As the total number of U.S. coronavirus cases surpassed 24 million on Monday, Los Angeles County, one of the hardest-hit areas, may face even more dire weeks ahead. Deaths in the county have continued to climb as the national death toll nears 400,000.
Hospitals have run out of room in intensive care units, though new cases and hospitalizations appear to be leveling off in recent days. The county records a coronavirus-related death roughly every seven minutes, and last week was its highest recorded ever for Covid-19 fatalities.
On Saturday alone, 253 people died of Covid-19, and with variants of the virus that could be more contagious now circulating in California, those numbers may rise.
It took nearly 10 months for the county, America’s most populous, to hit 400,000 cases, but little more than a month to add another 400,000, from Nov. 30 to Jan. 2, according to a New York Times database. On Saturday, the county became the nation’s first to surpass one million recorded coronavirus infections, a number only four states other than California have exceeded: Illinois, New York, Florida and Texas. (California on Sunday became the first state to have recorded more than three million cases.)
And the true scale of infections may be much higher than reported: One in three Los Angeles residents is believed to have been infected with the virus since the beginning of the pandemic, according to the Los Angeles Department of Health. To help quell the spread, the county’s public schools have asked health authorities for permission to begin providing Covid-19 vaccinations.
The virus is surging across California, where daily deaths are averaging 528, an increase of over 15 percent from a week ago. Much of the state, including the southern region, remains under a stay-at-home order.
The state is among many dealing with the arrival of a more contagious viral variant, first discovered in Britain; the first confirmed case in Los Angeles was reported on Saturday. It is believed to be potentially 50 percent more transmissible than the initial version of the virus.
Officials said they thought the variant, which has caused infections to soar in London and southeast England, has been spreading through Los Angeles for some time. While more contagious, the variant does not appear to cause more severe illness.
On Sunday night, the California Department of Public Health reported another variant that had grown more common across the state since December. Known as L452R, it was first detected in Denmark in March and appeared in California in May. In December, researchers at the University of California, San Francisco, sequenced genomes of coronavirus gathered around the state and found that the variant was present in just 3.8 percent of their samples. By January, it had jumped to 25.2 percent.
Charles Chiu, who led the sequencing, cautioned that he and his colleagues worked with a small sample size, so they have not yet proven that this variant is more contagious. “But there are worrisome signs that this variant may be highly transmissible,” he said.
Dr. Chiu and his colleagues are now looking more carefully for this variant across the state and are trying to understand how its mutations have altered it. They want to see if the variant can escape from monoclonal antibodies and perhaps even make vaccines less effective. “These are critical studies that need to be done,” Dr. Chiu said.
After weeks under a stay-at-home order, the county’s positivity rate is starting to taper. Dr. George Rutherford, an epidemiologist at the University of California, San Francisco, said the state and Los Angeles seemed to be “in the process of sort of gradually turning a corner here.”
He cautioned against panicking about the more transmissible variant, noting the same cautious behavior will help keep it at bay: stay home, wear a mask, physically distance.
For nearly the entire pandemic, political polarization and a rejection of science have stymied the United States’ ability to control the coronavirus.
That has been clearest and most damaging at the federal level, where President Trump claimed that the virus would “disappear,” clashed with his top scientists and abdicated responsibility for a pandemic that required a national effort to defeat it, handing key decisions to states under the assumption that they would take on the fight and get the country back to business.
But governors and local officials who were left in charge of the crisis squandered the little momentum the country had as they sidelined health experts, ignored warnings from their own advisers and, in some cases, stocked their advisory committees with more business representatives than doctors.
Nearly one year since the first known coronavirus case in the United States was announced north of Seattle on Jan. 21, 2020, the country is hurtling toward 400,000 total deaths, and cases, hospitalizations and deaths have reached record highs.
The situation has turned dire just as the Trump administration, in its final days, begins to see the fruits of perhaps its biggest coronavirus success, the Operation Warp Speed vaccine program. But already, a lack of federal coordination in distributing doses has emerged as a troubling roadblock.
The incoming president, Joseph R. Biden Jr., has said he will reassert a federal strategy to bring the virus under control, including a call for everyone to wear masks over the next 100 days and a coordinated plan to widen the delivery of vaccines.
“We will manage the hell out of this operation,” Mr. Biden said on Friday. “Our administration will lead with science and scientists.”
The strategy signals a shift from the past year, during which the Trump administration largely delegated responsibility for controlling the virus and reopening the economy to 50 governors, fracturing the nation’s response. Interviews by The Times with more than 100 health, political and community leaders around the country and a review of emails and other state government records offer a fuller picture of all that went wrong.
A nurse’s cry pierced the night from the balcony of an Egyptian hospital. She was screaming that the patients in the Covid-19 intensive care unit were gasping for air.
Ahmed Nafei, who was standing outside, brushed past a security guard, dashed in and saw that his 62-year-old aunt was dead.
Furious, he whipped out his phone and began filming. It appeared that the hospital had run out of oxygen. Monitors were beeping. A nurse was distressed and cowering in a corner as her colleagues tried to resuscitate a man using a manual ventilator.
At least four patients died.
Mr. Nafei’s 47-second video this month of the chaos at El Husseineya Central Hospital, about two and a half hours northeast of Cairo, spread rapidly on social media.
As outrage grew, the government denied that the hospital had run out of oxygen.
An official statement issued the following day concluded that the four who died had suffered from “complications” and denied that the deaths had “any connection” to an oxygen shortage. Security officers interrogated Mr. Nafei, and officials blamed him for violating rules barring visits and filming inside hospitals.
A New York Times investigation, however, found witnesses, including medical staff and relatives of patients, who said in interviews that the oxygen had fallen to precipitously low levels. At least three patients, they said, and possibly a fourth, had died of oxygen deprivation. A close analysis of the video by doctors in Egypt and the United States confirmed that the chaotic scene indicated an interruption in the oxygen supply.
The oxygen shortage was the result of a cascade of problems at the hospital, The Times’s investigation found. By the time patients were suffocating, a relief delivery of oxygen was already hours late and a backup oxygen system had failed.
“We’re not going to bury our heads in the sand and pretend everything is OK,” a doctor at the hospital said, speaking on condition of anonymity because he feared arrest. “The whole world can admit there’s a problem, but not us.”
The government’s rush to deny the episode is only the latest example of the lack of transparency in its response to the pandemic, which has led to cynicism and distrust of its public assurances.
Republicans in the Minnesota State Senate were feeling jubilant after the November election. They had held onto a slim majority despite an onslaught by Democrats. Now, it was time to party.
More than 100 senators, their spouses and their staff members gathered for a celebratory dinner at a catering hall outside the Twin Cities on Nov. 5, two days after Election Day. Masks were offered on arrival, but there was little mask wearing over hours of dining and drinking, at a moment when a long-predicted surge in coronavirus infections was gripping the state.
At least four senators in attendance tested positive for the coronavirus in the days afterward. One was the Republican majority leader, Paul Gazelka, an outspoken opponent of mask mandates and shutdown orders. He compared his symptoms to a “moderate flu” and recovered. So did two other senators.
The fourth was Senator Jerry Relph, a Vietnam veteran and grandfather from St. Cloud, Minn. Struggling to breathe after testing positive, he was admitted to a hospital in mid-November. He died on Dec. 18, at age 76.
His daughter Dana Relph is still furious at Republican leaders for holding the dinner and at the refusal of Mr. Gazelka to take responsibility.
“Why are you throwing a party with 100-plus people in the middle of a pandemic?” said Ms. Relph, 44, who was not allowed to visit her father until the day he died. “Why would you choose to do that when we know people are going to be eating and drinking and taking their masks off, where their inhibitions will be lowered?”
Mr. Gazelka declined an interview request, and a spokeswoman said he would not respond to Ms. Relph “out of respect for privacy requested from the family.”
Ten months into the coronavirus crisis, the continuing Republican resistance to mask wearing and social distancing is a striking political phenomenon. Four Democratic members of Congress tested positive this month after being in lockdown at the Capitol on Jan. 6 with Republicans who refused to wear masks.
Luke Letlow, just elected to Congress as a freshman Republican from Louisiana, died of Covid-19 in December, days before he was to be sworn in.
According to the election data site Ballotpedia, six state lawmakers have died from Covid-19, including the speaker of the New Hampshire State House and a Virginia state senator who succumbed on New Year’s Day. All six were Republicans.
Kimberly and Kelly Standard, who are twins, assumed that when they became sick with Covid-19 their experiences would be as identical as their DNA.
The virus had different plans.
Early last spring, the sisters from Rochester, Mich., checked themselves into the hospital with fevers and shortness of breath. While Kelly was discharged after less than a week, her sister ended up in intensive care, and spent almost a month in critical condition.
Nearly a year later, the sisters are bedeviled by the divergent paths their illnesses took.
“I want to know,” Kelly said, “why did she have Covid worse than me?”
Identical twins offer a ready-made experiment to untangle the contributions of nature and nurture in driving disease. With the help of twin registries in the United States, Australia, Europe and elsewhere, researchers are confirming that genetics can influence which symptoms Covid-19 patients experience.
These studies have also underscored the importance of the environment and pure chance: Even between identical twins, immune systems can look vastly different.
But at least some of the factors that influence the severity of a Covid-19 case are written into the genome. Recent studies suggest that people with type O blood, for example, may be at a slightly lower risk of becoming seriously sick (though experts have cautioned against overinterpreting these types of findings). Other papers have homed in on genes that affect how cells sound the alarm about viruses.
There even seems to be a measurable genetic influence on whether patients experience symptoms like fever, fatigue and delirium, said Tim Spector, an epidemiologist and the director of the TwinsUK registry based at St. Thomas’ Hospital in London.
Last year, he and his colleagues developed a symptom-tracking app. In a study that has not yet been published in a scientific journal, they reported that genetic factors might account for up to 50 percent of the differences between Covid-19 symptoms.
Still, Dr. Spector said, “It would be wrong to think we can answer this if we just crack the genes.”
Brazil approved two coronavirus vaccines for emergency use while rejecting an application for a third as South America’s most populous nation began a vaccination program that had been mired in chaos.
On Sunday, Brazil’s health regulator, Anvisa, authorized the vaccine from Sinovac, a private Chinese company that developed it in partnership with the Butantan Institute in São Paulo. It approved the vaccine produced by the University of Oxford in partnership with AstraZeneca, the British-Swedish pharmaceutical company.
A day earlier, regulators rejected an application for the Sputnik V vaccine developed by Russia, saying more documentation was needed.
Mônica Calazans, 54, a nurse in the state of São Paulo, was given the first shot of Sinovac’s CoronaVac vaccine on Sunday. Federal officials said vaccinations were expected to begin in all Brazilian states on Wednesday.
The first vaccination was attended by João Doria, the governor of São Paulo, who has feuded with Jair Bolsonaro, the president of Brazil, over the approval and rollout of vaccines. Mr. Bolsonaro had dismissed the seriousness of the pandemic and cast doubt on the Sinovac vaccine, while Mr. Doria negotiated directly with the Chinese to acquire doses. Brazil has had one of the worst outbreaks in the world, with the third-highest number of cases after the United States and India and the second-highest number of deaths after the United States, according to a New York Times database.
New questions about the efficacy of the Chinese vaccine emerged last week after officials at the Butantan Institute downgraded its efficacy to just over 50 percent, far below the 78 percent level announced earlier but still above the benchmark that the World Health Organization has said would make a vaccine effective for general use. That announcement signaled potential obstacles for China’s vaccine diplomacy as well as the epidemic control measures of countries that plan to use the Sinovac vaccine. So far at least 10 countries have ordered CoronaVac, seeking a total of 380 million doses.
Manuela Andreoni contributed reporting.
In recent days, tens of thousands of National Guard troops have flooded into Washington from across the country to protect lawmakers and ensure a smooth transition to the next administration.
The soldiers — several times more troops than are deployed to Iraq, Afghanistan, Somalia and Syria — may also be dealing with another risk: the coronavirus. At least 43 troops deployed to Washington contracted the virus, The Military Times reported, though none while on duty in the city, according to Air Force Capt. Tinashe T. Machona.
A spokesman for the D.C. National Guard, Maj. Matt Murphy, said that while Guard members with symptoms were directed to get tested and seek medical care, the size of the operation meant that testing all members was not feasible. Members underwent temperature checks and filled out questionnaires about their symptoms and exposure, he said.
“All 50 states, three territories and the District of Columbia are involved in this operation,” Major Murphy said. “To track down all 54 surgeon generals to see if they’re able to release numbers regarding their troops at this time would overwhelm us.”
Linsey Marr, a professor of civil and environmental engineering at Virginia Tech, said that while it was “very important for them to be there,” Guard members “should be doing everything reasonably possible” to prevent the spread, including wearing masks, getting tested and exercising extra caution in higher-risk settings like being in vehicles together, resting in the Capitol (as many have been pictured doing) and eating indoors.
“It’s almost certain that some of them are carrying the virus” with such a large crowd, Dr. Marr said.
The troops are frequently photographed in masks, standing at a distance. But many had to sleep huddled in crowded spaces in the Capitol, making room for lawmakers to continue business.
Dr. Ashish Jha, the dean of Brown University’s School of Public Health, said that systematic testing should be a priority for a group of that size, including for asymptomatic cases. “These folks are there to protect our political leaders, but we should not be putting them in harm’s way unnecessarily by not doing what we can to protect them from the virus,” he said.
The troops are mostly processed through the D.C. Armory, where they fill out a medical questionnaire, receive credentials and find out about their assignments and other logistics.
Earlier this summer, when the National Guard deployed troops to Washington for Black Lives Matter protests, a few tested positive, McClatchy reported at the time. The infected Guard members stayed in the city and quarantined while others went back to their home states.
Portugal’s hospitals are on the brink of becoming overwhelmed with coronavirus cases, with fears the country’s hospital system could buckle in the face of steadily rising infections. The country has registered more than 10,000 new cases of Covid-19 daily for the last five days.
Portugal has one of smallest intensive care unit capacities of any country in Europe, with just 672 beds available, and by Sunday, 647 intensive care patients were being treated for the coronavirus, according to the health ministry.
After visiting a hospital on Sunday, President Marcelo Rebelo de Sousa of Portugal told journalists that there was now pressure on health care structures that were greater than the first peak of the outbreak in March. The rate of infections, he added, could rise significantly in the coming weeks and necessitate “a much longer lockdown.”
Portugal began a month of nationwide restrictions on Friday, with measures similar to those the country enforced last spring, including the closure of nonessential stores and an order for citizens to stay at home.
Marta Temido, Portugal’s health minister, said the country was “very close to the limit” after visiting a hospital in Almada on Sunday and called on citizens to follow the latest lockdown rules in order to help reduce the “very high” pressure on hospitals.
“Everybody needs to make sacrifices,” she said.
Here’s what to know from elsewhere in the world:
European leaders are set to debate a proposal this week for coronavirus “passports” that would let vaccinated people travel freely within the bloc. Prime Minister Kyriakos Mitsotakis of Greece, where travel restrictions have hit the tourism industry hard, said in a letter to the president of the bloc’s executive arm that it was “urgent” for member states “adopt a common understanding” on vaccination certificates, according to Reuters. The issue is expected to be discussed during a video conference on E.U. coronavirus coordination on Friday.
Australia’s health secretary said the country was unlikely to fully reopen its borders in 2021, despite vaccination efforts and pressures from the tourism industry. Speaking to ABC News on Monday morning, the minister, Brendan Murphy, said that restarting international travel remained “a big question.”
“I think that we’ll go most of this year with still substantial border restrictions,” he said.
Germany’s health ministry has announced plans to systematically sequence coronavirus samples in order to detect and track variants of the virus that have the potential to spread more swiftly. “We want to be able to understand even better where known mutations are spreading and whether new mutations are occurring,” Jens Spahn, the health minister, said on Monday. The goal is to sequence at least 5 percent of new infections. Mr. Spahn said that while the variant that spread rapidly in England had been found in Germany, it was mostly linked to patients who had traveled from Britain.
In Japan, the health ministry reported three new cases on Monday of the variant that spread in Britain, the first to be discovered among residents with no travel history. Japan has reported a total of 45 cases of three different coronavirus variants, all but these latest three among people who had recently traveled or were close contacts of travelers from Britain, South Africa or Brazil. The three new cases were all confirmed in Shizuoka Prefecture, south of Tokyo and the home of Mt. Fuji, Japan’s highest peak.
Public schools in Los Angeles, which are already administering a huge coronavirus testing and tracing program for students, teachers and families in the nation’s second-largest district, have asked the state and county health authorities for permission to begin providing Covid-19 vaccinations, the superintendent said on Monday.
Austin Beutner, the superintendent, said the Los Angeles Unified School District was “uniquely situated — and uniquely qualified — to help in the vaccination effort,” with a dozen licensed clinics, 42 testing locations, more than 450 registered school nurses and partnerships with insurers that would allow them to begin administering inoculations immediately.
Though school districts in New York, Kansas City and the California cities of Riverside, Ventura and Long Beach have committed to vaccinate or have begun vaccinating school employees, schools have yet to be broadly deployed for general distribution of coronavirus vaccines.
But Los Angeles Unified, which has more than 1,400 K-through-12 schools and serves nearly 700,000 mostly low-income students across 710 square miles of Southern California, has throughout the pandemic operated not only as a school system, but as a large-scale social service and relief organization, distributing hundreds of thousands of free meals, pandemic supplies and virus tests to students, employees and their families. The district is also in a county with soaring rates of coronavirus infection: One Los Angeles County resident in three is now estimated to have contracted the virus.
“We’re raising our hand and saying, ‘Put me in, coach — we can help,’” Mr. Beutner said.
Last week, counties and cities throughout the state began opening mass inoculation sites by appointment to accommodate patients unable to procure vaccines from their pharmacists or doctors. The City of Los Angeles opened a site at Dodger Stadium, and Los Angeles County has said it will open five more such sites on Tuesday.
It is unclear whether the public health authorities will take the school district up on its offer. But Mr. Beutner called the notion of school-based community vaccination centers “just common sense.”
Schools have been integral to vaccine distributions in the past, operating as sites in the 1950s for the inoculation of millions of schoolchildren against polio, for instance, and in 2009 for the distribution of millions of doses of vaccines for the H1N1 swine flu virus.
India’s coronavirus vaccine rollout, one of the largest in the world, has been hobbled by technical glitches in a mobile phone application, leaving the country far short of its vaccination goals in the first few days of the campaign.
State officials complained of problems with a digital platform called the Covid Vaccine Intelligence Network, or CoWIN, which is used by both vaccine providers and recipients to monitor the campaign’s progress. It is mandatory for vaccine recipients to register on the app in order to be inoculated.
Dr. Ajoy Kumar Chakraborty, director of health services in the state of West Bengal, said Monday that the software had become overwhelmed and didn’t work at many vaccination sites, and that vaccinations were curtailed as a result.
In the first phase of the campaign, which began on Saturday, government officials plan to vaccinate 30 million health and frontline workers. On the first day, about 300,000 health care workers were set to be inoculated; the actual number was about 207,000. On Sunday, the number dropped to 17,072.
Dr. Manohar Agnani, a senior official in the federal Ministry of Health and Family Welfare, said on Sunday that feedback was being collected from states to “identify bottlenecks and plan corrective action.”
India has approved two vaccines for emergency use. One is the vaccine developed by AstraZeneca and Oxford University, which is manufactured by the Serum Institute of India and is known in the country as Covishield. The other is Covaxin, which was developed by India’s National Institute of Virology with Bharat Biotech, a local pharmaceutical company.
The government of India, which has a population of 1.3 billion people, has so far purchased 11 million doses of Covishield and 5.5 million doses of Covaxin, both of which require two doses per person. Unlike the Oxford-AstraZeneca vaccine, no Phase 3 clinical trial data has been released showing that Covaxin is safe and effective. Officials have said that vaccine recipients will not get to choose between the two.
Doubts about transparency are only one of the obstacles officials face in trying to end one of the largest outbreaks in the world. India has the second-highest number of cases after the United States, and the third-highest number of deaths after the United States and Brazil, according to a New York Times database.
The head of the World Health Organization has warned that the world is on the brink of a “moral failure” in ensuring coronavirus vaccines are distributed among the world’s poorest populations, and that the promise of equitable access to the vaccines “is at serious risk.”
Dr. Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, speaking at the opening session of a meeting of its executive board, said the world had the opportunity to “write a different story” than those of past pandemics in which rich countries benefited from widespread access to vaccines while the world’s poor were neglected.
“We now face the real danger that even as vaccines bring hope to some, they become another brick in the wall of inequality between the world’s haves and have-nots,” he said.
While the “stunning scientific achievement” of developing a vaccine in under a year has become “a much-needed source of hope,” Dr. Tedros warned that the world must do more to ensure the equitable distribution of the finite supply of approved vaccines to poorer nations.
In recent months, rich nations like the United States and Britain have cut deals with drug manufacturers and secured enough vaccine doses to ensure their citizens could be vaccinated, often multiple times over, and programs have already begun in most.
“Its right that all governments want to prioritize vaccinating health workers and older people first,” he said. But it was “not right” for young, healthy people in rich countries to be vaccinated before the more vulnerable.
Many nations have also committed to taking part in a complex vaccine-sharing scheme called Covax, a collaboration between international health organizations and global partners, designed to ensure that the world’s poorest nations can access vaccines. But Dr. Tedros said that in recent weeks, worrisome reports had made him fear wealthier nations would not follow through on their commitments.
“I need to be blunt: The world is on the brink of a catastrophic moral failure, and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” he said.
Dr. Tedros noted that even the countries and companies that “speak the language of equitable access” have continued to prioritize bilateral vaccine deals that circumvent the Covax program, drive up prices and see nations “attempting to jump to the front of the queue.”
“This is wrong,” he said.
At the heart of each coronavirus is its genome, a twisted strand of nearly 30,000 “letters” of RNA. These genetic instructions force infected human cells to assemble up to 29 kinds of proteins that help the coronavirus multiply and spread.
As viruses replicate, small copying errors known as mutations naturally arise in their genomes. A lineage of coronaviruses will typically accumulate one or two random mutations each month.
A coronavirus variant first reported in Britain, named Variant of Concern 202012/01 by Public Health England, is part of the B.1.1.7 lineage of coronaviruses, and is believed to be potentially 50 percent more transmissible than the initial version of the virus.
Some mutations have no effect on the coronavirus proteins made by the infected cell. Other mutations, like those in B.1.1.7, might alter a protein’s shape by changing or deleting one of its amino acids, the building blocks that link together to form the protein.
Through the process of natural selection, neutral or slightly beneficial mutations may be passed down from generation to generation, while harmful mutations are more likely to die out.
The B.1.1.7 lineage has now been detected in over 50 countries, including the United States. Britain has responded to the surge of B.1.1.7 with stringent lockdowns, and other countries have tried to prevent its spread with travel restrictions.
Federal health officials warn that it may become the dominant variant in the United States by March. It is no more deadly than other forms of the coronavirus. But because it can cause so many more infections, it may lead to many more deaths.
A former British Supreme Court justice is drawing condemnation after clashing with a woman with cancer during a televised debate over the country’s lockdown.
Jonathan Sumption, 72, who was a Supreme Court justice for six years before retiring in 2018 and has become one of the country’s most prominent anti-lockdown voices, said during a discussion broadcast on the BBC on Sunday that he did not accept that “all lives were of equal value.”
When he argued that the lives of his children and grandchildren were “worth much more” because of potential years ahead, another panelist pushed back.
“I’m the person who you say their life is not valuable,” said Deborah James, who hosts a podcast on the BBC and has stage four, metastatic bowel cancer.
Lord Sumption responded: “I didn’t say it wasn’t valuable, I said it was less valuable.”
“Who are you to question and put a value to life?” Ms. James then continued. “I believe life is sacred and I don’t think we should make those judgment calls.”
Lord Sumption said later that his comments had been misinterpreted, telling the British newspaper The Daily Mail: “I object extremely strongly to any suggestion that I was inferring that Miss James’s life was less valuable because she had cancer. I thought she was responding to my earlier comments about older people being protected by a total lockdown which is causing immense harm to the young who are unaffected.
“That harm can be to their mental health or through cooping undergraduates up at university or through the loss of jobs. I was saying this should not be inflicted on the young to protect old people like me.”
“One of the problems is that we were talking across each other,” he said on another television show, “Good Morning Britain,” on Monday, adding that he and Ms. James had had a friendly exchange afterward and he regarded the matter as “closed.”
The point he was trying to make, he said, was that policymakers had to make difficult choices including putting a value on human life. “This is a tool for policymakers,” he said. “It’s not a way of valuing individuals.”