Here’s what you need to know:Pedestrians walking past a chestnut vendor in the City of London on Monday.Credit…Tolga Akmen/Agence France-Presse — Getty Images

Nearly half of England is under the nation’s strictest lockdown measures, and people have been ordered to stay at home, but the coronavirus is still spreading at an alarming rate. Hospitals are treating more patients than at any time during the pandemic, and there is a growing debate about allowing tens of thousands of students to return to classrooms after the holiday break.

The nation’s scientists have said that a more contagious variant of the virus is driving the rise in cases and, having already imposed severe restrictions on more than 48 million people, it remains unclear what other tools the government has at its disposal to get the outbreak under control.

There were 41,385 new lab-confirmed cases reported in the U.K. on Monday, the highest figure yet on a single day. The National Health Service said there were now over 20,000 people in the hospital there, more than at the peak of the pandemic in April.

With the government scheduled to meet to evaluate the current restrictions on Wednesday, Prime Minister Boris Johnson is under pressure to impose another national lockdown and shift students — especially older ones in colleges and secondary schools, who may be more easily infected by the new virus variant — to remote learning.

The government said that it would rely on mass testing to keep the virus from spreading in schools, with military help. Some 1,500 soldiers are being dedicated to providing schools with the “guidance, materials and funding they need to offer rapid testing to their staff and students from the start of term,” according to the education secretary, Gavin Williamson.

But two teachers’ unions have said that staff has not been given adequate time to set up mass testing and the country’s board of scientific advisers, known as SAGE, has recommended against allowing classrooms to reopen, according to British media reports.

Even as the country’s health workers find themselves under growing pressure to treat the influx of patients, they are also being asked to speed up the largest mass vaccination program in the nation’s history.

Around 200,000 people are getting their first shot of the Pfizer-BioNTech vaccine every week. Ursula von der Leyen, the European Commission’s president, wrote on Twitter on Tuesday that the European Union would take an additional 100 million doses of that vaccine, bringing the total to 300 million doses. And with the approval of a vaccine from AstraZeneca and the University of Oxford expected in coming days, the number of doses available will expand drastically. The AstraZeneca vaccine, which comes without the stringent temperature requirements of Pfizer’s, should also be easier to distribute.

There is no evidence that the vaccines are any less effective against the variant of the virus spreading in Britain, and they remain the best chance for the country to break the spread of the current wave of infections.

But to meet the government’s promise to vaccinate all those over the age of 50 by spring, the speed of delivery would have to be 10 times as fast as it is now.

That will require not just supply, but enough staff to deliver the vaccines. And that means even more pressure on N.H.S. workers.

Sir Simon Stevens, the head of the N.H.S. in England, delivered a message to health workers “back in the eye of the storm,” praising their dedication and urging them to press on through “the toughest year most of us can remember.”

“Many of us have lost family, friends, colleagues and — at a time of year when we would normally be celebrating — a lot of people are understandably feeling anxious, frustrated and tired,” he said, delivering his remarks from a vaccination center on Tuesday. “Therefore now is the right time, I believe, on behalf of the whole country to record our enormous debt of gratitude and our huge thanks.”

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Health care workers treating a Covid-19 patient at Providence St. Mary Medical Center in Apple Valley, Calif., this month.Credit…Ariana Drehsler for The New York Times

Dozens of research papers published over the past few months have found that people whose bodies were teeming with the coronavirus more often became seriously ill and were more likely to die, compared with those who carried much less virus and were more likely to emerge relatively unscathed. Now that information could help hospitals.

The results suggest that knowing the so-called viral load — the amount of virus in the body — could help doctors distinguish those who may need an oxygen check just once a day, for example, from those who need to be monitored more closely, said Dr. Daniel Griffin, an infectious disease physician at Columbia University in New York.

Tracking viral loads “can actually help us stratify risk,” Dr. Griffin said. The idea is not new: Managing viral load has long formed the basis of care for people with H.I.V., for example, and for tamping down transmission of that virus.

Little effort has been made to track viral loads in Covid-19 patients. This month, however, the Food and Drug Administration said clinical labs might report not just whether a person is infected with the coronavirus, but also an estimate of how much virus is in their body.

This is not a change in policy. Labs could have reported this information all along, according to two senior F.D.A. officials who spoke on condition of anonymity because they were not authorized to speak publicly about the matter.

Still, the news came as a welcome surprise to some experts, who have for months pushed labs to record this information.

“This is a very important move by the F.D.A.,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. “I think it’s a step in the right direction to making the most use of one of the only pieces of data we have for many positive individuals.”

The F.D.A.’s change followed a similar move by the Florida Department of Health, which now requires all labs to report this information.

The omission of viral load from test results was a missed opportunity not just to optimize strained clinical resources, but also to better understand Covid-19, experts said. Analyzing the viral load soon after exposure, for example, could help reveal whether people who die from Covid-19 are more likely to have high viral loads at the start of their illnesses.

And a study published in June showed that the viral load decreases as the immune response surges, “just like you’d expect it to be for any old virus,” said Dr. Alex Greninger, a virologist at the University of Washington in Seattle, who led the study.

An uptick in the average viral load throughout entire communities could indicate an epidemic on the rise. “We can get an idea of whether the epidemic is growing or declining, without relying on case counts,” said James Hay, a postdoctoral researcher in Dr. Mina’s lab.





‘That Was Easy’: Harris Receives Covid-19 VaccineVice President-elect Kamala Harris received the Moderna Covid-19 vaccination on Tuesday at United Medical Center in southeast Washington, and urged the public to get vaccinated as well.

“Let’s do it.” “All righty. Ready?” “Yeah, I’m ready. That was easy. [laughing] Thank you. I have now been vaccinated — as Joe likes to say, there’s a big difference between the vaccine and vaccinations. I want to encourage everyone to get the vaccine. It is relatively painless. It happens really quickly. It is safe. Literally, this is about saving lives. It’s literally about saving lives. I trust the scientists, and it is the scientists who created and approved this vaccine. So I urge everyone, when it is your turn, get vaccinated. It’s about saving your life, the life of your family members and the life of your community.”

Vice President-elect Kamala Harris received the Moderna Covid-19 vaccination on Tuesday at United Medical Center in southeast Washington, and urged the public to get vaccinated as well.CreditCredit…Al Drago for The New York Times

Vice President-elect Kamala Harris received the first dose of the Covid-19 vaccine on Tuesday and urged the public to get vaccinated as well, declaring, “Literally this is about saving lives.”

Ms. Harris received the Moderna vaccine at United Medical Center, a public hospital in Southeast Washington, where she rolled up her sleeve and received the shot in her left arm.

“That was easy,” she said when it was over. “Thank you. I barely felt it.”

Ms. Harris appeared on live television to receive her shot, just as President-elect Joseph R. Biden Jr. did last week when he received the Pfizer-BioNTech vaccine at a hospital in Delaware. Ms. Harris’s husband, Douglas Emhoff, was also vaccinated on Tuesday.

After getting the vaccine, Ms. Harris urged Americans to get vaccinated as well, saying: “It is relatively painless. It happens really quickly. It is safe.”

“I trust the scientists, and it is the scientists who created and approved this vaccine,” she added. “So I urge everyone, when it is your turn, get vaccinated. It’s about saving your life, the life of your family members and the life of your community.”

Fresh graves at the Butovskoye cemetery, which serves as one of the burial grounds for those who died from the coronavirus, in Moscow, in June.Credit…Dmitry Serebryakov/Associated Press

MOSCOW — After months of questions over the true scale of the coronavirus pandemic in Russia and the efficacy of a Russian-developed vaccine, the state statistical agency in Moscow has added to the uncertainty with new figures indicating that the death toll from Covid-19 is more than three times as high as officially reported.

From the start of the pandemic early this year, the health crisis has been enveloped and, critics say, distorted by political calculations as President Vladimir V. Putin and Kremlin-controlled media outlets have repeatedly boasted of Russian successes in combating the virus and keeping the fatality rate relatively low.

Russia has reported more than three million cases of infection, making it the world’s fourth-hardest-hit country, and 55,827 deaths, which ranks it No. 8 worldwide for the highest number of deaths from the virus. A demographer at a government agency who questioned the official fatality figures, dismissing them as far too low, was fired over the summer.

New data issued on Monday by Rosstat, the state statistics agency, however, indicated that the demographer was right and that the real number of fatalities was far higher than previously reported. The agency reported that the number of deaths from January to November was 229,732 higher than over the same period last year, an increase that a senior official blamed largely on the coronavirus.

Tatiana Golikova, a deputy prime minister leading Russia’s efforts to combat the pandemic, told a government briefing on Monday that more than 81 percent of the increased number of deaths in 2020 was “due to Covid,” which would mean that the virus had killed more than 186,000 Russians so far this year.

This is still far fewer than the more than 334,000 deaths caused by Covid-19 in the United States but means that Russia has suffered more fatalities as a result of the pandemic than elsewhere in Europe like Italy, France and Britain, whose poor record has been regularly cited by Russian state media as proof of Russia’s relative triumph.

President-elect Joseph R. Biden Jr. speaking in Wilmington, Del., on Monday.Credit…Amr Alfiky/The New York Times

President-elect Joseph R. Biden Jr. is expected to fault the current pace of vaccine distribution under the Trump administration in remarks to be delivered in Delaware on Tuesday, and he will discuss his own plan to get Americans vaccinated as fast as possible, according to a transition official.

The president-elect is scheduled to speak about the coronavirus pandemic in the afternoon after receiving a briefing from his Covid-19 advisory team. His appearance comes with just over three weeks until he will take office amid a crisis that has already killed more than 335,000 people in the United States.

Also on Tuesday, Vice President-elect Kamala Harris received her first dose of the Covid-19 vaccine. She received her shot on live television, just as Mr. Biden did last week. Ms. Harris’s husband, Douglas Emhoff, was also vaccinated on Tuesday.

Mr. Biden and Ms. Harris are preparing to take office at a time of widespread personal suffering and economic disruption as a result of the virus. But the distribution of Covid-19 vaccines developed by Pfizer-BioNTech and Moderna has provided a sign of hope for taming the spread of the virus, albeit not before many more grim weeks.

President Trump’s mismanagement of the pandemic was at the center of Mr. Biden’s argument to voters about why they should deny him a second term, and soon, it would be up to Mr. Biden to begin steering the country through the continuing health crisis.

The president-elect has already offered a preview of what to expect, stressing the importance of wearing masks, promising to follow scientific expertise and calling for additional economic relief beyond the $900 billion stimulus package that Mr. Trump signed into law on Sunday.

Mr. Biden has vowed to get at least 100 million vaccine shots into the arms of Americans in his first 100 days in office, and he has said that getting children back in the classrooms should be a priority for the nation.

Speaking last week in Delaware, Mr. Biden nonetheless offered a sober warning about what lies ahead.

“One thing I promise you about my leadership during this crisis: I’m going to tell it to you straight,” he said. “I’m going to tell you the truth. And here’s the simple truth: Our darkest days in the battle against Covid are ahead of us, not behind us.”

Michael Ryan, the head of the emergencies program at the World Health Organization, shown in October, said, “we must honor those we’ve lost by getting better at what we do every day.”Credit…Christopher Black/World Health Organization, via Reuters

One of the World Health Organization’s senior officials warned on Monday that although the coronavirus pandemic has been “very severe,” it is “not necessarily the big one.”

Reflecting on the year in the W.H.O.’s final media briefing of 2020, the head of the emergencies program, Michael Ryan, said that his words may come as a shock.

More than 1.7 million people worldwide have died this year from Covid-19, more than 81 million cases have been recorded and the spread of the coronavirus has been unrelenting in many countries.

“These threats will continue,” Dr. Ryan said. “If there’s one thing we need to take from this pandemic with all the tragedy and loss is that we need to get our act together. We need to get ready for something that may even be more severe in the future.”

Dr. Ryan acknowledged that much progress has been made on improving how we communicate and govern during this pandemic, but, he said, this year was a “wake up call” and “we must honor those we’ve lost by getting better at what we do every day.”

Striking a similarly solemn tone, David Heymann, the chair of the W.H.O.’s strategic and technical advisory group for infectious hazards, predicted that SARS-CoV-2, the novel coronavirus that causes Covid-19, would become endemic, like the other human coronaviruses such as SARS and MERS that have spread in recent years.

Coronavirus vaccination programs, the W.H.O. said, would be integral to saving lives and protecting vulnerable people.

Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, promised that the organization would “not rest until those in need everywhere, in all countries, have access to vaccines and are protected.”

Prudence Nonzamedyanti, a participant in a coronavirus vaccine trial, at the Desmond Tutu H.I.V. Foundation Youth Center near Cape Town this month.Credit…Joao Silva/The New York Times

Over the past few months, rich nations like the United States and Britain have cut deals with multiple drug manufacturers and secured enough doses of coronavirus vaccine to inoculate their citizens many times over. China and Russia have conducted their own trials and begun mass vaccination programs.

Yet countries like South Africa, the African country hardest hit by the pandemic, are in a singular bind because they cannot rely on charity. Although its government is nearly insolvent and half of its citizens live in poverty, South Africa is considered too rich to qualify for cut-rate vaccines from international aid organizations.

And so, a few months from now, when a factory in South Africa is expected to begin churning out a million doses of coronavirus vaccine each day, those vials will probably be shipped to a distribution center in Europe and then rushed to Western countries that have ordered them by the hundreds of millions.

None have been set aside for South Africa, which does not expect to see the first trickle of doses until around the middle of next year.

“Where you’re not rich enough but you’re not poor enough, you’re stuck,” said Salim Abdool Karim, an epidemiologist who leads South Africa’s coronavirus advisory council.

Poor and middle-income nations, largely unable to compete in the open market, rely on a complex vaccine-sharing arrangement called Covax. A collaboration of international health organizations, Covax was designed to avoid the inequities of a free-market free-for-all. But its deals come with strings attached, and health advocates are questioning its transparency and accountability.

“The people at the top, they’re going to get the vaccine, the people who have power,” said Mtshaba Mzwamadoda, 42, who lives in a one-bedroom corrugated metal shack with his wife and three children. “Maybe we’ll get the vaccine in 2025.”

South Africa has recorded over one million cases and 26,000 deaths as of Monday, according to government figures.

With one of the strictest initial lockdowns in the world, South Africa avoided the high death toll that many experts feared. As restrictions eased in the last quarter of the year, however, the death toll climbed steadily, beginning to spike as the holiday season approached.

Scientists from the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal announced on Dec. 18 that the country was seeing a variant of the virus that accounts for the vast majority of samples tested in the current wave.

Lynsey Chutel and Sheri Fink contributed reporting.

Global Roundup

Medical staff treating a patient with Covid-19 in the intensive care unit at Maastricht University Medical Center+ in Maastricht, Netherlands, last month.Credit…Piroschka Van De Wouw/Reuters

The pandemic has caused the highest number of excess deaths in the Netherlands since World War II, the CBS, the country’s independent national statistics bureau, said on Tuesday.

Up to last week, the Netherlands — which has a population of roughly 17 million people — reported 162,000 deaths, about 13,000 more than usual, according to the CBS, the statistics bureau, whose figures are used by the government and businesses in the Netherlands. During both waves of the virus, when European countries struggled to contain cases, the number of excess deaths in the country was notable. All excess deaths during the first wave in the spring were caused by the coronavirus, according to the statistics bureau, and an August heat wave also caused some excess deaths this year.

Over the summer, the country had barely any lockdown measures in place, and some people were able to go on vacation. But over the past few months, as the country has been facing and trying to fight a brutal second wave of the pandemic, 6,100 more people died than would have been expected. The Netherlands has also found cases of the British variant in the past week.

The pandemic has hit the Netherlands particularly hard. Earlier this month, Prime Minister Mark Rutte announced harsh new lockdown measures — the strictest of the pandemic — until at least Jan. 19 because of “a dramatic increase in the number of infections, with figures up to around 9,000 per day,” according to the government.

In other developments from around the globe:

A woman in hotel quarantine in Queensland, Australia, is the first person in the country found to have a new South African strain of the coronavirus that is thought to be more contagious, health officials said on Tuesday. The woman had traveled from South Africa and has been transferred to a hospital north of Brisbane.

Officials in India said on Tuesday that they had found six cases of the virus variant first detected in Britain. The Indian Union Health Ministry said the patients had traveled from Britain and have been isolated in government-run facilities, while their close contacts have been quarantined. India is one of dozens of countries that have temporarily banned flights from Britain.

The United States on Tuesday began vaccinating its 28,500 troops in South Korea, as the government there reported a single-day record for coronavirus deaths. Service members are receiving the Moderna vaccine, though it is not mandatory, U.S. Forces Korea said in a statement. There have been more than 450 coronavirus cases tied to U.S. forces serving in South Korea. The country, which is struggling to contain a third wave of infections, has had a total of 58,725 cases and 859 deaths, with 40 reported on Tuesday. South Korean officials say vaccinations for the public will begin in February.

The Philippines on Tuesday banned foreign travelers from 19 countries and territories until Jan. 15 in an effort to keep out a more virulent strain of the coronavirus that was first detected in Britain. In addition to Britain, which was already under a travel ban, the countries and territories affected are: Australia, Canada, Denmark, France, Germany, Hong Kong, Iceland, Ireland, Israel, Italy, Japan, Lebanon, the Netherlands, Singapore, South Africa, South Korea, Spain, Sweden and Switzerland. Passengers who arrived before Wednesday and Filipino citizens arriving from those places must quarantine at a designated facility for 14 days, according to a government advisory.

Jason Gutierrez, Jennifer Jett, Livia Albeck-Ripka and Sameer Yasir contributed reporting.

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