Racing to ramp up Covid-19 vaccinations, states have opened mass inoculation sites and expanded eligibility. But a big problem remains: The supply is not increasing quickly enough.
The United States, facing a growing threat from more contagious and possibly deadlier virus variants, is gradually administering more doses every day, now up to an average of about 1.7 million, according to a New York Times database.
But states are also steadily widening access beyond the most vulnerable groups, frontline health care workers and nursing home staff and residents. Now, some state officials say they would be ready to administer thousands more shots every day — if they could get them.
New York State has used close to 90 percent of its initial doses, Gov. Andrew M. Cuomo said on Sunday, but is forging ahead to expand eligibility to people with underlying health issues. He said his state would be vaccinating more people if it had more doses.
On Sunday, the first day that appointment sign-ups opened for New Yorkers with chronic health conditions, tens of thousands flooded websites and many were left waiting for appointment openings.
Those who are now eligible include adults who have certain health conditions that may increase their risk of severe illness or death from the coronavirus. Aside from obesity and hypertension, other conditions that qualify New Yorkers for the vaccine include pulmonary diseases and cancer, Mr. Cuomo said this month. He also made pregnancy a qualifying condition.
The expansion comes as concern grows about new variants circulating. In an interview with “Axios on HBO” that aired Sunday, Dr. Anthony S. Fauci, President Biden’s chief medical adviser, warned Americans not to become complacent as more people are vaccinated.
“We still might have a stumbling block coming with the appearance of variants that would dominate the picture,” he said.
American officials have said that the more contagious virus circulating in Britain, B.1.1.7, could become dominant in the United States by March. British government scientists are increasingly finding that variant to be linked to a higher risk of death.
Coronavirus vaccines appear to protect against B.1.1.7, but are less effective against the B.1.351 variant, which has become dominant in South Africa.
Last week, California announced that it would soon become one of just a handful of states to expand vaccine access to people of any age with underlying health issues or severe disabilities. But supply is short.
The mass vaccination site at Dodger Stadium shut over the weekend because Los Angeles had exhausted its supply, Mayor Eric Garcetti said. He said the city received just 16,000 doses last week — roughly a day’s worth.
“When vaccines do get to Los Angeles, we know how to administer them,” Mr. Garcetti told reporters. “We have a great infrastructure set up, of amazing people, and we will give them to folks efficiently and safely. But the problem is, we still aren’t receiving enough doses soon enough.”
Officials in Georgia say constrained supply is getting in the way of expanding eligibility. When the Atlanta Board of Education called on Gov. Brian Kemp earlier this month to make teachers eligible for vaccinations, the governor said the state was not getting enough doses for residents who were already eligible.
Many districts around Atlanta, he said, had stopped scheduling new vaccine appointments because federal deliveries were falling so far short of the demand.
Experts say expanding eligibility requires a delicate balance of prioritizing those most at risk and ensuring doses do not go to waste.
“I don’t think anyone would want to be the person to receive the vaccine at the expense of someone else who is higher risk,” said Dr. Sarita Shah, an epidemiologist at Emory University in Atlanta.
Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said expanding eligibility too quickly could backfire. “People are going to be angry when they are promised a second dose and don’t get it on time,” he said.
Some experts, like Dr. Robert Murphy, the director of Northwestern’s Institute for Global Health, have called for more flexibility for places that have already vaccinated their most vulnerable residents.
“I think the dangerous thing is some places are too regimented with the current rules,” Dr. Murphy said. “If you’ve got an extra 50 vials, that’s 500 doses, and nobody is coming, and this thing is going to expire in a matter of days or weeks — give it out.”
People flying into England from South Africa, Brazil and 31 other countries deemed by Britain to be hot spots for coronavirus variants will be required starting Monday to complete a 10-day quarantine in a government-sanctioned hotel, costing nearly $2,500 for a single adult. Travelers from elsewhere are required to quarantine at home for 10 days.
Scotland is requiring all international air passengers, no matter where from, to isolate on arrival in a government-sanctioned hotel.
The compulsory quarantined hotel stays, which include meals, security guards and virus testing, bring Britain in line with similar requirements in some of the countries that have been praised for their virus response, such as Australia, New Zealand, Hong Kong and Singapore.
Britain, by contrast, has suffered one of the world’s worst coronavirus outbreaks in terms of deaths per capita. The country is under a monthslong lockdown to tame a huge surge in cases caused by a virus variant, first detected in southeastern England, which is more transmissible and potentially deadlier than others. But the available vaccines have shown evidence of being able to protect against the variant first detected there. Some vaccines have shown diminished efficacy against the variant first seen in South Africa.
Britain is vaccinating rapidly, with first doses already given to more than a fifth of the population. At a news conference on Monday, Prime Minister Boris Johnson called the vaccination campaign “an unprecedented national achievement” but warned that the threat from the virus remains dire.
The new quarantine requirement applies to British citizens and residents and Irish citizens who fly into England from any of the 33 nations on the British government’s “red list” of high-risk locations, which does not include the United States. Foreign nationals from those destinations who are not residents of Britain were already barred from entering the country.
Those who fail to comply face fines of up to 10,000 pounds (about $14,000), but concerns have been raised about Britain’s ability to safely handle the influx of passengers.
Heathrow, Britain’s busiest airport, warned over the weekend that the extra checks needed at border control could create long delays. The Times of London also reported fears that a lack of protocols for limiting interaction between travelers from high-risk countries and others on planes and in some parts of airports could lead to safety compromises.
“We’ve got the right balance — robust measures, but targeted measures,” Britain’s foreign secretary, Dominic Raab, said in an interview with the broadcaster Sky News on Sunday.
KANSAS CITY, Mo. — Cold weather and the nation’s homeless crisis have long been a fatal mix that community advocates and public officials have struggled to address. But this winter, the coronavirus has added a dangerous new complication as cities and community groups wrestle with how to shelter members of a vulnerable population from the elements while not exposing them to an airborne virus that spreads most easily indoors.
The calculation has taken on greater urgency in recent days as arctic weather freezes a large swath of the middle of the country, from Minnesota to Texas, with wind chills expected to dip as low as minus 60 degrees Fahrenheit in some places.
Officials in Ramsey County, Minn., which includes St. Paul, have set up shelters in a vacant hospital and a vacant seminary dormitory so that they can better distance homeless residents from one another.
Chicago officials have used former school buildings as well as Salvation Army and Y.M.C.A. locations to give service providers more space for shelter beds.
New Life Center, a nonprofit rescue mission in Fargo, N.D., outfitted an abandoned warehouse to expand its shelter capacity.
And in Kansas City, where the forecast calls for a low of minus 14 degrees on Monday, officials have converted the downtown convention center — the size of eight football fields — into a shelter.
With public spaces like libraries and the dining rooms of many fast food restaurants closed, people experiencing homelessness have fewer places to warm up during the day or use the bathroom. Traditional shelters have had to reduce their capacity for social distancing.
Kansas City typically spends $1.5 million a year on homeless services, according to a city spokesman. But this year, with the help of federal relief funds, it plans to spend $8.5 million on programs that include paying for hotel rooms to house families and providing financial assistance to prevent evictions.
At the urging of local activists, city officials opened a temporary shelter, with a capacity of 65 people, at a community center in mid-January. The number who showed up quickly exceeded that, and city leaders had a difficult call to make.
“We made a collective decision to say, ‘Look, if any one of these people had to spend the night in the street, it’s likely a death sentence,’” said Brian Platt, the city manager. “If they come inside and there’s a possibility of spreading or catching the Covid virus, there’s a greater chance that they could live through that.”
The World Health Organization on Monday authorized the use of the AstraZeneca-Oxford vaccine, clearing a path for the cheap and easy-to-store shots to be distributed in lower- and middle-income countries around the world.
A small clinical trial in South Africa recently failed to show that the vaccine could keep people from getting mild or moderate cases of Covid-19 caused by a coronavirus variant spreading there. But that vaccine had protected all participants against severe disease and death in other trials and may yet prevent severe disease and death caused by the variant first detected in South Africa.
The authorization, expected after a panel of W.H.O. experts recommended use of the vaccine last week, applied to the vaccine’s two manufacturers: AstraZeneca and the Serum Institute, the Indian producer that will supply many doses for the Covax initiative to bring vaccines to poorer parts of the world.
The W.H.O. last year authorized the Pfizer-BionNTech vaccine. But its decision on AstraZeneca’s vaccine has been highly anticipated, because the low price and easy storage requirements have made the vaccine the backbone of rollout plans in many countries around the world.
“Countries with no access to vaccines to date will finally be able to start vaccinating their health workers and populations at risk, contributing to the Covax Facility’s goal of equitable vaccine distribution,” Dr. Mariângela Simão, the W.H.O. assistant-director general for access to medicines and health products, said in a statement.
The W.H.O. panel of experts recommended that the AstraZeneca vaccine be used in all adults, and in countries where concerning new variants are circulating. Countries are expected to begin receiving their first tranches of the AstraZeneca vaccine from Covax later in February.
In announcing the authorization for the vaccine on Monday, Dr. Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., said that while virus cases appeared to be falling in many parts of the world, countries needed to remain vigilant.
“If we stop fighting it on any front,” he said, “it will come roaring back.”
After the results of the small clinical trial of the AstraZeneca vaccine in South Africa were released, South Africa decided to pause plans to distribute it. Instead, South Africa was planning to inoculate health workers with the Johnson & Johnson vaccine, which prevented hospitalizations and deaths in clinical trials in the country.
The W.H.O. panel that examined the AstraZeneca vaccine also advised that it be given to adults regardless of their ages, breaking with a number of European countries that have opted to restrict the use of the vaccine to younger people. And it recommended that the two doses of the vaccine be given between four and 12 weeks apart, citing evidence that the vaccine appears to work better when second doses are delayed.
Italy reversed course on a plan to open its ski slopes, pushing back a reopening that was set for Monday back to March 5 at the earliest.
The Health Ministry announced the decision on Sunday, citing concerns about new variants. Italy closed its slopes early last year as it was fighting Europe’s first major coronavirus outbreak, and about a month ago set Feb. 15 as a reopening date.
“There are not the conditions for further relaxation of the current containment measures including those for amateur skiing,” the board of scientific advisers to the government wrote in a report on Friday, adding that the more transmissible virus variant first found in Britain now represented nearly one in five cases in Italy.
More than 10,000 new cases and 200 deaths in Italy were reported on Sunday.
In the release announcing a new decree, the government promised economic relief for the ski sector. But the government’s sudden reversal upset owners of ski facilities and local authorities in mountainous regions near Switzerland, which has had slopes open for months.
In recent days, Luca Mantovani, the chief executive of a cable car company in Vigezzo, in Italy’s northern region of Piedmont, had already dispatched snowcats to groom slopes and hired waiters and cooks.
“What am I going to tell these guys now?” he said in a telephone interview. “You can’t just change your mind 24 hours before I am supposed to open.”
On Monday, Mr. Mantovani opened the slopes anyway, defying government orders. He said his company had lost 90 percent of its revenue this year and hasn’t received any government subsidies. A decree that contained some financial relief for the sector was halted by Italy’s government crisis.
Walter Ricciardi, a scientific adviser to the health minister, argued that the country’s level of contagion was high enough to warrant not just the closing of ski slopes but a nationwide lockdown. He said that skiers in Switzerland had contributed to the spread of the British variant across Europe.
“We have known since October that ski slopes could not be reopened,” he said on television on Sunday. “Politicians are reluctant to tell the truth, which is that we will have to fight.”
In other developments around the world:
The president of Zimbabwe, Emmerson D. Mnangagwa, said Monday that Zimbabwe would begin vaccinations this week. China donated 200,000 doses of its Sinopharm vaccine, on top of the 600,000 doses that Zimbabwe purchased.
The government of Rwanda said Sunday that it had begun vaccinating health care workers and other high-risk groups, making it the first country in East Africa to start its inoculation campaign. Rwanda, a country of about 13 million people, has recorded more than 17,000 cases and 239 deaths, according to a New York Times database. Last week, officials eased a lockdown in the capital, Kigali, that had been imposed in mid-January amid a second wave of infections. But movement within the country is restricted and a nighttime curfew is in effect.
Thirteen countries in the Middle East have reported cases of at least one of three new, more transmissible variants, the World Health Organization said Monday The situation in the Middle East remains critical, although case numbers in certain parts of the region are stabilizing, the W.H.O. said.
Back in the summer, Dr. Michael Mina made a deal with a cold storage company. With many restaurants closed, the firm had freezers to spare. And Dr. Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, had a half-million vials of human blood plasma coming to his lab from across the country, samples dating to the carefree days of January 2020.
The vials, now in three hulking freezers outside Dr. Mina’s lab, are at the center of a pilot project for what he and his collaborators call the Global Immunological Observatory. They envision an immense surveillance system that can check blood from all over the world for the presence of antibodies to hundreds of viruses at once.
That way, when the next pandemic washes over us, scientists will have detailed, real-time information on how many people have been infected and how their bodies responded.
It might even offer some early notice, like a tornado warning. Although this monitoring system will not be able to detect new viruses or variants directly, it could show when large numbers of people start acquiring immunity to a particular kind of virus.
The human immune system keeps a record of pathogens it has met before, in the form of antibodies that fight against them and then stick around for life. By testing for these antibodies, scientists can get a snapshot of which flu viruses you have had, what that rhinovirus was that breezed through you last fall, even whether you had a respiratory syncytial virus as a child.
Although the observatory would not have been able to identify the new coronavirus, it would have revealed an unusually high number of infections from the coronavirus family, which includes those that cause colds. It might also have shown that the virus was interacting with immune systems in unexpected ways, resulting in telltale markers in patients’ blood.
The risk associated with the spread of the new coronavirus variants in Europe is high for the general population and very high for vulnerable people, the European Center for Disease Prevention and Control said Monday.
Although the number of new coronavirus cases in European countries such as France, Germany and Spain has decreased in recent weeks, the situation is still of “high concern” because of the increased transmissibility and severity of the new variants, as well as the potentially lower effectiveness of the existing vaccines against the variant found in South Africa, the agency said in its new risk assessment.
In order to halt an escalation, European countries need to strengthen their restrictive measures and address “pandemic fatigue.”
As Europe’s sluggish vaccination campaign is lags behind other developed nations including Britain, the United States and Israel, the E.C.D.C. called on European governments to accelerate their inoculation pace of high-risk groups and to discourage non-essential travel. School closures should be the measure of last resort, the agency said.
After a bitter fight, the Chicago Public Schools reached a deal with its teachers’ union last week to reopen elementary and middle schools amid the pandemic. By early March, students who have been learning remotely for 10 months will be back in classrooms.
The agreement speeds up vaccinations for teachers, provides expanded accommodations for educators with medically vulnerable relatives and sets virus thresholds that would trigger a return to remote learning.
With other big cities across the United States, particularly on the West Coast, locked in conflict with teachers’ unions, the deal is a potential road map for how local officials can have children return to the classrooms and help President Biden achieve his goal of reopening most schools within the first 100 days of his administration.
In an interview with The New York Times, Mayor Lori Lightfoot, a Democrat, spoke frankly about her acrimonious relationship with the Chicago Teachers Union and how she plans to rebuild trust with students’ parents. Despite campaigning to restore an elected school board, she now says that she believes reopening would not have been possible without mayoral control of schools — something that mayors in Los Angeles, San Francisco and Portland, where schools remain closed, lack.
Mayor Lightfoot said that it is “important for us to talk about what’s happened to our children during this.” Their social life, she noted, had been torn away. “Our 3-, 4-, 5-year-olds?” she said. “Their social-emotional learning is absolutely central to their growth, and yet we see them learning on screens. We know that’s not the best way for them to learn.”
NEW ORLEANS — Since the first Mardi Gras in New Orleans in 1857, elaborate floats have paraded through the city on the last Tuesday before Lent. Thousands of people fill the streets, and marching bands and dance teams come from all over to perform. Artists and organizers spend months preparing, and the event typically brings the city millions of dollars in tourism and other revenue.
This year, bars are closed and parades are canceled. But the city was not ready to give up. Soon after the cancellation was announced in late November, one New Orleans resident, Megan Boudreaux, said on Twitter: “It’s decided. We’re doing this. Turn your house into a float and throw all the beads from your attic and your neighbors walking by.”
The idea took off, and float artists, carpenters and others began working on homes almost immediately.
Ms. Boudreaux said there were roughly 3,000 house floats in the greater New Orleans area.
“I think it just really speaks to how desperate people have been for something positive to look forward to,” she said. “It doesn’t matter if your budget is zero and you’re recycling cardboard boxes, or whether your budget is tens of thousands of dollars and you’ve got a mansion on St. Charles. We want everyone who wants to do this to participate.”
The floats won’t all be celebratory. Some will pay tribute to members of the Mardi Gras Indians, known for their elaborate hand-sewn suits, who have died. The community is Black, and its traditions are rooted in African culture. As it did in other parts of the country, the virus battered Black households in New Orleans.
For René Píerre, who has worked as a Mardi Gras float artist for 34 years, house floats brought hope for him and his wife, Inez, who had already lost her job as a mental health specialist when the parades were canceled. Mr. Píerre has worked on 60 house floats in greater New Orleans.
At a house with a float dedicated to the performer Dolly Parton, Inez Píerre leaned on the fence and watched as workers put large painted panels in place.
“Sometimes I have to sit and think about how easily tradition changes,” she said. “We’re a part of it; our names are down in the books. This is a dream come true.”
Annie Flanagan and
Dr. Anthony S. Fauci, the veteran director of the National Institute of Allergy and Infectious Diseases and the public face of the battle against the pandemic in the United States, was the recipient of a $1 million Dan David Prize, an award headquartered at Tel Aviv University and dedicated this year to outstanding contributions in public health.
The prize awards a total of $3 million a year to individuals and organizations for their achievements in three categories: expanding on knowledge of the past, enriching society in the present and promising to improve the future of the world. The theme of the prize varies from year to year. Previous laureates include cellist Yo-Yo Ma, former Vice President Al Gore, novelist Margaret Atwood and Dr. Demis Hassabis, an artificial intelligence researcher, neuroscientist and entrepreneur.
Dr. Fauci, 80, won in the “Present” category for his scientific contributions, including his research and his efforts to inform the public about the pandemic. He “leveraged his considerable communication skills to address people gripped by fear and anxiety and worked relentlessly to inform individuals in the United States and elsewhere about the public health measures essential for containing the pandemic’s spread,” the organizers of the Dan David Prize said in a statement.
It added, “He has been widely praised for his courage in speaking truth to power in a highly charged environment,” a reference to Dr. Fauci’s testy relations with former President Donald J. Trump and his supporters, who came to treat him as a villain.
The other Dan David Prize awards were shared this year by health and medicine historians Dr. Alison Bashford, Dr. Katharine Park and Dr. Keith A. Wailoo in the Past category; and Dr. Zelig Eshhar, Dr. Carl June and Dr. Steven Rosenberg, pioneers of an anti-cancer immunotherapy, in the Future category.