F.D.A. Authorizes the First At-Home Coronavirus Test

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The F.D.A. authorizes the first at-home coronavirus test.

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Instructions on how to use the home test from the Lucira Health website.Credit...Lucira Health

The Food and Drug Administration on Tuesday gave an emergency green light to the first rapid coronavirus test that can run from start to finish at home, paving a potential path for more widespread testing outside of health care settings.

With a relatively simple nasal swab, the test can return results in about half an hour, and is projected by the company to cost $50 or less, according to the product’s website.

The test, developed by the California-based company Lucira Health, requires a prescription from a health care provider. And children under the age of 14 are not allowed to perform the test on themselves.

But clinicians can also run the test on their patients, including children under the age of 14, potentially delivering answers during a single visit to a care center or pharmacy, instead of routing a tough-to-collect sample through a lab.

A handful of other tests have been cleared by the F.D.A. for at-home collection of samples, which are then shipped to a lab for processing. But Lucira’s test is the first to remove the need for an intermediary.

“Today’s authorization for a complete at-home test is a significant step toward F.D.A.’s nationwide response to Covid-19,” Jeff Shuren, director of the F.D.A.’s Center for Devices and Radiological Health, said in a statement. “Now, more Americans who may have Covid-19 will be able to take immediate action, based on their results, to protect themselves and those around them.”

People who test positive for the coronavirus are expected to isolate themselves from others for 10 days.

Laboratory tests that look for the coronavirus’s genetic material using a technique called polymerase chain reaction, or P.C.R., are still considered the gold standard for detecting the virus. But the new at-home test relies on similar principles by using a method called a loop mediated amplification reaction, or LAMP.

Like P.C.R., LAMP repeatedly copies genetic material until it reaches detectable levels, making it possible to identify the virus even when it is present at only very low levels in the respiratory tract. While faster and less cumbersome than P.C.R., LAMP is generally thought to be less accurate.

People taking the battery-powered test must swirl a swab in both of their nostrils, then dip and stir the swab into a vial of chemicals. That vial is then plugged into a test cartridge that processes the sample. Within half an hour, the test cartridge will light up as “positive” or “negative.”

Federal guidelines note that people taking the test should report the results to their health care providers, who must then inform public health authorities to help track the virus’s spread.

According to the product’s instructions, Lucira’s LAMP test was able to accurately detect 94 percent of the infections found by a well-established P.C.R. based test. It also correctly identified 98 percent of the healthy, uninfected people.

The study, which was conducted by the company, was small, and included only people who had symptoms of Covid-19.

As American states try to contain the virus, their approach is far from united.

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A youth football game in Columbus, Ohio, last week. Gov. Mike DeWine announced a three-week curfew Tuesday, one of many different strategies states are using as the virus spreads rapidly. Credit...Maddie McGarvey for The New York Times

Ohio announced a nightly curfew. Mississippi extended a mask mandate to seven more counties, while Iowa will issue its first statewide mask order. Maryland will order all bars, restaurants and night clubs to close by 10 p.m. Pennsylvania will require anyone who enters the state to be tested before arrival.

Those actions, announced in the past 24 hours by governors who warn that hospitals are reaching capacity, are just the latest to be added to the ever-expanding patchwork of pandemic-related restrictions as the coronavirus erupts to crisis levels across the United States. And they came as Dr. Anthony S. Fauci, the government’s top infectious disease expert, said on Tuesday that the nation needed “a uniform approach,” instead of a “disjointed” state-by-state, city-by-city response.

Some states are a patchwork within America’s crazy-quilt virus response. In Mississippi, where Gov. Tate Reeves lifted a statewide mandate in September, Monday’s extensions of a mandatory mask mandate meant that it was now in effect in 22 counties out of 82.

Across the United States, more than one million new cases have been identified over the last week as officials in all 50 states reported increasing caseloads. Though the situation is especially dire in the Midwest and Mountain West, the outbreak is spreading rapidly throughout the country. New Hampshire, Texas, Oregon and Tennessee are among 39 states that have set weekly case records in the last few days. Deaths are also rising, with a national average of more than 1,100 a day, the most since early August, when a summer surge was peaking. On Tuesday, more than 1,580 new deaths were reported nationwide, the highest single-day total since mid-May. Five states set single-day records for new deaths.

Coronavirus-related curfews are in force across New Mexico and Puerto Rico. Gov. Gavin Newsom of California has said he is considering imposing one, as is Los Angeles County, which imposed new restrictions on businesses Tuesday.

Several Republican governors are finally, if reluctantly, wielding the power of their authority as President Trump largely cedes the pandemic response on his way out of office. Gov. Kim Reynolds of Iowa, with hospitals filled to the brink and under pressure from doctors, hospitals, mayors and farmers alike, abruptly reversed herself this week and began requiring masks indoors.

In North Dakota, Gov. Doug Burgum had been preaching personal responsibility for months, but last week issued a mask order “until further notice” as the state leads the nation in rates of new cases and deaths per person, according to a New York Times database. In Utah, Gov. Gary Herbert also mandated masks, and Gov. Mark Gordon of Wyoming, visibly angry at a news conference last week, warned that he, too, may have to resort to requiring masks because people in his state were being “knuckleheads” about the virus.

Gov. Mike DeWine of Ohio, a rare Republican leader of a red state who has consistently bucked Mr. Trump’s opposition to tough restrictions, announced that his state will be under a curfew from 10 p.m. until 5 a.m. for three weeks starting on Thursday.

Ohio has seen a sharp rise in coronavirus cases and hospitalizations in recent weeks. It has been reporting an average of more than 7,000 new cases a day lately, seven times as many as in early October and more than at any time since the pandemic began. “These are astronomical numbers,” the governor said at a news conference on Tuesday, urging residents to wear masks and maintain strict social distancing until a vaccine is widely available.

Governor DeWine said all retail businesses would have to close during the curfew and that residents should stay home unless they are commuting to work or traveling for emergency purposes. He called the rules “common sense.”

In Illinois, Gov. J.B. Pritzker said that starting Friday the whole state would move to Tier 3 under the state’s mitigation plan, which imposes lower capacity ceilings on many businesses, and restricts private indoor gatherings to people in the same household, among other measures. Casinos and indoor venues like theaters and museums must close, and outdoor group activities will be limited to 10 people.

On the East Coast, Gov. Larry Hogan of Maryland announced that, beginning Friday, all bars, restaurants and night clubs would have to close by 10 p.m. and businesses, religious institutions and organizations would be limited to 50 percent of capacity.

“This is not the flu,” Mr. Hogan said as he pleaded with residents to take the virus seriously. “It’s not fake news. It’s not going to magically disappear just because we’re all tired of it and we want our normal lives back.” He warned that the state’s hospitals were coming under severe strain, and that some in the western part of the state were completely full.

In Pennsylvania, state health department officials strengthened the state’s mask order, requiring them to be worn in all indoor facilities, including homes, whenever people are with anyone from outside their households, even if they maintain social distance. The state also issued an order requiring anyone who enters, whether visitors or Pennsylvanians returning from travel, to be tested in the 72 hours before arrival.

The pandemic is already reaching into next year and affecting at least one iconic American celebration: Mardi Gras, suspected for igniting an early outbreak in New Orleans, will not be celebrated with parades in February. “Mardi Gras 2021 is not canceled,” at least as a religious holiday, a spokesman for Mayor LaToya Cantrell said at a news conference on Tuesday. “It is going to look different.”

Tracking the Coronavirus ›

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Chuck Grassley, the oldest Senate Republican, tests positive for the virus.

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Senator Charles E. Grassley of Iowa speaking to reporters at the Hart Senate Office Building in Washington last month.Credit...Anna Moneymaker for The New York Times

Senator Charles E. Grassley of Iowa, at 87 the oldest Republican serving in the chamber, on Tuesday announced that he had tested positive for the coronavirus, becoming the second octogenarian member of Congress to be diagnosed in the past week.

Mr. Grassley, who had said earlier that he was quarantining after exposure to the virus, said on Twitter that he was “feeling good” and would “keep up on my work” for Iowans from home, following his doctor’s orders and public health guidelines.

He did not disclose any details about the circumstances of his exposure, but Mr. Grassley was on hand Monday as usual to open the Senate in his role as president pro tempore — the post typically reserved for the most senior member of the majority party — and for the first vote of the week. Mr. Grassley took his mask off briefly to deliver remarks on the Senate floor, as many senators do. His remarks focused on the need for continued social distancing and mask-wearing in order to stem the spread of the pandemic, urging “everyone to do their part.”

His positive test result marked the latest alarming development in what is threatening to become a mini-outbreak on Capitol Hill, where lawmakers continue to meet in close quarters with inconsistently applied health precautions.

Senator Rick Scott, Republican of Florida, was also in quarantine after being exposed to someone in Florida who tested positive for the virus, and several House lawmakers remained in quarantine after similar exposures in their home states.

Representative Don Young of Alaska, the longest-serving member of the House and its oldest member, who is also 87, disclosed on Monday that he had been hospitalized over the weekend as he battled a case of the virus. Two other lawmakers — Cheri Bustos of Illinois and Tim Walberg of Michigan — also announced positive tests the same day.

As multiple votes took place on Tuesday, Mr. Grassley’s absence ended the longest consecutive streak of voting in the Senate held by a single member. The Iowan often boasted of his record of having never missed a vote since 1993, when floods ravaged his state.

Among the votes he missed was one to move to confirm Judy Shelton, President Trump’s pick for the Federal Reserve board, whose nomination stalled in the Senate after it failed to draw enough support to advance.

Fauci calls for a ‘uniform approach’ rather than a ‘disjointed’ state-by-state pandemic response.

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Fauci Stresses the Importance of Presidential Transitions

I have been now dealing with six administrations in my 35 years as director. I’ve been through five transitions. I can say that transitions are extremely important to the smooth continuity of whatever you’re doing. Right now, we are in a very difficult public health situation. If you want to have good continuity, which will mean maximal attack on infections, hospitalizations, deaths, you want to have the continuity I’ve used the metaphor. It’s like passing a baton in a race: you don’t want somebody to stop, give it to somebody, and then have them start running. You want everything to be smooth from one to the other. That is what we would like to do.

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CreditCredit...Evan Vucci/Associated Press

Dr. Anthony S. Fauci, the government’s top infectious disease expert, said on Tuesday that the nation needed “a uniform approach” to the coronavirus pandemic, rather than “a disjointed” state-by-state response — a remark that echoed the views of President-elect Joseph R. Biden Jr. and contrasted sharply with President Trump’s coronavirus strategy.

Dr. Fauci, who has directed the National Institute of Allergy and Infectious Diseases since 1984, has been in Mr. Trump’s cross hairs on and off during the pandemic. Speaking to Andrew Ross Sorkin of The New York Times at a DealBook virtual conference, Dr. Fauci steered clear of mentioning Mr. Trump or Mr. Biden by name, and insisted he wants to “stay out of the political stuff.”

But his remarks suggested that his own thinking is far more in line with that of Mr. Biden, who has promised a far more muscular federal approach to the pandemic.

“We need some fundamental public health measures that everyone should be adhering to, not a disjointed, ‘One state says one thing, the other state says another thing,’” Dr. Fauci said.

He also made clear — without overtly saying so — that he believes Mr. Trump should allow the Biden transition team access to federal health officials.

“I’ve been through five transitions; I can say that transitions are extremely important to the smooth continuity of whatever you’re doing,” he said, adding, “We need to transition to the team that will be doing it, similar to how we’re doing it.”

Mr. Biden had initially played down Mr. Trump’s refusal to allow the Biden transition “landing teams” access to federal agencies. But on Monday, in a speech in his home city of Wilmington, Del., Mr. Biden sharpened his criticism of the president, warning that “more people may die if we don’t coordinate.”

When Mr. Biden takes office on Jan. 20, he will inherit the immense task of distributing the coronavirus vaccine, assuming that one has been approved by then.

Dr. Fauci said that there were two elements to a successful vaccine: its level of efficacy and how many people take it. On Monday, Moderna announced that its vaccine appeared to be 94.5 percent effective; the drug maker Pfizer announced last week that its vaccine was more than 90 percent effective.

But those figures will not matter unless most people are inoculated, Dr. Fauci said. Unless the “overwhelming majority” of Americans, about 75 to 80 percent, receive a vaccine, the country will continue to face serious public health challenges, he said.

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This is the worst outbreak that we’ve had of a respiratory borne illness in 102 years. You can’t run away from the data. It’s incomprehensible to me how people are not seeing that these are real numbers. And unfortunately, we’ve gotten into a situation of political divisiveness that a public health message like I’m trying to give is not encroaching on anybody’s freedom public health message is your personal and your societal responsibility to your neighbors and to the rest of the country.

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CreditCredit...New York Times

The incoming president will be taking command of a nation torn by divisions that have created opposition to masks and skepticism of vaccines. Dr. Fauci made a plea for an end to that divide, which he said was hindering the federal response.

“We’ve got to get public health issues out of the realm of political divisiveness — this is not a political issue,” he said. “We’ve got to do everything we possibly can to pull together as a nation.”

He said that public health measures, like mask wearing and social distancing, would still be required, albeit to a lesser degree, while the public is vaccinated. If a sizable majority of Americans do get a vaccine, “we could be quite close to some degree of normality” by the fall of 2021, he predicted.

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A new study shows that coronavirus immunity may last longer than previously thought.

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Experts worried that immunity to the coronavirus might be short-lived will likely be relieved by the new findings.Credit...Cheney Orr/Reuters

How long might immunity to the coronavirus last? Years, maybe even decades, according to a new study — the most hopeful answer yet to a question that has shadowed plans for widespread vaccination.

Eight months after infection, most people who have recovered still have enough immune cells to fend off the virus and prevent illness, the new data show. A slow rate of decline in the short term suggests, happily, that these cells may persist in the body for a very, very long time to come.

The research, published online, has not been peer-reviewed or published in a scientific journal. But it is the most comprehensive and long-ranging study of immune memory to the coronavirus to date.

“That amount of memory would likely prevent the vast majority of people from getting hospitalized disease, severe disease, for many years,” said Shane Crotty, a virologist at the La Jolla Institute of Immunology who co-led the new study.

The findings are likely to come as a relief to experts worried that immunity to the virus might be short-lived, and that vaccines might have to be administered repeatedly to keep the pandemic under control.

And the research squares with a recent finding that survivors of SARS, caused by another coronavirus, still carry certain important immune cells 17 years after recovering, as well as with other encouraging evidence emerging from other labs.

Akiko Iwasaki, an immunologist at Yale University, said she was not surprised that the body mounts a long-lasting response because “that’s what is supposed to happen.” Still, she was heartened by the research: “This is exciting news.”

Biden’s Covid advisers say that by blocking the transition, Trump may hold up vaccine distribution.

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President-elet Joseph R. Biden Jr. has said that “more people may die” from the virus as a result of President Trump’s refusal to allow an organized transition.Credit...Ruth Fremson/The New York Times

Top health advisers to President-elect Joseph R. Biden Jr. warned on Tuesday that planning for the distribution of a Covid-19 vaccine and other attempts to fight the coronavirus were being frustrated by President Trump’s refusal to allow an organized transition to begin.

The leaders of Mr. Biden’s Covid Advisory Board said they were being prevented from working with government officials who are in charge of distributing the vaccines. And they said that they did not have access to any government data on case counts, deaths or hospitalization, relying instead on media and private reports.

“There’s no time to waste. We don't have a day to waste,” said Dr. David Kessler, a former commissioner of the Food and Drug Administration. “Vaccine distribution is difficult and daunting under any circumstance.”

The grim warnings from the health officials come as a political appointee of Mr. Trump’s at the General Services Administration has refused to formally recognize that Mr. Biden is the winner, a move that would allow current government health officials to work with the Biden transition team.

Mr. Biden on Monday said that “more people may die” from the virus as a result.

His health advisers offered more specifics on Tuesday, saying that the incoming team needs access to information about medical supply chains, data on testing, specifics about therapeutic efforts, and other data that will be critical once the Biden administration is in charge of responding to the pandemic.

“There is valuable information inside the information that is held by career officials,” said Vivek Murthy, a co-chair of Mr. Biden’s advisory board and a former surgeon general. “We need to talk to those individuals. We need to work together with them.”

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Colleges are eliminating spring break from their calendars.

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Cornell University is one of a growing number of institutions where the 2021 spring semester will not include the traditional weeklong break.Credit...Heather Ainsworth for The New York Times

From move-in day to commencement, colleges across the country have been disrupted by the pandemic in myriad ways. The latest is the demise of spring break, with the risks it poses of super-spreading beach parties and cross-country debauchery.

Academic calendars for the next semester increasingly are omitting the traditional week off near the end of winter. Instead, they are starting later or are including scattered shorter breaks instead, to deter the spread of the virus by discouraging travel during the term.

Cornell University, for instance, announced this week that the usual week’s respite from the gloomy Ithaca, N.Y., winter will be replaced by two short respites for “wellness” — a two-day midweek break in early March and a long weekend at the end of April.

Syracuse University and the 64-campus State University of New York system have replaced their spring breaks with a later start for in-person instruction. The University of Michigan and Michigan State University will each divide the break into single days off throughout the semester. The University of Kentucky and the University of Louisville plan a blend of those strategies.

Students who traveled for spring break early in the pandemic contributed significantly to the virus’ spread, according to a study by Daniel Mangrum, a research economist at the Federal Reserve Bank of New York and Paul Niekamp, an assistant professor of economics at Ball State University. Although many colleges canceled fall breaks this term, Halloween parties were linked to Covid-19 outbreaks at a number of colleges.

In Florida, a popular spring break destination, dozens of cases and at least two deaths were traced to the delay of a statewide stay-at-home order until after the traditional early March spring break season. Gov. Ron DeSantis, who did not issue the order until April 1, said at the time that the state was supportive of local governments that ordered event cancellations and beach closures, but that it was not his role to step in first.

A Washington State wedding that had 10 times the allowable number of guests has led to 3 outbreaks.

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People wearing masks walking past a theater in Olympia, Wash., on Sunday.Credit...Ted S. Warren/Associated Press

Officials trying to curb the spread of the coronavirus continue to wrestle with getting people to accept a cap on the size of major social occasions, with the latest transgression coming in Washington State, where the number of guests at a wedding reached 10 times the official quota.

More than 17 people among the 300 guests at the wedding, near Ritzville, Wash., about 60 miles southwest of Spokane, have since tested positive for Covid-19, the Grant County Health District said in a statement, and the number of cases continues to tick up.

The Nov. 7 wedding also ignited a chain reaction, the county said, with two subsequent outbreaks linked to the event.

In September, Gov. Jay Inslee had limited social gatherings to a maximum 30 people. He then instituted stronger measures that started on Tuesday, including a ban on all indoor gatherings — including wedding receptions — with certain exceptions, as well as a halt to dining in restaurants and drinking in bars.

Theresa Adkinson, the district administrator for Grant County, made a plea for anyone who attended the wedding to both get tested for the virus and to quarantine for two weeks. The public announcement was designed to reach people whom contact tracers could not.

“With more than 300 people attending the wedding from many communities, local health jurisdictions are unlikely to reach them all,” she said.

The county’s statement encouraged wedding planners to keep a log of the guests attending any ceremony for at least two weeks.

“If an outbreak occurs, this information may be critical to help save lives,” it said, also recommending that anyone who attends a social event get tested five to seven days afterward.

Other weddings around the country have also been notorious superspreader events.

An August wedding reception in rural Maine with 55 guests led to 177 coronavirus cases, including seven deaths, and caused outbreaks in a home for the elderly 100 miles away, in addition to one within a prison some 200 miles away, according to the Centers for Disease Control and Prevention.

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Chicago plans to bring youngest students back into classrooms starting in January.

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In Chicago, a sign in front of a school encouraged students to participate in remote learning in September, but now the city is talking about getting kids back into classrooms.Credit...Scott Olson/Getty Images

Mayor Lori Lightfoot of Chicago and other city officials announced a plan on Tuesday to begin reopening the city’s public schools in January, if the rapid increase in cases stabilizes. The plan calls for bringing pre-kindergarten and some special education students back first, on Jan. 11., followed by all kindergarten through eighth grade students starting on Feb. 1.

Mayor Lightfoot said in a statement that many students had not been well-served by remote instruction and that the decision to reopen early next year was “the result of balancing our commitment to equity with our current public health situation.”

Chicago made the announcement even as it is facing a second wave of cases. It noted that many states in the United States and countries in Europe were keeping schools open even as cases rose, because mitigation strategies in schools have been largely successful.

City officials said that before the city moves forward with its plan, it would need to achieve a 50 percent improvement in “doubling time” — the amount of time it takes for the number of newly diagnosed cases to double. Since early October, the doubling time in Chicago has been 12 days.

The city said it planned to do surveillance testing of school staff, though it was still working out the plan.

A number of big school systems, including Los Angeles and San Francisco, remain closed for in-person instruction and have no concrete plans for reopening. But some, including Houston and Miami-Dade, have brought many of their students back into classrooms.

New York City, the nation’s largest district, opened its schools for hybrid learning in October, but the system now teeters on the edge of closing down classrooms again because Mayor Bill de Blasio had committed to closing schools if the city’s seven-day average positivity exceeded 3 percent, a number it has been approaching. More than 70 percent of students in New York City have opted to receive remote-only instruction.

When Chicago Public Schools asked parents of pre-kindergarten and special education students in October if they wanted in-person instruction, roughly a third of students opted in, the district said.

In an op-ed in the Los Angeles Times on Tuesday, the superintendent of the Los Angeles Unified School District, Austin Beutner, wrote that, without significant changes in policy to reduce the spread of the virus, “it is unlikely that schools in Los Angeles will reopen for in-person instruction any time soon.”

Poll suggests Americans are more willing to be vaccinated.

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Heather Lieberman, 28, was vaccinated in Hollywood, Fla., in August. Americans are now more willing to get a vaccine for the coronavirus.Credit...Chandan Khanna/Agence France-Presse — Getty Images

In a sign that Americans are becoming less hesitant to take a coronavirus vaccine, a Gallup poll released on Tuesday showed that 58 percent of the adults who were surveyed were willing to be vaccinated, up from 50 percent in September.

The survey was conducted between Oct. 19 and Nov. 1, as coronavirus cases were surging across the country but before Pfizer and Moderna announced that their vaccines were 90 percent effective or better against the virus in late-stage trials.

Still, the results were promising for an eventual vaccine rollout, as widespread inoculation against the virus is seen as essential before restrictions can be lifted and life can return to normal, or something close to it.

Phoebe Danziger, a pediatrician at the University of Michigan who writes about medicine, ethics and culture, said in an interview that the Gallup data was consistent with what she had observed anecdotally.

“Clearly there’s a lot of hesitation out there, but it seems like there’s a slight shift into a positive view,” she said. As cases continue to rise across the Midwest, she senses that people across the political spectrum are starting to see that they are “really going to need this to get out of this mess.”

A rushed approval process for a vaccine was a concern for 37 percent of the adults Gallup polled, while 26 percent said they would wait for confirmation that a vaccine was safe. A smaller group — 12 percent — said that they did not trust vaccines in general, reflectinga mistrust of vaccines that has been on the rise across the country in recent years, stemming from the legacy of government experimentation on African-Americans and the disadvantaged as well as distrust of the pharmaceutical industry.

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The U.N. dips into an emergency fund as the first famines of the pandemic loom.

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The U.N announced that $100 million from a disaster emergency fund will be used to avert famine in countries such as Afghanistan, where there are almost 2.5 million registered refugees.Credit...Muhammad Sadiq/EPA, via Shutterstock

Scrambling to avert the first famines of the coronavirus era, the top relief official at the United Nations announced Tuesday that he was taking $100 million from a disaster emergency fund so the organization could fight acute hunger in seven countries.

Afghanistan, Burkina Faso, the Democratic Republic of Congo, Nigeria, South Sudan and Yemen will each receive a share of $80 million, with an extra $20 million set aside for Ethiopia, said the relief official, Mark Lowcock, the under secretary general for humanitarian affairs and emergency relief coordinator.

Mr. Lowcock has been warning for months about the possibility that the coronavirus pandemic could hasten the onset of famine in countries that have chronically struggled with armed conflict, drought, pestilence and pervasive shortages of food.

“No one should view a slide into famine as an inevitable side effect of this pandemic,” Mr. Lowcock said. “If it happens it is because the world has allowed it to happen.”

While famine is preventable in these countries, he said, “we have to act in time to make a difference.”

He withdrew the money from the Central Emergency Response Fund, a United Nations pool of money supplied by donor nations to help battle humanitarian disasters that often happen abruptly, like severe storms, earthquakes or floods. It is unusual for money from the fund to be used for a foreseeable hunger crisis.

It is unclear, however, whether the $100 million allocation can help stave off famine in these countries. Mr. Lowcock and the leaders of many nonprofit humanitarian groups have said it will take many billions of dollars in aid to counter the effects of the pandemic in the underdeveloped world.

On Tuesday, CARE, the global anti-poverty group, released a report that recommended the United States government alone allocate an extra $20 billion “to respond to the COVID-19 pandemic and its effects around the world.”

All of Switzerland’s regular intensive care beds are full.

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A medical worker monitors a patient in a hospital intensive care unit for Covid-19 patients in La-Chaux-de-Fonds, Switzerland.Credit...Fabrice Coffrini/Agence France-Presse — Getty Images

Switzerland has reached capacity in its regular intensive care ward beds, a national medical association said Tuesday. The group urged people who are especially vulnerable to the coronavirus to consider writing a living will, specifying whether they would want to be put on life support.

All of the country’s 876 adult intensive care beds, which are certified by the Swiss Society of Intensive Care Medicine, “are currently completely full,” the society said in a statement on Tuesday. Luca Lavina, a spokesman for the society, said that “ad-hoc” beds had been added to extend capacity for now.

The country, with a population of 8.5 million, has seen new infections explode recently, with more than 83,500 reported since Nov. 3, according to government figures. In that same period, 986 people have died.

Switzerland has been reluctant to introduce far-reaching measures to prevent the spread of the virus, and images from the country’s ski resorts have shown people packed together, most without face masks, as they wait for lifts up the mountain, despite a requirement to wear nose and mouth coverings in crowded public spaces.

The country’s health care system has been widely lauded in the past as a model for other countries. But with its intensive care wards now at capacity, doctors are having to face difficult choices about who receives care.

In asking for Swiss residents to consider writing a living will, the medical society explained: “That will make it easier for your own relatives, as well as the intensive care ward teams, to make decisions, so that we can provide the best possible and individualized care.”

A correction was made on 
Nov. 19, 2020

An earlier version of this item and its headline referred imprecisely to the status of intensive care wards in Switzerland. Regular capacity has been reached, but "ad hoc" beds have been added to handle overflow. Over all, intensive care capacity has been extended, it has not been exhausted.

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What you need to know about Moderna’s coronavirus vaccine.

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Researchers working in a Moderna lab. The drugmaker estimates that its coronavirus vaccine is 94.5 percent effective.Credit...Moderna Inc, via Reuters

On Monday, the Massachusetts-based company Moderna reported promising preliminary results from its coronavirus vaccine trial. Coming just a week after similar news from Pfizer and BioNTech, the announcement immediately gave the stock market a fresh jolt. It offered more hope that there’s going to be a way out of the pandemic.

Like Pfizer, however, Moderna released only early data from their trial. There’s more work to be done before they’ll know if the vaccine really is safe and effective. And even if Moderna’s vaccine gets the green light from the Food and Drug Administration, it will take months to reach widespread distribution. In the meantime, the United States is suffering a devastating explosion of new cases of Covid-19.

Here’s where things stand with the development of coronavirus vaccines.

Do the new vaccine trial results mean the end to the pandemic?

In the short term, no. The soonest that coronavirus vaccines could possibly become widely available would be in the spring. But if effective vaccines do indeed become available — and if most people get them — the pandemic could drastically shrink. As coronavirus infections became rarer, life could gradually return to normal.

Who participated in the vaccine trial?

Moderna recruited 30,000 volunteers across the United States to participate in its trial. A quarter of the participants are 65 years or older. White people make up 63 percent of the volunteers; 20 percent are Hispanic; 10 percent are Black; and 4 percent are Asian-Americans.

The 95 people who got sick with Covid-19 reflect the diversity of Moderna’s volunteers: Fifteen were 65 or older. The group also included 12 Hispanic volunteers, four Black participants, three Asian-Americans and one multiracial person. The efficacy and safety appeared the same in all of the subgroups, Moderna said in its announcement. But researchers will have to wait for the trial to advance further to confirm this finding.

What happens next?

Both the Moderna and Pfizer trials are continuing to gather more data from large studies. The two companies expect to apply to the Food and Drug Administration in the next few weeks for an emergency use authorization to begin vaccinating the public.

The F.D.A. will review the applications and consult with its own external committee of experts before making a decision. If it authorize the vaccines — as experts think it will — a committee at the Centers for Disease Control and Prevention will then make recommendations for who should be first to receive a vaccine.

It’s possible that the distribution of one or both vaccines will begin by the end of the year.

Is it safe to go to a holiday get-together?

“This is not going to dig us out of what’s ahead this next month,” Natalie Dean, a biostatistician at the University of Florida, warned about Thanksgiving and the coming holiday season.

If the preparations for vaccines don’t hit any major snags, we can realistically hope for large-scale distribution to begin in the spring.

But with exploding cases across the country right now, we have to take immediate measures. The only way to drive down infection rates for now will be to avoid large indoor gatherings, wear masks, practice physical distancing and use other public health measures.

The A.M.A. calls on correctional facilities to take stronger measures to stop the spread.

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At Cook County Jail in Chicago, cases exploded in just a little over two weeks, with more than 350 people infected.Credit...Tannen Maury/EPA, via Shutterstock

The American Medical Association on Tuesday called on correctional facilities and immigrant detention centers to adopt increased infection-control measures, provide additional protective equipment, and give inmates and workers priority access to vaccines to prevent the spread of the coronavirus.

The association also said in a statement that it supports the compassionate release of incarcerated people who have serious medical conditions or have reached an advanced age.

“Throughout the COVID-19 pandemic, we’ve seen the virus spread quickly in high-density populations, particularly in correctional facilities,” said Dr. Ilse R. Levin, an A.M.A. board member. “Being incarcerated or detained should not be synonymous with being left totally vulnerable to COVID-19. These steps are vital to protect people and stop the spread of the virus.”

The 1984 Sentencing Reform Act gave federal courts the power to reduce the sentences of federal prisoners for “extraordinary and compelling reasons,” such as a terminal illness. As the threat of the coronavirus loomed, several states moved to ease overcrowded prisons with ordered releases.

But critics said the response among prison officials and lawmakers has been largely uneven. As part of its new recommendations, the A.M.A. called for the development of clear criteria for prisoner release.

The coronavirus has spread quickly in confined and crowded national correctional facilities, where social distancing is impractical, bathrooms and day rooms are shared by hundreds of inmates, and access to cleaning supplies is tightly controlled. Many inmates are 60 or older, and many suffer from respiratory illnesses or heart conditions, putting them at increased risk.

In American jails and prisons, more than 252,000 people have been infected and at least 1,450 inmates and correctional officers have died, according to a New York Times database. Correctional facilities have seen a disproportionate rate of infection and death as compared with the general population.

Over the summer, the five largest known clusters of the virus in the United States were at correctional institutions, according to New York Times data. In one of those facilities, Cook County Jail in Chicago, cases exploded in just a little over two weeks, with more than 350 people infected. Last month, cases skyrocketed at a jail in central Montana’s Cascade County, where some prisoners had been sleeping on mats on an overcrowded floor. Nearly 50 people were infected.

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With virus cases up and revenue down, Wyoming proposes deep cuts in its health budget.

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Gov. Mark Gordon is proposing spending cuts to cover a shortfall in the state budget stemming from the energy slump in the spring. Credit...Cayla Nimmo/The Casper Star-Tribune, via Associated Press

The middle of a pandemic might not seem like the most opportune time to slash a state health department’s budget. But with the outbreak in his state worse now than it has ever been, Gov. Mark Gordon of Wyoming has proposed chopping another $46 million from the department, after cutting it by $89 million in August.

The downturn in the energy industry caused by pandemic shutdowns in the spring cost Wyoming more than $1 billion in lost state revenue, according to an analysis by NPR. The governor has resisted raising taxes to make up the budget shortfall and is looking to cut spending instead.

The latest proposed cuts, which require legislative approval, will affect services for the elderly, health care coverage for children, Medicaid payments to health care providers, and community mental health and substance abuse services. Together, the two reductions amount to about 14 percent of the department’s annual budget.

“These are really tough decisions,” Mr. Gordon, a Republican, wrote in his proposal, noting that the people affected will be “those suffering with increased depression, hopelessness and isolation during the pandemic.”

Wyoming was almost untouched by the coronavirus in the spring and summer, but over the past two months the virus has spread rapidly. It is now reporting about 900 new cases a day on average, up from about 130 a day in early October. Hospitalizations have risen by 64 percent over the past two weeks.

Mr. Gordon has said that the state’s hospitals are already overwhelmed, and he announced last week that he would use $10 million in federal relief money to bring additional medical workers into the state to help.

Kim Deti, a spokeswoman for the health department, said the governor’s budget cuts did not come as a surprise. “The reductions that were made are not going to directly affect our ability to respond to the pandemic,” she said.

Ms. Deti said the state’s contact tracers are now focusing mainly on notifying people who test positive for the virus, and do not always have time to start calling their close contacts as well. Other states have also cut back contact tracing when the virus began spreading out of control.

Pfizer says it will work with four states to refine plans for rolling out its vaccine.

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Pfizer’s vaccine candidate at a facility in Puurs, Belgium.Credit...Pfizer, via Reuters

The drug maker Pfizer says it will work with four states — Rhode Island, Texas, New Mexico, and Tennessee — to refine their plans for delivering and administering its Covid-19 vaccine before the vaccine receives its expected authorization. The step reflects the complexity of distributing on a large scale a vaccine that requires ultracold storage.

The pilot program, which the company announced on Monday, is aimed at helping the states with their planning, but it will not mean that they receive doses of the vaccine any earlier than other states do. The four participants were chosen to represent states of different sizes, populations, and existing capacities for delivering vaccines against other viruses, the statement said.

“We are hopeful that results from this vaccine delivery pilot will serve as the model for other U.S. states and international governments,” Angela Hwang, a Pfizer executive, said in a statement.

Pfizer, which announced last week that an early analysis had found its vaccine to be more than 90 percent effective, expects to collect the final safety data this week that it needs to submit its results to the Food and Drug Administration. Another developer, Moderna, announced on Monday that its vaccine candidate appeared to be 94.5 percent effective in an early analysis.

Both vaccines use what is known as messenger RNA technology, but their cold storage requirements are different. Pfizer’s vaccine must be kept much colder, at around minus 70 degrees Celsius, for long-term storage, though it can be kept for short periods in a conventional freezer or a cooler. That ultracold storage requirement could hinder its distribution, particularly in rural areas.

Moderna’s vaccine, on the other hand, can be kept for up to a month at 2 to 8 degrees Celsius (about 36 to 46 degrees Fahrenheit), the temperature of an ordinary refrigerator, the company said on Monday.

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Use mouthwash to reduce your chances of getting gingivitis, not coronavirus.

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Studies on mouthwash have focused so far on whether it protects against viruses infecting cells in the lab, not in people.Credit...Leon Neal/Getty Images

A rash of provocative headlines have flooded social media platforms, touting a tantalizing notion: Mouthwash, they claim, can “kill” the coronavirus “within 30 seconds,” according to a new study that has not yet been published in any peer-reviewed scientific journal.

The idea echoed several other findings published earlier this year that also promoted the virus-trouncing powers of familiar oral hygiene products. But experts have repeatedly cautioned against over-interpreting these results and others, because the studies examined how mouthwash works against viruses infecting cells in the lab, not people.

Nothing should be considered conclusive “unless human studies are performed,” said Dr. Maricar Malinis, an infectious disease expert at Yale University.

“I don’t have a problem with using Listerine,” said Angela Rasmussen, a virologist at Georgetown University. “But it’s not an antiviral.”

Even if people did a very thorough job of coating the inside of their mouths or noses with a coronavirus-killing chemical, a substantial amount of the virus could still remain in the body. The new coronavirus infiltrates not only the mouth and nose, but also deep in the throat and lungs, where mouthwash and nasal washes hopefully never enter.

Viruses that have already hidden away inside cells will be shielded from the fast-acting chemicals found in oral hygiene products, and “infected cells are constantly making more virus,” Dr. Rasmussen said. “It’s a timing issue.”

Relying on mouthwash or a nasal rinse to rid the body of infectious virus would be about as futile as trimming the tops of a cluster of weeds while paying little heed to the roots, and then expecting the garden pests to disappear.

In the context of the pandemic, a false sense of security could be dangerous, Dr. Rasmussen noted, adding that people should not rely on ordinary products in their medicine cabinets to cleanse their bodies of the coronavirus.

“You can use mouthwash to reduce your own chance of getting gingivitis,” she said. “I don’t think it’s going to have a meaningful impact on your ability to transmit this virus.”

‘I wouldn’t have expected mask wearing to become controversial,’ Bill Gates says.

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The fact that in the United States that the mask wearing skepticism or view that that’s a political act, the USA is worse than other countries. And is that because of our current leadership? Is it because of the our individualistic view of things? I think that’s hard to attribute. I wouldn’t have expected mask wearing to become controversial. I wouldn’t have expected the administration to find sort of the wildest fringe opinion possible And put that opinion as the leader of the coronavirus task force. So this thing is full of surprises. But you know people do want to protect themselves. They do want to protect their parents and grandparents. I hope we’re surprised on the upside by the demand for the vaccine.

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CreditCredit...New York Times

With several Covid-19 vaccine trials showing initial promising results, hopes are high that we might soon put the virus behind us. But the reality is likely a lot more complicated, experts told DealBook’s Andrew Ross Sorkin.

Bill Gates, the co-chairman of the Bill and Melinda Gates Foundation, explored the rush to develop an effective vaccine, and the political, social and behavioral obstacles that may hinder acceptance of treatments, even those deemed safe. He was joined on a video conference by Heidi Larson, the director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, and Albert Bourla, chief executive of Pfizer.

Mr. Gates expressed surprise at the widespread resistance to public health measures in the United States. “I wouldn’t have expected mask wearing to become controversial,” he said. "I wouldn’t have expected the administration to find sort of the wildest fringe opinion possible.”

His organization was working on vaccine development before the pandemic, but people were disconnected from those “reasonably obscure” efforts. The attention the coronavirus has brought to his foundation’s work hasn’t always been positive, however. He expressed dismay over conspiracy theories circulating about his financial interest in vaccine development, saying, “They’re not true.”

“Where does that come from? Is it because these are uncertain times? People prefer a simpler story?” he said. “I hope it fades away, because we’re just trying to play a constructive role.”

Mistrust is problematic from a health perspective, the panel members said. Without trust in a vaccine and people willing to take it, infection rates won’t fall.

But it’s important to understand skepticism the public has been feeling, Ms. Larson said: “We have to appreciate that it’s been a hyper-uncertain time.” Her research has shown only about half of people surveyed would take a vaccine, but “there’s always a chance” that things can change, she added.

Distrust can be countered by building community momentum and listening to concerns, Ms. Larson said, and that may help persuade people to participate, as she has seen in work on polio eradication.

The one thing that seemed clear to everyone on the panel is that the pandemic has changed habits, perhaps forever.

“My prediction would be that over 50 percent of business travel and over 30 percent of days in the office will go away,” Mr. Gates said of a post-coronavirus world.

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A Republican senator will participate in a vaccine trial to help increase public trust.

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Senator Rob Portman, Republican of Ohio, at a news conference in Washington last month.Credit...Pool photo by Graeme Jennings

Senator Rob Portman, Republican of Ohio, announced on Tuesday that he would participate in a coronavirus vaccine trial, in what he said was an effort to encourage broader participation in the vaccine trials and emphasize the safety of the vaccines once they have gone through the trial process and certification by the Food and Drug Administration.

He will participate in the Phase 3 trial for the vaccine being developed by the parent company, Johnson & Johnson, at a Cincinnati-based research site, CTI Clinical Trial and Consulting Services.

“I look at it as a way I can play a small role in supporting our country’s health care response to this pandemic,” Mr. Portman said in a statement. “The more people Johnson & Johnson has in the trial, the sooner they can have the complete data they need to finalize this phase of the trial, and move on to the FDA approval process.”

Mr. Portman’s announcement comes after weeks of concern about the politicization of vaccine development and fears that the rapid development and maligning of the federal government’s scientists during the pandemic will stop some people from seeking out a vaccine once it is released.

Vice President-elect Kamala Harris faced criticism earlier this year for saying she would not trust President Trump’s word on the safety of a vaccine, and would instead wait for medical experts to confirm the validity of the treatment.

“I hope that my announcement today will encourage others to feel confident in participating in vaccine clinical trials being conducted across this country,” Mr. Portman said. “I also hope it will reassure people about the safety and effectiveness of vaccines once they have gone through the trials and FDA approval process.”

Two companies, Moderna and Pfizer, this month have announced promising early data results in the development of their respective vaccines.

Chicago confronts a coronavirus surge as the Midwest fails to curb infections.

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More than 8,700 new cases are appearing on an average day in the Chicago metro area — more than in any whole state other than Illinois, California or Texas. Credit...Lyndon French for The New York Times

Coronavirus cases are soaring again around Chicago, a city where thousands of people have already died from the virus. Officials are pleading with residents to stay home.

New limits on gatherings, along with a nonbinding stay-at-home advisory, took effect in the city on Monday. State-ordered restrictions, like those on indoor dining, have so far failed to stop the runaway spread of the virus across Illinois.

“We’re in for a very difficult next few months,” said Gov. J.B. Pritzker, who has warned that a mandatory stay-at-home order could be issued soon if conditions don’t improve.

More than 8,700 new cases are appearing on an average day in the Chicago metro area — more than in any whole state other than Illinois, California or Texas. Cook County, which includes Chicago, has reported more than 500 coronavirus-related deaths just since Nov. 1.

And even though there has been encouraging news about potential vaccines in recent days, Mayor Lori Lightfoot warned that help was not imminent.

“I don’t expect that there will be a mass-produced amount of vaccine until deep into next year,” said Ms. Lightfoot, who predicted that most Chicago residents would not be vaccinated until the second or third quarter of 2021.

The surge in Chicago comes at a time when conditions are unraveling across the Midwest. Every state in the region has set a weekly case record in the last few days. Nebraska, Wisconsin and Minnesota have reported record numbers of deaths. North Dakota, South Dakota and Iowa have the country’s highest rates of new cases relative to their populations.

As the outlook worsens, several Midwestern governors have imposed new restrictions and issued stark warnings.

“If Iowans don’t buy into this, we lose,” Gov. Kim Reynolds said Monday as she expanded mask rules and put new limits on businesses and gatherings. “Businesses will close once again. More schools will be forced to go online. And our health care system will fail, and the cost in human life will be high.”

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Failure to protect the elderly in Belgium amounted to a human rights violation, according to Amnesty International.

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A memorial with pictures of residents who died from Covid-19 is placed inside the library in June at the Christalain nursing home in Brussels.Credit...Mauricio Lima for The New York Times

Belgian authorities violated the human rights of nursing home residents during the first months of the pandemic by failing to protect this vulnerable group and leaving some to die prematurely, according to a report by the local chapter of Amnesty International.

Belgium had one of the world’s highest coronavirus death rates in the world, driven in large part by fatalities at nursing homes. Between March and October, 61 percent of coronavirus deaths in the country were nursing home residents.

One of the reasons so many people died in care facilities was because they were not transferred to hospitals, the report said.

While Belgian authorities focused the majority of their efforts on protecting the hospitals, they violated the basic right of the nursing home residents by refusing their access to treatment and not providing protective equipment and testing in a timely manner, Amnesty International concluded.

Belgium, a decentralized, ethnically divided federation of three regions, never made a clear division of responsibilities between different branches of the government, contributing to general chaos in the already underfunded and understaffed nursing home sector.

The report was based on testimonies by nursing home residents, their families, directors and staff, as well as civil society organizations. Belgium’s top federal health official at the time, Maggie De Block, did not respond to a request for information by Amnesty International.

The report corroborates the findings of a New York Times investigation published in August.

Philippe Hensmans, the director of Amnesty International Belgium, said that nursing home residents were “abandoned” by the authorities until the situation was “publicly known.”

The government only took action “when this tragedy was publicly denounced, and when the worst of the first wave was over,” Mr. Hensmans said.

As Belgium and the rest of Europe confront a resurgent virus, Amnesty International called on Belgian authorities to provide access to best possible medical care for the care home residents.

“It is fundamental that our authorities give priority to respect of human rights of care home residents,” said Mr. Hensmans. “It is equally important to make sure all public investigations into the government’s shortcomings during the Covid-19 pandemic include the aspect of human rights.”

As the world combats the virus, the Red Cross says similar resolve is needed on climate change.

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Houses located beside the Padma river are seen flooded in Munshiganj district, on the outskirts of Dhaka, Bangladesh, in July.Credit...Mohammad Ponir Hossain/Reuters

Drawing lessons from the sweeping global response to the coronavirus pandemic, the Red Cross said on Tuesday that the world’s governments should show the same commitment in their efforts to deal with the impacts of climate change.

“Covid-19 has demonstrated that humanity has the capacity to recognize and respond to a global crisis, finding resources where none seemed available,” the International Federation of Red Cross and Red Crescent Societies said in its annual World Disasters Report.

The climate change threat has not abated during the pandemic. In fact, in many ways it has compounded the difficulties of people struggling to recover from natural disasters. The pandemic has diverted resources from disaster response, while lockdowns, social distancing and other measures to contain the spread of the virus have slowed evacuations and impeded relief efforts, the report said.

“Climate change is not waiting for Covid-19 to be brought under control,” it said. “Many people are being directly affected by the pandemic and climate-driven disasters all at once.”

The pandemic presents an opportunity to “look directly into the face of the climate crisis” and seriously prepare. Describing the shortfall in climate funding as “almost trivial” compared with the multibillion-dollar stimulus packages that have been crafted in response to the virus, the report urged governments to craft pandemic relief packages that include investment in helping communities adapt to climate change.

According to the report, in the first six months of the pandemic there were more than 100 floods, heat waves and other natural disasters — most of them attributable to extreme weather or climate change — that affected more than 50 million people. They include flooding in Kenya, Somalia, India and Bangladesh.

More recently, a series of cyclones has affected millions of people in the Philippines, which has one of the worst coronavirus outbreaks in Southeast Asia.

In the Western Hemisphere, the pandemic has complicated evacuation efforts during the most active Atlantic storm season on record, with 30 named storms, 13 of which were hurricanes.

Though scientists are not sure whether climate change is increasing the number of hurricanes, they say it is making them stronger. The latest, Hurricane Iota, made landfall in Nicaragua on Monday night as a Category 4 storm, less than two weeks after Hurricane Eta hit almost the same spot.

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The baseless ‘Great Reset’ conspiracy theory rises again.

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Justin Trudeau, the prime minister of Canada, addressed the United Nations General Assembly in a pre-recorded message in September.Credit...UNTV, via Associated Press

A baseless conspiracy theory about the coronavirus has found new life as cases surge once again.

On Monday morning, the phrase “The Great Reset” trended with nearly 80,000 tweets, with most of the posts coming from familiar far-right internet personalities. The conspiracy alleges that a cabal of elites has long planned for the pandemic so that they could use it to impose their global economic control on the masses. In some versions of the unfounded rumor, it is only President Trump who is thwarting this plan and keeping the scheme at bay.

The narrative first took root in late May, when Prince Charles and Klaus Schwab, the executive chairman of the World Economic Forum, announced plans to convene world leaders and discuss climate change and how to rebuild an economy damaged by the pandemic. The meeting was branded as a “Great Reset,” and the false rumors about the tight-knit group of elites manipulating the global economy took off.

Then, over the weekend and into Monday morning, a video of Prime Minister Justin Trudeau of Canada speaking from a United Nations meeting in September gained millions of views online. In the video, Mr. Trudeau referred to a “great reset” and also happened to utter the words “build back better,” which conspiracists saw as a tie-in to President-elect Joseph R. Biden Jr. — who had used the phrase as a campaign slogan.

Soon, far-right internet commentators with records of spreading misinformation posted about the conspiracy, collecting tens of thousands of likes and shares on Facebook and Twitter. The posters included Paul Joseph Watson, a former contributor to Infowars, and Steven Crowder, who has falsely asserted that coronavirus death tolls are inflated.

Joan Donovan, the research director at Harvard University’s Shorenstein Center, said it is “maddening” to see the same networks of influencers traffic in recycled conspiracies and get in the way of delivering accurate information to the public. “What is true is that Covid is on the rise in the U.S. because of poor leadership and the lack of a nationally coordinated response,” Ms. Donovan said.

Twitter said the tweets about the conspiracy did not violate its rules, and that “The Great Reset” was no longer trending.

Facebook did not immediately respond to requests for comment.

The virus has finally come for Nunavut, the remote Canadian territory.

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Cape Dorset in the Canadian territory of Nunavut, where the coronavirus first appeared this month.Credit...Sergey Ponomarev for The New York Times

The pandemic didn’t arrive in the far northern Canadian territory of Nunavut until early this month. On Monday, the premier of the vast but sparsely populated Arctic region imposed a two-week shutdown of most businesses, schools and events after the number of confirmed cases reached 26.

The cases are in three communities, but officials said on Monday that they feared the virus might have already spread to other places in the territory.

“Think of it as a circuit breaker, a chance to reset,” Joe Savikataaq, the premier, said. “No one is above the rules here. Let’s make this clear, so there’s no misunderstanding.”

The limited medical resources in the territory mean that patients requiring sophisticated treatments must be flown south. One person infected in the current outbreak was evacuated to a hospital in Winnipeg, Manitoba, about 900 miles away. That person has since been released and is recovering.

Contact tracing has yet to establish the source of the first known case in the territory, on Nov. 6. Until then, Nunavut had been the only region in Canada left untouched by the pandemic. Canada, a country of 38 million people, has had a total of about 300,000 coronavirus cases and 11,000 deaths, according to a New York Times database.

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After holding out, Republican governors reverse course and issue mask mandates.

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A coronavirus testing site in Salt Lake City over the weekend. Utah is one of several states led by Republican governors that have announced new mask mandates after initially resisting them.Credit...Bing Guan/Reuters

President-elect Joseph R. Biden warned on Monday that “more people may die” from the coronavirus if President Trump does not agree to coordinate planning for the mass distribution of a vaccine when it becomes available.

Mr. Biden also issued a simple plea. Holding up a paper medical mask, he asked: “Does anybody understand why a governor would turn this into a political statement?”

In the United States, the wearing of a mask has been caught up in the swirl of the nation’s toxic political divide long after the scientific community reached a consensus that they can play a dramatic role in slowing the spread of the virus and saving lives.

For months, Republican governors resisted calls for mask mandates. But as they have watched hospitals in their states stretched to the breaking point in recent weeks — driving home the reality of the dangers posed by a virus allowed to spread unchecked — that is starting to change.

In Utah last week, Gary Herbert, the Republican governor, issued a mask mandate “until further notice” as hospitals across the state were nearing or at full capacity.

Gov. Doug Burgum of North Dakota ordered residents of the state on Friday to wear masks indoors and outdoors if they could not socially distance. North Dakota has the country’s highest rates of new daily cases and deaths per person, according to a New York Times database.

In West Virginia, Gov. Jim Justice ordered on Saturday that residents must wear masks in indoor public settings.

Then on Monday evening, Kim Reynolds, the governor of Iowa, struck a somber tone as she announced that, starting Tuesday, Iowans would need to wear masks while indoors if they are unable to maintain social distance.

“There aren’t enough sheriffs in Iowa’s 99 counties to shut down every noncompliant bar,” she said. “If Iowans don’t buy into this, we lose,” she said, warning that schools and businesses could be closed.

Ms. Reynolds had flouted infectious disease experts who say masks are one of the most effective tools to control the spread of the virus. In September, she issued guidance that told students, teachers and workers that they did not have to quarantine after being in close contact with someone who was infected as long as both were wearing masks.

The rates of new daily cases and hospitalizations have roughly doubled in Iowa over the past two weeks.

Gov. Mike DeWine of Ohio, who is reportedly considering imposing a curfew on businesses, is expected to hold a news conference on Tuesday to announce plans to combat the spike in cases in his state.

But even before Mr. DeWine made any announcement, Mr. Trump issued a warning on Twitter, suggesting that he might support a primary challenger against the Republican governor.

“Who will be running for Governor of the Great State of Ohio? Will be hotly contested!” Mr. Trump wrote.

Mr. Biden offered praise for the Republican leaders, saying he had “enormous respect” for their actions.

“It’s about being patriotic,” he said. “There is nothing macho about not wearing a mask.”

One of the remaining holdouts is South Dakota, which has the country’s second-worst rates of new daily cases and deaths per person.

Its Republican governor, Kristi Noem, said at a rally for President Trump last month that her refusal to issue restrictions made South Dakotans “happy because they are free.” She has yet to issue any restrictions.

‘Iso’ is Australia’s word of the year, dictionary center says.

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People socially distancing in a park in Melbourne in October.Credit...Asanka Brendon Ratnayake for The New York Times

Australians have a long tradition of shortening words and ending them with an “o,” such as “arvo” for afternoon and “servo” for gas or service stations. Now a new abbreviation has joined the Australian English lexicon: “iso.”

Short for “self-isolation,” it has come to be used as a catchall for Australia’s self-isolation measures during the coronavirus pandemic, ranging from quarantine to statewide lockdowns. On Tuesday, the Australian National Dictionary Center said it had been named word of the year.

“Our fondness for abbreviating words in Australia, and a natural human inclination to make the unknown and scary familiar, quickly saw the descriptive term ‘self-isolation’ shortened to ‘iso’ in March this year,” the center’s senior researcher, Mark Gwynn, said in a statement.

He said the word was “linguistically productive” in that it can be combined with other words to describe pandemic life. For example, a bad self-inflicted haircut could be called an “iso cut,” while weight gain during lockdown may be referred to as “iso kilos.”

This year’s shortlist was dominated by coronavirus-related words, including “bubble,” referring to the “household bubble” system in which Melbourne residents on lockdown were allowed to socialize with only one other household, as well as the “travel bubble” between Australia and New Zealand, both of which have largely brought the virus under control. Other shortlisted words included “Covid-normal,” the phase of reopening in which all restrictions are lifted, and “Black Summer,” the commonly used name for the catastrophic bushfire season of 2019-20.

In Britain, “lockdown” was named Collins English Dictionary’s word of the year. Some other words on the shortlist: “coronavirus,” “self-isolate” and “Tiktoker.”

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Global Roundup

Boris Johnson is stalled under quarantine at home, and other news around the world.

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Larry, the 10 Downing Street cat, waiting to be let in to the official residence of Prime Minister Boris Johnson on Monday.Credit...Pool photo by Tolga Akmen

For Prime Minister Boris Johnson, this was supposed to be a critical week to reset his government after a tumultuous round of infighting that led to the abrupt ouster of his most influential adviser, Dominic Cummings.

Instead, Mr. Johnson began a 14-day quarantine in his Downing Street residence on Monday after being exposed to a member of Parliament who tested positive for the coronavirus.

The prime minister insisted he was “fit as a butcher’s dog” and was merely heeding the rules of Britain’s test-and-trace program. But Mr. Johnson’s enforced isolation will hobble his plan to regain momentum with public appearances and policy announcements after days of corrosive palace intrigue among his closest advisers.

The prime minister’s second close call with the virus — last April, he was hospitalized with a severe case of Covid-19 — deepens the sense of a government that cannot seem to get out of its own way.

Mr. Johnson’s exposure to the virus this time came during a meeting with Conservative lawmakers, one of whom, Lee Anderson, later developed symptoms and tested positive. A photo showed the two men standing barely three feet apart — neither wearing a mask — which raised questions about whether Downing Street practices proper social distancing, even after the outbreak that infected Mr. Johnson in March.

As a recovered patient, Mr. Johnson said his body was “bursting with antibodies.” He did not broach the risk of re-infection, which, while possible, is rare.

During his self-isolation Mr. Johnson plans to work from his apartment, which is above 11 Downing Street. He will also have access to his office at No. 10 next door without walking through parts of the building where others work.

Mr. Johnson will maintain a full schedule of events, conducted remotely, and hopes to use a video link to take part in Prime Minister’s Questions, his weekly grilling by the leader of the opposition in the House of Commons.

In other developments around the world:

  • The authorities in South Australia have ordered 4,000 people to quarantine as the Australian state reported five new cases of the virus on Tuesday. The outbreak in the capital city of Adelaide was traced to a worker at a hotel where coronavirus patients are quarantined.

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