Here’s what you need to know:Sandra Lindsay, a nurse at Long Island Jewish Medical Center, was inoculated with the Pfizer-BioNTech Covid-19 vaccine by Dr. Michelle Chester in Queens on Monday.Credit…Pool photo by Mark Lennihan

The first shot was given in the American mass vaccination campaign on Monday morning, opening a new chapter in the battle against the coronavirus pandemic, which has killed more people in the United States than in any other country.

Shortly after 9 a.m. on Monday, the first clinically authorized vaccination took place in Long Island Jewish Medical Center in Queens. The pandemic has scarred New York State profoundly, leaving more than 35,000 people dead and severely weakening the economy.

“I believe this is the weapon that will end the war,” Gov. Andrew M. Cuomo said at the event on Monday morning, shortly before the shot was given to Sandra Lindsay, a critical care nurse at the center. State officials said the shot was the first to be given outside of a vaccine trial in the United States.

Ms. Lindsay, who has treated patients throughout the pandemic, said that she hoped her public vaccination would instill confidence that the shots were safe.

“I feel like healing is coming,” she said. “I hope this marks the beginning of the end of a very painful time in our history.”

President Trump posted on Twitter: “First Vaccine Administered. Congratulations USA! Congratulations WORLD!”

Shortly afterward, Mayor Bill de Blasio of New York City said at a news conference that “To me, we were watching an incredibly historic moment, and the beginning of something much better for this city and this country.”

The vaccinations started after the Food and Drug Administration’s emergency authorization of the Pfizer-BioNTech vaccine on Friday night, and as the U.S. coronavirus death toll approaches 300,000, with a steady surge in new cases daily.

On Sunday, trucks and cargo planes packed with the first of nearly three million doses of coronavirus vaccine had fanned out across the country, as hospitals in all 50 states rushed to set up injection sites and their anxious workers tracked each shipment hour by hour. But the rollout is less centralized in the United States than in other countries that are racing to distribute it.

Across the country, according to Gen. Gustave F. Perna, the chief operating officer of the federal effort to develop a vaccine, 145 sites are set to receive the vaccine on Monday, 425 on Tuesday and 66 on Wednesday.

A majority of the first injections are expected to be given on Monday to high-risk health care workers. In many cases, this first, limited delivery would not supply nearly enough doses to inoculate all of the doctors, nurses, security guards, receptionists and other workers who risk being exposed to the virus every day. Because the vaccines can cause side effects including fevers and aches, hospitals say they will stagger vaccination schedules among workers.

Residents of nursing homes, who have suffered a disproportionate share of Covid-19 deaths, are also being prioritized and are expected to begin receiving vaccinations next week. But the vast majority of Americans will not be eligible for the vaccine until the spring or later.

On Monday afternoon at George Washington University Hospital, five of the first vaccinations are scheduled to take place at what the Department of Health and Human Services is calling a national ceremonial “kickoff event.”

The five people were selected by an algorithm the hospital is using to assign the first doses, the result of a survey hospital employees filled out that asked about age, underlying medical conditions and the risk they carry in their jobs, according to a federal health official familiar with the planning who was not authorized to speak publicly. The event is intended to demonstrate the way many health workers will be vaccinated this week, the official said.

The kickoff is part of what the official said will be a series of vaccination events featuring top health officials.

The moves come just six days after Britain became the first nation in the world to begin rolling out a fully tested vaccine. Since then, a handful of other nations have approved the same vaccine. In Canada, the first shipments of the Pfizer-BioNTech vaccine arrived on Sunday, Prime Minister Justin Trudeau announced on Twitter, and the first shots could be given as early as Monday. Among the first to receive the vaccine will be residents of nursing homes in Quebec and frontline health workers in Toronto.

Hours before the injections began in the United States, there had been uncertainty and expectation. On the snowy plains of Fargo, N.D., Jesse Breidenbach, the senior executive director of pharmacy for Sanford Health, which operates hospitals and clinics across the Upper Midwest, refreshed his email again and again on Sunday, waiting to receive a FedEx tracking number that would confirm that some 3,400 doses were en route.

The Sanford hospital in Fargo was converting its Veterans Club into a vaccination site, and officials said they would start inoculating a first group of emergency and critical-care doctors and nurses within hours after the vaccine arrived. But when would that be?

The answer came on Sunday afternoon: Expected vaccine delivery, 10:30 a.m. Monday, with vaccinations starting early in the afternoon.

The White House chief of staff, Mark Meadows, right, in October. Mr. Meadows tested positive for the coronavirus in early November.Credit…Oliver Contreras for The New York Times

President Trump said on Sunday night that he would delay a plan for senior White House staff members to receive the coronavirus vaccine in the coming days.

The shift came just hours after The New York Times reported that the administration was rapidly planning to distribute the vaccine to its staff at a time when the first doses are generally being reserved for high-risk health care workers.

Mr. Trump, who tested positive for the coronavirus in October and recovered after being hospitalized, also implied that he would get the vaccine himself at some point in the future, but said he had no immediate plans to do so.

“People working in the White House should receive the vaccine somewhat later in the program, unless specifically necessary,” Mr. Trump tweeted, hours after a National Security Council spokesman had defended the plan. “I have asked that this adjustment be made. I am not scheduled to take the vaccine, but look forward to doing so at the appropriate time. Thank you!”

It was not immediately clear why Mr. Trump decided to change the policy, or whether he had even been aware of it ahead of time. But White House staff members who work in close quarters with him had been told that they were scheduled to receive injections of the coronavirus vaccine soon, two sources familiar with the distribution plans said.

The goal of distributing the vaccine in the West Wing was to prevent additional government officials from falling ill in the final weeks of the Trump administration. The hope was to eventually distribute the vaccine to everyone who works in the White House, one of the people said.

It was not clear how many doses were being allocated to the White House or how many were needed, since many staff members had already tested positive for the virus and recovered. While many Trump officials said they were eager to receive the vaccine and would take it if it were offered, others said they were concerned it would send the wrong message by making it appear as if Trump staff members were hopping the line to protect a president who has already recovered from the virus and bragged that he is now “immune.”

Global Roundup

A passenger hugged a family member upon arrival from New Zealand at Sydney International Airport in Australia in October. The two countries are planning to bring in a two-way travel bubble.Credit…David Gray/Agence France-Presse — Getty Images

The New Zealand government intends to establish a travel bubble with Australia in the first quarter of next year, Prime Minister Jacinda Ardern announced on Monday.

The arrangement would allow people to travel freely between Australia and New Zealand without needing to quarantine for two weeks on arrival. Passengers arriving from New Zealand are already exempt from quarantine requirements in Australia.

The travel bubble was “pending confirmation” from Australian officials, Ms. Ardern said during a news conference, and would be contingent on “no significant changes in the circumstances of either country.”

New Zealand, population about five million, has managed to avoid the worst of the pandemic, with 2,096 cases and 25 lives lost, according to a New York Times database. In Australia, which has a population of about 25.5 million, 28,031 people have tested positive for the coronavirus, while 908 have died.

The governments of New Zealand and Australia announced in May that they had reached a formal agreement to form a travel bubble as soon as it was safe to do so. But surges in new cases, most notably in Victoria, Australia, left the plans suspended.

Here’s what else to know in coronavirus news from around the world:

Officials in South Korea have ordered schools in the Seoul metropolitan area to move all classes online starting Tuesday until at least the end of the year. Additional measures may be announced this week as the country struggles to contain its worst outbreak yet. South Korea, which has a population of about 50 million, reported 718 new cases on Monday, down from a record 1,030 the day before.

Japan is also struggling with an uptick in coronavirus cases and will hit pause on a nationwide campaign to encourage travel and tourism. With hospitals under increasing pressure from a recent, steady growth in new infections, the program, called “Go To Travel,” will be halted from Dec. 28 through at least Jan. 11, covering the most important holiday of the calendar, New Year’s, when many people travel home. The program had provided substantial discounts to consumers to encourage them to support the country’s beleaguered tourism and service sectors.

Singapore on Monday became the first Asian country to approve a coronavirus vaccine made by the American drug maker Pfizer, announcing that the first shipment would arrive this month and be given free to Singaporeans and long-term residents. Singapore has also agreed to buy vaccines from the American drug maker Moderna and the Chinese company Sinovac. “If all goes according to plan, we will have enough vaccines for everyone in Singapore by the third quarter of 2021,” Prime Minister Lee Hsien Loong said in an address to the nation.

Officials in Germany urged the public to not rush to stores to finish their Christmas shopping this week, as all but those selling essential goods prepared to close on Wednesday amid a heightened lockdown. Germany announced the stricter measures on Sunday after weeks of a partial lockdown that kept both schools and shops open but failed to adequately tackle the surging numbers of new coronavirus cases.

Austria wrapped up its first nationwide mass coronavirus testing on Sunday, turning up about 4,200 apparently symptomless infections. Slightly less than a quarter of the country’s population took part in the free screening, available to anyone more than 6 years old who had not been sick in the past three months. Rudi Anschober, the Austrian health minister, called it “not just a good start, but a successful step in containing the pandemic in Austria.”

The European Union launched a mobile app on Monday aimed at facilitating safe travel between its 27 member countries, as well as to Iceland, Liechtenstein, Norway and Switzerland, which belong to the bloc’s Schengen zone. The app, called Re-open EU, is intended to help residents of Europe navigate a patchwork of different national restrictions, as well as quarantine and testing requirements, and was introduced ahead of the busy holiday season.

Jennifer Jett, Ben Dooley and Monika Pronczuk contributed reporting.

For patients seriously ill with covid-19, a clinical trial shows the drug baricitinib may hasten their recovery.Credit…Ariana Drehsler for The New York Times

Adding an arthritis drug called baricitinib to Covid-19 treatment regimens that include the antiviral drug remdesivir might shave a day or more off recovery times, especially for those who are seriously sick, according to a study published on Friday.

The findings of a government-sponsored clinical trial were made public more than three weeks after the Food and Drug Administration issued an emergency use authorization for the dual treatment.

Earlier this month, some experts said they were uncomfortable deploying drugs without the opportunity to vet the underlying data supporting their performance. Last month, the World Health Organization also recommended against remdesivir as a treatment for Covid-19 patients because evidence supporting its use was lacking.

Limited results earlier were announced via news releases, showing that hospitalized patients treated with baricitinib and remdesivir recovered one day faster than those who had received remdesivir alone.

Some questioned adopting the combination treatment given baricitinib’s hefty price tag — which may be about $1,500 per patient — and also cited side effects like blood clots. Several doctors also wondered whether adding baricitinib would be worthwhile because steroids like dexamethasone were cheap and widely available. Both baricitinib and dexamethasone are thought to act by tamping down excessive inflammation, which drives many severe cases of Covid-19.

The new paper, published in the New England Journal of Medicine, adds some granularity to the findings, showing that certain groups of patients benefited from the addition of baricitinib far more than others.

The trial enrolled more than 1,000 hospital patients with Covid-19, all of whom received remdesivir. People who were sick enough to require a high dose of supplemental oxygen or a noninvasive form of ventilation recovered eight days faster when baricitinib was included in their drug regimen.

A funeral at Adolf Funeral Home & Cremation Services in Willowbrook, Il. Families of covid-19 victims who have died are using obituaries to vent their feelings about the pandemic.Credit…Lucy Hewett for The New York Times

By Sunday, deaths from the coronavirus were approaching 300,000 in the United States, a toll comparable to losing the entire population of Pittsburgh or St. Louis. Reports of new deaths have more than doubled in the last month to an average of nearly 2,400 each day, more than at any other point in the pandemic.

The deaths have been announced in the traditional fashion, in obituaries and notices on websites and in newspapers that have followed the same format for decades, noting birthplaces, family members, jobs and passions.

But in recent months, as the death toll from the coronavirus in the United States grows steadily higher, families who have lost relatives to the disease are writing the pandemic more deeply into the death notices they submit to funeral homes and the materials they share with newspapers’ obituary writers.

They are including pleas for mask wearing, rebuking those who believe the virus is a hoax, and describing, in blunt detail, the loneliness and physical suffering that the coronavirus inflicted on the dying.

Lida Barker, 92, a longtime resident of Gary, Ind., died on Nov. 20 after contracting the coronavirus in the nursing home where she lived. Her death devastated her children, three sisters who met on a Zoom call to write the obituary in the days after she died.

They wrestled with the wording of a mention of the coronavirus, settling on this: “In her memory, please wear a mask in public and take Covid-19 seriously. It is real; it hastened her death.”

Over decades, families have often declined to write in an obituary how their relative died when there was anxiety or fear attached to the cause, whether it was AIDS, an opioid overdose or suicide. But as the public has grown more aware of once-unfamiliar infectious diseases, mental illness and drug addiction, the tendency to conceal has slowly given way to candor.

And with funeral services postponed, and burials often happening without public eulogies or words spoken in memory, the obituary has taken on heightened importance, the family’s turn to deliver their own unfiltered message to the community.

Annie Innes, 90, received a coronavirus shot at Abercorn House Care Home in Hamilton, western Scotland, on Monday.Credit…Pool photo by Russell Cheyne

Less than a week after Britain began to introduce the Pfizer-BioNTech coronavirus shot — becoming the first nation in the world to administer a fully tested vaccine to the public — primary care doctors in England will begin offering doses to their patients.

Beginning on Monday, the shots will be delivered to more than 100 vaccination centers in villages, towns and cities by groups of doctors, the National Health Service said. The injections will still be prioritized, with the staff and residents of nursing homes and those aged 80 and over among the first in line as the country expands its program.

The physicians, known in Britain as general practitioners, face an “enormous challenge” to implement the mass vaccination program while also offering their usual services for patients, Prof. Martin Marshall, chairman of the Royal College of General Practitioners, said in a statement.

But the primary care doctors take a major role in administering other vaccines, such as those for seasonal flu, and Professor Marshall said, “We want to use this experience to help protect people from Covid-19 and start getting life back to normal again.”

Tens of thousands of vaccinations have already been given since the campaign began last Tuesday in hospitals around Britain. But the country received an initial batch of just 800,000 doses — or enough to vaccinate 400,000 people, because each person requires two doses — and it is still unclear when more will become available. Britain has a population of about 66 million.

Vaccinations will also begin in nursing homes later this week, the health service said, after stringent policies around the delivery of the doses were finalized. More doctors and pharmacies in the country will join the program “on a phased basis” over the next few months, the health service added, urging patients not to request the vaccine because doctors would directly contact those in priority groups to offer them the shot.

The vaccine program comes as cases continue to surge in Britain, with 18,447 new infections reported on Sunday and 144 deaths according to a Times database. The nation has reported about 1.8 million total cases and some 64,000 deaths since the pandemic began.

Bike commuters navigate the road alongside public and private vehicles without a bike lane in EDSA, Makati on October 27, 2020. The rise of bike culture in the Philippines due to limited transportation during the pandemic is sparking movements in policies and infrastructure toward the country becoming more bike-friendly.Credit…Kimberly dela Cruz for The New York Times

As the need for social distancing forces governments around the world to reduce public transportation service, city dwellers are hopping on bikes instead. Global bicycle sales have surged to the point where even Giant, the world’s largest bike maker, has struggled to fill orders.

In Manila, the cycling surge is notable because the Philippines has not only one of the highest numbers of coronavirus infections in Asia — more than 445,000, according to a New York Times database — but also some of the region’s worst urban congestion.

Last year, a study by the Asian Development Bank found that metro Manila, an area roughly six times the size of Paris, was the most congested of 24 cities that it surveyed across South and Southeast Asia. Japan’s development agency estimates that the cost of traffic to Manila’s economy is more than $72 million, or 3.5 billion Philippine pesos, a day.

Metro Manila was closed in March as part of a wider lockdown of Luzon, the country’s most populous island, imposed by President Rodrigo Duterte. When stay-at-home orders began to lift a few months later, public transit was still operating at limited capacity.

Some bus and train commuters started driving instead. But for many Manila residents, walking or cycling became their only means of getting to work.

Biking on Manila’s snarled, potholed roads can be hazardous, in part because some drivers regard cyclists as obstacles. Sidewalks, too, are often clogged with street vendors and makeshift parking areas. The Manila metropolitan area had 19 bicycle-related fatalities last year, according to official figures. By comparison, New York officials counted 28.

The government has been gradually easing restrictions on public transit in metro Manila since June. But by now, many commuters are hooked on cycling, and some downtown streets where vendors once sold vegetables and electronics are filled with bikes and accessories for sale.

The biking boom prompted Philippine officials to announce a plan in August to build a 400-mile bike lane network that would be financed through a pandemic-related stimulus fund.



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