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More than 27,000 new Covid-19 deaths have been reported in just the first 10 days of 2021, according to data from Johns Hopkins.

At this rate, more people could die from Covid-19 in January than any other month of this pandemic. December had a record high of 77,431 deaths due to Covid-19.

He also expressed concern about "the inevitable arrival of the more highly transmissible" strain of coronavirus that was first detected in the United Kingdom and has spread to at least eight US states, including California, Colorado, Connecticut, Florida, Georgia, New York, Pennsylvania and Texas.

There were 129,229 Covid-19 patients in US hospitals on Sunday, according to the COVID Tracking Project -- the sixth highest figure recorded. It was the 40th consecutive day that US Covid-19 hospitalizations remained above 100,000.

CNN medical analyst and emergency physician Dr. Leana Wen echoed that statement, telling CNN's Ana Cabrera Sunday, "The individuals who did not use masks or social distancing at the Capitol probably are also not following these guidelines when they go back to their home communities."

In Kentucky, Gov. Andy Beshear said his state was seeing a "real and significant increase in cases and our positivity rate from people's gatherings around the holiday."

"This surge that we're in right now is at least twice the rate, the seriousness, of the previous surges that we have seen," the governor said Friday. "This is our most dangerous time."

There were 7,497 Covid-19 patients in Florida hospitals on Sunday, according to the Florida Agency for Health Care Administration. That's about 3,000 patients more than were hospitalized in the state about a month ago, on December 12, when the AHCA reported 4,343 hospitalizations.

"The speed with which we are reaching grim milestones of COVID-19 deaths and cases is a devastating reflection of the immense spread that is occurring across the county," Los Angeles County Director of Public Health Barbara Ferrer said.

"The best way to protect ourselves, slow the spread, and stop overwhelming our hospitals, is to pause participating in any activities that aren't absolutely essential," she said.

Meanwhile, the nation's Covid-19 vaccine rollout "is absolutely not working as intended," said Dr. Megan Ranney, a CNN medical analyst and an emergency physician.

"We have three times as many doses that have been distributed to states as have actually gotten in arms," she said. "We have to do something different, and we have to do something different now."

President-elect Joe Biden will aim to release nearly all available doses of Covid-19 vaccines in an effort to quickly ramp up the US vaccine rollout, a spokesman for his transition team said.

But it could also be risky, because the vaccines by Pfizer/BioNTech and Moderna require two doses administered weeks apart to be about 95% effective, and vaccine manufacturing has not ramped up as rapidly as many experts had hoped.

Officials aren't recommending patients delay receiving their second doses, she said. People should still plan to receive the second dose of Pfizer's vaccine 21 days after the first dose, and the Moderna vaccine 28 days after the first dose.

"Right now, the issue is not so much supply, but it's actually that last mile of getting (vaccines) from the distribution sites to, actually, people's arms," she said. "If we have more supply, that's not actually solving for the right problem."

If there isn't enough vaccine in reserve for people to received second doses, she said, "I think that could really fuel vaccine hesitancy and further erode public trust in these vaccines."

n March of last year, Covid-19 infection and hospitalization numbers started climbing rapidly -- and deaths followed. At least 80% of the country's population was under stay-at-home orders.That was the first of several crushing surges. More than 33 million Americans have been infected with coronavirus, according to Johns Hopkins University, and more than 594,000 have died -- both numbers likely undercounts of the pandemic's true toll.

But now, the US is heading in the right direction, thanks to a powerful ally in the battle against the pandemic: Covid-19 vaccines.

Moderna said Tuesday it's seeking full approval for its vaccine from the US Food and Drug Administration.

Governors nationwide have eased Covid-19 restrictions, and nearly every state that had a mask mandate has now lifted it. But the pandemic certainly isn't over.

We all have more work to do," White House Covid-19 Response Team senior adviser Dr. Marcella Nunez-Smith said recently.

More than 50% of the US population has received at least one Covid-19 vaccine dose, CDC data shows, and more than 40% of the country is fully vaccinated.

Experts say they expect vaccine protection will last much longer than six months, to be confirmed as more data come in.

Both Pfizer and Moderna are also studying their vaccines in children as young as 6 months. Last month, the FDA granted Pfizer's vaccine an emergency use authorization for children 12 to 15.

But in practical terms for the public, there's not a big difference between emergency use authorization and full FDA approval, said Dr. Paul Offit, a member of the FDA's Vaccines and Related Biological Products Advisory Committee.

Both the Moderna and Pfizer vaccines have shown to be extremely safe in both clinical trials and in the real world, he said. Throughout the history of vaccines, he said, any serious side effects have happened within two months after inoculation.

For the first time in more than a year, millions of vaccinated Americans safely enjoyed close holiday gatherings without masks on Memorial Day.

But the majority of Americans still aren't fully vaccinated -- threatening the possibility of yet another post-holiday Covid-19 spike.

Any country that thinks the pandemic is over is wrong, said World Health Organization Director-General Tedros Adhanom Ghebreyesus.

"We're very encouraged that cases and deaths are continuing to decline globally, but it would be a monumental error for any country to think the danger has passed," he said.

‘Odds are, people are going to get sick this year,’”

In typical years, flu hospitalizes an estimated 140,000 to 710,000 people in the United States alone; some years, RSV can add on some 200,000 more. “Our baseline has never been great,” Yvonne Maldonado, a pediatrician at Stanford, told me. “Tens of thousands of people die every year.”

this time of year, on top of RSV, flu, and COVID, we also have to contend with a maelstrom of other airway viruses—among them, rhinoviruses, parainfluenza viruses, human metapneumovirus, and common-cold coronaviruses.

Illnesses not severe enough to land someone in the hospital could still leave them stuck at home for days or weeks on end, recovering or caring for sick kids—or shuffling back to work

“This is a more serious pathogen that is also more infectious,” Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison, told me. In the past year, COVID-19 has killed some 80,000 Americans—a lighter toll than in the three years prior, but one that still dwarfs that of the worst flu seasons in the past decade.

Globally, the only infectious killer that rivals it in annual-death count is tuberculosis

Rivers also pointed to CDC data that track trends in deaths caused by pneumonia, flu, and COVID-19. Even when SARS-CoV-2 has been at its most muted, Rivers said, more people have been dying—especially during the cooler months—than they were at the pre-pandemic baseline.

This year, for the first time, millions of Americans have access to three lifesaving respiratory-virus vaccines, against flu, COVID, and RSV. Uptake for all three remains sleepy and halting; even the flu shot, the most established, is not performing above its pre-pandemic baseline.

COVID could now surge in the summer, shading into RSV’s autumn rise, before adding to flu’s winter burden, potentially dragging the misery out into spring. “Based on what I know right now, I am considering the season to be longer,” Rivers said.

barring further gargantuan leaps in viral evolution, the disease will continue to slowly mellow out in severity as our collective defenses build; the virus may also pose less of a transmission risk as the period during which people are infectious contracts

even if the dangers of COVID-19 are lilting toward an asymptote, experts still can’t say for sure where that asymptote might be relative to other diseases such as the flu—or how long it might take for the population to get there.

it seems extraordinarily unlikely to ever disappear. For the foreseeable future, “pretty much all years going forward are going to be worse than what we’ve been used to before,”

although a core contingent of Americans might still be more cautious than they were before the pandemic’s start—masking in public, testing before gathering, minding indoor air quality, avoiding others whenever they’re feeling sick—much of the country has readily returned to the pre-COVID mindset.

When I asked Hanage what precautions worthy of a respiratory disease with a death count roughly twice that of flu’s would look like, he rattled off a familiar list: better access to and uptake of vaccines and antivirals, with the vulnerable prioritized; improved surveillance systems to offer  people at high risk a better sense of local-transmission trends; improved access to tests and paid sick leave

Without those changes, excess disease and death will continue, and “we’re saying we’re going to absorb that into our daily lives,” he said.

And that is what is happening.

last year, a CDC survey found that more than 3 percent of American adults were suffering from long COVID—millions of people in the United States alone.

“We get used to things we could probably fix.” The years since COVID arrived set a horrific precedent of death and disease; after that, this season of n+1 sickness might feel like a reprieve. But compare it with a pre-COVID world, and it looks objectively worse. We’re heading toward a new baseline, but it will still have quite a bit in common with the old one: We’re likely to accept it, and all of its horrors, as a matter of course.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Friday that the best way for the country to avoid another Covid-19 surge -- and another shut down -- is to get vaccinated.

A recent CNN analysis of CDC data found that the pace of newly-vaccinated adults will fall short of the Biden administration's goal of 70% of adults with one dose by July 4.

At present, 12 states have already met Biden's one-dose goal: California, Connecticut, Hawaii, Massachusetts, Maryland, Maine, New Hampshire, New Jersey, New Mexico, Pennsylvania, Rhode Island and Vermont.

The push to increase vaccinations is highlighted by further evidence that the mass vaccination programs this year have contributed greatly in the fight against Covid-19.

A daily average of 49,000 new cases reported to the CDC at the start of May has fallen to less than 14,000 Thursday.

Nearly 170 million people -- just over half of the total US population -- have received at least one dose of vaccine, and about 137.5 million people -- 41.4% of the population -- are fully vaccinated.

The CDC says vaccinated people may stop wearing masks in most cases, but unvaccinated people should continue to use them.

About 1.4 million new doses of Covid-19 vaccines have been administered since Thursday,

In Kentucky, Gov. Andy Beshear announced the state's new Covid-19 vaccine incentive which will give vaccinated adults "a shot at a million dollars," he said.

More than 2 million Kentuckians have already been vaccinated, but Beshear anticipates "a significant increase" following Friday's announcement, he said.

In Colorado, Gov. Jared Polis presented Sally Sliger with a super-sized check for $1 million as the winner of the first drawing in the state's 'Comeback Cash' initiative.

As vaccines continue to go into the arms of eligible teens and adults, health officials remain concerned over the safety of children. Only those ages 12 years and older are currently eligible to receive a Covid-19 vaccine in the US.

Research showing an increase in Covid-19 hospitalization rates among adolescents in the US is a reminder that even children can suffer from the virus,

As a result, bans on school mask mandates in states like Texas are irresponsible and could result in more children getting sick, Offit said.

Hawaii, which has maintained some of the toughest travel restrictions throughout the pandemic, is beginning to loosen rules on air travel, dropping its testing and quarantine requirements for people flying between the Hawaiian islands starting June 15. All pandemic restrictions will be lifted once the full vaccination rate reaches 70%,

The FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC), on which Offit sits, is set to meet on June 10 to discuss what the FDA should consider in either authorizing or approving the use of coronavirus vaccines in children under 12.

Both Moderna and Pfizer are running trials for their vaccines in children ages 11 and under.

Sars-CoV-2 shares between 80% and 90% of its genetic material with the virus that caused Sars – hence its name. Both consist of a strip of ribonucleic acid (RNA) inside a spherical protein capsule that is covered in spikes. The spikes lock on to receptors on the surface of cells lining the human lung – the same type of receptor in both cases – allowing the virus to break into the cell. Once inside, it hijacks the cell’s reproductive machinery to produce more copies of itself, before breaking out of the cell again and killing it in the process.

Coronaviruses have caused two other recent epidemics – severe acute respiratory syndrome (Sars) in China in 2002-04, and Middle East respiratory syndrome (Mers), which started in Saudi Arabia in 2012. In both cases, work began on vaccines that were later shelved when the outbreaks were contained.

Though nobody could have predicted that the next infectious disease to threaten the globe would be caused by a coronavirus – flu is generally considered to pose the greatest pandemic risk – vaccinologists had hedged their bets by working on “prototype” pathogens.

Cepi’s original portfolio of four funded Covid-19 vaccine projects was heavily skewed towards these more innovative technologies, and last week it announced $4.4m (£3.4m) of partnership funding with Novavax and with a University of Oxford vectored vaccine project.

Some of the Covid-19 vaccine projects are using these tried-and-tested approaches, but others are using newer technology.

All vaccines work according to the same basic principle. They present part or all of the pathogen to the human immune system, usually in the form of an injection and at a low dose, to prompt the system to produce antibodies to the pathogen. Antibodies are a kind of immune memory which, having been elicited once, can be quickly mobilised again if the person is exposed to the virus in its natural form.

Clinical trials, an essential precursor to regulatory approval, usually take place in three phases. The first, involving a few dozen healthy volunteers, tests the vaccine for safety, monitoring for adverse effects. The second, involving several hundred people, usually in a part of the world affected by the disease, looks at how effective the vaccine is, and the third does the same in several thousand people. But there’s a high level of attrition as experimental vaccines pass through these phases.

There are good reasons for that. Either the candidates are unsafe, or they’re ineffective, or both. Screening out duds is essential, which is why clinical trials can’t be skipped or hurried. Approval can be accelerated if regulators have approved similar products before.

No vaccine made from genetic material – RNA or DNA – has been approved to date, for example. So the Covid-19 vaccine candidates have to be treated as brand new vaccines, and as Gellin says: “While there is a push to do things as fast as possible, it’s really important not to take shortcuts.”

It’s for these reasons that taking a vaccine candidate all the way to regulatory approval typically takes a decade or more, and why President Trump sowed confusion when, at a meeting at the White House on 2 March, he pressed for a vaccine to be ready by the US elections in November – an impossible deadline.

In the meantime, there is another potential problem. As soon as a vaccine is approved, it’s going to be needed in vast quantities – and many of the organisations in the Covid-19 vaccine race simply don’t have the necessary production capacity. Vaccine development is already a risky affair, in business terms, because so few candidates get anywhere near the clinic. Production facilities tend to be tailored to specific vaccines, and scaling these up when you don’t yet know if your product will succeed is not commercially feasible. Cepi and similar organisations exist to shoulder some of the risk, keeping companies incentivised to develop much-needed vaccines. Cepi plans to invest in developing a Covid-19 vaccine and boosting manufacturing capacity in parallel, and earlier this month it put out a call for $2bn to allow it to do so.

The problem is making sure the vaccine gets to all those who need it. This is a challenge even within countries, and some have worked out guidelines. In the scenario of a flu pandemic, for example, the UK would prioritise vaccinating healthcare and social care workers, along with those considered at highest medical risk – including children and pregnant women – with the overall goal of keeping sickness and death rates as low as possible. But in a pandemic, countries also have to compete with each other for medicines.

Because pandemics tend to hit hardest those countries that have the most fragile and underfunded healthcare systems, there is an inherent imbalance between need and purchasing power when it comes to vaccines.

Outside of pandemics, the WHO brings governments, charitable foundations and vaccine-makers together to agree an equitable global distribution strategy, and organisations like Gavi, the vaccine alliance, have come up with innovative funding mechanisms to raise money on the markets for ensuring supply to poorer countries. But each pandemic is different, and no country is bound by any arrangement the WHO proposes – leaving many unknowns.

The risk of Covid-19 death for people from Chinese and mixed ethnic groups was found to be similar to that for white people.

Guardian research last month confirmed suspicions that minority groups faced the greatest risk from the coronavirus and showed that areas with high ethnic minority populations in England and Wales tended to have higher mortality rates in the pandemic.

“We cannot ignore how important racial discrimination and racial inequalities, for example, in housing, are, even among poorer socio-economic groups,” she said. “These factors are important but are not taken into account in most statistical modelling of Covid-19 risk factors.”

These groups are more likely to work in frontline roles in the NHS in England: nearly 21% of staff are from ethnic minorities, compared with about 14% of the population of England and Wales. Black, Bangladeshi and Pakistani populations have been shown to face higher levels of unemployment and child poverty than white groups.

The authors called for further research on the contribution of occupational risk and whether people from BAME backgrounds were placed at increased risk of exposure and infection.

To try to understand how much of the difference in Covid-19 morbidity was to do purely with ethnicity, the statisticians adjusted for age as well as region, rural and urban classification, area deprivation, household composition, socio-economic position, highest qualification held, household tenure, and health or disability as recorded in the 2011 census.

After all these factors were accounted for, Indian men and women were less likely than people from Bangladeshi and Pakistani background to die from Covid-19, but were still 1.3 times and 1.4 times more vulnerable than white people.

The ONS also checked to see if, within ethnic groups, socio-economic class made a difference. They found that the differences in risk of Covid-19-related death across ethnic groups were of similar magnitudes within all three socio-economic classes.

Some groups may be over-represented in public-facing occupations and could be more likely to be infected by Covid-19 . About 12.8% of workers from Bangladeshi and Pakistani backgrounds work in public-facing transport jobs such as bus, coach and taxi driving, compared with 3.5% of white people. The ONS said it plans to conduct further work to identify occupations that are particularly at risk.

Like the ONS data, the study found that people of black and Asian backgrounds were at higher risk of death, and it ruled out the idea that this was largely due to higher rates of underlying medical problems in these groups.

“It doesn’t have to be like this. As a society that prides itself on justice and compassion, we can and must do better.”

The study, which has not yet been peer-reviewed, found that people from deprived social backgrounds were also at a higher risk, and again this finding could not be explained by other risk factors.

The research accounts for health problems reported by people who filled in the 2011 census, but Hanif said differences in the extent of other underlying diseases in different ethnic groups in Britain – so-called co-morbidities – which have not been accounted for by the ONS, may be significant. For example, in the UK people of Pakistani and Bangladeshi descent are

“We have commissioned Public Health England to better understand the different factors, such as ethnicity, obesity and geographical location that may influence the effects of the virus.”

COVID-19 translational research is moving science from the bench preclinical stage of cell and animal research and rapidly through three phases of clinical trials. We can anticipate vaccines being at the patient/population “bedside” in the next few months.

Delaware has created a framework for COVID-19 vaccine distribution when it becomes available which can be found on coronavirus.Delaware.gov. Delaware’s distribution will have three phases

The state will begin with healthcare workers and those caring for vulnerable populations and other first responders and critical infrastructure workers. The second phase will vaccinate vulnerable persons: people over 65, those with chronic health conditions, homelessness and other vulnerabilities.Lastly, the rest of our Delaware population of more than 970,000 will be vaccinated.

And sadly, Black and Brown communities have been disproportionately infected and affected by COVID-19 here in Delaware and throughout the U.S. These communities remain vulnerable.

When COVID-19 vaccines become available, Black and Brown communities must be given equitable access to the vaccine.

The disproportionate effects of the COVID-19 pandemic on Black and Brown communities has pulled back a curtain of silence on the systemic racism in the health and healthcare systems in Delaware and across the United States.

Our real concern, the logic goes, should be for younger people who have their whole lives ahead of them and are sacrificing their economic futures to lockdowns. This collapse of the inter-generational compact has been far more effective at killing them off than any death panel dreamed up in Sarah Palin’s fevered imagination.

Similarly, ethnic and racial minorities including African Americans, Latinos/Hispanics, and Native Americans have all been disproportionately affected by COVID-19

Farm and food processing workers—dominated by Latino and other immigrant workers—are another population that has disproportionately been affected by COVID-19.

That social reciprocity has broken down to this degree ought to be an embarrassment and shame to us all.

Heavily agricultural regions like California’s Central Valleyand Washington State’s Yakima Valley have seen huge COVID spikes. In response, the U.S. Department of Labor has so far levied just $29,000 in fines against two companies, Smithfield and JBS, who have combined sales of $65 billion per year.

Adding to the misery of COVID-vulnerable populations is an unfortunate, and very human, tendency to find reasons to blame disadvantaged groups for their illness.

Reviewing the data and history pandemic discrimination, it’s hard to escape the conclusion that the majority of America has concluded that these groups—the poor, the minority, the imprisoned, and the elderly—are the “acceptable” losses.

Were the situation reversed and the white, middle aged, and middle/upper classes the primary victims of the pandemic—one of the features of the 1918 influenza—COVID-19 would be a true national emergency and there would be far less complaining about disrupted schools, work, and social life brought about by social distancing requirements and economic shutdowns

Last are the millions of Americans behind bars. Per statistics from the Marshall Project, there have been more than 121,000 COVID-19 cases reported among prisoners and more than a thousand deaths.

The message seems to be that Americans have abandoned e pluribus unum (out of many, one) for “everyone—or at least every group—for themselves.”

Pro-lifers have for decades protested American indifference to the deaths of millions of unborn children (another invisible and voiceless minority), and they have been right to do so. Where are these champions of human life when other weak and vulnerable populations are dying at the rate of a thousand a week or more?

as the federal government has left it to states to determine what to do with the vaccines it ships to them, and with some states pushing decision-making to local health departments and hospitals, the process has gone far from smoothly.

“There may have been an expectation from Operation Warp Speed or others that we’d give everyone the vaccine overnight.…It was a logistics equation for them. If you’ve been in vaccines for a long time, you know that’s the easy part. Getting it into actual arms is the hard part.”

Sen. Mitt Romney (R., Utah) criticized the vaccine rollout, saying in a statement that the lack of a comprehensive federal plan to be shared with states “is as incomprehensible as it is inexcusable.”

Public health officials and states say uptake is lagging for several reasons, beginning with holiday seasons that have kept staff of hospitals and nursing homes away from work. They also note they are facing high percentages of people, including some health-care workers, who are skeptical of taking the shots.

Hospitals and other sites are staggering appointments to avoid pulling too many workers from caring for patients amid a nationwide surge in Covid-19 cases, officials say. Administration of the vaccines also takes more time than a typical flu shot, particularly since they are being done in a socially distant way and may be preceded by a Covid-19 test.

Different state policies have led to confusion and shipment delays for hospitals, said Michael Wascovich, vice president of field pharmacy services for Premier Inc., a group purchasing organization whose members include 4,100 hospitals, 80% of which received doses.

“Every state is doing what they want to do,” he said. “You could be in Philadelphia and it’s completely different across the river if you’re in Trenton or Camden.”

Many states are following CDC guidelines to start with front-line medical workers and people in long-term care facilities, but not all. Florida Gov. Ron DeSantis on Dec. 23 extended eligibility to people aged 65 and older. Because each county and hospital in the state implemented its own approach, many people didn’t know whether to call, log on or show up in person to secure a spot.

CVS has begun administering doses at nursing homes and facilities in 48 states and Washington, D.C., with most eligible residents agreeing to be vaccinated, said Chris Cox, a CVS executive who is overseeing the vaccination rollout for the pharmacy chain.

In some cases, residents haven’t been vaccinated because of active outbreaks at facilities, while other facilities have taken longer than others to schedule their vaccination clinics, a challenge exacerbated by the holiday season, Mr. Cox said.

In May, the Centers for Disease Control and Prevention updated its guidelines to clarify that while COVID-19 spreads easily among speakers and sneezers in close encounters, touching a surface “isn’t thought to be the main way the virus spreads.” Other scientists have reached a more forceful conclusion. “Surface transmission of COVID-19 is not justified at all by the science,”

Surface transmission—from touching doorknobs, mail, food-delivery packages, and subways poles—seems quite rare.

n the past few months, scientists have converged on a theory of how this disease travels: via air. The disease typically spreads among people through large droplets expelled in sneezes and coughs, or through smaller aerosolized droplets, as from conversations, during which saliva spray can linger in the air.

All those studies that made COVID-19 seem likely to live for days on metal and paper bags were based on unrealistically strong concentrations of the virus. As he explained to me, as many as 100 people would need to sneeze on the same area of a table to mimic some of their experimental conditions. The studies “stacked the deck to get a result that bears no resemblance to the real world," Goldman said.

an obsession with contaminated surfaces distracts from more effective ways to combat COVID-19. “People have prevention fatigue,” Goldman told me. “They’re exhausted by all the information we’re throwing at them. We have to communicate priorities clearly; otherwise, they’ll be overloaded.”

Hygiene theater can take limited resources away from more important goals. Goldman shared with me an email he had received from a New Jersey teacher after his Lancet article came out. She said her local schools had considered shutting one day each week for “deep cleaning.” At a time when returning to school will require herculean efforts from teachers and extraordinary ingenuity from administrators to keep kids safely distanced, setting aside entire days to clean surfaces would be a pitiful waste of time and scarce local tax revenue.

As long as people wear masks and don’t lick one another, New York’s subway-germ panic seems irrational. In Japan, ridership has returned to normal, and outbreaks traced to its famously crowded public transit system have been so scarce that the Japanese virologist Hitoshi Oshitani concluded, in an email to The Atlantic, that “transmission on the train is not common.”

By funneling our anxieties into empty cleaning rituals, we lose focus on the more common modes of COVID-19 transmission and the most crucial policies to stop this plague. “My point is not to relax, but rather to focus on what matters and what works,” Goldman said. “Masks, social distancing, and moving activities outdoors. That’s it. That’s how we protect ourselves. That’s how we beat this thing.”

Moderna’s full approval request comes as more than 50 percent of the U.S. population has received at least one dose of a vaccine, but the pace of vaccinations has dropped sharply since mid-April. A recent poll from the Kaiser Family Foundation showed signs that some hesitant people have been persuaded: About a third of people who had planned to “wait and see” whether they would get vaccinated said that they had made vaccine appointments or planned to do so.

In the past two decades, the list of British calamities, policy misjudgments, and forecasting failures has been eye-watering: the disaster of Iraq, the botched Libyan intervention in 2011, the near miss of Scottish independence in 2014, the woeful handling of Britain’s divorce from the European Union from 2016 onward

What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years

The most difficult question about all this is also the simplest: Why?

The human immune system actually has two parts. There is, as Cummings correctly identifies, the adaptive part. But there is also an innate part, preprogrammed as the first line of defense against infectious disease. Humans need both. The same is true of a state and its government, said those I spoke with—many of whom were sympathetic to Cummings’s diagnosis. Without a functioning structure, the responsive antibodies of the government and its agencies cannot learn on the job. When the pandemic hit, both parts of Britain’s immune system were found wanting.

Britain’s pandemic story is not all bad. The NHS is almost universally seen as having risen to the challenge; the University of Oxford is leading the race to develop the first coronavirus vaccine for international distribution, backed with timely and significant government cash; new hospitals were built and treatments discovered with extraordinary speed; the welfare system did not collapse, despite the enormous pressure it suddenly faced; and a national economic safety net was rolled out quickly.

One influential U.K. government official told me that although individual mistakes always happen in a fast-moving crisis, and had clearly taken place in Britain’s response to COVID-19, it was impossible to escape the conclusion that Britain was simply not ready. As Ian Boyd, a professor and member of SAGE, put it: “The reality is, there has been a major systemic failure.”

“It’s obvious that the British state was not prepared for” the pandemic, this official told me. “But, even worse, many parts of the state thought they were prepared, which is significantly more dangerous.”

When the crisis came, too much of Britain’s core infrastructure simply failed, according to senior officials and experts involved in the pandemic response

Like much of the Western world, Britain had prepared for an influenza pandemic, whereas places that were hit early—Hong Kong, South Korea, Singapore, Taiwan—had readied themselves for the type of respiratory illness that COVID-19 proved to be.

The consequences may be serious and long term, but the most immediately tragic effect was that creating space in hospitals appears to have been prioritized over shielding Britain’s elderly, many of whom were moved to care homes, part of what Britain calls the social-care sector, where the disease then spread. Some 25,000 patients were discharged into these care homes between March 17 and April 16, many without a requirement that they secure a negative coronavirus test beforehand.

There was a bit too much exceptionalism about how brilliant British science was at the start of this outbreak, which ended up with a blind spot about what was happening in Korea, Taiwan, Singapore, where we just weren’t looking closely enough, and they turned out to be the best in the world at tackling the coronavirus,” a former British cabinet minister told me.

The focus on influenza pandemics and the lack of a tracing system were compounded by a shortfall in testing capacity.

Johnson’s strategy throughout was one that his hero Winston Churchill raged against during the First World War, when he concluded that generals had been given too much power by politicians. In the Second World War, Churchill, by then prime minister and defense secretary, argued that “at the summit, true politics and strategy are one.” Johnson did not take this approach, succumbing—as his detractors would have it—to fatalistic management rather than bold leadership, empowering the generals rather than taking responsibility himself

“It was a mixture of poor advice and fatalism on behalf of the experts,” one former colleague of Johnson’s told me, “and complacency and boosterism on behalf of the PM.”

What it all adds up to, then, is a sobering reality: Institutional weaknesses of state capacity and advice were not corrected by political judgment, and political weaknesses were not corrected by institutional strength. The system was hardwired for a crisis that did not come, and could not adapt quickly enough to the one that did.

Britain’s NHS has come to represent the country itself, its sense of identity and what it stands for. Set up in 1948, it became known as the first universal health-care system of any major country in the world (although in reality New Zealand got there first). Its creation, three years after victory in the Second World War, was a high-water mark in the country’s power and prestige—a time when it was a global leader, an exception.

Every developed country in the world, apart from the United States, has a universal health-care system, many of which produce better results than the NHS.

Yet from its beginnings, the NHS has occupied a unique hold on British life. It is routinely among the most trusted institutions in the country. Its key tenet—that all Britons will have access to health care, free at the point of service—symbolizes an aspirational egalitarianism that, even as inequality has risen since the Margaret Thatcher era, remains at the core of British identity.

In asking the country to rally to the NHS’s defense, Johnson was triggering its sense of self, its sense of pride and national unity—its sense of exceptionalism.

Before the coronavirus, the NHS was already under considerable financial pressure. Waiting times for appointments were rising, and the country had one of the lowest levels of spare intensive-care capacity in Europe. In 2017, Simon Stevens, the NHS’s chief executive, compared the situation to the time of the health sevice’s founding decades prior: an “economy in disarray, the end of empire, a nation negotiating its place in the world.”

When the pandemic hit, then, Britain was not the strong, successful, resilient country it imagined, but a poorly governed and fragile one. The truth is, Britain was sick before it caught the coronavirus.

In effect, Britain was rigorously building capacity to help the NHS cope, but releasing potentially infected elderly, and vulnerable, patients in the process. By late June, more than 19,000 people had died in care homes from COVID-19. Separate excess-death data suggest that the figure may be considerably higher

Britain failed to foresee the dangers of such an extraordinary rush to create hospital capacity, a shift that was necessary only because of years of underfunding and decades of missed opportunities to bridge the divide between the NHS and retirement homes, which other countries, such as Germany, had found the political will to do.

Ultimately, the scandal is a consequence of a political culture that has proved unable to confront and address long-term problems, even when they are well known.

other health systems, such as Germany’s, which is better funded and decentralized, performed better than Britain’s. Those I spoke with who either are in Germany or know about Germany’s success told me there was an element of luck about the disparity with Britain. Germany had a greater industrial base to produce medical testing and personal protective equipment, and those who returned to Germany with the virus from abroad were often younger and healthier, meaning the initial strain on its health system was less.

However, this overlooks core structural issues—resulting from political choices in each country—that meant that Germany proved more resilient when the crisis came, whether because of the funding formula for its health system, which allows individuals more latitude to top up their coverage with private contributions, or its decentralized nature, which meant that separate regions and hospitals were better able to respond to local outbreaks and build their own testing network.

Also unlike Britain, which has ducked the problem of reforming elderly care, Germany created a system in 1995 that everyone pays into, avoids catastrophic costs, and has cross-party support.

A second, related revelation of the crisis—which also exposed the failure of the British state—is that underneath the apparent simplicity of the NHS’s single national model lies an engine of bewildering complexity, whose lines of responsibility, control, and accountability are unintelligible to voters and even to most politicians.

Britain, I was told, has found a way to be simultaneously overcentralized and weak at its center. The pandemic revealed the British state’s inability to manage the nation’s health:

Since at least the 1970s, growing inequality between comparatively rich southeast England (including London) and the rest of the country has spurred all parties to pledge to “rebalance the economy” and make it less reliant on the capital. Yet large parts remain poorer than the European average. According to official EU figures, Britain has five regions with a per capita gross domestic product of less than $25,000. France, Germany, Ireland, Austria, the Netherlands, Denmark, and Sweden have none

If Britain were part of the United States, it would be anywhere from the third- to the eighth-poorest state, depending on the measure.

Britain’s performance in this crisis has been so bad, it is damaging the country’s reputation, both at home and abroad.

Inside Downing Street, officials believe that the lessons of the pandemic apply far beyond the immediate confines of elderly care and coronavirus testing, taking in Britain’s long-term economic failures and general governance, as well as what they regard as its ineffective foreign policy and diplomacy.

the scale of the task itself is enormous. “We need a complete revamp of our government structure because it’s not fit for purpose anymore,” Boyd told me. “I just don’t know if we really understand our weakness.”

In practice, does Johnson have the confidence to match his diagnosis of Britain’s ills, given the timidity of his approach during the pandemic? The nagging worry among even Johnson’s supporters in Parliament is that although he may campaign as a Ronald Reagan, he might govern as a Silvio Berlusconi, failing to solve the structural problems he has identified.

This is not a story of pessimistic fatalism, of inevitable decline. Britain was able to partially reverse a previous slump in the 1980s, and Germany, seen as a European laggard in the ‘90s, is now the West’s obvious success story. One of the strengths of the Westminster parliamentary system is that it occasionally produces governments—like Johnson’s—with real power to effect change, should they try to enact it.

It has been overtaken by many of its rivals, whether in terms of health provision or economic resilience, but does not seem to realize it. And once the pandemic passes, the problems Britain faces will remain: how to sustain institutions so that they bind the country together, not pull it apart; how to remain prosperous in the 21st century’s globalized economy; how to promote its interests and values; how to pay for the ever-increasing costs of an aging population.

“The really important question,” Boyd said, “is whether the state, in its current form, is structurally capable of delivering on the big-picture items that are coming, whether pandemics or climate change or anything else.”

"These viruses may be able to infect people who are further than 6 feet away from the person who is infected or after that person has left the space," the CDC said.

Many hospitals are now filled beyond capacity,

pandemic fatigue.

And many of those who are sick of taking precautions are getting sick.

, more people are socializing indoors.

"linger in the air for minutes to hours,"

A variant first detected in South Africa

Gathering with multiple friends indoors can be dangerous.

"If you go to a party with five or more people, almost certainly there's going to be somebody with Covid-19 at that party,"

more than 50% of all infections are transmitted from people who aren't showing symptoms.

That's an average of 3.5 people getting infected every second.Read More

The United States has confirmed at least 76 cases of a highly transmissible variant of the coronavirus that was first detected in the United Kingdom.

And the United States ranks 61st in how quickly virus samples are collected from patients, analyzed and then posted to an international database to find new variants.

While it may be more transmissible, there's no evidence this variant first detected in the UK is deadlier or causes more severe disease, the CDC said.

Some patients have been put in hospital break rooms, parking garages and gift shops.

As of Thursday, it has not been detected in the United States.

That didn't happen. Not even close.

As of Thursday morning, about 10.2 million vaccine doses had been administered, out of roughly 29.3 million doses that have been distributed across the United States, according to the CDC.

You can test

negative

but still be infected and contagious.

And don't think you're invincible -- even if you're young and healthy.

"We see severe illness among healthy, young adults with no apparent underlying causes," Hotez said.

more than 77,500 died in December, the country's deadliest month.

The US reported a record 125,379 hospitalized Covid-19 patients nationwide Thursday, according to the Covid Tracking Project. That number dipped slightly Friday, with 125,057 hospitalizations reported -- about an 163% increase from two months ago.

"We're also worried that at some point soon we're going to have a really tough time finding the space and the staff to take care of all the sick patients coming in with Covid-19 who really need our help," said Dr. Nicole Van Groningen of Cedars-Sinai Medical Center in Los Angeles.

Experts fear that in the coming weeks -- following holiday travel and gatherings -- the US could see another surge of cases that could drive hospitalizations and deaths even higher.

Georgia announced Friday a total of more than 8,700 new Covid-19 cases in the state -- a new high. Maryland on the same day reported its second-highest number of daily cases. New York, meanwhile, added nearly 16,500 new cases -- a day after it hit its highest ever one-day case count.

Texas health officials reported record-high Covid-19 hospitalizations across the state for the fifth day in a row, with more than 12,400 patients.

ICU capacity in many parts of the state remains dangerously low. In Southern California and the San Joaquin Valley, zero beds are available. One health official said earlier this week the surge of patients has been pushing hospitals to the "brink of catastrophe."

The variant has been found in at least 30 countries and has also been detected in Colorado, California and Florida.

"The discovery of the additional cases leads county health officials to believe that the new strain of the virus is widespread in the community," a county spokesperson said.The new cases were found in two men in their 40s and a man in his 50s, officials said.

"Currently, the US is doing less sequencing than many other countries -- a recent report from (genomics database) GISAID estimated that the US is sequencing 0.3% of positive cases versus the UK that's at about 7%."

the vaccines approved in the US require two doses based a few weeks apart. And the nation will continue to do it that way and will not follow the UK's decision to potentially delay second doses, Fauci told CNN on Friday.

"The fact is we want to stick with what the science tells us, and the data that we have for both [vaccines] indicate you give a prime, followed by a boost in 21 days with Pfizer and 28 days with Moderna. And right now, that's the way we're going with it, and that's the decision that is made," Fauci said. "We make decisions based on data. We don't have any data of giving a single dose and waiting for more than the normal period of time" to give the second dose, he added.

Hospitalizations are also surging, with the number of patients nationwide rising by more than 10,000 in just two weeks, according to data from the Covid Tracking Project.

As of Tuesday afternoon, the US reported 9.3 million cases of the virus and more than 232,000 people have died, according to data from Johns Hopkins University.

Researchers from the University of Washington's Institute for Health Metrics and Evaluation project that 399,163 Americans could lose their lives to Covid-19 by February 1.

However, more than 130,000 lives could be saved by March if Americans wore masks, Dr. Francis Collins, director of the National Institutes of Health, wrote in a blog post on Tuesday.

For those who are hoping to cast their ballot Tuesday, the CDC told CNN people recovering from Covid-19 or quarantining from being exposed to the virus can still go vote safely

"When possible, alternative voting options -- which minimize contact between voters and poll workers -- should be made available for people with Covid-19, those who have symptoms of Covid-19, and those who have been exposed," the CDC spokesperson said.

Meanwhile, more bad news, this time on Covid-19 cases in children.

There were 61,000 new cases in children during the last week of October, "which is larger than any previous week in the pandemic," the AAP said in a statement. And since the start of the pandemic through October 29, more than 853,000 children have tested positive for the virus, the AAP said. Nearly 200,000 of those cases were during the month of October.

Scientists are also using different strains of another virus, adenovirus, as a vector or a missile to deliver genes that code for these same spike proteins and that also provoke an immune response. The vector has been engineered in the lab to be replication-defective; that is, the vector is able to deliver the spike gene into humans but once it’s done its job, the vector cannot replicate any further. At least three groups are testing these vectors.

The science is paying off. Novavax, a Maryland-based company working on this type of vaccine, recently reported the results of its Phase 1 trial. The levels of antibodies generated were stunning, about four times higher than those in individuals who are recovering from a COVID-19 infection.

Nine vaccine candidates have now entered Phase 3 human trials, the final step before regulatory approval. The fact that entirely different approaches to vaccine development are all yielding promising early results is highly encouraging.

Equally important is the unprecedented global collaboration among scientists around the world, as well as the high degree of cooperation between scientists and clinicians, biopharmaceutical companies, government, philanthropic funders, and regulators. They are all working together toward the common goal of developing as quickly as possible a safe and effective vaccine against COVID-19.

My optimism doesn’t stop with these early results, although they are key. I’m also encouraged because at least five very different approaches (I’ve walked through only three above) are being explored to make a vaccine. As we say in Canada, if you want to win, you have to take many shots on goal.

the encouraging news is that all of the vaccine candidates that have entered trials in humans so far are safe and have elicited high levels of antibodies against COVID-19. Some have also been shown to activate the cellular arm of our immune system, another crucial component of our defenses against foreign pathogens.

the mandate that the approval process be above any political considerations and solely based on data from the clinical trials. Anything else risks losing the public’s confidence in a vaccine or, in a worst-case scenario, might result in a vaccine that is less effective than those that might be approved later, or the widespread administration of a vaccine that turns out to have serious adverse side effects. That would be a public-health tragedy.

The world will need billions of doses and many billions of dollars to produce and disseminate the vaccine. My main concern in this whole process is that governments will not spend enough on manufacturing the vaccine to administer it to every adult on the planet

Ensuring equitable access to a vaccine is imperative, and not just a generous gesture by wealthy nations. It’s also in their best interests. If the virus is anywhere, it’s everywhere.

The United States, the wealthiest nation in the world and historically the first among nations in its generosity and leadership, has yet to contribute to the various multilateral initiatives established to purchase vaccines for the developing world. To date, 75 industrialized nations have agreed to finance vaccine purchases for 90 lower-income countries. But the U.S. is not yet one of them.

The cost of manufacturing enough doses to vaccinate every adult on the planet will be in the hundreds of billions of dollars. But compared with the trillions of dollars that governments are now spending to assist individuals who have lost their jobs and to prop up their economies, $100–200 billion is a bargain and an insurance policy that developed countries cannot afford not to buy.

If people everywhere—regardless of their gender, citizenship, ethnicity, skin color, or ability to pay—have equal and timely access to a safe and effective vaccine against COVID-19, the world will come out of this pandemic stronger than it went in

When those countries vetted these vaccines, they made informed decisions, based on evidence about safety and efficacy released by the Chinese and Russian manufacturers — much of it also published in peer-reviewed scientific journals like The Lancet and JAMA — or after running independent trials of their own. To assume otherwise is to doubt the ability or integrity of these governments, some of which have health regulatory systems on par with those in the United States or Europe.

To some extent this is understandable. China’s and Russia’s self-serving propaganda campaigns touting their respective vaccines only increased wariness, especially abroad.

The protocols for trials vary, in other words, even for the same vaccine. Considering that, now imagine the potential for differences among results from trials for various vaccines — differences that may reveal as much about the trials’s designs as the vaccines’ performance.

The fact is that no Covid-19 vaccine has been developed or released as transparently as it should have been. And while China and Russia may have botched their rollouts more than some Western companies, that doesn’t necessarily mean their vaccines are shoddy.

Most vaccines produced in the West have already been bought up by rich countries: as of early December, all of Moderna’s vaccines and 96 percent of Pfizer-BioNTech’s, according to the People’s Vaccine Alliance, a coalition of organizations calling for wider and fairer access to vaccines worldwide.

When a vaccine is developed in and approved by a country on the W.H.O.’s trusted list, the organization usually relies on that assessment to quickly sign off. But when a vaccine maker anywhere else applies for prequalification, the W.H.O. conducts a full evaluation from scratch, including a physical inspection of the manufacturing facilities.

The new CDC guidance says fully vaccinated people can:Read MoreVisit other vaccinated people indoors without masks or physical distancingVisit indoors with unvaccinated people from a single household without masks or physical distancing, if the unvaccinated people are at low risk for severe disease.

Skip quarantine and testing if exposed to someone who has Covid-19 but are asymptomatic, but should monitor for symptoms for 14 daysThis means that vaccinated grandparents may finally feel comfortable visiting their unvaccinated grandchildren and giving them a big hug, especially if they're local -- the CDC still says people should avoid travel -- and as long as none of the unvaccinated people in that household are at risk for severe Covid-19.

However, people who are fully vaccinated still need to take precautions in many scenarios. The guidelines say fully vaccinated people must:Wear a mask and keep good physical distance around the unvaccinated who are at increased risk for severe Covid-19, or if the unvaccinated person has a household member who is at higher riskWear masks and physically distance when visiting unvaccinated people who are from multiple households.

If fully vaccinated people live in a non-health care congregate setting, such as a group home or detention facility, they should quarantine for 14 days and get tested if exposed to someone with a suspected or confirmed Covid-19 case.The guidelines say that the risk of infection in social activities like going to the gym or restaurant is lower for the fully vaccinated. However, people should still take precautions, as transmission risk in these settings is higher and increases the more unvaccinated people are involved. So wear that mask on the treadmill, and if dining out, keep it on while waiting for your meal

Walensky said CDC travel guidelines will remain the same for the vaccinated until there is more data about how much or how little vaccinated people can transmit the virus to others. She added that a "larger swath" of the population will also need to be vaccinated before it's really safe. About 90% of the country is still not vaccinated, Walensky said. Travel brings too much exposure to crowds and the spread of variants is also a real concern.

"We are here in no small measure because of the safety protection that many, many Americans have taken with regard to their family, friends and neighbors," Zients said. "We ask people to continue to do that so we can get there, as quickly and as permanently as possible."There are now 30 million people in the United States who are fully vaccinated, but the United States still averaged more than 60,000 cases per day over the last seven days, according to Johns Hopkins University.

"We continue to have high levels of virus around the country, and more readily transmissible variants have now been confirmed in nearly every state, while we work to quickly vaccinate people more and more each day, we have to see this through," Walensky said Monday. "Let's stick together. Please keep wearing a well fitting mask and taking the other public health actions we know work to help stop the spread of this virus."

Experts have long said the best defenses against surging cases are preventative measures like masks and social distancing, as well as widespread vaccination. So far, at least 22.1 million doses of coronavirus vaccines have been distributed and nearly 6.7 million have made their way into patients' arms. Health officials had hoped to get 20 million people vaccinated at the start of the new year, but the administration of vaccines has undergone delays and roadblocks.

So far, the state's vaccination efforts have struggled, and only about a third of the more than 2.1 million doses received have made it into the arms of residents.

California, an epicenter of the pandemic in the US, added 49,685 new cases on Sunday alone, bringing the total number of cases in the state since the pandemic began to more than 2.6 million.

Starting Monday, the state will boost its vaccine rollout to include health care workers, nursing home residents and staff, and those living in congregate settings such as assisted living or shelters, according to new guidance from the state health department

As the surge ratchets up infection, hospitalization and fatality numbers across states, officials are working to make it easier to access vaccinations.

De Blasio spoke Sunday from a site at the Bathgate Industrial Park, stating that the city is "well on-pace" to reach 100,000 vaccinations by this week

The Georgia Department of Public Health has launched a Covid vaccine locator website in hopes of increasing access in the state that has administered the least vaccines per capita,

More than 28,400 new Covid-19 deaths have been reported in just the first 11 days of 2021, according to data from Johns Hopkins.

At this rate, more people could die from Covid-19 in January than any other month of this pandemic. December had a record high of 77,431 deaths due to Covid-19.

The recent riot at the US Capitol would likely be a "surge event" that "will probably lead to a significant spreading" across the country, the director of the Centers for Disease Control and Prevention said

"Then these individuals all are going in cars and trains and planes going home all across the country right now.

many hospitals across the country have said worker safety is already their top priority, and unions are taking advantage of a difficult situation to divide staff and management, rather than working together.

Recognizing that, some workers — like the nurses at Mission Hospital — are forming new unions or thinking about organizing for the first time. Others, who already belong to a union, are taking more active leadership roles, voting to strike, launching public information campaigns and filing lawsuits against employers.

Labor experts say it's too soon to know if the outrage over working conditions will translate into an increase in union membership, but early indications suggest a small uptick. Of the approximately 1,500 petitions for union representation posted on the National Labor Relations Board website in 2020, 16% appear related to the health care field, up from 14% the previous year.

Stephanie Felix-Sowy said her team is fielding dozens of calls a month from nonunion workers interested in joining. Not only are nurses and respiratory therapists reaching out, but dietary workers and cleaning staff are as well, including several from rural parts of the state where union representation has traditionally been low.

Research shows that health facilities with unions have better patient outcomes and are more likely to have inspections that can find and correct workplace hazards. One study found New York nursing homes with unionized workers had lower COVID-19 mortality rates, as well as better access to PPE and stronger infection control measures, than nonunion facilities.

The nurses at Mission Hospital say administrators have minimized and disregarded their concerns, often leaving them out of important planning and decision-making in the hospital's COVID-19 response.

Early in the pandemic, staffers struggled to find masks and other protective equipment,

The hospital discouraged them from wearing masks one day and required masks 10 days later. The staff wasn't consistently tested for COVID-19 and often not even notified when exposed to COVID-positive patients.

the concerns persisted for months. And some nurses said the situation fueled doubts about whether hospital executives were prioritizing staff and patients, or the bottom line.

Although the nurses didn't vote to unionize until September, Waters said, they began acting collectively from the early days of the pandemic. They drafted a petition and sent a letter to administrators together. When the hospital agreed to provide advanced training on how to use PPE to protect against COVID transmission, it was a small but significant victory

Even as union membership in most industries has declined in recent years, health workers unions have remained relatively stable:

But with another surge of COVID cases approaching, the nurses decided not to wait any longer to take action