at all.

Vaccines take at least a few days to be protective. Pfizer’s recipe is based on a molecule called messenger RNA, or mRNA, which once injected into human cells and instructs them to make a coronavirus protein called Spike. None of these components are infectious or can cause Covid-19. But they act as coronavirus mimickers, teaching the body to recognize the real virus and defeat it should it ever occur.

It is believed that the production of spikes occurs within hours of the first shot. However, the body needs at least a few days to memorize the material before it can break down its entire arsenal of defenses against the virus. Immune cells take this time to examine the protein, then mature, multiply, and sharpen their spike-spotting reflexes.

Data from Pfizer’s clinical trials suggests that the vaccine could protect its recipients from disease about a week or two after the first injection. A second shot of mRNA, released three weeks after the first, helps the immune cells incorporate the most important features of the virus into memory and speed up the protection process.

Covid19 vaccinations>

Answers to your vaccine questions

With a coronavirus vaccine spreading out of the US, here are answers to some questions you may be wondering about:

    • If I live in the US, when can I get the vaccine? While the exact order of vaccine recipients may vary from state to state, most doctors and residents of long-term care facilities will come first. If you want to understand how this decision is made, this article will help.
    • When can I get back to normal life after the vaccination? Life will only get back to normal once society as a whole receives adequate protection against the coronavirus. Once countries have approved a vaccine, they can only vaccinate a few percent of their citizens in the first few months. The unvaccinated majority remain susceptible to infection. A growing number of coronavirus vaccines show robust protection against disease. However, it is also possible that people spread the virus without knowing they are infected because they have mild or no symptoms. Scientists don’t yet know whether the vaccines will also block the transmission of the coronavirus. Even vaccinated people have to wear masks for the time being, avoid the crowds indoors and so on. Once enough people are vaccinated, it becomes very difficult for the coronavirus to find people at risk to become infected. Depending on how quickly we as a society achieve this goal, life could approach a normal state in autumn 2021.
    • Do I still have to wear a mask after the vaccination? Yeah, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This seems to be sufficient protection to protect the vaccinated person from disease. What is not clear, however, is whether it is possible for the virus to bloom in the nose – and sneeze or exhale to infect others – even if antibodies have been mobilized elsewhere in the body to prevent that vaccinated person gets sick. The vaccine clinical trials were designed to determine whether people who were vaccinated are protected from disease – not to find out whether they can still spread the coronavirus. Based on studies of flu vaccines and even patients infected with Covid-19, researchers have reason to hope that people who are vaccinated will not spread the virus, but more research is needed. In the meantime, everyone – including those who have been vaccinated – must imagine themselves as possible silent shakers and continue to wear a mask. Read more here.
    • Will it hurt What are the side effects? The vaccine against Pfizer and BioNTech, like other typical vaccines, is delivered as a shot in the arm. The injection in your arm feels no different than any other vaccine, but the rate of short-lived side effects seems to be higher than with the flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported serious health problems. The side effects, which can be similar to symptoms of Covid-19, last about a day and are more likely to occur after the second dose. Early reports from vaccine trials suggest that some people may need to take a day off because they feel lousy after receiving the second dose. In the Pfizer study, around half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headache, chills, and muscle pain. While these experiences are not pleasant, they are a good sign that your own immune system is having a potent response to the vaccine that provides lasting immunity.
    • Will mRNA vaccines change my genes? No. Moderna and Pfizer vaccines use a genetic molecule to boost the immune system. This molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse with a cell, allowing the molecule to slide inside. The cell uses the mRNA to make proteins from the coronavirus that can stimulate the immune system. At any given moment, each of our cells can contain hundreds of thousands of mRNA molecules that they produce to make their own proteins. As soon as these proteins are made, our cells use special enzymes to break down the mRNA. The mRNA molecules that our cells make can only survive a few minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a little longer, so the cells can make extra viral proteins and trigger a stronger immune response. However, the mRNA can hold for a few days at most before it is destroyed.

The California nurse’s illness schedule falls well within the post-vaccination vulnerability window, said Dr. Ranney. It’s also very likely that he discovered the virus around the time he got the shot, maybe even before that. People may notice symptoms of Covid-19 between two and 14 days after the coronavirus emerges, if they ever have symptoms.

A similar situation appears to have developed recently with Mike Harmon, the Kentucky state chartered accountant, who tested positive for the virus this week the day after receiving his first dose of an unspecified coronavirus vaccine.

“It appears that I was unknowingly exposed to the virus and got infected either shortly before or after receiving the first dose of the vaccine on Monday,” Harmon said in a statement. Mr Harmon reiterated his “full confidence in the vaccine itself and the need for as many people to receive it as soon as possible”.

Jerica Pitts, a Pfizer spokeswoman, noted that the vaccine’s protective effect “is significantly increased after the second dose, supporting the need for a two-dose series”.

“People may have contracted an illness before or immediately after being vaccinated,” she said.

Pfizer’s vaccine, when given in its full two-dose regimen, was found to be 95 percent effective in preventing symptomatic cases of Covid-19 – a figure that is very welcome news given the rise Coronavirus case numbers was celebrated. Still, a small percentage of people who are not protected after vaccination remain, said Dr. Ranney. “There is no such thing as a vaccine that is 100 percent effective.”

It is also unclear how well Pfizer’s vaccine can protect against asymptomatic infections, or whether it significantly limits the ability of the coronavirus to spread from person to person. This means that measures such as masking and distancing remain essential even after a full vaccination.

Data collected by Pfizer during its late-stage clinical trials suggested that the vaccine might provide at least some protection after a single dose. However, the study was not intended to specifically test how effective a one-shot regimen would be.

Dr. Krutika Kuppalli, an infectious disease doctor at the Medical University of South Carolina, said some of her colleagues tested positive shortly after their first shots. “None of this surprises me given the prevalence of the cases now,” she said. Given the expected delay in vaccination effect, “this should not be viewed as a vaccination failure”. Dr. Kuppalli, who received her first dose of Pfizer’s vaccine on Dec. 15, added that taking Covid-19 between vaccine doses shouldn’t stop anyone from getting a second shot after consulting a health care provider.

In the past few weeks, more than 2.7 million people in the US have received their first dose of Pfizer’s vaccine, or a similar shot of Moderna. Both vaccines require a second injection – and as they’re made available to more people, it’s important to keep clear communication about how and when vaccines work, said Dr. Bell.

“For now we should stick to the dosages as the experiments were carried out,” he said. “This is what will bring you maximum effectiveness.”

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Taiwan Vows to Follow Covid-19 Limits

TAIPEI, Taiwan – Betrachten Sie für einen Moment in dieser Zeit der Angst und des Verlusts und des Todes, der Massenarbeitslosigkeit und der abgeflachten Volkswirtschaften die alternative Realität der Twilight Zone, die Taiwan ist.

Seit Monaten und Monaten ist das Leben auf der Insel mit einem Wort normal – gruselig. Hochzeiten wurden abgehalten, sorgenfrei. Die Leute haben Profi-Ballspiele gepackt, Cellokonzerte besucht und Nachtmärkte überfüllt. Taiwans Bevölkerung ist größer als die Floridas, aber die Zahl der Todesopfer bei Covid-19 kann auf zwei Hände gezählt werden.

Es ist die Art von Off-the-Chart-Erfolg gegen das Virus, die bei vielen Bewohnern ein sinkendes Gefühl im Magen hervorgerufen hat: Wie lange kann das Glück der Insel noch anhalten?

Für Chen Shih-chung, Taiwans Gesundheitsminister und Leiter der epidemischen Kommandozentrale, ist der Erfolg umso mehr ein Grund, nicht auf dem Fundament der Coronavirus-Strategie der Regierung zu schwanken. Die Insel ist seit März für die meisten Besucher abgeriegelt. Personen, die Zutritt haben, müssen noch zwei Wochen lang unter strenger Beobachtung unter Quarantäne gestellt werden, einschließlich taiwanesischer Staatsbürger.

Die hohen Mauern haben die Insel vor Infektionen bewahrt, aber sie laufen Gefahr, Taiwan wirtschaftlich und politisch zu isolieren, wenn der Rest der Welt seine Abwehrkräfte lockert, während die Impfungen beginnen.

Die Regierung wird sich wahrscheinlich nicht an diesen Richtlinien orientieren, bis es Impfstoffe gibt, die eine bewährte und dauerhafte Waffe gegen das Virus sind, sagte Chen in einem Interview. Taiwan werde nicht wie einer dieser Orte sein, schlug er vor, die die Sperrung unter öffentlichem Druck erleichterten, um sie später wieder verschärfen zu müssen.

“Ich glaube, es wird eine weitere Welle geben”, sagte er. “Weil jeder denkt: ‘Ich habe den Impfstoff bekommen, oder ich bekomme den Impfstoff nächste Woche, ich habe so lange gewartet, dass ich jetzt frei sein kann, oder?'”

Sobald es mehr Beweise dafür gibt, ob die aktuellen Impfstoffe eine dauerhafte Immunität bieten, „können wir erst dann wirklich anfangen, uns ein bisschen zu entspannen“, sagte er.

Wenn Impfungen rund um den Globus beginnen, wird die Frage, wie und wann die Grenzkontrollen in Covid gelockert werden sollen, auch andere Orte wie Australien und Neuseeland konfrontieren, die ihre geografische Insellage als primäre Verteidigung gegen die Pandemie eingesetzt haben.

Taiwan hat bereits viel länger an seinen Einreisebeschränkungen und Quarantänen festgehalten, als es viele Regierungen könnten, ohne sich einer großen öffentlichen Gegenreaktion zu stellen. Die Wirtschaft der Insel hat sich während der Pandemie zusammen mit der Welt verlangsamt, wächst aber weiterhin mit einem anständigen Tempo.

Japan und Südkorea, zwei andere asiatische Demokratien, die für ihre Virusreaktionen gelobt wurden, kämpfen jetzt mit einem großen Aufflammen neuer Infektionen.

Aber so erfolgreich und unermüdlich Taiwans Gesundheitsbeamte auch waren, die Insel hat auch von purem Glück profitiert, sagte C. Jason Wang, Associate Professor an der Stanford University School of Medicine.

Angesichts der weltweit steigenden Zahl von Fällen und einer an vielen Orten zirkulierenden ansteckenden Variante des Virus wird eine größere Anzahl infizierter Menschen zwangsläufig an Taiwans Grenzen ankommen, sagte Dr. Wang. Das heißt, es ist nur eine Frage der Zeit, bis positivere Fälle an der Verteidigung der Regierung vorbeikommen.

Taiwan bestätigte am Mittwoch seinen ersten Fall mit der neuen Variante bei einer Person, die aus Großbritannien angereist war, positiv getestet und ins Krankenhaus eingeliefert wurde. Als Reaktion darauf verschärfte die Regierung ihre Einreiseverbote und Quarantäneregeln weiter.

“Es ist bemerkenswert, dass Taiwan die Linie so lange gehalten hat”, sagte Dr. Wang. Aber selbst wenn die Insel ihre Bevölkerung bis Mitte 2021 impft, “haben Sie noch sechs Monate Zeit”, sagte er. “Es ist wirklich schwierig, das noch sechs Monate durchzuhalten.”

Für Herrn Chen, 67, war 2020 ein Jahr harter Anrufe, auch wenn er eine Virusreaktion ausgelöst hat, um die jeder Beamte des öffentlichen Gesundheitswesens auf dem Planeten beneiden würde.

Covid19 Impfungen >

Antworten auf Ihre Impfstofffragen

Mit der Verbreitung eines Coronavirus-Impfstoffs ab den USA finden Sie hier Antworten auf einige Fragen, über die Sie sich möglicherweise wundern:

    • Wenn ich in den USA lebe, wann kann ich den Impfstoff bekommen? Während die genaue Reihenfolge der Impfstoffempfänger von Staat zu Staat unterschiedlich sein kann, werden die meisten Ärzte und Bewohner von Langzeitpflegeeinrichtungen an erster Stelle stehen. Wenn Sie verstehen möchten, wie diese Entscheidung getroffen wird, hilft dieser Artikel.
    • Wann kann ich nach der Impfung wieder zum normalen Leben zurückkehren? Das Leben wird erst wieder normal, wenn die Gesellschaft als Ganzes ausreichend Schutz gegen das Coronavirus erhält. Sobald die Länder einen Impfstoff zugelassen haben, können sie in den ersten Monaten höchstens einige Prozent ihrer Bürger impfen. Die nicht geimpfte Mehrheit bleibt weiterhin anfällig für Infektionen. Eine wachsende Anzahl von Coronavirus-Impfstoffen zeigt einen robusten Schutz vor Krankheit. Es ist aber auch möglich, dass Menschen das Virus verbreiten, ohne zu wissen, dass sie infiziert sind, weil sie nur leichte oder gar keine Symptome haben. Wissenschaftler wissen noch nicht, ob die Impfstoffe auch die Übertragung des Coronavirus blockieren. Selbst geimpfte Menschen müssen vorerst Masken tragen, Menschenmassen in Innenräumen meiden und so weiter. Sobald genügend Menschen geimpft sind, wird es für das Coronavirus sehr schwierig, gefährdete Personen zu finden, die infiziert werden können. Je nachdem, wie schnell wir als Gesellschaft dieses Ziel erreichen, könnte sich das Leben im Herbst 2021 einem normalen Zustand nähern.
    • Muss ich nach der Impfung noch eine Maske tragen? Ja, aber nicht für immer. Hier ist der Grund. Die Coronavirus-Impfstoffe werden tief in die Muskeln injiziert und stimulieren das Immunsystem zur Produktion von Antikörpern. Dies scheint ein ausreichender Schutz zu sein, um die geimpfte Person vor einer Krankheit zu bewahren. Was jedoch nicht klar ist, ist, ob es möglich ist, dass das Virus in der Nase blüht – und geniest oder ausgeatmet wird, um andere zu infizieren -, selbst wenn Antikörper an anderer Stelle im Körper mobilisiert wurden, um zu verhindern, dass die geimpfte Person krank wird. Die klinischen Impfstoffstudien sollten feststellen, ob geimpfte Menschen vor Krankheiten geschützt sind – und nicht herausfinden, ob sie das Coronavirus noch verbreiten können. Basierend auf Studien zu Grippeimpfstoffen und sogar mit Covid-19 infizierten Patienten haben Forscher Grund zu der Hoffnung, dass geimpfte Menschen das Virus nicht verbreiten, aber weitere Forschung ist erforderlich. In der Zwischenzeit müssen sich alle – auch geimpfte Menschen – als mögliche stille Streuer vorstellen und weiterhin eine Maske tragen. Lesen Sie hier mehr.
    • Wird es wehtun? Was sind die Nebenwirkungen? Der Impfstoff gegen Pfizer und BioNTech wird wie andere typische Impfstoffe als Schuss in den Arm abgegeben. Die Injektion in Ihren Arm fühlt sich nicht anders an als bei jedem anderen Impfstoff, aber die Rate kurzlebiger Nebenwirkungen scheint höher zu sein als bei einer Grippeschutzimpfung. Zehntausende Menschen haben die Impfstoffe bereits erhalten, und keiner von ihnen hat ernsthafte gesundheitliche Probleme gemeldet. Die Nebenwirkungen, die den Symptomen von Covid-19 ähneln können, dauern etwa einen Tag und treten nach der zweiten Dosis wahrscheinlicher auf. Frühe Berichte aus Impfstoffversuchen deuten darauf hin, dass einige Menschen möglicherweise einen Tag frei nehmen müssen, weil sie sich nach Erhalt der zweiten Dosis mies fühlen. In der Pfizer-Studie entwickelte etwa die Hälfte Müdigkeit. Andere Nebenwirkungen traten bei mindestens 25 bis 33 Prozent der Patienten auf, manchmal mehr, einschließlich Kopfschmerzen, Schüttelfrost und Muskelschmerzen. Obwohl diese Erfahrungen nicht angenehm sind, sind sie ein gutes Zeichen dafür, dass Ihr eigenes Immunsystem eine starke Reaktion auf den Impfstoff zeigt, die eine dauerhafte Immunität bietet.
    • Werden mRNA-Impfstoffe meine Gene verändern? Nein. Die Impfstoffe von Moderna und Pfizer verwenden ein genetisches Molekül, um das Immunsystem zu stärken. Dieses als mRNA bekannte Molekül wird schließlich vom Körper zerstört. Die mRNA ist in einer öligen Blase verpackt, die mit einer Zelle verschmelzen kann, so dass das Molekül hineinrutschen kann. Die Zelle verwendet die mRNA, um Proteine ​​aus dem Coronavirus herzustellen, die das Immunsystem stimulieren können. Zu jedem Zeitpunkt kann jede unserer Zellen Hunderttausende von mRNA-Molekülen enthalten, die sie produzieren, um eigene Proteine ​​herzustellen. Sobald diese Proteine ​​hergestellt sind, zerkleinern unsere Zellen die mRNA mit speziellen Enzymen. Die mRNA-Moleküle, die unsere Zellen herstellen, können nur wenige Minuten überleben. Die mRNA in Impfstoffen ist so konstruiert, dass sie den Enzymen der Zelle etwas länger standhält, sodass die Zellen zusätzliche Virusproteine ​​bilden und eine stärkere Immunantwort auslösen können. Die mRNA kann jedoch höchstens einige Tage halten, bevor sie zerstört wird.

In einer kürzlich durchgeführten Meinungsumfrage erhielt Herr Chen, ein ausgebildeter Zahnarzt, eine höhere Zustimmungsrate als jeder andere Spitzenbeamte, einschließlich seines Chefs, Präsident Tsai Ing-wen. Er wird als potenzieller Kandidat für den Bürgermeister von Taipeh, der Hauptstadt der Insel, erwähnt. Seine coole, unerschütterliche Miene bei den epidemischen Nachrichten der Regierung hat ihm eine seltsame Art von Berühmtheit eingebracht. Es ist nicht jeder Gesundheitsminister mittleren Alters, der in Gucci für die lokale Ausgabe von GQ fotografiert wird.

Doch nach Herrn Chens Aussage haben seine Entscheidungen seit Beginn des Ausbruchs bestimmte Menschen auf Schritt und Tritt verärgert. Zum Beispiel, als er Medizinern im Februar das Verlassen der Insel untersagte. Oder als er im März bekannt gab, dass die Insel fast allen Nichtansässigen die Einreise untersagt.

Viele der Ideen der taiwanesischen Regierung zum Umgang mit dem Virus stammten aus dem „Herumtollen im Dunkeln“, sagte Chen.

Als zum Beispiel im Februar eine Gruppe von Infektionen auf dem Kreuzfahrtschiff Diamond Princess auftrat, erlaubten Beamte in Japan, wo das Boot angedockt hatte, vielen Passagieren, die negativ getestet wurden, frei zu gehen. Einige von ihnen wurden später positiv getestet. Taiwan nahm zur Kenntnis.

“Bis dahin wurde uns sehr klar”, sagte Herr Chen. “Nach dem Test müssen Sie sowohl die positiven als auch die negativen Aspekte unter Quarantäne stellen.”

Taiwans Betonung auf strenge Quarantänen hat dazu beigetragen, Infektionen einzudämmen, ohne das Krankenhaussystem zu überfordern oder enorme Kosten für Tests zu verursachen. Einige Experten fordern die Regierung nun auf, insbesondere an der Grenze umfassendere Tests durchzuführen, um mehr Fälle zu erfassen, die keine Symptome aufweisen.

“Wir haben viele unserer Richtlinien entwickelt, als es weltweit einige Millionen Infektionen gab”, sagte Chan Chang-chuan, Professor am College of Public Health der National Taiwan University. „Aber jetzt gibt es zig Millionen, und wir nähern uns hundert Millionen. Es ist eine ganz andere Phase. “

Herr Chan sagte, er glaube, Taiwan sollte damit beginnen, alle an der Grenze zu testen und nicht nur unter Quarantäne zu stellen. Dies wurde bereits für Personen aus Großbritannien begonnen, bei denen festgestellt wurde, dass die übertragbarere Variante des Coronavirus im Umlauf ist.

Taiwans Position war, dass Träger des Virus, die nach 14 Tagen Isolation asymptomatisch sind, wahrscheinlich nicht sehr infektiös sind. Herr Chen sagte, er habe keinen Zweifel daran, dass es einige asymptomatische Fälle gegeben habe, die es nie auf das Radar der Regierung geschafft hätten.

“Aber wenn diese Infektionen keine Probleme verursachen, sollte ich dann viel Energie darauf verwenden, diese Leute zu finden?” er sagte. “Oder sollte ich mich auf Infektionen konzentrieren, die bereits Probleme verursachen?”

Es ist unklar, wie viel Glücksspiel dieser Ansatz mit sich gebracht hat. Eine im Oktober in The Lancet veröffentlichte Studie ergab, dass von 14.765 Personen, deren Blut in einem Krankenhaus in Taipeh entnommen wurde, ein geringerer Anteil positiv auf Coronavirus-Antikörper getestet wurde als in anderen Ländern. Dennoch könnte der Anteil immer noch eine viel höhere Anzahl von asymptomatischen oder leicht symptomatischen Infektionen bedeuten, als sich in Taiwans offiziellen Fallzahlen widerspiegelt, schrieben die Autoren der Studie.

“Im Grunde ist es ein Kompromiss zwischen dem Geld, das Sie ausgeben möchten, und dem Risiko, das Sie eingehen möchten”, sagte Dr. Wang, der Stanford-Professor. Da die weltweite Fallzahl ansteigt und wahrscheinlich mehr Infektionen nach Taiwan gelangen, ist es „eine Frage der Menge an Leckagen, die Sie in Ihrem Haus haben möchten.“

Dale Fisher, Professor für Infektionskrankheiten an der National University of Singapore, stellte Taiwans strenge Grenzpolitik dem „flinkeren“ Ansatz Singapurs gegenüber. Der Stadtstaat hob kürzlich die Beschränkungen für Reisende aus Taiwan auf, aber Taiwan erwiderte dies nicht.

“Wir glauben, dass selbst wenn ein Reisender es hereinbringt, es eine gute Chance gibt, dass es sich sowieso nicht ausbreitet”, sagte Dr. Fisher. “Wenn Sie kein Vertrauen in Ihr System haben, würden Sie die Grenzen schwieriger halten.”

Der wahre Test für Taiwan sei, wenn die Impfstoffe keine dauerhafte Immunität bieten und die Welt länger mit Covid leben müsse. Wie gut würde es Taiwans Volk ertragen, für ein weiteres Jahr von der Welt abgeschottet zu sein? Noch fünf Jahre?

“Deshalb würden wir sagen, schließen Sie Ihre Grenzen, wenn Sie nur Zeit gewinnen möchten, um sich zu organisieren”, sagte Dr. Fisher. “Aber denken Sie nicht an eine Strategie.”

Categories
Politics

In Trump’s Last Chapter, a Failure to Rise to the Covid-19 Second

WASHINGTON — It was a warm summer Wednesday, Election Day was looming and President Trump was even angrier than usual at the relentless focus on the coronavirus pandemic.

“You’re killing me! This whole thing is! We’ve got all the damn cases,” Mr. Trump yelled at Jared Kushner, his son-in-law and senior adviser, during a gathering of top aides in the Oval Office on Aug. 19. “I want to do what Mexico does. They don’t give you a test till you get to the emergency room and you’re vomiting.”

Mexico’s record in fighting the virus was hardly one for the United States to emulate. But the president had long seen testing not as a vital way to track and contain the pandemic but as a mechanism for making him look bad by driving up the number of known cases.

And on that day he was especially furious after being informed by Dr. Francis S. Collins, the head of the National Institutes of Health, that it would be days before the government could give emergency approval to the use of convalescent plasma as a treatment, something Mr. Trump was eager to promote as a personal victory going into the Republican National Convention the following week.

“They’re Democrats! They’re against me!” he said, convinced that the government’s top doctors and scientists were conspiring to undermine him. “They want to wait!”

Throughout late summer and fall, in the heat of a re-election campaign that he would go on to lose, and in the face of mounting evidence of a surge in infections and deaths far worse than in the spring, Mr. Trump’s management of the crisis — unsteady, unscientific and colored by politics all year — was in effect reduced to a single question: What would it mean for him?

The result, according to interviews with more than two dozen current and former administration officials and others in contact with the White House, was a lose-lose situation. Mr. Trump not only ended up soundly defeated by Joseph R. Biden Jr., but missed his chance to show that he could rise to the moment in the final chapter of his presidency and meet the defining challenge of his tenure.

Efforts by his aides to persuade him to promote mask wearing, among the simplest and most effective ways to curb the spread of the disease, were derailed by his conviction that his political base would rebel against anything that would smack of limiting their personal freedom. Even his own campaign’s polling data to the contrary could not sway him.

His explicit demand for a vaccine by Election Day — a push that came to a head in a contentious Oval Office meeting with top health aides in late September — became a misguided substitute for warning the nation that failure to adhere to social distancing and other mitigation efforts would contribute to a slow-rolling disaster this winter.

His concern? That the man he called “Sleepy Joe” Biden, who was leading him in the polls, would get credit for a vaccine, not him.

The government’s public health experts were all but silenced by the arrival in August of Dr. Scott W. Atlas, the Stanford professor of neuroradiology recruited after appearances on Fox News.

With Dr. Deborah L. Birx, the coordinator of the White House virus task force, losing influence and often on the road, Dr. Atlas became the sole doctor Mr. Trump listened to. His theories, some of which scientists viewed as bordering on the crackpot, were exactly what the president wanted to hear: The virus is overblown, the number of deaths is exaggerated, testing is overrated, lockdowns do more harm than good.

As the gap between politics and science grew, the infighting that Mr. Trump had allowed to plague the administration’s response from the beginning only intensified. Threats of firings worsened the leadership vacuum as key figures undercut each other and distanced themselves from responsibility.

The administration had some positive stories to tell. Mr. Trump’s vaccine development program, Operation Warp Speed, had helped drive the pharmaceutical industry’s remarkably fast progress in developing several promising approaches. By the end of the year, two highly effective vaccines would be approved for emergency use, providing hope for 2021.

The White House rejected any suggestions that the president’s response had fallen short, saying he had worked to provide adequate testing, protective equipment and hospital capacity and that the vaccine development program had succeeded in record time.

“President Trump has led the largest mobilization of the public and private sectors since WWII to defeat Covid-19 and save lives,” said Brian Morgenstern, a White House spokesman.

But Mr. Trump’s unwillingness to put aside his political self-centeredness as Americans died by the thousands each day or to embrace the steps necessary to deal with the crisis remains confounding even to some administration officials. “Making masks a culture war issue was the dumbest thing imaginable,” one former senior adviser said.

His own bout with Covid-19 in early October left him extremely ill and dependent on care and drugs not available to most Americans, including a still-experimental monoclonal antibody treatment, and he saw firsthand how the disease coursed through the White House and some of his close allies.

Yet his instinct was to treat that experience not as a learning moment or an opportunity for empathy, but as a chance to portray himself as a Superman who had vanquished the disease. His own experience to the contrary, he assured a crowd at the White House just a week after his hospitalization, “It’s going to disappear; it is disappearing.”

Weeks after his own recovery, he would still complain about the nation’s preoccupation with the pandemic.

“All you hear is Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid, Covid,” Mr. Trump said at one campaign stop, uttering the word 11 times.

In the end he could not escape it.

By late July, new cases were at record highs, defying Mr. Trump’s predictions through the spring that the virus was under control, and deaths were spiking to alarming levels. Herman Cain, a 2012 Republican presidential candidate, died from the coronavirus; the previous month he had attended a Trump rally without a mask.

With the pandemic defining the campaign despite Mr. Trump’s efforts to make it about law and order, Tony Fabrizio, the president’s main pollster, came to the Oval Office for a meeting in the middle of the summer prepared to make a surprising case: that mask wearing was acceptable even among Mr. Trump’s supporters.

Arrayed in front of the Resolute Desk, Mr. Trump’s advisers listened as Mr. Fabrizio presented the numbers. According to his research, some of which was reported by The Washington Post, voters believed the pandemic was bad and getting worse, they were more concerned about getting sick than about the virus’s effects on their personal financial situation, the president’s approval rating on handling the pandemic had hit new lows and a little more than half the country did not think he was taking the situation seriously.

But what set off debate that day was Mr. Fabrizio’s finding that more than 70 percent of voters in the states being targeted by the campaign supported mandatory mask wearing in public, at least indoors, including a majority of Republicans.

Mr. Kushner, who along with Hope Hicks, another top adviser, had been trying for months to convince Mr. Trump that masks could be portrayed as the key to regaining freedom to go safely to a restaurant or a sporting event, called embracing mask-wearing a “no-brainer.”

Mr. Kushner had some reason for optimism. Mr. Trump had agreed to wear one not long before for a visit to Walter Reed National Military Medical Center, after finding one he believed he looked good in: dark blue, with a presidential seal.

But Mark Meadows, the White House chief of staff — backed up by other aides including Stephen Miller — said the politics for Mr. Trump would be devastating.

“The base will revolt,” Mr. Meadows said, adding that he was not sure Mr. Trump could legally make it happen in any case.

That was all Mr. Trump needed to hear. “I’m not doing a mask mandate,” he concluded.

Aside from when he was sick, he was rarely seen in a mask again.

The president had other opportunities to show leadership rather than put his political fortunes first.

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.

After he recovered from his bout with the virus, some of his top aides, including Mr. Kushner and Jason Miller, a senior campaign strategist, thought the illness offered an opportunity to demonstrate the kind of compassion and resolve about the pandemic’s toll that Mr. Trump had so far failed to show.

When Mr. Trump returned from the hospital, his communications aides, with the help of Ivanka Trump, his daughter, urged him to deliver a national address in which he would say: “I had it. It was tough, it kicked my ass, but we’re going to get through it.”

He refused, choosing instead to address a boisterous campaign rally for himself from the balcony of the White House overlooking the South Lawn.

Mr. Trump never came around to the idea that he had a responsibility to be a role model, much less that his leadership role might require him to publicly acknowledge hard truths about the virus — or even to stop insisting that the issue was not a rampaging pandemic but too much testing.

Alex M. Azar II, the health and human services secretary, briefed the president this fall on a Japanese study documenting the effectiveness of face masks, telling him: “We have the proof. They work.” But the president resisted, criticizing Mr. Kushner for pushing them and again blaming too much testing — an area Mr. Kushner had been helping to oversee — for his problems.

“I’m going to lose,” Mr. Trump told Mr. Kushner during debate preparations. “And it’s going to be your fault, because of the testing.”

Mr. Morgenstern, the White House spokesman, said that exchange between the president and Mr. Kushner “never happened.”

Mr. Azar, who was sometimes one of the few people wearing a mask at White House events, privately bemoaned what he called a political, anti-mask culture set by Mr. Trump. At White House Christmas parties, Mr. Azar asked maskless guests to back away from him.

The decision to run the government’s response out of the West Wing was made in the early days of the pandemic. The idea was to break down barriers between disparate agencies, assemble public health expertise and encourage quick and coordinated decision-making.

It did not work out like that, and by fall the consequences were clear.

Mr. Trump had always tolerated if not encouraged clashes among subordinates, a tendency that in this case led only to policy paralysis, confusion about who was in charge and a lack of a clear, consistent message about how to reduce the risks from the pandemic.

Keeping decision-making power close to him was another Trump trait, but in this case it also elevated the myriad choices facing the administration to the presidential level, bogging the process down in infighting, raising the political stakes and encouraging aides to jockey for favor with Mr. Trump.

The result at times was a systemwide failure that extended well beyond the president.

“What we needed was a coordinated response that involved contributions from multiple agencies,” said Dr. Scott Gottlieb, who was commissioner of the Food and Drug Administration for the first two years of the Trump administration.

“Someone needed to pull that all together early,” he said. “It wasn’t the job of the White House, either. This needed to happen closer to the agencies. That didn’t happen on testing, or on a whole lot of other things.”

The relationship between Mr. Azar and Dr. Stephen M. Hahn, the commissioner of the Food and Drug Administration, grew increasingly tense; by early November, they were communicating only by text and in meetings.

Dr. Birx had lost the clout she enjoyed early on in the crisis and spent much of the summer and fall on the road counseling governors and state health officials.

Mr. Meadows was at odds with almost everyone as he sought to impose the president’s will on scientists and public health professionals. In conversations with top health officials, Mr. Meadows would rail against regulatory “bureaucrats” he thought were more interested in process than outcome.

Some of the doctors on the task force, including Dr. Anthony S. Fauci and Dr. Robert R. Redfield, were reluctant to show up in person at the White House, worried that the disdain there for mask wearing and social distancing would leave them at risk of infection.

Vice President Mike Pence was nominally in charge of the task force but was so cautious about getting crosswise with Mr. Trump as they battled for re-election that, in public at least, he became nearly invisible.

The debates inside the White House increasingly revolved around Dr. Atlas, who had no formal training in infectious diseases but whose views — which Mr. Trump saw him deliver on Fox News — appealed to the president’s belief that the crisis was overblown.

His arrival at 1600 Pennsylvania Avenue was itself something of a mystery. Some aides said he was discovered by Kayleigh McEnany, the White House press secretary. Others said John McEntee, the president’s personnel chief, had been Googling for a Trump-friendly doctor who would be loyal.

Marc Short, Mr. Pence’s chief of staff, opposed hiring Dr. Atlas. But once the president and his team brought him in, Mr. Short insisted that Dr. Atlas have a seat at the task force table, hoping to avoid having him become yet another internal — and destructive — critic.

Once inside, Dr. Atlas used the perch of a West Wing office to shape the response. During a meeting in early fall, Dr. Atlas asserted that college students were at no risk from the virus. We should let them go back to school, he said. It’s not a problem.

Dr. Birx exploded. What aspect of the fact that you can be asymptomatic and still spread it do you not understand? she demanded. You might not die, but you can give it to somebody who can die from it. She was livid.

“Your strategy is literally going to cost us lives,” she yelled at Dr. Atlas. She attacked Dr. Atlas’s ideas in daily emails she sent to senior officials. And she was mindful of a pact she had made with Dr. Hahn, Dr. Fauci and Dr. Redfield even before Dr. Atlas came on board: They would stick together if one of them was fired for doing what they considered the right thing.

Health officials often had a hard time finding an audience in the upper reaches of the West Wing. In a mid-November task force meeting, they issued a dire warning to Mr. Meadows about the looming surge in cases set to devastate the country. Mr. Meadows demanded data to back up their claim.

One outcome of the meeting was a Nov. 19 news conference on the virus’s dire threat, the first in many weeks. But while Mr. Pence, who led the briefing, often urged Americans to “do their part” to slow the spread of the virus, he never directly challenged Mr. Trump’s hesitancy on masks and social distancing. At the briefing, he said that “decision making at the local level” was key, continuing a long pattern of the administration seeking to push responsibility to the states.

Mr. Azar had been cut out of key decision-making as early as February, when Mr. Pence took over the task force. Mr. Azar would complain to his associates that Mr. Pence’s staff and task force members went around him to issue orders to his subordinates.

On tenterhooks about his job status, Mr. Azar found an opening that offered a kind of redemption, steering his attention through the summer and fall to Operation Warp Speed, the government’s effort to support rapid development of a vaccine, lavishing praise on Mr. Trump and crediting him for nearly every advance.

Behind the scenes, Mr. Azar portrayed Dr. Hahn to the White House as a flailing manager — a complaint he also voiced about Dr. Redfield. In late September, he told the White House he was willing to fire Dr. Hahn, according to officials familiar with the offer.

For their part, Dr. Hahn, Dr. Redfield, Dr. Birx and other senior health officials saw Mr. Azar as crushing the morale of the agencies he oversaw as he sought to escape blame for a worsening crisis and to strengthen his own image publicly and with the White House.

Health officials on the task force several times took their complaints about Mr. Azar to Mr. Pence’s office, hoping for an intervention.

Caitlin B. Oakley, a spokeswoman for Mr. Azar, said he had “always stood up for balanced, scientific, public health information and insisted that science and data drive the decisions.”

Once eager to visit the White House, Dr. Hahn became disillusioned with what he saw as its efforts to politicize the work of the Food and Drug Administration, and he eventually shied away from task force meetings, fearing his statements there would leak.

If there was a bureaucratic winner in this West Wing cage match, it was Dr. Atlas.

He told Mr. Trump that the right way to think about the virus was how much “excess mortality” there was above what would have been expected without a pandemic.

Mr. Trump seized on the idea, often telling aides that the real number of dead was no more than 10,000 people.

As of Thursday, 342,577 Americans had died from the pandemic.

In an Oval Office meeting with senior health officials on Sept. 24, the president made explicit what he had long implied: He wanted a vaccine before the election, according to three people who witnessed his demand.

Pfizer’s chief executive had been encouraging the belief that the company could deliver initial results by late October. But Mr. Trump’s aides tried in vain to make clear that they could not completely control the timing.

Dr. Fauci and Dr. Hahn reminded West Wing officials that a company’s vaccine trial results were a “black box,” impossible to see until an independent monitoring board revealed them. A vaccine that did not go through the usual, rigorous government approval process would be a “Pyrrhic victory,” Mr. Azar told them. It would be a shot no one would take.

Dr. Moncef Slaoui, the scientific leader of Operation Warp Speed, said the president never asked him to deliver a vaccine on a specific timetable. But he said Mr. Trump sometimes complained in meetings that “it was not going to happen before the election and it will be ‘Sleepy Joe’” who would ultimately get credit.

In late October, science and regulations worked against Mr. Trump’s waning hopes for pre-Election Day good news. At the F.D.A., scientists had refined the standards for authorizing a vaccine for emergency use. And at Pfizer, executives realized that the agency was unlikely to authorize its vaccine on the basis of so few Covid-19 cases among its clinical trial volunteers.

They decided to wait for more data, a delay of up to a week.

When Pfizer announced on Nov. 9 — two days after Mr. Biden clinched his victory — that its vaccine was a stunning success, Mr. Trump was furious. He lashed out at the company, Dr. Hahn and the F.D.A., accusing “deep state regulators” of conspiring with Pfizer to slow approval until after the election.

The president’s frustration with the pace of regulatory action would continue into December, as the F.D.A. went through a time-consuming process of evaluating Pfizer’s data and then that of a second vaccine maker, Moderna.

On Dec. 11, Mr. Meadows exploded during a morning call with Dr. Hahn and Dr. Peter Marks, the agency’s top vaccine regulator. He accused Dr. Hahn of mismanagement and suggested he resign, then slammed down the phone. That night, the F.D.A. authorized the Pfizer vaccine.

In the weeks that followed, Mr. Pence, Mr. Azar, Dr. Fauci and other health officials rolled up their sleeves to be vaccinated for the cameras.

Mr. Trump, who after contracting Covid-19 had declared himself immune, has not announced plans to be vaccinated.

Michael D. Shear, Noah Weiland, Sharon LaFraniere and Mark Mazzetti reported from Washington, and Maggie Haberman from New York. Katie Thomas contributed reporting from Chicago.

Categories
Politics

U.S. Officers Say Covid-19 Vaccination Effort Has Lagged

Vaccine distribution in the United States has started more slowly than expected, federal health officials confirmed in a press conference Wednesday, but also expressed confidence that the pace would accelerate in the coming weeks.

As of Wednesday, more than 14 million doses of the Pfizer and Moderna vaccines had been shipped to the United States, up from 11.4 million doses on Monday morning. However, according to a dashboard from the Centers for Disease Control and Prevention, only 2.1 million people had received their first dose on Monday morning.

“We agree that this number is lower than hoped,” said Moncef Slaoui, scientific adviser to Operation Warp Speed, the federal effort to accelerate vaccine development and distribution. He added, “We know it should be better and we are working hard to do better.”

The 2.1 million doses administered by the CDC are an underestimate of the real number due to delays in reporting. And a CDC official said in a separate press conference Wednesday that 2.6 million people had received their first dose. Whatever the number, it falls far short of the goal that federal officials put forward just this month of having 20 million people vaccinated by the end of this year.

The Operation Warp Speed ​​press conference came the day after President-elect Joseph R. Biden Jr. gave a speech in Wilmington, Delaware, criticizing the Trump administration for these delays. Mr Biden said that at the current vaccination rate, it will take “years, not months” to protect the whole country.

When he takes office on January 20, Mr. Biden will employ a law called the Defense Production Act to “direct private industry to expedite the manufacture of the materials and protective equipment needed for vaccines.” However, the Trump administration has already used that law to expedite manufacturing and Mr Biden has given few details on how his plan will be different. He has promised to give 100 million shots in the first 100 days of his tenure – or enough for about 50 million people if he uses the two-dose vaccines.

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Answers to your vaccine questions

With a coronavirus vaccine spreading out of the US, here are answers to some questions you may be wondering about:

    • If I live in the US, when can I get the vaccine? While the exact order of vaccine recipients may vary from state to state, most doctors and residents of long-term care facilities will come first. If you want to understand how this decision is made, this article will help.
    • When can I get back to normal life after the vaccination? Life will only get back to normal once society as a whole receives adequate protection against the coronavirus. Once countries have approved a vaccine, they can only vaccinate a few percent of their citizens in the first few months. The unvaccinated majority remain susceptible to infection. A growing number of coronavirus vaccines show robust protection against disease. However, it is also possible that people spread the virus without knowing they are infected because they have mild or no symptoms. Scientists don’t yet know whether the vaccines will also block the transmission of the coronavirus. Even vaccinated people have to wear masks for the time being, avoid the crowds indoors and so on. Once enough people are vaccinated, it becomes very difficult for the coronavirus to find people at risk to become infected. Depending on how quickly we as a society achieve this goal, life could approach a normal state in autumn 2021.
    • Do I still have to wear a mask after the vaccination? Yeah, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This seems to be sufficient protection to protect the vaccinated person from disease. What is not clear, however, is whether it is possible for the virus to bloom in the nose – and sneeze or exhale to infect others – even if antibodies have been mobilized elsewhere in the body to prevent that vaccinated person gets sick. The vaccine clinical trials were designed to determine whether people who were vaccinated are protected from disease – not to find out whether they can still spread the coronavirus. Based on studies of flu vaccines and even patients infected with Covid-19, researchers have reason to hope that people who are vaccinated will not spread the virus, but more research is needed. In the meantime, everyone – including those who have been vaccinated – must imagine themselves as possible silent shakers and continue to wear a mask. Read more here.
    • Will it hurt What are the side effects? The vaccine against Pfizer and BioNTech, like other typical vaccines, is delivered as a shot in the arm. The injection in your arm feels no different than any other vaccine, but the rate of short-lived side effects seems to be higher than with the flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported serious health problems. The side effects, which can be similar to symptoms of Covid-19, last about a day and are more likely to occur after the second dose. Early reports from vaccine trials suggest that some people may need to take a day off because they feel lousy after receiving the second dose. In the Pfizer study, around half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headache, chills, and muscle pain. While these experiences are not pleasant, they are a good sign that your own immune system is having a potent response to the vaccine that provides lasting immunity.
    • Will mRNA vaccines change my genes? No. Moderna and Pfizer vaccines use a genetic molecule to boost the immune system. This molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse with a cell, allowing the molecule to slide inside. The cell uses the mRNA to make proteins from the coronavirus that can stimulate the immune system. At any given moment, each of our cells can contain hundreds of thousands of mRNA molecules that they produce to make their own proteins. As soon as these proteins are made, our cells use special enzymes to break down the mRNA. The mRNA molecules that our cells make can only survive a few minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a little longer, so the cells can make extra viral proteins and trigger a stronger immune response. However, the mRNA can hold for a few days at most before it is destroyed.

“This will be the greatest operational challenge we have ever faced as a nation,” said Biden, “but we will make it.”

In a tweet on Tuesday, President Trump appeared to blame the governors, saying it was “a matter for states to distribute the vaccines as soon as they are brought into designated areas by the federal government.” But several governors recently said their states were in trouble because they didn’t get enough money from the federal government.

Speaking at the Operation Warp Speed ​​press conference Wednesday, General Gustave F. Perna, the effort’s logistics director, said his team had no clear understanding of why these delays were occurring. He said the CDC is collecting data to better understand the factors driving slow absorption. “To get more specificity at this point after two weeks, I don’t think it’s appropriate,” he said.

However, General Perna pointed out a few possible factors. In addition to the delays in coverage, the holiday season and winter weather have delayed recording. Hospitals and other institutions that administer the vaccines are still learning how to store the cans in very cold temperatures and how to administer them properly. And the states have set aside many doses to be dispensed to their long-term care facilities. This initiative is currently in preparation and is expected to take several months.

So far, most of the vaccines given have been dispensed in hospitals, clinics and nursing homes. Dr. Slaoui and General Perna both said they expected the pace of rollout to accelerate significantly once pharmacies start offering vaccines in their stores.

The federal government has agreements with a number of pharmacy chains – including Costco, Walmart and CVS – to dispense vaccines in their stores and other locations as soon as vaccines become more widely available. To date, 40,000 pharmacy locations have signed up for this program, General Perna said.

“What we should look at is the rate of acceleration over the coming weeks,” said Dr. Slaoui, “and I hope it’s going in the right direction.”

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China Approves Sinopharm’s Covid-19 Vaccine because it Strikes to Inoculate Tens of millions

The Chinese government 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 firm called Sinopharm, said on Wednesday that 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.

If supported, the interim results will bolster claims that Chinese officials have made in recent days that the country’s vaccines are safe and effective. Even before the government issued its official approval, the authorities had already moved ahead with mass vaccinations, defying industry norms. They plan to vaccinate 50 million people in China by mid-February, when hundreds of millions are expected to travel for the Lunar New Year holiday.

But Sinopharm’s announcement provided no breakdown of results and left many questions unanswered, adding to a lack of clarity that has dogged China’s coronavirus vaccine development for months. Wu Yonglin, Sinopharm’s president, said on Thursday that the company would publish details of the trials in major academic journals later.

China’s drive to develop a homegrown vaccine speaks to the country’s technological and diplomatic ambitions. A successful vaccine 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 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, and 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.

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 authoritarian Communist Party, which 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. The Chinese companies have said their vaccine would be cheaper and easier to transport, which if proven could give them significant appeal in the developing world.

Chinese vaccines may still be greeted with other questions. Scientists said that the headline figures released by Sinopharm were encouraging but that the lack of supporting data made it difficult for the results to be independently assessed.

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.

Sinopharm on Wednesday did not disclose the size of the trial population or provide detailed information about any serious side effects, data points that scientists look for in such releases. On Thursday, Mr. Wu, Sinopharm’s president, said at a news briefing that more than 60,000 people had been vaccinated as part of the trials.

“With each of these vaccines we’re dealing with bits and pieces of information, but the Chinese companies have provided even less information than the Russian companies have,” said Dr. Kim Mulholland, a pediatrician at the Murdoch Children’s Research Institute in Melbourne, Australia.

“At least with the Russian vaccines we were told the number of cases and the basis of evidence for why their vaccine was effective,” said Dr. Mulholland, who has been involved in the oversight of many vaccine trials, including ones for a Covid-19 vaccine.

Michael Baker, a professor with the department of global health at the University of Otago in Wellington who is an adviser to the New Zealand government, said that while the initial figures from Sinopharm looked promising, without more information it was difficult to know for sure.

“It’s pretty light on the details,” he said. “One question is: What markets do they propose to use these vaccines in? Because if they want to have a global market, they’re obviously going to have to supply all those details.”

Details about the efficacy of another Chinese vaccine candidate, made by Sinovac, a private Beijing-based vaccine maker, have also been released in a piecemeal fashion.

The absence of detailed information on the safety and efficacy of Chinese vaccines has not stopped officials in the country from administering them to the public. Officials in several provinces and cities say they are focusing on what China calls “key priority groups” — doctors, hotel employees, border inspection personnel and workers in food storage and transportation, as well as travelers — in an ongoing inoculation drive.

Chinese officials and companies had already administered Chinese-made vaccines, mostly made by Sinopharm, to more than a million people in China. The campaign drew criticism from overseas scientists who said they were concerned that the authorities did not closely monitor people after they received injections outside clinical trials.

To China, a vaccine that can help protect its 1.4 billion people is crucial to its plans to revitalize the economy.

The country has largely stamped out the coronavirus with a combination of restrictions on foreign arrivals, mass testing and tight lockdowns of neighborhoods whenever any cases are detected. But officials remain concerned that the winter could bring a new wave of infections and hope that a widely available vaccine can help prepare the country for when regular travel and trade resume.

Already, new local outbreaks were being reported in Beijing and the northern city of Shenyang this week, prompting the imposition of new measures. In Shenyang, officials declared that the city was in “wartime status” as they rolled out restrictions on large-scale gatherings including group meals, training sessions and end-of-year parties.

Sinovac and Sinopharm use inactivated coronaviruses to make their vaccines — a tried-and-true method dating back over 130 years. The companies use chemicals to disable the virus’s genes so that it cannot replicate. Yet the inactivated coronavirus can still cause the body’s immune system to produce antibodies against it. By comparison, Moderna and Pfizer are taking a revolutionary gene-based approach that had never before been approved for widespread use.

Experts say there are drawbacks to inactivated vaccines like the ones being made by Sinovac and Sinopharm. They require starting off with large batches of live coronavirus samples, which can pose a biosecurity risk. Once the live samples are inactivated, it takes an extra manufacturing step to ensure that none of them survive the treatment.

Another advantage of the vaccines produced by Moderna and Pfizer is that they are faster to make and said to be more stable than traditional vaccines. Pfizer projects that it will be able to produce up to 1.3 billion doses in 2021, while Moderna expects to be able to make 500 million to one billion doses.

The Chinese government has promised to produce 610 million doses by the end of the year and expects to make more than one billion doses next year. Several large countries like Brazil and Indonesia, where Chinese companies have been conducting trials, have each received shipments of more than a million doses of Sinovac vaccines. Turkey has ordered 50 million doses.

People who were previously vaccinated in China have said the two-dose regimen costs about $60 to $150. According to people who have received the Sinovac vaccine, the company is charging about $30 a dose. Sinopharm has said the cost of two doses should be lower than $150. Zeng Yixin, the deputy minister of the National Health Commission, said on Thursday that the vaccine would be provided to the Chinese public for free, a reversal of previous statements by Chinese officials.

Reporting and research were contributed byElsie Chen, Claire Fuand Amber Wang.

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Health

He Was Hospitalized for Covid-19. Then Hospitalized Once more. And Once more.

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

In another study of 1,775 coronavirus patients discharged from 132 VA hospitals in the first few months of the pandemic, nearly a fifth were hospitalized again within 60 days. More than 22 percent of them required intensive care and 7 percent required ventilators.

In a report of 1,250 patients discharged from 38 Michigan hospitals from mid-March to July, 15 percent were hospitalized again within 60 days.

Recurring recordings do not only affect patients who were seriously ill the first time.

“Even if they have had a very mild course, at least a third will have significant symptoms two to three months later,” said Dr. Eleftherios Mylonakis, chief infectious disease at Warren Alpert Medical School and Lifespan Hospitals at Brown University, co-wrote another report. “There is a wave of readmissions that is building up because at some point these people will say that I am not fine.”

Many re-hospitalized patients were prone to severe symptoms because they were over 65 years old or had chronic illnesses. But some younger and previously healthy people have also returned to hospitals.

When Becca Meyer, 31, of Paw Paw, Michigan, fell ill with the coronavirus in early March, she initially stayed at home and nursed symptoms such as difficulty breathing, chest pain, fever, extreme fatigue, and hallucinations, including the vision of being attacked by a sponge the shower.

Ms. Meyer, mother of four, was finally hospitalized for a week in March and again in April. She was readmitted in August with an infection and in September with severe nausea. This is evident from medical records that labeled her condition as “long-range Covid-19”.

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Health

U.Okay. Authorizes Covid-19 Vaccine From Oxford and AstraZeneca

LONDON – The UK on Wednesday became the first country to approve the emergency coronavirus vaccine developed by AstraZeneca and Oxford University, clearing the way for a cheap and easy-to-store shot that much of the world will rely on to help the pandemic.

In a bold departure from prevailing global strategies, the UK government also decided to give as many people as possible a first dose of coronavirus vaccines rather than holding back supplies for quick second shots, significantly increasing the number of people vaccinated.

That decision has put Britain at the forefront of a far-reaching and unsafe experiment to speed up vaccination that some scientists believe will contain the suffering of a pandemic that kills hundreds of people in the UK and thousands around the world every day.

The effects of delaying the second dose to allow more people to receive partial protection from a single dose are not fully known. The UK, viewed by experts as the first country to implement such a plan, will also delay the second dose of the Pfizer BioNTech vaccine, which has been used there for several weeks and is in clinical trials after a single dose.

Some participants in the Oxford AstraZeneca vaccine clinical trial received the two doses several months apart. UK regulators said Wednesday that the first dose of the vaccine had 70 percent effectiveness against Covid-19 between the time that shot was taken and a second shot was administered, although those numbers apply to a limited subset of study participants, and so do also done have not been published.

Together, the UK’s two steps – getting the Oxford-AstraZeneca vaccine approved and extending the dose gap – provided the clearest signal yet of how countries still infected with the virus could speed up the pace of vaccination programs.

The Oxford-AstraZeneca shot is expected to be the world’s dominant form of vaccination. At $ 3 to $ 4 per dose, this is a fraction of the cost of some other vaccines. It can also be shipped and stored in regular refrigerators for six months instead of the ultra-cold freezers required for Pfizer-BioNTech and Moderna vaccines. This makes it easier to administer to people in poorer and hard-to-reach parts of the world.

“This is very good news for the world – it greatly facilitates the global approach to a global pandemic,” said Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine. Regarding the decision to postpone the second dose, he said, “In a pandemic, it is better to provide some level of protection to more people than that all people who are vaccinated have full protection.”

Instead of giving the two shots of the coronavirus vaccines within a month as originally planned, clinicians in the UK will wait up to 12 weeks to give people a second dose, the government said. Matt Hancock, the health secretary, said people would get the AstraZeneca vaccine early next week.

For the UK, where hospitals are overwhelmed by cases of a new, contagious variant of the virus, the drug agency’s decision offered hope of redress. Healthcare is preparing to vaccinate almost a million people a week in makeshift locations in soccer stadiums and racetracks.

At two full-strength doses, AstraZeneca’s vaccine showed 62 percent effectiveness in clinical trials – significantly less than Pfizer and Moderna’s roughly 95 percent effectiveness. For reasons scientists don’t yet understand, AstraZeneca’s vaccine showed 90 percent effectiveness in a smaller group of volunteers given a starting dose of half strength.

UK regulators approved the vaccine in two full strength doses, saying the other regime’s more promising results were not confirmed by a full analysis. They warned that the promising results for efficacy after a single dose of the vaccine were only true in a limited number of study participants.

Updated

Dec. 30, 2020, 7:16 am ET

In the past few days, the Oxford scientists who developed the vaccine have expressed some support for delaying the second dose. Andrew Pollard, the director of the Oxford Vaccine Group, said in a radio interview Monday that it “makes a lot of sense to start with as many people as possible” by delaying the second dose.

The UK healthcare sector now needs to figure out how to get people to take a vaccine that appears less effective than other vaccines available, but which could hasten the end of the pandemic.

The approval was based on data from late-stage clinical trials in the UK and Brazil. The Indian Medicines Agency is also expected to soon decide whether to approve the vaccine, which is made there by a local vaccine manufacturer, the Serum Institute.

In the US, where the Food and Drug Administration is waiting for data from a separate clinical trial, a decision is further away. The study was canceled in September and delayed by nearly seven weeks – much longer than other countries – when regulators looked at whether a vaccine-related disease in a participant in the UK was carried out. The American regulators ultimately allowed the process.

AstraZeneca has more ambitious manufacturing goals than other vaccine manufacturers and expects to manufacture up to three billion doses over the next year. With two doses per person, this would be enough to vaccinate almost one in five people worldwide. The company has committed to offering it worldwide at cost until at least July 2021 and in poorer countries on a permanent basis.

However, the company has also been haunted by communication errors that have damaged its relationship with U.S. regulators and cast doubt on whether the vaccine will stand up to intense public and scientific scrutiny. These mistakes have shifted the vaccine timeline in the United States, where key FDA officials were baffled when they learned about the break in their clinical trials in September from the news media rather than AstraZeneca.

These setbacks have not dampened the UK craze for the country’s leading homegrown vaccine. According to analysts, this could correct the course of Prime Minister Boris Johnson’s career if introduced quickly.

The UK has made AstraZeneca the linchpin of its vaccination strategy by ordering 100 million doses, 40 million of which should be available by March. The UK has vaccinated hundreds of thousands of people since the Pfizer vaccine was approved on December 2nd. However, the country has struggled to manage it beyond hospitals and doctor’s offices, and some of its highest priority recipients, like nursing home residents, are still at risk.

“We think we’ve figured out the formula for success and figured out how to get the effectiveness that everyone else has after two doses,” Pascal Soriot, managing director of AstraZeneca, told The Times of London in an interview published on Saturday. The company has not released any evidence of efficacy rates as high as Pfizer or Moderna. “I can’t tell you more because we will eventually publish,” Soriot told the Times.

Oxford scientists published interim results from clinical trials of the vaccine in The Lancet this month. The upcoming final results of these studies are not expected to differ significantly from the interim data, as is typical in clinical research.

AstraZeneca’s US study had more than 27,000 enrolled participants last week, which was just below the target of 30,000. The study could have results and, if positive, lead to an emergency clearance in the US in February or March, Moncef Slaoui, head of Operation Warp Speed, the US federal effort to expedite coronavirus vaccines, said in a news conference last week.