Covid-19 Live Updates: U.S., Breaking a Record, Tops the 3,000 Daily Death Mark

Just one week after the United States broke a daily record for coronavirus deaths, it did so again on Wednesday, when officials across the country reported at least 3,011 new fatalities.

Last week’s record — 2,885 deaths reported in a single day — was a milestone because not since the pandemic’s first peak, in spring, had so many deaths been reported. The high point then was 2,752 deaths, on April 15.

As a brutal surge gathers speed across the country, the country went on last week to record its most coronavirus-related deaths over a seven-day period.

With a seven-day average of 2,249 deaths, the U.S. broke the previous mark of 2,232, set on April 17. Seven-day averages can provide a more accurate picture of the virus’s progression than daily death counts, which can fluctuate.

And all the while, the United States is speeding toward another stunning total: 300,000 total deaths since the coronavirus slipped into the country at the beginning of the year and began laying siege. At least 288,000 deaths have been recorded, according to a New York Times database.

The milestones are being toppled as U.S. officials race to approve and distribute a Covid-19 vaccine for Americans. Britain began vaccinating its own citizens this week, and Canada appears near to doing the same.

But things have moved more slowly in a country still mired over a presidential election that took place more than a month ago, with many Republicans refusing to acknowledge the results and some working actively to undo them.

Regardless of the outcome, on Wednesday, a glance at any coronavirus map of the country made one thing clear: With very few exceptions, every state is a red state now.

At the five-hospital Tanner Health System west of Atlanta, the first emails about capacity land in the inboxes of Dr. Benjamin Camp, the chief medical officer, and Deborah Matthews, the chief nursing officer, at about 6:30 a.m. each day. Then the juggling starts.

Early in the Covid-19 pandemic, they expanded the number of critical care beds at the largest of the Tanner hospitals in Carrollton to 20 beds from 12, and in nearby Villa Rica to 10 beds from six.

But even that is not enough now: All 30 beds are full most days, leaving Dr. Camp and Ms. Matthews to scramble from before dawn to the end of the day.

“The worry is,” Ms. Matthews said, “what are you going to do with the 31st I. C.U. patient? What are you going to do with the next patient who needs to be on a ventilator? You have contingency plans for all of that, but you are just constantly thinking about those things.”

Hospitals across the country are operating near or above capacity as they cope with a growing flood of Covid-19 cases. New data released this week by the federal Department of Health and Human Services gives a detailed geographic picture of the crisis.

The onslaught has been relentless.

Overall, Tanner’s hospitals are now treating about 82 Covid-19 patients, four times as many as they had in late summer. The federal data shows that both the Carrollton and Villa Rica hospitals have been operating at well over 100 percent of their usual capacity. The Carrollton hospital normally has 148 beds, but it has been running 180, Dr. Camp said.

With so many hospitals facing the same problems, the elasticity in the health care system is gone. Hospitals that fill up cannot count on being able to transfer patients elsewhere, and medical workers are being run ragged.

“There is not a lot of wiggle room,” said Loy Howard, president of the Tanner Health System. “I have been doing this for 35 years, and I have not seen this kind of wear and tear on the staff.”

Hospitals in cities large and small are running short of intensive care beds. In El Paso, just 13 of the 400 intensive care beds were unoccupied last week. In Fargo, N.D., there were just three. In Albuquerque, there were zero.

In all, more than one-third of Americans live in areas where hospitals are running critically short of intensive care beds. Hospitals serving more than 100 million Americans reported having fewer than 15 percent of intensive care beds still available as of last week, according to a New York Times analysis of the federal data released on Monday.

It is the first time federal government has published detailed geographic information on Covid-19 patients in hospitals, something public health officials have long said would be crucial to responding to the epidemic and understanding its impact.

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Canada Approves Pfizer-BioNTech Coronavirus Vaccine

After completing an independent review, Health Canada, the country’s drug regulator, announced on Wednesday that it had approved the coronavirus vaccine made by Pfizer and BioNTech and that shots could start being given as early as next week.

This is a momentous occasion. I mean, the geek in me is amazed that we — no one would have thought. I think, you know, even when we looked back at the first discovery of the virus, that less than a year later we’d be authorizing and then distributing a vaccine. So I think it’s just a testament to the decades of science and technology and research that’s gone into the development of that vaccine. I think it’s a testament to the work of regulators internationally working together. It’s a testament to our team that’s really dedicated an incredible amount of time and energy and resources to do that. And I think, you know, it’s an exceptional day for Canada. When we do an authorization, it means that we’ve looked at it and the benefits outweigh the potential risks. But it is still a drug. It’s still a vaccine, and there are potential risks, even if they’re rare. So that’s why it’s important that we continue to monitor it. So I would say to Canadians, you know, we’ve authorized it. If it is their turn to get the vaccine, they absolutely should feel comfortable getting that. But we still do need to continue to monitor it as we would any product, because, obviously, when we do the research, the research are done in clinical trials. They’re done in smaller groups of people under ideal conditions. And we need to get information from the vaccine as it goes out and starts to get used in higher numbers of people, not only in Canada, but around the world.

Canada has approved the coronavirus vaccine made by Pfizer and BioNTech, its drug regulator said on Wednesday, opening the possibility that Canadians will start receiving it next week.

The regulator, Health Canada, said it had completed a full, independent review of the data on the vaccine’s safety and effectiveness. While Britain approved the vaccine earlier, it did so on an emergency basis, was limited to a single production run and largely relied on Pfizer’s analysis. Bahrain has also issued an emergency approval.

“It’s a testament to the work of regulators internationally,” said Dr. Supriya Sharma, the chief medical adviser at Health Canada. “It’s an exceptional day for Canada.”

Canada has ordered a total of 76 million doses from Pfizer. (An earlier version of this article incorrectly reported that the order had been for six million doses.) Maj. Gen. Dany Fortin, the Canadian military officer overseeing distribution of the vaccine to provincial health care systems, said Pfizer would start shipping the vaccine from a plant in Belgium on Friday.

That could make it possible, he said, for Canadians to begin receiving shots as early as next Wednesday.

If that timeline holds up, Canadians may receive injections of the vaccine from the U.S.-based company before Americans do. Canada expects to receive an initial batch of 249,000 doses. Each person will require two doses.

Dr. Sharma said that the vaccine was subject to the same degree of review as any previous drug or vaccine. But to accelerate that process, Health Canada began reviewing data from clinical trials and manufacturing tests as it was being generated, allowing for a “rolling review.”

When asked why her group was able to approve the vaccine ahead of the Food and Drug Administration in the United States, Dr. Sharma said, apparently jokingly, “we’re just better.”

She added: “We’re not in a race with any other regulator. We’re trying to beat the virus.”

It will be up to Canada’s provincial governments to decide who will first be vaccinated. Dr. Howard Njoo, the country’s deputy chief public health officer, said a federal panel has recommended that the first injections be given to people over the age of 80, residents and workers of long-term care homes, health care workers and Indigenous communities.

François Legault, the premier of Quebec, said his province will first target long-term care homes, which have been the main source of Covid-related deaths in the province.

The vaccine will be distributed to provinces based on their populations. But because the Pfizer-BioNTech vaccine must be shipped and stored at extremely low temperatures until shortly before use, General Fortin said, it will not be sent to Canada’s remote and sparsely populated northern territories.

Gov. Tom Wolf of Pennsylvania announced on Twitter on Wednesday that he had tested positive for the coronavirus.

“I have no symptoms and am feeling well and I am in isolation at home,” he wrote. “I am following CDC and Department of Health guidelines.” Referring to his wife, he wrote, “Frances has been tested and, as we await the result, is quarantining at home with me.”

The governor added that he was performing his duties remotely, “as many are doing during the pandemic.”

“As this virus rages, my positive test is a reminder that no one is immune from COVID,” Mr. Wolf said. “Following all precautions as I have done is not a guarantee, but it is what we know to be vital to stopping the spread of the disease.”

Mr. Wolf, a Democrat, is at least the ninth U.S. governor to report receiving a positive test result, though in the case of Mike DeWine of Ohio, the result was almost immediately contradicted by another test and is thought to have been a false positive. Several other governors have quarantined when a family member, staff member or close associate tested positive.

So far, none of the governors have reported experiencing severe illness. The first governor known to have tested positive was Gov. Kevin Stitt of Oklahoma, a Republican, in mid-July.

Thousands of Britons received the first clinically authorized, fully tested coronavirus vaccine on Tuesday, with people reporting minimal side effects.

But two health workers with a history of serious allergies had reactions after being given the vaccine, British drug regulators said on Wednesday. As they investigate what precisely caused the reactions, the regulators warned that people prone to severe allergic reactions should not receive the Pfizer-BioNTech vaccine for the time being.

Scientists said that for the vast majority of people, the new advice should not cause any concerns about receiving the coronavirus vaccine, and that it was difficult to protect against certain rare reactions with any new vaccine.

Dr. Anthony S. Fauci, the nation’s leading expert on infectious diseases, said on Wednesday that the allergic reactions were concerning but most likely rare, the kind of effects that show up when a vaccine moves out of testing and into broader distribution.

“If I were a person that had an underlying allergic tendency, I might want to be prepared that I might get a reaction and therefore be ready to treat it,” Dr. Fauci said, in a webcast moderated by Sanjay Gupta of CNN, sponsored by Harvard and The New England Journal of Medicine.

Dr. Fauci acknowledged that the problem could turn out to affect a lot of people.

“That’s one of the reasons why it’s important to cover the waterfront with different vaccine platforms,” he said, adding, “If in fact we do find out that there is a consistent issue of a certain subset of people like those with allergic reactions, you’ll always have other vaccine platforms that you can use and hopefully you will not see that with those other platforms.”

Because of their severe allergies, the two health workers carried adrenaline pens, the generic term for an EpiPen. The National Health Service said that both workers were recovering well after being treated for symptoms of anaphylactoid reactions that they developed shortly after their shots.

Regulators said the reactions were “associated with administration” of the vaccine, but did not describe the health workers’ symptoms or what kind of treatment they received.

“We know from the very extensive clinical trials that this wasn’t a feature,” Dr. June Raine, the chief executive of Britain’s Medicines and Healthcare products Regulatory Agency, said on Wednesday.

As a precaution, British regulators said, “any person with a history of a significant allergic reaction to a vaccine, medicine or food,” like people who have anaphylactoid reactions or carry an EpiPen, should not receive the Pfizer-BioNTech vaccine. They said that the vaccines should be delivered only at sites with access to resuscitation measures.

Dr. Moncef Slaoui, the head of the Trump administration’s Operation Warp Speed, said that a panel of experts meeting in the United States on Thursday to consider Pfizer’s application for emergency authorization would likely discuss the allergic reactions.

He said he thought that the United States would also advise people with a history of severe allergic reactions not to get the vaccine “until we understand exactly what happened” in the British cases.

After authorizing the Pfizer-BioNTech vaccine for emergency use last week, British regulators said that people with a hypersensitivity to ingredients in the vaccine should not be given the shot. But the regulators’ updated advice on Wednesday expanded that warning to cover anyone with a history of significant allergic reactions.

The regulators are now investigating the two cases from Tuesday, a process that experts said would involve looking at whether the reactions stemmed from the vaccine itself or were incidental. The regulators said they would release updated advice once they do.

Allergic reactions are a very rare response to some vaccines. Anaphylactic reactions, the most serious of those responses, are estimated to occur around once every 100,000 to 1,000,000 doses of the most commonly given vaccines, according to the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.

A 2015 study supported by the Centers for Disease Control and Prevention in the United States turned up 33 confirmed cases of vaccine-triggered anaphylaxis among more than 25 million vaccine doses, translating to a rate of 1.3 cases of such reactions in every million doses of vaccine.

Pfizer’s vaccine trials, which included tens of thousands of participants, excluded people with a history of reacting badly to vaccines, or having severe allergic reactions to any ingredients in the coronavirus vaccine.

Among those who participated in the trials, a very small number of people had allergic reactions. A document published by the Food and Drug Administration in the United States on Tuesday said that 0.63 percent of participants who received the vaccine reported potential allergic reactions, compared to 0.51 percent of people who received a placebo.

In Pfizer’s late-stage clinical trial, one of the 18,801 participants who received the vaccine had an anaphylactic reaction, according to safety data published by the F.D.A. on Tuesday. None in the placebo group did.

Scientists said that there is a very small risk of allergic reactions to any vaccine, just as there is to food and medicines. And anaphylactic reactions to any new vaccine or medicine are particularly difficult to prevent ahead of time.

“Anaphylaxis is almost always very specific, with some known overlaps between exposures, but just because I’m allergic to peanuts doesn’t mean I’m allergic to bee stings,” said Dr. Naor Bar-Zeev, a pediatric infectious diseases specialist and epidemiologist at Johns Hopkins Bloomberg School of Public Health.

He added, “Rare events — and anaphylaxis is among the rarest of all — can never be known from Phase 3 trials or before licensure.”

Dr. Bar-Zeev said the risk of rare side effects from vaccines, especially amid a pandemic, had to be balanced against the risk of contracting the disease itself. But he said that even in the best of circumstances, very rare side effects are only discovered well after clinical trials are conducted and new drugs and vaccines are licensed.

In wealthier countries, he added, regulators have well-established systems for identifying rare side effects, and those events will become evident more quickly in the midst of mass vaccinations.

With any new medicine or vaccine, he said, “Anaphylaxis will occur, will be treatable, and if treated, will be unlikely to cause death. The risk is very, very small indeed.”

Dr. Jesse Goodman, a professor of medicine and infectious diseases at Georgetown University and the former F.D.A. chief scientist, said that it was difficult to fully evaluate the British cases without more details.

But he said that clinical trials typically enroll healthier people than the general population, and that safety issues can come up as the vaccines are administered to the general public.

“The people in clinical trials are different, generally healthier, so as vaccines are used outside of trials things will occur that may or may not be due to the vaccine,” he said. “So to ensure safety and maintain confidence, it becomes really important to sort out quickly whether or not they are related.”

Unlike most new vaccines, which are gradually rolled out over years as people slowly visit their doctors and get new shots, the new coronavirus vaccines will quickly be given to many more people than received it in clinical trials.

“They’re large, well-performed studies, but they’re still of tens of thousands of people,” he said of the clinical trials. “It does mean we need those strong safety monitoring systems.”

People with latex allergies can also, on rare occasions, have severe allergic reactions to vaccines held in vials or syringes with latex.

The changing guidance from British regulators testified to the careful monitoring of vaccines that follows an emergency authorization, like the one issued in Britain last week for the Pfizer-BioNTech vaccine. The speed with which regulators warned people on Wednesday was a sign that the monitoring system was effective, scientists said, and reassurance that people did not need to hesitate to get a coronavirus vaccine.

“For the general population, this does not mean that they would need to be anxious about receiving the vaccination,” said Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine.

He added, referring to a famous British love-it-or-hate-it yeast paste: “One has to remember that even things like Marmite can cause unexpected severe allergic reactions.”

Denise Grady, Katie Thomas and Carl Zimmer contributed reporting.

A bipartisan group of moderate lawmakers circulated details about their $908 billion stimulus compromise but was still struggling to reach agreement on crucial details, as congressional leaders remained at odds on an economic relief plan to address the pandemic.

The moderates’ six-page framework, which was obtained by The New York Times, said the group had an “agreement in principle” for providing $160 billion to state and local governments and offering liability protections to businesses “as the basis for good faith negotiations,” but it omitted any substantive details about how to address the thorniest impediments to their agreement.

The lack of specifics underscored the remaining hurdles for the group — led by Senators Susan Collins, Republican of Maine, Joe Manchin III, Democrat of West Virginia — as it works to strike a deal in the coming days. Yet there is no guarantee that their plan will advance. Democratic leaders have called it a starting point for negotiations, but Senator Mitch McConnell, Republican of Kentucky and the majority leader, has not endorsed it. And the Trump administration presented its own $916 billion proposal on Tuesday with notable differences.

Mr. McConnell had suggested earlier Tuesday that Democrats drop their demand for funding for state and local governments in exchange for Republicans dropping their insistence on including a liability shield for businesses, but his idea was immediately rejected by Democrats. And the administration proposal offered by Steven Mnuchin, the Treasury secretary, contained both.

The moderates’ framework would revive a lapsed weekly federal unemployment benefit at $300 a week for 16 weeks, from the end of December to April, and extend a series of unemployment programs set to expire at the end of the month.

It notably does not include another round of stimulus checks, which some lawmakers — including Senators Bernie Sanders, the Vermont independent, and Josh Hawley, Republican of Missouri — have lobbied for in recent days. Mr. Mnuchin’s proposal would include a $600 stimulus check for each American, but would not revive the supplemental unemployment benefit.

The original $2.2 trillion stimulus law enacted in March distributed $1,200 stimulus checks and established the enhanced unemployment benefits at $600 a week through July, which President Trump later extended unilaterally at $300 a week for most workers.

Speaker Nancy Pelosi and Senator Chuck Schumer of New York, the minority leader, urged Republicans to allow bipartisan talks to move forward, calling them the best opportunity for compromise.

In response, Mr. McConnell slammed the two Democrats for rejecting both the White House offer and his overture on Tuesday, his first major concession since efforts to reach agreement on another coronavirus relief deal began.

“At every turn, they have delayed, deflected, moved the goal posts, and made the huge number of places where Congress agrees into a hostage of the few places we do not,” Mr. McConnell said.

The moderates’ plan would repurpose money Mr. Mnuchin clawed back from the Federal Reserve and leftover funds in the expired Paycheck Protection Program and allow small businesses to receive another loan from the popular small-business program. It would provide $10 billion to child care providers, $25 billion in rental assistance, $82 billion for education providers, $6 billion for vaccine development and distribution and $7 billion for state, local and tribal governments to conduct testing and tracing.

To give negotiators additional time to reach an agreement both on a stimulus deal and the dozen annual spending bills, lawmakers in the House overwhelmingly passed a stopgap measure extending the government funding deadline to Dec. 18 from Friday.

The United Arab Emirates approved a Chinese coronavirus vaccine on Wednesday, citing preliminary data showing that it was 86 percent effective. The move, the first full approval of a Chinese vaccine by any nation including China, could bring the vaccine a step closer to widespread use around the world.

The announcement by the Emirates’ Ministry of Health and Prevention was the first official indicator of a Chinese vaccine’s potential to help stop the pandemic. If trials elsewhere produce similar findings, the Chinese vaccines could offer a lifeline to developing countries that cannot afford vaccines developed in Western nations that are likely to be more expensive and more difficult to store and distribute.

Chinese government officials and Sinopharm, the state-owned maker of the vaccine, were silent on Wednesday about the Emirati announcement. Scientists noted that the announcement was lacking in data and other critical details.

Sinopharm would not confirm or comment on the news, even hours after it was reported. A spokeswoman for the company hung up the phone when reached and did not respond to messages and calls afterward.

The news release from the Emirati government did not give important specifics, like the number of Covid-19 cases that were analyzed or the ages of volunteers, leaving it unclear to scientists how Sinopharm came to its conclusions about the vaccine’s effectiveness.

“The devil is in the details,” said Beate Kampmann, director of the Vaccine Center at the London School of Hygiene and Tropical Medicine. “It’s very difficult to judge this without seeing the number of cases. The main thing is, the trial results need to be made public.”

Still, the news that a Chinese vaccine was found to be 86 percent effective comes as a boost to China’s biomedical ambitions, even though that figure falls short of the performance reported for vaccines developed by Pfizer and Moderna, which have said that their vaccines are more than 90 percent effective.

The vaccine could also help bring China closer to fulfilling a pledge by China’s top leader, Xi Jinping, to make a vaccine a “global public good.”

The Emirates is one of 10 countries where Sinopharm is testing two coronavirus vaccine candidates. The health ministry said it had reviewed an interim analysis of data from late-stage clinical trials that also showed the vaccine was 100 percent effective in preventing moderate and severe cases of the disease. It did not say whether it had conducted an independent analysis of the raw data. The ministry said there were no serious safety concerns.

The results announced by the Emirates bode well for Sinopharm’s vaccines to obtain full regulatory approval in China, which Sinopharm sought before final trials were complete. The company is also conducting trials in Bahrain, Jordan, Peru, Argentina and elsewhere.

“I think it could hit the market in China very soon, and there will be news within the next one to two weeks,” said Tao Lina, a vaccine expert in China and a former immunologist at the Shanghai Center for Disease Control and Prevention.

GLOBAL ROUNDUP

Chancellor Angela Merkel pleaded with Germans to meet fewer people and stay at home over the holidays in an impassioned speech to lawmakers on Wednesday, as her country saw a record number of deaths from the coronavirus.

“I’m sorry, from the bottom of my heart, I am really sorry,” the visibly emotional chancellor said during a budget debate in Parliament. “But if the price we pay is 590 deaths a day then I have to say this is not acceptable.”

Ms. Merkel, a physicist who won praise in the spring for her detailed explanations of the science behind why Germans needed to stay at home, was frustrated five weeks ago when the governors of the country’s 16 states agreed only to partial restrictions that left most stores and schools open.

The result has been stubbornly high numbers of new infections and record numbers of people dying from the virus — as many in the first seven days of December as died in traffic accidents across the country in all of 2019, according to a report by Germany’s National Academy of Sciences that urged a strict lockdown over Christmas and New Year.

Through early testing, contact tracing and a coordinated effort from all levels of government, Germany emerged from the first wave of the virus with relatively few fatalities and enough intensive care beds to take on patients from neighboring countries.

But even as other European countries, including Belgium, France and Ireland, returned to severe restrictions on movement in October, Germany’s governors continued to squabble over how best to handle the virus, citing the different experiences in their regions.

State authorities are responsible for health policy in Germany and, without their cooperation, the chancellor has been helpless to enforce stricter measures. While some of the states with the highest infection numbers and most crowded hospitals have already tightened restrictions, ordering schools closed and imposing curfews, others have stressed the importance for people of gathering for Christmas.

How difficult the situation has been for the chancellor, as a scientist, was apparent, as she pounded her fist in anger and pressed her palms together in supplication, urging people to begin scaling down their activities in the coming 14 days and calling for schools to break early for Christmas and shun outdoor stands selling seasonal treats such as mulled wine or fresh waffles.

“If we have too many contacts before Christmas and then later this becomes the last Christmas we celebrate with our grandparents, then we missed something,” Ms. Merkel said. “We would do well to really take seriously what scientists tell us.”

In other developments across the world:

• In Japan, Prime Minister Yoshihide Suga’s cabinet has extended funding until June for a program that subsidizes domestic tourism, a Transport Ministry official said on Wednesday. The government has already scaled back the nearly $13 billion “Go to Travel” program in places where infection rates are high, and the Tokyo metropolitan government has asked the elderly and people with underlying illnesses not to participate. Preliminary figures suggest that those who participate experience a higher incidence of symptoms associated with Covid-19.

• The period of self-isolation and quarantine will be reduced to 10 days from 14 days in Wales beginning Dec. 10, officials said Wednesday. “We know that self-isolating is hard for people and we believe families, communities and business will welcome the announcement today to safely reduce the days in which people have to isolate,” said Vaughan Gething, the minister for health and social services.

With the coronavirus re-emerging in New York, Gov. Andrew M. Cuomo began holding his popular news briefings virtually on Wednesday, rather than in person with reporters in the same room.

The shift, months after the virus first devastated the state, will put Mr. Cuomo in sync with other leaders who transitioned away from in-person briefings long ago, including Mayor Bill de Blasio and Gov. Gavin Newsom of California.

Richard Azzopardi, a senior adviser to Mr. Cuomo, said that “given the new stricter C.D.C. guidelines released Friday and the reality of rising cases in New York, going remote is now the most prudent action.”

While none of the directives released by the Centers for Disease Control and Prevention last week were new, the stark warnings in the guidance reflected deepening concern at the agency that the pandemic is spiraling out of control. The agency urged Americans to wear masks indoors and avoid indoor spaces outside the home, labeling indoor dining as a “high-risk” scenario.

Despite months of mounting evidence of the virus’s airborne transmission indoors and the effectiveness of proper face coverings, Mr. Cuomo did not wear a mask when he addressed reporters from behind a dais, flanked by aides who tended to remove their masks after entering the room.

“We have sat in these seats six feet apart, socially distanced, without masks, since Covid started,” Mr. Cuomo said in October when confronted by a reporter about his decision to not wear a mask. “The rule is six feet apart. And that’s what we do.”

Gov. Philip D. Murphy of New Jersey continues to hold in-person briefings regularly in Trenton, wearing a mask before standing up from the dais but taking it off when answering questions from reporters, who are masked and socially distanced.

At the peak of the New York outbreak in the spring, Mr. Cuomo’s daily briefings were televised nationally, elevating the governor’s profile and offering viewers a rare window into his relationship with the press as he fended off question after question from local reporters. The briefings were typically held in the State Capitol in Albany or in a cramped room in his Manhattan office, with capacity capped and chairs for reporters spaced to ensure social distance.

As the virus waned in New York, however, Mr. Cuomo has held in-person briefings less frequently, opting instead for conference calls with reporters.

During an in-person briefing in his Midtown office on Monday, plexiglass partitions were placed between the governor and his aides for the first time, a last-ditch attempt at creating a safe environment. His staff wore masks during the presentation, but Mr. Cuomo did not.

The next day, Mr. Cuomo’s office said his briefings would be held through Zoom “until further notice.”

“We are making every effort to protect public health and balance it with the need for reporters across the state to continue to have access, so they can continue to do their jobs,” Mr. Azzopardi said in a statement.

After getting blowback from parents and local officials, California has reversed course, and will now allow public playgrounds to remain open under the state’s stay-at-home orders.

In an update on Wednesday, the California Department of Public Health said that “playgrounds may remain open to facilitate physically distanced personal health and wellness through outdoor exercise.”

The stringent regional stay-at-home orders that took effect in much of the state on Sunday night initially called for public playgrounds to be closed. But parents, local officials and public health experts pushed back fiercely, arguing that playgrounds are a safe and essential way for families to get fresh air and exercise with very low risk of contracting the virus.

“We have learned a lot about how to mitigate spread, including masks, distancing, ventilation and hand hygiene,” Monica Gandhi, an infectious disease doctor and professor of Medicine at the University of California, San Francisco, wrote in an email. “Therefore, to institute the same measures as in March, including shutting down of playgrounds, outdoor dining (where there has been no data to show that this is unsafe), and prohibiting members of different households to gather outside, is draconian and not data-driven.”

Many Californians expressed relief at the move and thanked the state for adjusting its guidance. “Families spoke out, we introduced a resolution, they will now allow playgrounds to open. The right decision,” Matt Haney, a member of the San Francisco board of supervisors, wrote on Twitter.

A dozen state legislators wrote a letter to Gov. Gavin Newsom on Friday arguing that closing playgrounds would be especially hard on low-income families who “may have little to no outdoor space of their own available.” On Wednesday, those legislators expressed gratitude that the governor listened.

“Every parent knows how important playgrounds are for our youngest Californians,” wrote Assemblywoman Lorena Gonzalez on Twitter.

Los Angeles County followed the state’s lead on Wednesday and changed its pandemic restrictions to allow playgrounds to reopen, “so that all children can have safe access to the outdoors,” the county supervisor, Hilda Solis, said in a statement posted on Twitter.

“Play is crucial for childhood development,” Ms. Solis said. “But low-income communities of color living in dense housing often do not have access to a yard.”

The county had closed its playgrounds before the governor announced the state restrictions. Public health officials have said that it was difficult to enforce compliance with social distancing at those sites.

Some older Californians were less fortunate on Monday.

The United States Forest Service announced it would close the campgrounds at eight national forests in California to help stem the spread of the virus. The announcement comes as most of California has entered a new round of lockdowns. The eight national forests with closed campgrounds are: Angeles, Cleveland, Inyo, Los Padres, San Bernardino, Sequoia, Sierra and Stanislaus.

Residents will still be permitted to visit the parks during the day, but may not use overnight accommodations. The order will remain in effect until Jan. 6.

Chris Hurn wasn’t surprised scammers were trying to get government money. An enormous relief effort like the $523 billion Paycheck Protection Program is bound to attract grifters.

As thousands of applications for government-backed loans flooded into his firm, Fountainhead Commercial Capital, it reported at least 500 suspicious cases to federal officials, Mr. Hurn said. But what shocked him was the brazen glee of the scammers who got money anyway.

At least a dozen times, “someone tried to defraud us, got turned down and then followed up to taunt us that they got their loan,” said Mr. Hurn, Fountainhead’s chief executive.

Four months after the federal government’s signature coronavirus relief program for small businesses expired, investigators and lawmakers have only scratched the surface of schemes that illicitly tapped its forgivable loans. The program’s hastily drafted and frequently revised rules, its removal of normal lending guardrails and governmental pressure to swiftly approve applications created the ideal conditions for thievery to thrive.

“We couldn’t believe how many people were trying to take advantage and game the system,” said Mr. Hurn, whose firm made more than 8,000 loans. “A lot of my employees, including me, were a little frustrated with humanity.”

So far, the Justice Department has brought criminal charges against more than 80 people accused of stealing at least $127 million from the relief program, but there’s far more to uncover. The House Select Subcommittee on the Coronavirus Crisis said it had identified more than $4 billion in potentially improper loans, and some bankers believe the total will be much higher.

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Cuomo Outlines Coronavirus Vaccine Distribution Plan

Gov. Andrew M. Cuomo said New York’s first allocation of the Pfizer-BioNtech vaccine could arrive as soon as this weekend if it’s approved. Nursing home residents and staff members would be the first to get doses, followed by high-risk medical workers.

The state has set up 90 regional distribution centers that are capable of cold storage. This is a different definition of cold storage. This is like really, really cold storage. Not every facility can do it. Not every hospital can do it. But we’ve identified 90 regional centers that can keep the vaccine at the required temperature, and they’ll act as distribution centers for that region. It could arrive as soon as this weekend. That assumes the F.D.A. does act right away. The F.D.A. does approve it. And the military turns around and ships it immediately. But it could actually be coming this weekend. Further allocations will be in the following weeks. Our state priority: Nursing home residents, first, nursing home staff — there was a discussion about do you do the residents or did or do you do the staff? New York, we decided to do both the residents and the nursing home staff. Then you go to high-risk hospital workers. The allocation by region, again, this is based on number of nursing home residents, number of nursing home staff and number of high-risk health care workers. After we take care of all the high-risk, health care workers, we’ll then move to all long-term and congregate care staff and residents, then E.M.S. and other health care workers. And then essential workers, general population, starting with those who have the highest risk.

Gov. Andrew M. Cuomo of New York offered more specifics on Wednesday for how a coronavirus vaccine, once authorized by federal regulators, would be distributed across the state, and laid out plans for how hospitals should deal with the surging number of cases.

Mr. Cuomo said New York City would get 72,000 of the initial doses of the Pfizer-BioNTech vaccine once the state receives them, which he said may be as soon as this weekend. Long Island will get 26,500 of the initial doses, he said, and the Mid-Hudson region 19,200.

The governor said the allocations were based on the number of nursing home residents and workers in each region, as well as the number of high-risk medical workers; those groups are the first priorities for vaccination.

The next people in line are residents and employees of long-term and congregate care facilities; then emergency medical service and other health care workers; then other kinds of essential workers; and finally, the rest of the population.

Mr. Cuomo also discussed the state’s “surge and flex” program, which is intended to keep hospitals from becoming overwhelmed by transferring patients when necessary.

He said Dr. Howard Zucker, the state health commissioner, had written a letter to hospital and nursing home administrators outlining how to prevent overcrowded conditions, which proved disastrous in the spring.

“This is a hospital capacity crisis,” Mr. Cuomo said, warning that “they’re going to have to be extraordinarily flexible and nimble to handle the additional caseload that is coming up.”

In his letter, Dr. Zucker called on individual hospitals and systems to alert the state before they reach 80 percent of capacity, and even earlier during a surge.

He also asked hospitals to report staffing or personal protective equipment shortages as well as bed occupancy. Nursing homes are required to have a 60-day stockpile of personal protective equipment, and hospitals must have 90 days’ worth.

“As we learned in the spring, keeping a watchful eye on capacity ensures that there is support in place and/or alternative plans to prevent any facility from being overwhelmed,” Dr. Zucker wrote.

Mr. Cuomo also said the Centers for Disease Control and Prevention had agreed to allow undocumented immigrants to receive vaccinations without having to provide identifying information, setting aside a Trump administration requirement that has caused consternation in some states

Administration officials have said collecting names, addresses, birth dates, ethnicities and other information was “critically necessary” to ensure that people receive follow-up doses and to assess the vaccine’s effectiveness and safety.

Mr. Cuomo, however, said that it would seem as if “you were trying to use the vaccination to identify undocumented people,” and that it could undercut the vaccination drive.

“If undocumented people don’t get vaccinated,” he said, “it compromises their health, and it compromises the whole program.”

The governor also said the state had joined a program that would allow pharmacy employees to vaccinate employees and residents at nursing homes.

In Mr. Cuomo’s first virtual briefing — a precaution taken because of the rising number of cases in the state and country — the governor said 4,993 people were hospitalized.

Mayor Bill de Blasio of New York City made a rare appearance at the briefing to join Mr. Cuomo in calling for Congress to provide more federal relief money to help the state recover economically from the pandemic.

A top federal vaccine official said Wednesday that 2.9 million doses of Pfizer’s Covid-19 vaccine will be shipped around the country in the first week after it is authorized by the Food and Drug Administration — half of the initial shipment from Pfizer.

On a call with reporters, Gen. Gustave F. Perna, the chief operating officer for Operation Warp Speed, the federal effort to speed a vaccine to market, said that 2.9 million doses would be sent out once the vaccine is authorized, and 2.9 million saved for booster shots, which are given three weeks later. The remaining 500,000 of an available 6.4 million doses are to be held in reserve, in case they are unexpectedly needed.

Health care workers and nursing home residents will be the first groups to receive the vaccine.

General Perna said he had decided to set aside the doses earmarked for the second shot out of caution.

“Eventually, we will become much more confident in our manufacturing, our distribution process, state handling, et cetera,” he said. “And then the requirement for reserve won’t be necessary.”

An outside panel of experts is scheduled to meet on Thursday to consider whether the Pfizer vaccine, which was developed with a German company, BioNTech, should be authorized for limited use. The vaccine was found to be 95 percent effective in a clinical trial. The Food and Drug Administration is expected to make its decision within days.

But supply will initially be limited.

Pfizer, which had to scale back its initial estimates because of manufacturing struggles, has said it can provide about 25 million doses to the United States before the end of the year, and has a contract to provide 100 million doses in total by March. The company is in negotiations with the federal government over supplying additional doses next year, but has said it may not be able to do so until June. The vaccine has already been authorized in the United Kingdom, Bahrain and Canada.

A similar vaccine, developed by Moderna, could also be authorized within weeks, and government officials have said they hope to have given 20 million people their first dose of that vaccine before the end of the year.

Alice McGraw, 2 years old, was walking with her parents in Lake Tahoe this summer when another family appeared, heading in their direction. The little girl stopped.

“Uh-oh,” she said and pointed: “People.”

She has learned, her mother said, to keep the proper social distance to avoid risk of infection from the coronavirus. In this and other ways, she’s part of a generation living in a particular new type of bubble — one without other children. They are the toddlers of Covid-19.

Gone for her and many peers are the play dates, music classes, birthday parties, the serendipity of the sandbox or the side-by-side flyby on adjacent swings. Many families skipped day care enrollment in the fall, and others have withdrawn their children amid the new surge in coronavirus cases.

With months of winter isolation looming, parents are growing increasingly worried about the developmental effects the ongoing social deprivation are having on their very young children.

“People are trying to weigh pros and cons of what’s worse: putting your child at risk for Covid or at risk for severe social hindrance,” said Suzanne Gendelman, whose daughter, Mila, 14 months old, regularly spent rug time with Alice McGraw before the pandemic.

“My daughter has seen more giraffes at the zoo than she’s seen other kids,” Ms. Gendelman said.

It is too early for published research about the effects of the pandemic lockdowns on very young children, but childhood development specialists say that most children are likely to be OK because their most important relationships at this age are with parents.

Still, a growing number of studies highlight the value of social interaction to brain development. Research shows that neural networks influencing language development and broader cognitive ability get built through verbal and physical give-and-take — from the sharing of a ball to exchanges of sounds and simple phrases.

These interactions build “structure and connectivity in the brain,” said Kathryn Hirsh-Pasek, director of the Infant Language Laboratory at Temple University and a senior fellow at the Brookings Institution. “They seem to be brain feed.”

Dr. Hirsh-Pasek characterized the current environment as a kind of “social hurricane” with two major risks: Infants and toddlers don’t get to interact with one another and, at the same time, they pick up signals from their parents that other people might be a danger.

“We’re not meant to be stopped from seeing the other kids who are walking down the street,” she said.

Doctors noticed a sex disparity early in the pandemic: Men infected with the coronavirus were hospitalized at much higher rates than women, and men died at higher rates.

The gap was first observed in China, then seen in Italy and in New York City. Now a large global study has confirmed that men with Covid-19 are at higher risk than women for both severe disease and death.

The analysis, published in Nature Communications on Wednesday, examined more than 3 million Covid-19 cases in dozens of countries and most American states. While the researchers found no differences in the proportion of male and female patients infected with the virus, men were nearly three times as likely to be admitted to intensive care than women, and 40 percent more likely to die.

The sex bias is a “worldwide phenomenon,” with only a “few exceptions,” the authors wrote, and the disparity has implications both for medical care as well as for mitigation strategies — and specifically, vaccination.

Rhode Island, the smallest U.S. state in area, now has the fastest spread of coronavirus, with more new cases per capita being reported than any other state, according to a New York Times database.

While infection rates have climbed throughout the Northeast in recent weeks, Rhode Island has gotten much worse much faster than its neighbors. Over the past week, it has averaged more than 1,300 new cases a day, or 123.5 cases for every 100,000 people.

By contrast, Connecticut is averaging 78.2 cases for every 100,000, and Massachusetts 71. Midwestern states like South Dakota and Minnesota that had the worst spread in the nation a few weeks ago have fallen down into the 90s by this measure.

The state moved aggressively in the spring to try to keep the virus out, establishing quarantine rules and setting up checkpoints on major highways to stem the flow of refugees from hard-hit New York. Its case counts stayed relatively low for most of the summer. But after Labor Day and the start of the school year, infection numbers began climbing steadily, and have not slowed since.

Gov. Gina Raimondo has imposed a two-week “pause” on the economy, and with health care workers in short supply, the state Department of Health has begun issuing temporary licenses to doctors, nurses and others who have retired, are visiting the state or have recently completing training programs.

“We need you,” the governor implored on Twitter.

Experts attribute some of Rhode Island’s relative vulnerability to its compact size and the concentration of its population in Providence, the capital. In contrast, next-door Massachusetts has large rural areas where case rates are low, but in Rhode Island an outbreak is likely to spread quickly through densely packed urban households. Studies indicate that as many as half of Covid-19 cases arise through transmission from one member of a household to another.

“One of the things Rhode Island suffers from in the context of Covid is that it’s not a very big state in terms of its footprint,’’ said Samuel Scarpino, an assistant professor at the Network Science Institute at Northeastern University. “It’s as though Massachusetts was getting reported on in terms of only what’s happening in Boston.’’

On surveys that measure social distancing and masking, Rhode Island is about even with Massachusetts and other states in the Northeast, Dr. Scarpino said. But the nationwide mobility data that his laboratory tracks shows that people in Rhode Island, like those elsewhere, have been leaving home to go to work this month and last at a rate of about 60 percent of what was once normal, compared to only 40 percent in early September. Rhode Island also ranked above the U.S. average in mobility over the Thanksgiving holiday.

“All of those things contribute to more cases getting into households,’’ Dr. Scarpino said.

Other factors that might be contributing to the heavy Rhode Island caseload, Megan L. Ranney, an emergency room physician and associate professor at Brown University suggested on Twitter, include a large population of college students whose return in the fall seeded some transmission chains and — in a pandemic that has disproportionately affected low-income workers who cannot afford to stay home — the state’s high poverty rate compared with others in the region. Like some other states, Rhode Island only imposed new restrictions on restaurants, bars and gyms after case counts had begun to surge.

“At the end of the day, regardless of the reason,’’ Dr. Ranney tweeted, “our hospitals are overwhelmed & everyone knows someone who’s sick.”

The Central District Health board in Boise, Idaho, tried to meet Tuesday evening to consider imposing a mask mandate and other measures. But the meeting was beset from the very beginning.

Before the board had even completed roll call, one commissioner, Diana Lachiondo, interrupted to say she was stepping out to phone the police, because protesters had gathered outside her home. Four minutes later, she tearfully interrupted again, saying she had to leave the meeting because the protesters had begun banging on the door, where her 12-year-old son was home alone.

The board tried to carry on with business, hearing from a doctor about how the pandemic has overwhelmed his staff. But then the meeting was hastily adjourned at the request of the city’s mayor and chief of police, who told the board it was unsafe to continue.

Protesters had gathered outside the Central District Health building in Boise, as well as the homes of Ms. Lachiondo and at least two other board members, to protest the mitigation measures the board was considering for four of Idaho’s most populous counties. The police set up barricades at the building to keep protesters from entering.

The proposed measures included a mask mandate for public and private places where people of different households could not remain at least six feet apart. The board received more than 3,000 written public comments about the proposal over four days.

Another board member, Dr. Ted Epperly, later told The Idaho Statesman that about 15 protesters gathered outside his house during the meeting, “beating garbage cans and flashing strobe lights through my windows,” and that two people had knocked on his door.

The Boise Police Department said one person was arrested on charges of misdemeanor trespassing inside the Central District Health building. Investigators were also securing warrants to arrest others involved for disturbing the peace, the police said in a statement.

Mayor Lauren McLean of Boise wrote on Twitter that the protesters had come from “outside our community,” and that their purpose was to “disrupt local government in action, to intimidate their families.”

“This is not OK,” she wrote. “Let me be clear: we will hold offenders accountable.”