Here’s what you need to know:A resident is vaccinated with the covid-19 vaccine on Wednesday in Napa, California.Credit…Max Whittaker for The New York Times

More than 50 million people in the United States who are 65 or older — as well as younger people with underlying conditions — are now cleared to receive a coronavirus vaccine in the wake of the federal government’s abrupt course reversal on who should get priority.

But that’s much easier said than done.

Some experts have suggested that declaring so many more people eligible might actually make the process of signing up for a vaccine and getting one even more complicated.

“This is creating a lot of confusion and chaos and anxiety days before a new administration comes in,” Claire Hannan, executive director of the Association of Immunization Managers, told NPR on Wednesday morning.

The challenges are many.

States have struggled to set up phone and online sign-up systems, and many of the oldest Americans, who are most at risk of death from a coronavirus infection, have struggled to use them, encountering complicated registration sites, error messages and other roadblocks. Appointments have been booked as soon as they open up. Some in the first priority groups have succeeded in booking their shots — but weeks out. Servers have crashed amid skyrocketing demand. Some areas have multiple sign-up systems, increasing confusion.

In Georgia, a man spoke to Atlanta’s Channel 2 Action News about how he had called the Troup County Covid hotline more than 100 times to try and make an appointment for his mother.

“No one’s ever picking up,” Eric Moore said. “I promise you, I called 134 times.”

There are also questions about how to prioritize people at increased risk of severe illness from Covid-19, an expansive category that the Centers for Disease Control and Prevention estimates includes more than 100 million adults with conditions such as obesity, which affects at least 40 percent of adults, diabetes, cancer, and chronic lung and heart disease.

The federal government’s revised guidance, announced by Alex M. Azar II, the secretary of health and human services, at a news conference on Tuesday, is not binding. As with testing and tracing earlier in the pandemic, each state has been left to devise its own plan based on local needs, at times creating confusion and scattershot approaches.

In New York, there was concern about the crush of demand outpacing availability. The governor said Tuesday the state would accept the new federal guidance to prioritize those 65 and older after eligibility had just been expanded statewide to include residents 75 and older and more essential workers.

On Wednesday, Mayor Bill de Blasio of New York City acknowledged that people may be frustrated by trying to make appointments online or on the phone.

As eligibility continued to expand, he said the city would keep administering doses over the next few weeks “and then we’re going to run out of the vaccine.” The city usually receives about 100,000 doses per week, the city’s health commissioner said Tuesday at a City Council hearing to address problems with the rollout. But officials don’t find out until a couple of days beforehand.

“Even with normal supplies that we expect to have delivered next week, we will run out of vaccine at some point next week unless we get a major new resupply,” the mayor said Wednesday.

Other states were reassessing their vaccination plans based on the new federal guidance, though some may not change course. In Arkansas, Dr. Jose Romero, the health secretary, said that Gov. Asa Hutchinson would stick to his plan of opening vaccinations to people 70 and older and some essential workers starting Monday.

The federal government has delivered about 29.4 million doses to states, territories and federal agencies as of Wednesday, and about 10.3 million doses had been administered. The Trump administration originally said that 20 million Americans would be vaccinated by Jan. 1.

West Virginia, South Dakota and North Dakota had administered the most first doses per capita among states, federal data shows. California, where the virus is raging, was among the states that had administered the fewest of its doses — just 26 percent of those the state had already received. The state is moving to loosen eligibility and open mass vaccination centers, including one at Dodger Stadium in Los Angeles.

Mr. Azar said on Tuesday that the country was “on track” to reach the rate of one million vaccinations a day in about a week, and stressed that data collection about each states’ progress has been slow and faulty. He also faulted states that had been “overly prescriptive and trying to micromanage every single dose of vaccine” and said the government would send more doses to states based on their success in distributing ones they had already received.

The allocation will also be based on the size of a state’s population of people 65 and older, not on its general adult population, he said. It was unclear, however, whether that would hold past Jan. 20, when President-elect Joseph R. Biden Jr. takes office.

Mr. Biden is expected to announce details of his own vaccination plan — which will include federally supported mass vaccination clinics — on Thursday. Mr. Biden has set a goal of 100 million shots administered in his first 100 days.

As of Wednesday, the country had recorded more than 23 million cases and more than 380,000 deaths, according to a Times database. New cases have increased steadily since the fall, and a record number of deaths were reported on Tuesday: more than 4,400.

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Moving a Covid-19 victim from a hospital morgue in Baltimore last month.Credit…Andrew Caballero-Reynolds/Agence France-Presse — Getty Images

As America slogs through this grimmest of winters, there is no relief in the daily tabulations of coronavirus-related deaths: More than 4,400 were reported across the United States on Tuesday, according to a New York Times database, a number once unimaginable.

Yet even as Covid-19 touches thousands of families, the nation is distracted by the political crisis gripping Washington in the last days of the Trump administration.

Tuesday’s death count, which set another daily record, represented at least 1,597 more people than those killed in the terrorist attacks of Sept. 11, 2001.

The U.S. death toll, already the world’s highest by a wide margin, is now about 20,000 shy of 400,000 — only a month after the country crossed the 300,000 threshold, a figure greater than the number of Americans who died fighting in World War II.

But much of the nation’s attention is focused on the fallout from the Capitol siege, prompted in part by President Trump’s efforts to prevent Congress from certifying Joseph R. Biden Jr.’s victory in the November election.

On Wednesday, the House will vote to formally charge Mr. Trump with inciting violence against the country. House lawmakers have formally notified Vice President Mike Pence that they will impeach the president if Mr. Pence and the cabinet do not remove Mr. Trump from power by invoking the 25th Amendment.

As people in the country wait to see how Mr. Trump’s tenure will end, they have also focused on the stories of the five people who were left dead after last week’s rampage — in particular, the death of Brian D. Sicknick, a Capitol Police officer who was overpowered by the mob and struck on the head with a fire extinguisher.

“Brian is a hero,” his brother Ken Sicknick said. “That is what we would like people to remember.”

Each coronavirus death is no less painful to the families and friends who have lost loved ones. Among the latest victims are a revered basketball coach, a travel writer who loved country winters and an architect who had survived the Holocaust.

The health Secretary Alex M. Azar II tried to highlight the urgency of the crisis on Tuesday as the Trump administration said that it would release all available vaccine doses and instructed states to immediately begin inoculating every American 65 and older.

“This next phase reflects the urgency of the situation we face,” he said. “Every vaccine dose that is sitting in a warehouse rather than going into an arm could mean one more life lost or one more hospital bed occupied.”

Despite manufacturing delays, health experts are optimistic about Johnson & Johnson’s one-shot vaccine.Credit…Mark Ralston/Agence France-Presse — Getty Images

Johnson & Johnson expects to release critical results from its coronavirus vaccine trial in as little as two weeks but probably won’t be able to provide as many doses this spring as it promised the federal government because of manufacturing delays.

If the vaccine can strongly protect people, as some outside scientists expect, it will offer big advantages over the two vaccines authorized in the United States. Unlike those, which require two doses, Johnson & Johnson’s could need just one, greatly simplifying logistics for local health departments and clinics struggling to get shots in arms. Its vaccine can also stay stable in a refrigerator for months, whereas the others have to be frozen.

But the encouraging prospect of a third effective vaccine is tempered by apparent lags in the company’s production. In the company’s $1 billion contract signed with the federal government in August, Johnson & Johnson pledged to have 12 million doses ready by the end of February, ramping up to a total of 100 million doses by the end of June.

Federal officials have been told that the company has fallen as much as two months behind the original production schedule and won’t catch up until the end of April, when it was supposed to have delivered more than 60 million doses, according to two people familiar with the situation who were not authorized to discuss it publicly.

Dr. Paul Stoffels, Johnson & Johnson’s chief scientific officer, said he expected to see clinical trial data showing whether the company’s vaccine is safe and effective in late January or early February. He declined to provide details about the company’s production capacity.

Representative Pramila Jayapal tested positive after the siege on the Capitol.Credit…Pool photo by Graeme Jennings

At least 60 sitting members of Congress — more than one in 10 — have tested positive for the coronavirus or are believed to have had Covid-19 at some point since the pandemic began. The list includes 44 Republicans and 16 Democrats.

That’s a higher proportion than the general population. As of Wednesday, a bit fewer than one in 14 Americans were known to have had the virus, according to a New York Times database, though many more cases have probably gone undetected.

Five House members have reported positive tests since the attack on the Capitol last week, when many lawmakers were holed up in a secure location together and some refused to wear masks — a situation that angered several Democrats, including Representative Pramila Jayapal of Washington, one of those who has since tested positive.

And on Wednesday, Representative Ayanna Pressley of Massachusetts said that her husband, Conan Harris, who was at the Capitol to see her sworn in, has also tested positive. In a statement, Ms. Pressley said that Republican colleagues who had refused to wear masks while in a “confined space” had displayed an “arrogant disregard for the lives of others.”

Congress’s attending physician warned members afterward that it was possible they were exposed while sheltering and recommended that they be tested.

Congress has struggled to stem the spread within its ranks in recent weeks. Most members who have tested positive have done so since the election in November, as cases have surged across the country.

Representative Jake LaTurner, Republican of Kansas, said he received word just after the attack on the Capitol last Wednesday that he had tested positive. He did not return to the House floor for a vote early on Thursday.

Representative Gus Bilirakis of Florida and Representative Michelle Steel of California, both Republicans, were absent from the House floor when the mob entered the Capitol because each had received positive test results earlier that morning. Representative Chuck Fleischmann, Republican of Tennessee, said on Sunday that he had tested positive after exposure to Mr. Bilirakis, with whom he shares a residence.





Yankee Stadium to Become Mass Coronavirus Vaccination SiteMayor Bill de Blasio said the New York Yankees were working with the city to turn Yankee Stadium into a mass Covid-19 vaccination site. No opening date has been set.

We’re speeding up the process of giving vaccines all the time. Yesterday, 28,599 doses given. We are opening up mega-sites, 24/7 mega-sites. We talked yesterday about CitiField, and again, thanks to the New York Mets for stepping up. That’s fantastic. That’s going to serve a lot of people. Well, we’ve heard back from the New York Yankees. And we welcome them into the fold too. We’re working with them now to work out a plan to use Yankee Stadium as well. And that’s got to be great for the people of the Bronx. So that plan is in motion, we’ll announce it when the details have been worked through. But there’s going to be more and more sites, not just stadiums, but more sites of all kinds, more hours reaching more people. And now anyone 65 years old or over does qualify. So if you’re 65 or over, regardless of your health situation — obviously, you’re vulnerable, we’ve talked about this before — you have the right to be vaccinated. You can sign up now. We have sites, as I said, 24/7 sites, and sites with other hours, extended hours, all over the five boroughs. On the 24/7 sites, yesterday, we opened a site at 125 Worth Street, right here, in the City Hall area, Lower Manhattan. Today, Staten Island, the Vanderbilt Clinic on Staten Island open 24/7 from this point on. And again, more sites coming in Staten Island. Saturday, the Health and Hospitals Corona Clinic in Queens will go to 24/7. And obviously, CitiField will be right behind that. We’re going to just keep building and building out capacity.

Mayor Bill de Blasio said the New York Yankees were working with the city to turn Yankee Stadium into a mass Covid-19 vaccination site. No opening date has been set.CreditCredit…Corey Sipkin/Associated Press

An additional three cases of a variant of the coronavirus, which has been surging in the United Kingdom, have now been identified in New York, bringing the total number of cases in the state to 15, Gov. Andrew M. Cuomo announced on Wednesday.

State officials have narrowed down the new cases of the more contagious variant to two clusters, one on Long Island and another stemming from a jewelry store in Saratoga Springs, where the first case of the variant was discovered on Jan. 4.

Amid mounting evidence that the variant is continuing to spread in New York, hospitalizations statewide continued to climb — more than 8,920 people reported Wednesday — and state and city officials scrambled to accelerate a sluggish rollout of the vaccine.

“We’re locked in a footrace between its quick distribution and the spread of new cases,” Mr. Cuomo, a third-term Democrat, said in a statement.

Both New York City and the state have added large vaccination sites in recent days. On Wednesday, Mayor Bill de Blasio said that the city was working with the New York Yankees to use their home stadium, in the Bronx, though there is no opening date yet.

The announcement followed the mayor’s reveal on Tuesday that Citi Field, the Mets’ stadium in Queens, would become a mass vaccination site starting the week of Jan. 25. The site at Citi Field will operate seven days a week and is expected to have the capacity to vaccinate 5,000 to 7,000 people a day.

The stadiums are the latest large sports venues across the country to be converted into vaccination sites, including the home stadiums of the Los Angeles Dodgers and San Diego Padres baseball teams, the Arizona Cardinals of the N.F.L., the San Antonio Spurs of the N.B.A., and the Hard Rock Stadium in Miami.

New York State also opened its first three state-run vaccination sites on Wednesday morning: in the Jacob K. Javits Center in Manhattan, in the Westchester County Center and at the New York State Fair Expo Center, where eligible New Yorkers can get a shot after booking an appointment online.

The list of eligible New Yorkers was expanded to include people 65 and older on Tuesday; individuals in those groups could immediately schedule appointments on the state’s website. So far, demand has far outpaced supply, with state officials warning people to be prepared to receive an appointment weeks in the future.

On Tuesday, New York City administered 28,599 doses, Mr. de Blasio said. He added that the city plans to reach its goal of administering one million doses by the end of the month.

But the mayor also warned on Wednesday that unless the city gets a major resupply of the vaccine soon, it will run out of doses at some point next week.

In New Jersey, residents 65 and older and people ages 16 to 64 with certain medical conditions will be eligible to the vaccine as of Thursday, Gov. Philip D. Murphy at a news conference on Wednesday.


Paramedics taking a patient to an emergency room in Shawnee, Okla., last month. Many Oklahoma hospitals are inundated with Covid-19 patients. Credit…Nick Oxford/Reuters

Oklahoma is in the grip of a frightening surge of the coronavirus, the worst it has yet seen and one of the worst in America’s winter.

Mercy Hospital Ardmore, in rural Oklahoma, has so many Covid-19 patients that some people are being cared for in curtained-off areas of hallways and the emergency department’s waiting room.

It has been this way for weeks.

“The people coming in are very, very sick, and they don’t quickly get better,” said Paula Pfau, the hospital’s nursing director.

Oklahoma is averaging nearly 4,000 new cases each day, an increase of almost 50 percent from two weeks ago. Rural counties in the southern part of the state, including around Ardmore, are now among the hardest hit in the country relative to their populations.

Family gatherings and parties over the holidays are at least partly to blame, according to hospital officials and the Oklahoma State Department of Health.

Nationally, the country is facing its worst days of the pandemic: There were over 4,400 Covid-19 deaths reported in the United States on Tuesday, a record, according to a New York Times database. Hospitalizations are at a near-record high of 131,326, according to the Covid Tracking Project. And more than 380,000 people in the United States have died from Covid-19.

Oklahoma is experiencing the third worst outbreak in the country, behind Arizona, which is enduring a surge even worse than its summer peak, and California, where a weekslong flood of cases is wearing hospitals and their workers thin.

There is no statewide mask mandate in Oklahoma, although the city of Ardmore has had one since November.

A crush of new Covid-19 patients emerged seven to 10 days after Thanksgiving, and another after Christmas and New Year’s Eve.

“In rural Oklahoma, we didn’t get our first case for a long time,” Ms. Pfau said. “We kind of decided the surge couldn’t happen here. We don’t have public transportation. We don’t have Uber. We’re in the middle of the country, with all this space. So we kept on with business as usual. And now it’s just a full-force hit.”

Coronavirus cases were relatively low in Oklahoma until the summer, when the daily number of new cases spiked in June, then surpassed 1,000 each day in September.

An indoor rally in July held by President Trump in Tulsa was linked to a spike in cases there by the director of the Tulsa Health Department, Dr. Bruce Dart, who had pleaded with attendees to wear face masks, which were not worn by most at Mr. Trump’s rally.

Now, pretty much everyone in the state knows someone who has been sick, said Dr. Jennifer Clark, a physician and former hospital administrator who is helping lead an effort by Oklahoma State University to keep rural health care providers updated on the pandemic.

“There’s a heavy sense of grief,” she said.

Global Roundup

In Tokyo, which is under a state of emergency, on Wednesday.Credit…Koji Sasahara/Associated Press

Japan expanded its state of emergency to seven more prefectures on Wednesday, citing rising new coronavirus infections and strains on the medical system.

The seven prefectures, which include Osaka and Kyoto, were added to an emergency declaration made for Tokyo and three surrounding prefectures last week. The expanded state of emergency is set to last until Feb. 7.

The emergency measures have little legal heft and rely mostly on voluntary compliance. Restaurants and bars are urged to close by 8 p.m. and employers are encouraged to allow 70 percent of their employees to work from home. Large sporting and cultural events are limited to 5,000 spectators or half the venue’s capacity.

Dr. Toshio Nakagawa, the chairman of the Japan Medical Association, said on Wednesday that the measures might have to be extended to the whole country. “I don’t think it’s necessary at this moment,” Dr. Nakagawa said. “However, there is no rule that it can be declared only after everybody thinks it’s absolutely too late.”

Japan has recorded nearly 296,000 cases of the coronavirus and at least 4,100 deaths, according to a New York Times database.

In other global developments:

Virus flare-ups in the last few weeks have prompted new city and regional lockdowns in China, including areas in and around Beijing and in the northeast. In all, more than 22 million people have been ordered to remain inside their homes — double the number affected a year ago in Wuhan, the city where the virus was first reported.

To alleviate the strain on hospitals in Britain, which are facing a surge in coronavirus patients, the country’s health secretary said on Wednesday that the government was considering measures like allowing thousands of patients who need only minimal treatment to be moved out of hospitals to hotels.

Jean-Marie Le Pen, the founder and longtime leader of France’s largest far-right party, contracted Covid-19 a few weeks ago, according to the newspaper Le Parisien. Mr. Le Pen, who is 92 and has heart disease, told the paper that his symptoms were moderate and that he did not initially suspect that they might be caused by the coronavirus. France has reported more than 2.8 million coronavirus cases, but its vaccination campaign, begun in late December, is off to a slower start than most of its European neighbors, with fewer than 200,000 people vaccinated so far.

Turkey authorized on Wednesday the emergency use of a Chinese vaccine whose level of efficacy has been called into question. Brazilian scientists said recently that the vaccine — CoronaVac, developed by Sinovac — appeared to be just over 50 percent effective. Officials in Turkey, one of the countries where it was tested, have said it was 91.25 percent effective. Turkey’s health minister, Fahrettin Koca, publicly received a dose just after he announced the authorization, and promised that the vaccine would be distributed fairly.

Germany’s cabinet agreed to tighten the rules for entering the country, in an attempt to limit the spread of new coronavirus variants. Travelers coming from countries like Britain where new variants are especially widespread will have to present a negative test result.

It is “not possible” for Germany to end its lockdown on Feb. 1 as scheduled, the health minister, Jens Spahn, said on Wednesday in an interview: “This virus is still too present for that, and the health care system is still too burdened for that.”

The Vatican said it had begun vaccinating residents and employees; it was not clear when Pope Francis, who had said he would get the vaccine, would be inoculated.

The prime minister of Estonia resigned after his coalition government became engulfed by a scandal over the misuse of state loans intended for pandemic relief.

A virus variant that was first detected in Britain has been found in the Philippines, in a traveler who arrived last week from the United Arab Emirates, the Philippine government said. The variant, known as B.1.1.7, has been found in about 50 countries. The Philippines added China, Jamaica, Luxembourg, Oman and Pakistan to its list of countries and territories whose citizens are barred from entering.

The head of the Tokyo Olympic organizing committee, Yoshiro Mori, said on Tuesday that it would be “absolutely impossible” to postpone the Summer Games again. The Olympics are scheduled to begin on July 23, delayed from last July by the pandemic.

Spain registered almost 39,000 new cases of Covid-19 on Wednesday, the highest daily count since the pandemic inundated the country in March. Based on health ministry data collected over the past two weeks, Spain now has almost 500 cases for every 100,000 inhabitants, prompting several regions to announce tighter restrictions. “We are facing hard weeks, a complicated January,” said Salvador Illa, Spain’s health minister.

Vials containing CoronaVac, Sinovac Biotech’s vaccine against Covid-19, at the Butantan biomedical production center in São Paulo, Brazil, on Tuesday.Credit…Amanda Perobelli/Reuters

Scientists in Brazil have downgraded the efficacy rate of a Chinese coronavirus vaccine that they hailed last week as a major triumph, diminishing hopes for a shot that could be quickly produced and easily distributed to the developing world.

Officials at the Butantan Institute in São Paulo said on Tuesday that a trial conducted in Brazil showed that CoronaVac, the vaccine manufactured by the Beijing-based company Sinovac, had an efficacy rate of just over 50 percent. That rate, slightly above the benchmark that the World Health Organization has said would make a vaccine effective for general use, was far below the 78 percent level announced last week.

The implications could be significant for a vaccine that is crucial to China’s global health diplomacy. At least 10 countries have ordered more than 380 million doses of CoronaVac, though regulatory agencies have yet to fully approve it.

The announcement could also be a setback for China’s biotech ambitions.

For months, Chinese officials had said that the vaccines made by Sinovac and Sinopharm, a state-owned company, would be important tools for fighting the pandemic in poorer countries that do not have extensive health care infrastructures. Unlike the vaccines made by the American drugmakers Pfizer and Moderna, they do not need to be frozen.

The Oxford-AstraZeneca and Johnson&Johnson vaccines could provide an alternative, but it is unclear if the governments that have bought CoronaVac can get out of their deals and seek other options.

In response to the CoronaVac trial, Natalia Pasternak, a microbiologist, told reporters on Tuesday, “It is not the best vaccine in the world,” but added that CoronaVac is a “perfectly acceptable vaccine” that would mean fewer serious cases and deaths. Ms. Pasternak is the president of Instituto Questão de Ciência, a Brazilian organization dedicated to promoting science.

Many of the countries that have ordered CoronaVac are relatively poor, desperate to halt the pandemic and protect their populations.

Indonesia, for example, has ordered 125.5 million doses. The country has reported nearly 850,000 coronavirus cases and nearly 25,000 deaths, the highest numbers in Southeast Asia. On Wednesday morning, its president, Joko Widodo, was injected with CoronaVac on live television.

A pharmacist administers the Covid-19 vaccine to a health care workers last month in Columbus, Ohio. Credit…Brian Kaiser for The New York Times

Two new variants of the coronavirus that may be more contagious have been detected in Ohio, researchers announced on Wednesday. Evidence for both variants is still preliminary, other experts cautioned, and warrants further study.

“As we sequence more, we will find more variants and we will see more mutations,” said Emma Hodcroft, a molecular epidemiologist at the University of Bern in Switzerland. “But very few mutations we are looking at today have never appeared before.”

One of the variants was spotted in an elderly woman during routine genetic surveillance by scientists at Ohio State University. The variant carries a mutation called N501Y, which has been linked to greater contagiousness; it is present in variants discovered in Britain, South Africa and Japan.

But the variant in Ohio is distinct from those others, and appears to have emerged from a version of the coronavirus that has been circulating in Columbus since September, said Daniel Jones, a molecular biologist at Ohio State University, who led the research.

The research has been submitted to the preprint server bioRxiv, where it is expected to appear on Wednesday, but has not yet been reviewed carefully by other experts.

“The fact that it’s occurring in that background suggests an independent arising in the U.S.,” Dr. Jones said. “Now obviously, that has consequences for travel restrictions and all that, if we’re now seeing the same mutation.”

The Centers for Disease Control and Prevention announced Tuesday that starting on Jan. 26, the United States will require all international travelers arriving in the country to show proof of a negative coronavirus test or recent recovery from Covid-19.

Some experts urged caution in interpreting the impact of the variant’s discovery in Ohio. The worrisome mutations at N501 “have appeared and disappeared multiple times, so I’m not sure finding isolated cases of 501 mutations on their own is worth getting too excited about,” Dr. Hodcroft said.

A second virus variant, also in Ohio, first cropped up around Christmas during routine surveillance. The numbers of known infections are small, because the team analyzes only about 10 samples per week. Among those samples, the variant was detected in one case the first week, about 30 percent of cases the following week, and 60 percent last week, Dr. Jones said.

The variant contains three alterations in the spike protein on the surface of virus, which it uses to enter human cells. One of those mutations may increase contagiousness, but “there’s not been a lot of biology on it at this point to know what it does,” he said.

Dr. Hodcroft said the emergence of this second variant is potentially more significant, because it may be the same as a version reported in Massachusetts and West Virginia. “It would be great to know if other states are reporting increases as well,” she said.

Surveillance of the virus in the U.S. has been limited, with labs sequencing only a tiny fraction of samples. But the C.D.C. has said it will sequence more samples to gain a clearer idea of variants that are emerging.

The Ohio team has sequenced a total of 222 samples of the virus since April, but stepped up their efforts about six weeks ago, following reports of the more contagious variant in Britain. The scientists now plan to ramp up the numbers to as many 50 samples per week to assess how widely the variants might have spread.

On the Standing Rock Reservation in North Dakota, four Lakota elders from one family have died in the pandemic, including the parents of Jessie Taken Alive-Rencountre, right, and her sister Nola Taken Alive, who placed a bundle of sage in their mother’s coffin.Credit…Victor J. Blue for The New York Times

Native Americans, who are dying of Covid-19 at nearly twice the rate of white people, are also facing a cultural crisis: The coronavirus is tearing through the ranks of tribal elders, inflicting an incalculable toll on bonds of language and tradition that flow from older generations to the young.

“It’s like we’re having a cultural book-burning,” said Jason Salsman, a spokesman for the Muscogee (Creek) Nation in eastern Oklahoma whose grandparents contracted the virus but survived. “We’re losing a historical record, encyclopedias. One day soon, there won’t be anybody to pass this knowledge down.”

Native Americans and volunteer groups are trying to protect the elders as a mission of cultural survival, and putting elders and fluent Indigenous language speakers at the head of the line for vaccinations. But the efforts face huge obstacles. Elders who live in remote locations often have no means to get to the clinics and hospitals where vaccinations are administered. And there is deep mistrust of the government in a generation that was used as medical guinea pigs, shipped off to boarding schools and punished for speaking their own languages.

Activists say there is still is no reliable death toll of Native elders. They say the deaths are often overlooked or miscounted, especially off reservations and in urban areas, where about 70 percent of Indigenous people live.

Adding to the problem, tribal health officials say their sickest members can essentially vanish once they are transferred out of small reservation health systems to larger hospitals with intensive-care units.

“We don’t know what happens to them until we see a funeral announcement,” said Abigail Echo-Hawk, the director of the Urban Indian Health Institute.

The virus has claimed fluent Choctaw speakers and dressmakers from the Mississippi band of Choctaws. It took a Tulalip family matriarch in Washington State, then her sister and brother-in-law. It killed a former chairman of the Yocha Dehe Wintun Nation in California who had spent decades fighting to preserve Native arts and culture. Remote meetings of the Diné Hataałii Association, a group of Navajo medicine men and women, now regularly include updates on members who have died.

“When they pass on, all that knowledge is gone forever, never to be retained,” said Avery Denny a member of the association and professor at Diné College. “It’s just lost.”

Dr. Gregory Michael in a photo posted to Facebook by his wife.Credit…via Facebook

Health authorities are investigating the case of a Florida doctor who died from an unusually severe blood disorder 16 days after receiving the Pfizer coronavirus vaccine.

Dr. Gregory Michael, a 56-year-old obstetrician and gynecologist in Miami Beach, received the vaccine at Mount Sinai Medical Center on Dec. 18 and died 16 days later from a brain hemorrhage, his wife, Heidi Neckelmann, wrote in a Facebook post.

Shortly after receiving the vaccine, Dr. Michael developed an extremely serious form of a condition known as acute immune thrombocytopenia, which prevented his blood from clotting properly.

Pfizer said in a statement that it was “actively investigating” the case, “but we don’t believe at this time that there is any direct connection to the vaccine.”

“There have been no related safety signals identified in our clinical trials, the post-marketing experience thus far,” or with the technology used to make the vaccine, the company said. “Our immediate thoughts are with the bereaved family.”

About nine million people in the United States have received at least one shot of either the Pfizer or Moderna coronavirus vaccine, the two authorized in the United States. Serious reported problems have included 29 cases of anaphylaxis, a severe allergic reaction, though none were reported as fatal. Many people have had side effects like sore arms, fatigue, headache and fever, which are usually transient.

Local and federal agencies are investigating Dr. Michael’s death. Several experts said the case was highly unusual but could have been a severe reaction to the vaccine.

The Florida Department of Health referred Dr. Michael’s death to the Centers for Disease Control and Prevention for investigation. Kristen Nordlund, a C.D.C. spokeswoman, said in a statement that the agency would “evaluate the situation as more information becomes available and provide timely updates on what is known and any necessary actions.”

Alex Ovechkin of the Washington Capitals, foreground, at a practice in Arlington, Va., on Tuesday.Credit…Ricky Carioti/The Washington Post, via Associated Press

The N.H.L. season will begin on Wednesday with some drastic modifications to its format and at least one delayed opener because of the coronavirus.

The myriad challenges of the pandemic will keep fans out of the stands at most arenas, expand rosters in the event of outbreaks and force the league to maintain flexibility.

Deputy Commissioner Bill Daly said Monday that he did not expect the league to have access to vaccines for players, staff members and other personnel this season.

Commissioner Gary Bettman said that he expected losses from a lack of attendance to exceed $1 billion, but that he believed the league would have lost less money if it had canceled the season.

One player agent, Allan Walsh, dismissed that claim, calling it “a deliberate and intentionally misleading statement.”

For hockey players and fans, there may not be a sense of normalcy until the playoffs, which are set to return to their usual format of 16 teams and four rounds of best-of-seven series.

And although there will be no traditional January Winter Classic, there will be outdoor hockey in Nevada.

Bettman said Lake Tahoe would host the league for the first time, with two games against a backdrop of snowy mountains and the lake, but no spectators. The Vegas Golden Knights will face the Colorado Avalanche there on Feb. 20, and the Philadelphia Flyers will play the Boston Bruins on Feb. 21.

All 31 franchises will have to navigate an abbreviated season with long odds of being completed smoothly.

Rather than the traditional 82-game schedule, each team will play 56 games. And each will carry three goalies and a four-to-six-player taxi squad in case of injury or a coronavirus-related absence.

There will not be any cross-border travel because of restrictions between the United States and Canada.

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