As Eligibility for Coronavirus Vaccines Expands in U.S., So Does Confusion

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In Georgia, which has one of the country’s slowest vaccine distribution rates, health departments have been inundated with people trying to book appointments.
Credit…Nicole Craine for The New York Times

The evolving distribution system for coronavirus vaccines in the United States has opened up the prospect of inoculations to millions more people this week, but has simultaneously set off a new wave of confusion.

At least 28 states and Washington, D.C., have begun vaccinating older people, a New York Times survey shows, in many cases marking a shift in earlier plans that put medical workers and nursing home residents at the front of the line for the inoculations.

As cases and deaths from the coronavirus reach record levels across the country, much is in flux when it comes to states’ plans for distributing vaccines. At least 32 states have expanded their vaccination programs to include critical workers, such as police officers, teachers, grocery store employees and other people at risk of being exposed to the virus on the job. More than a dozen states have said they expect to expand their vaccination pools significantly before the end of the month.


Not prioritizing by age

The changing rollout in many states, which matches a new federal appeal this week that all people over 65 — not just those in long-term care facilities — should be prioritized, was embraced by many older people, who have been the most vulnerable to Covid-19 and have been waiting eagerly for vaccinations and a return to normal life. But the sudden availability to so many more people also caused a deluge of problems as people tried to figure out whether their state was now allowing them to get shots, how to sign up and where to go.

“Once we get people in, the experience is wonderful,” said Logan Boss, a spokesman for the Northwest Health District in Georgia, which on Monday expanded access to the vaccine to people over the age of 65.

Until then, the process can be fraught. “It’s the anxiety, the frustration, the difficulty people have in scheduling appointments — which we are making with a very limited supply of vaccine that comes in — in quantities that we don’t know until it arrives,” he said.

In states across the country, demand for the vaccine has far outweighed supply, leading to crashed websites, long lines outside vaccination clinics and overwhelmed public health departments that are facing a torrent of calls and emails.




While the federal government advises states on how best to distribute vaccines, states follow their own plans, and that has created a patchwork of policies. While some offered shots to older people in December or early January, most focused their initial plans on medical workers and those in long-term care facilities.

And the rules are changing by the day: At least 14 states and Washington, D.C., opened up vaccinations to older people this week, and some of those changes came after the new federal call on Tuesday to open up vaccines to a wider group.

Dr. David Kessler headed the Food and Drug Administration during the presidencies of George Bush and Bill Clinton.
Credit…Jason Henry for The New York Times

President-elect Joseph R. Biden Jr. has chosen Dr. David Kessler to help lead Operation Warp Speed, the program to accelerate development of coronavirus vaccines and treatments, according to transition officials.

Dr. Kessler, a pediatrician and lawyer who headed the Food and Drug Administration during the presidencies of George Bush and Bill Clinton, has been a key adviser to Mr. Biden on Covid-19 policy and is co-chair of the transition team’s Covid-19 task force.

He will replace Dr. Moncef Slaoui, a researcher and former drug company executive, who will become a consultant to Operation Warp Speed. Dr. Kessler will share top responsibilities for the initiative with Gen. Gustave F. Perna, who will continue as chief operating officer, according to a Biden transition spokesman.

Dr. Kessler’s responsibilities will cover manufacturing, distribution and the safety and efficacy of vaccines and therapeutics.

“Dr. Kessler became a trusted adviser to the Biden campaign and to President-elect Biden at the beginning of the pandemic, and has probably briefed Biden 50 or 60 times since March,” said Anita Dunn, a co-chair of the transition team. “When staff gets asked, ‘What do the doctors say?,’ we know that David Kessler is one of the doctors that President-elect Biden expects us to have consulted.”

Dr. Kessler will join Operation Warp Speed at a critical time. Although the program is widely credited with making possible the development of two highly effective coronavirus vaccines in record time, it has been much less successful at delivering the shots to the public — a complex task that it shares with numerous federal, state and local authorities.

The Trump administration has vowed to vaccinate 20 million people by the end of 2020, but as of Thursday, just over 11 million inoculations had been given, according to the Centers for Disease Control and Prevention.

Dr. Kessler is close to Dr. Anthony Fauci, the nation’s top infectious disease doctor, who became the leading governmental voice on the pandemic. The two worked closely to speed the development and approval of drugs that changed the course of the AIDS epidemic in the 1990s.

Global Roundup

A quarantine center under construction in Shijiazhuang, a city of 11 million people in northern China.
Credit…Yang Shiyao/Xinhua, via Associated Press

China’s National Health Commission said on Friday that more than 1,000 people nationwide were being treated for Covid-19, a day after the country reported its first coronavirus death on the mainland since May.

The commission said that 144 new cases had been recorded on Thursday, the highest daily figure since a series of new outbreaks began at the end of last year.

Of 1,001 total patients in China, the commission said, 26 were reported to be in serious condition. While the toll remains far lower than in other countries, the surge is challenging the government’s much-touted success in wresting the coronavirus under control.

Hebei, the northern province surrounding Beijing that has been hardest hit in the latest surge, reported 90 more cases on Thursday. New outbreaks have also appeared in the central province of Shaanxi and in Guangxi, a southern province that borders Vietnam.

The new outbreaks suggest that the virus is once again spreading widely despite the measures China has taken, including electronic monitoring and new lockdowns. More than 28 million people have been ordered to remain inside their homes — more than the number affected last January when the central government locked down Wuhan, the city where the virus was first reported.

The National Health Commission reported that nine of the 144 cases recorded on Thursday involved people returning to China, but most of the new ones have spread domestically.

In Shijiazhuang, a city of 11 million people where residents have been ordered to stay home since last week, the authorities have scrambled to build a large quarantine center in a rural district. The facility, which covers 82 acres, will ultimately have 3,000 trailer-like units, the state-run Xinhua news agency reported.

  • China’s Foreign Ministry said on Friday that it would allow a British scientist from the World Health Organization who had been stuck in Singapore to enter the country, after the scientist tested negative for coronavirus antibodies. The scientist is part of a team of experts from the health agency who arrived in the central city of Wuhan on Thursday to begin hunting for the source of the virus. Two members of the team — the British scientist and another from Qatar — were unable to enter because they had tested positive for coronavirus antibodies. The other 13 members are undergoing two weeks of quarantine in Wuhan, where the virus first emerged in late 2019.

In other developments around the world:

  • France strengthened border controls and extended a curfew to the entire country to keep the coronavirus in check, and the authorities warned that new restrictions are possible in the coming days if the epidemic worsens. For at least 15 days starting Saturday, everyone will have to be home and shops will have to close by 6 p.m., barring certain exceptions.

  • Britain on Friday started barring arrivals from Latin American countries and Portugal over fears of a coronavirus variant first detected in Brazil.

  • In northern India, hundreds of thousands of Hindu worshipers have gathered on the banks of Ganges River in recent days as part of the Kumbh Mela, an annual pilgrimage, despite the potential risks of coronavirus infection. India has reported more than 10 million cases during the pandemic, the second-highest tally in the world, and more 150,000 deaths. The country’s health authorities plan to begin a campaign on Saturday to inoculate 300 million people by August.

  • Thailand’s national tourism authority has named six resorts that are offering “golf quarantine” packages under a December law that allows foreigners who meet certain requirements to spend their mandatory two-week quarantine on the links. The agency said this week that Thailand “remains a golfer’s paradise even during the Covid-19 pandemic.”

  • Greece’s government said it would establish a dedicated police force for the public transit system in Athens after a subway employee was attacked by two passengers who refused to wear face masks. The attack this week, which was captured by security cameras, left the employee with a fractured nose, jaw and ribs.

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Biden Outlines $1.9 Trillion Economic Rescue Package

President-elect Joseph R. Biden Jr. on Thursday proposed a spending package to combat the economic downturn caused by the coronavirus. The plan includes $1,400 direct payments to individuals and more generous unemployment benefits.

During this pandemic, millions of Americans, through no fault of their own, have lost the dignity and respect that comes with a job and a paycheck. Millions of Americans never thought they’d be out of work — many of them never even envisioned the idea — are facing eviction, waiting for hours in their cars to feed their families as they drive up to a food bank. A growing chorus of top economists agree that the moment of crisis — in this moment of crisis, with interest rates at historic lows, we cannot afford inaction. Our rescue plan also includes immediate relief to Americans hardest hit and most in need. We will finish the job of getting a total of $2,000 in cash relief to people who need it the most. The $600 already appropriated is simply not enough. One in seven households in America, more than one in five Black and Latino households in America, report they don’t have enough food to eat. So we’re going to extend emergency nutritional assistance for 30 — for 43 million children and their families enrolled in the SNAP program through the rest of this year. To the millions of you just looking for a fighting chance in this economy, I promise you, we will not forget you. We understand what you’re going through. We will never, ever give up.

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President-elect Joseph R. Biden Jr. on Thursday proposed a spending package to combat the economic downturn caused by the coronavirus. The plan includes $1,400 direct payments to individuals and more generous unemployment benefits.CreditCredit…Amr Alfiky/The New York Times

President-elect Joseph R. Biden Jr. on Thursday proposed a $1.9 trillion rescue package to address the economic downturn and the coronavirus, outlining the type of sweeping aid that Democrats have demanded for months and signaling a shift in the federal government’s pandemic response as Mr. Biden prepares to take office.

The package includes more than $400 billion to respond to the pandemic directly, including money to accelerate vaccine deployment and safely reopen most schools within 100 days. Here’s a look at what’s in the plan.

He acknowledged the high price tag but said the country could not afford to do anything less. “The very health of our nation is at stake,” Mr. Biden said. “We have to act, and we have to act now.”

Mr. Biden detailed the initiative, called thee American Rescue Plan, in an evening speech in Delaware, effectively kicking off his presidency. The package, which would be financed entirely through increased federal borrowing, flows from the idea that the virus and the recovery are intertwined.

A $20 billion “national vaccine program” he announced envisions community vaccination centers around the country.

Mr. Biden also called for a “public health jobs program” to address his goals of bolstering the economy and the Covid-19 response while also rebuilding the nation’s fragile public health infrastructure. The proposal would fund 100,000 public health workers to engage in vaccine outreach and contact tracing.

At the same time, Mr. Biden is keen to address the racial disparities in health that have been exposed by the pandemic, which has also disproportionately claimed the lives of people of color. He pledged to increase funding for community health centers and intends to fund efforts to mitigate the pandemic in prisons and jails, where Black and Hispanic people and are overrepresented.

Ambulances at hospital in London on Wednesday.
Credit…Alastair Grant/Associated Press

Hospitals across England are stretched to the brink with Covid-19 patients, medical workers are at their breaking point, and the death toll is soaring.

Decisions about who dies and who is given a chance at survival through intensive care grow more challenging by the day. The amount of oxygen being given to severely ill patients has been reduced in a few hospitals to prevent a “catastrophic failure” of overstressed infrastructure. Ambulance crews frequently wait hours to offload patients. And medical workers on the front lines are reporting levels of emotional trauma that outstrip even those of combat veterans.

The number of hospitalized Covid-19 patients in England has risen sharply since Christmas and now dwarfs the spring peak by 70 percent, with almost 14,000 more patients in hospitals than on April 12.

Prime Minister Boris Johnson warned this week that there was a “very substantial” risk that many hospitals will soon run out of beds in intensive care units, even as the nation continues to set daily records for fatalities.

And although the number of new infections in England has started to show signs of slowing — with nearly 49,000 new cases reported on Thursday, compared with the recent high of more than 60,000 daily cases — the consequences of weeks of raging spread are being felt across the country.

Mr. Johnson’s cabinet is considering even tighter restrictions. The country is not only trying to contain a more contagious variant of the virus first seen in the fall, but also to fend off other highly infectious variants — one first detected in South Africa, and two in Brazil.

Prof. Neil Greenberg, a forensic psychiatrist based at King’s College London, released a report this week that showed nearly half of the staff treating the most seriously ill patients reported symptoms of post-traumatic stress disorder, severe anxiety and depression.

A similar survey of military veterans who had recently served in combat roles in Iraq or Afghanistan had a PTSD rate of 17 percent.

Debbie Heglin, a caregiver, got an injection of the Moderna vaccine at the Sonoma County Fairgrounds in California this week.
Credit…Jim Wilson/The New York Times

People who received two shots of the Moderna Covid-19 vaccine in its earliest, Phase 1 clinical trial are being offered a third shot, a so-called booster, as part of a continuing study to determine whether repeated vaccinations are needed and whether they are safe and effective, the company said on Thursday.

The vaccines made by Moderna and Pfizer, both using genetic material called mRNA, were shown in clinical trials to be about 95 percent effective at preventing symptomatic cases of Covid-19 when administered as a two-shot regimen. But they have not been in use long enough to tell how long the immunity lasts or whether additional booster shots will be needed.

“We anticipate that an additional dose could further boost the levels of neutralizing antibodies, should such a boost be required, and that this is expected to be an advantage of mRNA vaccines,” Colleen Hussey, a Moderna spokeswoman, said in a statement.

The immune system makes neutralizing antibodies in response to a virus or a vaccine, and can block the virus from breaking into cells.

The company’s statement said the boosters were being offered to participants six to 12 months after their second shot. Volunteers in early trials received different vaccine doses as part of the company’s attempts to calibrate the most effective amount of active ingredient to use.

The Moderna vaccine was ultimately given an emergency green light from the Food and Drug Administration as a two-dose vaccine of 100 micrograms of mRNA each. Trial volunteers who got lower doses might especially benefit from a third shot, said Akiko Iwasaki, an immunologist at Yale University.

In its statement, Moderna said that boosters might also be studied in people who took part in its later, Phase 3 study of 30,000 participants, “if accumulating antibody persistence data indicate that this is warranted.”

Company officials said at a conference this week that they thought protection should last at least a year, according to a report by CNBC. But Moderna’s chief executive, Stephane Bancel, also said in an interview with CNBC that the vaccine might have to be adjusted in the future to immunize people against new coronavirus variants or strains, much as flu vaccines are regularly revamped.

Sales in the Bronx on November.
Credit…James Estrin/The New York Times

As New York City officials strive to control the coronavirus by this summer, it is becoming clear that the economic fallout will last far longer: The city’s property tax revenues are projected to decline by $2.5 billion next year, the largest such drop in at least three decades.

The anticipated shortfall, which Mayor Bill de Blasio announced on Thursday, is largely driven by a projected drop in the value of office buildings and hotel properties, which have all but emptied out since the pandemic began.

Roughly half of the city’s tax revenue comes from real estate, and the economic projections suggest that the city’s budget will remain in a precarious position for the foreseeable future.

For now, the city will partly offset the loss with increased revenues from income taxes: The “rich got richer,” according to a slide from the mayor’s presentation.

But the city will still likely have to substantially cut spending elsewhere.

“This is just a total economic dislocation for certain industries,” the mayor said. “We’ve never seen anything like what’s happened to the hotel industry. We’ve never seen Midtown in the situation it is now.”

Mr. de Blasio and Gov. Andrew M. Cuomo, who have battled with the Trump administration for more federal aid, have expressed optimism that President-elect Joseph R. Biden Jr., together with a Democratic-led Congress, will bring substantial assistance.

Indeed, just before Mr. de Blasio’s expected announcement, the incoming Senate majority leader, Chuck Schumer, said that he and Mr. Biden had reached a deal for the federal government to cover the full costs of state and city expenses related to a disaster declaration from last March, when the virus was first discovered in New York.

The move is expected to save the state and city about $2 billion, money that Mr. Schumer’s office said could be used to “tackle Covid-related budget gaps.”

Still, few expect the federal government to be able to fully meet the budgetary needs of state and local governments.

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