{{{LivE?}}}Covid-19 Live Updates: Head of U.S. Vaccine Distribution Apologizes to States for Shortfalls…………

29 min readDec 19, 2020

At least 14 states are getting fewer doses than expected in the near term. Britain heads into a harsh lockdown, citing a new variant of the virus.

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Congressional leaders push to finalize a $900 billion stimulus deal before midnight Sunday.

Here’s what you need to know:

The head of Operation Warp Speed apologizes for shortfalls in vaccine deliveries to at least 14 states.
Boris Johnson orders a severe lockdown, saying a more infectious variant of the virus is ripping through Britain.
The C.D.C. advisory panel has endorsed the Moderna vaccine.
Thousands of internal documents reveal how China censored its internet in the early days of the pandemic.
Emmanuel Macron’s condition is stable ‘compared to Friday,’ according to his doctor.
Coronavirus cases in Syria go uncounted amid shortages of critical supplies and medical personnel.
The pandemic pushes the start of a major 9/11 trial past the 20th anniversary of the attacks.

The head of Operation Warp Speed apologizes for shortfalls in vaccine deliveries to at least 14 states.

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U.S. General Apologizes for Smaller Vaccine Deliveries in Some States

Gen. Gustave F. Perna, chief operating officer for Operation Warp Speed, apologized after a number of states last week received fewer initial doses of the coronavirus vaccine than planned.

“Last week we kicked off the initial distribution of the Pfizer vaccine, following E.U.A. Through snowstorms, holiday rush and with everything else going on in the country, we delivered the first 2.9 million doses across the country, to every state. And we saw vaccines going into arms. What a remarkable feat. Last night, the F.D.A. granted emergency use authorization to Moderna. And America, we are ready to distribute that vaccine. Now, this week many have heard concerns about allegations of vaccine doses being cut. I want to assure everybody, and I want to take personal responsibility for the miscommunication. Jurisdictions have asked me for planning numbers, and rightly so. We want to be open and transparent with them at all times. I have to work on the estimates that we know, and we provide them forecasts accordingly. But vaccine manufacturing is a very arduous, technical capability. At the end of the day, the number of doses available to us to allocate ended up being lower. And so as we gave forecasts to the jurisdictions, and governors and states, work their priorities against those forecasts, when we had to decide what was going to eventually be shipped out, I had to lower the allocations to meet the releasable doses that were presented to me. So to the governors, to the governor’s staffs: Please accept my personal apology if this was disruptive in your decision-making and in your conversations with the people of your great state. I will work hard to correct this.”

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1:57U.S. General Apologizes for Smaller Vaccine Deliveries in Some States

Gen. Gustave F. Perna, chief operating officer for Operation Warp Speed, apologized after a number of states last week received fewer initial doses of the coronavirus vaccine than planned.CreditCredit…Stefani Reynolds for The New York Times

Gen. Gustave F. Perna, who heads Operation Warp Speed, the Trump administration’s multiagency effort to get coronavirus vaccines out to Americans, apologized repeatedly on Saturday morning for confusion over vaccine deliveries to states.

He attributed some of the problems to the federal government’s miscalculation of how many doses of Pfizer-BioNTech’s vaccine could be shipped. The discrepancies disrupted vaccination plans and stirred consternation in at least 14 states.

General Perna is in charge of the logistics for distributing the coronavirus vaccines to the states, and he took full and sole responsibility for the delays and confusion around the vaccine rollout, and for the discrepancies between the number of doses states were expecting and what they are receiving.

“It was my fault,” he said. “It was a planning error, and I am responsible.”

“I want to take personal responsibility for the miscommunication,” General Perna said at a news conference. He said the number of vaccines available to allocate ended up being lower than initial forecasts.

“I had to lower the allocations to meet the releasable doses that were presented to me,” General Perna said. “So to the governors,” he said, “please accept my personal apology if this was disruptive in your decision-making.”

He added that he did not understand with “exactness” the requirements for the release of each batch of doses. He referred several times to the Food and Drug Administration’s involvement, but was unclear about how that would have delayed shipments.

The F.D.A. merely requires a certificate that includes the results of quality control tests for each lot of vaccine at least 48 hours before distribution and does not require the certificates be reviewed before shipments occur. That enables the F.D.A. to keep track of the batches being shipped. The requirement is included in the emergency authorization paperwork the F.D.A. sent to Pfizer.

Officials in Oregon, Iowa, Washington, Massachusetts, Wisconsin, Vermont, Minnesota, Nevada, Connecticut, California, Michigan, Idaho, Virginia and New Jersey said that they were caught off guard on Wednesday when they learned that next week’s shipment of the vaccine would contain fewer doses than the first week’s.

Governors and state health departments have spoken with alarm this week of how few vaccines they have received compared with what had been promised.

“This is disruptive and frustrating,” Gov. Jay Inslee of Washington wrote on Twitter on Thursday. “We need accurate, predictable numbers to plan and ensure on-the-ground success.”

Dr. Mark Levine, commissioner of the Vermont Department of Health, said in a Friday briefing that “all my colleagues in the region are reporting a 25 to 35 percent decrease in their allocation for next week.”

“As we were walking in, I learned as many as 975 doses out of an expected 5,850 doses would not be coming in when we expected,” he said. “What everyone around the country is upset about, in addition to just the number, is there’s been no communication, so there’s no understanding of what this really means.”

On Saturday, General Perna noted that boxes of the Moderna vaccine, which was approved for emergency use by the Food and Drug Administration on Friday, were being packed and loaded, and that truckloads would begin rolling out on Sunday.

He said that the government remained on track to allocate about 20 million vaccine doses across the country by the end of December, and that the distribution of those doses would be “pushing into the first week of January.”

“There is no problem with the process,” he said. “There is no problem with the Pfizer vaccine. There is no problem with the Moderna vaccine.”

He also expressed confidence that “we will have the agility to correct ourselves and get things right, so that the next time it will go flawlessly.”

— Giulia McDonnell Nieto del Rio, Noah Weiland and Sharon LaFraniere

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Congressional leaders push to finalize a $900 billion stimulus deal before midnight Sunday.

The U.S. Capitol building on Friday. Both chambers of Congress continue to negotiate on a new stimulus package as the deadline draws near.Credit…Anna Moneymaker for The New York Times

With less than 36 hours to strike an elusive agreement on a $900 billion stimulus package and prevent a lapse in government funding, U.S. lawmakers and aides on Saturday worked feverishly to finalize the details on how to prop up the nation’s shuddering economy and send billions of dollars to distribute vaccines and support struggling American families and businesses.

Both chambers hastily approved a two-day stopgap bill on Friday, giving negotiators a window to hammer out both a final agreement and legislative text on a relief deal. The measure is expected to be merged with a catchall omnibus package needed to keep the government funded for the remainder of the fiscal year.

Congressional leaders hope to jam both spending packages through Congress and onto President Trump’s desk by the time funding lapses at midnight on Sunday.

“We need to pass these measures with a big bipartisan vote and get them signed into law without further delay,” Senator Mitch McConnell of Kentucky, the majority leader, said on the Senate floor on Saturday.

But the biggest hurdle was a last-ditch push led by Senator Patrick J. Toomey, Republican of Pennsylvania, to insert language that would limit the powers of the Federal Reserve, potentially keeping it from lending to businesses and municipalities in future crises.

On a private caucus call Saturday morning, Speaker Nancy Pelosi denounced the attempt.

“For them to write in there that this cannot happen ever again is just beyond the pale,” Ms. Pelosi said, according to a person on the call, who was not authorized to speak publicly, depicting the move as a way to deprive President-elect Joseph R. Biden Jr.’s administration of the critical tools needed to support the country’s economic recovery.

Mr. Toomey, who has fought to curtail the scope of the Federal Reserve’s power, rejected that characterization but declined to comment on whether he would accept a compromise.

In a speech on the Senate floor, Senator Chuck Schumer of New York, the minority leader, said that the Fed chairman, Jerome Powell, opposed the measure and that the language was “the only significant hurdle to completing an agreement.”

Negotiators are also haggling over the final details of provisions, including who should be eligible for the $600 direct payments, tax extenders and the length of the enhanced and extended unemployment benefits. Although negotiators are coalescing around a $300 supplemental benefit — half the benefit established in the original $2.2 trillion stimulus law — it is unclear how long the benefits would run, and whether they would to taper to an end. Democrats are pushing for a hard cliff to end the benefits, in part to give lawmakers a deadline to return to the negotiating table.

On the call, Ms. Pelosi also criticized Republicans for suggesting cuts to unemployment and food assistance programs to keep the overall cost of the package below $1 trillion.

Senate Republicans voiced support for Mr. Toomey’s provision in the relief package.

— Emily Cochrane

WHAT’S AT STAKE

If you’re among those awaiting pandemic relief, Times Opinion would like to hear from you.

The U.S. has recorded over 250,000 cases in a day for the first time.

Lining up for coronavirus testing in San Bernardino, Calif., on Friday.Credit…Alex Welsh for The New York Times

As the United States welcomed the news Friday that a second vaccine, by Moderna, had been authorized by the federal government for emergency use, the country confronted another stark reminder of how desperately vaccines are needed: a single-day caseload of over 251,000 new coronavirus cases, a once-unthinkable record.

It’s been only a week since the Food and Drug Administration first approved a Covid-19 vaccine, the one created by Pfizer and BioNTech. As trucks have carried vials across the country and Americans began pulling up their sleeves for inoculations, more ominous numbers have piled up:

Monday: 300,000 total dead in the United States.
Wednesday: 3,611 deaths in a single day, shattering the previous record of 3,157 on Dec. 9.
Thursday: Over one million new cases in just five days, pushing the country’s total of confirmed cases past 17 million.

Three months ago, new cases were trending downward and death reports were flat, but those gains have been lost. Now there are nearly six times as many cases being reported each day, and three times as many deaths, according to a New York Times database.

The South is on a particularly worrisome trajectory. Georgia, Arkansas and South Carolina have all set weekly case records. Tennessee is confirming new cases at the highest per capita rate in the country.

As cases continue to spike, officials are warning that hospitals, which now hold a record of nearly 114,000 Covid-19 patients, could soon be overwhelmed. More than a third of Americans live in areas where hospitals are running critically short of intensive care beds, federal data show. A recent New York Times analysis found that 10 percent of Americans — across a large swath of the Midwest, South and Southwest — live in areas where I.C.U.s are either completely full or have less than 5 percent of beds available.

In California, hospitals are especially stretched. The state reported just 2.1 percent availability of I.C.U. beds on Friday, after the number of available beds fell by 37 percent over the past month. In Los Angeles County, officials say, an average of two people are dying of Covid-19 every hour, and I.CU. capacity could be exceeded within the month.

There has been rapid improvement in much of the Midwest and Mountain West. Iowa is adding fewer than half the cases it was at its November peak. South Dakota, Montana, Nebraska, Colorado and Wyoming are all seeing sustained declines in cases.

But because deaths are a lagging indicator, North Dakota still has the nation’s highest daily death rate for its size, despite progress in slowing new cases after the governor reversed months of resistance and announced a mask mandate and restrictions on businesses in mid-November.

As Christmas approaches, American families will be tempted again to gather indoors, as many did for the Thanksgiving holiday, despite a torrent of warnings from public health officials and elected leaders. And whatever progress is being made now in some places could, once again, be negated.

“There’s no need for that many to have died,” David Hayes-Bautista, a professor of medicine at the University of California, Los Angeles, said after the country’s pandemic death toll hit 300,000 on Monday. “We chose, as a country, to take our foot off the gas pedal. We chose to, and that’s the tragedy.’’

Mitch Smith, Julie Shaver, John Eligon, Amy Harmon, Remy Tumin and Jill Cowan contributed.

— Ron DePasquale

HOLIDAY SPIRIT

Christmas is coming, and the guilt trips have begun.

Boris Johnson orders a severe lockdown, saying a more infectious variant of the virus is ripping through Britain.

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Boris Johnson Orders New Lockdown in Sharp Reversal

Days after saying it would be “inhuman” to end Britain’s plans to relax coronavirus restrictions over Christmas, Prime Minister Boris Johnson ordered a lockdown in parts of England.

“First, we will introduce new restrictions in the most affected areas, specifically those parts of London, the Southeast and the East of England.“ “Second, we’re issuing new advice on travel. Although the new variant is concentrated in tier-4 areas, it is nonetheless present at lower levels around the country. So we’re asking everyone in all tiers to stay local.” “Third, we must, I’m afraid, look again at Christmas. And as prime minister, it’s my duty to take difficult decisions to do what is right to protect the people of this country. Given the early evidence we have on this new variant of the virus, the potential risk it poses, it is with a very heavy heart. I must tell you, we cannot continue with Christmas as planned. In England, those living in tier-4 areas should not mix with anyone outside their own household at Christmas, though, support bubbles will remain in place for those of particular risk of loneliness or isolation. Across the rest of the country, the Christmas rules allowing up to three households to meet will now be limited to Christmas Day only rather than the five days as previously set out. As before, there will be no relaxation on the 31st of January, so people must not break the rules at New Year. They must not break the rules at New Year, it’s very, very important to emphasize that.”

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1:35Boris Johnson Orders New Lockdown in Sharp Reversal

Days after saying it would be “inhuman” to end Britain’s plans to relax coronavirus restrictions over Christmas, Prime Minister Boris Johnson ordered a lockdown in parts of England.CreditCredit…Andrew Testa for The New York Times

LONDON — Alarmed by what he called a faster-spreading variant of the coronavirus, Prime Minister Boris Johnson abruptly reversed course on Saturday and imposed a wholesale lockdown on London and most of England’s southeast.

The decision, which Mr. Johnson announced after an emergency meeting of his cabinet, came after the government got new evidence of a variant first detected several weeks ago in Kent, southeast of London, which the prime minister asserted was 70 percent more transmissible than previous versions. Cabinet ministers were told that in London, cases had nearly doubled in the last week, with the new variant accounting for 60 percent of those.

The new measures, which take effect at the end of Saturday night, are designed, in effect, to cut off the capital and its surrounding counties from the rest of England. They are the most severe measures the government has taken since it imposed a lockdown on the country in March, and they reflect a fear that the new variant could supercharge the transmission of the virus as winter takes hold.

“When the virus changes its method of attack, we must change our method of defense,” a somber Mr. Johnson said at a news conference. “We have to act on information as we have it, because this is now spreading very fast.”

Viral mutations are not usual, and this variant — known as VUI 202012/01 — has been detected in a handful of other countries, but medical experts expressed alarm about its apparent infectiousness. British ministers have been told that there is no evidence that the new variant is inherently more dangerous, or that it is more resistant to vaccines than others.

Its infectiousness, however, raises the prospect of accelerating infections, leading to more hospitalizations and deaths. The British government said it had notified the World Health Organization about the prevalence of the new variant.

Though Mr. Johnson said a few days ago that it would be “inhuman” to cancel Christmas, that will be the broad effect of the new restrictions on social mixing. A plan to allow three households to meet together over the holiday will be scrapped in London and the southeast, with no household mixing permitted at all. In other parts of the country, three households will be allowed to gather, but only on Christmas Day.

The coronavirus has mutated many times since it emerged in China in 2019, according to epidemiologists. On Friday, South Africa reported it had identified a new variant, which it said was driving a new wave of infections there. It is not clear whether it is same variant as the one identified in Britain.

— Mark Landler and Stephen Castle

CONTAINMENT EFFORTS

Read more about Britain’s effort to fight a new variant of the coronavirus with harsh lockdowns.

The C.D.C. advisory panel has endorsed the Moderna vaccine.

Staff members who received the Covid-19 vaccine waited to make sure they did not experience an allergic reaction at Redlands Community Hospital in California on Friday.Credit…Alex Welsh for The New York Times

An independent panel of experts advising the Centers for Disease Control and Prevention voted on Saturday to endorse a second coronavirus vaccine for use in adults 18 and older.

The committee’s recommendation, by a vote of 11 in favor and none against (with three recusals due to conflicts of interest), followed Friday’s announcement that the vaccine, made by Moderna, had been granted an emergency authorization by the Food and Drug Administration.

The advisory committee’s endorsement now awaits final approval from Dr. Robert R. Redfield, director of the C.D.C., which is expected shortly.

The committee’s vote signals to hospitals and doctors that they may proceed to inoculate patients with the Moderna vaccine. Some 5.9 million doses are scheduled to ship on Sunday, and the first vaccinations are expected to begin on Monday.

Unlike the Pfizer-BioNTech vaccine, which was authorized for use in people 16 and older, Moderna’s inoculations are intended for adults only. (Moderna did not begin its pediatric studies until Dec. 9 and did not expect to have a full set of data until sometime next year.)

In adults, Moderna’s vaccine was more than 94 percent effective at preventing symptomatic cases of Covid-19. It’s still unclear how well the two vaccines fare at curbing coronavirus transmission.

Much of the advisory committee’s deliberations centered on the severe allergic reactions reported after injections of the Pfizer-BioNTech vaccine, which contains ingredients similar to those in Moderna’s recipe.

Six cases of anaphylaxis have now been documented in the United States, as well as two in Britain. In addition, milder allergic reactions have been reported. Experts have said these cases shouldn’t deter a vast majority of people from getting the vaccine. More than 272,000 doses of Pfizer’s vaccine have already been doled out nationwide.

Half of the people who received Moderna’s vaccine in clinical trials also reported some uncomfortable symptoms, including fatigue, headaches and soreness, after their second shot, given about four weeks after the first. Some volunteers also developed fevers or rashes around injection sites.

Incidents like these appear to be much more common with Moderna’s vaccine than Pfizer’s, which contains a smaller dose of active ingredients. But most of the side effects disappeared within a day or so of the shot.

Neither Moderna nor Pfizer has yet collected data in people who are pregnant or breastfeeding. But none of the 13 volunteers who became pregnant while participating in Moderna’s clinical trials, six of whom received the vaccine, reported harmful effects.

Dr. Jacqueline Miller, Moderna’s senior vice president, also drew attention to the representation of people of varying races and ethnicities in Moderna’s trials — a nod to the disproportionate effect of the pandemic on communities of color.

In discussions this week, experts repeatedly noted the importance of partnering with representatives from communities of color to reaffirm vaccine safety and efficacy for people who might be skeptical of the shots.

On Sunday, C.D.C. officials will deliver more guidance about allocating the newly cleared vaccines.

— Katherine J. Wu

VACCINE ENDORSEMENT

Read more about the C.D.C. panel’s endorsement of the Moderna vaccine.

Thousands of internal documents reveal how China censored its internet in the early days of the pandemic.

People attended a vigil in Hong Kong in February, for the late Dr. Li Wenliang. Reports of Dr. Li’s death were squashed by the Chinese government in an effort to control news about the virus within the country.Credit…Tyrone Siu/Reuters

In the early hours of Feb. 7, China’s powerful internet censors experienced an unfamiliar and deeply unsettling sensation. They felt they were losing control.

The news was spreading quickly that Li Wenliang, a doctor who had warned about a strange new viral outbreak only to be threatened by the police and accused of peddling rumors, had become one of its victims. Grief and fury coursed through social media. To people at home and abroad, Dr. Li’s death showed the terrible cost of the Chinese government’s instinct to suppress inconvenient information.

Yet China’s censors decided to double down. Warning of the “unprecedented challenge” Dr. Li’s death posed and the “butterfly effect” it might set off, officials got to work suppressing the inconvenient news and reclaiming the narrative, according to confidential directives sent to local propaganda workers and news outlets.

They ordered news websites not to issue push notifications alerting readers to his death. They told social platforms to gradually remove his name from trending topics pages. And they activated legions of fake online commenters to flood social sites with distracting chatter, stressing the need for discretion: “As commenters fight to guide public opinion, they must conceal their identity, avoid crude patriotism and sarcastic praise, and be sleek and silent in achieving results.”

The orders were among thousands of secret government directives and other documents that were reviewed by The New York Times and ProPublica. They lay bare in extraordinary detail the systems that helped the Chinese authorities shape online opinion during the pandemic.

Though China makes no secret of its belief in rigid internet controls, the documents convey just how much behind-the-scenes effort is involved in maintaining a tight grip on online discourse to enforce the Communist Party’s consensus: an enormous bureaucracy, armies of people, specialized technology , the constant monitoring — and, presumably, lots of money.

— Raymond Zhong, Paul Mozur, Jeff Kao and Aaron Krolik

NO ‘NEGATIVE NEWS’

Read the full article about how Chinese officials stage-managed what appeared online in the early days of the outbreak, which The Times copublished with ProPublica, the nonprofit investigative newsroom.

EUROPE ROUNDUP

Emmanuel Macron’s condition is stable ‘compared to Friday,’ according to his doctor.

President Emmanuel Macron of France virtually attended a meeting at the Foreign Ministry in Paris on Thursday. His positive test for the coronavirus was announced on Thursday, after a week in which he met with numerous European leaders.Credit…Pool photo by Charles Platiau

As President Emmanuel Macron of France entered his third day in isolation after being infected with the coronavirus, his doctor said on Saturday that he was in “stable health condition compared to Friday.”

“He is still presenting the same symptoms of the Covid-19 illness (fatigue, coughing, aches) which do not prevent him from performing his duties,” Dr. Jean-Christophe Perrochon said in a statement, adding that regular clinical examinations “have proved to be reassuring.”

On Friday, a day after the positive results of his coronavirus test were announced, Mr. Macron released a self-made video in which he promised “to report daily on the evolution of the disease” — an event and a commitment that marked a departure from France’s tradition of secrecy around the health of its presidents.

Although it is still unclear how Mr. Macron contracted the virus, France’s health minister, Olivier Véran, said on Thursday that he had probably not been infected at the presidential Élysée Palace but “possibly at a European Council four or five days ago in Brussels” during a dinner with other heads of state.

On Friday, Prime Minister Igor Matovic of Slovakia was reported to have tested positive for the virus. Mr. Matovic attended the same European Council meeting last week.

Speaking of the general situation in France, where the number of new daily cases have recently rebounded, Mr. Macron warned on Friday: “We have to be vigilant as the virus is gaining in strength again.”

France Coronavirus Map and Case Count

A detailed map shows the extent of the coronavirus outbreak, with charts and tables of the number of cases and deaths.

France exited a lockdown imposed to fight back the second wave of the coronavirus pandemic only days ago. But the country is already grappling with a rebound in infections.

“The evolution of the pandemic is worrisome,” said Jérome Salomon, a top official at France’s health ministry, adding that the upcoming Christmas break could prove a “high-risk period.”

The number of new daily Covid-19 cases, which had fallen below 10,000 in late November thanks to lockdown restrictions, has picked up again and reached an average 13,000 cases per day over the past seven days.

In other news from around Europe:

Hungary’s government is extending a moratorium on household and business loan repayments until July and halving a local business tax collected by municipalities as of Jan. 1 to support jobs during the pandemic, according to Reuters. Opposition leaders said the tax cut would jeopardize public services and allow the nationalist government of Prime Minister Vikto Orban to exert political pressure on cities.
Northeastern Aragón became the fourth region in Spain to announce a tightening of lockdown restrictions ahead of the Christmas festive season, in order to rein in a recent uptick in Covid-19 cases. On Saturday, the regional leader, Javier Lambán, ordered residents to remain within their provinces over the Christmas holidays, making a U-turn on a previous decision that the travel ban would be lifted on Dec. 21.
The government of Sweden, which has embraced relatively few coronavirus restrictions and is grappling with a serious rise in infections, issued several new recommendations on Friday, including the use of face masks. “We need to do more now because the medical system is strained,” Prime Minister Stefan Lofven said. The new recommendations include a four-person-per-table limit in restaurants, cafes and bars, and a ban on the sale of alcohol after 8 p.m. Stores, shopping centers and gyms are asked to further limit the number of people in their premises. All nonessential state, municipal and county workplaces will close until Jan. 24.

Raphael Minder and Christina Anderson contributed reporting.

— Constant Méheut

Coronavirus cases in Syria go uncounted amid shortages of critical supplies and medical personnel.

Women watched U.S. troops patrol the roads of the northeastern Syrian town of Al Jawadiyahin, near the border with Turkey, on Thursday. The coronavirus is surging in Syria, which has little capacity to cope with another crisis.Credit…Delil Souleiman/Agence France-Presse — Getty Images

Syrians living in bomb-scarred cities have long had to deal with a kneecapped health system that can barely handle the basic needs of the country’s exhausted population. Now, like the rest of the world, Syrians are facing the coronavirus. And detected cases are skyrocketing.

The U.N. Security Council, which met on Wednesday to discuss the humanitarian situation in Syria, reported that cases had more than quadrupled in October and November compared with the previous two months.

Syria has no organized independent data collection, and government data and propaganda tend to obscure the country’s difficulties. For instance, the Syrian Ministry of Health reported a total of 8,580 infections as of Dec. 9, while the Security Council, relying on reports from inside the country, counted at least 30,000 at the start of the month. Many say the true numbers are likely far greater.

“There is no doubt the Covid-19 infection and mortality rates for Syria are vastly undercounted and underreported,” said Dr. Michele Heisler, medical director at the nonprofit Physicians for Human Rights and a professor of internal medicine and public health at the University of Michigan.

The undercounts, coupled with the disastrous state of Syria’s hospitals after a decade of civil war and a severe lack of medical professionals, leave millions of people at risk of grave consequences if they become infected. Emergency doctors make up just 0.3 percent of the country’s public hospital workers, according to the World Health Organization.

“For years, the Syrian government and its Russian allies have attacked health workers and facilities as a strategy of war, resulting in a battered health system ill equipped to respond to the pandemic,” Dr. Heisler said.

Since the beginning of the conflict in 2011, Physicians for Human Rights has documented 595 attacks on health facilities in Syria. The group attributed about 90 percent of them to the Syrian government or its Russian allies, and has also recorded the killing of 923 medical professionals.

Some parts of Syria do not have access to clean water, sanitation or power. Widespread privation means that masks and soap come last on shopping lists. Conditions in camps for Syrians displaced by the war are often even worse, with open sewage and overcrowding fostering the spread of disease.

“Social distance is a fantasy in a camp, but if we’re going to prevent a massive outbreak, we need to make it a reality,” Kieren Barnes, the Mercy Corps country director for Syria, said in March.

In order to receive care, many coronavirus patients have had to pay bribes for hospital admission and oxygen supplies, according to a Physicians for Human Rights report released on Wednesday.

Dr. Heisler pointed to the stoppage of cross-border aid, inequitable access to health care and severe disparities in the government’s distribution of humanitarian supplies to explain why the health system’s “ability to respond to the pandemic as well as to other diseases is tremendously compromised.” There is also little testing capacity and a shortage of personal protective equipment.

“I don’t know that we’ll ever know the true scale of it,” a humanitarian worker focused on southern Syria told the group’s researchers. “The toll has got to be in the tens of thousands, if not higher. Every bed is full.”

— Lauren Wolfe

The pandemic pushes the start of a major 9/11 trial past the 20th anniversary of the attacks.

A prisoner at Guantánamo Bay, Cuba, in 2019.Credit…Doug Mills/The New York Times

The military judge overseeing the Sept. 11 case at Guantánamo Bay in Cuba delayed litigation deadlines again on Friday, postponing the start of the trial of the accused mastermind Khalid Shaikh Mohammed and four accused co-conspirators until after the 20th anniversary of the attacks next year.

The death penalty case, in its eighth year of pretrial proceedings, was already complicated by its remote location, procedural issues, legal challenges and the control of classified evidence by different elements of the U.S. government.

“The coronavirus Covid-19 pandemic has continued to worsen,” the judge, Col. Douglas K. Watkins of the Army, wrote in a two-page order that extended deadlines for another 30 days, for a total of 300 days of delay since the start of the pandemic.

Based on the timetable toward trial set by a previous judge, the selection of the military officers for the jury will now start on Nov. 7, 2021, at the earliest.

The pandemic has paralyzed much of the work of the court, whose participants commute from the mainland to the military commissions courtroom in Cuba for each session. The last hearing in the case was held in February.

The pandemic has also forced cancellation of all hearings in the case, which recessed in the midst of the judge taking extensive testimony on the question of whether key interrogations of the prisoners at Guantánamo in 2007 are inadmissible at trial because they are tainted by C.I.A. torture.

— Carol Rosenberg

THE 9/11 TRIAL

Read more about how the coronavirus crisis has compounded the problems in the troubled case at Guantánamo Bay, Cuba.

Restaurant chains are struggling to reach a unified approach, with varied rules across the U.S.

With 43 locations scattered across the United States, Fogo De Chão has been dealing with a patchwork of pandemic regulations. At this location, in Rosemont Ill., only two panels of an outdoor structure must be kept open.Credit…Lyndon French for The New York Times

Executives at the Brazilian steakhouse chain Fogo de Chão thought they had seen the worst of it.

Earlier in the year, when seemingly each hour brought news of another city or state shutting down because of the pandemic, executives switched from email to the messaging system WhatsApp to communicate in real time with the general managers of their 43 locations scattered across the United States.

“The first time we heard a state issue a stay-at-home order we were like, ‘What does that mean? What are they talking about?’” Barry McGowan, the company’s chief executive, said. “Then it was like dominoes falling. Boom. Boom. Boom.”

Communicating with vendors was a hit or miss. Trucks full of food pulled up to restaurants that had been closed.

The restaurant chain created a takeout menu in three days. It reached out to landlords to negotiate breaks on its leases. And as mandates to stay closed were lifted, it spent about $1 million renting tents and other equipment to set up outdoor dining in places where indoor dining was still restricted.

For a while, it worked. Diners flocked to the restaurants and spent lavishly. Before the pandemic, Fogo de Chão sold about 500 premium steaks, like Wagyu and Tomahawk rib-eyes, per week. That shot up to 1,300 per week by July.

But with virus cases rising again across the country, new restrictions have been placed on indoor and outdoor dining — no indoor dining in Philadelphia, Chicago and New York City; indoor dining curfews in New Jersey and Massachusetts; no restaurant dining at all in much of California.

For larger dine-in chains like Fogo de Chão, the ever-changing patchwork of rules poses a particular logistical challenge: How do you come up with a companywide approach when different locations are dealing with their own specific regulations?

“What you have is a massive deviation from standard in terms of how a chain is operating restaurant locations in different states, which then requires a whole set of processes and management to make sure that you comply with the regulations,” said Sean Ryan, a partner at Kearney, a consulting firm. “It’s costly and time consuming.”

— Julie Creswell and Gillian Friedman

VIRUS RESTRICTIONS

Large dine-in chains are finding it difficult to enact uniform approaches to the pandemic when dealing with different regulations across the country.

An American student is sentenced to 4 months in prison for violating quarantine rules in the Cayman Islands.

With her semester at Mercer University in Georgia complete, Skylar Mack, 18, flew down to the Cayman Islands in late November to watch her boyfriend compete in the islands’ jet ski racing national championship.

When she arrived, however, there was a problem.

She got there on a Friday; the championship was on Sunday. And per the country’s laws, she was required to remain in her hotel room for 14 days before going anywhere on the islands.

To elude the restrictions, Ms. Mack, after receiving a negative coronavirus test, slipped an electronic monitoring bracelet from her wrist and escaped to a beach on Grand Cayman’s South Sound, where she saw her boyfriend, Vanjae Ramgeet, 24, win first place.

But the authorities found out, and Ms. Mack and Mr. Ramgeet were sentenced this week to four months in prison for the quarantine breach.

“This was as flagrant a breach as could be imagined,” Justice Roger Chapple said in court during the sentencing, according to the Cayman Compass. “It was borne of selfishness and arrogance.”

The islands, a British territory of nearly 65,000 residents, have reported 310 infections and two deaths.

Ms. Mack’s relatives in suburban Atlanta are now scrambling to pull together letters from friends and family attesting to her character in an effort to get the sentence overturned on appeal, said Jeanne Mack, Ms. Mack’s grandmother.

Jeanne Mack has even written to President Trump for help. She received a response from the Office of Presidential Correspondence, dated Thursday, stating that her correspondence had been forwarded “to the appropriate federal agency for further action.”

The family and Skylar, a junior pre-med student, make no illusions about what happened, Jeanne Mack said: What she did was wrong.

“I’ll do everything to get you home, and when I get you here, I’m going to kick your butt,” Ms. Mack, 68, said of her sentiment toward her granddaughter. “We’re not saying, ‘poor, innocent Skylar.’ We’re simply saying the punishment does not meet the crime.”

Skylar Mack pleaded guilty to breaking the quarantine rules and was initially sentenced to 40 hours of community service and a fine. But the punishment was increased after the prosecutor appealed.

She and her boyfriend were the first to be sentenced under a new law that allows for up to two years in prison and a $12,000 fine for quarantine violations, according to The Associated Press.

Jeanne Mack said that her granddaughter was scheduled to appear before a panel of judges on Tuesday that will decide whether her appeal can proceed. If it can, then the family hopes that she will be released on bond pending the appeal.

— John Eligon

@TwoShotsInTheArm celebrates the vaccinations of health care workers.

Sandra Lindsay, a nurse at Long Island Jewish Medical Center, getting the first COVID-19 vaccine from Dr. Michelle Chester at Long Island Jewish Medical Center in New Hyde Park, N.Y., on Monday.Credit…Pool photo by Mark Lennihan

Ever since March, Alex Goldstein has run the Twitter account @FacesOfCovid to share the obituaries and stories of people who died from the coronavirus.

But when he watched Sandra Lindsay, a nurse at a Queens hospital, become the first person in the United States to receive a coronavirus vaccine, he knew it was time to set up another Twitter account.

The result is @TwoShotsInTheArm, which shares images of health care workers receiving the vaccine. The name of the account is a hat tip to the number of doses required by the Pfizer-BioNTech and the soon-to-be approved Moderna vaccines.

The account, Mr. Goldstein said in an email, is “a playful way to finally share a shred of good news, and perhaps most importantly, encourage others to follow suit when it’s their turn in line for the vaccine.”

“You can see the relief and joy on the faces of our health care workers and it is impossible not to smile along with them,” said Mr. Goldstein, who is the chief executive of a strategic communications firm in Boston.

With only days into the country’s largest vaccination campaign, the submissions are starting to come in. “I’m getting vaccinated for the baby joining our family any day now!” an emergency room doctor in New York City wrote in. “It may only be a small twinkle now, but there is a light at the end of the tunnel and it will continue to grow,” wrote a pharmacist in Jackson, Miss.

Mr. Goldstein hopes it adds “some good news into our daily doom scrolling.”