The European Union drug regulator approved the Moderna coronavirus vaccine on Wednesday after moving up a decision that had been scheduled for later in January.
The regulator, the European Medicines Agency, approved the Pfizer-BioNTech vaccine in late December after coming under criticism for being too slow, as Britain and the United States began rolling out vaccination campaigns before the European Union had even granted the drugs authorization.
The bloc, which is home to about 450 million people in 27 countries, has taken the lead in approving and ordering the vaccines on behalf of its members. The Pfizer vaccination was introduced in the final days of 2020 in most European Union countries, a few weeks behind Britain and the United States, but criticism has been growing that the process is taking too long and that there are not enough doses to go around yet.
The European Union has said that the availability of shots will pick up, along with production. The European Medicines Agency, which is based in Amsterdam, has also been criticized for not yet having started a review of the University of Oxford-AstraZeneca vaccine which has recently been approved for use in Britain and in India.
The European Union agency said that it needed more information to reach a decision of its own on the Oxford-AstraZeneca vaccine and that it expected the developers to share more data in January. The makers of the vaccine have not yet formally submitted a request to the European Union for approval.
Both the Pfizer-BioNTech decision in December and the Moderna decision on Wednesday were moved forward by the European Medicines Agency, reflecting the political and economic pressure on developed countries that have multibillion-dollar contracts with the pharmaceutical companies not to be seen as falling behind their peers in mass immunization campaigns.
The European Commission, the executive arm of the European Union, will need to formalize the regulator’s approval before the Moderna vaccine is rolled out, a process that can take up to two days.
The summer surge that raged across the Sun Belt started in Arizona. For more than a month, from early June until mid July, the state added cases at the highest per capita rate in the country. Thousands died. Hospitals were stretched thin. At the peak, more than 3,800 cases were emerging each day.
As a new year begins, Arizona is again in dire shape, with a higher rate of new cases than any other state. Hospitalizations and deaths have surpassed records. Over the last week, the state has averaged more than 8,000 cases a day, more than double the summer peak.
“It shouldn’t have to have taken this amount of destruction for folks to take it seriously,” said Kristin Urquiza, who spoke of losing her father to the coronavirus at the Democratic National Convention last summer. In recent months, she said, she has been in Phoenix, helping her mother but also watching the city around her be overtaken by the virus that killed her father in June.
“There might be some hope that people will begin to think about it differently if they see it take hold of people they love,” she said.
Yet the cases keep pouring in, with no sign of slowing and little indication, some Arizona health care leaders say, of the kind of widespread public vigilance that might bring the outbreak under control. At the same time, vaccines in the state are being administered at among the lowest rates in the country.
“Most Americans don’t want to know, don’t want to acknowledge, don’t really want to recognize and certainly — even as it’s descending upon us — do not appear to understand the dire circumstances that we are facing,” said Dr. Marjorie Bessel, the chief clinical officer at Banner Health, Arizona’s largest hospital network.
Arizona is by no means alone in its struggle. Nationally, it has become routine for more than 200,000 infections and more than 2,500 deaths to be announced in a single day. California, Rhode Island, Tennessee and Oklahoma are all identifying cases at extraordinarily high rates.
The outlook is especially alarming in Southern California. In just two weeks, more than 240,000 cases had been identified in the Los Angeles metropolitan area. That is more cases than at least 19 entire states have identified over the entire pandemic. Hospitals have become so crowded that the Los Angeles County emergency medical services agency directed ambulances not to transport patients who cannot be resuscitated by emergency responders out in the field.
The hospital system in Arizona is not at that point yet, but it is close.
More than 4,600 coronavirus patients are currently hospitalized, forcing multiple hospitals to operate at over 120 percent of licensed bed capacity, send new emergency patients elsewhere and put a halt to elective surgeries.
Only 136 intensive care unit beds are available out of nearly 1,800 statewide, according to state data, but beds are not the most pressing issue, Dr. Bessel said. Staff and resources are. Nurses are being quickly trained in new skills and hundreds of health care workers are being flown in from other states.
Still, Dr. Bessel acknowledged, there comes a point when resources can be stretched no thinner and more drastic measures, such as rationing care, might have to be considered.
After Sandra Lindsay became the first person in the United States to receive a Covid-19 vaccination outside a clinical trial, something unexpected happened: She acquired a fan club.
Half a dozen inspired youngsters in Lee, N.H., ranging in age from 8 to 12, each sent Ms. Lindsay a letter praising her for leading the way.
“I would like to thank you for taking the first vaccine in the U.S.A.,” 12-year-old Finley wrote. “I have had a hard time in this era. What you did was incredibly brave.” He added, “You helped everyone who was unsure, and you gave hope to those who are lonely and felt unsafe.”
On Monday, Ms. Lindsay, 52, the director of critical care nursing at Long Island Jewish Medical Center in Queens, was in the vanguard again. The requisite 21 days had passed, so it was time for her, and hundreds of other health care workers and long-term care patients at the head of the line, to receive the second half of the two-dose Pfizer-BioNTech vaccine.
By the end of the day, 118,304 people in the city had gotten a first dose of coronavirus vaccinations, and 756 had gotten a second, according to the New York City Department of Health and Mental Hygiene. Across the country, other early recipients were getting shot No. 2 as well.
Nearly all states have made getting health care workers and nursing home residents immunized a top priority. But the effort, now three weeks old, has been slower than many governors and public health officials hoped.
The federal government has shipped more than 15 million vaccine doses to states, but only 4.5 million people have received them so far. There are 21 million health care workers nationwide, and three million residents of nursing homes and other long-term care facilities.
Dr. Mark P. Jarrett, chief quality officer for Northwell Health, which operates Long Island Jewish, 22 other hospitals and 800 ambulatory care sites in the New York metropolitan area, said his organization has vaccinated about 27,000 employees with either the Pfizer or the Moderna vaccines. The Moderna recipients will get their second shot after 28 days.
The two-stage nature of the vaccines will affect how fast the vaccination program progresses, Dr. Jarrett noted. “I would expect that general public inoculations could start in late February, and it will take a long time to complete,” he said. “You’re talking about millions of people, and they have to come back for second shots.”
Ms. Lindsay said on Tuesday that she had experienced no side effects from the vaccine, and that she was touched by the children’s letters, which left her “very, very emotional.”
She said she had been sure since the early days of the pandemic that she would get vaccinated as soon as she could: “Given my experiences on the front lines, and seeing the hard work of my colleagues and the suffering and death of patients, I knew back then that when it was developed, I wanted to take the vaccine.”
But even with the two shots now safely in her arm, she still worries about going to work.
“I have been a nurse for more than 26 years, and I’ve never been more scared than I am right now, even with the vaccine, because this virus is so erratic, unpredictable and does not discriminate,” she said. “You never know what you are walking into.”
The World Health Organization has criticized China for not authorizing a team of international experts to enter the country to investigate the origins of the coronavirus pandemic, a highly anticipated trip that has been months in the making.
Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, said at a Tuesday news conference that two members of the U.N. agency’s 10-person team were already in transit to China when they were informed that the necessary visa permissions had not yet been granted. The team had been expected to go to Wuhan, the city where the virus first emerged.
Dr. Tedros, who has been criticized for praising China despite the country’s early mishandling of the outbreak, said he was “very disappointed” by the news and was in touch with “senior Chinese officials” to resolve the issue.
Michael Ryan, the head of the emergencies program at the W.H.O., said that one of the experts in transit had already returned home, while the other was staying in a third country awaiting further instructions. The rest of the team, consisting of experts from the Netherlands, Japan, the United States and elsewhere, had not yet left for China when news of the visa delays came through.
Hua Chunying, a spokeswoman for China’s Ministry of Foreign Affairs, said at a regularly scheduled briefing on Wednesday that the government was doing its best to resolve the issue but that “the question of the virus investigation is very complicated.”
It appeared to be the latest example of China’s efforts to stymie an independent investigation into the origins of the virus, which has infected more than 86 million people and killed 1.8 million around the world since the initial outbreak in Wuhan more than a year ago.
The W.H.O. has discussed sending an investigative team to Wuhan since last January, but the Chinese government has delayed those plans while promoting flimsy theories that the outbreak started outside of China. Last summer, two W.H.O. experts were allowed into China to negotiate the terms of the investigation, but they did not go to Wuhan.
The Chinese government has yet to release crucial information about its own internal investigations into the virus’s origins, including data from animal samples taken in and around Wuhan.
Most scientists say the virus probably jumped to humans from an animal, probably a bat. They say that solving the mystery of its origin is critical to preventing future pandemics and helping to develop vaccines and treatments. In the absence of more solid information, numerous conspiracy theories about the virus have flourished.
China has largely, but not entirely, subdued the virus within its borders. In Hebei Province near Beijing, a small flare-up in infections led the local authorities to declare “wartime” mode this week. After Hebei reported 63 new cases in a day, officials in Shijiazhuang, the provincial capital, on Wednesday imposed tougher travel controls, barred gatherings and moved elementary and middle schools to online learning.
The W.H.O.’s criticism of China marks a rare public fissure in what has otherwise been a close relationship.
For months, the W.H.O. has publicly praised China for its response to the coronavirus, in the hope that such a soft-handed approach would yield crucial access and information. Critics say that in doing so, the organization allowed the Chinese government to whitewash its mistakes and portray itself as a transparent and cooperative global partner in the pandemic response.
Some have expressed concern that by now, the inquiry has become so politicized it is unlikely to yield concrete findings. But one thing is almost certain: if and when the W.H.O. team does arrive in China, another delay is expected. Like all other Chinese citizens and foreign visitors, the investigators will be required to quarantine for 14 days.
President Trump has not said where he plans to go after leaving the White House on Jan. 20. But the leader of Scotland made clear on Tuesday that Mr. Trump is not welcome in her country.
Nicola Sturgeon, Scotland’s first minister, said that under newly imposed virus restrictions, which prohibit all but essential travel, a visit by the president to one of his Scottish golf resorts, Trump Turnberry, would not be acceptable.
Rumors that Mr. Trump would head for Scotland flared after a Scottish paper reported that an American military version of a Boeing 757 — sometimes used by Mr. Trump — was scheduled to land at a nearby airport on Jan. 19, the day before Joseph R. Biden Jr. is to be sworn in as president.
“We are not allowing people to come into Scotland,” Ms. Sturgeon told reporters in Edinburgh, “and that would apply to him just as it applies to anybody else — and coming in to play golf is not what I would consider to be an essential purpose.”
A plain-spoken politician, Ms. Sturgeon said she did not know what Mr. Trump’s travel plans were, but that she hoped his immediate plan was to exit the White House. On Monday, she imposed a lockdown on Scotland, which, like England, is battling a surge in coronavirus cases because of a rapidly spreading new variant.
Under the new rules, people are required to stay at home and to work from there, where possible. Places of worship have been closed, and schools will operate by remote learning. Scotland has frequently moved faster and further than England to impose restrictions during the pandemic.
The White House initially declined to comment on the report, first published in Scotland’s Sunday Post paper, but later denied it.
“This is not accurate,” the press secretary, Kayleigh McEnany, said on Tuesday. “President Trump has no plans to travel to Scotland.”
Two White House officials said that while there’s been almost no concrete discussion of what Mr. Trump will do on Jan. 20 because he is so focused on trying to overturn the election results, they do not believe he is considering Scotland.
Mr. Trump has owned the Trump Turnberry resort since 2014 and has long thought of it as an escape. In November 2016, according to Anthony Scaramucci, the former White House communications director, he had planned on flying to the resort if, as he then expected, he lost the presidential race to Hillary Clinton.
When the coronavirus began spreading through New York, Gov. Andrew M. Cuomo ordered state-run hospitals to stop suing patients over unpaid medical bills, and almost all of the major private hospitals in the state voluntarily followed suit by suspending their claims.
But Northwell Health, which is the state’s largest health system and is run by one of Mr. Cuomo’s closest allies, sued more than 2,500 patients last year, records show.
The lawsuits each sought an average of $1,700 in unpaid bills, plus large interest payments. They hit teachers, construction workers, grocery store employees and others, including some who had lost work in the pandemic or gotten sick themselves.
“My salary was cut in half. I’m now working only two days a week. And now I have to deal with this,” said Carlos Castillo, a hotel worker in New York City who was sued for $4,043 after being hospitalized with a seizure at Long Island Jewish Medical Center, which is part of the Northwell system. Mr. Castillo, 37, said he was worried the hospital would seize his paychecks and leave him unable to pay rent.
After a New York Times article was published Tuesday morning about the lawsuits, Northwell abruptly announced it would stop suing patients during the pandemic and would rescind all legal claims it filed in 2020.
It has sued over unpaid bills as small as $700, records show.
Northwell’s chief executive officer, Michael Dowling, was the state health director and deputy secretary to former Gov. Mario Cuomo, the current governor’s late father, and he is a close friend to the younger Mr. Cuomo.
During the pandemic, Mr. Dowling has served as the governor’s closest ally in the hospital industry. Both men wrote books this year, and Mr. Cuomo wrote a blurb promoting Mr. Dowling’s writing.
A Northwell spokeswoman declined to say whether Mr. Dowling had discussed the lawsuits with Mr. Cuomo. A spokesman for the governor did not respond to requests for comment.
Richard Miller, Northwell’s chief business strategy officer, defended the cases, saying Northwell had the right to collect what it was owed. He said that Northwell has a financial-assistance program for low-income patients that is more generous than required by the government, and he said the system sues only employed patients that it believes have the ability to pay and who do not respond to outreach attempts.
Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, a nonprofit that advocates anti-poverty policies, criticized hospitals for suing patients during the pandemic.
She said that a few hundred dollars may not mean much to a hospital chain but can be a significant burden for a low-income patient. “It means someone is going hungry,” Ms. Benjamin said. “It means a kid is not getting a winter coat.”
ROME — People around the world counted down to the end of 2020 with relish, pegging their hopes on the idea that the new year would bring vaccines and something that felt like normalcy.
But the coronavirus keeps no calendar. The bad news rolled in during the first days of 2021, including about the virus variant that has sent Britain into a desperate lockdown, serving notice that tougher times could be ahead. More than ever, hope is riding on the vaccine rollouts that have been fumbled and slower than promised around the world.
So far, the new year doesn’t look, or feel, so different.
“It’s OK to be upset and feel down right now,” Joe Wicks, a British fitness instructor whose online sessions last year drew millions of views, said as he broke down in a Monday night video reacting to England’s new restrictions.
Even places that much of the world looked to with admiration for their response to the pandemic have stumbled into the new year. In South Korea, infections soared to the largest daily increases yet during Christmas week. In Japan, a looming state of emergency for Tokyo is dashing long-harbored hopes.
The pandemic has warped notions of national identity, truth and time itself, but it has also created a shared vulnerability. The whole world seems to be alone together, cut off from the pre-Covid conceptions of what life was supposed to look like.
“It’s been tough,” said Fabrizio Topi, a cafe owner in Rome struggling to make ends meet. “But it’s the same the world over.”
That search for unity in itself is something. Taking lessons from natural disasters, charity groups and mental health advocates have emphasized the importance of staying connected and fostering communities that recognize that many are in a similar situation. Other people are looking within themselves for resilience and even improvement to beat back despondency.
But nearly a year into the crisis, after any New Year’s buzz has worn off, talk of common fragility and self-actualization can feel like whistling in the dark.