C.D.C. Recommends That Nursing Homes and Health Workers Get Vaccines First

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A certified nursing assistant at a nursing home in New Mexico.
Credit…Isadora Kosofsky for The New York Times

An independent panel advising the Centers for Disease Control and Prevention voted Tuesday to recommend that residents and employees of nursing homes and similar facilities be the first people in the United States to receive coronavirus vaccines, along with health care workers who are especially at risk of being exposed to the virus.

The panel, the Advisory Committee on Immunization Practices, voted 13 to 1 during an emergency meeting to make the recommendation. The director of the C.D.C., Dr. Robert R. Redfield, is expected to decide by Wednesday whether to accept it as the agency’s formal guidance to states as they prepare to start giving people the shots as soon as two weeks from now.

“We are acting none too soon,” said Dr. Beth Bell, a panel member and global health expert at the University of Washington, noting that Covid-19 would kill about 120 Americans during the meeting alone.

States are not required to follow the panel’s recommendations, but they usually do. The final decision will rest with governors, who are consulting with their top health officials as they complete distribution plans.

The new recommendation is the first of several expected from the panel over the coming weeks, as vaccines developed by Pfizer and Moderna go through the federal approval process, on the thorny question of which Americans should be at the front of the long line to get vaccinated while supply is still scarce. The panel described it as an interim recommendation that could change as more is learned about how well the vaccines work in different age groups and how well the manufacturers keep up with demand.

The roughly three million people living in long-term care and those who care for them are a relatively clear target; 39 percent of deaths from the coronavirus have occurred in such facilities, according to an analysis by The New York Times. But states and health systems will ultimately have to decide which of the nation’s 21 million health care workers should qualify to receive the first doses, as there won’t be enough at first for everyone.

Pfizer and Moderna have estimated that they will have enough to vaccinate, at most, 22.5 million Americans by year’s end, with the required two doses, a few weeks apart. The C.D.C. will apportion the supply among the states, with the initial allocation proportional to the size of each state’s adult population.

The only member of the committee to vote against the recommendation was Dr. Helen Talbot, an infectious-disease specialist at Vanderbilt University, who expressed discomfort with putting long-term-care residents in the first priority group because the vaccines’ safety had not been studied in that particular population. “We enter this realm of ‘we hope it works and we hope it’s safe,’ and that concerns me on many levels,” she said before the vote.

But most panel members who offered opinions said they thought the high death rate among that group made it imperative to include it.

Dr. José Romero, the chairman of the panel, said that he felt strongly that its process had adhered to its core principles: “maximizing benefit and minimizing harm,” promoting justice and addressing health inequities. Dr. Bell, the co-chair, acknowledged that all of the members would have liked more data from clinical trials but said that because of the pandemic emergency, “we need to act.”

Also Tuesday, C.D.C. officials moved to decrease the quarantine time for people who may have been exposed to the coronavirus, according to a senior administration official who was not authorized to speak publicly. The move had been expected and encouraged by Vice President Mike Pence, who leads the White House coronavirus task force.

At a task force meeting on Tuesday afternoon, C.D.C. officials said they would reduce the guidance from 14 days to seven days for patients who have been exposed to the virus but who get a negative test, and to 10 days for people who do not get a test.

If adopted, the more relaxed guidance could lead to some infections being missed. Studies have found that the median incubation period for the virus is five days. A significant majority of people — 97.5 percent of those exposed to the virus — develop symptoms by the 12th day after infection.

A spokeswoman for the C.D.C. declined to comment on the change last week, saying only that the agency “is always reviewing its guidance and recommendations in the light of new understandings of the virus that causes Covid-19,” and that the change will be announced “when appropriate.”




‘We Can Get Started’: Britain to Begin Vaccine Campaign

Matt Hancock announced Wednesday that the National Health Service would start administering doses of a coronavirus vaccine as early as next week.

What we do know is that we can get started next week with that first load, and then several millions will be coming throughout December. And people will get — be contacted by the N.H.S. when it’s their turn. And I urge you very strongly to come forward because obviously being vaccinated is good for you. It’s approved as clinically safe by the regulator, and it’s good for your community, as well, to help keep — get this virus finally, under control once and for all. You know, 2020 has been just awful. And 2021 is going to be better, and help is on its way. Help is on its way with this vaccine, and we can now say that with certainty rather than with all the caveats that I normally have to put around that. This will take time to roll out. You’ve got to have that 21 days in between the jabs anyway. And we’ve got to get this rolled out at the speed of which it could be manufactured. But I’m confident now with the news today that from spring, from Easter onwards, things are going to be better.

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Matt Hancock announced Wednesday that the National Health Service would start administering doses of a coronavirus vaccine as early as next week.CreditCredit…Andrew Testa for The New York Times

Britain gave emergency authorization on Wednesday to Pfizer’s coronavirus vaccine, leaping ahead of the United States to become the first Western country to allow mass inoculations against a disease that has killed more than 1.4 million people worldwide.

The decision kicked off a vaccination campaign with little precedent in modern medicine, encompassing not only ultracold dry ice and trays of glass vials but also a crusade against anti-vaccine misinformation.

Britain beating the United States to authorization — on a vaccine codeveloped by the American pharmaceutical giant Pfizer, no less — may intensify pressure on U.S. regulators, who are already under fire from the White House for not moving faster to get doses to people. And it has stirred up a global debate about how to weigh the desperate need for a vaccine with the imperative of assuring people that it is safe.

“Help is on its way with this vaccine — and we can now say that with certainty, rather than with all the caveats,” the British health secretary, Matt Hancock, said on Wednesday, as the government exulted in the authorization.

While the go-ahead bodes well for Britain, which broke from the European Union’s regulatory orbit to approve the shot early, it will have no effect on the distribution of the hundreds of millions of doses that other wealthy countries have procured in prepaid contracts.

It also offers little relief to poorer countries that could not afford to buy supplies in advance and may struggle to pay for both the vaccines and the exceptional demands of distributing them.

The Pfizer vaccine, developed with BioNTech, a smaller German firm, must be transported at South Pole-like temperatures, a requirement that could dictate who will be vaccinated first in Britain: Nursing-home residents were supposed to be the top priority under an advisory committee’s plans, but efforts to limit transportation of the vaccine and ensure it remains cold may mean that National Health Service staff will receive the shots first.

The government said on Wednesday that 800,000 doses would be available by next week for health workers to begin administering. For Britain, which has suffered one of Europe’s highest per capita death tolls from the virus, the decision by its drug regulator testified to a vaccination strategy that has been the most aggressive in the West.

After the government strengthened an old law that allows Britain to step out from under the European Union’s regulatory umbrella in public health emergencies, its Medicines and Healthcare Products Regulatory Agency fast-tracked a review of the Pfizer vaccine, which was 95 percent effective in a late-stage trial.

The White House, concerned that Britain would approve a vaccine first, summoned Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, for a meeting on Tuesday. A panel of outside advisers to the F.D.A. is scheduled to meet on Dec. 10 to decide whether the agency should grant emergency authorization to the Pfizer vaccine.

While American regulators pore over raw data from vaccine makers to validate their results, their counterparts in Britain and elsewhere in Europe lean more heavily on companies’ own analyses. The European Union is set to conduct its own review of the Pfizer and BioNTech vaccine, after the companies submitted their final application to the bloc’s health authorities on Tuesday.

The global race to develop a vaccine is poised to shatter records for time to market. Around the world, researchers are testing 57 vaccines in clinical trials, and nearly 100 others are being tested in animals or cells. China and Russia have approved vaccines without waiting for the results of late-stage trials, known as Phase 3, which experts say raises serious risks.

In Russia, President Vladimir V. Putin announced on Wednesday that mass vaccinations of the general public would begin by the end of next week. In televised remarks, Mr. Putin said that more than two million doses of the Sputnik V vaccine had been produced. The health minister, Mikhail Murashko, said that more than 100,000 people had already received the vaccine.

There has been speculation that President Trump would fire Dr. Stephen Hahn because his agency failed to approve a vaccine before Election Day.
Credit…Al Drago for The New York Times

Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, was summoned to the White House on Tuesday morning to explain why regulators had not yet approved the emergency use of the Covid-19 vaccine developed by Pfizer, according to people familiar with the situation.

Mark Meadows, the White House chief of staff, called for the session out of concern that the British government may approve emergency use of a Covid-19 vaccine before American regulators act, embarrassing the Trump administration, government officials said. The meeting was reported earlier by Axios. 

The F.D.A.’s approval process for a vaccine is generally considered more stringent than Britain’s because vaccine makers are required to submit raw data for review. British regulators, like some of their European counterparts, rely more heavily on the companies’ own analyses of their data, experts say, although they reserve the right to verify the accuracy of those reports.

“F.D.A. is one of the few regulatory agencies in the world that actually looks at the raw data,” Dr. Hahn said in an interview on Tuesday with ABC News. “We are going to do our own analysis.”

An F.D.A. spokesman said that agency experts are reviewing “thousands of pages of technical information,” including data on the effect of Pfizer’s vaccine on various subgroups of clinical trial participants, as well as the company’s manufacturing controls.

For months, the White House has pressured the F.D.A. to speed up development and approval of a vaccine. Speculation has raged that President Trump would fire Dr. Hahn because his agency failed to approve a vaccine before Election Day.

One administration official said Dr. Hahn prepared for Tuesday’s meeting by pulling data from the past few weeks showing how productive the F.D.A. has been. Another described the meeting with Mr. Meadows as uneventful. The officials asked to remain anonymous because they weren’t authorized to speak publicly.

The British government is hoping that within days, its drug regulator will approve emergency use of Pfizer’s vaccine, whose data has been under a rolling review. Soon afterward, it could approve a vaccine developed by AstraZeneca and scientists from the University of Oxford. It’s possible Britain could approve a Pfizer vaccine before the F.D.A. does.

Pfizer and its German partner, BioNTech, announced on Nov. 18 that clinical trial results showed its vaccine was 95 percent effective and had no serious side effects. It submitted an application for emergency use authorization to the F.D.A. two days later. 

The F.D.A.’s outside advisory panel of experts is scheduled to meet to discuss the Pfizer vaccine on Dec. 10. Barring unexpected problems, regulators are expected to approve the request for emergency authorization in mid-December.

Eager to highlight that success, the White House said Tuesday that the president will host a “Covid-19 Vaccine Summit” on Dec. 8. Vice President Mike Pence, who heads the White House coronavirus task force, will also attend the meeting with private sector executives and governors. The meeting was first reported by the website StatNews.

The event will mark a rare appearance by the president since he lost the election. He has had few public events and did not attend the sole coronavirus task force briefing last month held by Mr. Pence and top government health officials.

“The president looks forward to convening leaders from the federal government, state governments, private sector, military and scientific community for a comprehensive discussion with the American people as the administration prepares to deliver this historic, lifesaving vaccine to every ZIP code in the United States within 24 hours of an F.D.A. approval,” a White House spokesman, Brian Morgenstern, said in a statement

Cook County Sheriff Tom Dart, right, who dealt with a large coronavirus outbreak at the Cook County Jail last Spring, has tested positive for the virus.
Credit…Scott Olson/Getty Images

Sheriff Tom Dart of Cook County, Ill., whose jail at one point had the nation’s largest known cluster of coronavirus cases, has tested positive for the virus, officials said on Tuesday.

At least 1,750 inmates and correctional officers at the Cook County jail have been infected since the pandemic began, including eight inmates and four officers who died of Covid-19. (An earlier version of this item incorrectly said that three officers had died.) The county, which includes Chicago, has more than 5.1 million residents, second only to Los Angeles County, Calif.

Sheriff Dart, who took office in 2006, continued to work long hours overseeing the jail as it sought to control the virus outbreak. He learned on Friday that he had tested positive, officials said.

He joined at least 30 other sheriffs across the nation who have contracted the coronavirus. The job often requires spending a significant amount of time in jails — congregate settings that are often crowded and unsanitary, and where social distancing can be all but impossible.

Sheriff Mark Lamb of Pinal County, Ariz., southeast of Phoenix, tested positive in June, just before he was scheduled to meet with President Trump; he went to an infirmary instead. In August, five Florida sheriffs tested positive after attending a law enforcement conference.

There have been at least 59,300 infections and 115 deaths in the nation’s jails, including 49 deaths among jail correctional staff. When state and federal prisons are included as well, the figures jump to at least 342,000 infections and 1,736 deaths.

Sheriff Dart began to isolate himself on Nov. 20 after experiencing symptoms consistent with Covid-19, according to a statement from his office. He was tested four days later and received the results Nov. 27, his office said.

Before he fell ill, Mr. Dart often spoke about the elaborate precautions he took to avoid getting sick and potentially infecting his family. During an interview with The Times in April, when the virus was raging inside the jail, he described coming home after working long days, removing his work clothes in the garage and leaving them in the car until he was satisfied that they were not contaminated.

A patient arriving by ambulance at Maimonides Medical Center in Brooklyn on Monday.
Credit…Dave Sanders for The New York Times

As New York City confronts a sharp rise in coronavirus cases, its health commissioner on Tuesday issued an advisory urging people over 65 years old or those who face an increased risk of severe illness from the virus to halt all nonessential activities and stay home as much as possible.

“We need you, if you’re older, if you have pre-existing conditions, to take additional precautions,” Mayor Bill de Blasio said at a news conference. The advisory does not carry penalties if not followed.

Still, the notice comes after the city has seen a sustained increase in positive test results and hospitalizations and a day after the governor warned that every region in the state was facing potential issues with hospitals being overrun. On Tuesday, the city reported a seven-day average rate of positive test results of 4.14 percent, its highest since early June. (Mr. de Blasio has said that the increase could reflect anomalies in testing over the Thanksgiving holiday, when fewer tests were conducted.)

The city health commissioner, Dave A. Chokshi, said that more than 1,100 patients with the coronavirus were hospitalized in the city, more than double the total from three weeks ago.

The numbers are far below those from the spring, when the city was a center of the pandemic and hundreds of virus-related deaths were reported each day. But Dr. Chokshi warned that the recent uptick in cases and hospitalizations followed a “tragically familiar pattern” that would likely bring more deaths as well.

Dr. Mitchell Katz, head of the city’s public hospital system, said that intensive-care units in the 11 public hospitals were about two-thirds full. But he also noted that the city had ventilators and personal-protective equipment ready if cases continued to rise.

“We are well prepared,” he said.

The state’s data show that 28 percent of the city’s intensive-care unit beds, across both public and private facilities, have been available on average in the last week.

The health commissioner’s advisory does not carry enforcement penalties, and does not require the closures of nonessential businesses, a move that would be under the authority of the state government.

The advisory, which mirrors guidance from the Centers for Disease Control and Prevention, recommends that older adults and those with underlying health issues leave home only to travel to work or school, or for essential visits to the doctor, grocery stores or pharmacies. It also covers those sharing households with those people, like caregivers.

In a statement, the city said the advisory was intended to “moderate case growth and preserve hospital capacity.” State health officials have expressed a similar concern: that hospitals may be overwhelmed given an expected jump in cases during the holiday season.

On Tuesday, Gov. Andrew M. Cuomo said that 3,774 people were hospitalized with the virus in New York State, its highest total since late May. The seven-day average rate of positive test results statewide was 3.97 percent, according to state figures.

“My projection is that the numbers will continue to go up through the holiday season,” he said.

Still, as in the city, the spike in the state’s hospitalizations is far less steep than it was in late March and early April.

Gareth Rhodes, an aide to Mr. Cuomo, said on Twitter that the number of virus patients hospitalized in the state had risen by an average of 131 per day in the last week, compared to a weekly average of 1,225 per day in the spring.

New York City accounts for 31.8 percent of those hospitalized statewide, Mr. Rhodes said. In the spring, when hospitalizations climbed above 18,000 statewide, the city accounted for 64.7 percent of the state’s hospitalizations.

Despite rising positivity rates statewide, Mr. Cuomo has resisted imposing the kind of widespread shutdowns seen in March.

In response to a question about the city’s advisory, Mr. Cuomo emphasized that it was “guidance” and not a restriction.

“New York City offers guidance, advice, which is the same advice and guidance that we have been issuing and they have been issuing and every expert has been issuing since this started,” he said.

Global Roundup

Preparing a shop ahead of reopening in London on Monday.
Credit…Andrew Testa for The New York Times

Much of England will swap lockdown for less stringent coronavirus restrictions, after Parliament approved new rules on Tuesday despite a substantial revolt among lawmakers in Prime Minister Boris Johnson’s Conservative Party.

The rebellion, by lawmakers who want to go farther in easing the limits on public life, underscored the rising tide of discontent among Mr. Johnson’s own members of Parliament over his handling of the pandemic, exacerbated by fears that the curbs could lay waste to large swathes of the hospitality industry.

Caught between the competing demands of this vocal faction of his lawmakers, and those of his more cautious scientific advisers, Mr. Johnson opted to keep stringent measures in place, including restrictions on many pubs and restaurants.

From Wednesday there will be some relaxation from the lockdown in all areas, as all stores, gyms, and hairdressers will be allowed to reopen. Religious services and weddings can restart, and limited numbers of spectators will be allowed at some outdoor sporting events.

But England will return to a system under which coronavirus restrictions differ from place to place, with areas of the country divided into three “tiers” based on an assessment of the coronavirus risks in each one. That is similar to the framework in place earlier in the year, which failed to prevent a second wave of the pandemic or avert last month’s lockdown.

In other global developments:

  • In France, President Emmanuel Macron said on Tuesday that he was considering implementing a widespread vaccination campaign next spring after a more targeted one for health workers and vulnerable populations. Mr. Macron, speaking at a news conference in Paris alongside Alexander De Croo, the Belgian prime minister, said there would probably be a first wave of priority vaccinations in early 2021 with first-generation vaccines, which might prove logistically complex to deploy. But Mr. Macron repeated that getting a vaccine would not be mandatory, and he insisted instead on a “strategy of conviction and transparency.”

  • The border between the United States and Canada will remain closed “until the virus is significantly more under control everywhere around the world,” Canada’s prime minister, Justin Trudeau, told the Canadian Broadcasting Corporation. The restrictions on nonessential travel, which were put in place March 21 and have been renewed monthly, do not affect trade.

  • Hamas, the militant group that rules the Gaza Strip, said on Tuesday that Yehya Sinwar, its chief in the territory, had tested positive for the coronavirus. Hamas said that Mr. Sinwar was doing “well” and was working while in quarantine.

  • Vietnam suspended commercial flights on Tuesday, two days after its first case was confirmed in 89 days. Two additional cases were reported in Ho Chi Minh City on Tuesday, both linked to a flight attendant who officials said violated quarantine regulations. Officials were working to trace the contacts of the three infected people, and Prime Minister Nguyen Xuan Phuc urged vigilance in prevention measures.

  • Ireland exited a six-week lockdown on Tuesday, reopening nonessential businesses, gyms and religious services. Health officials still discourage socializing, but groups of six people will be permitted inside bars and restaurants serving substantial meals starting on Friday.

  • The Netherlands began requiring masks in public buildings on Tuesday, making it one of Europe’s last countries to introduce the mandate. The government had long discouraged the use of masks, saying they promoted a false sense of security, before an abrupt shift in October when they advised people to use them. Violations under the new law will carry a fine of 95 euros, or $114.

  • In Spain, the regional leader of Madrid, Isabel Díaz Ayuso, inaugurated her flagship infrastructure project: a new hospital on Tuesday focused on patients affected by epidemics like Covid-19. The hospital has no patients yet, as only a quarter of its infrastructure has been installed and its medical staff is incomplete. Ms. Díaz Ayuso told reporters on Tuesday that “a new hospital can never be bad news,” but the project, which she announced in May, has come under intense criticism, with medical professionals and opposition politicians calling on her government to instead strengthen staffing and resources at existing hospitals.

  • After a Franciscan convent in northwestern Germany without a single known Covid-19 case tested its 161 nuns, 76 of the tests came back positive on Monday, signaling a potentially dangerous cluster in a religious community with many elderly members. “We have an outbreak,” Sister Maria Cordis Riker, who heads the convent, said in a telephone interview. “But we are grateful that so far, the course of the disease has been mild and no one is in hospital.” Local health authorities are trying to find out how the virus got into the convent, which has limited visits during the pandemic. For more than a century, the convent has maintained continuous prayer around the clock, but social distance and health regulations have obliged it to cut back to 50 percent of capacity — one nun praying at a time, instead of the usual two.

  • The United Nations said that the coronavirus pandemic has created a record need for global humanitarian aid, forecasting that 235 million people will require aid in 2021, an increase of 40 percent over the same period last year. The proportion of people needing aid rose to one in 33 people worldwide from one in 45 last year. Fighting off famine, poverty and disease while keeping children vaccinated and in school will require $35.1 billion in funding, or more than double the record $17 billion raised in 2020, the United Nations said.

  • As the busiest shopping period of the year begins after a monthlong lockdown in England, two of Britain’s retail giants — Debenhams and the Arcadia Group, which owns brands including Topshop and Miss Selfridge — have toppled in the last two days. The retailers employ about 25,000 people. More bankruptcies are expected, as the lockdowns have relentlessly exposed retailers that were slow to invest in online sales.

Passengers leave Los Angeles International Airport after arriving from Shanghai, China, after a positive case of the coronavirus was announced in the Orange County suburb of Los Angeles in January.
Credit…Ringo Chiu/Reuters

The coronavirus may have infected people in the United States as early as Dec. 13, more than a month earlier than researchers had thought, according to scientists who analyzed blood samples taken from American Red Cross donations. Outside scientists cautioned, however, that the virus was probably not spreading that early.

The researchers noted that they cannot say whether the apparent infections were in travelers who had been infected in other countries, or whether the infections themselves were dead ends, and did not lead to community transmission.

Before this new report, the earliest documented infection in the country was on Jan. 19 in someone who had traveled to China. Although other genetic studies have suggested the possible presence of the virus earlier than Jan. 19, the new study found that blood donations from nine states sent to the Centers for Disease Control and Prevention carried coronavirus antibodies — protein markers of past exposure to the virus.

But at least one prominent virus researcher cautioned that these results could be interpreted differently. Trevor Bedford, an epidemiologist at the University of Washington who has been deeply involved in genetic studies of how, when and where the virus has spread, said in a series of tweets that he thought the study could be identifying people who had antibodies to other human coronaviruses, which cause common colds, although he did not rule out that it may have picked up some cases of travelers who had been infected in other countries.

In the new report, which was released online Monday and has been accepted for publication in the journal Clinical Infectious Diseases, Dr. Sridhar V. Basavaraju of the C.D.C. and others reported that they had looked for antibodies that reacted to the specific virus that has caused the pandemic, SARS-CoV-2.

In more than 7,000 samples, 106 showed antibodies, they found. The researchers did not find these tests definitive, however, because they can sometimes reveal antibodies to other coronaviruses.

After further tests, they found one blood sample to be most convincing because it showed antibodies to a specific part of the SARS-CoV-2 protein. It was collected on Jan. 10 in Connecticut and was “likely from an individual with a past or active SARS-CoV-2 infection.” That person could have been infected while traveling.

About a dozen members of Congress have been infected in the last two weeks, and a patchwork of rules has led to inconsistent safety protocols.
Credit…Stefani Reynolds for The New York Times

Facing a dangerous spike in coronavirus cases among lawmakers, Congress’s attending physician appealed to members on Monday to steer clear of public dinners and receptions, stay in Washington rather than return home to their states between legislative sessions and keep masks on even when speaking on the House and Senate floors.

Dr. Brian P. Monahan’s recommendations were the most aggressive attempt yet to tamp down the spread of the virus around the Capitol, where about a dozen lawmakers have been infected in the last two weeks and a patchwork of rules has led to inconsistent safety protocols.

In a memo, the doctor detailed a relatively new rapid-testing program for lawmakers traveling to and from their home states, but also strongly discouraged them from traveling at all.

“During this time of dramatic and sustained increase in coronavirus transmission nationally, if you can remain in the Washington, D.C., region and avoid travel, that would be preferable,” Dr. Monahan wrote.

After months of unevenly imposed virus guidelines on Capitol Hill, where virus precautions have been the subject of partisan disputes, the physician urged lawmakers to improve their social-distancing and mask-wearing practices.

“Due to experience in the Congress of increased disease frequency occurring in certain circumstances, I recommend that you DO NOT ATTEND dinners, receptions or restaurant gatherings outside of your family unit,” Dr. Monahan wrote.

While face coverings are already mandated on the House floor and strongly encouraged for senators, Dr. Monahan said they would also be “required” anytime lawmakers or aides had contact with people outside their family unit. He also asked lawmakers to keep their faces covered when speaking on the floor of either chamber, a change for many members who routinely remove their masks when speaking.

He added that while those working in the Capitol were allowed to eat with a mask off for brief periods of time, “you MAY NOT sit at a table with a beverage or a partially consumed food item without a face cover for a prolonged period.”

Dr. Monahan also encouraged lawmakers to switch from cloth facial coverings to surgical masks and to consider using face shields, especially when they fly or travel on public transportation.

“Wherever possible, wear a face shield in addition to a face cover if you anticipate close crowding at these occasions,” he wrote.

In June, the New Hampshire House of Representatives met in the Whittemore Center at the University of New Hampshire, its first meeting away from the State House since the Civil War.
Credit…Charles Krupa/Associated Press

When the New Hampshire legislature — the largest in the country — assembles on Wednesday to launch its new session, it will do so outdoors, for the sake of coronavirus safety.

The 400 members of the lower chamber, the House of Representatives, will congregate with plenty of social distance on a field hockey pitch at the University of New Hampshire in Durham, according to Paul Smith, the House clerk. Members who choose not to wear masks can attend, but will be put in a separate section from those who wear them.

The much smaller Senate, with 24 members, will meet separately at another spot on the campus, and then join with the House later in the day, Mr. Smith said.

The decision to move outdoors, rather than use the university’s sports arena as it had in the spring, was made on Sunday “out of abundance of caution,” he said: “The fact is, we’ve seen an uptick in numbers across the state.”

New Hampshire has been averaging 422 new coronavirus cases a day lately, 27 percent more than the average two weeks ago, according to a New York Times database.

The State Constitution calls for the legislature to convene on the first Wednesday in December of even-numbered years for what is known as Organization Day, when members are sworn in and a speaker is elected, among other organizational business.

The leaders of the new Republican majorities in each chamber — Dick Hinch in the House and Chuck Morse in the Senate — announced on Sunday that they had proposed moving Organization Day outdoors, because “an outdoor venue will lower the risk for all members and staff.”

The worry isn’t hypothetical. After the House Republican caucus met at a ski resort in Manchester Nov. 20, a number of attendees tested positive. The state health department said on Tuesday that it was “aware of cases stemming from the event,” and was conducting contact tracing. Mr. Hinch said in a statement that the number of people affected was “very small” and that he had no reason to think they would attend the legislative session on Wednesday.

The outgoing Democratic speaker, Steve Shurtleff, said on Tuesday that about 50 Republican members were refusing to wear masks during House sessions. Gov. Chris Sununu is now allowing members to be sworn in remotely, and once the news about the Manchester event broke, Mr. Shurtleff said, more members have been calling in to say they would choose that option and not appear in person.

Shifting gears to get 400 chairs set up outside on short notice “presented many logistical challenges,” Mr. Smith said. But so far, the weather forecast seems to be cooperating: partly cloudy and breezy, with temperatures in the low 40s. “Thank God that that’s happening,” he said.

Younger students, like those lined up for the first day of kindergarten at P.S. 161 in Brooklyn last September, would return to in-person learning under Mayor de Blasio’s plan.
Credit…Juan Arredondo for The New York Times

After a summer of uncertainty and fear about how schools across the globe would operate in a pandemic, a consensus has emerged in recent months that is becoming policy in more and more districts: In-person teaching with young children is safer than with older ones, and particularly crucial for their development.

On Sunday, New York City, home to the country’s largest school system, became the most high-profile example of that trend, when Mayor Bill de Blasio announced that only elementary schools and some schools for children with complex disabilities would reopen after all city classrooms were briefly shuttered in November. There is no plan yet to bring middle and high school students back into city school buildings.

It was an abrupt about-face for the mayor, who had for months promised to welcome all of the city’s 1.1 million children — from 3-year-olds to high school seniors — back into classrooms this fall.

But the decision put New York in line with other cities around America and across the world, which have reopened classrooms first, and often exclusively, for young children, and in some cases kept them open even as they have confronted second waves of the virus.

In-person learning is particularly crucial for young children, who often need intensive parental supervision to even log on for the day, education experts say. And mounting evidence has shown that elementary school students in particular can be safe as long as districts adopt strict safety measures, though it’s an unsettled question for older students.

“With younger kids, we see this pleasant confluence of two facts: science tells us that younger children are less likely to contract, and seemingly less likely to transmit, the virus,” said Elliot Haspel, the author of Crawling Behind: America’s Child Care Crisis and How to Fix It. “And younger children are the ones that most need in-person schooling, and in-person interactions.”

Districts including Chicago, Washington D.C. and Philadelphia have either begun to bring back only young children or have plans to do so whenever they eventually reopen classrooms.

In Rhode Island, Gov. Gina Raimondo, a strong proponent of keeping schools open, recently asked colleges to shift to all-remote learning after Thanksgiving, and gave districts the option of reducing the number of high school students attending in person. But she asserted that middle and elementary schools were not sources of community spread.

That model of giving priority to younger students has been pioneered in Europe, where many countries have kept primary schools open even as most other parts of public life have shuttered during the continent’s second wave.

Italy has kept its primary schools open but kept teaching remote for middle and high schools. All schools in Germany are open, and discussions about possible closures have focused mainly on high schools.

And in America, more and more districts have begun to prioritize elementary school students for in-person learning.

In urban districts that have been slow to reopen, that has meant making plans to bring back the youngest students. In parts of the Midwest where school districts were more aggressive about reopening, and where there has been a huge rise in cases in recent weeks, public health officials have prioritized keeping elementary schools open even as they have closed high schools and in some cases middle schools.

“The data is becoming more compelling that there is very limited transmission in day care and grade schools,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of President-elect Joseph R. Biden Jr.’s coronavirus task force, in a recent interview.

“I keep telling people, ‘Stop talking about kids — talk about those younger than 10,’” he added. “We’re seeing a very different epidemiology in that group than we’re seeing, for example, in high school students.”

And while there’s great concern about how students are falling behind by not being in classrooms, new data released this week by the Northwest Evaluation Association, known as NWEA, a non-profit research group that provides assessments used by thousands of school districts to measure student growth and proficiency, shows that students lost modest ground in math, but held steady in reading on assessments administered this fall.

The analysis, based on the scores of 4.4 million students in grades three through eight, was on the whole encouraging, but came with important caveats. “While there’s some good news here, we want to stress that not all students are represented in the data, especially from our most marginalized communities,” said Beth Tarasawa, executive vice president of research at NWEA. “This increases the urgency to better connect to students and families who may be weathering the Covid storm very differently.”

A woman helped her daughter take a coronavirus test at the University of Minnesota last month.
Credit…Jenn Ackerman for The New York Times

A small but growing body of evidence, some of which has not yet been published in a peer-reviewed scientific journal, suggests that some rapid tests for the coronavirus may falter in children, letting low-level infections slip by unnoticed.

In a recent study of more than 1,600 people in Massachusetts, Binax NOW, a rapid test manufactured by Abbott Laboratories, caught 96.5 percent of the coronavirus infections found by a more accurate laboratory test in adults with symptoms. But the rapid test detected just 77.8 percent of the symptomatic cases in people 18 or under. Among people without symptoms, the test faltered further, identifying 70.2 percent of adults and 63.6 percent of children.

Another recent paper, published in November in Clinical Microbiology and Infection, found that a different rapid test by Abbott, called the PanBio, identified just 62.5 percent of coronavirus cases in people 16 or younger, compared with 82.6 percent of infections in adults, although the number of pediatric samples tested was small.

Children rarely seem to be stricken with serious cases of Covid, and the youngest among them may also be less likely to pass the coronavirus on to others. But the new findings should encourage more in-depth studies of diagnostic tools for the virus in pediatric populations, health experts said.

In medicine, children are often “assumed to be just miniature versions of grown-ups,” said Jennifer Dien Bard, a clinical microbiologist at Children’s Hospital Los Angeles. “But they are not just small adults. It’s really important that any testing that is available, that there are specific strategies offered for children and their specific needs.”

It may be that children are naturally predisposed to carry less of the virus. They might even be less likely to transmit it to others. For now, however, “if your goal is to detect infection, molecular tests are the way to go,” said Dr. Nira Pollock, the associate medical director of the infectious-diseases diagnostic laboratory at Boston Children’s Hospital, referring to laboratory diagnostics that use a different, less rapid method called polymerase chain reaction.

The White House Christmas decorations are themed “America the Beautiful.” The holiday season is one area where the norm-breaking president appears intent on savoring tradition.
Credit…Doug Mills/The New York Times

The red and gold party invitations make no mention of the coronavirus, nor do they acknowledge the holiday message that public health officials have been trying to emphasize to Americans: Stay home.

Instead, the invitations are the latest example of how President Trump is spending his final weeks in office operating in an alternative universe, denying the realities of life during the pandemic.

“The president and Mrs. Trump request the pleasure of your company at a holiday reception to be held at the White House,” reads the cursive text, displayed under a presidential seal.

Invitations to at least 20 White House parties, the first one on Monday at 7 p.m., have been sent out so far, according to administration officials. The guest lists include current and former officials and allies, some from out of state; Republican National Committee officials; campaign staff members; and some Republicans on Capitol Hill.

But in more than half a dozen interviews on Tuesday, many invitees said they did not plan to attend because of the personal risk that attendance would require. Others joked that since so many people in the president’s orbit had already tested positive for the virus, the White House had achieved herd immunity and was now a safe space for a quick stop to view the Christmas decorations.

The holiday party season, canceled across most of Washington, will be a rare time when the White House will feel busy. Inside the West Wing in recent weeks, there has been noticeably less foot traffic in and out of the Oval Office, as staff members pondering their career moves give a president who refuses to concede some space. Mr. Trump has made few public appearances since the election was called for Joseph R. Biden Jr.

But the holiday season at the White House — complete with a gingerbread house made with 25 pounds of chocolate and 25 pounds of royal icing by the in-house pastry team — is one area where the norm-breaking president appears intent on savoring tradition.

On the afternoon of Dec. 11, Mr. Trump is hosting a party for the West Wing staff and their families. There are also receptions planned for the evenings of Dec. 14 and Dec. 16, according to guests and copies of invitations. Officials said there were at least 20 holiday events on the calendar through December.

Stephanie Grisham, the chief of staff to Melania Trump, the first lady, said guests would be strongly encouraged to wear masks when they were not eating and the guest lists were smaller than usual. She did not say how many people were invited to each event.

Other restrictions were being put in place that were not instituted when the president hosted a large crowd for an indoor party on election night.

“Guests will enjoy food individually plated by chefs at plexiglass-protected food stations,” Ms. Grisham said in a statement. “All passed beverages will be covered. All service staff will wear masks and gloves to comply with food safety guidelines. Attending the parties will be a very personal choice. It is a longstanding tradition for people to visit and enjoy the cheer and iconic décor of the annual White House Christmas celebrations.”

The latest guidance from Mayor Muriel E. Bowser of Washington, a Democrat, limits indoor gatherings in the city to no more than 10 people. Beginning Dec. 14, restaurants in Washington are allowed to operate indoors only at 25 percent capacity.

The White House is exempt from the city’s restrictions because it is on federal property.

Stanford coach David Shaw during a game. Stanford will practice and play on the road the next two weeks because of coronavirus restrictions in Santa Clara County, Calif.
Credit…Jed Jacobsohn/Associated Press

Stanford University is taking its football team on the road to maneuver around public health restrictions in California.

In a statement on Tuesday, Stanford said its team would leave for Seattle later in the day to practice for Saturday’s game against the University of Washington. Next week, Stanford will prepare for its game against Oregon State University from Corvallis, Ore., after Pac-12 Conference officials moved the matchup there from the Stanford campus.

The university’s decision came a few days after the authorities in Santa Clara County, where Stanford is located, temporarily banned “all recreational activities that involve physical contact or close proximity to persons outside one’s household.”

“I am gravely concerned by the continuing surge in Covid-19 cases and hospitalizations,” Dr. Sara Cody, the Santa Clara County health officer, said when officials announced the new restrictions. “The number of patients hospitalized with Covid-19 in our county has doubled in just the past couple of weeks, and we are at risk of exceeding our hospital capacity very soon if current trends continue.”

The county’s order also affected the San Francisco 49ers, who will play their next two “home” games near Phoenix. San Jose State University, which is also in Santa Clara County, has not yet announced its plans to comply with the new restrictions, which will be in effect until at least Dec. 21.

Taxi drivers, protesting outside city hall in New York in late August, are one group of workers who may have a hard time in the post-coronavirus economy.
Credit…Amr Alfiky/The New York Times

The nation’s economic recovery from the pandemic will hinge to some extent on how quickly people can change jobs: whether show managers can become electricians, whether taxi drivers can become plumbers, how many cooks can manage software for a bank.

The labor market has recovered 12 million of the 22 million jobs lost from February to April. But many positions may not return any time soon, even when a vaccine is deployed.

This is likely to prove especially problematic for millions of low-paid workers in service industries like retailing, hospitality, building maintenance and transportation, which may be permanently impaired. What will janitors do if fewer people work in offices? What will waiters do if the urban restaurant ecosystem never recovers its density?

The prognosis is bleak. Marcela Escobari, an economist at the Brookings Institution, warns that even if the economy adds jobs as the coronavirus risk fades, “the rebound won’t help the people that have been hurt the most.”

Looking back over 16 years of data, Ms. Escobari finds that workers in the occupations most heavily hit since the spring will have a difficult time reinventing themselves. Taxi drivers, dancers and front-desk clerks have poor track records moving to jobs as, say, registered nurses, pipe layers or instrumentation technicians.

The virus is abruptly taking out a swath of jobs that were thought to be comparatively resilient, in services that require personal contact with customers. And the jolt has landed on workers with little or no education beyond high school, toiling in the low-wage service economy.

“The damage to the economy and particularly to workers will probably be longer lasting than we think it is going to be,” said Peter Beard, senior vice president for regional work force development at the Greater Houston Partnership.

What’s more, he said, the effects of the pandemic will intensify underlying dynamics that were already transforming the workplace. Automation, for one, will most likely accelerate as employers seek to protect their businesses from future pandemics.

Face masks are required on the boardwalk at Rehoboth Beach in Delaware as the state is experiencing a surge of coronavirus cases.
Credit…Mark Makela/Getty Images

The pandemic is accelerating in Delaware, the state newly thrust into the limelight as President-elect Joseph R. Biden Jr. builds his administration from his home in Wilmington. Daily reports of new Covid-19 cases in Delaware are up 50 percent from two weeks ago, according to a New York Times database.

The state saw relatively few cases through much of the year, but that has changed in the last month.

Delaware had 682 new cases on Tuesday, a record, said Jennifer Horney, the founding director of the epidemiology program at the University of Delaware. The state has averaged about 500 cases a day over the last week, more than triple the average in late October, according to the Times database.

“I think it is sort of like everywhere — people are fatigued and letting down their guard,” Dr. Horney said. “There is more community transmission among people of all ages.”

The number of Covid-19 patients in the state’s hospitals has doubled since the end of October, she said, and the state is bracing for even more patients once the lag time for infections over Thanksgiving has passed.

As of Wednesday morning, there had been at least 36,343 cases in Delaware and 777 deaths since the beginning of the pandemic, according to the Times database.

The state has been fairly consistent from the beginning of the pandemic in asking its residents to follow mitigation methods, including face masks and social distancing. Some of its regulations were tightened right before Thanksgiving, including capping gatherings in homes at 10 people, limiting indoor dining at restaurants to 30 percent of capacity and banning youth sports teams from leaving the state or playing opponents from out of state.

Given Delaware’s small size, residents often travel to the surrounding states — Maryland, Pennsylvania and New Jersey — all of which are seeing increasing cases. Still, the infection rates in the Mid-Atlantic states, relative to population, are still far below those in the upper Midwest.

In Delaware, previous outbreaks had been concentrated among the state’s large chicken farms and around the beach resorts in the southern part of the state. But these days, current cases are less linked to specific clusters and are spread more generally among people in the more populous north, Dr. Horney said.

The dosing of BNT162b2, the mRNA-based vaccine candidate against COVID-19, during the clinical test.
Credit…BioNTech/EPA, via Shutterstock

Pfizer and BioNTech have submitted their final application to the European health authorities for approval of their Covid-19 vaccine, the companies announced Tuesday.

Initial approval could come as early as Dec. 29 when the European Union’s medicine agency plans to meet in an extraordinary session to decide if the data submitted is “sufficiently robust” to show the safety and efficacy of the vaccine.

“Today’s announcement marks another key milestone in our efforts to fulfill our promise to do everything we can to address this dire crisis given the critical public health need,” Dr. Albert Bourla, chief executive of Pfizer, said in a statement.

Last month, Pfizer announced that the vaccine was more than 90 percent effective based on a Phase 3 study involving 43,538 participants, and that it had already submitted an application to the Food and Drug Administration in the United States to authorize it for emergency use.

“We will continue to work with regulatory agencies around the world to enable the rapid distribution, should the vaccine receive the approval, contributing to the joint efforts to let the world heal and regain its normal pace of life,” said Ugur Sahin, co-Founder of BioNTech, the German start-up that created the vaccine.

The news comes a day after Moderna, the makers of another promising vaccine, announced that it had applied for approval from the European market.

If the applications are approved by the European Medicines Agency, the first doses could be available before the end of the month. The agency is “assessing all the applications for COVID-19 medicines under the minimum time frame necessary to allow for a thorough evaluation of the medicine’s benefits and risks,” it said.

If the agency concludes that the benefits of the vaccine outweigh its risks, it will recommend a conditional marketing authorization, which the European Commission will then fast-track to approve in all European member states within days.

On Tuesday, BioNTech officials, speaking at a news conference, said vaccine doses were waiting for approval to be shipped.

“We have produced a stockpile; everything that we have can really be distributed within a few hours,” said Sierk Poetting, the company’s chief financial officer and chief operating officer.

Gaza’s Hamas Chief Yehya Al-Sinwar in Gaza City last year.
Credit…Mohammed Salem/Reuters
  • Hamas, the militant group that rules the Gaza Strip, said on Tuesday that Yehya Sinwar, its chief in the territory, had tested positive for the coronavirus. Hamas said that Mr. Sinwar was doing “well” and was working while in quarantine.

  • Vietnam suspended commercial flights on Tuesday, two days after its first case was confirmed in 89 days. Two additional cases were reported in Ho Chi Minh City on Tuesday, both linked to a flight attendant who officials said violated quarantine regulations. Officials were working to trace the contacts of the three infected people, and Prime Minister Nguyen Xuan Phuc urged vigilance in prevention measures.

  • Ireland exited a six-week lockdown on Tuesday, reopening nonessential businesses, gyms and religious services. Health officials still discouraged socializing, but groups of six people will be permitted inside bars and restaurants serving substantial meals starting on Friday.

  • The Netherlands began requiring masks in public buildings on Tuesday, making it one of Europe’s last countries to introduce the mandate. The government had long discouraged the use of masks, saying they promoted a false sense of security, before an abrupt shift in October when they advised people to use them. Violations under the new law will carry a fine of 95 euro, or $114.

Students at a high school in California in October. Schools in the state have relied on remote learning since March, exacerbating inequality among students.
Credit…Salgu Wissmath for The New York Times

Seven families sued the state of California on Monday over the quality of education that their children are receiving at home this year, saying they have been left behind by the shift to remote learning during the pandemic.

The suit argues that a lack of attention to the realities of remote learning has exacerbated inequality in schools and deprived minority students from poor families of their right to an education.

“The change in the delivery of education left many already underserved students functionally unable to attend school,” the lawsuit, which was filed Monday in the Alameda County Superior Court, asserts. “The state continues to refuse to step up and meet its constitutional obligation to ensure basic educational equality or indeed any education at all.”

The plaintiffs include 15 Black and Latino students in Oakland and Los Angeles, who range from kindergartners to high school seniors. The suit details their individual struggles as they try to continue their education despite a lack of sufficient computers, internet access and instruction.

For two twins in Oakland, who were in second grade when distance learning began, the experience “barely resembled learning,” the suit said. Their teacher held remote classes only twice between March 17 and the end of the school year. When the twins’ mother asked why, the teacher responded that because some students could not connect to the internet, classes were canceled for everyone, it said. The mother “felt like her children had been written off.”

Representatives of the state of California could not immediately be reached for comment.

California schools, with more than six million students, have relied on mostly remote learning since March. Early progress reports this fall showed a sharp drop in performance as students struggled to learn from home.

Some states are using emergency cellphone alerts regarding the coronavirus pandemic.
Credit…Susan Montoya Bryan/Associated Press

It was the day before Thanksgiving when Brian Stone, of Tilghman, Md., heard the alarm ring from his phone: the jarring buzz that tells people to look out for missing children or evacuate their homes to escape an advancing wildfire.

But this alert was different: It told him to wear a face mask and to expect stricter enforcement of coronavirus health orders.

Mr. Stone then turned off the notification system.

“You get this beep, this electronic sound, and you think it’s something important, and it’s just ‘Wear a mask and be safe,’” said Mr. Stone, whose wife, Ellen, wrote a letter to The Baltimore Sun about the emergency alert. “It wasn’t an emergency.”

Ed McDonough, a spokesman for the Maryland Emergency Management Agency, said: “We’ve been trying to be very judicious in how we use it.” Mr. McDonough said officials felt that with families gathering for Thanksgiving, it was important to remind them to be as safe as possible.

State and local officials are turning to the Wireless Emergency Alert system to warn residents of rising case counts and of other public health issues related to the virus. The model allows police departments and other public agencies to warn residents with geographically targeted messages, usually when there is severe weather or a child has been abducted.

In Los Angeles, officials used the system to tell residents that virus testing sites were expanding their hours ahead of the holidays.

On Monday, Rhode Island issued an alert to warn residents that hospitals were at capacity. And in Pennsylvania, Gov. Tom Wolf said in a news release last week that the state would use the alerts to target specific regions of the state with high case counts.

While emergency alerts provide an easy way to get important information to residents, the system also potentially oversaturates people with messages, creating a “boy who cried wolf” effect that could lead people, like Mr. Stone, to become disillusioned with the system.

Mr. Wolf said the alerts are “one more way to reach as many Pennsylvanians as we can to provide timely information on Covid-19.”

A Palestinian refugee receiving aid last month at the United Nations center in Gaza City.
Credit…Mohammed Abed/Agence France-Presse — Getty Images

The coronavirus pandemic has created a record need for global humanitarian aid, the United Nations said on Tuesday, forecasting that 235 million people will require aid in 2021, an increase of 40 percent over the same period last year.

The proportion of people needing aid rose to one in 33 people worldwide from one in 45 last year. Fighting off famine, poverty and disease, while keeping children vaccinated and in school, will require $35.1 billion in funding, or more than double the record $17 billion raised in 2020, the United Nations said.

Even as much of the world looks with hope to promising coronavirus vaccines, which could begin to be rolled out as early as next month, the lingering impact of the pandemic — including rising food prices, falling incomes and halted education — will disproportionately hit more vulnerable people, said Mark Lowcock, organization’s humanitarian and emergency relief efforts.

Extreme poverty will increase for the first time since the ’90s, life expectancy will fall, deaths from diseases like malaria and tuberculosis will double, twice as many people will face starvation, and many children will be unable to go back to school, he said.

“The rich world can now see the light at the end of the tunnel,” Mr. Lowcock said. “The same is not true in the poorest countries. The Covid-19 crisis has plunged millions of people into poverty and sent humanitarian needs skyrocketing.”

The United Nations presented its forecast in Geneva on Tuesday as it introduced its Global Humanitarian Overview, an annual assessment of projected needs. At the same event last December, before the coronavirus outbreak had grown to a global pandemic, the United Nations predicted 168 million people would need aid in 2020, requiring $28.8 billion in funding.

Its plan for 2021 would target aid to 160 million people in 56 countries, with the largest populations in Yemen, Ethiopia, the Democratic Republic of Congo, Afghanistan, Sudan, Syria and Nigeria.

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