The drugmaker AstraZeneca announced on Monday that an early analysis of some of its late-stage clinical trials, conducted in the United Kingdom and Brazil, showed that its coronavirus vaccine was 70.4 percent effective in preventing Covid-19, suggesting that the world could eventually have at least three working vaccines — and more supply — to help curb the pandemic.
The British-Swedish company, which has been developing the vaccine with the University of Oxford, became the third major vaccine developer this month to announce encouraging early results, following Pfizer and Moderna, which both said that their vaccines were about 95 percent effective in late-stage studies.
AstraZeneca’s results are a reassuring sign of the safety of the vaccine. It came under global scrutiny after AstraZeneca temporarily paused its trials in September to investigate potential safety issues after a participant in Britain developed a neurological illness.
Oxford and AstraZeneca said they would submit their data to regulators in Britain, Europe and Brazil and seek emergency authorization.
The company said its early analysis was based on 131 coronavirus cases. The trials used two different dosing regimens, one of which was 90 percent effective in preventing Covid-19 and the other of which was 62 percent effective.
The regimen that was 90 percent effective involved using a halved first dose and a standard second dose. Oxford and AstraZeneca also said that there were no hospitalized or severe cases of the coronavirus in anyone who received the vaccine, and that they had seen a reduction in asymptomatic infections, suggesting that the vaccine could reduce transmission.
AstraZeneca’s vaccine is expected to come with relatively simple storage requirements, which would be an asset once it gets rolled out. The company has said it anticipates the vaccine will require refrigeration, though it has not provided details about how long and at what temperature it can be kept. Moderna’s vaccine can be kept for up to a month at the temperature of an ordinary refrigerator. Pfizer’s can be kept for up to 5 days in conventional refrigerators, or in special coolers for up to 15 days, but otherwise needs ultracold storage.
AstraZeneca has said it aims to bring data from its studies of its vaccine being conducted overseas to the Food and Drug Administration — which would mean that the agency will likely review and authorize a vaccine before late-stage data are ready on how well the vaccine works in American participants. British regulators already have been conducting a so-called rolling review of the vaccine.
“Today marks an important milestone in our fight against the pandemic,” AstraZeneca’s chief executive, Pascal Soriot, said. “This vaccine’s efficacy and safety confirm that it will be highly effective against Covid-19 and will have an immediate impact on this public health emergency.”
Professor Andrew Pollard, the chief investigator of the Oxford Vaccine Trial, said that “these findings show that we have an effective vaccine that will save many lives.”
In the wake of results suggesting that two prospective coronavirus vaccines are remarkably effective, the official in charge of the federal coronavirus vaccine program explained on Sunday news shows how the vaccines might be distributed to Americans as early as next month.
Dr. Moncef Slaoui, head of the administration’s Operation Warp Speed, said that within 24 hours after the Food and Drug Administration approves a vaccine, doses will be shipped to states to be distributed. “Within 48 hours from approval,” the first people would likely receive injections, Dr. Slaoui said on ABC’s “This Week With George Stephanopoulos.”
Two companies, Pfizer and Moderna, announced this month that their vaccines were about 95 percent effective, and Pfizer formally submitted an application to the F.D.A. for emergency approval. Regulators at the agency will spend about three weeks reviewing the application. On Dec. 10, an outside advisory board on vaccines will meet to discuss the application, and the agency is expected to make a decision shortly after that meeting. Moderna is expected to submit its own application soon.
Even if the first vaccine is authorized in mid-December, officials and company representatives have estimated that there will only be enough doses available to treat about 22.5 million Americans by January. Each vaccine requires two doses, separated by several weeks.
Dr. Slaoui said vaccines would be shipped to states, proportioned according to their population, and that states would decide how and where to distribute the doses. He said that likely within a day after a vaccine receives F.D.A. authorization, a committee at the Centers for Disease Control and Prevention would issue recommendations for which groups should be first to receive a vaccine.
High-priority groups are likely to include frontline medical workers and residents of nursing homes. Dr. Scott Gottlieb, a former F.D.A. commissioner, said on the CBS show “Face the Nation” that those groups would likely be followed by other older adults and then expanded to younger adults in the spring. Both he and Dr. Slaoui estimated that tens of millions of adults could be vaccinated by sometime in May.
Immunizations for children would follow. Dr. Slaoui said on the CNN show “State of the Union” that the youngest participants in the clinical trials so far have been 12 to 14 years old and that approval for younger children and toddlers would likely not occur until late in 2021, after clinical trials for those age groups are conducted.
On “Face the Nation,” Larry Merlo, the chief executive of CVS Health, said that pharmacists and other medical staff from CVS plan to immunize residents of more than 25,000 long-term care facilities, beginning about 48 hours after a vaccine is approved. He said that for several years, CVS has been going to nursing homes to administer the seasonal flu vaccine, so “we have the systems, we have the processes, and we have built the logistics directly for the Covid vaccine.”
Mr. Merlo, whose company runs 10,000 pharmacies across the country, also said as the supply of the vaccines increase, they would be administered by CVS pharmacies and also by kiosks and mobile trailers that have been doing coronavirus testing in underserved communities.
Coronavirus patients are swamping U.S. hospitals in record numbers, straining the health care system much more widely than the first acute outbreaks did in the spring.
The total number of patients in hospitals with Covid-19 nationally has hit new highs every day since Nov. 11, when hospitalizations first exceeded the April peak. There were nearly 84,000 on Sunday, according to the Covid Tracking Project.
The surge comes as the Thanksgiving and the December holidays approach, when travel and family visits are expected to accelerate the spread of the virus and further strain hospitals.
With a week of November left to go, the United States has already had its highest monthly case total, reporting more than 3,075,000 new coronavirus cases since Nov. 1, according to a New York Times database. By the time the month is over, the tally could top four million, more than double the number in October.
November’s case total is nearly 2.9 million more than March’s total.
The landscape has changed markedly since March, when the virus was concentrated mainly in outbreaks on the East and West Coasts and in a few big cities like New Orleans and Detroit. In New York City, especially, when hospitals were flooded with patients in the spring, medical workers were flown in from across the nation to help, and the Navy deployed a hospital ship to the city.
Now, though, with the strain being felt nearly everywhere, few hospitals can spare anyone to help in other places, and the focus is on acute shortages of staff, more than of beds.
The explosion of cases in rural parts of Idaho, Ohio, South Dakota and other states has prompted local hospitals that lack such experts on staff to send patients to cities and regional medical centers, but those intensive care beds are quickly filling up.
After months of unrelenting stress from the pandemic, many workers are getting sick themselves, suffering from burnout or even retiring early. Hundreds of nurses near Philadelphia went on strike last week over the trauma of the pandemic, low pay and limited resources.
The military deployed medical crews to help overwhelmed hospitals in El Paso, and the Texas state government has been dispatching thousands of workers to assist in other hard-hit areas of the state. The traveling nurses that some hospitals depend on for crisis staffing are in high demand in many states, and their rates have shot up. Overall, about one-fifth of U.S. hospitals are now short-staffed, according to an NPR analysis of data from the Department of Health and Human Services.
Hospitals can set up more beds, but “where they’re going to get stretched is on personnel,” Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration, said Sunday on the CBS program “Face the Nation.” “They just won’t have the people to staff them.”
Angelia Gower, a patient access manager in the SSM Health system in St. Louis, said she has seen the problem firsthand. She has been filling in on night shifts after several of her employees contracted Covid-19 and one lost a parent to the disease, creating both a logistical challenge and a morale crisis for her department.
“That takes a toll, on not just my employee and her life, but all of the staff that knows her,” Ms. Gower said.
Early in the pandemic, she said, her team was strained by furloughs brought on by the financial pressures that the coronavirus put on the hospital system. Those furloughs are over, she said, but “we are still working short-staffed.”
The pandemic may present an opportunity to reshape the future of emergency medicine. If the shift to greater use of telemedicine continues after the pandemic, it could reduce reliance on the emergency room, where crowding has long been a problem.
This could happen if telemedicine increases the ability for doctors to see more patients more quickly. A Veterans Health Administration study found that same-day access to primary care was associated with fewer emergency visits for conditions that weren’t true emergencies.
During the pandemic, educational campaigns have tried to raise awareness about telemedicine, offering guidelines on when people should seek immediate attention, and when an online consultation is adequate. And American Medical Association officials are seeking to keep the regulatory flexibility on telemedicine that has been allowed during the pandemic.
Telemedicine isn’t a solution for every health problem. And patients with limited digital fluency and access may get left behind as reliance on telemedicine grows. But the potential payoff is large: A review of medical records of older patients found that 27 percent of emergency room visits could have been replaced with telemedicine.
According to the American College of Emergency Physicians, more than 90 percent of emergency departments are routinely crowded, which has long been recognized as problematic.
On average, a patient visiting an emergency room will wait about 40 minutes. Although that’s down from about an hour a decade ago, 17 percent of patients visiting an emergency department in 2017 waited over an hour.
Longer wait times can be harmful. For some conditions, a systematic review in 2018 found, longer waits are associated with lower-quality care and adverse health outcomes that include increased mortality.
With coronavirus cases on the rise, a marketing push is underway to persuade skeptical Americans to immunize themselves once vaccines are ready.
The federal government, which has sent mixed messages about a pandemic that has caused more than 250,000 deaths nationwide, is not leading the charge. Instead, the private sector is backing a planned $50 million campaign.
The Ad Council, a nonprofit advertising group, led a similar effort in the 1950s, when it urged Americans to get vaccinated against polio. The White House has collaborated with the Ad Council on previous public health efforts, but it is not currently involved in this one.
President-elect Joseph R. Biden Jr. has blamed President Trump for causing anxiety about the safety of potential immunization efforts. Anti-vaccine sentiment has been growing for decades, driven in part by a backlash against pharmaceutical companies.
Fifty-eight percent of American adults said they were willing to take a coronavirus vaccine, according to a Gallup poll conducted between Oct. 19 and Nov. 1. Another poll, conducted last month by Ipsos and the World Economic Forum, found that 85 percent of Chinese adults, 79 percent of British adults and 76 percent of Canadian adults plan to be vaccinated, compared to 64 percent of Americans.
The Ad Council has joined with a coalition of experts known as the Covid Collaborative, which concluded through its own survey that only one-third of Americans plan to get vaccinated.
Research by the Covid Collaborative also suggests that less than 20 percent of Black Americans believe that a vaccine will be safe or effective. Many respondents said they had little faith in the government’s ability to look after their interests or cited distrust stemming from past ethics violations, like the infamous Tuskegee study, which tracked Black men infected with syphilis but did not treat them.
Global Roundup
The Seoul city government said on Monday that it was closing nightclubs and banning late-night restaurant dining starting Tuesday as South Korea tightened guidelines to battle a surge in coronavirus infections.
South Korea’s daily caseload rose above 300 for five straight days before dropping to 271 on Monday. Most of the new cases in the recent spike were reported in Seoul, the capital, and in nearby cities.
Unlike the earlier waves of infections that had been clustered around several churches and outdoor rallies, the current surge was more widespread, originating in gatherings of family and friends where people took off their masks, health officials said. On Monday, the military said that 36 service members had tested positive in an artillery unit near the border with North Korea.
The new restrictions in Seoul include a ban on gatherings of more than 100 people and mandate that nightclubs, dance halls, casinos and other high-risk entertainment facilities shut. No more than 10 people can attend outdoor rallies.
Restaurant dining will be allowed until 9 p.m., and museums, schools, churches, stadiums and other public facilities must reduce the number of visitors and students they can accept between 20 and 67 percent of capacity, depending on the type of facility. The city will also reduce the number of buses and subways that run late at night.
“The third wave of the pandemic is underway because of a silent spread of the virus in our daily lives, leading to over 2,000 additional cases in a week,” said Kang Do-tae, South Korea’s vice health minister.
In other developments around the world:
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Prime Minister Boris Johnson of Britain is expected on Monday to outline the tiered system of restrictions that will be introduced when the country emerges from a monthlong lockdown on Dec. 2.
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Parts of Southern Ontario, including Toronto, entered the strictest phase of Canada’s tiered system of restrictions on Monday. Under the new restrictions, indoor gatherings are not allowed, outdoor gatherings are limited, and in-person dining and in-person retail shopping at businesses other than select stores, including supermarkets, is prohibited.
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Turkey recorded its highest daily number of cases, 6,017, on Sunday, according to the country’s health ministry. Critics have repeatedly challenged the government’s coronavirus figures as an undercount.
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The French agriculture ministry said on Sunday that 1,000 minks had been slaughtered at a farm south of Paris after some of the animals tested positive for the coronavirus, and that minks were being tested at two other farms. France is the second European country, after Denmark, to cull farmed mink because of the virus.
Concerned over the increasing likelihood that the economy is headed for a “double-dip” recession early next year, aides to President-elect Joseph R. Biden Jr. are pushing for Democratic congressional leaders to reach a quick compromise stimulus agreement, according to people familiar with the discussions.
Until now, Mr. Biden, Speaker Nancy Pelosi of California and Senator Chuck Schumer of New York, the Democratic leader, have insisted that Republicans agree to a spending bill of $2 trillion or more, while Senator Mitch McConnell of Kentucky, the majority leader, wants a much smaller package. The resulting impasse has threatened to delay additional economic aid until after Mr. Biden’s inauguration on Jan. 20.
Many of the president-elect’s advisers have become convinced that deteriorating economic conditions from the renewed surge in Covid-19 infections and the looming threat of millions of Americans losing jobless benefits in December amid a wave of evictions and foreclosures require more urgent action before year’s end, Jim Tankersley and Emily Cochrane report. That could mean moving at least part of the way toward Mr. McConnell’s offer of a $500 billion package.
Mr. Biden’s team is also considering a range of other policy options for fighting a renewed downturn and the prospect of rising unemployment when he takes office, according to the people familiar with his plans. Some of them, like a sweeping spending bill that includes all or large parts of his campaign proposals for infrastructure, could depend on Democrats’ winning Senate control in two special elections in Georgia in January.
Others would not require Congress. Mr. Biden’s aides have weighed having the president-elect announce in the coming weeks that he will sign executive orders on his first day in office extending moratoriums on evictions and foreclosures, and deferrals of some student loan payments that are set to expire at the end of the year, the people familiar with the discussions said.
Such orders could lessen or avoid an economic cliff of expiring protections for renters, homeowners and some borrowers, which experts fear could hasten an economic contraction.
More travelers were screened at airport security checkpoints on Sunday than on any day since the pandemic took hold in March, a worrying sign that people flying to visit their families for Thanksgiving could increase the spread of the coronavirus.
A little more than one million people were screened by the Transportation Security Administration on Sunday, according to federal data published on Monday. That number is about half of what it was in 2019, but it represents a big increase from the spring, when less than a half a million people flew on any given day.
The Centers for Disease Control and Prevention and Dr. Anthony Fauci, the country’s top infectious disease expert, have been strongly discouraging holiday travel for fear that it would increase the number of new infections, which have surged in recent weeks as the weather turns colder and more people spend time indoors.
Airlines have said that flying is safe because of the precautions the industry has put in place, like high-end air filtration. They also point to the relatively few published cases of the coronavirus being spread during a flight. But the science on in-flight safety is far from settled, and travelers would still be at risk of contracting or spreading the virus at airports and once they are at their destination.
The increase in travel during the holidays has been encouraging for airlines. But it won’t be enough to offset the deep losses they have suffered during the pandemic. The nation’s largest airlines have collectively reported tens of billions of dollars in losses so far this year, and analysts expect demand to remain weak for a couple of years or more. The industry is hoping that the incoming Biden administration and Congress will give airlines more aid early next year.
Since the pandemic erupted in China, the country has grown adept at swiftly smothering coronavirus flare-ups by ordering residents across entire cities to line up for nucleic acid tests that can pinpoint carriers. So officials snapped into action after a cluster of infections linked to Pudong International Airport in Shanghai grew over the weekend.
On Sunday, Pudong International Airport ordered cargo handlers and other potentially exposed workers to immediately undergo tests. But this time, the plan faltered badly.
The urgent order prompted a crush of hundreds of workers who merged on an airport parking garage that had been converted into a temporary test center, and video that spread first on Chinese social media showed guards in protective suits struggling to hold back a seething, anxious crowd trying to walk up a ramp. Other video shared by Shanghai residents appeared to show a worker who had fainted being carried out of the garage.
Shanghai authorities ordered the blitz of tests after testing confirmed five cases since Friday linked to the airport, including three workers and two of their spouses. The scenes of workers jammed together drew criticisms that the poorly organized testing only exposed them to greater risks of infecting each other, and the video quickly began to disappear from Weibo and WeChat, China’s two main social media platforms, as censors apparently stepped in.
“Even if the outbreak is urgent, there aren’t even the most basic safety and distancing measures,” said one comment widely shared on Weibo. “This can cause big problems.”
The government moved quickly to combat the anxiety about the cluster and scenes of mayhem. The Shanghai police issued pictures of airport workers in orderly lines, waiting to be tested in the garage — apparently after officials had restored control. “Currently everything is normal and there is an orderly queue for tests,” said The Paper, a news website based in Shanghai.
Chinese health officials appear likely to step up tests and disinfection at airports and other sites that handle imported goods. Earlier this month, tests revealed two infections among freight handlers at the Pudong Airport, and Chinese experts have repeatedly raised the theory that the virus may be carried on goods from abroad.
Hong Kong’s government said on Sunday that it would give cash payments of about $650 to residents who tested positive for the coronavirus, a policy designed to encourage people to get tested.
Sophia Chan, Hong Kong’s health secretary, said the policy was aimed at people who had avoided getting tested because they were afraid of the financial consequences of being forced to stay home from work if they tested positive.
“We hope they don’t avoid it for income reasons, for fear of halting work and losing income,” she told reporters on Sunday.
Critics said the policy would give people an incentive to intentionally infect themselves, and that the payment of 5,000 Hong Kong dollars was not enough to make up for wages lost by people who tested positive and could not go to work.
“Now, if you catch this lethal disease that has already killed over 1.38 million people worldwide, you get paid by the Hong Kong government: precisely not enough for meaningful relief but just enough to give the impression of a reward,” Jeffrey Ngo, a pro-democracy activist from Hong Kong, tweeted.
Government officials defended the move, saying it was unlikely that people would try to deliberately catch the coronavirus to get the government money because the symptoms of the disease could be serious.
“I can’t see anyone who would abuse this scheme because this virus could be mild or serious,” Ho Kai-ming, the deputy secretary for labor and welfare, told reporters, according to the public broadcaster. “It’s a priority for everyone in Hong Kong to end the spread of the virus, and people should not make jokes.”
Black Friday has long been the biggest shopping day of the year, with doorbuster deals inspiring some die-hard shoppers to camp out all night in front of big-box stores.
But as coronavirus cases climb across the country and public health officials beg people to avoid crowds, will stores still try to lure customers inside? And if they do, will customers take the bait and show up?
“This year is going to be a Black Friday unlike any other,” said Kelly O’Keefe, managing partner at the Brand Federation, a consulting firm. “We’re not going to have crowds knocking down Walmart’s door this year. There will be fewer people in stores and there will be much better management of those people.”
Here’s what some of the biggest retailers are doing to keep customers safe on Black Friday this year:
Best Buy
Best Buy said it was selling this year’s new gaming consoles online only, to avoid lines outside stores.
The electronics chain said it would limit the number of customers inside stores to comply with social-distancing guidelines as recommended by the Centers for Disease Control and Prevention. Best Buy also said it would consider limiting store hours, reducing occupancy and shifting to curbside-only pickup service “on a case-by-case basis to help local communities contain outbreaks.”
All pickup orders will now happen curbside, and pickup will be available before and after in-store hours.
The stores will require customers and employees to wear face coverings and will supply face coverings to customers who do not have one. Best Buy will provide sanitizer wipes near high-touch displays to give the customers the option of wiping down surfaces before engaging with them.
Walmart
Walmart put on three separate sales in November, both online and in store.
It is offering customers the option to pick up their online Black Friday orders through Walmart’s contactless curbside pickup service.
On Black Friday itself, Walmart stores will open at 5 a.m., and customers will be asked to form a single, straight line to enter the stores. Employees will hand out sanitized shopping carts and will remind customers to wear a mask when entering the store. Walmart will limit the number of customers in the store to 20 percent capacity and will direct customers to shop down the right-hand side of aisles.
Target
Target has spread its sale offerings throughout all of November, offering promotions of different product categories each week.
To minimize lines, Target has added mobile checkout devices to allow store employees to help shoppers check out anywhere in the store. The company also allows guests to check out by themselves using Target’s mobile app.
Additionally, the company has added thousands of items eligible for same-day pickup.
Target says it will monitor the number of shoppers to ensure people have enough space to shop safely and will allow customers to reserve a spot in line outside their local store.
Home Depot
The home improvement retailer has made Black Friday prices available throughout the holiday season, from Nov. 6 through December, both in store and online, in an effort to reduce crowds. Home Depot said it had reduced the number of items displayed in certain areas in stores to create more space for social distancing.
Ventilators, the sophisticated breathing machines used to sustain the most critically ill patients, are far more plentiful than they were eight months ago, when New York, New Jersey and other hard-hit states were desperate to obtain more of the devices, and hospitals were reviewing triage protocols for rationing care. Now, many hot spots face a different problem: They have enough ventilators, but not nearly enough workers with the years of training to operate them.
Since the spring, American medical device makers have radically ramped up the country’s ventilator capacity by producing more than 200,000 critical care ventilators, with 155,000 of them going to the Strategic National Stockpile. At the same time, doctors have figured out other ways to deliver oxygen to some patients struggling to breathe — including using inexpensive sleep apnea machines or simple nasal cannulas that force air into the lungs through plastic tubes.
But with new cases in the United States approaching 200,000 per day and a flood of patients straining hospitals across the country, public health experts warn that the ample supply of available ventilators may not be enough to save many critically ill patients.
“We’re now at a dangerous precipice,” said Dr. Lewis Kaplan, president of the Society of Critical Care Medicine. Ventilators, he said, are exceptionally complex machines that require expertise and constant monitoring for the weeks or even months that patients are tethered to them. The explosion of cases in rural parts of Idaho, Ohio, South Dakota and other states has prompted local hospitals that lack such experts on staff to send patients to cities and regional medical centers, but those intensive care beds are quickly filling up.
Public health experts have long warned about a shortage of critical care doctors, known as intensivists, a specialty that generally requires an additional two years of medical training. There are 37,400 intensivists in the United States, according to the American Hospital Association, but nearly half of the country’s acute care hospitals do not have any on staff, and many of those hospitals are in rural areas increasingly overwhelmed by the coronavirus.
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