New York City Reopens Elementary Schools in Midst of Worsening Outbreak

Healthcare workers at Lincoln Community Hospital in Hugo, Colorado, on Tuesday.
Credit…Stephen Speranza for The New York Times

The United States has recorded its most coronavirus-related deaths over a weeklong period, as a brutal surge gathers speed across the country.

With a seven-day average of 2,249 deaths, the country broke the previous mark of 2,232 set on April 17 in the early weeks of the pandemic. Seven-day averages can provide a more accurate picture of the virus’s progression than daily death counts, which can fluctuate and disguise the broader trend line.

The United States is approaching 300,000 total deaths, with nearly 283,000 recorded, according to a New York Times database. The nation is averaging nearly 200,000 cases per day, an increase of 15 percent from the average two weeks earlier, and has recorded over than 15 million total cases.

Much has changed since the previous peak in April. The coronavirus is no longer concentrated in big urban areas like New York City and now envelops much of the country, including rural areas that had avoided it for several months.

Many of the hardest-hit counties on a per person basis are now in the Midwest. North Dakota, where one in every 10 residents has contracted the virus, has the highest total reported cases by population, followed closely by South Dakota, Iowa, Wisconsin and Nebraska.

The latest wave to hit the United States has hospitalized record numbers. Each day since Dec. 2, more than 100,000 Covid-19 patients were in hospitals. That far surpasses the number of people hospitalized during the peaks spring and summer, which at their worst had nearly 60,000 Americans in the hospital daily.

The new peak also comes as the nation prepares for holiday celebrations, and as colder temperatures may push people to congregate indoors. Infectious-disease experts have warned that trends in the United States, which reported a record 2,885 deaths on Wednesday, could continue to worsen over the next several weeks.

Against the warnings of public health officials, millions of Americans traveled over the Thanksgiving holiday, stoking fears that another wave of travel could accompany this month’s celebrations even as the pandemic rages.

And even without traveling far, gatherings between people from different households pose a risk.

“These are going to be perfect scenarios for replication of the virus,” said Dr. Fadi Al Akhrass, an infectious-disease specialist at Pikeville Medical Center in Kentucky.

Dr. Al Akhrass said people seemed more willing to accept the severity of the virus than they were in April, but that “everybody learned the hard way.”

“The value of Christmas is what we give, not what we take — this is something we need to consider this season,” he said. “Giving up on large gatherings will probably be the best gift of them all.”

The Trump administration is said to have turned down an offer from Pfizer to purchase additional doses of its vaccine. 
Credit…Doug Mills/The New York Times

Before Pfizer’s coronavirus vaccine was proved highly successful in clinical trials last month, the company offered the Trump administration the chance to lock in supplies beyond the 100 million doses the pharmaceutical maker agreed to sell the government as part of a $1.95 billion deal months ago.

But the administration, according to people familiar with the talks, never made the deal, a choice that now raises questions about whether the United States allowed other countries to take its place in line.

As the administration scrambles to try to purchase more doses of the vaccine, President Trump plans on Tuesday to issue an executive order that proclaims that other nations will not get the U.S. supplies of its vaccine until Americans have been inoculated.

But the order appears to have no real teeth and does not expand the U.S. supply of doses, according to a description of the order on Monday by senior administration officials.

The vaccine being produced by Pfizer and its German partner, BioNTech, is a two-dose treatment, meaning that 100 million doses is enough to vaccinate only 50 million Americans. The vaccine is expected to receive authorization for emergency use in the U.S. as soon as this weekend, with another vaccine, developed by Moderna, also likely to be approved for emergency use soon.

Britain plans to begin a vaccination drive on Tuesday using the Pfizer-BioNTech vaccine, making it the first Western nation to start mass vaccinations.

On Nov. 11 — two days after Pfizer first announced early results indicating that its vaccine was more than 90 percent effective — the European Union announced that it had finalized a supply deal with Pfizer and BioNTech for 200 million doses, a deal they began negotiating in months earlier. Shipments could begin by the end of the year, and the contract includes an option for 100 million more doses.

Asked if the Trump administration had missed a crucial chance to snap up more doses for Americans, a spokeswoman for the Department of Health and Human Services said, “We are confident that we will have 100 million doses of Pfizer’s vaccine as agreed to in our contract, and beyond that, we have five other vaccine candidates.”

The government was in July given the option to request 100 million to 500 million additional doses. But despite repeated warnings from Pfizer officials that demand could vastly outstrip supply and amid urges to pre-order more doses, the Trump administration turned down the offer, according to several people familiar with the discussions.

In a statement, Pfizer said that “any additional doses beyond the 100 million are subject to a separate and mutually acceptable agreement,” and that “the company is not able to comment on any confidential discussions that may be taking place with the U.S. government.”

The bulk of the global supply of vaccines has already been claimed by wealthy countries like the United States, Canada, Britain and countries in Europe, leading to criticism that people in low- and middle-income countries will be left behind. The United States has declined to participate in a global initiative, called Covax, that is meant to make a vaccine available globally.

The decision to issue the executive order was reported earlier by Fox News.

People at Santa Monica beach in Los Angeles on Sunday. 
Credit…Philip Cheung for The New York Times

As the United States neared 15 million coronavirus cases, the governors of California and New York again sounded alarms about the spiraling public health crisis on both coasts.

Gov. Andrew M. Cuomo of New York on Monday announced new criteria for rolling back the state’s reopening and reintroducing shutdown restrictions by region, as his counterpart in California, Gov. Gavin Newsom, warned that hospitals across the state have continued to fill rapidly to dangerous levels.

Dr. Anthony S. Fauci, the federal government’s top infectious disease expert, echoed the concerns of both governors as officials across the country have warned that the spread of the virus could accelerate during the holiday season and into 2021.

“The middle of January can be a really dark time for us,” Dr. Fauci said.

Under the new plan announced by Mr. Cuomo, the state health department will use hospitalization rates as thresholds for a shutdown and for restricting indoor dining, which he said could be barred in New York City as soon as Monday. His announcement followed new guidance from the Centers for Disease Control and Prevention that said eating inside at restaurants was a high-risk scenario.

“If you’re going to overwhelm the hospital system, then we have no choice but to go to close down,” Mr. Cuomo said at a news conference in New York City.

For weeks, Mr. Cuomo has warned of rising case counts, hospitalizations and positive test rates in every part of New York state. On Monday, he reported that 4,602 people were hospitalized in the state, coming a week after he announced the state would focus on hospitalizations and warned of a “nightmare of overwhelmed hospitals.”

Hospitals across California have also continued to fill rapidly, Mr. Newsom said on Monday. More than 10,000 Covid-19 patients are now hospitalized in the state, he said, 72 percent more than two weeks ago. The number in intensive care has risen by 69 percent over that time.

“You can see how quickly this grows,” he said at a news conference.

Starting Monday, millions of Californians are living under some of the most aggressive restrictions since March, when the state imposed the nation’s first stay-at-home order. Experts say that order helped to curb the spread of the virus in California at a time when it was raging out of control in the spring in places like New York City and hospitals there were swamped.

This time around, California’s new directives to stay home as much as possible in three of its five regions have run into much more resistance, even though the virus is more prevalent now than it has ever been. On top of that, law enforcement leaders around the state, including Sheriff Don Barnes of Orange County, have said they will not enforce the new restrictions.

California is averaging 21,000 new known cases a day, twice as many as the state was reporting at its worst point this summer and by far its highest levels of the pandemic. And because California has fewer hospital beds per capita than all but two states, it takes less to overwhelm the state’s health infrastructure.

On Monday, Mr. Newsom sought to head off any panic about hospital capacity.

He said the state still had more than 73,000 open hospital beds, and that regional leaders have been gauging where to pull back on elective surgeries to preserve space for emergency patients. He discussed programs to bring on additional health care workers and to allow some patients in hard-hit areas to be treated at home with oxygen (not ventilators, as an earlier version of this item said).

“I hope some of this will add more optimism to the frame,” he said.

Even so, state officials say that they expect the situation to worsen as the impact of Thanksgiving travel and gatherings becomes clearer.

“We know that cases that potentially occurred during Thanksgiving are going to show up right about now,” said Dr. Mark Ghaly, the California secretary of health and human services.

In Michigan, Gov. Gretchen Whitmer said on Monday that her administration would extend for 12 days the closures of high schools, universities and some businesses like casinos and movie theaters, as well as a shutdown of indoor dining and organized sports, as officials monitor the number of available hospital beds.

The Royal Free Hospital in North London on Monday. The hospital is one of the hospitals that will start administering a Covid-19 vaccine on Tuesday.
Credit…Andrew Testa for The New York Times

Preparing to take a first step in what could prove to be one of the most daunting logistical challenges undertaken during peacetime, hospitals across Britain readied for the start of the largest mass vaccination effort in the nation’s history, part of a global campaign without precedent.

An army of health care workers — assisted by tens of thousands of volunteers and the military — will begin rolling out inoculations of a Covid-19 vaccine on Tuesday morning, aiming to vaccinate more than 20 million citizens in just a few months time.

With virtually the whole world still at grave risk from the pandemic, other nations will watch closely as the U.K. becomes the first Western nation to begin its mass vaccination campaign.

In the United States, the Food and Drug Administration could approve the vaccine by Pfizer and BioNTech — one of three that have shown success in large-scale clinical trials — by the end of the week. And the Trump administration’s top health officials outlined an ambitious timetable on Sunday for distributing the first coronavirus vaccinations to as many as 24 million people by mid-January.

Regulatory approval in the European Union is also likely in coming days and nations across the Continent are also planning their own wide scale vaccinations programs.

Russia, where the government has come under criticism for making a dash for a vaccine without taking proper precautions, began its national vaccination campaign over the weekend. Even though the vaccine, Sputnik V, has yet to be proven fully safe and effective, health care workers have started to inoculate thousands of people.

Russia made its vaccine available for free to teachers, medical workers and social-service employees younger than 61 in Moscow. But distrust of the vaccine — 59 percent of Russians say they have no intention of getting a shot — looms large as the country races to roll out the vaccine while facing the fiercest onslaught of the pandemic yet, with some 500 deaths per day.

The complexities of the undertaking in the United Kingdom are further complicated by the special challenges presented by the vaccine itself, since the first stages of the campaign will rely on batches produced by Pfizer and BioNTech, which need to be stored at very low temperatures.

But officials said that the plan is to move distribution beyond hospitals relatively quickly.

The entire effort will fall under the jurisdiction of the country’s health professionals and under the umbrella of the National Health Service. Widely respected in Britain, the N.H.S. offers health care free of charge with only a few exceptions.

Family doctors will carry much of the burden, calling on their experience of giving at least 15 million flu shots each year.

And temporary vaccination clinics are also being prepared, including drive through sites, sports stadiums or public buildings.

Retired health workers are being drafted as volunteers and charitable organizations are expected to support the effort. One charity, the St John Ambulance, aims to help train up to 30,000 first aid workers and others to help out at vaccination centers.

But much of the planning has been shrouded in secrecy, in part because of security concerns.

Europol has warned that organized crime groups might target transit containing vaccines for hijacking and theft, and last week Interpol warned against an “onslaught of all types of criminal activity linked to the Covid-19 vaccine,” which it has described as “liquid gold.”

A closed elementary school in the San Fernando Valley section of Los Angeles in July.
Credit…Richard Vogel/Associated Press

Elementary school students who were learning remotely in the spring lost the equivalent of roughly three months’ progress in math and fell a month and a half behind in reading, according to a new analysis released this week by the consulting firm McKinsey & Company.

The analysis was based on data from in-classroom assessments taken by hundreds of thousands of elementary school students across 25 states this fall, and it compared their performance with that of students who took similar assessments in previous years. The conclusions are in line with previous studies showing that children have fallen far behind during the pandemic.

The losses appeared more severe among nonwhite students. The authors of the report estimate that those students may have fallen three to five months behind in math, on average, compared with two months for white students.

The assessment data came from Curriculum Associates, whose diagnostic tests are taken by roughly 30 percent of K-8 students across the country.

Other recent reports have reached similar findings. NWEA, a nonprofit organization, found that students in third through eighth grade who took the group’s assessments in the fall of 2020 scored 5 to 10 percentile points lower in math than students in the same grade did in the fall of 2019. The group did not find significant losses in reading generally, although there was evidence of declines among Black and Hispanic students in the upper elementary grades.

Many school districts that started the year remotely have reported large increases in the number of students failing courses. On Monday, the superintendent of the Los Angeles Unified School District, the country’s second largest, said the district had seen a 15 percent increase in D’s and F’s among high school students this year compared to last year, and a 10 percent drop in reading proficiency among elementary school students.

The McKinsey report argues that schools will need to take major steps to help their students catch up after classrooms reopen, like providing daily tutoring or summer school for most or all students.

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Jérôme Salomon, a French health official, said on Monday that new daily infections were no longer decreasing and remain particularly high among people older than 75.CreditCredit…Dmitry Kostyukov for The New York Times

French health authorities said on Monday that a drop in the number of new infections and of hospitalizations in the country was still far short of what President Emmanuel Macron has said was necessary for lockdown rules to be eased any further, raising fears that a hoped-for end-of-year holiday reprieve could be pushed back.

In a speech last month, Mr. Macron promised that restrictions on movement would largely be lifted by Dec. 15 and establishments like theaters and museums would be allowed to reopen if France could get down to about 5,000 new infections a day and the number of Covid-19 patients in intensive care fell to the 2,500-to-3,000 range.

But Jérôme Salomon, a top official at the French health ministry, said on Monday that despite a recent sharp drop, France was still averaging 10,000 new cases a day, and there were nearly 3,200 patients in intensive care.

“Over the past couple of days, the number of new daily infections is no longer decreasing and is still particularly high among people older than 75,” Mr. Salomon said at a news conference, adding that it would be “very difficult” to reach the 5,000 goal by next week if that trend continued.

Mr. Salomon praised French citizens for bringing the number of new cases down from a peak of more than 80,000 a day in early November by following curfews and lockdown rules. He said the cold weather — which pushes people inside and makes it harder to ventilate closed spaces, thereby accelerating the spread of respiratory viruses — was mostly to blame.

“The winter season is going to be very hard,” Mr. Salomon said. Citing a rebound of the epidemic in the United States after Thanksgiving, he said health authorities were concerned that end-of-year gatherings could lead to “intra-family contaminations.”

More than 26,000 people are hospitalized around France because of the coronavirus, and more than 55,000 people have died so far. France is planning a vaccination campaign in 2021, starting in retirement homes, but Mr. Salomon cautioned that it would take several months for vaccinations to have an effect on the overall situation.

“It will take time to bring the epidemic under control,” he said.

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Canada Will Receive First Vaccine Delivery Next Week, Trudeau Says

Justin Trudeau, Canada’s prime minister, said the country’s first doses of the Pfizer coronavirus vaccine were expected to arrive next week. The vaccine has not yet been approved by the country’s national regulator.

Canada has secured an agreement with Pfizer to begin early delivery of doses of their vaccine candidate. We are now contracted to receive up to 249,000 of our initial doses of Pfizer-BioNTech’s Covid-19 vaccine in the month of December. Pending Health Canada approval, the first shipment of doses is tracking for delivery next week. Shipments will continue to arrive into 2021, with millions of doses on the way. The large mass manufacturings will be happening into 2021. But with these 249,000 doses coming in December, we will be able to begin on the most vulnerable populations and make sure that we have the logistical, grounding and foundation in place to be able to deliver right across the country over the first months of 2021.

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Justin Trudeau, Canada’s prime minister, said the country’s first doses of the Pfizer coronavirus vaccine were expected to arrive next week. The vaccine has not yet been approved by the country’s national regulator.CreditCredit…Blair Gable/Reuters

Justin Trudeau, Canada’s prime minister, said Monday that the first doses of the Pfizer coronavirus vaccine will start arriving in his country next week at 14 distribution centers.

But inoculations will have to wait until the national regulator approves the treatment.

“The regulatory process needs to be as rigorous as it always is,” Mr. Trudeau told reporters. “There are no corners cut by Health Canada in terms of approving a vaccine for safe use by Canadians.”

Mr. Trudeau said that Pfizer will send 249,000 doses to Canada by the end of December. That’s a small portion of the six million doses Canada has ordered from the company. But officials said last week they anticipate that large quantities of many of the vaccines Canada has ordered from seven different makers will be shipped early next year.

The 14 centers that will receive the vaccine are equipped with special freezers to store the vaccine at its required temperature of minus 80 degrees Celsius. Distribution is being handled through a new national coordinating body set up by the Public Health Agency of Canada with the help of the country’s military.

Canadian officials have said that regulatory approval for Pfizer’s vaccine may come as soon as this week.

Christmas decorations in London last week.
Credit…Andrew Testa for The New York Times

As a deadly wave of coronavirus cases extends across Europe, several countries are planning to loosen restrictions over the holidays to allow families and friends to gather.

In a four-day period beginning Dec. 23, people across Britain can form a Christmas bubble, which will allow members of up to three households to spend time together in private homes or to attend places of worship.

In Germany, officials have agreed to extend a partial lockdown to Jan. 10, but loosen restrictions from Dec. 23 to Jan. 1, allowing private gatherings of as many as 10 people from any number of households. Spanish officials have decided to allow travel between regions to see relatives and close friends, but said that social gatherings around Christmas and New Year’s Day must be limited to 10 people if not from the same household.

In France, residents will be under a nationwide curfew from 9 p.m. to 7 a.m. beginning Dec. 15, when a national lockdown ends. However, the curfew will not apply from Christmas Eve to New Year’s Eve, officials said.

“We will be able to travel without authorization, including between regions, and spend Christmas with our families,” President Emmanuel Macron of France said.

Norway, one of the few European countries to keep a second wave at bay, limits private gatherings to five guests. But around Christmastime, the country will allow residents to double their guests over any two days. However, people must continue to socially distance.

While some countries are becoming more permissive, Italy will tighten its restrictions on Christmas Day, Dec. 26 and New Year’s Day, when residents will be prohibited from leaving their hometowns. Travel will be banned between regions in Italy from Dec. 21 through Jan. 6, and an 11 p.m. to 5 a.m. curfew will be implemented.

These delicate attempts at balancing a social time of year and easing the burden on hospitals come after nearly 105,000 people died of Covid-19 in November in 31 countries monitored closely by the European Center for Disease Prevention and Control.

Health experts have cautioned that holiday travel could drive new spikes in cases.

Police officers seized the computer, cellphone and hard drives of Rebekah D. Jones, an outspoken critic of Florida’s handling of coronavirus data, Ms. Jones said.

Ms. Jones, who filed a whistle-blower complaint against the state after she was fired as its virus data manager in May, said agents from the Florida Department of Law Enforcement knocked on her door at 8:30 a.m. on Monday with a search warrant.

Law enforcement officials said they were investigating unauthorized access to the Department of Health’s internal messaging system.

A brief video that Ms. Jones posted on Twitter shows agents with guns drawn and Ms. Jones, in sweatpants, telling them her husband and children were upstairs. Her children, ages 2 and 11, were still asleep, she said in an interview on Monday afternoon.

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“They put a gun six inches from my face,” she said.

The agents took her computer, cellphone and other hardware, Ms. Jones said, including hard drives “that had evidence of corruption in the state.”

Ms. Jones was a geographic information systems manager in the Florida Department of Health’s division of disease control and health protection before she was fired for insubordination in May. She said her firing was retribution for refusing to manipulate coronavirus data to show that counties were ready to reopen after the state went into a lockdown. The Department of Health has denied the accusation.

Ms. Jones, who had helped create a dashboard of coronavirus data that was praised by the White House, built a rival dashboard in June with the use of public data.

In a statement, the Department of Law Enforcement said it served the warrant at Ms. Jones’s Tallahassee residence in connection to an investigation that began on Nov. 10, after Department of Health employees received an unauthorized message on their emergency alert system. The message warned employees to “speak up before another 17,000 people are dead,” The Tampa Bay Times reported last month. “You know this is wrong. You don’t have to be a part of this. Be a hero. Speak out before it’s too late.”

Gretl Plessinger, a spokeswoman for the Department of Law Enforcement, said in a statement, “Agents believe someone at the residence on Centreville Court illegally accessed the system.” She added, “Our investigation is active.”

Ms. Jones denied any involvement in the unauthorized message, asking a reporter to send her the earlier article about the incident, which she said she had not seen.

“I’m not a hacker. I wouldn’t know how to do that,” she said. “It’s data science, not computer programming.”

GLOBAL ROUNDUP

People in Carlton Gardens in Melbourne, Australia, on November 15.
Credit…Erik Anderson/EPA, via Shutterstock

Australian states on Monday celebrated “Freedom Day,” as coronavirus restrictions eased in the lead up to Christmas and summer in the Southern Hemisphere.

In New South Wales and Victoria, more people will be allowed in bars, restaurants, shops and places of worship, and dance halls will be reopened in a limited capacity.

“From Monday, life will be very different,” said Gladys Berejiklian, the premier of New South Wales.

In Sydney, Australia’s most populous city, up to 50 people will be allowed on dance floors at weddings, and attendance at funerals will be unlimited. Up to 5,000 people will be permitted at seated outdoor events, and from next week, workers are being encouraged to return to the office.

In Victoria, where an outbreak in July sent the city of Melbourne into one of the world’s longest and strictest lockdowns, people can now have 30 people over at their homes and gather in groups of 100 outside. Masks, previously mandated, have to be worn only on public transport, in indoor shopping centers and crowded places.

Melbourne welcomed its first international visitors since June on Monday, when a jet carrying 253 passengers arrived from Sri Lanka. The travelers will quarantine for 14 days in hotels under strict conditions.

Last month, Victoria achieved effective elimination of the virus, and has now gone 38 days without a new case. But as people celebrated across the country, Daniel Andrews, the premier of Victoria, warned that even with the eased restrictions, there was a need to remain vigilant.

“This thing is not done,” Mr. Andrews told reporters on Sunday. “It is not over, it can come back.”

In other developments across the world:

  • In Germany, Markus Söder, Bavaria’s premier, announced a state of emergency on Sunday as daily infections in the country have not significantly decreased despite a nationwide partial lockdown. Mr. Söder’s announcement prohibits people from leaving their homes in areas where there are more than 200 infections per 100,0000 in a week. The governors of Saxony and Thuringia announced that new lockdown measures in their states would be discussed this week.

  • The Vatican announced Monday that Pope Francis would visit Iraq in March, his first international trip in 15 months. Matteo Bruni, a Vatican spokesman, said in a statement that plans for the trip “will take into consideration the evolution of the worldwide health emergency.” Francis plans to visit Baghdad, Erbil, Mosul, Qaraqosh and the plains of Ur and Nineveh during the four-day visit, scheduled for March 5 to 8. The Vatican’s online news website said that Francis had “long expressed his desire to visit Iraq,” and had planned on visiting in 2020.

  • Greece is extending its lockdown until Jan. 7, with schools, courts, bars, restaurants, gymnasiums and ski resorts remaining closed, said Stelios Petsas, a government spokesman. Travel between regions is to remain prohibited while a nighttime curfew will also stay in place.

  • On Monday, Denmark expanded lockdown measures until Jan. 3 in 38 of 98 municipalities, including Copenhagen, officials said. Beginning Dec. 9, restaurants, museums, movie theaters and other similar cultural establishments must close. Select grade school students and students at universities will be sent home.

  • Organizers of the biennial Paris Air Show canceled the 2021 show on Monday because of the pandemic and its devastating effect on the aerospace industries, the Associated Press reported. The show, which attracts exhibitors and officials from around the world, had been scheduled for June. Organizers said they hoped the next one in June 2023 would celebrate a global rebound from the crisis.

The victims of coronavirus were remembered during a Mass at Nembro’s cemetery in November.
Credit…Fabio Bucciarelli for The New York Times

Every Monday night in the northern Italian town that had perhaps the highest coronavirus death rate in all of Europe, a psychologist specializing in post-traumatic stress leads group therapy sessions in the local church.

“She has treated survivors of war,” the Rev. Matteo Cella, the parish priest of the town, Nembro, in Bergamo province, said of the psychologist. “She says the dynamic is the same.”

First the virus exploded in Bergamo. Then came the shell shock. The province that first gave the West a preview of the horrors to come now serves as a disturbing postcard from the post-traumatic aftermath.

In small towns where many know one another, there is apprehension about other people, but also survivor’s guilt, anger, second thoughts about fateful decisions and nightmares about dying wishes unfulfilled. There is a pervasive anxiety that, with the virus surging anew, Bergamo’s enormous sacrifice will soon recede into history, that its towns will be forgotten battlefields from the great first wave.

And most of all there is a collective grappling to understand how the virus has changed people. Not just their antibodies, but their selves.

Bergamo, like everywhere, now confronts a second wave of the virus. But its sacrifice has left it better prepared than most places, as the widespread infection rate of the first wave has conferred a measure of immunity for many, doctors say. And its medical staff, by now drilled in the virus’s awful protocols, are taking in patients from outside the province to alleviate the burdens on overwhelmed hospitals nearby.

But the wounds of the first wave gnaw at them from within.

Talking about these things does not come easily to people in Italy’s industrial heartland, jammed with metal-mechanic and textile factories, paper mills, billowing smokestacks and gaping warehouses. They prefer to talk about how much they work. Almost apologetically they reveal that they are hurting.

Rudolph W. Giuliani, at age 76, is in the high-risk category for the virus.
Credit…Erin Schaff/The New York Times

Rudolph W. Giuliani, the former New York City mayor and President Trump’s personal and campaign lawyer, has tested positive for the coronavirus, Mr. Trump announced on Twitter on Sunday.

Mr. Giuliani has been admitted to Georgetown University Medical Center, according to a person who was aware of his condition but not authorized to speak publicly. Mr. Giuliani, at age 76, is in the high-risk category for the virus. Later Sunday, he wrote on Twitter: “Thank you to all my friends and followers for all the prayers and kind wishes. I’m getting great care and feeling good. Recovering quickly and keeping up with everything.”

His son, Andrew H. Giuliani, a White House adviser, said on Nov. 20 he had tested positive for the virus. He had appeared at a news conference with his father the day before.

Mr. Giuliani has been acting as the lead lawyer for Mr. Trump’s efforts to overthrow the results of the election. He has repeatedly claimed he has evidence of widespread fraud, but he has declined to submit that evidence in legal cases he has filed.

@RudyGiuliani, by far the greatest mayor in the history of NYC, and who has been working tirelessly exposing the most corrupt election (by far!) in the history of the USA, has tested positive for the China Virus. Get better soon Rudy, we will carry on!!!” Mr. Trump wrote on Twitter. It was unclear why Mr. Trump was the one announcing it.

Mr. Giuliani recently traveled to three battleground states that Mr. Biden won to make his case. On Thursday he attended a hearing at the Georgia Capitol, where he didn’t wear a mask. He also went maskless on Wednesday at a legislative session in Michigan, where he lobbied Republicans to overturn the results of the election there and appoint a slate of electors for Trump.

“Mayor Giuliani tested negative twice immediately preceding his trip to Arizona, Michigan, and Georgia,” the Trump campaign said. “The Mayor did not experience any symptoms or test positive for COVID-19 until more than 48 hours after his return.”

However, a person in contact with the former mayor said he began feeling ill late this past week.

The Arizona state legislature will close for a week after at least 15 current and incoming lawmakers were potentially exposed to the virus after interacting with Mr. Giuliani, the Arizona Capitol Times reported.

Mr. Giuliani has repeatedly been exposed to the virus through contact with infected people, including during Mr. Trump’s preparation for his first debate against President-elect Joseph R. Biden Jr. in September, just before the president tested positive.

His infection is the latest in a string of outbreaks among those in the president’s orbit. Boris Epshteyn, a member of the Trump campaign legal team, tested positive late last month. The same day, Mr. Giuliani attended a meeting of Republican state lawmakers in Pennsylvania about allegations of voting irregularities. One of the lawmakers at that meeting was notified shortly after, while at the White House, that he had tested positive.

Mark Meadows, the president’s chief of staff, and at least eight others in the White House and Mr. Trump’s circle, tested positive in the days before and after Election Day.

Mr. Trump was hospitalized on Oct. 2 after contracting the coronavirus. Kayleigh McEnany, the president’s press secretary, Corey Lewandowski, a campaign adviser, and Ben Carson, the housing secretary, are among those in the president’s circle who have tested positive this fall.

Mr. Giuliani appeared on Fox News earlier on Sunday. Speaking with the host Maria Bartiromo via satellite, Mr. Giuliani repeated baseless claims about fraud in Georgia and Wisconsin on “Sunday Morning Futures.” When asked if he believed Mr. Trump still had a path to victory, he said, “We do.”

On Monday, Gov. Gretchen Whitmer of Michigan said that a four-hour hearing last Wednesday with a roomful of unmasked witnesses had all the ingredients of a super-spreader event.

“That hearing last week was reckless, it was unnecessary and didn’t change a thing,” she said. “It’s action like this that threatens our ability to open up some of these businesses.”

Local health officials have said that anyone in the room during the hearing should get tested for the coronavirus and quarantine for 10 days. Lee Chatfield, the Republican House speaker, canceled the legislative session for Tuesday, noting that several lawmakers were waiting for the results of tests.

Melina Delkic, Kathleen Gray and Bryan Pietsch contributed reporting.

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‘Go for It’: U.K.’s First Vaccine Patient Encourages Others

Margaret Keenan, the first patient in Britain to receive the coronavirus vaccine, hopes to set an example for people hesitant to get vaccinated.

It was fine, it was fine. I wasn’t nervous at all. It was really good. “And what do you say to those who might be having second thoughts about this?” Well, I would say go for it. Go for it, because it’s free and it’s the best thing that’s ever happened, at the moment. So, do please go for it. That’s all I’ll say, you know. If I can do it, well, so can you.

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Margaret Keenan, the first patient in Britain to receive the coronavirus vaccine, hopes to set an example for people hesitant to get vaccinated.CreditCredit…Pool photo by Jacob King

Britain’s National Health Service delivered its first shots of the Pfizer-BioNTech Covid-19 vaccine on Tuesday, opening a mass vaccination campaign with little precedent in modern medicine and making Britons the first people in the world to receive a clinically authorized, fully tested vaccine for the disease.

Across the nation, vaccine centers are beginning the careful process of delivering vaccinations on a tight schedule, as the vaccine must be used or discarded within five days of being defrosted. “We’re doing it with military precision, and in fact, we have had the military helping with our planning too,” said Fiona Kinghorn, who oversaw the vaccine rollout at one site in Cardiff, Wales.

The effort marks a turning point in the remarkable race to produce a vaccine and the global effort to end a pandemic that has killed 1.5 million people worldwide. At one Welsh vaccination center, a retired nurse on the facility staff described the response by her most recent patient, another nurse. “She just cried and said this was such an emotional day,” she said, adding: “I think partly because she worked on a Covid ward, so she has seen the consequences and probably the outcomes. I presume she has seen a lot.”

At 6:31 a.m. Tuesday, Margaret Keenan, 90, a former jewelry shop assistant, rolled up the sleeve of her “Merry Christmas” T-shirt to receive the first shot, and her image quickly became an emblem of hope and resilience.

“I feel so privileged to be the first person vaccinated against Covid-19,” said Ms. Keenan, who lives in Coventry, in central England. “It means I can finally look forward to spending time with my family and friends in the new year after being on my own for most of the year.”

British regulators leapt ahead of their American counterparts last week to authorize a coronavirus vaccine, upsetting the White House and setting off a spirited debate about whether Britain had moved too hastily, or if the United States was wasting valuable time as the virus was killing about 2,200 Americans a day over the last week, as of Monday.

President Trump planned on Tuesday to issue an executive order proclaiming that other nations will not get U.S. supplies of its vaccine until Americans have been inoculated, a directive that appeared to have no real teeth but nevertheless was indicative of the heated race to secure shipments of doses.

For the people receiving vaccinations in Britain, among them doctors and nurses who have fortified the country’s National Health Service this year, the shots were an early glimpse at post-pandemic life. Besides Ms. Keenan, none attracted as much attention as William Shakespeare, who was second in line for a shot in Coventry and who, the National Health Service confirmed, really is named William Shakespeare. Twitter took the news of his vaccination as an opportunity for delighted wordplay, cracking jokes about the Taming of the Flu and the Gentlemen of Corona.

“Today is a great day for medical science, and the future,” Chris Whitty, the chief medical officer for England, said on Tuesday. (An earlier version of this item mistakenly said he was the chief medical officer for all of Britain.)

The first 800,000 doses of the Pfizer-BioNTech vaccine for Britain were transported in recent days from a manufacturing plant in Belgium to government warehouses in Britain, and then to hospitals.

Fifty hospitals will be administering the shots until the government can refine a plan for delivering them at nursing homes and doctor’s offices. The vaccine must be transported at South Pole-like temperatures before it can be stored for five days in a normal refrigerator, Pfizer has said. First to receive the vaccine will be doctors and nurses, certain people age 80 and over, and nursing home workers.

Some doctors and nurses have received invitations in recent days to sign up for appointments, with the first shots intended for those at the highest risk of severe illness. The government has indicated that people aged 80 and over who already have visits with doctors scheduled for this week, or who are being discharged from certain hospitals, will also be among the first to receive shots.

Nursing home residents, who were supposed to be the government’s top priority, will be vaccinated in the coming weeks, once health officials start distributing doses beyond hospitals.

Hundreds of people are still dying in Britain each day from the virus, and the country has made allowances for travel over the Christmas period that scientists fear will seed another uptick in infections.

“It is amazing to see the vaccine, but we can’t afford to relax now,” Prime Minister Boris Johnson of Britain said on Tuesday morning as he visited a London hospital. Trying to calm a recipient’s nerves about needles, he suggested, “I always try to think of something else — recite some poetry.”

Ms. Keenan, the first vaccine recipient, showed no such nerves. Nicola Sturgeon, Scotland’s first minister, said on Twitter that watching Ms. Keenan receive the shot gave her “a bit of a lump in the throat.”

“Feels like such a milestone moment after a tough year for everyone,” Ms. Sturgeon added.

Administering Ms. Keenan’s shot was May Parsons, a nurse who is originally from the Philippines and has worked for the National Health Service for 24 years.

“The last few months have been tough for all of us working in the N.H.S.,” she said, “but now it feels like there is light at the end of the tunnel.”

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transcript

transcript

Cuomo Outlines New Criteria for Virus Restrictions

With hospitalizations rising, Gov. Andrew M. Cuomo of New York outlined new criteria for regional shutdowns and for restricting indoor dining.

Today, the Department of Health is going to issue an order saying hospitals have to increase their bed capacity 25 percent. We can issue up to 50 percent, they can do that physically, but we’re only going to go to 25 percent because we don’t have a capacity criticality at this moment. If our hospital capacity becomes critical, we’re going to close down that region, period. We call closed down a Red Zone. What is critical hospital capacity? Our formula is if your seven-day average shows that within three weeks, you will hit critical hospital capacity, we close you down. So if your seven-day average says if that continues for three weeks, you’re going to hit critical hospital capacity we close you down. We want that three-week buffer. And then we call critical 90 percent of your hospital capacity. Five days, if the hospitalization rate doesn’t stabilize in New York City, we’re going to close indoor dining. We’re now at 25 percent in New York City. In the rest of the state, any region where the hospitalization rate doesn’t stabilize, they’re now at 50% percent capacity indoor dining, we’re going to go to 25 percent. We are looking at hospitalization capacity, and if we don’t get the rate under control and you are going to overwhelm your hospitals, we will have to go back to shutdown.

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With hospitalizations rising, Gov. Andrew M. Cuomo of New York outlined new criteria for regional shutdowns and for restricting indoor dining.CreditCredit…Mike Groll/Office of Governor Andrew M. Cuomo, via Associated Press

Amid a worrisome increase in the number of people hospitalized with the coronavirus across New York, Gov. Andrew M. Cuomo announced new criteria for rolling back the state’s reopening and reintroducing shutdown restrictions by region.

Under Mr. Cuomo’s new plan, the state health department will use hospitalization rates as thresholds for a shutdown and for restricting indoor dining.

For weeks, Mr. Cuomo has warned of rising cases, hospitalizations and rates of positive test results in every part of the state.

In an attempt to avoid restrictions, the state’s health department will order hospitals statewide to increase their capacity by 25 percent, a strategy it used in the spring as hospitals in and around New York City began to fill.

Mr. Cuomo also warned that the state would move to restrict indoor dining in areas where the hospitalization rate continued to increase. His announcement followed new guidance from the Centers for Disease Control and Prevention that said eating inside at restaurants was a high-risk scenario.

“If after five days, we haven’t seen a stabilization in a region’s hospitalization rate, we’re going to clamp down on indoor dining,” he said Monday.

The governor did not provide details on what numbers would represent “stabilization.” But he said that under his plan, restaurants in New York City could lose indoor dining as early as Monday, though it was not guaranteed. In other regions of the state, restaurants’ maximum indoor capacity would move from a 50 percent limit to 25 percent, he said.

Under his new plan, regions of the state will be forced to shut down if they appeared to be on track to hit a “critical” level of hospitalizations, which Mr. Cuomo said was 90 percent of their total capacity.

The state will look at the seven-day average rate of increase in a region’s hospitalization rate. If projections show that a region will hit 90 percent within three weeks, restrictions will be implemented that include the closing of non-essential businesses, limiting restaurants to takeout and delivery, and prohibiting nearly all gatherings.

None of the regions of the state had yet approached the threshold for a shutdown, Mr. Cuomo said.“We don’t have a capacity criticality at this point,” he said.

Mr. Cuomo also did not provide details about what threshold would need to be met for indoor dining to resume, providing an uncertainty that frustrated the city’s restaurant owners.

Mr. Constantinou added that for months, New York City’s 25,000 restaurants have been in a state of constant whiplash as they have adapted to shifting public health guidance and government regulations.

“They keep changing the laws on what’s safe, what’s not safe,” he said. “I feel like everyone’s confused.”

In contrast with Mr. Cuomo’s approach, Gov. Philip D. Murphy of New Jersey said on Monday that the state was not ready to suggest indoor dining should shut down.

“If we saw explicit waves of transmission coming out of the indoor dining experience, obviously we would have a different approach,” he said.

Even as the average rate of positive test results and the number of cases in New York has risen in recent weeks, Mr. Cuomo had been resisting imposing the kind of widespread shutdowns that he implemented in March.

Instead, the state has since October imposed targeted restrictions on smaller areas, known as “micro-clusters,” where positive test rates had been relatively higher. These included parts of New York City and its suburbs, as well as major population hubs upstate.

And as some of New York City’s public schools reopened in a reflection of changing public health thinking around the importance of keeping schools operating for younger students, Mayor Bill de Blasio announced a change on Monday to the data the city would use to measure the spread of the virus.

“Our indicators need to be retooled to reflect what we’re seeing now, and to make sure we’re giving people the fullest picture of what we’re facing,” Mr. de Blasio said at a news conference.

Mr. de Blasio said that the city would no longer report a daily rate of positive test results, since the seven-day average rate is more accurate. He said that the seven-day average rate citywide was 4.98 percent.

The city will also report probable cases as well as confirmed cases, and will add the number of positive antigen test results to the number of probable cases it reports. Though antigen tests are generally faster, they are less likely to detect the infection in people with a low viral load.

Mr. de Blasio said Monday that the city had recorded a seven-day average of 2,180 confirmed cases and 616 probable cases.

And the city will now track the seven-day average number of people hospitalized per 100,000 city residents, which he reported on Monday was at 2.28 people, and which the mayor said he hoped would dip below 2.

Students having their temperatures checked before entering Public School 316 in Brooklyn on Monday.
Credit…Anna Watts for The New York Times

New York City is reopening some of its public schools Monday in the teeth of a worsening coronavirus outbreak.

The decision to do so reflects changing public health thinking around the importance of keeping schools operating, particularly for young students, and the real-world experience of over two months of in-person classes in the city’s school system, the nation’s largest.

Schools around the country have had to make the difficult decision of when to close and what metrics to follow, with some staying open amid local positivity rates in the teens and others using low single-digit thresholds.

Of the nation’s 75 largest public school districts, 18 have gone back to remote learning in the past month, according to data compiled by the Council of the Great City Schools and reported in The Wall Street Journal.

In California, many of the biggest school districts were already closed before new restrictions took effect on Sunday in three regions of the state. The new restrictions include stay-at-home orders, but do not require schools that had reopened to close again (an earlier version of this item incorrectly said they do). In the last week, California has reported more than 150,000 new cases, a record for all states.

Decisions to shutter schools have often been made on the local level and in inconsistent ways. Some schools have “paused” for short periods of time — as was the case in dozens of Central Texas districts or recently in Delaware, at the governor’s suggestion. Others have opted for blended learning with some days in school and some days remote.

Many have endured jarring periods of closing, opening and closing again. All of the solutions seem to be leading to burnout, instability and turmoil. New York City students, parents and teachers have felt their own whiplash, from a full shutdown before Thanksgiving to a partial reopening less than three weeks later.

Mayor Bill de Blasio has committed himself to keeping schools open, his aides say, and has started with elementary schools and those for students with severe disabilities. (About 190,000 children in the grades and schools the city is reopening this week would be eligible.)

Three of the country’s largest districts — in Birmingham, Ala., Tulsa, Okla., and Wichita, Kan. — made the opposite decision and closed over the past week. In Birmingham, the superintendent said the pandemic was “drastically impacting our community and our schools.” In Tulsa, two public school employees died recently after testing positive for the virus. And several of Wichita’s public schools had so many staff members quarantined that they could hardly cover vacancies by the time the district decided to close, the superintendent said.

The United States has diverged from other countries around the world in closing schools but leaving indoor dining and bars open. Many parents have criticized that situation, saying that risks of infection are higher in restaurants and bars and that it prioritizes the economy over education. Across Europe and Asia, students, especially very young ones, have largely continued going to school while other parts of daily life have shut down.

While Mr. de Blasio’s decision was applauded by many parents, there is no guarantee that the pattern of chaos that they have faced will abate as the fall turns to winter. New York City’s rules for handling positive cases all but guarantee frequent and sudden closures of individual classrooms and school buildings.

And it remains unclear whether the city will be able to reopen its middle and high schools to in-person learning any time soon.

One thing that could hamper the city’s efforts, officials cautioned, is a truly rampant second wave in New York.

The test positivity rate has only increased since the city closed schools, and the seven-day rolling average rate exceeded 5 percent last week. Hospitalizations have quickly mounted. Still, Mr. de Blasio said on Monday that “the schools in this city are among the safest places to be.” He noted that later this week the city planned to reopen some schools on Staten Island, even though the borough has seen positive infection test rates surge recently.