Britain gave emergency authorization on Wednesday to Pfizer’s coronavirus vaccine, leaping ahead of the United States to become the first Western country to allow mass inoculations against a disease that has killed more than 1.4 million people worldwide.

The decision kicked off a vaccination campaign with little precedent in modern medicine, encompassing not only ultracold dry ice and trays of glass vials but also a crusade against anti-vaccine misinformation.


Britain beating the United States to authorization — on a vaccine codeveloped by the American pharmaceutical giant Pfizer, no less — may intensify pressure on U.S. regulators, who are already under fire from the White House for not moving faster to get doses to people. And it has stirred up a global debate about how to weigh the desperate need for a vaccine with the imperative of assuring people that it is safe.

“Help is on its way with this vaccine — and we can now say that with certainty, rather than with all the caveats,” the British health secretary, Matt Hancock, said on Wednesday, as the government exulted in the authorization.

While the go-ahead bodes well for Britain, which broke from the European Union’s regulatory orbit to approve the shot early, it will have no effect on the distribution of the hundreds of millions of doses that other wealthy countries have procured in prepaid contracts.

It also offers little relief to poorer countries that could not afford to buy supplies in advance and may struggle to pay for both the vaccines and the exceptional demands of distributing them.

The Pfizer vaccine, developed with BioNTech, a smaller German firm, must be transported at South Pole-like temperatures, a requirement that could dictate who will be vaccinated first in Britain: Nursing-home residents were supposed to be the top priority under an advisory committee’s plans, but efforts to limit transportation of the vaccine and ensure it remains cold may mean that National Health Service staff will receive the shots first.

The government said on Wednesday that 800,000 doses would be available by next week for health workers to begin administering. For Britain, which has suffered one of Europe’s highest per capita death tolls from the virus, the decision by its drug regulator testified to a vaccination strategy that has been the most aggressive in the West.

After the government strengthened an old law that allows Britain to step out from under the European Union’s regulatory umbrella in public health emergencies, its Medicines and Healthcare Products Regulatory Agency fast-tracked a review of the Pfizer vaccine, which was 95 percent effective in a late-stage trial.

The White House, concerned that Britain would approve a vaccine first, summoned Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, for a meeting on Tuesday. A panel of outside advisers to the F.D.A. is scheduled to meet on Dec. 10 to decide whether the agency should grant emergency authorization to the Pfizer vaccine.

While American regulators pore over raw data from vaccine makers to validate their results, their counterparts in Britain and elsewhere in Europe lean more heavily on companies’ own analyses. The European Union is set to conduct its own review of the Pfizer and BioNTech vaccine, after the companies submitted their final application to the bloc’s health authorities on Tuesday.

The global race to develop a vaccine is poised to shatter records for time to market. Around the world, researchers are testing 57 vaccines in clinical trials, and nearly 100 others are being tested in animals or cells. China and Russia have approved vaccines without waiting for the results of late-stage trials, known as Phase 3, which experts say raises serious risks.

For all its size and economic might, California has long had one of America’s lowest number of hospital beds relative to its population. Now state officials warn that this shortfall, combined with acute staffing shortages, may prove catastrophic.

In the spring, California had some of the earliest outbreaks and was the first state to issue a stay-at-home order. By summer, many Californians thought the worst was behind them, only to see an explosion of cases at the end of June. The number of cases dropped, then plateaued, before skyrocketing again this fall.

Now, California is experiencing its largest surge in coronavirus cases as the nation is on the brink of reaching 100,000 hospitalizations for the first time, according to the Covid Tracking Project. On Sunday, California became the first state to record more than 100,000 cases in a week, according to a New York Times database. The state government estimates that about 12 percent of its confirmed cases end up in a hospital.

Complicating the situation for hospitals is the fact that cases are now exploding in nearly all parts of the country, meaning that healthcare workers cannot be brought from other states as an emergency stopgap like they were in the spring, when the pandemic was mostly concentrated in a few coastal states, experts say.

Even though California has some of the country’s most restrictive measures to prevent the spread of the virus, an influx of people with severe cases of Covid-19 may force overwhelmed hospitals to turn patients away by Christmas, Gov. Gavin Newsom warned this week.

A dearth of hospital beds has been a worldwide problem throughout the pandemic, but California, with a population of 40 million, has a particularly acute shortage.

In addition to beds, a shortage of nursing staff will make handling the surge of virus cases “extraordinarily difficult for us in California,” said Carmela Coyle, the head of the California Hospital Association, which represents 400 hospitals across the state.

“This pandemic is a story of shortage,” Ms. Coyle said. “It’s what has made this pandemic unique and different from other disasters.”

At the county level, health officers are counting down the days until their hospitals are full. Dr. Sara Cody, the chief health officer for Santa Clara County, which includes a large slice of Silicon Valley, projects that hospitals in the county will reach capacity by mid-December.

“We have done everything that we can do as local leaders and health officials,” said Dr. Cody, who led the effort in March to put in place the country’s first shelter-in-place order. “We have worked as hard as we can work. We have tried everything that we know how to do. But without bold action at the state or federal level we are not going to be able to slow this down. We are not an island.”

Beyond California, hospitals have been scrambling in recent weeks to handle a new rush of patients, particularly in parts of the Sun Belt and New England that had largely avoided coronavirus spikes in the spring and summer.

In Rhode Island, where infections have rapidly increased in recent weeks, a field hospital opened on Monday in the state’s second-largest city, Cranston. At a cost of $8 million, a former call center for Citizens Bank was converted into a 335-bed field hospital. In New Mexico, a vacant medical center in Albuquerque was being used for recovering coronavirus patients. “We are seeing the worst rates that we’ve seen since the pandemic hit,” Mayor Tim Keller said in a recent interview.

A court officer gave Demetre Cornish a mask as he appeared behind plexiglass barriers in State Supreme Court in Manhattan in October.Credit…Jefferson Siegel for The New York Times
Since October, state and federal court officials have taken extraordinary measures to restart criminal trials in New York City. They have constructed plexiglass boxes with special air filters in court. They have asked witnesses to testify in face shields and have spread jurors out in courtroom galleries.

But those efforts have not stopped the virus from disrupting nearly every step of the process. The state and federal courts in the city have been able to complete only nine criminal jury trials since the pandemic hit in March, officials said. Last year, there were about 800 criminal trials in the city.

Courts are stalled across the country. Federal judges in Nebraska, Nevada, Colorado and several other jurisdictions recently suspended jury trials in response to rising virus cases. A court in McKinney, Texas, a suburb of Dallas, held the state’s first virtual criminal trial last month.

Each court has determined its own protocols. One local courthouse in Orange County, Calif., has completed 114 criminal trials since May, while the federal courthouse across the street has determined it is unsafe to hold any trials at all.

In New York City courts, the challenge of preventing the virus’s spread is magnified by the dense population. In normal times, clerks, court officers and lawyers squeeze into courtroom galleries and line the crowded hallways, waiting for cases to be called.

For months, the logistical problems have threatened the ability of hundreds of defendants to secure their constitutional right to a speedy trial. Now, as a second wave of the virus threatens the New York region, the delays are only worsening — and officials foresee the backlog of unresolved cases continuing to grow.

Some prosecutors, citing safety concerns, have pushed to delay trials because their witnesses live out of state or work in hospitals with Covid-19 patients. In other cases, prosecutors said the fears of catching the virus during trials had been overblown. Defense lawyers told a court in Brooklyn they were unwilling to spend weeks inside a cramped courtroom.

“Is it fair for people to be languishing in pretrial detention and presumed innocent with no prospect of a trial in the future for them?” said New York’s chief administrative judge, Lawrence K. Marks. “A criminal justice system cannot be, in any sense of the word, fully functioning, if it is not conducting jury trials.”

Families and community organizations in Los Angeles and Oakland sued California this week, saying that it has failed during the pandemic to provide low-income Black and Latino students the free and equal education that the State Constitution guarantees.

According to the lawsuit, California has failed to provide critical equipment, support and oversight as public schools have shifted to remote instruction in their effort to prevent the spread of the coronavirus. It says parents and grandparents have had to become tutors, counselors and computer technicians because of an inadequate response.

“Despite the fact that the home has become the exclusive learning environment for children,” the complaint says, “the state has offered families no training, support, or opportunity to provide input into plans for remote learning, the eventual return to in-person instruction, or the delivery of compensatory education.”

The lawsuit, filed on Monday in Alameda Superior Court, arises from widespread concern that remote instruction has exacerbated disparities in education for students who cannot afford laptops or Wi-Fi access — let alone tuition to private schools that have kept classrooms open. In large districts across the nation, failure rates appear to be rising, particularly among disadvantaged students, putting them at increased risk for disengagement and dropping out.

It is the latest in a series of legal efforts aimed at pressuring California to address socioeconomic inequities in its public school system.

Weeks before the pandemic began forcing schools to shutter classrooms in the spring, a $50 million legal settlement ended another suit brought by Public Counsel, a nonprofit legal aid organization, which filed on behalf of California students who were not getting adequate reading instruction in elementary schools. Public Counsel also was part of a coalition of advocacy groups that last year sued the University of California system, charging that its use of standardized testing for admissions was disadvantaging Black and Latino students.

But the lawsuit also comes at an intensely difficult moment in the pandemic for California, which faces soaring infection rates. A spokesman for Gov. Gavin Newsom, who warned on Monday that the state might have to tighten public health restrictions, said the state had worked to balance long-term educational needs with the immediate health crisis.

“Throughout the pandemic this administration has taken important actions to protect student learning while also taking necessary steps to protect public health,” said the spokesman, Jesse Melgar. “We will defend our position in court.”

Taxi drivers, protesting outside city hall in New York in late August, are one group of workers who may have a hard time in the post-coronavirus economy.

The nation’s economic recovery from the pandemic will hinge to some extent on how quickly people can change jobs: whether show managers can become electricians, whether taxi drivers can become plumbers, how many cooks can manage software for a bank.

The labor market has recovered 12 million of the 22 million jobs lost from February to April. But many positions may not return any time soon, even when a vaccine is deployed.

This is likely to prove especially problematic for millions of low-paid workers in service industries like retailing, hospitality, building maintenance and transportation, which may be permanently impaired. What will janitors do if fewer people work in offices? What will waiters do if the urban restaurant ecosystem never recovers its density?

The prognosis is bleak. Marcela Escobari, an economist at the Brookings Institution, warns that even if the economy adds jobs as the coronavirus risk fades, “the rebound won’t help the people that have been hurt the most.”

Looking back over 16 years of data, Ms. Escobari finds that workers in the occupations most heavily hit since the spring will have a difficult time reinventing themselves. Taxi drivers, dancers and front-desk clerks have poor track records moving to jobs as, say, registered nurses, pipe layers or instrumentation technicians.

The virus is abruptly taking out a swath of jobs that were thought to be comparatively resilient, in services that require personal contact with customers. And the jolt has landed on workers with little or no education beyond high school, toiling in the low-wage service economy.

“The damage to the economy and particularly to workers will probably be longer lasting than we think it is going to be,” said Peter Beard, senior vice president for regional work force development at the Greater Houston Partnership.

What’s more, he said, the effects of the pandemic will intensify underlying dynamics that were already transforming the workplace. Automation, for one, will most likely accelerate as employers seek to protect their businesses from future pandemics.


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