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Coronavirus Vaccine Set to Begin U.S. Distribution

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First U.S. Coronavirus Vaccines Leave Michigan Plant

Workers at a Pfizer plant in Kalamazoo, Mich., packed boxes of the Pfizer-BioNTech vaccine on Sunday morning and loaded them onto trucks. Nearly 3 million doses are expected to reach all 50 states this week.

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Workers at a Pfizer plant in Kalamazoo, Mich., packed boxes of the Pfizer-BioNTech vaccine on Sunday morning and loaded them onto trucks. Nearly 3 million doses are expected to reach all 50 states this week.CreditCredit…Pool photo by Morry Gash

The first of nearly three million doses of the first Covid-19 vaccine were packed in dry ice and put on trucks at a Pfizer plant in Kalamazoo, Mich., on Sunday morning, destined for hundreds of distribution centers in all 50 states, the most ambitious vaccination campaign in American history.

Workers applauded as the first truck left the plant carrying a load of the vaccine.

The inoculation effort, set in motion after the Food and Drug Administration’s emergency authorization on Friday night of the vaccine developed by Pfizer and BioNTech, comes as the U.S. coronavirus death toll approaches 300,000. And it is happening amid fears that Americans will continue to crowd together indoors over the holiday season and accelerate surges in cases, hospitalizations and deaths.

Officials reported more than 207,000 new cases and more than 2,200 deaths on Saturday. That brought the total number of U.S. cases to more than 16 million, by far the most in the world, less than a week after the country surpassed 15 million. More than 3,000 deaths were reported for the first time on Wednesday.

The first injections are expected to be given by Monday to high-risk health care workers, the initial step toward the goal of inoculating enough people by spring to finally halt the spread of a virus that has sickened millions and upended the country’s economy, education system and daily life.

UPS and FedEx said plans to ship the vaccine were already underway on Saturday, with vials of vaccines packed at Pfizer facilities and prepared for shipping. Employees from the Centers for Disease Control and Prevention were on hand to make sure there were no mishaps, according to a senior C.D.C. official.

About 2.9 million doses of the vaccine are to travel by plane and guarded truck from Pfizer facilities in Michigan and Wisconsin to designated distribution locations, mostly hospitals. Gen. Gustave F. Perna, the chief operating officer of Operation Warp Speed, the federal effort to bring a vaccine to market, said that 145 sites would receive the vaccine on Monday, 425 on Tuesday and 66 on Wednesday. He likened the operation to the Allied invasion of Europe in World War II.

“D-Day was the beginning of the end, and that’s where we are today,” he said, cautioning it would still take months “to eventually achieve victory.”

States are largely planning to follow C.D.C. recommendations about who gets vaccinated first: health care workers at high risk of exposure and residents of nursing homes and other long-term care facilities, a population that has died from the virus at disproportionately high rates.

FedEx and UPS will transport the vaccine throughout most of the country, and each delivery will be followed by shipments of extra dry ice a day later. Pfizer designed special containers, with trackers and enough dry ice to keep the doses sufficiently cold for up to 10 days. Every truck carrying the containers will have a device that tracks its location, temperature, light exposure and motion.

The rapid development of the vaccine, and its authorization based on data showing it to be 95 percent effective, has been a triumph of medical science, but much in this complicated next stage could go wrong.

The Pfizer vaccine needs to be kept at minus 94 degrees Fahrenheit, and the special boxes it is being shipped in can be opened no more than twice a day, to maintain the deep freeze. Side effects, like achiness or headache, could cause some of the nurses, doctors and others who are first in line for the vaccine to miss a day or two of work, challenging overburdened hospitals.

Rollout of the Pfizer vaccine is also less centralized in the United States than in other countries that are racing to distribute it. (In Britain, the process is very centralized, and in Canada, it is somewhere in between.)

States say they have only a fraction of the funding they need from the federal government for staffing to administer the shot, for tracking who has received both doses of the vaccine — a booster is needed three weeks after the initial injection — and for other crucial pieces of the effort.

Additional vaccines are in the pipeline. Moderna recently applied for emergency authorization for its vaccine and said it was “on track” to produce 20 million doses by the end of this month and between 500 million and a billion through 2021.

Reporting was contributed by Roni Caryn Rabin, Julie Bosman, Reed Abelson and Richard Pérez-Peña.

Both CVS and Walgreens will send teams of pharmacists and support staff into thousands of long-term care facilities in the coming weeks to vaccinate all willing residents and staff members.
Credit…Shannon Stapleton/Reuters

The Food and Drug Administration’s emergency authorization on Friday night of the vaccine developed by Pfizer and BioNTech cleared the way for a complex effort led by the giant pharmacy chains CVS and Walgreens to give the vaccine to nursing home residents and workers, who have died from the virus at disproportionate rates.

Both companies have contracts with the federal government to send teams of pharmacists and support staff into thousands of long-term care facilities in the coming weeks to vaccinate all willing residents and staff members. CVS and Walgreens are both planning to administer their first vaccinations on Dec. 21.

More than 40,000 facilities have chosen to work with CVS. Nearly 35,000 picked Walgreens. Each U.S. state has already picked, or will soon pick, either the Pfizer or the Moderna vaccine for all of its long-term care facilities that will be working with CVS and Walgreens.

CVS has designated about 1,000 of its store pharmacies to serve as hubs for receiving the Pfizer vaccine. The shipments will come via FedEx and UPS.

“Those folks know that they are to bring that product right back to our pharmacy,” said Chris Cox, a CVS executive leading the company’s planning of the effort. “So no dropping it off at the back door, no dropping it off with our front store colleagues — it is to go straight to the pharmacy counter, so that the pharmacists themselves can receive it.”

On the morning the Pfizer doses are ready to go out to a nursing home, pharmacists will load them into small, hand-held coolers intended to keep the doses refrigerated for up to 24 hours. The pharmacists will drive with the doses in their own cars — traveling separately from several support staff members in an effort to maintain social distancing restrictions. The farthest long-term care facility will be about 75 miles by car, though most drives will be much shorter.

Once the CVS teams arrive at a nursing home, they’ll go room by room to administer shots to residents, while facility workers will generally be vaccinated in a common area. The visit will last two to four hours on average, Mr. Cox said. The CVS teams will generally make three visits to each home. For the Pfizer vaccine, each visit will be separated by about three weeks, the amount of time between the first shot and the booster.

“There’s a healthy level of anxiety here because the stakes are so high and the purpose is so great,” Mr. Cox said. “But I’d also say that we’ve been planning this for months — and we’ve been planning for the hardest and most potentially complex scenarios that could face us — so I feel confident that we’re ready to go.”

States are largely planning to follow recommendations from the Centers for Disease Control and Prevention about who gets vaccinated first: health care workers at high risk of exposure to the coronavirus and residents of nursing homes and other long-term care facilities. But there is some variation among their plans.

Gov. Ron DeSantis of Florida said that “tip-of-the-spear, high-contact workers” in hospitals would receive the very first shots and that he hoped to reach “as many elderly people as we can” by the end of December. Ohio has prioritized getting initial doses of the vaccine to people in nursing homes and assisted living centers. And in Mississippi, Dr. Thomas Dobbs, the state health officer, said frontline hospital workers would get the shots ahead of nursing home residents, in part to ease any anxiety those residents might have about the vaccine.

“They’re still a little bit hesitant,” he told reporters on Tuesday. “If we don’t put ourselves out there first, take the first doses of vaccine and show that we believe in it and trust it, I don’t think the long-term care folks are going to have the uptake they need.”

In most states, the concerted effort to vaccinate nursing home residents will begin a week later.

CVS, Walgreens and other pharmacies are also set to play a key role in vaccinating the general public once vaccines are more widely available, but that process will involve people going into their local pharmacies and could be weeks or months away.

Abby Goodnough contributed reporting.

A flu shot being administered in Detroit last month.
Credit…Matthew Hatcher/Getty Images

Despite the horrifying surge of Covid-19 cases and deaths in the United States right now, one bit of good epidemiology news is emerging this winter: It now looks unlikely that the country will endure a “twindemic” of flu and the coronavirus hitting at the same time.

That comes as a profound relief to public health officials who predicted as far back as April that thousands of flu victims with pneumonia could pour into hospitals this winter, competing with equally desperate Covid-19 pneumonia victims for scarce ventilators.

“Overall flu activity is low, and lower than we usually see at this time of year,” said Dr. Daniel B. Jernigan, director of the influenza division of the Centers for Disease Control and Prevention. “I don’t think we can definitively say there will be no twindemic; I’ve been working with flu for a long time, and I’ve been burned. But flu is atypically low.”

Since September, the C.D.C. “FluView” — its weekly report on influenza surveillance — has shown all 50 states in shades of green and chartreuse, indicating “minimal” or “low” flu activity. Normally by December, at least a few states are painted in oranges and reds for “moderate” and “high.”

A combination of factors has made the flu season remarkably quiet, experts said.

In the Southern Hemisphere, where winter stretches from June through August, widespread mask-wearing, rigorous lockdowns and other precautions against Covid-19 transmission also drove the incidence of flu down to record lows. In the United States, the cancellation of large indoor gatherings, closings of schools and use of masks have been mitigating all respiratory diseases, including influenza.

That has buoyed the spirits of flu experts.

Dr. William Schaffner, medical director at the National Foundation for Infectious Diseases, which promotes flu shots, said he was recently on a telephone discussion with other preventive medicine specialists. “Everybody was in quiet awe about how low flu is,” he said. “Somebody said: ‘Shh, don’t talk about it. The virus will hear us.’”

Festive stands in Ansbach, Germany, last week.
Credit…Laetitia Vancon for The New York Times

BERLIN — Germans will be forced into a strict lockdown over Christmas after weeks of milder restrictions failed to prevent the coronavirus from spreading through the country, leading to record numbers of new infections and deaths.

Starting on Wednesday, most stores, schools and hairdressers will be required to close, and gatherings over the holidays will be restricted, Chancellor Angela Merkel said on Sunday. The measures, which Ms. Merkel announced after consultation with the governors of Germany’s 16 states, will apply through at least Jan. 10. Restaurants will still be allowed to sell takeaway food, but consumption of both food and alcohol in public will be banned.

“The ‘lockdown light’ had an effect, but it was not enough,” Markus Söder, governor of Bavaria, said, referring to the partial restrictions on social contacts that have been in place since early November. “If we are not careful, Germany will become the problem child of Europe,” he added.

Under the new restrictions, private meetings between people from two separate households will be limited to no more than five people over the age of 14, in addition to children. The restrictions will be expanded for Christmas, when people from up to four different households, plus children, will be allowed to meet, but only from Dec. 24 to 26.

No exception will be made over New Year’s, when gatherings will be banned, as will the fireworks that normally accompany the holiday in Germany.

Germany recorded 20,200 new infections on Sunday, more than 2,000 more than were recorded on the same day last week. The country has lost 21,787 people to the virus and the number of people being treated in intensive care is increasing.

Bahrain participated in a large-scale trial of a vaccine manufactured by the Chinese state-owned drug maker Sinopharm this year.
Credit…Mazen Mahdi/Agence France-Presse — Getty Images

Bahrain said on Sunday that it had approved the use of a Chinese vaccine against the coronavirus, after the United Arab Emirates became the first government to do so on Wednesday.

Bahrain said that the vaccine, manufactured by Sinopharm, a Chinese state-owned drug maker, was 86 percent effective based on testing of more than 42,000 volunteers, the same preliminary results that the Emirates cited. Bahrain’s statement provided few additional details of the approval process. Sinopharm had no immediate reaction to the decision.

Experts had described the reported efficacy of the Sinopharm vaccine as a respectable result that would help China’s efforts to play a key role in the global coronavirus inoculation drive, but they noted the lack of detail in the initial announcements. It also falls short of the results reported by the American drug makers Pfizer and Moderna, which said that their coronavirus vaccines were more than 90 percent effective.

Last month, Bahrain said it had begun providing the Sinopharm vaccine to frontline medical workers under an emergency-use authorization. The decision announced on Sunday will allow the vaccine to be administered to the wider public. Bahrain was involved in the testing of the Chinese vaccine, with more than 7,700 people in the island kingdom volunteering for Phase 3 clinical trials.

Bahrain, which has a population of about 1.5 million, said on Thursday that it would offer coronavirus vaccinations free to all citizens and residents, but did not specify which company or companies would provide the shots.

In other global developments:

  • Italy has overtaken Britain as the country with the most coronavirus fatalities in Europe, with both countries reporting more than 64,000 deaths.

  • South Korea reported 1,030 new coronavirus cases on Sunday, setting a record for the second consecutive day as the country struggles to contain a fourth wave of infections. Early in the pandemic, South Korea was praised as a model for its aggressive antivirus efforts, but President Moon Jae-in warned on Sunday that restrictions could be raised to their highest level after they were already tightened in the capital, Seoul, last week.

  • Panama, which has the highest infection rate in Latin America, reported a record 2,806 coronavirus cases on Saturday.

The Port of Seattle in June. Over 95 percent of overseas trade for the United States flows through one of around 150 deepwater ports in the country.
Credit…Ruth Fremson/The New York Times

As the virus surges, outbreaks are starting to re-emerge in ports across the United States.

In interviews with over a dozen longshoremen, their families and maritime officials at multiple ports in the country, all urged government officials to recognize the essential nature of longshore work and protect individuals from conditions that make it ripe for the virus to spread.

They say longshore workers should be provided rapid testing and early access to the vaccine so they can remain on the job and prevent outbreaks from shutting the nation’s ports.

“We’re hidden,” said Kenneth Riley, the president of the local longshoremen’s union in Charleston, S.C. “But if you think some of the store shelves were empty as we got into this pandemic, let these ports shut down and see how empty they’ll be.”

Longshore work is exhausting, and often requires close contact with others. The trade is essential to the economy, with longshore workers serving as a crucial link between moving goods from a shipping vessel onto trucks and trains that send them to their final destination, experts said.

Over 95 percent of overseas trade for the United States flows through one of around 150 deepwater ports in the country, according to the Army Corps of Engineers.

The workers at highest risk of being exposed to the virus are deep sea longshoremen, who are primarily Black and do most of the work that requires the lifting and moving of goods, union officials noted.

Many officials note that since the nature of longshore work is day labor, workers may look for any reason to escape getting tested unless they show symptoms to prevent going weeks without pay as they isolate.

“There are people who know they’re sick, and go into work,” said Alan A. Robb, the president of the longshore union’s Gulf Coast district office, in Texas. “They can’t afford to miss a day.”

The International Longshoremen’s Association, a union that represents about 65,000 longshore workers, has lobbied the federal government and state officials for support.

A Milanese architect and a team of consultants came up with the design, which will be used on the temporary pavilions where the vaccine will be available.
Credit…Stefano Boeri Architetti

Italy on Sunday unveiled a floral logo and a slogan for its coronavirus vaccination campaign: “With a flower, Italy comes back to life.”

A Milanese architect, Stefano Boeri, and a team of consultants came up with the flower design, which will be used on the temporary pavilions where the vaccine will be dispensed.

“This idea of a spring flower helping us emerge from a dark and cold winter is the message we want to give,” Mr. Boeri said in a streamed news conference on Sunday morning.

About 1.8 million Italians — health workers and nursing home residents — are expected to start receiving the Pfizer vaccine in mid-January, said Domenico Arcuri, the official in charge of the coronavirus response, at the news conference. Vaccines in Europe are awaiting approval from the European Medicines Agency.

About 1,500 pavilions will be set up in the main squares of Italian cities, Mr. Arcuri said, along with information booths also bearing the flower design.

Mr. Arcuri said that logistical questions, such as acquiring needles and syringes, were under control and that Italy had issued “a call to arms for 3,000 doctors and 12,000 nurses” to operate the pavilions.

Italy was the first European country to impose a nationwide lockdown in March, when the coronavirus swelled its hospitals, and a resurgence of the virus in the fall led to restrictions being reimposed. The country has registered a total of more than 64,000 virus deaths.

Mr. Arcuri said he hoped the “campaign of information and communication” would persuade Italians skeptical of the vaccine that the shots were safe.

Peter Vlitas, a travel industry executive, used the CommonPass app on a United Airlines flight to Newark from London in October.
Credit…The Commons Project Foundation

In the coming weeks, major airlines including United, JetBlue and Lufthansa plan to introduce a health passport app, called CommonPass, that aims to verify passengers’ coronavirus test results — and perhaps soon, vaccinations.

CommonPass notifies users of local travel rules — like having to provide proof of a negative virus test — and then aims to check that they have met them. The app will then issue confirmation codes, enabling passengers to board certain international flights.

“This is likely to be a new normal need that we’re going to have to deal with to control and contain this pandemic,” said Dr. Brad Perkins, the chief medical officer at the Commons Project Foundation, a nonprofit organization in Geneva that developed CommonPass.

Electronic vaccination credentials could have a profound effect on efforts to control the virus and restore the economy. They could prompt more employers and college campuses to reopen. And developers say they may also give some consumers peace of mind by creating an easy way for movie theaters, cruise ships and sports arenas to admit only those with documented virus vaccinations.

But the digital passes also raise the specter of a society split into health pass haves and have-nots, particularly if venues begin requiring the apps as entry tickets. The apps could make it difficult for people with limited access to vaccines or online verification tools to enter workplaces or visit popular destinations. Civil liberties experts also warn that the technology could create an invasive system of social control, akin to the heightened surveillance that China adopted during the pandemic — only instead of federal or state governments, private actors like employers and restaurants would determine who can and cannot access services.

In October, United tested CommonPass on a flight to Newark Liberty International Airport in New Jersey from Heathrow Airport in London. United and four other airlines plan to start using it soon on some international flights.

Charley Pride performing in New York in 1975.
Credit…Bettmann Archive, via Getty Images

Charley Pride, who was celebrated as a country music’s first Black superstar and known for hits such as “Kiss an Angel Good Mornin’” and “Is Anybody Goin’ to San Antone,” died on Saturday at age 86 while in hospice care in Dallas.

The cause of his death was complications of Covid-19, said Jeremy Westby, the singer’s publicist.

Lauded as a star who paved the way for other country music artists of color, Mr. Pride was praised for his contributions to the country music canon. In November, he received the Country Music Association’s Lifetime Achievement Award at the 54th annual Country Music Association Awards, where he also performed.

Some guests at the show, which was Mr. Pride’s last public event, were not wearing masks. However, event organizers said all protocols from the Centers for Disease Control and Prevention were followed.

Born March 18, 1934 in Sledge, Miss., Mr. Pride served in the army before moving to Montana to try to make it as a baseball player. There, he worked at a smelting plant and played semiprofessional baseball in East Helena, where he was paid $10 to sing the national anthem before games.

He began his country music career in the 1960s after signing with RCA Records, later quitting his factory job after his 1967 song “Just Between You and Me” became a Top 10 country hit.

As a Black man entering the country music industry in the 1960s, Mr. Pride’s career did not escape prejudice. Once radio stations learned he was Black, many refused to play his music, and during a 1970s award show, singer Loretta Lynn was told not to embrace him should he win an award she was presenting. (She did so anyway.)

“We’re not colorblind yet,” Mr. Pride wrote in his memoir, “Pride: The Charley Pride Story” (1994). “But we’ve advanced a few paces along the path, and I like to think I’ve contributed something to that process.”

During his career, Mr. Pride recorded over 50 hits that made it to Top 10 on the country charts, with over 20 hitting No. 1. Mr. Pride also racked up notable awards: Country Music Association’s male vocalist of the year in 1971 and 1972, Country Music Association’s entertainer of the year in 1971 and a lifetime achievement Grammy Award in 2017.

Dolly Parton said on Saturday she was “heartbroken” over Mr. Pride’s death, calling him one of her “dearest friends.”

“What a horrible, horrible virus,” she said on Twitter. “Charley, we will always love you.”

Mr. Pride is survived by his wife, Ebby Rozene Cohran Pride, and his children, Carlton, Charles and Angela.

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