Credit…Andrew Testa for The New York Times

Struggling to limit the spread of a potentially more infectious variant of the coronavirus, the British government ordered more sections of England to be placed under the most restrictive lockdown measures on Wednesday, as health officials said severely curtailing human contact was the only way to protect people.

“The new variant makes everything so much harder because it spreads so much faster,” Matt Hancock, the British health secretary, said at a news conference.

Two variants, the one detected in the U.K. and another in South Africa, are currently being studied by scientists, and while early indications suggest they are both more transmissible, more laboratory tests are needed to gain a fuller understanding of the dangers they pose.

New infections are soaring and the number of people in the hospital — nearly 19,000 — is about where it was at the peak of the outbreak in the spring. On Tuesday, 691 deaths were attributed to the virus, he said.

“That is 691 people who died just before Christmas,” Matt Hancock, the British health secretary, said at a news conference. “Against this backdrop of rising infection, rising hospitalization and rising numbers of people dying of coronavirus, it is vital that we act.”

Areas of England including Sussex, Oxfordshire, Suffolk, Norfolk and Cambridgeshire will move to the highest level of restrictions starting the day after Christmas, Mr. Hancock said.

Mr. Hancock also said that British officials were concerned about the spread of the virus variant identified in South Africa. He said it was even more easily transmitted than the variant already spreading widely in London and southeast England.

The British authorities have detected two cases of the South Africa variant, Mr. Hancock said. In both cases, the infected people had been in contact with people who had traveled to Britain from South Africa in recent weeks. Mr. Hancock said that those infected with the new variant and their close contacts would be quarantined, and that travel from South Africa would be restricted.

At least five other countries have put in place similar travel bans.

And more than 50 countries have banned travelers from the U.K. since Prime Minister Boris Johnson first raised the alarm over the variant spreading in England on Saturday, when he imposed a lockdown on London and most of England’s southeast.

The United States has not imposed such a ban. But in New York City, Mayor Bill de Blasio said on Wednesday that sheriff’s deputies would conduct home and hotel visits to ensure that travelers from the United Kingdom were quarantining as required.

“We cannot take chances with anyone who travels, particularly folks traveling in from the U.K.,” Mr. de Blasio said.




U.K. Travelers to N.Y.C. Will Face Quarantine Order, de Blasio Says

On Wednesday, Mayor Bill de Blasio of New York cautioned that all travelers to the city from the United Kingdom would be receive an order to quarantine, and could face fines of $1,000 a day for failing to do so.

For folks coming in from the United kingdom, we will have a new approach given this new strain we’re seeing there. Effective immediately, all travelers, literally every single traveler coming in from the United Kingdom, will receive a Department of Health commissioner’s order directing them to quarantine. This will be a personal and direct order to every single one of them, telling them they must quarantine. And that will be given to all travelers beyond just those — I want to be clear — beyond anyone coming in just from the U.K., every traveler who comes into the city. But specifically for folks coming in from the U.K., given that particular concern, we are going to have sheriff’s deputies go to the home or the hotel of every single traveler coming in from the U.K. So when they arrive at the airport, they’re going to have to fill out the form notifying us that they are coming into New York City. We’re going to provide them with that commissioner’s order. But then there’s going to be a follow-up, direct home visit or hotel visit from the sheriff’s deputy to confirm that they are following the quarantine or if they are not, they will be penalized. We cannot take chances with anyone who travels, particularly folks traveling in from the U.K. So to everyone, look, if you don’t comply with the quarantine, that’s $1,000 fine to begin — Day 1 — if you continue not to comply with a quarantine, it is $1,000 for each additional day.

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On Wednesday, Mayor Bill de Blasio of New York cautioned that all travelers to the city from the United Kingdom would be receive an order to quarantine, and could face fines of $1,000 a day for failing to do so.

Britain had developed a three-tiered system to limit the spread of the virus in the fall. But the discovery of the new variant forced the government to add yet another, more restrictive, fourth tier.

Under the fourth tier, all nonessential businesses must close and people cannot meet with others indoors unless they live with them or they are part of their support bubbles. People living alone or who are the only adults in their houses may form support networks with another household.

Teachers this summer protesting school reopenings in Salt Lake City. The district was the only one in Utah that kept classes completely remote through the fall.
Credit…Rick Bowmer/Associated Press

It remains unclear how much vaccinating teachers will lead to a broad return to normal for U.S. schools, but at least one district — Salt Lake City, Utah — is planning to reopen as soon as its teachers get their second dose in the coming weeks.

Salt Lake City, with 21,000 students, was the only district in Utah to stay completely remote this fall. (Many other districts were forced to close schools temporarily in response to outbreaks.) In November, Salt Lake approved a plan to begin offering in-person instruction to elementary school students starting on Jan. 25. But it had not made any plans to open for middle or high school students.

The arrivals of the vaccine, and some prodding from the state government, have apparently prompted the district to firm up its plans.

Earlier this month, Gov. Gary Herbert, a Republican, announced that teachers and other school staff would be eligible to receive vaccines right after frontline health care workers. Getting teachers vaccinated, he said, would not only keep them safe but would also reduce disruption for families by helping schools avoid the “Ping-Pong effect” of going between in-person or remote learning.

Soon after, Republicans in the Utah state legislature proposed giving every teacher in the state a $1,500 bonus — except those in Salt Lake City.

The proposal prompted a series of discussions between the district and the legislature, which resulted in the district’s interim superintendent’s announcing a plan to reopen for middle and high school students on Feb. 8, with the timing of the vaccine playing a key role.

A spokesman for the Utah State Health Department said the current estimate was that teachers and school staff would likely be vaccinated in mid-to-late January.

Brad Wilson, the House Speaker, said that, if the Salt Lake City Board of Education approved the reopening plan in its meeting on Jan. 5, Salt Lake City teachers would be eligible for the $1,500 bonuses along with teachers in the rest of the state. (Other nonadministrative school staff, like lunchroom employees, secretaries, janitors and bus drivers, will receive $1,000 bonuses.)

Other states, including Arizona and Kentucky, have said that they will prioritize teachers for vaccinations, but it is not clear when teachers in those states will actually get their first shots.

In Lexington, Ky., where schooling has been remote since March, the district recently asked teachers to indicate whether or not they wanted to be vaccinated. The administration said vaccines, which might be administered as soon as January, would provide a path to reopening, according to the Lexington Herald-Leader.

A health care worker receiving the Pfizer vaccine at Providence St. Mary Medical Center in Apple Valley, Calif., on Dec. 17.
Credit…Ariana Drehsler for The New York Times

The Trump administration reached a deal with Pfizer and BioNTech to bolster the supply of their coronavirus vaccine for the United States by 100 million doses by the end of July.

The new agreement means the companies will supply the United States with a total of 200 million doses, enough to vaccinate 100 million Americans. The additional shots will cost $1.95 billion, or $19.50 per dose, the companies said.

The agreement, announced on Wednesday, would help the United States at least partly offset a looming vaccine shortage that could leave millions of American adults uncovered in the first half of 2021. Under the new agreement, Pfizer will provide an additional 70 million doses by the end of June and another 30 million by the end of July, doubling the deliveries it promised in the initial contract. However, even with Pfizer’s new contract, the government is still short doses for about 60 million Americans eligible to be inoculated.

So far, only two coronavirus vaccines — Pfizer-BioNTech’s and one made by Moderna — have won federal authorization for emergency distribution, and most of what the companies are capable of producing for the next six months has already been allocated through contracts with the United States and other governments.

The Pfizer contracts will now cost the government nearly $4 billion.

As part of the deal, the government agreed to invoke the Defense Production Act to give Pfizer better access to roughly nine specialized products it needs to make the vaccine. The government’s promise to free up supplies is not mentioned in statements issued by Pfizer or the government, but was critical to the deal, according to people familiar with the negotiations.

In September, Pfizer began asking for the government’s help in obtaining supplies, according to documents reviewed by The New York Times, but the Trump administration had already granted priority status to orders from Moderna and other companies that had been working with it more closely to develop their vaccines.

Others familiar with the negotiations said the government expressed concern that prioritizing Pfizer could squeeze the supply chain, hindering the other vaccine makers that the government was backing through its vaccine development program, called Operation Warp Speed.

The new contract with Pfizer includes options for the government to purchase an additional 400 million doses.

A gazebo outside a bar in London on Dec. 15. The city and much of southeastern England has since returned to lockdown.
Credit…Andrew Testa for The New York Times

A team of British scientists released a worrying study on Wednesday of the newly discovered coronavirus variant sweeping Britain. They warned that the variant was so contagious that new control measures, such as closing down schools and universities, might be necessary. Dr. Nicholas Davies, the lead author of the study, said that the findings “are pretty convincing that more rapid vaccination is going to be a really important thing for any country that has to deal with this or similar variants.”

As of Tuesday, the variant had not been identified in the United States, according to the Centers for Disease Control and Prevention.

The study, released by the Center for Mathematical Modeling of Infectious Diseases at the London School of Hygiene and Tropical Medicine, has not yet undergone review by a scientific journal. The study compares a series of models as predictors of data on infections, hospitalizations, and other variables. Other researchers are studying the variant in laboratory experiments to determine if it is biologically distinct.

The study found no evidence that the variant was more deadly than others. But they estimated that it was 56 percent more contagious. On Monday, the British government released an initial estimate of 70 percent.

Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health who was not involved in the study, said that it presented a compelling explanation of the past and potential future of the variant.

The variant, which came to the attention of British researchers this month, has been rapidly spreading in London and eastern England. It carries a set of 23 mutations, some of which may make it more contagious.

The authors of the study found more evidence that the variant does indeed spread more rapidly than others. For example, they ruled out the possibility that it was becoming more common because outbreaks started in places where people were more likely to come into contact with others.

The researchers built different mathematical models and tested each one as an explanation for the variant’s spread. They analyzed which model of the spread best predicted the number of new cases that were actually confirmed, as well as hospitalization and deaths.

Closing schools until February could buy Britain some time, the researchers found, but lifting those extra restrictions would then cause a major rebound of cases.

Dr. Davies and his colleagues also took into account the protection that vaccines will provide. Vaccine experts are confident that coronavirus vaccines will be able to block the new variant, although that has to be confirmed by laboratory experiments that are now underway.

Benjamin Mueller contributed reporting.




Frustration at Britain’s Ports Over Travel Restrictions

In Britain, about 4,000 truck drivers were stuck along roads near the southeastern English port in Dover after a 48-hour shutdown to prevent the spread of a variant of the coronavirus. Truckers who want to travel to France must show proof of a negative virus test.

“We don’t have food to eat, we don’t have drink, we don’t have anything — nobody don’t care about us.” “But now they say about some Covid test, but there is no Covid test. And I talked with the police officer. He said to me, when you go to the Maidstone. I say to them, how can we go to the Maidstone if the traffic — if the traffic with the trucks — is 200 kilometers?” [shouting] [yelling in distress] [arguing]

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In Britain, about 4,000 truck drivers were stuck along roads near the southeastern English port in Dover after a 48-hour shutdown to prevent the spread of a variant of the coronavirus. Truckers who want to travel to France must show proof of a negative virus test.CreditCredit…Justin Tallis/Agence France-Presse — Getty Images

Ferries and trains from Britain began arriving in Calais on Wednesday, as France reopened its ports to Britain after a 48-hour shutdown. But the logjam of thousands of Europe-bound trucks stuck in southeast England will take days to clear because drivers must show a negative coronavirus test before they can cross the channel.

The British army was mobilized to help the National Health Service, the country’s health care system, set up facilities to offer rapid coronavirus tests to drivers, who have been stuck in Britain since Sunday night, when France blocked passage to prevent the spread of a variation of the coronavirus that has swept through parts of England. Results from the test are usually available within 30 minutes, although the test is considered unreliable by some health professionals.

As testing sites were being set up Wednesday there was mounting frustration, confusion and skepticism about the plans in Dover. Trucks are parked around the ports, on closed sections of the motorway and at Manston Airport, a closed airfield nearby that has been turned into a giant parking lot for trucks.

Drivers were reportedly told they needed to go to the airport to take the tests, and it took until the afternoon before they were being administered. Drivers who weren’t at the airfield were reluctant to leave their spots in line closer to the border. Frustrations have been building and skirmishes have broken out among drivers, other waiting passengers and the police. One man was arrested after blocking a highway. For most of the day, access to the port was blocked by drivers and other travelers unwilling to move. Later in the day, another testing facility was set up at the port.

Hundreds of other freight drivers lined up along the motorway were told that tests would be administered to them where they were.

Authorities cautioned that it could take days to clear out the more than 5,000 Europe-bound trucks jammed into the area.

“I think it will take a few days to work our way through,” Robert Jenrick, (not Robert Jenkins, as was reported earlier here) a government minister, said on Sky News on Wednesday morning. Any drivers who received a positive test result, he said, would be offered a more accurate test, called a PCR test, which takes longer to process. If that was also positive they would be offered hotel accommodations to self-isolate for 10 days.

Rod McKenzie, the director of policy at Road Haulage Association, which represents the British road transport industry, said there were probably 8,000 to 10,000 trucks in Britain waiting to cross the border.

“It’s a mammoth task,” he told Sky News. “The border is still effectively shut, the testing is effectively not happening.” Some drivers have already spent three nights sleeping in their trucks with limited access to food and toilets.

Trucks in Europe carrying goods to Britain were still allowed to pass this week, but their numbers had declined amid fears that the drivers would be marooned once they crossed into Britain. The German airline Lufthansa flew 80 metric tons of fruit and vegetables from Frankfurt to the north of England on Wednesday for a supermarket supplier that chartered the flight. The airline said it was unusual to transport just a cargo of fresh goods on its own.

The crisis at the border has raised concerns about food supplies around the Christmas holidays, because Britain relies on importing fresh fruit and vegetables, especially in the winter.

“It is essential that lorries get moving across the border as quickly as possible,” Andrew Opie of the British Retail Consortium said. “Until the backlog is cleared and supply chains return to normal, we anticipate issues with the availability of some fresh goods.”

Dr. Susan Moore and her son, Henry Muhammed.
Credit…Henry Muhammed

Lying in a hospital bed with an oxygen tube hugging her nostrils, the Black patient gazed into her smartphone and, with a strained voice, complained of an experience all too common among Black people in America.

Susan Moore, the patient, said the white doctor at the hospital in suburban Indianapolis where she was being treated for Covid-19 had downplayed her complaints of pain. He told her that he felt uncomfortable giving her more narcotics, she said, and suggested that she would be discharged.

“I was crushed,” she said in a video posted to Facebook. “He made me feel like I was a drug addict.”

In her post, which has since circulated widely on social media, she showed a command of complicated medical terminology and an intricate knowledge of treatment protocols as she detailed the ways in which she had been an advocate for herself with the medical staff. She knew what to ask for because she, too, was a medical doctor.

But that was not enough to get her the treatment and respect she said she deserved. “I put forth and I maintain if I was white,” she said in the video, “I wouldn’t have to go through that.”

After Dr. Moore, 52, complained about her treatment, she received care that she said “adequately treated” her pain. She was eventually sent home, and on Sunday, just over two weeks after posting the video, Dr. Moore died of complications from Covid-19, said her son, Henry Muhammed.

Dr. Moore’s case has generated outrage and renewed calls to grapple with biased medical treatment of Black patients. Voluminous research suggests that Black patients often receive treatment inferior to that of their white counterparts, particularly when it comes to relieving pain.

Patrick Huggins helps Martha Fields to her car on Wednesday at Superlo Foods in Memphis, Tenn. The state has seen an enormous surge in coronavirus cases.
Credit…Whitten Sabbatini for The New York Times

Tennessee is struggling with the nation’s worst surge of coronavirus cases per capita, with at least 4,330 new cases and 133 deaths reported on Tuesday, according to a New York Times database. Over the past week, the number of cases per day has averaged 8,432, an increase of 78 percent from the average two weeks earlier.

Yet the governor, Bill Lee, a Republican, has not issued any statewide safety mandates, arguing that local communities are best qualified to make their own public health decisions. At the same time, some Republican leaders in the statehouse in Nashville are supporting legislation that would strip authority from the six county-run health departments in Tennessee, giving their powers to implement and enforce public health initiatives to elected county mayors in the midst of a pandemic fraught with political divisions.

At the local level, on Tuesday, a majority of Knox County Commissioners voted to remove the authority of the board of health and reduce it to an advisory capacity, an action that will require a second vote in January. Commissioners who supported the measure, all of whom are Republicans, said it was necessary to address constitutional concerns regarding the power of unelected officials.

Opponents argued that the political move undermined efforts to combat the virus as it rages through the state.

“They’re fighting over who should hold the fire hose while the fire burns the house down,” said Larsen Jay, the Republican chairman of the Knox County Commission, who voted against the ordinance. “We are the No. 1 place for Covid spread in the world and they are fighting over a constitutional theory.”

Before the pandemic, local health boards, which are tasked with preventing the spread of diseases and ensuring community safety, were relatively uncontroversial, but since the virus appeared, health board officials in many states have been thrust into the political spotlight as some communities protest mask mandates and business closures. They have also become targets. In Idaho on Tuesday, a district health board postponed a virtual meeting, citing safety concerns after demonstrators opposed to measures to stop the spread of Covid-19 gathered outside the department’s headquarters in Boise and the homes of two board members.

Lawmakers in at least 24 states have drafted legislation to weaken public health powers this year, according to a report by The Associated Press and Kaiser Health News.

In Knox County, home to Knoxville, while the ordinance would effectively gut the health board’s ability to implement and enforce policy, it will have to be approved again in January if it is to take effect..

Shoppers at a flea market in Buenos Aires on Monday. Argentina announced that it had approved a Russian vaccine for emergency use.
Credit…Juan Ignacio Roncoroni/EPA, via Shutterstock

Argentina’s Ministry of Health announced on Wednesday that it had approved the emergency use of Russia’s Sputnik V vaccine, making it the third country, after Russia and Belarus, to do so.

The Argentine government reached a deal with Russia’s National Center of Epidemiology and Microbiology, the maker of the vaccine, to provide enough doses for 10 million people by February, and another five million by March.

Argentine officials said that a plane sent to retrieve 300,000 doses had already arrived in Russia on Wednesday, and that the government would begin vaccinations before the end of the year.

News of Sputnik V has been met with hesitation in Russia and elsewhere. The vaccine has not yet completed human trials.

Russia is conducting a vaccination campaign using Sputnik V, and a number of other countries have also negotiated deals to receive the vaccine, including Brazil, India, Mexico and Venezuela, but none of these governments have approved it for use. On Tuesday, Belarus became the first country outside Russia to do so.

Two weeks ago, in an attempt to fight skepticism about the Russian vaccine among Argentines, President Alberto Fernández said he would be the first one to be inoculated once it arrives.

“I have no doubt in the quality of the vaccine,” he said at a news conference in Buenos Aires.

Argentina has been hard-hit by the virus, recording more than 1.5 million cases and 42,000 deaths. In a statement that stressed the scale of loss, the Argentine government said that it had seen data that verified Sputnik V’s safety and an efficacy exceeding 91 percent.

“The known and potential benefits outweigh the known and potential risks to public health,” the statement said.

Argentina also granted the Pfizer-BioNTech vaccine emergency approval on Wednesday, but it has not yet struck a deal with Pfizer to receive doses. Argentina was among the countries where that vaccine was tested.

Argentina does have a deal with AstraZeneca, which made a vaccine in partnership with Oxford University, to receive 22 million doses during the first months of 2021. But all of the planned purchases announced would cover less than half of the country’s population.

In other vaccination news:

  • Canada’s regulator approved Moderna’s Covid-19 vaccine on Wednesday, a move that will make it easier to inoculate people in the remote and northern regions of the country. Health Canada, which conducted a full review on an accelerated schedule, said the vaccine can be used only on patients 18 and older until it can be tested further. The government had determined that the Pfizer-BioNTech product currently being dispensed would be impractical for use in the vast but sparsely populated Far North because it must be shipped and stored at extremely low temperatures. Officials said earlier that the initial doses of the Moderna vaccine would be reserved for that region. Prime Minister Justin Trudeau has said that deliveries of the Moderna vaccine would begin within 48 hours of approval and that 168,000 doses would arrive before the end of the month.

  • More than a million Americans have received their first dose of a Covid-19 vaccine since vaccinations began 10 days ago, according to Dr. Robert R. Redfield, the director of the Centers for Disease Control and Prevention. He said that while the virus continues to sweep the nation, the early milestone represents progress toward protecting the health care workers who are treating patients infected with the virus and the Americans who are considered most vulnerable: older people in group-living settings.

  • Dubai said it would start inoculating people at no cost on Wednesday, using the coronavirus vaccine made by Pfizer and BioNTech, Reuters reported. Saudi Arabia is the only other Arab country using the Pfizer vaccine, but the United Arab Emirates and Bahrain have rolled out a vaccine to the general public developed by China National Pharmaceutical Group, or Sinopharm. A message on the Dubai Health Authority’s hotline said the first phase of the vaccine would be for citizens and Dubai residents ages 60 and over, as well as for individuals with chronic illness.

  • A 90-year-old woman living in a retirement home received the first coronavirus inoculation in Switzerland on Wednesday, kicking off the start to the mass vaccination campaign on the European mainland. Swiss regulators approved the Pfizer-BioNTech vaccine last weekend, and the first 107,000 doses from an order of three million arrived on Tuesday. The Moderna and AstraZeneca vaccines are still under review.

A box of Eli Lilly’s antibody treatment, bamlanivimab, at Floyd Medical Center in Rome, Ga. Despite worries that the drug would be scarce, the hospital has infused about 100 patients and has not had to turn anyone away.
Credit…Floyd Medical Center

When federal regulators approved two antibody treatments last month for emergency use in high-risk Covid-19 patients, doctors worried there would not be enough to go around.

President Trump had taken one of the treatments, made by Regeneron, in October and promoted it as a “cure.” Early trial data had shown the treatments could keep people at risk of severe disease out of the hospital if administered soon after infection with the coronavirus.

But in a surprising turn of events, the treatments are sitting unused in hospital refrigerators around the country, just when they might do the most to help patients and relieve the burden on overwhelmed hospitals as cases and deaths surge to record levels.

The federal government has on hand nearly 532,000 doses of the two drugs, and 55 percent of that has been shipped out, according to the Department of Health and Human Services. But early data collected from hospitals by the federal government suggest that they have given only about 20 percent of their supply to patients.

Hospitals and clinics, staggered by the needs of the sick and gearing up to help administer the new coronavirus vaccines, have not focused as much attention on these treatments, which have to be infused into patients in a narrow window of time, within 10 days of when they start showing symptoms, but before they’re sick enough to be hospitalized. Administrators have struggled to identify people who should get the antibody drugs because of delays in testing and a lack of coordination between testing sites and hospitals.

And demand from patients themselves has been weaker than expected. Some have been reluctant to venture out of their homes to get the therapies in hospitals — or perceive the treatments aren’t available to them but are going to well-connected people like Chris Christie, the former Republican governor of New Jersey, and Ben Carson, the housing secretary in the Trump administration.

“There were politicians getting it, and bragging about it, or whatever, and then people thought, well it’s not for me — it’s for those people,” said Dr. Daniel M. Skovronsky, chief scientific officer of Eli Lilly, which manufactures one of the antibody treatments.

Federal and state health officials have had to take the extraordinary step of urging patients to seek out treatments that were once expected to be snatched up.

Coronavirus: Then & Now

As 2020 comes to a close, we are revisiting subjects whose lives were affected by the pandemic. When Dan Levin first spoke with Kalee Kamer in April, she was participating in a virtual drug recovery meeting via Facebook Live.

Kalee Kamer can almost pinpoint the moment two epidemics — opioid addiction and Covid-19 — collided in her city of Portsmouth, Ohio: When the state’s backlog of unemployment payments began to arrive in the spring, unleashing a wave of deadly overdoses.

“You’d see them gripe on Facebook ‘when’s my money coming?’” she recalled of residents. “And then you’d see the R.I.P. posts.”

Temptation and grief are never far in Portsmouth, the largest city in Scioto County, which in 2019 had the highest overdose death rate reported by any Ohio county ever, according to Harm Reduction Ohio, a nonprofit group.

Lisa Roberts, a nurse who works for the Portsmouth Health Department, expects around 100 overdose deaths in the county this year, which would be nearly three times the number of residents who have died from Covid-19. She attributes the devastating toll to both the pervasiveness of synthetic opioids like fentanyl, which are far more deadly than heroin and frequently get laced into illegal drugs, and the shuttering of rehab facilities and recovery meetings.

“It’s kind of a perfect storm,” she said.

In the early days of the pandemic, Ms. Kamer attended drug recovery meetings online with her fiancé, who was also in recovery. Since then, Ms. Kamer, 33, says she has lost count of the people she knows who have fatally overdosed during the pandemic. For a while, she feared her fiancé, Chris Keeton, would not survive either. After more than five months sober, he relapsed in May.

Alone and desperate to avoid drugs, Ms. Kamer, who had lost her waitressing job in March, spent the next few weeks mostly hanging out with a friend at a fire tower west of town. Then in June, she got a job at an outpatient drug treatment center.

A few weeks later, her boyfriend came home and admitted his drug use. “My life was crumbing,” Mr. Keeton, 34, said. “I broke down and cried and said I need help.”

He has been sober since early July, and she will celebrate three years of sobriety on Christmas Eve, she said. The couple this month finally set a date for their wedding: May 1, 2021.

Earlier this month, a Scioto County commissioner succumbed to the coronavirus. But even as virus cases rise, Ms. Kamer is more afraid of the opioid crisis, for which there is no vaccine.

“I worry, who are they going to try to recover with Narcan,” she said of emergency medical workers. “Or whose dead body are they going to go try to identify. That’s the fear that I have now, because it’s constant.”

Global roundup

Shoppers in Milan’s city center this month.
Credit…Alessandro Grassani for The New York Times

Across Europe, people who have lost loved ones face an empty chair or an agonizing void this holiday season. That is hard enough. But a surge in infections, a new fast-spreading variant of the virus and mounting deaths have led the authorities to shut down Christmas, too.

The upending of holiday rituals has had a particularly disruptive effect in Italy, which is home to the Vatican, panettone and pandoro Christmas cakes, Neapolitan Nativity scenes and multigenerational family reunions.

Since at least October, the country has focused on rules for the festive season with the obsession of a child counting down the days on a chocolate-filled Advent calendar. Government ministers and virologists, celebrity entrepreneurs and influencers held forth on striking the right balance between health and mirth.

But the months of Christmas mania coincided with a dizzying increase in contagions that put a renewed burden on hospitals and catapulted Italy back to the ignoble position of deadliest country in Europe.

About 600 people die of the virus on average every day in Italy, more than any country other than the much larger United States and Brazil. Italy has lost more than 69,000 people to the virus and experienced more deaths generally than in any year since 1944, during World War II.

Prime Minister Giuseppe Conte himself started the holiday countdown in October, asking Italians to respect restrictions to enjoy “Christmas holidays with more serenity.” But by last Friday, he had switched the talk from saving Christmas for Italians to saving Italians from Christmas. In an almost apologetic speech to the nation, Mr. Conte introduced restrictions that limited movement and closed bars and restaurants from Dec. 24 to Jan. 6.

Monica Mazzoleni, whose mother died of the virus, decided with her father to spend Christmas Day away from the family table, avoiding the empty chair where her mother would sit. Instead, they intend to go to a restaurant near the northern city of Calusco d’Adda.

“We wanted to get away,” she said. But even those plans had to be canceled when the government closed restaurants. “There will be no Christmas for us,” she said.

In other developments from around the world:

  • President Emmanuel Macron of France is “showing signs of improvement” after he tested positive for the virus last week, his office said on Wednesday. Previous updates on his health had said he was stable, with minor symptoms like coughing, fever and headaches.

  • The health authorities in Hong Kong said that two students who returned from London this month appeared to have been infected by the coronavirus variant circulating in Britain. Starting on Thursday, anyone coming from Britain will be required to quarantine for three weeks at designated hotels, up from two weeks. (When announcing the extension, the health authorities said that the third week could be spent at home.) The government closed its borders on Tuesday to anyone who was recently in Britain, including Hong Kong residents.

  • In Italy, a patient with no apparent connection to the United Kingdom was also found to be infected with the newly identified variant of the coronavirus in the central region of Marche on Wednesday, doctors from the Ospedali Riuniti Virology Laboratory in Ancona said. The case suggests that the new variant is already circulating in the country. On Sunday, the health ministry said that two other people who had arrived from Britain were infected with the variant.

President Trump on his way to the Army-Navy football game earlier this month.
Credit…Samuel Corum for The New York Times

Like a coin flip that never lands, America’s double-headed presidency is queasily suspended in midair as President Trump threatens to veto a bipartisan, Biden-blessed bill intended to speed relief to families, businesses and governments in time for the holidays.

The 11th-hour disruption was one of those entirely predictable surprises that have defined the Trump era. Over the last four years — especially on big-ticket budget deals (like the 2019 defense bill) — Mr. Trump has absented himself from negotiations and piped up only at the last possible second, often to little or no effect on priorities like funding his border wall.

In a speech posted late Tuesday on his Twitter account, Mr. Trump positioned himself as a guardian of the working class who had been quietly watching the congressional negotiations in horror as they crammed billions in wasteful spending into the bill, which he called “a disgrace.”

He is now pushing for $2,000 payments for individuals, not the $600 stimulus checks included in the compromise, a position embraced by progressives and deplored by conservatives.

It is not clear how Mr. Trump’s proposal will be taken in Congress. Democrats planned to raise the amount of the direct payments on Thursday by unanimous consent, but whether it passes there or even comes up in the Senate is unclear. The stimulus bill passed both houses on Monday with a veto-proof majority.

Why is Mr. Trump doing this now? One reason: A no has always been more attractive than a yes for the disruptive Mr. Trump, whose 2016 presidential run was impelled by his dislike of President Barack Obama but turbocharged by his contempt for the Republican Party establishment.

The opposite holds for President-elect Joseph R. Biden Jr., who ran in 2020 as a reassuring figure intent on restoring kindness and sanity to government. Mr. Biden offered tempered approval of the unloved $900 billion compromise deal on Tuesday, calling it a “down payment” on another coronavirus relief package next year.

On the stimulus issue, Mr. Biden is actually far closer to Mr. Trump than Mitch McConnell, the Senate Republican leader, who has been wary of writing bigger checks. But Mr. Biden, speaking to reporters on Tuesday, when the deal seemed done, cast it as a hopeful harbinger of future agreements with Mr. McConnell, his frequent bargaining partner in the Obama years.

In that sense, Mr. Biden is coming in as president the way he left the vice presidency, with a smile of reassurance, while Mr. Trump is going out as he came in — with a defiant scowl.

How the current impasse, which comes at a moment of acute national crisis, plays out is hard to say. Mr. Trump is scheduled to leave this afternoon for his annual Christmas trip to Florida, though his plans could change.

But what struck many Republican aides most on Wednesday was Mr. Trump’s sudden embrace of a cause typically championed by the other party.

While Mr. Trump floated the idea of increasing the size of the checks in private last week, he did not push for the proposal on Twitter or weigh in personally with legislative leaders, nor did he instruct Treasury Secretary Steven Mnuchin, who represented him in the talks, to reject the compromise.

Boarded-up storefronts in Los Angeles. The stimulus package approved by Congress may not do enough for millions of jobless Americans if hiring does not pick up significantly.
Credit…Philip Cheung for The New York Times

New economic data from the federal government on Wednesday highlighted the recovery’s precarious state.

A report from the Commerce Department showed that personal income fell in November for the second straight month and that consumer spending fell for the first time since April.

Separately, the Labor Department said applications for unemployment benefits remained high last week ahead of a new injection of federal aid.

About 869,000 people filed new claims for state jobless benefits. That was down from a week earlier but is significantly above the level in early November, before a surge in coronavirus cases prompted a new round of layoffs in much of the country.

Another 398,000 people filed for Pandemic Unemployment Assistance, one of two federal programs to expand jobless benefits that were set to expire this month without congressional action.

Help may be on the way. After months of delays, Congress on Monday passed a $900 billion economic relief package providing aid to unemployed people, small businesses and most households. Most urgently, it would prevent jobless benefits from expiring at the end of this week for millions of people. But on Tuesday evening, President Trump demanded sweeping changes in the bill, throwing into doubt whether he would sign it.

The data released Wednesday showed the toll that the delays in aid — along with rising virus cases — have taken on the economy. Personal income fell 1.1 percent in November and is down 3.6 percent since July, as waning federal assistance more than offset rising income from wages and salaries. Consumer spending, which helped drive the initial recovery after lockdowns lifted last spring, also faltered, falling 0.4 percent as the weather cooled and virus cases rose. Spending on dining and travel both fell last month, the Commerce Department said.

The income and spending data was just the latest evidence that after rapid gains in the spring and summer, the recovery has stalled and could be going into reverse. Some forecasters expect the December employment report to show a net loss of jobs.

“That huge looming cliff that everyone’s been talking about for months on end, that’s been averted,” said AnnElizabeth Konkel, an economist for the hiring site Indeed. “But there’s no momentum forward. It feels like we’re just stuck. Hopefully the new stimulus package will help get a little more wind in our sails.”

The relief bill was smaller than many economists said was needed to carry the economy through the pandemic and ensure a robust recovery. It won’t revive industries that have been ravaged by the pandemic or undo the damage left by months of lost income for many households.

But the recent deterioration in the economy shows why economists across the ideological spectrum were urging Congress to act quickly even if that meant accepting a smaller bill.

“Without the aid, it seemed like we were on the precipice and there was definitely concern that we could have had a double-dip recession,” said Daniel Zhao, senior economist with the career site Glassdoor. “The position that we find ourselves in now is significantly stronger than where we were even a week ago.”

Erik Vammen works in a shed that formerly housed mink at the Semper Avanti mink farm in Moldrup, Denmark, earlier this month. Danish mink farmers killed the entire population of 15-17 million farmed mink during a coronavirus outbreak earlier this year.
Credit…Andrew Kelly/Reuters

The weasel family continues to hold the position as the nonhuman animals most affected by the coronavirus. Fortunately they, too, have vaccines in the pipeline.

A number of other animals can be infected by the virus, but without severe illness. Farmed mink, however, can sicken and die. And because the virus rampages through mink farms, millions of the animals have been slaughtered to prevent the spread of mutations that could potentially affect human drugs or vaccines.

But mink may have protection soon. The head of the International Fur Foundation, Mark Oaten, said that he expected news in 2021 of Russian vaccines in development for commercially farmed mink. The U.S. Department of Agriculture has invited applications from veterinary pharmaceutical makers for permits or licensing for mink vaccines for SARS-CoV-2, the virus that causes Covid-19 in people.

A small study last month, not yet peer-reviewed, showed success in blocking infection in laboratory ferrets. And endangered black-footed ferrets, located at the National Black-Footed Ferret Conservation Center in Colorado, have already received an experimental vaccine.

No infections have been discovered among the endangered ferrets, but since their population is at risk, researchers developed an experimental vaccine that may or may not work. It has produced antibodies, according to news reports.

Infections in farmed mink do not threaten the species as a whole, but they do threaten the viability of the industry that raises them. Denmark slaughtered its entire population of 15 to 17 million farmed mink. Most would have been killed in a normal year in any case — but they would have been skinned and the furs sold. Instead, many were buried — sloppily as it turned out. Denmark is now facing the task of exhuming millions of carcasses in the spring and incinerating them, to avoid environmental contamination caused by their decomposition.

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