As England enters a strict new national lockdown and other European nations extend restrictions to try to slow the spread of the coronavirus, political leaders have pointed to the promise of mass vaccination campaigns to bring an end to the suffering.
But in the race to beat the virus, the virus is still way out in front.
Around the world, inoculation efforts in many countries are rolling out slower than promised, even as the count of new infections soars and record numbers flood hospitals, placing a double burden on health care providers who have also been tasked with leading the vaccination push.
And a more contagious variant spreading widely in England and detected in dozens of other countries threatens to give the virus an even greater advantage.
Prime Minister Boris Johnson said that England would be locked down until inoculations reached the four most vulnerable groups: residents in nursing homes and those who care for them, everyone over the age of 70, all frontline health and social care workers, and everyone who is clinically extremely vulnerable.
“If we succeed in vaccinating all those groups, we will have removed huge numbers of people from the path of the virus,” he said.
That goal, he added, could be achieved by the middle of February.
But to do that, the pace of vaccinations will need to increase drastically.
The four groups that the prime minister cited include 13.9 million people in England, according to Nadhim Zahawi, the minister overseeing the vaccine effort.
Since the campaign started on Dec. 8, fewer than 800,000 people in England had been vaccinated as of Dec. 27, the last date when data was available.
But with the introduction on Monday of the first doses of a vaccine developed by the University of Oxford and AstraZeneca — shots that are easier to transport and do not need to be stored at very cold temperatures — British officials said that the campaign could now be ramped up.
To meet Mr. Johnson’s target, some two million doses need to be given every week.
According to Mr. Johnson, England is outpacing many countries in the European Union, where vaccination campaigns did not kick off until just before Christmas.
Data from 19 of the bloc’s 27 member states, including France, Germany and Italy, show that about 500,000 vaccinations have been carried out so far.
In Germany, where the government was poised to extend lockdown measures through January, nearly 265,000 people received a first shot as the nationwide drive entered its second week, according to health officials. At the moment, Germany and other European Union countries are relying on the BioNTech-Pfizer vaccine, which requires another booster shot weeks later to reach full efficacy. England has decided to delay that second shot and other countries are exploring doing the same.
The Italian government said that as of Monday, 151,606 people had been vaccinated. A majority, 134,255, were health care professionals.
The vaccination drives in Germany and Italy are moving much faster than in France, where only about 500 people received the vaccine during the previous week.
And the campaign in the United States, the world’s leader in new infections, is off to a much slower start than promised.
About 4.5 million people in the United States have received a dose of a Covid-19 vaccine, according to the Centers for Disease Control and Prevention, far short of the goal that federal officials set to give at least 20 million their first shots before the end of December.
The small number of vaccine recipients is particularly striking in New York City, where roughly 110,000 people — in a city of more than eight million — have received the first of two doses necessary to help prevent serious cases of the disease. That is about a quarter of the total number received by the city.
California’s daily coronavirus case tallies remain around four times what they were during the state’s summer surge, and officials predict that the aftereffects of a December surge linked to holiday gatherings will worsen as the winter drags on.
After new infections — driven by Thanksgiving travel and gatherings, then Christmas festivities — resulted in a surge unlike any the state had yet seen, the trajectory of its new cases has leveled off somewhat in the early days of 2021.
But there are more than twice as many Covid-19 patients in California hospitals now as there were a month ago, and many intensive care units in the state have been overflowing. At least six people in the state have also been found to be infected with the new, more transmissible variant of the virus first identified in Britain.
In the pandemic’s brutal logic, more cases inevitably translates to more suffering and deaths. As of Monday night, 4,258 people with Covid-19 had died in the preceding two weeks, compared with 3,043 in the two weeks before that.
“This is a deadly disease, this is a deadly pandemic,” Gov. Gavin Newsom told reporters on Monday. “It remains more deadly today than at any point in the history of the pandemic.”
There has been some progress. California’s daily average of 38,086 cases per day over the past week represents a decrease of 11 percent from the average two weeks earlier, for example. And although Covid-19 hospitalizations have increased by 18 percent over the past two weeks, to 20,618, Governor Newsom said that represents a slight flattening of the curve.
But the state’s last major Covid-19 surge, over the summer, only produced around 10,000 infections on its worst days. And in Los Angeles County, the latest crisis has stretched the health care system so thin that incoming patients at one hospital were recently being instructed to wait in an outdoor tent.
Mayor Eric Garcetti of Los Angeles said on Sunday that the county’s latest surge was infecting a new person every six seconds, and that many transmissions were occurring in private settings.
“It’s a message for all of America: We might not all have the same density as L.A., but what’s happening in L.A. can and will be coming in many communities in America,” he said.
The worst of the state’s outbreak is concentrated in Southern California and the San Joaquin Valley, where intensive care units are at zero percent capacity. Officials are now working to bring in extra nursing staff to care for the flood of patients; Governor Newsom said that 90 patients were being kept at “alternate care sites” outside hospitals to help ease the burden.
The state is also facing an oxygen shortage for patients, and it has deployed the U.S. Army Corps of Engineers and the California Emergency Medical Services Authority to help deliver and refill oxygen tanks.
In a sign of how dire that shortage is, Marianne Gausche-Hill, the medical director for Los Angeles County’s E.M.S. agency, issued guidelines to emergency workers on Sunday for administering the “minimum amount of oxygen necessary” to keep patients’ oxygen saturation level at or just above 90 percent. (A level in the low 90s or below is a concern for people with Covid-19.)
More inoculations would help ease California’s burden, but Governor Newsom said vaccinations were only just ramping up after facing some early challenges. So far, he said, the state has only administered about 35 percent of the coronavirus vaccine doses it has received.
“That’s not good enough,” he said. “We recognize that.”
In the meantime, said Dr. Mark Ghaly, the state’s secretary of health and human services, Californians should be extra cautious about gathering with people outside their household now that the virus is so prevalent.
“The same activities that you did a month ago, today are just so much more risky than they were from a Covid transmission perspective,” he said.
While many countries are still reeling from Covid-19, China — where the pandemic originated — has become one of the safest places in the world. The country reported fewer than 100,000 infections for all of 2020. The United States has been reporting more than that every day since early November.
China resembles what “normal” was like in the pre-pandemic world. Restaurants are packed. Hotels are full. Long lines form outside luxury stores. Instead of Zoom calls, people are meeting face to face to talk business or celebrate the new year.
The country will be the only major economy to have grown this past year. While such forecasts are often more art than science, one outfit is predicting that the Chinese economy will surpass that of the United States in 2028 — five years earlier than previously expected.
Citizens of China don’t have freedom of speech, freedom of worship or freedom from fear — three of the four freedoms articulated by President Franklin D. Roosevelt — but they are able to move around and lead a normal day-to-day life. In a pandemic year, many of the world’s people would envy that.
But China’s freedom of movement comes at the expense of nearly every other kind. The country is roughly the most surveilled in the world. The government took extreme social-control measures at the beginning of the outbreak to keep people apart — approaches that are beyond the reach of democratic governments.
“There are actually a lot of parallels between how the Chinese government treats a virus and how they treat other problems,” said Howard Chao, a retired lawyer in California who invests in start-ups on both sides of the Pacific.
“It’s kind of a one-size-fits-all approach: Just completely take care of the problem,” he said. “So when it comes to a virus, maybe that’s not too bad a thing. When it comes to certain other problems, maybe not such a good thing.”
The Mississippi Department of Corrections has reported that 108 people died in its prisons in 2020, a toll that was significantly higher than a year earlier. But as of Monday, the department had not disclosed whether any of those deaths were caused by the coronavirus, though more than 1,400 inmates have been infected since the pandemic’s start, according to state data.
Grace Fisher, a spokeswoman for the prison system, did not respond to email and phone inquiries about how the state prison system determines, records and makes public the causes of inmate deaths. A spokeswoman for Gov. Tate Reeves did not respond to an email and phone call seeking comment.
Many states report Covid-19 cases and deaths in online dashboards. Others report them in news releases or when requested.
Mississippi’s prison system has touted its handling of the virus, saying in a news release in December that its prisons “remain among the safest in the nation from the Covid-19 virus.”
Burl Cain, the state’s prison commissioner, said in May that the prison system had successfully managed the virus by restricting inmate transfers, suspending family visits and using increased cleaning and disinfection practices.
Advocates of greater transparency from prison authorities say it is unclear whether Mississippi’s prisons are opting not to disclose coronavirus deaths or if officials are uncertain of a full count because deaths are not being fully investigated.
Cliff Johnson, the director of the University of Mississippi School of Law’s MacArthur Justice Center — which filed a Freedom of Information request to obtain the number of prison deaths — said the lack of information about the causes of prison deaths represented a public safety threat.
All but three states have reported Covid-19 deaths in their prison systems. Vermont has recorded no prisoner deaths from the virus, a representative for that system said. Wyoming has not disclosed any deaths. But Mississippi’s prison system is far larger, with about 16,350 inmates, compared with just 3,200 in Wyoming and Vermont combined.
In New Jersey, whose prisons house about 15,000 inmates, at least 53 have died from Covid-19, according to state data.
The rate of coronavirus testing in Mississippi’s prisons is among the lowest in the nation. Since the pandemic began, only one in five prisoners has been tested, according to state records.
The Food and Drug Administration late Monday criticized an idea floated by one of the administration’s top vaccine officials for stretching the limited number of Covid-19 vaccine doses, saying that a proposal for half-doses of the Moderna vaccine was “premature and not rooted solidly in the available science.”
The agency’s statement, posted on its website Monday night, exposed a fissure between Trump administration officials about whether they can somehow economize vaccine supplies in order to inoculate more people quicker. Moderna and the Pfizer-BioNTech are the only companies so far whose vaccines are authorized for emergency use in the United States, and together they can deliver only enough doses to vaccinate 185 million Americans by the end of June.
On Sunday, Moncef Slaoui, the scientific leader of Operation Warp Speed, the administration’s vaccine development program, said that federal officials and Moderna were discussing possibly halving each of Moderna’s two doses — effectively giving recipients the equivalent of one full dose.
He said data from Moderna’s clinical trials demonstrated that people between the ages of 18 and 55 who received two 50-microgram doses showed an “identical immune response” to the two 100-microgram doses.
But the F.D.A., which would have to approve such a change in protocol, suggested in its statement that the available data was insufficient to justify that shift — or other proposed regimen changes designed to stretch out doses.
“We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19,” the statement said. Such changes should be researched in clinical trials before adopted, it said. Experts said such studies would take weeks, if not longer.
While some data already exists, clinical trial recipients of the Moderna or BioNTech vaccine who did not receive two doses at the proper time “were generally only followed for a short period of time,” the agency said. Therefore, “we cannot conclude anything definitive about the depth or duration of protection after a single dose of vaccine,” it said.
Changing the dosage could also complicate the vaccine effort just as the public is beginning to become more accepting of the program, according to Dr. Anthony S. Fauci, the government’s top infectious disease expert.
“One of the dangers of making a change in midstream is that it could confuse the public,” he said in an interview on Monday.
He also suggested that changing the vaccine dosage was “the right answer to the wrong question.” The current problem, he said, is not that there are not enough doses, but that state and local governments have been unable to vaccinate people with the doses they already have.
“At the present time we are not dealing with a shortage of doses — we are dealing with the need to increase our efficiency in getting people vaccinated,” he said. He suggested that changing the dosage “could become appropriate” if a shortage emerged.