Hospitals are rolling out the first small shipments, as boxes of precious frozen vials arrive at locations around the country. How well initial vaccinations go will help reassure a wary public when it’s their turn sometime next year.

Here’s what we know so far about who is getting it first, where they will be administered, and who’s next in line:

HOW MUCH VACCINE IS EACH STATE GETTING?

U.S. officials say it’s based on a state’s population of people 18 and older. Federal officials haven’t released a breakdown, but some states have shared their initial allocations.

The U.S. currently has 6.4 million Pfizer doses and has shipped around 3 million doses to 636 locations for the first round of vaccinations. Since the Pfizer vaccine requires two doses, the government is holding back the second shots to ensure people can get them three weeks after the first dose.

An additional 500,000 doses are being held in reserve for any emergencies, according to Army Gen. Gustave Perna of Operation Warp Speed, the government effort to develop and distribute COVID-19 vaccines.

Perna said Monday that if the FDA also quickly authorizes the second vaccine, from Moderna and the National Institutes of Health, for emergency use, 6 million doses of that shot will be shipped in the first wave to 3,285 locations across the U.S. The government’s advisory panel is scheduled to review the request on Dec. 17.

Based on Pfizer’s and Moderna’s stockpiles, federal officials estimate 20 million people in the first priority group could be vaccinated by the end of the year — meaning they’d have around 40 million shots available. Moderna’s vaccine also requires two shots, but the second shot comes four weeks after the first.

WHEN CAN I GET VACCINATED?

It depends on your risk of getting infected or getting seriously ill. Are you a health care worker? A resident of a nursing home or getting long-term care? Those folks are first in line for the initial, limited supply, the Centers for Disease Control and Prevention decided early this month.

Health care workers in New York, Connecticut, Florida, and Ohio were among the first in the U.S. to get the vaccine.

WHO’S NEXT IN LINE?

It’s not yet clear who will be included in the second phase. An expert panel that advises the CDC on vaccines will meet again to recommend the next group to states and local health departments. Possibilities include anyone 65 and older, teachers, police, firefighters and workers in other essential fields, such as food production.

More vaccines are in the pipeline, and officials have said they want to have shots widely available to everyone else before the middle of next year.

To find out when it is your turn, watch for notices from your state.

WHEN WILL KIDS AND PREGNANT WOMEN BE ABLE TO GET VACCINATED?

Currently, you must be 18 or older to take a coronavirus vaccine.

Pfizer began enrolling a portion of kids between the ages of 12 and 17 for their vaccine trials in the fall and Moderna’s vaccine trial in children is just getting underway, but it is too soon to know the results of the immune response and safety in children.

Pregnant women have been excluded from large-scale clinical trials, so when vaccines do become available for the general population, there will not be sufficient data to support a formal recommendation for pregnant women to receive vaccinations.

Dr. Christopher Zahn, the vice president of practice activities of the American College of Obstetricians and Gynecologists, said in a statement to NBC News that women who are pregnant or considering pregnancy should consult their doctors and base decisions on the available data and their “individual risk factors and the potential benefits.”

WHERE CAN I GET A SHOT?

Pharmacies, health clinics and your doctor’s office are the likely options. States are working on signing them up. Local health departments will also probably run mass vaccination clinics.

The government struck a deal in October with CVS and Walgreens to administer the coronavirus vaccinations to residents and staff at long-term care facilities first, and eventually the general public. 

Once doses are widely available, people will be able to use an existing government website, vaccinefinder.org, to find COVID-19 shots. The website is already used to find vaccines for the flu and other diseases.

CVS Health CEO Larry Merlo told NBC’s TODAY show that patients will have to schedule a vaccine appointment via the CVS app,  unlike being able to just walk into a CVS and get a seasonal flu shot.

COVID-19 shots are likely to be limited for awhile, and which type people get will probably depend on what’s available.

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HOW MUCH WILL IT COST?

It should be free. The government is paying for the vaccine itself. And you shouldn’t be charged a copay or other fee to get it.

Even if a provider charges a fee for giving the shot, the cost will be covered by private and government insurance, based on a set reimbursement fee. If you don’t have insurance, providers can tap a government fund to cover costs.

WHEN WILL I GET MY SECOND SHOT?

It depends on the brand of vaccine. Pfizer’s is three weeks later, and Moderna’s is four weeks.

Each state’s strategy on how they will remind people to return for their second vaccine shot varies. Some have said they will provide vaccination record cards as a reminder to return for a second shot. Others plan on sending reminder texts, calls or letters in the mail, depending on the location.

Shots will be recorded in state and local vaccine registries that already keep track of other vaccinations. COVID-19 vaccines can’t be mixed and matched, so if a second dose is needed, providers will be checking to make sure you get the right one.

One concern, however, is that because the U.S. lacks a national database, if people leave their state before their scheduled second shot, health officials won’t have access to previous immunization information. Current efforts to create a national vaccine registry are raising privacy concerns from some local officials and a number of states have refused to sign the CDC’s data use agreement.

Not all vaccines in development require two shots. Johnson & Johnson is testing a single-dose vaccine.

WHAT ARE THE INGREDIENTS IN THE NEW PFIZER VACCINE?

Pfizer’s new COVID-19 vaccine contains the genetic material known as mRNA, as well as three categories of ingredients: fats, salts and sugar.

Pfizer made a list of its ingredients available in a letter to the FDA published here. They are: mRNA,lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3-phosphocholine, and cholesterol), potassium chloride, monobasic potassium phosphate, sodium chloride, dibasic sodium phosphate dihydrate, and sucrose.

HOW DOES THE MRNA VACCINE FROM PFIZER WORK AND IS IT SAFE?

The vaccine from Pfizer and BioNTec, called BNT162b2, takes a new approach to protecting you from infection by using what is called messenger RNA or mRNA. Unlike a traditional vaccine, this new one relies on genetic information from the virus to stimulate an immune response against COVID-19.

Instead of injecting weakened or an inactivated germ into your body, this vaccine injects the genetic material that our cells read to make proteins. It teaches your body how to make the protein that triggers antibody production so if the real virus later enters your body, your immune system will recognize it and respond, according to the Centers for Disease Control and Prevention. 

The Pfizer vaccine is 95% effective is safe and also protects older people most at risk of dying, according to results of its late-stage trial announced in November. A final data analysis of the more than 43,000 participants found the vaccine was highly effective against the virus 28 days after the first dose, and its efficacy was consistent across all ages, races and ethnicities, the drugmakers said. Additionally, the elderly, who are seen as at high risk of severe illness from COVID-19, saw vaccine effectiveness of more than 94%, they added.

This is the first RNA vaccine to be approved for use in humans.

WHAT ABOUT SIDE EFFECTS?

The experimental vaccines have been tested in tens of thousands of volunteers so far, and serious side effects have not been reported. Health officials will be monitoring for side effects as more people get vaccinated, as well as for any potential longer-term issues.

Dr. Anthony Fauci, the nation’s top infectious disease expert, has noted that people might feel achy or feverish right after the shot, or some soreness in the arm. Other temporary side effects reported by study participants included fatigue, headache and chills, lasting one to three days.

CAN I GET AN ALLERGIC REACTION TO THE VACCINE?

Vaccines can sometimes cause allergic reactions, but they are usually rare and short-lived. British regulators are looking into reports of allergic reactions in two people who received the new Pfizer COVID-19 vaccine on the first day of a vaccination program. In the meantime, they’re telling people to skip the vaccine if they’ve had a history of serious allergic reactions.

The UK’s Medical and Healthcare Products Regulatory Agency said people should not receive the Pfizer vaccine if they have had a significant allergic reaction to other vaccines, medicine or food, such as those who have been told to carry an adrenaline shot — such as an EpiPen — or others who have had potentially fatal allergic reactions.

Sec. Azar said Friday the FDA was finalizing the fact sheet on allergy warnings for the vaccine. It was not clear at the time this story was published what that guidance would be.

CAN I STOP WEARING A MASK AFTER GETTING A COVID VACCINE?

No. For a couple reasons, masks and social distancing will still be recommended for some time after people are vaccinated.

To start, the effect of vaccinations generally aren’t immediate, and the first vaccines by Pfizer and Moderna require two shots.

People are expected to get some level of protection within a couple of weeks after the first shot. But full protection may not happen until a couple weeks after the second shot. And even if they’re protected from getting sick, vaccinated people might still be able to get infected and pass the virus on, although it would likely be at a much lower rate.

Once vaccine supplies start ramping up, it will still still take months to get hundreds of millions of shots into people’s arms.

WHAT IF I HAD COVID-19?

Having COVID-19 gives you protection against another infection, but it is not known yet how long that immunity will last. And there’s nothing to indicate that previously infected people shouldn’t get vaccinated, according to the CDC advisory panel.

By vaccinating those with prior infections, “The expectation is for them to be more protected,” said Moncef Slaoui, who’s heading U.S. vaccine development. But studies will be needed to support that, he said.

People with a prior COVID-19 diagnosis weren’t allowed to volunteer for the vaccine tests. But there was no screening to rule out people who might have been previously infected and not known it. So some people with symptom-free infections might have been included. The CDC panel said there was no need to test for those silent infections before getting a vaccine.

For health care workers who had COVID-19, the panel suggests that they might want to let their fellow health workers go ahead of of them since the chance of reinfection is low for the next three months.

House Speaker Nancy Pelosi, D-Calif., spoke with Treasury Secretary Steven Mnuchin by phone Monday evening and continues to press for help for struggling states and localities. But top Democratic allies of President-elect Joe Biden came out in support of a $748 billion plan offered by a bipartisan group of lawmakers and hinted they won’t insist on a pitched battle for state and local aid now.

“We cannot afford to wait any longer to act. This should not be Congress’ last COVID relief bill, but it is a strong compromise that deserves support from both Republicans and Democrats in the Senate,” said Sen. Chris Coons, D-Del. “We cannot leave for the holidays without getting relief to those Americans who need it.”

The message from Coons, a confidant of Biden, and a similar message from Senate Majority Whip Dick Durbin, D-Ill., came as a bipartisan group of lawmakers unveiled a detailed COVID-19 aid proposal on Monday in hopes it would serve as a model for their battling leaders to follow as they try to negotiate a final agreement.

But the group was unable to forge a compromise on GOP-sought provisions shielding businesses from COVID-related lawsuits, a key priority of Senate Majority Leader Mitch McConnell. The Kentucky Republican is pressing a lowest-common-denominator approach that would drop the lawsuit shield idea for now if Democrats agree to drop a $160 billion state and local aid package.

Pelosi has insisted for months that state and local aid would be in any final bill, but as time is running out, Democrats appear unwilling to hold the rest of the package hostage over the demand. Several Democrats appeared at the bipartisan news conference endorsing the $748 billion package.

“I found it interesting that they separated out the state and local and liability provisions. Senator McConnell had suggested that earlier,” said Sen. John Cornyn, R-Texas. “Seems to me that we’re making some progress on it.”

Cornyn, a McConnell lieutenant, spoke after a dozen or so lawmakers unveiled two bills. One is a $748 billion aid package containing money for struggling businesses, the unemployed, schools and vaccine distribution. There is also $45 billion for transportation and transit assistance, funding for rural internet service and help for the Postal Service, among other provisions. The other bill proposes a $160 billion aid package for state and local governments and a modified liability shield that is backed by Republicans and Democratic moderate Joe Manchin of West Virginia, but it is probably too politically freighted to advance.

The path forward for their proposals — and for COVID-19 aid more generally — remains unclear, though Cornyn said the bipartisan plan has lots of “good stuff” for any yearend agreement.

Any agreement is likely to be forged in parallel negotiations between Pelosi and Mnuchin — closely watched by McConnell.

Outstanding issues in the leadership talks include a potential second round of direct payments to individuals, a plan for $300-per-week bonus unemployment benefits, state and local aid, and the GOP-sought liability shield against COVID-19-related lawsuits.

Sen. Susan Collins, R-Maine, said she hoped that top Capitol Hill leaders and the administration will use the proposals as the basis for a COVID-relief package “that is urgently needed by our struggling families, our hard-hit small businesses, our stressed-out health care providers, our overwhelmed Postal Service, our challenged schools, and so many others.”

Lawmakers also worked to finalize a yearend catchall funding package that will be the basis for the last significant legislation of the Trump presidency.

There’s a hoped-for deadline of midnight Friday to deliver the completed package to President Donald Trump, which is when a partial government shutdown would arrive with the expiration of last week’s temporary funding bill. But there’s no guarantee that the massive yearend measure will be completed in time. If the talks drag, further temporary bills could be needed.

Negotiations on the $1.4 trillion catchall spending bill are “essentially finished,” said a congressional aide participating in the talks. While details are closely held, “the status quo is prevailing.” That means Trump would get another $1.4 billion or so for a final installment to continue construction of his long-sought U.S.-Mexico border wall.

Republicans have succeeded in killing a $12 billion plan to break last year’s budget mini-agreement by using accounting maneuvers to pad veterans health care funding to accommodate big cost increases from expanding access to health care services from private providers. Instead, a different set of moves is being employed to provide for equivalent spending increases for other domestic programs.

The post-election lame-duck session is the last chance to wrap up the unfinished work this year, a goal of all involved, though they have been slow until now to forge the often-tricky compromises required to pull the measure together.

Pelosi has not thrown in the towel on her drive to obtain state and local aid, which was part of the almost $2 trillion CARES Act that passed the Senate unanimously in March. But many Republicans are adamantly against the idea now.

President-elect Joe Biden wants as much COVID relief as possible but has no direct influence on the negotiations. While he’ll empower Democrats after taking office next year, GOP leaders like McConnell are playing hardball and have forced Pelosi to scale back her demands. And while McConnell supported a $300-per-week bonus unemployment benefit this summer, he’s pulled back since the November election.

No. 2 House Democrat Steny Hoyer of Maryland displayed flexibility in an appearance on CNN on Sunday that Republicans interpreted as a harbinger of further Democratic retreat.

“The legislative process is a give and take and the items that I just mentioned are absolutely critical to get done, and although I think state and local assistance is critically important, the others are critically important too,” Hoyer said.

The ambitious initiative known as COVAX created to ensure the entire world has access to COVID-19 vaccines has secured only a fraction of the 2 billion doses it hopes to buy over the next year, has yet to confirm any actual deals to ship out vaccines and is short on cash.

The virus that has killed more than 1.6 million people has exposed vast inequities between countries, as fragile health systems and smaller economies were often hit harder. COVAX was set up by the World Health Organization, vaccines alliance GAVI and CEPI, a global coalition to fight epidemics, to avoid the international stampede for vaccines that has accompanied past outbreaks and would reinforce those imbalances.

But now some experts say the chances that coronavirus shots will be shared fairly between rich nations and the rest are fading fast. With vaccine supplies currently limited, developed countries, some of which helped fund the research with taxpayer money, are under tremendous pressure to protect their own populations and are buying up shots. Meanwhile, some poorer countries that signed up to the initiative are looking for alternatives because of fears it won’t deliver.

“It’s simple math,” said Arnaud Bernaert, head of global health at the World Economic Forum. Of the approximately 12 billion doses the pharmaceutical industry is expected to produce next year, about 9 billion shots have already been reserved by rich countries. “COVAX has not secured enough doses, and the way the situation may unfold is they will probably only get these doses fairly late.”

To date, COVAX’s only confirmed, legally binding agreement is for up to 200 million doses, though that includes an option to order several times that number of additional doses, GAVI spokesman James Fulker said. It has agreements for another 500 million vaccines, but those are not legally binding.

The 200 million doses will come from the Serum Institute of India, the company that will likely make a large portion of the coronavirus shots destined for the developing world. CEO Adar Poonawalla says it has a confirmed order for 100 million doses each of a vaccine developed by Oxford University and AstraZeneca and one from Novovax.

“We don’t have anything beyond that in writing,” he told The Associated Press. “If they want more, they’ll have to place more orders.”

He said the lack of commitment from COVAX will mean a much longer wait for people in developing countries. Poonawalla also noted that his company’s first priority would be making shots for India, which has suggested it wants at least 300 million vaccines. It’s likely India would not be able to take all of those at once, but a big order could delay the distribution of vaccines for other parts of the developing world, Poonawalla said.

Potentially further slowing down the process is that neither the AstraZeneca vaccine nor the Novovax one has been licensed by any regulatory agency yet — and any injection distributed by COVAX will likely need WHO approval. COVAX does not have any supplies of the two vaccines that appear to be most effective so far — the Pfizer-BioNTech shot and the Moderna one. The United Kingdom has already begun giving the Pfizer vaccine, and the United States and Canada are rolling it out this week. Some Gulf countries have also authorized it.

Still, GAVI said they “aim to start rolling out safe and effective vaccines to COVAX (member countries) at scale within the first and second quarters of the New Year.”

Even with vaccines in hand, the rollouts will take many months, even in rich countries, and many developing ones are facing serious logistical challenges that will add to delays, noted Dr. Gagandeep Kang, an infectious diseases expert at the Christian Medical College at Vellore in southern India.

Even senior officials at the WHO have acknowledged privately that attempts to fairly allocate vaccine through the initiative are flawed, despite publicly lauding its success.

“The whole call for global solidarity has mostly been lost,” said Dr. Katherine O’Brien, WHO’s vaccines chief, during a recent internal discussion, a recording of which was obtained by the AP.

Asked to clarify her remarks, O’Brien said in an email that “every country should have access to COVID-19 vaccines, as early as feasible.”

Adding to COVAX’s difficulties, O’Brien noted at a news conference this month that it was still $5 billion short to buy the doses it’s planning to obtain next year.

According to a report GAVI issued ahead of a meeting this week, the alliance itself concluded that the risk COVAX will fail is “very high,” saying it was “established in record time and has to navigate unchartered territory.”

But John Nkengasong, director of the Africa Centers for Disease Control and Prevention, criticized Western countries for buying up the global vaccine supply “in excess of their needs while we in Africa are still struggling with the COVAX (effort).”

With no certainty about which shots would work, governments scrambled in recent months to sign multiple deals to ensure their citizens would have at least some COVID-19 injections. Canada, for example, bought nearly 200 million vaccines — enough to cover its population of 38 million about five times over.

Nkengasong called the idea that people in rich countries would get immunized while Africans go without “a moral issue.”

Beyond the ethics, experts note that failing to protect people in the developing world will leave a reservoir of coronavirus that could spark new outbreaks at any time.

Amid fears COVAX can’t deliver, some developing countries are pulling out entirely or seeking their own private deals. Earlier this month, the tiny Pacific island nation of Palau announced it was abandoning the initiative and would get donated vaccines from the U.S. instead. Other low and middle-income countries, including Malaysia, Peru, and Bangladesh, have stayed in the initiative but also recently inked their own deals with drugmakers as a Plan B.

Anban Pillay of the South African Ministry of Health said that joining COVAX was just a stop-gap measure before signing bilateral deals with pharmaceutical companies.

Kate Elder, vaccines policy adviser at Doctors Without Borders, said “it’s increasingly looking like the ship has sailed on equitable vaccine distribution” — and GAVI, WHO and others need to discuss how to increase vaccine manufacturing.

To that end, South Africa and India have asked the World Trade Organization to waive some provisions regulating intellectual property rights to make it easier for manufacturers in poor countries to make COVID-19 drugs and vaccines. But many rich countries are reluctant to do that.

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As more countries in the West authorize the vaccine, “the difference between people in rich countries getting vaccinated and the lack of any vaccines for the developing world will become quite stark,” said Anna Marriott, health policy manager at Oxfam. “And it will only prolong the pandemic.”

Cheng reported from Toronto. Associated Press writers Cara Anna in Nairobi; Lori Hinnant in Paris; Julhas Alham in Dhaka, Bangladesh; Victoria Milko in Jakarta, Indonesia; Eileen Ng in Kuala Lumpur, Malaysia; and Krishan Francis in Colombo, Sri Lanka, contributed to this report.

On the same day, hospital workers across the country began unloading precious frozen vials of the Pfizer COVID-19 vaccine as the largest vaccination campaign in U.S. history got underway, with the first shots administered to health care workers in New York.

Early supplies are sparse, and health care workers are first in line, not just doctors and nurses but also janitors and other staff. So are nursing home residents. How well initial vaccinations go will help reassure a wary public when it’s their turn sometime next year. Another vaccine candidate, one from Moderna, could be approved by the Food and Drug Administration as soon as the end of the week.

The vaccine campaign is offering hope in the fight against the pandemic that has infected over 16 million in the U.S. alone.

US Ramps Up Vaccination Efforts

Hundreds more U.S. hospitals will begin vaccinating their workers Tuesday as federal health officials review a second COVID-19 shot needed to boost the nation’s largest vaccination campaign.

Packed in dry ice to stay at ultra-frozen temperatures, shipments of Pfizer’s COVID-19 vaccine are set to arrive at 400 additional hospitals and other distribution sites, one day after the nation’s death toll surpassed a staggering 300,000. The first 3 million shots are being strictly rationed to front-line health workers and elder-care patients, with hundreds of millions more shots needed over the coming months to protect most Americans.

In Florida, government officials expect to have 100,000 doses of the vaccine by Tuesday at five hospitals across the state.

Vaccinations were also expected to kick off Tuesday in New Jersey, which is dividing some 76,000 doses among health workers and nursing home residents, NBC New York reports. The federal government is coordinating the massive delivery operation by private shipping and distribution companies based on locations chosen by state governors.

Following another initial set of deliveries Wednesday, officials with the Trump administration’s Operation Warp Speed in Washington said they will begin moving 580 more shipments through the weekend.

NFL Won’t Be Cutting in Line for Coronavirus Vaccine

The NFL won’t be cutting in line to get the coronavirus vaccine.

“No one should be thinking about the vaccine going anywhere other than our first responders and the most vulnerable people right now,” said DeMaurice Smith, executive director of the NFL Players Association.

“We’re in complete harmony with the union in that we feel that it’s vital that frontline healthcare workers and another essential service workers are at the front of the line,” said Dr. Allen Sills, the NFL’s chief medical officer.

“The rollout of the vaccine is going to be driven by public health concerns and what medical and government officials determine to be the most efficacious for risk reduction across society as a whole. We’re prepared to support that effort,” Sills said.

On a recent media conference call, Smith and NFLPA president JC Tretter emphasized that football doesn’t deserve any favors or special treatment when it comes to COVID-19 inoculations.

The NFL will continue spending millions of dollars on daily COVID-19 tests, combined with social distancing and contact tracing to mitigate infections so they can get all 256 regular season games and 13 playoff contests in the books culminating in Super Bowl 55 on Feb. 7 in Tampa, Florida.

Alabama Loosens Licensing Rules for Doctors as Virus Rages

Regulators have loosened rules to make it easier for out-of-state doctors to work in Alabama as the coronavirus pandemic both fills hospital beds and strains medical staff by sickening doctors and nurses, officials said Monday as the first doses of vaccine arrived.

With an average of more than 2,100 people hospitalized daily over the last week with the illness caused by the virus, COVID-19, the Alabama Board of Medical Examiners and the Medical Licensure Commission decided to let qualified physicians from other states and Canada seek temporary emergency licenses to work in the state.

The Alabama Hospital Association has reported staffing shortages caused by both an inadequate number of beds in places and a lack of staff to treat patients, partly because medical workers are among the ill.

Under an emergency rule adopted by regulators during a weekend meeting, doctors licensed in other states or Canada can seek a license to work in an Alabama hospital for 180 days or until Gov. Kay Ivey ends the state’s public health emergency.

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The LA Party Society has been operating without licenses and permits in the downtown Fashion District, prosecutors allege in a lawsuit filed Nov. 25, as well as in defiance of COVID-19 Stay-at-Home orders.

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City Attorney Mike Feuer also said the club is a “hub of violence and crime,” including several shootings over the summer.

“Beyond the bullets, assaults, and criminal activity, packing people into an unlicensed nightclub during the pandemic is the height of irresponsibility,” Feuer said Monday in a news release. “That’s why licensed clubs are closed right now.”

The nuisance abatement lawsuit seeks to permanently shut down the club, which has been operating out of a storefront, as well as prohibit the defendants from using the property as a nightclub in the future.

The lawsuit alleges that the nightclub is advertised as a secret venue on social media and offers pole dancing, music, hookah, performances and a bar. Prosecutors say that while the storefront looks closed, patrons enter through a back door.

The suit names as defendants LA Party Society operator Yves Oscar, Jr., as well as Frontier Holdings East, LLC and Regal Group, LLC, each of which has an ownership interest in the property and are managed by real estate investor David Taban.

They are scheduled to appear in court in April, records show.

It was not immediately clear if Oscar and Taban had attorneys who could speak on their behalf and efforts to reach them were unsuccessful.

“We ask that you immediately reclassify the restaurant industry as critical infrastructure before more damage is done,” the letter says. “As it is becoming obvious to Californians, these essential businesses do more than simply provide a place to eat. Restaurants are active participants in local neighborhoods, providing meals to senior citizens and working with food banks to feed families struggling to put food on their tables.”

The governor’s office did not immediately respond to a request for comment.

The petitioners submitted their letter Friday. The signers were Sens. Patricia Bates, R-Laguna Niguel, and Scott Wilk, R-Lancaster, along with Sens. Melissa Melendez, R-Lake Elsinore, Andreas Borgeas, R-Fresno, Brian Dahle, R- Redding, Shannon Grove, R-Yucca Valley, Melissa Hurtado, D-Hanford, Brian Jones, R-El Cajon, and Jim Nielsen, R-Roseville; Sen.-elect Rosilicie Bogh, R-Rancho Cucamonga, and Assemblywoman Monique Limon, D-Santa Barbara.

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“We urge you, in the strongest possible terms, to reclassify restaurants as essential businesses and adopt the industry’s protocols that would allow restaurants to operate safely,” the letter reads. “The future of thousands of restaurants, their employees and the unique character of our local communities are dependent on the survival of this industry.”

The petitioners pointed out that in 2019, 1.8 million jobs statewide were tied to the restaurant and food service industry. Roughly 60% of eateries are owned by people of color, and 50% are owned or partially owned by women, according to the lawmakers’ letter.

The California Restaurant Association last week prevailed in a case against Los Angeles County related to public health-mandated restaurant closures earlier this year. However, the industry has not filed suit challenging the governor’s decree.

The current closures are connected to Newsom’s limited stay-at-home order issued on Nov. 19, as well as the broader regional order he signed on Dec. 3, citing rapidly escalating coronavirus infection rates.

“The bottom line is, if we don’t act now, our hospital system will be overwhelmed,” he said. “If we don’t act now, we’ll continue to see the death rate climb, more lives lost.”

The 68-year-old co-host of “The Talk” posted the health update to Instagram on Monday, explaining that her ongoing recovery has coincided with a previously planned break for the CBS daytime-chat series. She also pointed out that she is currently quarantining away from husband Ozzy Osbourne, who is 72.

“I wanted to share I’ve tested positive for covid 19,” she wrote. “After a brief hospitalization, I’m now recuperating at a location away from Ozzy (who has tested negative) while The Talk is on scheduled hiatus. Everyone please stay safe and healthy.”

The Instagram account for “The Talk” commented on the post, writing, “Wishing you a speedy recovery, Mrs. O, we love you.”

A number of celebrities shared their well-wishes in the comments, including Carrie Ann Inaba, who posted about her own positive COVID-19 test on Thursday.

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“Love you so much my friend,” the “Dancing With the Stars” judge wrote on Osbourne’s post. “Sending you so much love… and praying for a full recovery.”

Also sharing her support was Nicole Scherzinger, who competed against Osbourne as an opposing judge on two recent seasons of the British version of “The X Factor.”

“Praying for you and love you,” Scherzinger said.

This is not the only recent health concern for “The Osbournes” couple, who tied the knot in July 1982. Ozzy was diagnosed with Parkinson’s disease in February 2019 and opened up about his ongoing battle with the illness earlier this year on “Good Morning America.”

The new program was spearheaded by the Keck Medicine of USC team in partnership with campus operational teams, according to a letter sent to the USC community from Dr. Sarah Van Orman, USC Student Health’s chief health officer and Keck School of Medicine of USC’s division chief for college health.

The polymerase chain reaction test results will be available within 24-48 hours, but a majority of results will be ready on the same day as the test, Orman said, adding that PCR tests are the “gold standard of COVID-19 testing.”

USC is also pursuing innovative solutions to the COVID-19 pandemic.

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“The university is in the process of operationalizing and validating a technology solution for rapid and accurate detection of the virus that causes COVID-19. Data from the validation of this technology is currently under review,” Orman said.

“We hope to share confirmation of this screening system in the next few weeks.”

The university is preparing for a greater density of students, faculty and staff on campus during the spring semester.

The decision extends a modified version of the district’s “no fail” policy of the 2020 spring semester, when schools first closed after the virus outbreak began, the Los Angeles Times reported.

The nation’s second-largest school district said it wants to avoid penalizing students who may be struggling during the public health emergency.

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The Times said the new policy grew out of concerns about the dramatic rise in D and F grades as many schools remain closed and rely on distance-only learning. Many students are coping with is inconsistent or inadequate internet access and an insufficient learning environment at home.

Monday’s directive notes that, compared to last year, grades have deteriorated, especially for “high-need students,” the newspaper reported.

The claim cost the company about $100,000 because the company had temporarily close its facility and have four co-workers quarantine, the U.S. Attorney’s Office for the Northern District of Georgia said.

Santwon Antonio Davis, 35, who was charged in May, pleaded guilty to one count of wire fraud.

Davis “caused unnecessary economic loss to his employer and distress to his coworkers and their families,” Byung J. “BJay” Pak, U.S. attorney for the district, said in a statement.

Read the full story at NBCNews.com.

In the email, confirmed by NBC News, Pichai said the company will test out a “flexible work week” that entails working at least three days a week in the office and other days at home.

“We are testing a hypothesis that a flexible work model will lead to greater productivity, collaboration, and well-being,” Pichai wrote in an email first reported by the New York Times. “No company at our scale has ever created a fully hybrid work force model — though a few are starting to test it — so it will be interesting to try.”

Google isn’t the only tech company to contest the traditional workplace. In October, Microsoft released “Embracing a flexible workplace,” which included more guidance on an adaptable work site, work hours and work location. In May, Facebook CEO Mark Zuckerberg wrote in a Facebook post that the company could have half of all employees working remotely over the next decade. Twitter has said it will offer a permanent work-from-home option for its staffers.

Read the full story at NBCNews.com.

“The number of ICU beds has reached capacity, however, the hospitals themselves have the ability through their surge plans to convert other equipment and beds into ICU beds,” said Riverside University Health System spokesman Jose Arballo.

Arballo said there are currently no plans to open up the county’s two federal medical facilities in Riverside and Indio, although he said the equipment remains stored at the sites if needed.

“We are confident that the hospitals have the ability when they get to this point to be able to add more capability to their facilities,” he said.

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The ICU figure includes both COVID and non-COVID patients.

The aggregate number of coronavirus infections recorded since the public health documentation period began in early March was 119,691 as of Monday, compared to 112,950 on Friday, according to RUHS data. The number of deaths tied to COVID-19 rose to 1,586.

The RUHS reported 930 COVID-positive hospitalizations, up 121 from Friday. The number includes 184 patients being treated in intensive care units, up 14 from Friday. Both are records.

The county does not release updated coronavirus statistics on weekends.

Meanwhile, Riverside County officials announced that they anticipate the first shipments of the Pfizer vaccine to begin arriving in the region on Friday. Officials estimate the county will receive between 14,000 and 15,000 doses. Selected healthcare workers at the county’s acute care hospitals will be the first to receive the vaccine, which has been found to be 95% effective in preventing COVID-19, according to Pfizer and U.S. officials.

The number of known active virus cases countywide is 47,291, an increase of 5,504 compared to Friday. The active count is derived by subtracting deaths and recoveries from the current total — 119,691 — according to the county Executive Office.

The number of verified patient recoveries is 70,814. That figure has previously been underreported due to health officials not being able to confirm the status of patients in follow-up interviews.

Riverside County’s overall state-calculated positivity rate is 14.8%.

The 11-county Southern California region’s available ICU capacity dropped to 2.7% Monday.

The metric is a key indicator for Gov. Gavin Newsom’s “regional stay-at-home” order, which went into effect just before midnight on Dec. 6 locally. The order was triggered when ICU bed availability across Southern California fell below 15%.

The mandate is slated to remain in effect until at least Dec. 28, when regions may be moved out of lockdown if bed capacity has recovered.

It impacts bars, theaters, museums, hair salons, indoor recreational facilities, amusement parks and wineries — all of which are supposed to remain closed. Restaurants are confined to takeout and delivery, with capacity limitations on retail outlets.

The county logged 3,250 COVID-19 new infections, raising the cumulative case total to 105,754.

Hospitalizations jumped from 1,236 Sunday to 1,287, including 288 ICU patients, up from 284 the previous day. Both are new records — a daily occurrence since last week.

The county’s ICU bed availability shrunk from 11.2% Sunday to 9.3% Monday in the unadjusted category, but is at zero for the “adjusted” metric that the state has created to reflect the difference in beds available for COVID-19 patients and non-coronavirus patients.

The Southern California region’s percentage of ICU beds available stands at 2.7%.

No new fatalities were reported Monday in Orange County, leaving the death toll at 1,694. On Sunday, 14 COVID-19 fatalities were reported.

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Last week, the county reported 62 fatalities, up from 41 and 26, respectively, in the two previous weeks.

Prior to this month, the record for ICU patients in Orange was 245 during a mid-July surge. Overall hospitalizations have been breaking records daily since Dec. 2.

Orange County, which had 53% of its ventilators available as of Monday, is awaiting its first shipment of vaccines, expected to arrive Wednesday. About 25,000 doses are expected, according to Orange County CEO Frank Kim.

The county has the necessary deep freezers and dry ice available to store the medicine, he said, noting that frontline hospital workers are expected to be among the first to receive the Pfizer vaccine.

The plan is to use the doses as soon as possible.

“Once it is in, we’re just going to get it all out in 48 hours,” Kim said. “I don’t want to sit on it. The minute it comes in I don’t care what time of day it is, I’ll push it out.”

The outbreak in the jails, which started last week, has escalated to 416 inmates, 37 of whom are newly booked prisoners, said Carrie Braun of the Orange County Sheriff’s Department.

“The vast majority are asymptomatic,” Braun said, adding that most of the infected inmates are housed at the Theo Lacy jail in Orange and the men’s Central Jail in Santa Ana.

Sheriff Don Barnes, who had earlier kept testing restricted to newly booked inmates, anyone showing symptoms, or those exposed to an infected person, will now seek to test everyone in the jails, Braun said. When an inmate tests positive, they are restricted to a single cell in isolated status, and any others exposed are being quarantined together as they await test results, Braun said.

The outbreak recently delayed the murder trial of Austin Ambriz when he tested positive on the eve of closing argument and has also affected an ongoing preliminary hearing involving Johnny Martinez, the reputed leader of Orange County’s chapter of the Mexican Mafia. Cordova has tested positive for COVID-19 and is showing symptoms, according to sources.

Martinez is charged with a murder conspiracy in Placentia along with co-defendants Ysrael Cordova, Augustine Velasquez, Gregory David Munoz and Ricardo Valenzuela.

Joel Garson, one of the attorneys involved in the case, criticized officials for allowing the hearing to continue during the outbreak. Martinez has been placed in quarantine, Garson said, and the three other defendants appeared at a hearing this morning.

“Why wasn’t (Cordova) quarantined when he was exposed?” Garson said. “Then I wouldn’t have to worry and nobody else in the courts either. There were bailiffs dealing with him throughout the day. He probably exposed six or seven people within that six-feet radius and sat in a courtroom with a dozen people most of the day (last week) and I assume they knew he was exposed (to another infected inmate).”

Braun said the sheriff is ordered to bus inmates to court and has attempted to reduce the number on the buses. But since inmates from multiple facilities are housed together in a holding tank at the court, there is going to be mixing of populations, Braun acknowledged.

Meanwhile, Barnes has been ordered by an Orange County Superior Court judge to reduce his jail population by half by Friday, meaning 1,800 inmates could be released to home confinement or ankle-bracelet monitoring or just fully set free. Barnes has said he wants to appeal the ruling, which the county Board of Supervisors is expected to consider at Tuesday’s meeting.

“We need to look at all options if the inmates are released prematurely,'” said Orange County Supervisor Lisa Bartlett. “We need to look out for the health and welfare of our citizens in the county… There are no easy answers here, but first and foremost it is our top priority to make sure we keep our residents of the county safe.”

The county is also dealing with an uptick in outbreaks at skilled nursing and assisted living facilities. As of Monday, 29 skilled nursing facilities have had two or more confirmed cases of COVID-19, and 30 assisted living facilities had two or more cases.

County officials have been asked to provide personal protective equipment, more training or staffing to help curb the spread of COVID-19 in those facilities, where the main reason for the spread is likely from employees who contract the virus off-site, Kim said.

Orange County’s adjusted daily case rate per 100,000 rose Tuesday to 30.3, up from 22.2 last week, with the positivity rate increasing from 8.8% to 10.6%.

The county’s Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 13% last week to 16.2% this week.

All of the county’s metrics now fall within the state’s most-restrictive, purple, tier of the four-tier coronavirus monitoring system.

The conference’s North Division winner, the Washington Huskies, have been pulled from the game due to COVID-19 cases that left the team without enough eligible players to compete, the conference announced Monday.

So now the Trojans will take on the Oregon Ducks, which finished just behind Washington in the North Division. Fifty-three scholarship players are needed, and the Huskies also were below the number required for a specific position requirement.

Washington’s athletic director issued a statement expressing disappointment. The unusual, but not unexpected, development seemed a possibility after Washington had to cancel last week’s game against Oregon.

“I am crushed for our student-athletes, coaches and staff who have worked tirelessly to find a healthy way to compete this season,” UW Athletic Director Jennifer Cohen said in a statement. “Husky student-athletes come to Washington to compete for championships, so this one really hurts for everyone involved — our students, our coaches and our community of loyal Husky fans and alumni. Our football program has battled through adversity all year during these challenging times, and I am so disappointed they won’t have the opportunity to play and represent the University of Washington in the Pac-12 Championship Game Friday night.”

The Trojans (5-0) finished a brief regular season with a comeback win Saturday over UCLA.

The pandemic, though, is a nightmare — one that has now claimed 300,000 lives in the U.S. and counting.

“Wake up, my little girl, wake up!” Palomo’s mother, Maria Palomo Salinas, screamed, her grief echoing through a Harlingen, Texas, hospital, when her daughter died of COVID-19 complications around 2 a.m. on a Saturday in late November.

Palomo was 27 and, as a health care worker, was probably weeks away from getting the new vaccine that could have protected her from the virus. Instead, she became yet another victim of the relentless outbreak whose U.S. toll is accelerating as it eclipses another round-number mark.

“The numbers are staggering — the most impactful respiratory pandemic that we have experienced in over 102 years, since the iconic 1918 Spanish flu,” Dr. Anthony Fauci, the government’s top infectious-disease expert, said days before the U.S. reached the milestone.

The U.S. crossed the 300,000 threshold on the same it day it launched the biggest vaccination campaign in American history, with health care workers rolling up their sleeves for COVID-19 shots Monday.

The death toll was reported by Johns Hopkins University from data supplied by health authorities across the U.S. The real number of lives lost is believed to be much higher, in part because of deaths that were not accurately recorded as coronavirus-related during the early stages of the crisis.

It took four months for the virus to claim its first 100,000 American lives. But with cold weather driving people inside, where the virus spreads more easily, months of reluctance in many states to require masks, and an increase in gatherings over the holidays, some public health experts project 100,000 more could die before the end of January.

“It can certainly feel like you’re standing on the beach and sandbagging a tsunami,” said Dr. Leon Kelly, who attends to both the dead and the living as coroner for El Paso County, Colorado, and deputy medical director of its public health department.

Already, the number of dead in the U.S. rivals the population of St. Louis or Pittsburgh. The toll is equivalent to repeating a tragedy on the scale of Hurricane Katrina every day for 5 1/2 months.

“To me it represents an extraordinary failure in our response,” said Jennifer Nuzzo, a public health researcher at Johns Hopkins, contrasting U.S. officials’ scattershot response with the massive mobilization after nearly 3,000 Americans were killed in the 9/11 terrorist attacks.

“To think, now we can just absorb in our country 3,000 deaths a day as though it were just business as usual. It just represents a moral failing.”

The U.S. accounts for nearly 1 out of 5 confirmed virus deaths worldwide, far more than any other country despite its wealth and medical resources.

While the pandemic’s toll continues to soar, much has changed since the U.S. surpassed 200,000 deaths in late September.

Scientists’ furious pursuit of a vaccine is finally delivering results, beginning with the rollout of Pfizer’s formula. If a second vaccine is authorized soon, as expected, 20 million people could be vaccinated by month’s end.

At the same time, the country is poised for a major shift after an election that was, in large part, a referendum on the Trump administration’s handling of the virus. President-elect Joe Biden has made clear his first priority upon taking office next month will be a comprehensive overhaul of efforts to defeat the infection.

Still, experts said, it could take well into the new year for the first wave of vaccines and other precautions to bring cases and deaths under control. Experts are warning the country must steel itself for a deadly winter.

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“We are heading into probably the worst period possible because of all the things we had in the spring, which is fatigue, political resistance, maybe the loss of all the good will we had about people doing their part,” Nuzzo said.

More than 109,000 people with the virus are now in U.S. hospitals, according to the COVID Tracking Project, far eclipsing the 60,000 who filled wards during the previous peaks in April and July.

On a single day last week, the U.S. recorded more than 3,300 COVID-19 deaths, easily exceeding the heights reached in April, when the New York City area was the epicenter.

Doctors now have far more experience in treating patients, and a few drugs have been approved to speed recovery. But the toll now is far more widespread, reaching into rural areas and small and medium-size communities that don’t have big-city resources.

In Waterloo, Iowa, Dr. Stacey Marlow called the wife of an 89-year-old COVID-19 patient in his final hours, not realizing until well into the conversation that the couple’s son had also died of the virus in her hospital just two days earlier.

“We see these horror stories every day so they start to run together,” said Marlow, who works in the emergency room at UnityPoint Allen Hospital.

In Los Angeles, the county’s health director, Barbara Ferrer, fought tears during a televised briefing last week as she reported a steep rise in local deaths, up to an average of 43 each day, compared with roughly a dozen in mid-November.

“Over 8,000 people who were beloved members of their families are not coming back,” Ferrer said.

In Columbia, South Carolina, the family of a third-grade teacher, Staci Blakely, asked the school district to announce her death in hopes of persuading the public to take the virus seriously.

“One of the ways we can celebrate her life is being sure that we continue to take care of each other,” schools Superintendent Greg Little said.

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And then there are the families and colleagues of health care workers who are still being lost to COVID-19, even as hope draws within view.

For weeks now, Dr. James Williams has been hearing the voice of his friend Dr. Juan Fitz, an emergency room physician in Lubbock, Texas, who was hospitalized for the virus this fall after months of triaging COVID-19 patients.

“I am airborne. I am cavalry,” the 67-year-old Fitz said over the summer, describing his role in taking on the pandemic. “I go into the thick of it and, challenged by the situation, find ways to improve and sort things out.”

He died on Nov. 3.

“I’m sorry, it still gets me,” a distraught Williams said Friday, hours before the first vaccine won approval. Choking back tears, he recalled his last text message to Fitz, one the soldier-in-scrubs never answered.

Please know, he wrote, “you have an Army of friends and colleagues pulling for you.”

___

Associated Press writers Jeffrey Collins in Columbia, South Carolina, and Christopher Weber in Los Angeles contributed to this story.

Los Angeles Unified School District campuses would be an ideal setting for administering COVID-19 vaccines to students and their families, Superintendent Austin Beutner said Monday, while again imploring elected officials to provide financial support for schools to prepare for an eventual return to in-person instruction.

Noting that more than 230,000 COVID-19 tests have been conducted on school campuses, Beutner said the campuses are geographically positioned to provide access to the vaccine — first to essential school workers and eventually to students and families.

“The country faces an enormous challenge in making sure the vaccine is made available to essential workers, like the staff who work in our schools as well as those who have been most impacted by the virus: low-income communities of color like those served by our schools,” Beutner said in an address to the school community. “Health experts will need to answer the question of how to provide
people with access to the vaccine, including shipping and distributing the vaccine, and training clinical staff to properly administer it.

“Schools may be a good answer to the question of where the vaccine can best be
provided.”

Beutner said LAUSD is organized around 42 groupings of schools that each serve a local community. Within each community, there are several hundred thousand people, he said.

Coronavirus Deaths in Your City and State — and Across the US

These charts use daily coronavirus death data from Johns Hopkins University to show the seven-day moving average of deaths at the city, state and country level.

The impact of coronavirus varies enormously in the United States from one place to another.

Source: Johns Hopkins University.
Credit: Visuals by Amy O’Kruk/NBC, data analysis by Ron Campbell/NBC

“It makes sense to provide the vaccine to students and their families at a place they trust, where they are almost every day — their local neighborhood school,” he said.

Beutner and the top school administrators in New York and Chicago had an op-ed in The Washington Post over the weekend, repeating Beutner’s call for a “Marshall Plan” — the coordinated relief effort for Western Europe following World War II — for supporting schools as they look to return to in-person instruction once the pandemic eases.

Beutner said there has been a great deal of attention to the pandemic’s impact on hospitals, emergency rooms, businesses and the overall economy.

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“There’s not been enough media coverage or attention paid to the plight of children during this crisis,” he said. “Not just their struggles with online education, but the impact this is having on their social and emotional wellbeing. This issue too is very real. There’s an old saying: `Just because you can’t measure something, doesn’t mean it’s not important.’ This is even more important when it comes to children. Their wellness can’t be easily measured. They lack voice in the conversation … but their needs are very real.”

Beutner shared a bit of good news amid the pandemic, saying the Class of 2020 had a record-high graduation rate of 82.9%, something he called a remarkable accomplishment. But he stressed that the ongoing pandemic and issues with online learning will impact future graduation rates.

This week, the Department of Health and Human Services is expected to send out 2.9 million doses of the Pfizer vaccine, and “we hope we will see as much of that used as humanly possible this week,” secretary Alex Azar told NBC News’ “TODAY” on Monday.

“We know we have the vaccine available to get to 20 million people by the end of December and then a total of 50 million by the end of January,” Azar said.

Under the CARES Act, the COVID-19 vaccine will be free to anyone who wants it, but providers will be able to charge an administration fee (which is covered by health insurance) for giving the shot to someone.

Wondering what this means for when you can get vaccinated? Here’s what we know so far:

Who gets the vaccine first and when?

States will receive these first doses based on their population, and governors will then determine how to distribute the vaccine.

But healthcare personnel and long-term care facility residents should receive the vaccine first, according to the Advisory Committee on Immunization Practices, the independent panel of medical and public health experts that’s responsible for coordinating vaccine distribution.

“Healthcare personnel” includes all paid and unpaid people who work in healthcare settings and are at greater risk of exposure to COVID-19 patients or infected substances, according to the CDC. This group includes everyone from physicians to medical students, maintenance staff in hospitals to home aides and more.

People who live in long-term care facilities, such as nursing homes and assisted living facilities, are priority because older adults are at a greater risk of requiring hospitalization or dying from COVID-19.

“Between now and the end of December, you would likely get a substantial proportion of health care providers and people in your nursing homes [vaccinated],” Dr. Anthony Fauci, the nation’s leading expert on infectious diseases told New York Gov. Andrew Cuomo on Dec. 8.

The vaccines are distributed to hospitals and long-term care facilities (where CVS and Walgreens will administer the vaccinations to residents and staff).

Those who are 65 and older are also recommended to get the vaccine early if supplies are limited. And other groups that could get vaccinated early next year include essential workers and people who have underlying conditions that put them at greater risk of severe illness from COVID-19, including cancer, kidney disease, heart conditions and type 2 diabetes.

As vaccinations become more widely available, the ACIP will release additional recommendations for distributing vaccines to priority groups.

The general population

Vaccines could be available in pharmacies and supermarkets as soon as late February and into March, Azar said Monday.

And according to Fauci, adults who don’t have underlying health conditions and who are not essential healthcare workers will be able to “walk in to a CVS or to a Walgreens and get vaccinated” with their first shot by April, he said during an interview with Facebook CEO Mark Zuckerberg on Nov. 30.

The COVID vaccines in the works are considered “prime-boost immunization,” because they require two shots scheduled 28 days apart. While the first injection provides some protection, it peaks seven to 10 days after the second injection is administered, Fauci said. (People will receive a vaccination card that serves as a reminder for when they are due to get the second injection, and includes information about where and when you received the vaccination.)

“If we do that well, by the time we get into the core of the summer and get to the end of the summer and into the start of the third quarter of 2021, we should be in good shape,” he said.

Fauci has said that 75%-85% of Americans need to get the vaccine in order to achieve herd immunity. 

Pregnant people and children

Pregnant people and children were excluded from both Pfizer and Moderna’s clinical trials, so it’s not clear whether these vaccines are safe for these groups.

Studies on COVID-19 vaccines for pregnant people and children will likely begin in mid-January, Fauci said at Columbia University’s Grand Rounds 2020 event Thursday.

Moderna’s vaccine is still under review by the FDA, but is expected to be ready by late December.  

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“I feel hopeful today. Relieved,” critical care nurse Sandra Lindsay said after getting a shot in the arm at Long Island Jewish Medical Center in New York.

With a countdown of “3-2-1,” workers at Ohio State University’s Wexner Medical Center gave the first injections to applause.

And in New Orleans, Steven Lee, an intensive care unit pharmacist at Ochsner Medical Center, summed up the moment as he got his own vaccination: “We can finally prevent the disease as opposed to treating it.”

Other hospitals around the country, from Rhode Island to Texas, unloaded precious frozen vials of vaccine made by Pfizer Inc. and its German partner BioNTech, with staggered deliveries set throughout the day and Tuesday. A few other countries have authorized the vaccine, including Britain, which started vaccinating people last week, and Canada, which began doing so on Monday.

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For health care workers, who along with nursing home residents will be first in line for vaccination, hope is tempered by grief and the sheer exhaustion of months spent battling a coronavirus that still is surging in the U.S. and around the world.

“This is mile 24 of a marathon. People are fatigued. But we also recognize that this end is in sight,” said Dr. Chris Dale of Swedish Health Services in Seattle.

Packed in dry ice to stay at ultra-frozen temperatures, the first of nearly 3 million dosesbeing shipped are a down payment on the amount needed. More of the Pfizer-BioNTech vaccine will arrive each week. And later this week, the FDA will decide whether to green-light the world’s second rigorously studied COVID-19 vaccine, made by Moderna Inc.

While the U.S. hopes for enough of both vaccines together to vaccinate 20 million people by the end of the month, there won’t be enough for the average person to get a shot until spring.

“This is the light at the end of the tunnel. But it’s a long tunnel,” New York Gov. Andrew Cuomo said.

Now the hurdle is to rapidly get vaccine into the arms of millions, not just doctors and nurses but other at-risk health workers such as janitors and food handlers — and then deliver a second dose three weeks later.

“We’re also in the middle of a surge, and it’s the holidays, and our health care workers have been working at an extraordinary pace,” said Sue Mashni, chief pharmacy officer at Mount Sinai Health System in New York City.

Plus, the shots can cause temporary fever, fatigue and aches as they rev up people’s immune systems, forcing hospitals to stagger employee vaccinations.

A wary public will be watching closely to see whether health workers embrace vaccinations. Just half of Americans say they want to get vaccinated, while about a quarter don’t and the rest are unsure, according to a recent pollby The Associated Press-NORC Center for Public Health Research.

The FDA, considered the world’s strictest medical regulator, said the Pfizer-BioNTech vaccine, which was developed at breakneck speed less than a year after the virus was identified, appears safe and strongly protective, and it laid out the data in a daylong public meeting last week for scientists and consumers alike to see.

“Please, people, when you look back in a year and you say to yourself, ‘Did I do the right thing?’ I hope you’ll be able to say, ‘Yes, because I looked at the evidence,’” Dr. Francis Collins, director of the National Institutes of Health, said Sunday on NBC’s “Meet the Press.” “People are dying right now. How could you possibly say, ‘Let’s wait and see’?”

Still, in winning approval for widespread emergency use, the vaccine was cleared before a final study in nearly 44,000 people was complete. That research is continuing to try to answer additional questions.

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For example, while the vaccine is effective at preventing COVID-19 illness, it is not clear if it will stop the symptomless spread that accounts for half of all cases.

The shots still must be studied in children and during pregnancy. But the American College of Obstetricians and Gynecologists said Sunday that vaccination should not be withheld from pregnant women who otherwise would qualify.

Also, regulators in Britain are investigating a few severe allergic reactions. The FDA instructed providers not to give the vaccine to those with a known history of severe allergic reactions to any of its ingredients.

___

Associated Press writers Marion Renault, Andrew Welsh-Huggins, Tamara Lush and Kathy Young contributed to this report.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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Pfizer CEO Albert Bourla hasn’t received his company’s Covid-19 vaccine shot yet, saying Monday he and other executives will not “cut the line” as U.S. officials kick off a massive effort to distribute the vaccine across the country.

The vaccine, which Pfizer developed in partnership with Germany-based BioNTech, is the first approved for emergency use in the U.S. to prevent Covid-19. The Food and Drug Administration on Friday authorized the vaccine for use in people 16 and older, and the Centers for Disease Control and Prevention on Sunday officially recommended its use.

However, there are limited doses available and as such, the CDC has recommended states prioritize health-care workers and long-term care residents for initial distribution.

While Bourla’s company developed the vaccine, he is not a frontline health-care worker himself. He said he’s also 59 and in relatively good health, so it’s not entirely appropriate for him to receive the vaccine before other people who need it more. If he was vaccinated on camera, he said it might help increase the public’s willingness to receive it, citing Pfizer’s internal research. But he emphasized that “none of the executives and board members will cut the line.”

Bourla also urged Americans to “trust science” and encouraged people to get vaccinated when appropriate, based on their age and occupation.

“This is a vaccine that was developed without cutting corners from a company with 171 years of credentials,” Bourla said Monday on “Squawk Box.” “This is a vaccine that was developed in the spotlight, in the daylight, with all the data being put in a server.”

Bourla’s comments come as the first deliveries of doses are set to arrive at more than 100 of the country’s 636 pre-determined distribution sites. Some frontline health-care workers are due to be vaccinated as soon as Monday morning and vaccination is set to begin among long-term care residents next week, according to Operation Warp Speed officials.

It’s a monumental logistical challenge. The federal government has partnered with UPS, FedEx, McKesson, CVS, Walgreens, among others, to help distribute the vaccine and actually administer it. But state immunization officials have warned that the so-called last-mile delivery of the vaccine will be the most challenging, and states are largely responsible for that effort. State officials have repeatedly called on the federal government to provide more funding to hasten the effort.

The vaccine could not arrive soon enough. The U.S. is approaching the heart-wrenching milestone of 300,000 deaths caused by Covid-19. Top U.S. health officials, including CDC Director Dr. Robert Redfield, have warned that the rate of death is unlikely to slow for months, even as a vaccine is rolled out. That’s because the U.S. doesn’t have enough doses to broadly vaccine throughout the population of 331 million Americans, and needs to prioritize the country’s most vulnerable and essential.

Alex Azar, secretary of the Department of Health and Human Services, which has partnered with the Department of Defense to run Operation Warp Speed, said Monday on the “TODAY” show that the general population could begin getting vaccinations by the end of February or early March. Dr. Celine Gounder, a member of President-elect Joe Biden’s Covid-19 advisory board, later Monday called it a “fairly optimistic timeline” on CNN.

A few meters ahead, nearly invisible in the darkness, a bat made high-pitched squeaks as it strained its wings against the thin nylon net that had ensnared it. One of the researchers removed the bat, which used its pointed teeth to bite her gloved fingers.

The November nighttime outing was part of a project at Brazil’s state-run Fiocruz Institute to collect and study viruses present in wild animals — including bats, which many scientists believe were linked to the outbreak of COVID-19.

The goal now is to identify other viruses that may be highly contagious and lethal in humans, and to use that information to devise plans to stop them from ever infecting people — to forestall the next potential global disease outbreak before it gets started.

In a highly connected world, an outbreak in one place endangers the entire globe, just as the coronavirus did. And the Brazilian team is just one among many worldwide racing to minimize the risk of a second pandemic this century.

To some, it might seem too soon to contemplate the next global outbreak, with the world still grappling with the devastating fallout of the ongoing one. But scientists say it’s highly like that, without savvy intervention, another novel virus will jump from animal to human host and find the conditions to spread like wildfire.

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As this pandemic has shown, modern transport can disperse the pathogen to all corners of the globe in a matter of hours and spread easily in densely populated cities.

It’s not a question of if, but of when, according to Dr. Gagandeep Kang, an infectious diseases expert at Christian Medical College at Vellore in southern India.

She pointed to previous research that found India was among the most likely places in the world for such a “spillover” event to occur, due to population density and increasing human and livestock incursion into its dense tropical forests teeming with wildlife.

It’s no coincidence that many scientists are focusing attention on the world’s only flying mammals — bats.

Bats are thought to be the original or intermediary hosts for multiple viruses that have spawned recent epidemics, including COVID-19, SARS, MERS, Ebola, Nipah virus, Hendra virus and Marburg virus. A 2019 study found that of viruses originating from the five most common mammalian sources — primates, rodents, carnivores, ungulates and bats — those from bats are the most virulent in humans.

Bats are a diverse group, with more than 1,400 species flitting across every continent except Antarctica. But what many have in common are adaptations that allow them to carry viruses that are deadly in humans and livestock while exhibiting minimal symptoms themselves — meaning they are able to travel and shed those viruses, instead of being quickly hobbled.

“The secret is that bats have unusual immune systems, and that’s related to their ability to fly,” said Raina Plowright, an epidemiologist who studies bats at Montana State University.

To get off the ground and sustain flight requires an incredible amount of energy, with bats’ metabolic rate increasing sixteen-fold, Plowright said. “You’d expect them to get cell damage from all that metabolic exertion,” she said.

But that doesn’t happen. Instead, bats are remarkably resilient, with many species living more than 30 years — highly unusual for such small mammals.

Plowright and other bat scientists believe evolutionary tweaks that help bats recover from the stress of flying also give them extra protection against pathogens.

“Bats seem to have evolved a collateral benefit of flight — resistance to deal with some of the nastiest viruses known to science,” said Arinjay Banerjee, a virologist at McMaster University in Canada.

While scientists are still untangling the mystery, two leading theories are that bats may have evolved what Banerjee called “an efficient DNA repair mechanism” or that their bodies may tightly regulate inflammation triggers and not overreact to viral infections.

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Probing the secrets of bat immune systems may help scientists understand more about when bats do shed viruses, as well as providing hints for possible future medical treatment strategies, he said.

Bats and other animals that carry pathogens don’t innately pose a risk to humans — unless conditions are right for a spillover event. “The virus has to come out of the host for us to get infected,” said Cara Brook, a disease ecologist at the University of California, Berkeley.

The bad news: Increasing destruction and fragmentation of habitats worldwide — especially biodiverse areas like tropical forests — means “we are seeing higher rates of contact between wildlife and humans, creating more opportunities for spillover,” she said.

That’s why the Brazilian researchers chose Pedra Branca park. As one of the world’s largest forests within an urban area, it offers a constant interaction of wild animals with the thousands of humans and domestic animals in surrounding communities. The scientists are studying not just bats, but also small primates, wild cats and domestic cats in homes with confirmed COVID-19 cases.

Scientists and governments would stand a better chance at containing future outbreaks if they had faster notice of when and where they begin, said Ian Mackay, a virologist at Australia’s University of Queensland.

“Ongoing, constant, nonstop surveillance,” along the lines of the flu labs set up by the World Health Organization across the globe, could help researchers be better prepared, he said. He also suggested that labs for virus discovery could regularly sample waste water or materials from hospitals.

In India, a National Mission on Biodiversity and Human Well-Being has been pending since 2018 and will likely be launched next year. Abi Tamim Vanak, a conservation scientist at Ashok Trust for Research in Ecology and Environment in Bengaluru, said that a core part of the plan is to set up 25 sentinel surveillance sites across the country in both rural and urban areas.

“They will be the first line of defense,” he said.

A varied patchwork of virus surveillance programs exists in several countries, but funding tends to wax and wane with the political climate and sense of urgency.

Among the most ambitious endeavors is the Global Virome Project, which aims to discover 500,000 new viruses over 10 years.

The U.S. Agency for International Development recently announced the launch of the $100 million STOP Spillover project, an effort led by scientists at Tufts University and including global partners to study zoonotic diseases in Africa and Asia.

One approach that won’t help, scientists say, is treating bats as the enemy – vilifying them, throwing stones or trying to burn them out of caves.

This spring, villagers in the Indian state of Rajasthan identified bat colonies in abandoned forts and palaces and killed hundreds with bats and sticks. They also sealed some crevices where the bats lived, effectively trapping them. In the Indian state of Karnataka, villagers cut down old trees where bats tend to roost.

Scientists say those those tactics are likely to backfire.

An investigation by the U.S. Centers for Disease Control and Prevention and Ugandan health authorities found that, after a mining operation attempted to exterminate bats from a cave in Uganda, the remaining bats exhibited higher infection levels of Marburg virus. This led to Uganda’s most severe outbreak of Marburg hemorrhagic fever, caused by the virus, in 2012.

“Stress is a huge factor in upsetting the natural balance that bats have with their viruses — the more you stress bats, the more they shed viruses,” said Vikram Misra, a virologist at the University of Saskatchewan in Canada.

Although orders issued by Indian forest officials reiterating the complete ban on killing of wildlife and information campaigns to dispel myths were largely successful, convincing people not to attack bats means dispelling long-running cultural assumptions.

“People have a lot of misconceptions about bats. They’re nocturnal and look a little weird flying, and there’s a lot of literature and culture built around bats being scary,” said Hannah Kim Frank, a biologist at Tulane University. “But bats aren’t aggressive — and attacking bats doesn’t help control diseases.”

Bats also play vital roles in ecosystems: They consume insects like mosquitos, pollinate plants like agave, and disperse seeds.

“We actually need bats in the wild to consume insects that otherwise destroy cotton, corn and pecan harvests,” said Kristen Lear, an ecologist at Bat Conservational International.

A better approach to minimize disease risk, Frank said, is simply to minimize contact between wild bats and people and livestock.

She suggested that research on when bats migrate, and when new pups are born, could inform decisions about when people should avoid certain areas or keep their livestock penned up.

In North America, some scientists advocate restricting public access to caves where bats roost.

“Cave gating — bat-friendly gates, built with iron crossbars — can keep humans out and allow bats to move freely,” said Kate Langwig, an infectious disease ecologist at Virginia Tech. “If we leave the bats alone, and don’t try to hurt or exterminate them, they are going to be healthier.”

Perhaps the most significant factor bringing bats into more frequent contact with people and domestic animals is the destruction of habitat, which forces bats to seek out new foraging and roosting grounds.

In Australia, widespread destruction of winter flowering eucalyptus trees that provide nectar for fruit bats — known locally as “flying foxes” — prompted the bats to move into areas closer to human settlements looking for alternate meals, including to a suburb of Brisbane called Hendra.

There, the bats transmitted a virus to horses, which in turn infected people. First identified in 1994 and named Hendra virus, it is highly lethal, killing 60% of people and 75% of horses infected.

A similar chain of events took place in Bangladesh, when habitat destruction drove fruit bats into cities, where they spread Nipah virus,which causes severe encephalitis in humans, by licking date palm sapfrom collection barrels.

To potentially reverse the movement of bats, Montana State University’s Plowright and colleagues based in Australia are studying restoring the bats’ original habitat.

“Every city in Australia is full of fruit bats that lost their winter habitats,” she said. “The idea is to plant new forests and make sure they are away from places with domestic animals and people.”

Whether the goal is to curb the spread of known zoonotic diseases or to reduce the risk of new ones emerging as pandemics, the strategy is the same: Reduce contact between humans and wild animals.

“In the history of COVID-19, bats have been more victim than victimizer,” said Ricardo Moratelli, coordinator of the Fiocruz project in Brazil. “Bats host a large number of parasites, and they deal with these parasites well. The problem is when human beings enter into contact with them.”

—-

Larson reported from Washington. Silva de Sousa reported from Rio de Janeiro. Ghosal reported from New Delhi.

—-

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Hospital workers across the country began unloading precious frozen vials of the COVID-19 vaccine Monday as the largest vaccination campaign in U.S. history got underway, with the first shots administered to health care workers in New York.

Early supplies are sparse, and health care workers are first in line, not just doctors and nurses but also janitors and other staff. So are nursing home residents. How well initial vaccinations go will help reassure a wary public when it’s their turn sometime next year.

Still, the vaccine is offering hope in the fight against the pandemic that has killed more than 300,000 and infected over 16 million in the U.S. alone.

US Coronavirus Death Toll Surpasses 300,000

The U.S. surpassed the once-unthinkable threshold of 300,000 COVID-19 deaths Monday, according to an NBC News tally.

The grim milestone was reached on the same day health care workers across the country began receiving the first shots of Pfizer’s coronavirus vaccine. There have been more than 16.4 million confirmed cases of the deadly virus in the U.S. since the pandemic began earlier in the year.

A recent surge in transmissions has led to record-breaking numbers of hospitalizations and deaths over the last two weeks, with an average of more than 210,000 new infections and nearly 2,500 deaths a day this month.

A record of more than 109,000 people were in the hospital in the U.S. with COVID-19 as of Monday, according to the COVID Tracking Project.

Nursing Homes Face Vaccine Fears

After 110,000 deaths ravaged the nation’s nursing homes and pushed them to the front of the vaccine line, they now face a vexing problem: Skeptical residents and workers balking at getting the shots.

Being first has come with persistent fears that the places hit hardest in the pandemic — accounting for nearly 40% of the nation’s death toll — could be put at risk again by vaccines sped into development in months rather than years. Some who live and work in homes question if enough testing was done on the elderly, if enough is known of side effects and if the shots could do more harm than good.

Internal surveys by groups including the American Nurses Foundation suggest many workers in long-term care facilities are so concerned about the vaccine they would refuse it.

Christina Chiger, a 33-year-veteran nurse’s aide at a nursing home in Tampa, Florida, is exhausted and frightened after a relentless nine months that left two dozen residents dead and made 16-hour shifts common. But she has no plans to take the vaccine, for now at least.

“Will there be side effects? Will it actually work?” she asked. “If we all get sick from taking this, who’s going to take care of our patients?”

Cultural issues could also be at play. People of color make up a majority of aides and other frontline workers in nursing homes, and some minorities express mistrust of medicine that experts see linked with past abuses.

A poll released last week by The Associated Press-NORC Center for Public Affairs Research found Black and Hispanic people in the U.S. are far less likely than white people to agree to be vaccinated. Some 53% of whites said they would get the shots, compared with 24% of Blacks and 34% of Hispanics.

First COVID Vaccine Shots Administered to US Health Workers

A critical care nurse at the Long Island Jewish Medical Center in Queens received the first shot of Pfizer’s COVID-19 vaccine in the state of New York, and reportedly first in the nation.

Northwell Health, the state’s largest healthcare provider, began vaccinating workers Monday. The first shot went to critical care nurse Sandra Lindsay, who received the vaccine just after 9:20 a.m. ET during a livestreamed event with gov. Andrew Cuomo.

“I feel hopeful today. Relieved,” said Lindsay.

FedEx Completes First Deliveries of Pfizer and BioNTech’s COVID Vaccine

FedEx announced in a tweet Monday that it has “safely” completed its first deliveries of the Pfizer and BioNTech COVID-19 vaccine.

“We’re honored to be able to use our network to transport these critical vaccines in the U.S., and eventually the world,” the shipping giant posted just before 7 a.m. on its official Twitter account.

The first inoculations of Pfizer’s vaccine could come as soon as Monday, with healthcare workers and nursing home residents first in line.

Trump Says He’s Nixing Plans for Early Vaccine at White House

President Donald Trump says he’s reversing an administration directive to vaccinate top government officials against COVID-19 while public distribution of the shot is limited to front-line health workers and people in nursing homes and long-term care facilities.

Trump made the announcement in a tweet Sunday night, hours after his administration confirmed that senior U.S. officials, including some White House aides who work in close proximity to Trump and Vice President Mike Pence, would be offered coronavirus vaccines as soon as this week under federal continuity of government plans.

“People working in the White House should receive the vaccine somewhat later in the program, unless specifically necessary,” Trump said in a tweet. “I have asked that this adjustment be made. I am not scheduled to take the vaccine, but look forward to doing so at the appropriate time.”

It was not immediately clear what effect Trump’s tweet would have on the government’s efforts to protect top leadership.

Los Angeles, San Francisco Counties Break COVID-19 Records

Los Angeles County again broke a record for coronavirus hospitalizations this weekend as San Francisco County reported the highest number of COVID-19 cases since the pandemic began.

Statewide, more than 30,000 confirmed coronavirus cases were reported Sunday.

In San Francisco County, health officials reported 323 new cases on Saturday. In Los Angeles County, the nation’s most populous, officials said on Sunday that more than 4,000 people were hospitalized for COVID-19. The record-breaking figures in Los Angeles and San Francisco counties come as more than 325,000 doses of a COVID-19 vaccine are on their way to California. Millions of residents in the majority of the state are under stay-at-home orders.

CORRECTION (Dec. 14, 11:13 p.m. ET): An earlier version of this story reported a daily record for COVID-19 cases had been set on Monday, based on an NBC News tally. NBC News later reported a daily record had not been set.

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An advisory committee of the Centers for Disease Control and Prevention has recommended that top priority goes to long-term care facilities and front-line health care workers, but the early allocation was always expected to fall far short of the need and to require selective screening even among critical hospital workers.

Hospitals in general are advised to target the members of their workforces at highest risk, but the institutions are left on their own to decide exactly who that will be, Colin Milligan, a spokesperson for the American Hospital Association, said by email.

“It is clear that the hospitals will not receive enough in the first weeks to vaccinate everyone on their staff, so decisions had to be made,” Milligan wrote.

Read the full story at NBCNews.com

Being first has come with persistent fears that the places hit hardest in the pandemic — accounting for nearly 40% of the nation’s death toll — could be put at risk again by vaccines sped into development in months rather than years. Some who live and work in homes question if enough testing was done on the elderly, if enough is known of side effects and if the shots could do more harm than good.

“You go get that first and let me know how you feel,” said Denise Schwartz, whose 84-year-old mother lives at an assisted living facility in East Northport, New York, and plans to decline the vaccine. “Obviously it would be horrible for her to get COVID, but is it totally safe for someone who’s elderly and in fragile health?”

As the U.S. begins shipping out freezer-packed vials of newly approved vaccine from Pfizer and its German partner BioNTech, public health officials say the answer is yes.

Everyone from members of the military to former presidents have announced their intentions to get the shots, echoing the refrains of others who say the drugs are the product of rigorous review, firm data and independent experts.

In an ongoing study of nearly 44,000 people, the U.S. Food and Drug Administration found the vaccine was safe and more than 90% effective across recipients of different ages, including older adults and those with health problems that put them at high risk of COVID-19.

But the undercurrent of doubt in nursing homes persists, sometimes fueled by divisive politics, distrust of institutions and misinformation. And so far, the workers are the ones being heard the loudest.

“Folks are concerned about it, that it was rushed through by people who were not listening to the science,” said Denise Allegretti, a director at 1999 SEIU, the nation’s largest healthcare worker union.

Internal surveys by groups including the American Nurses Foundation suggest many workers in long-term care facilities are so concerned about the vaccine they would refuse it.

Christina Chiger, a 33-year-veteran nurse’s aide at a nursing home in Tampa, Florida, is exhausted and frightened after a relentless nine months that left two dozen residents dead and made 16-hour shifts common. But she has no plans to take the vaccine, for now at least.

“Will there be side effects? Will it actually work?” she asked. “If we all get sick from taking this, who’s going to take care of our patients?”

Resistance to the vaccine in nursing homes is not entirely unexpected — about 3 in 10 staffers, and 2 in 10 residents were not vaccinated for the flu last year, for example — but it’s no less worrisome.

Given how easily COVID-19 spreads, particularly in communal settings, experts believe around 70% of the population will need to receive the vaccine for it to be successful.

“Nursing home staff has always been a challenge to vaccinate,” said Litjen Tan, chief strategist at the advocacy group Immunization Action Coalition. “We’re cutting it close.”

Cultural issues could also be at play. People of color make up a majority of aides and other frontline workers in nursing homes, and some minorities express mistrust of medicine that experts see linked with past abuses.

A poll released last week by The Associated Press-NORC Center for Public Affairs Research found Black and Hispanic people in the U.S. are far less likely than white people to agree to be vaccinated. Some 53% of whites said they would get the shots, compared with 24% of Blacks and 34% of Hispanics.

The AP-NORC poll also found women were less likely than men to say they would be vaccinated. An estimated 9 in 10 front-line nursing home workers are women. Overall, about a quarter of U.S. adults said they would refuse to get a vaccine, and another quarter said they weren’t sure.

“They don’t trust it. They don’t trust the science,” said Lori Porter, who heads the National Association of Health Care Assistants and blames the Trump administration for making faith in science a political issue and undermining his own experts. “There’s so much misinformation that has circled over this pandemic this whole year that they don’t feel they can trust anyone.”

The federal government is seeking to blunt such attitudes with a $250 million ad campaign set to roll out this week that will eventually target healthcare workers and vulnerable groups. The pitch touts how vaccines will help beat COVID-19 the same way they defeated smallpox, measles and polio.

“One of the great triumphs of medical science … has been vaccinations,” Anthony Fauci, the top U.S. infectious disease scientist, said in one video.

The American Health Care Association, which represents nursing homes, has called for every resident and staff member to get both vaccine doses by March 1, even though it expects no federal or state mandates requiring shots.

“Our hope is that we get widespread acceptance of the vaccine,” said AHCA’s president, Mark Parkinson. “But if we don’t, I assure you that our organization as well as individual operators will be analyzing whether or not they can mandate the vaccine. We’re just hoping that we don’t have to go there.”

John Sauer, head of the Wisconsin branch of LeadingAge, which represents non-profit long-term care facilities, said the misery most residents and workers have already witnessed should be all the convincing they need. “They know that this could literally be a life-and-death situation.”

No reliable gauges of nursing home residents’ opinion on the coronavirus vaccine have emerged. Among older adults in general, the AP-NORC poll found greater acceptance of the vaccine than among younger people.

But fears persist among many older people, over the possibility of bad interactions for people already on a long list of drugs, or of undiscovered problems specific to their age group.

As with many vaccines, the drug companies say recipients may experience fever, fatigue or sore arms from the injection. Authorities are investigating several allergic reactions reported in Britain by health workers with a history of severe allergies.

Penelope Ann Shaw, a 77-year-old nursing home resident in Braintree, Massachusetts, said she plans to refuse the vaccine, as she does with annual flu shots, because of drug allergies and her concerns about how little is known about the new coronavirus drugs.

“For me, I think it’s a little premature,” said Shaw, who has Guillain-Barre syndrome, an immune system disorder, and was the lone long-term care resident to serve on the federal Coronavirus Commission for Safety and Quality in Nursing Homes. “You’re not doing it with me.”

After a year in which many facilities have walled off to the world, crippling some residents in isolation, and leading to medical declines and deaths in others, some need no convincing.

Among them is 85-year-old Harriet Krakowsky, a resident of the Hebrew Home at Riverdale in New York City, who had friends killed by the virus and is still waiting for visitation restrictions to ease so she can meet two great-grandchildren who were born this year.

“For the first time in six or seven months,” she said, “there’s a little light at the end of the tunnel.”

San Jose State University professor and cybersecurity expert Ahmed Banafa believes the uncertainty comes down to safety.

“They have to keep this one secret,” he said. “They don’t want to give anybody an advance knowledge about where the shipments going to go.”

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He said too much information on where shipments are headed could potentially lead to physical theft of the vaccine. Cyberthieves could also disrupt the supply chain.

But Banafa said people shouldn’t worry.

“I believe that FBI and CISSA, which is the cybersecurity and infrastructure security agency, they’re aware of all the risks around the shipment, so they have a plan,” he said.

Nearly 2.9 million doses are expected to go out this week, with more than 327,000 doses headed to California.

In a video Sunday, California Gov. Gavin Newsom announced the approval of the Pfizer vaccine by a panel of medical professionals on the West Coast.

“A 17-member panel…unanimously recommending the quick distribution of the Pfizer vaccine,” he said. “They reviewed the safety. They reviewed the efficacy.”

In the Bay Area, UCSF will be one of the first hospitals to get the first doses. Hospital officials say the situation is fluid. Doses could arrive Monday or Tuesday, with vaccinations potentially happening Wednesday.

But which people who’ve had Covid-19 are at risk? And who should be screened with a battery of heart tests before being cleared for exercise?

Those questions were a main focus of a recent virtual sports medicine conference sponsored by the American College of Sports Medicine, the American Orthopaedic Society for Sports Medicine and the American Medical Society for Sports Medicine.

Doctors want to ensure that athletes and recreational exercisers who’ve had Covid-19 can return to physical activity as safely as possible after their recovery, but much still needs to be learned about this new virus, Dr. Carrie Jaworski, director of the division of primary care sports medicine at NorthShore University HealthSystem in Chicago, said at the conference on Dec. 5.

“The main issue is really the cardiovascular implications, which quite honestly we’re still figuring out,” she said.

Read the full story on NBCNews.com

Trump made the announcement hours after his administration confirmed that senior U.S. officials, including some White House aides who work in close proximity to Trump and Vice President Mike Pence, would be offered coronavirus vaccines as soon as this week under federal continuity of government plans.

“People working in the White House should receive the vaccine somewhat later in the program, unless specifically necessary,” Trump said in a tweet. “I have asked that this adjustment be made. I am not scheduled to take the vaccine, but look forward to doing so at the appropriate time.”

It was not immediately clear what the scale of the vaccination program was supposed to be, according to two people briefed on the matter, or what effect Trump’s tweet would have on the government’s efforts to protect top leadership.

News that White House staff would receive the vaccine early drew criticism on social media. Trump and his aides have consistently flouted the COVID-19 guidelines issued by his own administration, including hosting large holiday parties with maskless attendees this December.

Officials said earlier Sunday that doses of the newly approved vaccine from Pfizer would be made available to those who work in close quarters with the nation’s top leaders. They said the move was meant to prevent more COVID-19 spread in the White House and other critical facilities. Trump was hospitalized with the virus for three days in October.

“Senior officials across all three branches of government will receive vaccinations pursuant to continuity of government protocols established in executive policy,” National Security Council spokesperson John Ulyot had said. “The American people should have confidence that they are receiving the same safe and effective vaccine as senior officials of the United States government on the advice of public health professionals and national security leadership.”

The two people briefed on the matter spoke on condition of anonymity because they were not authorized to discuss the matter publicly. The New York Times first reported that top U.S. officials would get early access to the vaccine.

The move to vaccinate top U.S. officials would be consistent with the rollout of rapid testing machines for the coronavirus, which were similarly controlled by the federal government with kits reserved to protect the White House complex and other critical facilities.

According to guidance from the Centers for Disease Control and Prevention, there is not yet enough information to determine whether those who have had COVID-19 should also get the vaccine.

Pence has not come down with the virus, and his aides have been discussing when and how he should receive the vaccine as the administration looks to boost public confidence in the shot.

The Pfizer vaccine requires two doses administered three weeks apart, meaning Trump administration officials would receive the final shot just weeks before leaving office.

Aides to President-elect Joe Biden have been discussing when and how he should receive the vaccine and have been working to establish plans to boost virus safeguards in the West Wing to keep the 78-year-old Democrat healthy.

According to a Capitol Hill official, lawmakers have not been informed how many doses would be made available to them, adding it would be premature to speculate who might receive them. The official was not authorized to discuss it publicly and spoke on condition of anonymity.

___

Associated Press writer Lisa Mascaro contributed to this report from Washington.

Dr. Anthony Fauci noted Thursday in a discussion sponsored by Columbia University that pregnant women have not been included in any Covid vaccine clinical trials to date, but “those studies will probably start in mid- to late-January.”

While kids for the most part battle the virus successfully, they will be part of new COVID-19 vaccine trials.

“Most children don’t get severely affected so we don’t have to put them into the hospital, but they can still transmit infection so it’s important to make sure you keep your children home if they have respiratory symptoms because they might have COVID and you don’t want them spreading it to others,” explained Dr. Mark Sawyer.

Sawyer is a pediatric infectious disease specialist at Rady Children’s Hospital in San Diego, California and he’s also part of governor Gavin Newsom’s COVID-19 vaccine safety panel. He explains how kids tend to get similar on-set respiratory symptoms that adults do with the virus.

“To the best that parents can we want to keep kids from getting together in large groups in fact trying to keep your family from getting together in large groups because we’re clearly on an upswing of COVID across the country,” said Dr. Sawyer.

While more than a million children have been confirmed infected with the virus, experts think that number is much higher, because the illness is often mild in kids and may go undetected. Which is why Dr. Sawyer is encouraging people wear face coverings.

“This virus keeps reminding us that if we don’t do that it’s going to swell up in numbers just as we’re seeing now and that’s likely to continue at least until we get a vaccine that can help us deal with this pandemic, so people need to wear a mask,” he said.

Pfizer BioNTech became the first COVID-19 vaccine developers to include children in U.S. trials in September, but data is still missing on the effects of the vaccine in kids and teens under 16. This as other vaccine companies such as Moderna, plan their trials on kids and teens.

Health officials say it’s unlikely a vaccine will be ready by the start of next school year.

Helen Cordova sat patiently and joked with other medical personnel as she was given the Pfizer vaccine — administered with a shot in her right arm.

Thousands of doses of the vaccine arrived at Los Angeles International Airport Sunday night, marking the first step in a massive undertaking that will see the county attempt to vaccinate 6 million people in six months, beginning with critical health care workers.

LAX officials trumpeted the arrival of the vaccine on Twitter, posting photos of the FedEx jetliner carrying the vaccine, which received formal approval from federal authorities over the weekend for immediate use.

Gov. Gavin Newsom was among the elected officials on hand at the Kaiser Permanente facility in Hollywood to watch Cordova’s inoculation. Moments later, he tweeted, “History made.” A handful of other Kaiser workers were also vaccinated as cameras rolled.

Pfizer and U.S. officials said the vaccine has been found to be 95% effective in preventing COVID-19.

Army Gen. Gustave Perna of Operation Warp Speed told reporters Saturday that UPS and FedEx would be delivering the vaccine to nearly 150 distribution centers across the country.

Los Angeles County’s initial allotment of vaccine is expected to be nearly 83,000 doses, a population-based percentage of the roughly 327,000 doses being received by the state of California. The county’s vaccines will be dispersed to nine ultra-cold storage facilities — the locations of which ware not being released due to security concerns, although some hospitals have publicly stated they would be handling the medication. Those facilities will then distribute the doses to 83 acute-care hospitals, which will then oversee its administration to selected critical frontline workers.

UCLA Health officials said they expected to get the vaccines Monday or Tuesday, with shots administered on Wednesday.

“UCLA Health is implementing comprehensive and detailed plans to receive, store and administer COVID-19 vaccinations. We anticipate a limited number of doses arriving in the next day or two, with additional supplies to follow. We have been designated as a regional hub for distribution to other acute-care hospitals,” a UCLA Health statement said.

“Based on the phased allocations made available to UCLA Health, we are committed to offering vaccinations in a fair, equitable and orderly manner that prioritizes those at greatest risk, consistent with guidelines established by the U.S. Centers for Disease Control and Prevention as well as the California and Los Angeles County departments of public health. UCLA Health anticipates beginning to inoculate our own frontline health care workers as soon as Wednesday.”

Officials with Cedars-Sinai Medical Center said they had no definitive information yet on when they would be receiving the vaccine.

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According to Newsom’s office, a Western States Scientific Safety Review Workgroup — a group of experts created by governors of California, Nevada, Oregon and Washington to independently verify the safety of any vaccine — concluded its review of the Pfizer vaccine Sunday and confirmed it is “safe and efficacious.”

The Pfizer vaccine was co-developed by German partner BioNTech. It needs to be stored at minus-94 degrees Fahrenheit.

Last week, L.A. County Public Health Director Barbara Ferrer said that the county hopes to receive its second allotment of a vaccine made by Moderna — about 250,000 doses, pending FDA approval — around Dec. 20-21. Much of that second dose allotment will be distributed directly skilled nursing facilities, allowing them to administer it right away instead of waiting for a federal distribution agreement with CVS and Walgreens to begin on roughly Dec. 28.

Staff and residents of nursing facilities and long-term care facilities will be among the first wave of people receiving the Moderna vaccine, which does not require the ultra-cold storage needed for the Pfizer vaccine. Long-term care facilities will still receive the vaccine through CVS and Walgreens.

Ferrer said public health officials on Friday began the process of training skilled nursing facility staff on how to administer the vaccination, while noting that those staffers already administer flu vaccines, so it is not a new experience.

The county anticipates receiving another 150,000 doses of vaccine by the end of December, followed by weekly allotments of 250,000 beginning in January. Both vaccines require two doses, separated by about three weeks. With the county planning to vaccinate 6 million people in six months, that equates to 12 million doses of vaccine.

After the distribution of vaccines to health care workers, skilled nursing facilities and long-term care staff and residents is completed, priority will then move to “essential workers” and then to people at highest risk of severe illness from the virus, such as seniors or those with underlying health conditions.

The county’s chief science officer insisted Thursday the process will be done equitably based on health priorities, not on power or prominence.

“Equity is a fundamental principle here,” Dr. Paul Simon said. “We want to make sure all people have access, and that those that are at greatest risk either because of higher risk of exposure, or greater risk of severe illness because of chronic health conditions or other factors have more immediate access to the vaccine.”

Simon conceded that the judgment of who is considered “at risk” could become a matter for debate.

“That probably is going to become an important consideration when we really start to roll things out — when we move beyond the highest-risk groups into groups where the risks may be a little bit more uncertain or there are larger areas of gray,” he said. “And there, I think, we will do our best to prioritize, be as transparent as possible. I don’t think we’re going to be doing validation checks with each person as they float through the line, so I think there is sort of an honor system to some degree. But we will do everything possible to make sure we are doing this in an equitable manner, tending to the risks and making sure that we maximize the benefits.”

The timing of when the vaccine will start to become available to more of the general population remains a mystery. Simon said that while the vaccine offers a glimmer of hope about a potential end to the pandemic and lockdown orders, the county is still in the midst of a dangerous surge in cases, so residents should expect to see restrictions continuing for months.

He said the administration of the vaccine — an effort to vaccinate about 6 million people in six months — will be a “massive undertaking the scale of which many would argue is unprecedented given the time emergency.”

But he said a major factor in moving the county closer to “herd immunity” and an eventual return to normalcy will rely on people actually agreeing to be vaccinated.

“We recognize many folks have concerns about the vaccines and may be hesitant to be vaccinated,” Simon said. “As we implement the county plan to vaccinate literally millions of Angelenos, it will be critically important that we address this vaccine hesitancy with accurate, understandable, culturally sensitive and linguistically appropriate information, relying on trusted community leaders to help deliver these messages.”

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The first wave of shipments is going to health care workers and nursing home residents. Officials say vaccines should be available to everyone by the middle of next year.

Trucks with Pfizer’s vaccine rolled out Sunday. They will deliver to 145 distribution centers around the country by Monday, said Army Gen. Gustave Perna of Operation Warp Speed, the government effort to develop and distribute COVID-19 vaccines. An additional 425 sites will get shipments Tuesday, and the remaining 66 on Wednesday.

For now, only Pfizer’s vaccine, which the Food and Drug Administration greenlit Friday, is being shipped. Another vaccine by Moderna will be reviewed by an expert panel this week and could get the go-ahead soon afterward.

Other vaccines also could follow.

HOW MANY SHOTS WILL BE SHIPPED OUT INITIALLY?

Around 3 million.

When states were told their first-round allocations earlier this month, the figures were based on the 6.4 million Pfizer doses that were ready for distribution at the time, Perna said. Since the Pfizer vaccine requires two doses, the government is holding back the second shots to ensure people can get them.

An additional 500,000 doses are being held in reserve for any emergencies, Perna said.

HOW MUCH VACCINE IS EACH STATE GETTING?

U.S. officials say it’s based on a state’s population of people 18 and older. Federal officials haven’t released a breakdown, but some states have shared their initial allocations.

Colorado, for example, says it’s supposed to get 46,800 doses of the Pfizer vaccine in the first round, with more expected in the weeks that follow. If the Moderna vaccine gets the green light, the initial shipment for that shot would be 95,600 doses, said Kevin Klein, director of the state’s Division of Homeland Security and Emergency Management.

HOW MUCH MORE IS ON THE WAY?

By the end of December, U.S. officials say they expect to have enough vaccine to give 20 million people their first doses — meaning they’d have around 40 million shots available. That’s factoring in Moderna’s vaccine, which also requires two doses and still has to clear regulatory hurdles.

Officials say they expect to be able to vaccinate an additional 30 million people in January and 50 million more in February.

WHY NOT DISTRIBUTE ALL THE DOSES RIGHT AWAY?

Even though Pfizer study data indicates people get some level of protection after the first shot, officials say full protection means two doses. And they need to be sure they’ll have that second dose for people at the right time — three weeks after the first shot.

For Moderna’s vaccine, the second shot comes four weeks after the first.

Yet officials say exactly how many additional shots will become available from week to week might vary based on how much can be produced, especially in the beginning, so they don’t want to risk anyone not being able to get their second shot.

COULD THE STRATEGY CHANGE?

Officials say they might adjust once they become more confident about the flow of future supplies.

“As we get more experience on quality control on the production, we’ll get greater confidence, of course, at the level of supply reserve we hold back for the second dose administration,” Health and Human Services Secretary Alex Azar said in a briefing with reporters. “But we will not distribute the vaccine knowing that a booster will not be available, either from reserve supplied by us, or from ongoing, expected, predicted production.”

HOW ARE DOSES ALREADY AVAILABLE?

Even though the Pfizer shots just got the green light from regulators, shipments can start right away because manufacturing and stockpiling of the doses was underway. It was a chance officials took to speed up delivery if the vaccines were shown to be safe and effective.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Despite record amounts of charitable donations this year, the effects of the pandemic are suffocating nonprofits across the country as organizations face soaring costs and demand for help, yet are largely without their own support systems, including volunteers and in-person fundraising events.

December is typically the most important month for nonprofit revenues, as Christmas and end-of-year tax deductions drive a flood of charitable giving. The holiday campaign season that charities big and small rely on is underway in full force amid a resurging pandemic that has infected more than 16 million people and claimed nearly 298,000 lives in the U.S. alone.

The Salvation Army, already down 18% in funding this year, projects its Red Kettle campaign will net half as much as it did in 2019. That’s a $60 million drop for the iconic fundraising drive being crippled by the pandemic in numerous ways.

Thousands of kettle locations were eliminated because the businesses that once hosted them have closed and foot traffic has diminished as much of the public opts to stay at home. Its pool of volunteer bell ringers is smaller, as many older helpers — some who dress up as Santa Claus — are unable to participate because they’re at high-risk for COVID-19. There’s even a national coin shortage, in part because pandemic shopping has turned increasingly digital.

The Salvation Army’s thrift stores as a separate funding stream are also projected to take a $150 million hit this year.

The Christian social services charity expects 6.6 million people — a 155% increase over last year — will seek their help between Thanksgiving and Christmas, for food, toys, and rent assistance as eviction moratoriums expire.

“The numbers in terms of the people who we are serving are simply off the charts and how we’re going to meet the increased need is causing us to be concerned about the giving levels we’re seeing so far,” said Kenneth Hodder, the U.S. national commander for the Salvation Army.

But multiple studies and surveys say more people than ever are giving and at greater amounts than usual.

The GivingTuesday Data Commons estimates there was a 23% jump in the number of people who participated in the movement to donate on the Tuesday after Thanksgiving in the U.S.

The organization said 16.8 million people across the country gave a collective $2.47 billion on Dec. 1 — a 25% increase in total dollars compared to Giving Tuesday last year. That’s more than what any single U.S. philanthropic foundation gave in 2019, with the exception of the Bill and Melinda Gates Foundation, said Woodrow Rosenbaum, GivingTuesday’s chief data officer.

Fidelity Charitable said it has distributed 32% more grants and seen a 20% increase in people setting up investment accounts for charitable giving this year. But, the donor-advised fund operator, which generally caters to a wealthier donor base, also said two-thirds of its surveyed donors decreased or stopped volunteering during the pandemic.

There have been efforts to encourage more giving since the coronavirus took hold of modern life in March.

The IRS is urging the public to utilize a special $300 tax deduction that can be claimed next year for cash donations in 2020 to tax-exempted nonprofits. The initiative allows non-itemized filers to get the tax break only for 2020, as part of the Coronavirus Aid, Relief and Economic Security Act passed by Congress last spring.

Big philanthropic players have also stepped up.

The Ford Foundation said it has already surpassed last year’s total giving with $580 million in grants. It’s giving another $400 million through a bond. Ford and four other foundations announced earlier this year they would borrow $1.7 billion through bonds to help keep afloat donations-dependent nonprofits through the crisis.

“Even in the best of times, even the most well-known nonprofits live on the edge financially,” said Hilary Pennington, an executive vice president at Ford.

That all might not be enough.

When stay-at-home orders were first issued in March, Adam Porter, the Meals on Wheels director for the nonprofit Sound Generations in Seattle, feared the worst because volunteers typically deliver more than half of the hundreds of thousands of meal kits the organization provides to the elderly.

“I said to myself: ‘Well, game over. We gave it a good shot but we won’t have a program without our volunteers,’” Porter said.

The program has made do with 40 fewer active volunteers this year compared to last, while Sound Generations has raised $200,000, or nearly 10%, more in donations overall. The remaining volunteers, Porter said, have taken on more work to ensure there’s no waitlist for food.

Nationally, Meals on Wheels America said its 5,000 community programs are, on average, serving 77% more meals this year compared to 2019, and nearly all of them are facing financial strain because they’ve also had to buy additional safety equipment and pay drivers to replace volunteers. Though the national organization has given emergency grants worth more than $31 million to local programs since April, increasing donations are simply not bridging the gap in many cases.

The nonprofit tracker Candid also projected in July that 22,000 or 7% of nonprofits in the U.S. may close because of the coronavirus crisis.

Among those struggling the most are arts organizations, which have collectively lost an estimated $14.6 billion in revenue to date this year, according to the Americans for the Arts. The national advocacy group projects 12,000 arts and cultural nonprofits are at risk of being wiped out forever.

But as the world recovers from the isolation of the pandemic, Rosenbaum of GivingTuesday said, arts and social services organizations that draw people together will be among the most integral to rebuilding a sense of community.

“They have a role of community,” Rosenbaum said. “And a role of healing.”

Yet it’s not just Democratic states asking for help amid plunging tax revenue, rising joblessness and a stuttering economy. Plenty of Republican-led states are feeling the pain, too.

Just this past week, five GOP governors made a joint statement calling for Congress to pass a relief package to help their states deal with the fallout from the fast-spreading pandemic.

“The people in our states continue to pay a high price for Congress’ inaction,” said the statement from the Republican governors of Arkansas, Maryland, Massachusetts, New Hampshire and Vermont. “There is no more room for partisan positioning and political gamesmanship.”

Alaska, Florida and Texas are among other Republican-led states where tax revenue has taken a hit.

Sending tens of billions in unrestricted aid to state and local governments has been a key sticking point for congressional Republicans, including Senate Majority Leader Mitch McConnell. The Democratic-controlled House passed a relief bill late last spring that included about $900 billion in direct aid to governments. One of the latest compromise proposals has that amount down to $160 billion, but even that appears too much for many Republican lawmakers.

“Under no circumstance should American taxpayers be responsible for the excesses of wasteful states like New York and California,” said Republican Sen. Rick Scott of Florida.

While New York had a $6 billion budget deficit before the pandemic hit, in large part because of rising Medicaid costs, California’s economy was roaring. The state had record tax revenue and had built up $21 billion in reserves.

Scott noted that state and local government revenue is stronger now than it was projected to be in the spring, when swaths of the economy and stock markets were in freefall. That’s largely because federal stimulus measures earlier in the spring boosted the economy, which in turn kept taxes flowing, said Shelby Kerns, executive director on the National Association of State Budget Officers.

She said the coronavirus outbreak has affected the economy of virtually every state, no matter which party is in control.

“We have not seen it be a red state-blue state problem,” Kerns said.

States have been hit especially hard if they rely on tourism — Republican-led Florida and Democrat-led Hawaii and Nevada among them — or energy. That group includes Alaska, North Dakota and Wyoming, all led by Republican governors and legislatures.

A Moody’s Analytics report in September found all of them with above-average revenue loss. Florida’s situation is less dire because the state does not tax income, but state officials still expect revenue to be $5.4 billion less over the next year and a half than before the pandemic.

The bipartisan National Governors Association is calling for $500 billion over three years to stabilize government finances. The group says the infusion is needed because deep government cuts that could happen otherwise would make the overall economy worse.

As much as congressional Democrats want money directed to state and local governments, many Republicans are dead set against it. McConnell warned in April against using federal aid “to bail out state pensions by borrowing money from future generations.”

It’s true that some big Democratic states, most notably Illinois and New Jersey, have massive unfunded pension liabilities for public-sector workers. For years, those liabilities have forced leaders to decide between tax increases and program cuts as they try to put more money into the systems.

McConnell’s own state, Kentucky, has the third-worst unfunded pension liability. Republicans have controlled the legislature there for years, and a Republican was in the governor’s office until a year ago. A Pew Charitable Trusts report found that as of 2018 — the most recent year for which nationwide data is available — Kentucky’s pension fund had only about 45% of what it needs to meet its obligations, leaving it $28 billion short. Out of the eight other states with pension funding under 60%, only South Carolina is fully under GOP control.

Overall, states are still doing worse financially than they were a year ago, even if their revenue projections are better than what they had anticipated after the virus hit the U.S. Kerns, of the state budget officials’ group, said states are facing another uncertain time as extended unemployment benefits, help for small businesses and other federal aid are set to expire by the end of the year, even as COVID-19 cases and deaths skyrocket nationally.

“When we talk about the states that are beating those projections,” Kerns said, “better than Armageddon isn’t necessarily good.”

The Moody’s report from September found that states and cities face a collective shortfall of $450 billion over the next two years if no further federal relief comes through. A National League of Cities survey of members released this month found that cities were reporting, on average, revenues down 21% while spending is up 17%.

Across the country, the shortfalls have meant pay cuts for some government workers, delayed road projects and cancellation of police academy classes. This past week, Hawaii Gov. David Ige announced a plan to furlough 40,000 state workers next year, even though the savings would cover less than one-fourth of the state’s $1.4 billion budget gap.

While states such as Idaho and South Carolina have fared relatively well financially through the pandemic, some GOP-controlled states are facing budget problems. In Mississippi, lawmakers this week proposed a budget for the coming fiscal year that would include cuts for universities, community colleges, prisons, mental health and child protection services.

Texas went from projecting a $3 billion surplus in late 2019 to expecting a $4.6 billion shortfall by summer. In Alaska, Gov. Mike Dunleavy is proposing what he calls an extraordinary response to revive Alaska’s economy, including direct payments of about $5,000 to each resident from the state’s oil-wealth fund and an infrastructure plan to create jobs. The state’s economy has been battered by the COVID-19 pandemic, which has depressed demand for oil and led to a steep drop in tourism.

In Kansas, where Republicans control the Legislature, Democratic Gov. Laura Kelly told legislative leaders Friday that the state will have to pay for its own expanded coronavirus testing program at a cost of $120 million for just eight weeks if it doesn’t get more federal aid.

Even if Congress delivers some help to state and local governments, some governors said they will consider it only a down payment.

“It’s like a 90-day Band-Aid,” said Maryland Gov. Larry Hogan, a Republican. “We’re going to have to come back to get the major relief package that we’ve been pushing since April.”

Associated Press writers John Hanna, Audrey McAvoy and Brian Witte contributed to this report.

His decision comes with two goals: to prevent potentially spreading the virus to his elderly patients and to communicate to the surrounding rural communities that the vaccine is safe and available.

“We plan to do that on camera in a very public way to help people feel comfortable with the vaccine,” Huth said. “It’s important that as a health care leader in this area, we’re also leading the way on this important initiative.”

Rural communities will see a particular challenge in distributing the vaccine, as officials and health care workers there will have to quickly cobble together communications networks across large areas while also contending with faltering and underfunded public health systems. On top of all that, there exists rampant distrust of medical advice — much of it shared, sown and re-emphasized by President Donald Trump, who has many supporters in rural areas.

Read the full story at NBCNews.com

Critical care nurse Sandra Lindsay was the first person in the U.S. to receive the vaccine.

“I feel hopeful today. Relieved,” Lindsay said after getting a shot in the arm at Long Island Jewish Medical Center in New York.

“This is the light at the end of the tunnel. But it’s a long tunnel,” New York Gov. Andrew Cuomo said as he watched Lindsay’s vaccination via video.

The first of many freezer-packed COVID-19 vaccine vials made their way to distribution sites across the United States on Monday, as the nation’s pandemic deaths surpassed the horrifying new milestone of 300,000.

The rollout of the Pfizer vaccine, the first to be approved by the Food and Drug Administration, ushers in the biggest vaccination effort in U.S. history — one that health officials hope the American public will embrace, even as some have voiced initial skepticism or worry.

Quick transport is key for the vaccine, especially since this one must be stored at extremely low temperatures — about 94 degrees below zero.

More of the Pfizer-BioNTech vaccine will arrive each week. And later this week, the FDA will decide whether to green light the world’s second rigorously studied COVID-19 vaccine, made by Moderna Inc.

Now the hurdle is to rapidly get vaccine into the arms of millions, not just doctors and nurses but other at-risk health workers such as janitors and food handlers — and then deliver a second dose three weeks later.

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“We’re also in the middle of a surge, and it’s the holidays, and our health care workers have been working at an extraordinary pace,” said Sue Mashni, chief pharmacy officer at Mount Sinai Health System in New York City.

Plus, the shots can cause temporary fever, fatigue and aches as they rev up people’s immune systems, forcing hospitals to stagger employee vaccinations.

A wary public will be watching closely to see whether health workers embrace vaccination. Just half of Americans say they want to get vaccinated, while about a quarter don’t and the rest are unsure, according to a recent poll by The Associated Press-NORC Center for Public Health Research.

Early Sunday, workers at Pfizer — dressed in fluorescent yellow clothing, hard hats and gloves — wasted no time as they packed vials into boxes. They scanned the packages and then placed them into freezer cases with dry ice. The vaccines were then taken from Pfizer’s Portage, Michigan, facility to Gerald R. Ford International Airport in Grand Rapids, where the first cargo plane took off amid what airport officials called a “jubilant” mood.

“This is a historic day,” said Richard W. Smith, who oversees operations in the Americas for FedEx Express, which is delivering 630-some packages of vaccine to distribution sites across the country. United Parcel Service also is transporting a share of the vaccine.

Helping with the transport of the vaccine has special meaning to Bruce Smith, a FedEx package handler at the Grand Rapids airport, whose older sister, Queen, died after she contracted the coronavirus in May. She was hospitalized in Georgia one day after he saw her on a video chat, and they never spoke again.

“I think she would be ecstatic to know that something that has ravaged our family — that a family member is going to be part of such a big project,” said Smith, 58, whose nephew, Queen’s son, also got sick and is still undergoing therapy for stroke-like symptoms. “It is very, very important.”

Tracked with GPS-enabled sensors, the initial shipments were expected to contain about 3 million doses, with many more to come. Federal officials say the first shipments of Pfizer’s vaccine will be staggered, arriving in 145 distribution centers Monday, with another 425 sites getting shipments Tuesday, and the remaining 66 on Wednesday. Doses of the vaccine, co-developed by German partner BioNTech, are given out based on each state’s adult population. Then the states decide where they go first.

In California, where health care workers will be among the first to be vaccinated, state health officials are prioritizing hospitals that have adequate storage capacity, serve high-risk populations and have the ability to vaccinate people quickly.

Initial surveys have found that even some health care workers don’t want to be first in line. Dr. Graham Snyder, who’s led the vaccine task force at Pennsylvania health care giant UPMC, estimates that about half of its employees are willing to get the vaccine as soon as it’s offered.

But many health officials expect enthusiasm to grow.

“There’s that thought that maybe they don’t have to be so afraid to come to work if they can be vaccinated and be immune,” said Dr. Sandra Kemmerly, medical director of hospital quality at the 40-hospital Oschner Health System in Louisiana and Mississippi. Employees approved for the first round are getting texts and emails directing them to schedule their initial injection, she said. Enough vaccine is being saved so that each person who gets the first dose of vaccine can get a second required shot a few weeks later.

Senior U.S. government officials, including some White House officials who work in close proximity to President Donald Trump and Vice President Mike Pence, are among those who will be offered coronavirus vaccines as soon as this week, two people familiar with the matter confirmed.

A survey from The Associated Press-NORC Center for Public Affairs Research found that about half of Americans want to get the vaccine as soon as possible. Another quarter aren’t sure, while the remaining quarter say they aren’t interested. Some simply oppose vaccines in general. Others are concerned that the vaccines have been rushed and want to see how the rollout goes.

Dr. Stephen Hahn, commissioner of the FDA, which approved the Pfizer vaccine Friday, has repeatedly insisted that the agency’s decision was based on science, not politics, despite a White House threat to fire him if the vaccine wasn’t approved before Saturday.

Speaking to Fox News Sunday, Dr. Moncef Slaoui, chief science adviser to Operation Warp Speed, a U.S. effort to get vaccines developed quickly, also said he is “very concerned” about the skepticism about the vaccine in some circles.

“Unfortunately … there’s been a confusion between how thorough and scientific and factual the work that has been done is, and the perception that people are thinking that we cut corners …,” Slaoui said. “I can guarantee you that no such things have happened, that we follow the science.”

He called the development of vaccines from several pharmaceutical companies, including Moderna and AstraZeneca, “a remarkable achievement of science, academia, the industry ecosystem and the U.S. government, working together.”

While the vaccine was determined to be safe, regulators in the U.K. are investigating several severe allergic reactions. The FDA’s instructions tell providers not to give it to those with a known history of severe allergic reactions to any of its ingredients.

The Moderna vaccine will be reviewed by an expert panel Thursday and soon afterward could be allowed for public use.

—-

Irvine reported from Chicago. Associated Press writer Zeke Miller in Washington contributed to this report.

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But now, just as possible solution to the virus’s spread is on the horizon, she is particularly worried about what she is hearing from her patients, NBC News reports. Many of them fear that the vaccines aimed at stopping the spread of Covid-19 will be harmful to Black Americans.

Concerns about vaccines have left some Black people entirely unwilling to take a vaccine, while others have said that they want to wait and see how the first wave of vaccine distribution is handled.

When those concerns come up, “I look my patients in the eye and I say that I understand, I’ve read the studies myself, and my job is to protect you and I will not do you wrong,” said James, a family physician who is also an assistant professor at the University of Illinois College of Medicine. “I don’t respond with writing them off as irrational and ignorant.”

As a result of her conversations with patients and her own medical experience, “I’m already seeing the writing on the wall that we are not prepared to roll this vaccine out to vulnerable communities,” said James, who co-founded the Institute for Antiracism in Medicine earlier this year. “I feel like I’m screaming into a void in trying to get people to understand that I can see that this will fail if we continue to do what we normally do with distribution.”

Over the past several months, as infections, hospitalizations and deaths from Covid-19 continue to rise across the country, it is having the harshest effects on Black communities like the one James serves. By almost every metric, be it increased unemployment, diminished academic performance or exposure to pre-existing conditions that put a person at a greater risk of getting sick, the virus and its economic fallout have often affected Black Americans more severely than other groups.

“It’s been very overwhelming,” James said.

Read the full story on NBCNews.com

They typically leave Canada to hunker down in warmer climates for six months. They could fly, skirting travel restrictions at the border, but they’d rather “freeze their buns off” than go to the U.S., where COVID-19 infections and deaths are surging.

“It’s not worth taking a chance. It’s not nearly as bad in this country as it is down there,” said Monk, 69. “Pretty much every Canadian person we do know that goes down (to the U.S.) is not going. It’s pretty widespread.”

“Snowbirds” like the Monks, often retirees who live somewhere warm like Arizona or Florida part time to escape cold weather, won’t be flocking south this winter. For Canadians who drive, nonessential border travel is banned until at least Dec. 21. For some, it’s fear of the virus.

While their absence is being felt by vacation rentals, restaurants and shops, RV parks and campgrounds are seeing an increase in campers as people travel closer to home.

A huge chunk of the snowbird population is Canadian. Evan Rachkovsky of the Canadian Snowbird Association said most people he’s spoken with are suspending trips to the U.S.

But some are still adamant about going.

“Some tell me just simply this is something they’ve been doing for 10, 20, 30 years, so it’s habitual in that sense,” Rachkovsky said. “It’s a lifestyle as opposed to vacationing for two weeks.”

For those who go, they may face recommendations to quarantine for up to two weeks, though states often don’t enforce it. They’re also going into communities where hospitals are normally busiest during the winter months, and COVID-19 could overwhelm them.

Health insurance hurdles are deterring retired Toronto accountant Mel Greenglass, who for almost a decade has spent four months in southwest Florida near Naples. Canadian snowbirds must buy a supplemental plan to their government-provided coverage for any emergencies during their stay. It would have been $2,800 for him and his girlfriend this season, up from $1,800 previously, and he feared they wouldn’t be covered if they caught the virus.

Insurers “are not going to lay out a lot of money to cover everybody just by raising their premiums a little bit,” said Greenglass, 78. He added that adapting to the Canadian winter won’t be easy: “I don’t even own a pair of boots.”

It’s easier for those who don’t have international borders to cross. Kathy Scott, 73, and her 81-year-old husband intend to make their annual drive from Salt Lake City to Arizona after Christmas.

Scott said she plans to mask up and practice social distancing to avoid burdening the medical system, adding that she’s “not having any problem asking people about having been tested, about quarantining, about where they’ve been.”

Snowbirds’ plans have a huge impact on tourism. In Florida, 3.6 million Canadians visited last year, making up a quarter of its foreign tourists, according to the state tourism office. Visit Florida estimates that only 15,000 Canadians arrived between April and September, the last month with available statistics. That’s about an 99% decrease from the same period last year.

The Arizona Office of Tourism said an estimated 964,000 Canadian visitors were responsible for $1 billion of the $26.5 billion in tourism spending last year. In September, visitors overall spent $752 million, down 60% from the $1.9 billion expected in a normal year.

Becky Blaine, the office’s deputy director, said it helps that many people are looking closer to home for vacation. But that will only go so far to offset the loss of international visitors. She’s also not sure how much of a boost RV parks and campgrounds will get.

“Now that kids are back in school though, it would be more of that retiree population versus over the summer when everybody rented RVs, including myself,” Blaine said.

Bobby Cornwell, executive director of the Florida and Alabama RV Parks & Campground Association, believes it’s not “all doom and gloom” for his industry. Snowbirds make up 30% of the business for Florida’s RV parks, he said. There have been cancellations, but park operators are seeing people of all ages road-tripping.

“I really wanna hammer this home: From the people we’re getting feedback from, many of our parks throughout the whole state, for every cancellation, there’s one or two campers who come in,” Cornwell said. “I haven’t heard of anything disastrous.”

Bruce Hoban, co-founder of the 2,000-member Vacation Rental Owners and Neighbors of Palm Springs, said property managers who rent condos to snowbirds for two- to three-month stints in the desert resort city are having a hard time. But vacation rentals for stays under 30 days have been “through the roof.”

Normally, rentals generate 25% of the $25 million Palm Springs rakes in from an occupancy tax. They’re now generating 50%. Between vacation rentals and hotels, the city did 5.5% more business between July and September compared with the same period last year.

“It’s a big shift,” Hoban said. “The amount of people coming on vacation rentals was like nothing we had ever seen. … Yes, we lost two-and-a-half months of what is normally our most expensive, highest time of the year because of Coachella festivals and stuff. We lost all that. We have more than made up for it since then.”

But shop owners like Julie Kathawa, 49, aren’t expecting big business from younger vacationers. Julie’s Hallmark sells cards and gifts in Bermuda Dunes, outside Palm Springs, and already feels the crunch of fewer snowbirds, who make up about 20% of her business from November to April. She’s relying mostly on online mail orders.

“I’m grateful for it, but it’s not the same. I think it’s going to help me through December,” Kathawa said. “Other than that, I don’t think it’s going to be as profitable or as exciting in January, February and March because we would still have all this tourism.”

___

Spencer reported from in Fort Lauderdale, Florida.

Tess Pawlisch worked in San Francisco for the last four years.

But this year, Pawlisch has found herself writing work emails, holding team meetings and taking client calls from hotel rooftops, hammocks and beaches in Tulum, Mexico. 

“I decided to do something new and went to Tulum, one of the few places really open right now but still lovely,” said Pawlisch, a communications professional. “After a pandemic and being in San Francisco for so long, I just wanted something that was easy and beautiful.”

Pawlisch is part of a wave of working professionals who have ditched their apartments for a nomadic lifestyle, taking advantage of their companies’ decisions to support remote work throughout Covid-19. Many of these professionals have left their home cities and are now bouncing around from Airbnb to Airbnb. 

“These jobs can be exhausting at times, but at least they can be while looking at blue skies in 80 degree weather,” said Pawlisch. 

This growing lifestyle trend comes at a perfect time for Airbnb, which went public on Thursday. Airbnb shares quickly jumped to more than twice their $68 initial public offering price. Shares of Airbnb closed at $139.25 on Friday, giving the company a market value of $83.2 billion on a non-diluted basis. It’s now worth almost as much as online travel stalwart Booking, which has a valuation of $85.6 billion, and more than many hotel chains such as Marriott, which holds a market cap of more than $41.7 billion. 

Although the company’s revenue last quarter was down 19% from the year-ago quarter as the pandemic crushed the travel industry, the company has bounced back much faster than its peers as urban residents fled their shut-down cities for more rural retreats. The rebound began within two months of the pandemic, the company said in its prospectus.

‘Making life exciting again’

Trey Ditto never imagined leaving his Brooklyn apartment, but when the pandemic forced everyone to quarantine, he found himself sharing a workspace with his wife, who also had to work from home, and their two-year-old. Almost immediately, the couple found an Airbnb in upstate New York that would be near the city but provide them with ample space for everyone. 

“We just couldn’t possibly both work and raise a child in an apartment in New York and not be able to leave or enjoy outside,” said Ditto, who works in communications. “We were fortunate enough to find a home that fit our size requirement and was far away enough from New York where we felt we were away from the madness but close enough to New York where I could drive back in.”

When it became clear that the coronavirus was not going away anytime soon, Ditto and his wife moved in September to another Airbnb in Texas to be near family for the rest of 2020. 

“If you had told me at the beginning of the year that I would be hopping around the country living in other peoples’ homes, I would’ve laughed at you,” said Ditto, who had previously lived in New York for 13 years. 

Aishwarya Vardhana decided she wanted to get away from San Francisco after living locked up in a small apartment with relatives for the first three months of quarantine. Vardhana was tired of the monotony, and missed the excitement of seeing friends or going to parties and concerts around the city. She and her friends decided to move to Airbnbs near national parks that they could hike and explore. 

“Being on lockdown in San Francisco was claustrophobic,” Vardhana said. Traveling to national parks and staying at Airbnbs “was really about making life exciting again and energizing.”

Vardhana was joined on her trip by her friend Anika Raghuvanshi, who said she no longer felt tied to a specific location after her company announced that it would be prioritizing remote work. Vardhana and Raghuvanshi stayed with friends at Airbnbs in Montana, Idaho, Utah and Wyoming. 

“It felt really exciting to be able to see and experience more of the world,” Raghuvanshi said. “That was the catalyst for me.”

Leona Marlene and her partner have been living nomadically after going on a road trip with family in the summer. The couple loved the experience and realized they could actually save money on rent if they left San Francisco and stayed at Airbnbs, some of which offer significant discounts to folks who do month-long bookings, Marlene said. 

They listed everything they owned on Facebook Marketplace, and within a week, they had sold it all. Since then, Marlene and her boyfriend have been to Airbnbs in Austin and Indianapolis.

“After rent, utilities, all of our groceries and stuff, we’re spending more than $4,500 a month and we can’t even experience the perks of living in the city,” said Marlene, who documents her nomadic life on YouTube. “There’s just never been a better time to do something like this.”

The biggest problem: Unreliable Wi-Fi

Bouncing between Airbnbs isn’t always easy.

Emily Buckley, for example, has used Airbnb in 2020 to stay with her boyfriend in Kansas City, Denver, Austin, New Orleans and Atlanta, among several other cities. She’s enjoyed the freedom of the nomadic lifestyle, in particular not knowing where they will go next. 

But the couple ran into some issues along the way. At one location, Buckley and her boyfriend arrived to an Airbnb that was drastically smaller than they anticipated from the photos of the listing. 

“That was kind of a hard month,” she said. 

At an Airbnb in Asheville, North Carolina, they were planning to meet up with another couple who are also working professionals. When they arrived, they discovered the internet connectivity wasn’t reliable enough to get work done. Ultimately, the four of them had to rent a second Airbnb for a week and commute to it just for the internet. 

“We just chalked it up to the trials and tribulations of living nomadically and out of Airbnbs — there’s an element of surprise,” said Buckley, a start-up executive.

In fact, unreliable Wi-Fi was the chief complaint among all the Airbnb nomads CNBC interviewed. Some have complained about dealing with Wi-Fi that vacillates between electrifyingly fast and completely disconnected. Another nomad told CNBC he estimates that about 10% of the units he stays at have bad Wi-Fi. 

This is why James Vaught and Mack Sullivan, long-time nomads, always sift through reviews for information about a unit’s Wi-Fi quality before booking a short-term unit. They also make sure to leave detailed reviews about Wi-Fi and internet speeds when they leave. Additionally, Sullivan and Vaught always rent units where they will have the entire place to themselves, meaning they won’t need to share the internet with the host family or other guests. They also tend to look for places that advertise having a smart TV or Roku — signals that the place has internet that is at least good enough to stream video. 

“Between what they advertise and what’s reality, you just have to hope that you have good people who have written accurate reviews,” said Sullivan, who blogs about his nomadic experiences with Vaught. 

Vaught and Sullivan have been living as nomads since 2016. Back then, the two worked remotely out of an RV. Later, they tended to sign short leases for apartments living as “slow-mads,” as they put it. But since April 2020, the couple has conducted their nomadic lifestyle exclusively through Airbnb. 

They appreciate that when they book through Airbnb, they know the total price they will pay from the moment they book. Unlike staying for a short time at an apartment, they don’t have to worry about paying any utilities, deposits or anything else. 

Sullivan and Vaught also like the fact that Airbnb tends to support guests when problems arise. They have previously used competing websites, and in one situation, they ended up at a unit that was not as advertised and received little help from the company. 

As vaccines for Covid-19 start to be distributed, some folks will be returning to their previous lives. 

Ditto and his family, for example, will move into a rental house at the end of the month. Although Airbnb has been good to them in 2020, Ditto said he misses his own furniture and the feeling of being in his home. 

“You lose the feeling of home when you’re sleeping in someone else’s bed and sitting on someone else’s couch,” Ditto said. 

Pawlisch, meanwhile, was able to lock down a San Francisco apartment she’d long been eyeing at a great price.

“Tulum doesn’t feel real. It’s a fairy tale,” Pawlisch said. “But I’m ready to have a place that’s my own and feel a little more grounded.”

Others, however, have fallen in life with the lifestyle, and plan to keep living it for the foreseeable future. 

“Having that freedom is something I’ve never experienced in my life,” Buckley said. “I love that anticipation when we’re about to see our next Airbnb.”

Trucks will roll out Sunday morning as shipping companies UPS and FedEx begin delivering Pfizer’s vaccine to nearly 150 distribution centers across the states, said Army Gen. Gustave Perna of Operation Warp Speed, the Trump administration’s vaccine development program. An additional 425 sites will get shipments Tuesday, and the remaining 66 on Wednesday.

Initially, about 3 million doses were expected to be shipped nationwide. It was unclear exactly who would receive the first shots, though health care workers and nursing home residents were the priority. Perna said health authorities would decide.

A similar number of shots will be held back for those recipients’ second dose, which is needed for full protection from COVID-19.

The announcement Saturday kicks off a massive logistical operation involving the federal and state governments, private companies and health care workers to quickly distribute limited vaccine supplies throughout the U.S. It offers hope in a country grappling with surging COVID-19 infections and deaths, which are overwhelming hospitals and raising fears that things will only get worse as people gather over the holidays.

Perna compared the vaccine distribution effort to D-Day, the U.S.-led military offensive that turned the tide in World War II.

“D-Day was the beginning of the end and that’s where we are today,” Perna said a news conference. But he added that it would take months of work and “diligence, courage and strength to eventually achieve victory.”

MaineHealth, a network of 12 hospitals based in Portland, plans to provide an expected first delivery of nearly 2,000 vaccines to doctors, nurses and others facing risk as they treat COVID-19 patients, said Dr. Dora Mills, chief health improvement officer.

“It’s almost hard for me to talk about without tearing up,” Mills said Saturday. “This vaccine gives us some glimmer of light at the end of the tunnel.”

The first shipments will leave Pfizer’s manufacturing plant in Kalamazoo, Michigan, by truck and then be flown to regional hubs around the country. Medical distributor McKesson and pharmacy chains, including CVS and Walgreens, also are involved in the initial rollout and vaccinations at nursing homes and assisted living centers.

In a key distribution challenge, the vaccine, co-developed with BioNTech, must be stored and shipped at ultra-low temperatures — about 94 degrees below zero. Pfizer has developed shipping containers that use dry ice, and GPS-enabled sensors will allow the company to track each shipment and ensure it stays cold.

Distribution sites are mainly large hospitals and other facilities able to meet those ultra-cold storage requirements. Within three weeks, vaccines should be delivered to all vaccination sites identified by states, such as local pharmacies, Perna said.

The vaccine was timed to arrive Monday so health workers could receive the shots and begin giving them, Perna said.

Workers at Mount Sinai Hospital System in New York did a dry run this week to prepare for their shipment. In a clean room, pharmacists practiced making separate doses of a training vaccine and ensuring the freezer was kept at temperatures colder than in Antarctica.

“Not a lot of people have vaccinated for a large pandemic like this,” said Susan Mashni, vice president of pharmacy at Mount Sinai. “So we want to make certain that we get it right. There’s a lot of different moving pieces and parts.”

At a meeting where an expert panel advising the Centers for Disease Control and Prevention on vaccines unanimously endorsed the Pfizer shot, some said local health officials were struggling to ensure the vaccine is distributed fairly and to those most in need and to ease people’s concerns about getting the shot.

But “the funding necessary for state and local health departments to carry out this program has been put in the deep freeze,” said Dr. Jeffrey Duchin, a Seattle physician representing the National Association of County and City Health Officials.

The Food and Drug Administration authorized emergency use of the vaccine late Friday. It capped an unprecedented global race to speed vaccines through testing and review, chopping years off the normal development process.

The FDA found the vaccine highly protective with no major safety issues. U.S. regulators worked for months to emphasize the rigor and independence of their review, but President Donald Trump’s administration pressured the agency until the final announcement. A top White House official even threatened to remove FDA chief Stephen Hahn if a ruling didn’t come before Saturday.

Concerns that a shot was rushed out could undermine vaccination efforts in a country with deeply ingrained skepticism about vaccines.

“Science and data guided the FDA’s decision,” Hahn said Saturday. “We worked quickly because of the urgency of this pandemic, not because of any other external pressure.”

While the vaccine was determined to be safe, regulators in the U.K. are investigating several severe allergic reactions. The FDA’s instructions tell providers not give it to those with a known history of severe allergic reactions to any of its ingredients.

The FDA’s vaccine director, Dr. Peter Marks, said the agency will carefully track any reports of allergic reactions in the U.S.

Next week, the FDA will review a vaccine from Moderna and the National Institutes of Health that appears about as protective as Pfizer’s shot. On Friday, the Trump administration said it had purchased 100 million more doses of that vaccine on top of 100 million it previously ordered.

The announcement came after revelations that the White House opted not to lock in an additional 100 million doses of Pfizer’s vaccine for delivery in the second quarter of 2021. The Trump administration contends the current orders plus those in the pipeline will be enough to accommodate any American who wants to be vaccinated by the end of the second quarter of 2021.

___

Stobbe reported from New York, and Scolforo from Harrisburg, Pa. Associated Press Medical Writer Lauran Neergaard in Alexandria, Virginia, video journalist Marshall Ritzel and Health Writer Candice Choi in New York contributed to this story.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

___

This story was first published on Dec. 12, 2020. It was updated on Dec. 14, 2020, to correct the name of one of the companies involved in the initial rollout at U.S. nursing homes and assisted living centers. It is Walgreens, not Rite Aid.

In past years, the celebrations have included rosaries, mariachi bands, ministries and plays for children and adults. Family and friends from neighboring Juárez, Mexico, would cross the international bridges to join in celebration.

But in the midst of the growing coronavirus pandemic along the border, the observance on Saturday by the El Paso Diocese will be virtual — a choice that has been difficult, but necessary, to maintain both faith and public health.

“It’s dramatically different this year,” said Monsignor Arturo Bañuelas, of St. Mark Catholic Church. “Last year, we had thousands of people come. We’re doing the same, but it’s all livestreamed.”

The Dec. 12 celebration, also known as El Día de Nuestra Señora de Guadalupe, marks the date in 1531 when the Virgin Mary appeared to Juan Diego, an Indigenous peasant, to ask that a church be built on the side of a hill outside of Mexico City.

Read the full story on NBCNews.com

The deaths reported Friday exceeded by 6% the previous high of 3,124 deaths reported Wednesday.

The U.S. also reached a record daily confirmed infections at 231,775, according to a tally by Johns Hopkins University. That’s nearly 4,000 more than the previous high on Dec. 4.

The increases come as millions of doses of the COVID-19 vaccine developed by Pfizer start rolling into hospitals on Monday. The first vaccines will go to hospital staff and other health care professionals.

The U.S. leads the world in confirmed cases at 16 million and deaths at more than 297,000, according to a tally by NBC News. The coronavirus has caused more than 1.6 million global deaths.

Governors Will Have Big Say on Who Gets Coronavirus Vaccine First, Dr. Birx Says

State governors will have to decide who will be inoculated first, placing priority on the most vulnerable, once COVID-19 vaccines are approved and delivered, White House coronavirus response coordinator Dr. Deborah Birx said Friday.

Meanwhile, the American people will need to continue taking precautions against the virus as the country forges ahead with the monthslong process of vaccination, Birx, a native of Newtown Square in Delaware County, Pennsylvania, said in an interview with NBC10’s Lauren Mayk.

Under the current guidance set forth by the Centers for Disease Control and Prevention, the first in line to get the vaccine will be front-line health care workers and people with critical health needs, including those in nursing homes and other long-term care facilities. After them will be essential workers like firefighters, police officers, teachers and others.

“Each governor is going to have to look at equity – who’s really in need – and make the decision about who is most vulnerable to hospitalizations and bad outcomes and immunize them first,” Birx said.

Read the full story on NBCPhiladelphia.com

Case Reported in Hawaii County Thought to Be Last Without COVID

A county on a Hawaii island believed to be the last one in the U.S. without any coronavirus cases has reported its first resident testing positive.

The Hawaii Department of Health on Thursday reported the case in Kalawao County on the island of Molokai. The health department says an adult resident tested positive after returning to the island on a local flight.

The person is in self-isolation and currently doesn’t have virus symptoms. The health department says contact tracing was conducted and all other passengers on the flight are in self-quarantine.

Outbreaks at 2 Washington Nursing Homes After Staff Attended Wedding

Washington state health officials are investigating coronavirus outbreaks that occurred at two nursing home facilities after some staff attended a 300-person wedding, NBC News reports.

Between the two Grant County facilities — Lake Ridge Center and Columbia Crest Center — officials have reported 23 deaths.

One additional death that “can be directly linked to an attendee of the wedding” was reported at a nursing home facility in Ephrata, the Grant County Health District said in a press release Thursday.

Read the full story on NBCNews.com

Nearly 100 COVID-19 Cases Linked to Unlawful Basketball Tournament

Santa Clara County is investigating a COVID-19 spike linked to an unlawful basketball tournament that left 94 positive cases across three counties, NBC Bay Area reports.

The county learned that 33 out of 37 players and all three coaches that traveled from Santa Clara County to Placer County on Nov. 7 and 8 for the tournament tested positive for coronavirus.

As of Friday, 49 youth players, three coaches and 35 other contacts from Santa Clara County-based teams were infected, as well as 17 other people from two other counties, health officials say.

The private basketball program, which was not named, was violating local and state orders at the time of the outbreak and has been cited, county officials say.

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And the NBA champion Los Angeles Lakers were home, with nobody there to watch.

The NBA preseason — a truncated 49-game, nine-day sprint — opened Friday with a five-game slate, action returning to NBA arenas for the first time in exactly nine months. Coaches debuted with their new teams: Stephen Silas with Houston, Tom Thibodeau with New York, Billy Donovan with Chicago and Tyronn Lue with the Los Angeles Clippers. Rookies, such as No. 4 pick Patrick Williams of the Bulls and No. 8 pick Obi Toppin of the Knicks, got their first NBA minutes.

As will be the case in most buildings, at least to start the season, almost nobody was at any of these games. With the coronavirus pandemic ongoing and case numbers still rising, the era that started for the NBA with the suspension of last season on March 11 — the night that Utah’s Rudy Gobert tested positive — resumed with the league and its teams erring on the sides of caution and safety.

“It’s different, for sure,” Lakers coach Frank Vogel said before his team faced the Clippers inside a very empty Staples Center.

Well, some things were different.

Coaches wore masks. Detroit showed old videos of actual fan interactions — with the disclaimer that they were taped previously — during some timeouts. Bench seating areas were all spaced out, nobody next to one another.

“The atmosphere will be obviously significantly different than what guys are used to in an arena,” Orlando coach Steve Clifford said. “And I think that’s going to be one of the valuable aspects of playing these four exhibition games. Just like in the bubble, we had to get used to a different-type environment and I think these four games will hopefully allow us to see what the regular season is going to be like in these big arenas also.”

So, yes, much was different.

Other things — like Wall’s explosion to the basket — were just like normal.

Wall’s first basket since December 2018 came on the first possession of Houston’s preseason, when he got to the rim for an easy score in his Rockets debut, one that came after his recovery from heel and Achilles injuries.

The Rockets’ next basket? Wall set up Cousins for a 3-pointer, the center’s first basket since Game 6 of the 2019 finals with the Warriors, two months before he tore his ACL and missed last season.

Reigning NBA scoring champion James Harden wasn’t playing for the Rockets, still not cleared to be back on the floor with the team that he hasn’t practiced with yet and apparently no longer wants to be with. LeBron James and Anthony Davis, who were last seen on the floor together when the Lakers topped the Miami Heat in the NBA Finals in the Walt Disney World bubble — less than two months ago — were among the regulars who got the champs’ preseason opener off.

There are seven more games Saturday.

Friday’s games:

KNICKS 90, PISTONS 84

At Detroit, R.J. Barrett scored 15 points and Toppin finished with 11 points and seven rebounds in his debut as the Knicks won their preseason opener.

Julius Randle scored 11, while Elfrid Payton and Nerlens Noel each scored 10 for New York.

Svi Mykhailiuk and Saddiq Bey led the Pistons with 14 points apiece. None of Detroit’s five starters — all playing between 15 and 22 minutes — reached double figures, and they shot a combined 8 for 34.

MAGIC 116, HAWKS 112

At Atlanta, Nikola Vucevic had 18 points and 11 rebounds and all five Orlando starters reached double figures.

Dwayne Bacon had 14 points, Evan Fournier had 13, Aaron Gordon scored 12 and Markelle Fultz added 10 for the Magic, who also got 10 off the bench from Michael Carter-Williams.

De’Andre Hunter scored 18 for the Hawks, who got 14 points apiece from John Collins and Danilo Gallinari, 14 rebounds from Clint Capela and 13 points from Cam Reddish. Trae Young shot just 2 for 9 for Atlanta.

ROCKETS 125, BULLS 104

At Chicago, Wall had 13 points and nine assists in 19 minutes and the Rockets led wire-to-wire.

Bruno Caboclo had 17 points for Houston, which led by as many as 32. Gerald Green and Eric Gordon scored 16 apiece, Cousins had 14 points in 15 minutes and Ben McLemore added 10 for the Rockets — who had a 35-0 edge in points off turnovers until the final moments.

Coby White scored 15 for the Bulls. Lauri Markkanen added 13 for Chicago, Williams had 12 in his NBA debut, Noah Vonleh and Zach LaVine each added 12 and Tomas Satoransky finished with 11.

LAKERS 87, CLIPPERS 81

At Los Angeles, Talen Horton-Tucker scored 19 points and Kyle Kuzma had 18 for the Lakers.

Montrezl Harrell had 13 points and 12 rebounds against his former team and Dennis Schroder added 10 points for the Lakers. Paul George had 10 for the Clippers and Kawhi Leonard managed three in 14 minutes.

Both teams shot exactly 30 for 84 from the field, and none of the Clippers’ starters logged even 15 minutes.

TRAIL BLAZERS 127, KINGS 102

At Portland, Carmelo Anthony had 21 points in 23 minutes for a Trail Blazers team that had to close its practice facility earlier in the week over coronavirus concerns.

Harry Giles had 18 points and 14 rebounds against his former team. CJ McCollum and Gary Trent Jr. also scored 18 apiece for the Blazers, while Damian Lillard scored 15 and Derrick Jones Jr. had 15 on 6-of-7 shooting in his Portland debut.

Buddy Hield had 23 points and Harrison Barnes scored 16 for the Kings, who gave up 35 points in the first nine minutes. De’Aaron Fox scored 10.

___

More AP NBA: https://apnews.com/NBA and https://twitter.com/AP_Sports

Her partner, Dr. Carlos Araujo-Preza, was sitting on the hood of his car in their driveway. He was wearing scrubs and a respirator — the one he’d worn in the intensive care unit each day while treating coronavirus patients — and he had a duffel bag packed at his feet.

King got out of her car and asked what he was doing.

“I have COVID,” he said.

As a critical care pulmonologist, he’d spent months treating hundreds of critically ill COVID-19 patients at HCA Houston Healthcare in Tomball. The sickest of the sick. The vast majority of those in need of hospital care were elderly or suffered from underlying health problems.

Read the full story at NBCNews.com.

Superior Court Judge Peter J. Wilson issued the order in response to a lawsuit brought by the American Civil Liberties Union on behalf of inmates, some of whom have been released, who said they were particularly at risk due to underlying health conditions.

Barnes said his department was “evaluating the order, its impacts and our options for appeal.”

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“If the order stands, it will result in the release of more than 1,800 inmates,” Barnes said. “Many of these inmates are in pretrial status for, or have been convicted of, violent crimes and will be released back into the community. This order puts our community at substantial risk and does not take into account the impact on the victims of these crimes.”

Wilson chided the county’s attorneys for failing to respond to the allegations from the inmates about the lack of social distancing in the jail system.

The ruling comes as Barnes wrangles with a new outbreak of COVID-19 this week in his jails after months of successfully preventing any deaths from the coronavirus and only three hospitalizations of inmates during the pandemic.

Austin Ambriz, one of the inmates who tested positive this week, was on trial for murder in Brea and closing arguments scheduled for Thursday had to be rescheduled for Jan. 4.

Barnes announced on Thursday there were 102 inmates infected with COVID-19. That number increased to 138 on Friday. Of those, 27 are  newly booked inmates and 111 are in general population.

The plaintiffs include 27-year-old Sandy Gonzalez, who is awaiting trial for robbery and possession of drugs.

“She is medically vulnerable and has Type 2 diabetes and a history of smoking,” according to Wilson’s ruling. “She was exposed to her cellmate… who developed COVID-19 on the evening of May 14, 2020.”

The next day, Gonzalez tested positive, and she was moved to a “disciplinary isolation cell,” Wilson said.

Another plaintiff is 53-year-old Mark Trace, who pleaded guilty to possession of drugs for sale and was sentenced to a year and four months in jail, Wilson said. Trace was held in the Theo Lacy jail in Orange until March 10, Wilson said.

Trace has “multiple, significant underlying health conditions” that include “sclerosis of the liver, hepatitis C and D, asthma, tuberculosis, valley fever and seizures.”

Trace was jailed in his own cell that was open and “shared air with the approximately 12 other individuals in his module,” according to Wilson.

“He was unable to consistently practice social distancing during his time in custody, and his access to medical care slowed after the COVID-19 outbreak began,” Wilson wrote.

It is not clear when the jail population has to be reduced by half, but Wilson mandated a report by year’s end.

Americans might have expected that their country would marshal its tremendous financial and intellectual resources, and its technological might, to fend off COVID-19, the disease caused by the coronavirus. Instead, it has been crippled for the better part of a year, and is now heading into a winter that one of its top doctors said could be the gravest public health crisis in its history. Ten months after the first COVID-19 death in the United States, the country is hurtling toward an appalling milestone: 300,000 deaths out of more than 15 million confirmed cases.

Yes, vaccines are coming, and the first vaccinations may begin next week. But their cumulative effect on the nation’s health will not be felt until well into 2021. If Americans do not change their behavior quickly, experts warn, the weeks and months ahead will be filled with more death and despair, packed hospitals and unemployment lines, and further political polarization and alienation.

The time to change our path is now.

Read the full story on NBCNews.com

On Friday, Virginia joined Washington, D.C., and 16 other states that have been using the Association of Public Health Laboratories’ National Key Server, which allows phones to “talk to each other” across state borders. This means users in these 18 areas won’t have to download a separate app in places they are visiting.

“This is especially important considering added travel during the holiday season,” said a statement from Dr. Norman Oliver, Virginia’s state health commissioner.

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Apple and Google co-created the technology that uses Bluetooth wireless signals to anonymously detect when two phones have been in close proximity. A user who tests positive for the virus can have their phone trigger a notification to other people they’ve spent time near.

The states beyond Virginia are Alabama, California, Colorado, Connecticut, ​Delaware, Maryland, Michigan, Minnesota, Nevada, New Jersey, New York, North Carolina, North Dakota, Pennsylvania, Washington and Wyoming.

In August, Virginia became the first state in the country to utilize the technology. It has since recorded nearly 900,000 downloads. It is now the final state to join the national server.

Hawaii and Oregon are piloting an app with a limited population on the National Key Server.

In some states, such as Colorado, Connecticut, Maryland and Washington, Apple users receive a pop-up message from Apple to adjust their iPhone settings to activate the notification feature. Adoption is much higher in these places compared with those that require residents to download distinct app, including North Carolina, North Dakota and Virginia.

Data obtained by The Associated Press from 16 state public health departments shows 8.1 million Americans adopted the contact tracing tool in these areas through late November. That pales in comparison to the roughly 110 million residents in those regions. California did not have an app available in November.

Coronavirus cases have surged across the United States since Thanksgiving, posing a threat to hospitals with limited bed capacity and staffs that have already been stretched thin.

More than 3,000 Americans died in a single day this week, which is more deaths than on D-Day or 9/11. The country has seen over a million cases in five days and 100,000 people currently hospitalized. Since the start of the pandemic, over 290,000 people have died because of COVID-19 nationwide.

“It’s a surge above the existing surge,” said Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle. “Quite honestly, it’s a warning sign for all of us.”

Across the country, contact tracers and emergency room doctors are hearing repeatedly from new coronavirus patients that they socialized over Thanksgiving with people outside their households, despite emphatic public-health warnings to stay home and keep their distance from others.

The virus was raging across the nation even before Thanksgiving but was showing some signs of flattening out. It has picked up steam since, with new cases per day regularly climbing well over 200,000.

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The dire outlook comes even as the U.S. stands on the brink of a major vaccination campaign against COVID-19, with the Food and Drug Administration expected to give the final go-ahead any day now to use Pfizer’s formula against the scourge that has killed over 290,000 Americans and infected more than 15.6 million.

On Friday, White House chief of staff Mark Meadows pressed FDA chief Stephen Hahn to grant authorization by the end of the day or face possible firing, according to two administration officials speaking on condition of anonymity.

President Donald Trump, who has been fuming at the FDA for not moving faster on the vaccine, called the agency a “big, old, slow turtle” on Twitter, adding: ”Get the dam vaccines out NOW, Dr. Hahn. Stop playing games and start saving lives.”

Hahn has said he would be guided by “science, not politics.”

COVID-19 deaths in the U.S. have climbed to a seven-day average of almost 2,260 per day, about equal to the peak seen in mid-April, when the New York City area was under siege. New cases are running at about 195,000 a day, based on a two-week rolling average, a 16% increase from the day before Thanksgiving, according to an Associated Press analysis.

In Washington state, contact tracers counted at least 336 people testing positive who said they attended gatherings or traveled during the Thanksgiving weekend. More are expected.

The virus could still be incubating in someone who was exposed while traveling home the Sunday after Thanksgiving; the end of that two-week incubation period is this Sunday.

Zana Cooper, a 60-year-old cancer survivor in Murrieta, California, tested positive for COVID-19 after attending a Thanksgiving dinner with her son’s girlfriend’s family. At the dinner, the girlfriend’s father, who had recently traveled to Florida, wasn’t feeling well and went to bed early.

Cooper learned the following Sunday that he tested positive.

“My first reaction was the f-word. I was so mad,” she said. “I was upset. I was angry. I was like, ‘How dare you take my life in your hands?’”

She has had fever and headaches, a runny nose and bloodshot eyes, and in recent days it has become more difficult to breathe and she has been using an inhaler. She said she believes she brought the virus home to her daughter and two grandchildren, who live with her and are now ill with what a doctor diagnosed as COVID-19.

In Philadelphia, a woman in her 20s gathered with 10 relatives on Thanksgiving, though she didn’t feel well the day before. She later tested positive for COVID-19. Her family started developing symptoms, and seven members tested positive, said Philadelphia Health Commissioner Dr. Thomas Farley.

The next round of festivities could yield even more cases. Wall-to-wall holidays started this week. Hanukkah began Thursday evening and ends Dec. 18, followed by Christmas, Kwanzaa and New Year’s Eve.

“This is not the time to invite the neighbors over for dinner. This is not the time to start having parties,” said Arizona State University researcher Dr. Joshua LaBaer.

In parts of New York state, contact tracers are regularly hearing from the newly infected that they attended Thanksgiving festivities, said Steuben County Public Health Director Darlene Smith. Still unknown is how many they will infect and how many eventually will need a bed in intensive care, she said.

“It’s the domino effect,” Smith said.

Harry and Ashley Neidig, of Shepherdstown, West Virginia, tested positive for COVID-19 last week. They said they believe they contracted it from someone at their jobs as security officers but didn’t know of their possible exposure before they celebrated Thanksgiving with both sides of the family.

On the Tuesday after Thanksgiving, Ashley Neidig, 25, noticed she couldn’t smell a menthol-scented body scrub. After the couple got tested, they contacted their families to warn them. Some were awaiting test results, and so far no one else has had any symptoms, said Harry Neidig, 24.

“We feel bad because … we definitely should’ve put a heavier weight into our decision to go,” he said. “We should have told our family, ‘Hey, given the nature of our job, we can’t quarantine like other people in an office job.’”

He added: “You might want to take another look before you go somewhere for Christmas.”

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The surge around the country has swamped hospitals and left nurses and other health care workers exhausted and demoralized.

“Compassion fatigue is the best word for what we’re experiencing,” said Kiersten Henry, an ICU nurse practitioner at MedStar Montgomery Medical Center in Olney, Maryland. “I feel we’ve already run a marathon, and this is our second one. Even people who are upbeat are feeling run down at this point.”

While some hospitals are scrambling to find beds and convert storage rooms and other places for use in treating patients, they are also dealing with dire staff shortages.

“We know how to make new beds,” said Dr. Lew Kaplan, a critical care surgeon at the University of Pennsylvania’s Perelman School of Medicine. “We don’t know how to make new staff.”

___

AP data journalist Nicky Forster in New York and Associated Press writer Marion Renault in Rochester, Minn., contributed to this report.

Walgreens said it expects to get its first doses of the Covid-19 vaccine on Dec. 21 and start giving shots to nursing home residents and staff members in the days leading up to Christmas.

The national drugstore chain will play an instrumental role in the early rollout of the much-anticipated vaccination. Walgreens and CVS Health struck deals with the federal government to vaccinate staff and residents at long-term care facilities, which most states have put at the top of the priority list along with health-care workers for receiving Pfizer’s and Moderna’s Covid-19 vaccines.

Pfizer’s vaccine is expected to win emergency clearance from the Food and Drug Administration imminently, while Moderna’s approval is expected to soon follow.

The start of vaccinations at nursing homes will represent a significant milestone in the coronavirus pandemic, because long-term care facilities have been particularly hard hit with Covid-19 outbreaks and deaths. They are typically home to older Americans who have underlying health conditions, making them more vulnerable to develop severe cases of the disease and potentially to die from it.

Rick Gates, senior vice president of pharmacy and healthcare at Walgreens, shared the timing and more details about the rollout in an interview with CNBC. He said he hopes the vaccinations at long-term care facilities give Americans more comfort and confidence in the vaccine. For example, he said, Walgreens’ staff can learn more about the typical side effects, such as soreness near the injection site, so they can better counsel patients and reduce anxiety or alarm.

Public education

“It’s going to also help us from an education perspective because there are a lot saying that they may not get the vaccine,” he said. “The more we have from a practical application perspective, then we can educate more broadly on the safety protocols that we’re seeing with the vaccines as well as we expand into larger populations.”

The vaccine’s distribution could become a hopeful inflection point during a particularly dark stretch of the coronavirus pandemic. The single-day death toll from the coronavirus in the U.S. hit an all-time high on Wednesday with 3,124 fatalities, according to CNBC’s analysis of Johns Hopkins University data. The daily death toll surpassed the number of people killed on 9/11 and the total killed in the Pearl Harbor attack.

The Food and Drug Administration has yet to officially approve a Covid-19 vaccine, but Commissioner Stephen Hahn earlier Friday said the agency was working “rapidly” to grant emergency use authorization for Pfizer’s vaccine, which the pharma company developed with BioNTech. On Thursday, a panel of outside advisors recommended that the FDA grant limited clearance to the vaccine, which has proven to be 95% effective in large-scale clinical trials.

That is the final hurdle before the multistep process of Covid-19 vaccines’ distribution to nursing homes can be finalized at the state level and the vaccinations begin.

“We’re ready and certainly excited to get vaccines to start to help America pivot past this challenging time,” Gates said.

The process

States will determine how much of their initial vaccine allocation will go to health-care workers at hospitals and how much will go to long-term care facilities.

Walgreens, which is working with FedEx to receive vaccine shipments, has designated some of its drugstores as hubs that will keep doses in special freezers and have dry ice on hand, Gates said. Pfizer’s vaccine, in particular, requires ultra-cold storage at minus 94 degrees Fahrenheit. Gates said those vaccine doses will be taken to long-term care facilities for on-site clinics that are staffed by two to 15 people, depending on the size of the facility.

Walgreens has more than 27,000 pharmacists trained to administer vaccines. The company said it’s hiring between 8,000 and 9,000 pharmacy team members to support the Covid-19 vaccine and other related efforts, such as testing.

About 30,000 nursing homes and assisted living facilities have chosen Walgreens to administer the vaccine, and the company expects to make two to three visits per nursing home, Gates said. That’s because both Pfizer’s and Moderna’s vaccines require two doses a few weeks apart.

The Trump administration’s vaccine czar, Dr. Moncef Slaoui, has said “significantly noticeable” side effects were reported in 10% to 15% of trial participants for those vaccines. For that reason, some nursing home operators have expressed concerns over the number of visits per facility, saying it’s important to have opportunities to stagger the dates staff receive shots.

Side effects

They worry that if their entire staff is vaccinated on the same day, side effects from the shot may result in numerous staff members having to take off a day or two off work, leaving the facility short on nurses and other workers.

Gates acknowledged those concerns and said Walgreens would adapt its administration plans if the side effects are seen in the broader population.

“Obviously, we’ll have to be flexible in how we’re going to support long-term care facilities, because they still need to service and take care of the residents of those long-term care facilities as well,” he said.

For many other Americans, however, the wait for a vaccine will be longer.

Walgreens is not yet sure when it will have vaccines at its drugstores to give to the general public, Gates said. He said it’s working with state officials to hear which people will get priority, such as essential workers and those who are immunocompromised, and identify those people during distribution.

And he knows from personal experience that some Americans are eager to claim their spot in the line. “Even my mom knows what number she is in the state of Iowa right now,” he said.

Shots for health workers and nursing home residents are expected to begin in the coming days after the Food and Drug Administration authorized an emergency rollout of what promises to be a strongly protective vaccine from Pfizer Inc. and its German partner BioNTech.

Initial doses are scarce and rationed as the U.S. joins Britain and several other countries in scrambling to vaccinate as many people as possible ahead of a long, grim winter. It will take months of work to tamp down the coronavirus that has surged to catastrophic levels in recent weeks and already claimed 1.5 million lives globally.

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While the FDA decision came only after public review of data from a huge ongoing study, it has also been dogged by intense political pressure from the Trump administration, which has accused the agency of being too slow and even threatened to remove FDA chief Stephen Hahn if a ruling did not come Friday.

The move sets off what will be the largest vaccination campaign in U.S. history — but it also has global ramifications because it’s a role model to many other countries facing the same decision.

The world desperately needs multiple vaccines for enough to go around, and the Pfizer-BioNTech shot is the first based on rigorous scientific testing to emerge from that worldwide race — a record-setting scientific achievement that shaved years off the usual process.

“I don’t think you would have found a scientist on this planet that would have predicted this 11 months ago,” said Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia who advises the FDA.

The U.S. is considering a second vaccine, made by Moderna Inc., that could roll out in another week. In early January, Johnson & Johnson expects to learn if its vaccine is working in final testing.

Europe is set to make its own decision on the Pfizer-BioNTech and Moderna shots later this month, an important step as some other candidates that multiple countries were anxiously awaiting have hit roadblocks. Friday, Sanofi and GSK announced a months-long delay after early tests showed their vaccine didn’t work well enough in older adults.

And China and Russia didn’t wait for final-stage tests before beginning vaccinations with some homegrown shots.

About 3 million doses of the Pfizer-BioNTech vaccine are expected in the first shipments around the country, according to officials with Operation Warp Speed, the Trump administration’s vaccine development program. A similar amount is to be held in reserve for those recipients’ second dose.

A Centers for Disease Control and Prevention advisory committee is poised to recommend who’s first in line. Expected to follow health workers and nursing homes are other essential workers, older adults and people at high risk because of other health problems. U.S. authorities don’t expect enough for the general population before spring, and that’s assuming there are no manufacturing glitches.

In a still unfinished study of nearly 44,000 people, the FDA found the vaccine was safe and more than 90% effective across recipients of different ages, including older adults, races and those with health problems that put them at high risk from the coronavirus.

Emergency use means the vaccine still is experimental. Most important for would-be recipients to know:

• Some protection begins after the first dose, but it takes a second dose three weeks later for full protection. It’s unclear how long protection lasts.
• The vaccine protects against COVID-19 illness, but no one yet knows if it can stop the silent, symptomless spread that accounts for roughly half of all cases. The ongoing study will attempt to answer that but for now, the vaccinated still will need to wear a mask and keep their distance.
• Expect a sore arm and some flu-like symptoms such as fever, fatigue, headache and chills after the second dose. While uncomfortable, those reactions only last about a day. “That’s just your immune system working. It’s a good thing,” Offit said.
• Authorities are investigating several allergic reactions reported in Britain by people with a history of severe allergies. Offit said it is routine in the U.S. for the vaccinated to stick around for a half-hour so they could get prompt treatment if such reactions appear.

If emergency use of Moderna’s vaccine also is authorized, the U.S. expects to vaccinate 20 million people by the end of December. They hope to have enough for another 30 million people in January and 50 million in February.

Getting shots into arms is the big challenge, especially as a new poll from The Associated Press-NORC Center for Public Affairs Research found only half of Americans want the vaccine when it’s their turn. About a quarter say they won’t get it and the rest aren’t sure.

Political interference has complicated health authorities’ message that the testing was rigorous and cut no corners.

President Donald Trump bashed the FDA, again, Friday for taking too long, complaining that the agency “is still a big, old slow turtle.” One of his deputies even pressed Hahn to clear the shots by the end of the day or face possible firing, two administration officials said.

The FDA is unique in analyzing drugmakers’ raw data, a process that takes longer than many other countries’ regulatory reviews. In addition, the FDA insisted that large COVID-19 vaccine studies track at least half the participants for two months to look for side effects, a time period when historically any vaccine problems appear.

AP journalist Jonathan Lemire contributed to this report.

New York Gov. Andrew Cuomo on Friday banned indoor dining in New York City, saying he had been waiting in vain for hospitalization rates to stabilize. Pennsylvania Gov. Tom Wolf did the same on Thursday and also suspended school sports and closed gyms, theaters and casinos.

A record of more than 107,000 people were in the hospital in the U.S. with COVID-19 as of Thursday, according to the COVID Tracking Project. More than 290,000 Americans have died of the virus.

Hospitals around the country have been overrun.

“We’re constantly looking for beds,” said Cassie Ban, an intensive care nurse at Indiana University Health.

Health care workers will be among the first to start getting the nation’s first COVID-19 vaccine in the coming days after the Food and Drug Administration gave it the final go-ahead Friday.

Before the pandemic, an ICU nurse might handle two patients per shift. Ban said she now regularly cares for four or five. The national death toll doesn’t begin to capture what COVID-19 does to each critically ill patient or the medical teams who care for them, she said.

“I wish people could see what I do,” Ban said. “People are terrified and they’re alone. Each one of those numbers is the death of a person who wasn’t ready to go yet.”

Although concerns remain about getting enough beds, masks and other equipment, many frontline health workers are most worried about staff shortages.

Nurses are the most scarce resource of all, said Kiersten Henry, an ICU nurse practitioner at MedStar Montgomery Medical Center in Olney, Maryland.

“I feel we’ve already run a marathon, and this is our second one. Even people who are upbeat are feeling run down at this point,” Henry said.

Many expressed frustration over some Americans’ disregard and even contempt for basic precautions against the virus.

Dr. Lew Kaplan, a critical care surgeon at the University of Pennsylvania’s Perelman School of Medicine, said health care workers are treated as “heroes” for helping patients but are seen as “close to evil incarnate” when they ask people to wear masks.

“It is very disheartening, while you are struggling to manage the influx of patients, there are others who won’t accept public health measures,” said Kaplan, president of the Society of Critical Care Medicine.

Raju Mehta, a critical care physician at Advocate Health and Hospital in the Chicago area, said that early on in the pandemic, many frontline workers were energized by a sense of purpose. Now, that morale is beginning to crumble.

“Seeing what we’re seeing, day in, day out, for eight months, takes a toll,” Mehta said. “It’s tough knowing what we see, and then what happens outside our walls.”

Municipal authorities had already approved an ordinance, on April 3, on the use of masks in public. However, with the increase in the number of COVID-19 cases in Lancaster and throughout the region, the city council decided to take this action, according to a statement from the city council of that city.

The new ordinance, according to Lancaster authorities, modifies the city’s municipal code so that anyone who doesn’t wear a mask in public, faces a misdemeanor charge.

“The goal of this ordinance, and of our law enforcement in Lancaster in general, is to promote peace, safety, and public welfare in our communities,” Mayor Parris said. “While I would hope everyone knows by now the importance of wearing a mask, the fact that violations are now misdemeanors is one more reason to do the right thing and mask up.”

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Robert Sloan Mateer, 30, is named in a five-count indictment charging him with possession of at least 15 or more unauthorized access devices with intent to defraud, aggravated identity theft, possession with intent to distribute methamphetamine, possession of a firearm in furtherance of a drug trafficking crime, and being a felon in possession of ammunition, according to the U.S. Attorney’s Office.

If convicted of all charges, Mateer would face between 17 years and life in prison.

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According to an affidavit, during a traffic stop on Oct. 1, Pasadena police officers arrested Mateer and found inside his Maserati 17 unemployment benefits debit cards, several other credit and debit cards, $197,711 in cash, more than 85 grams of methamphetamine, and a loaded firearm with no serial number.

Prosecutors allege that evidence gathered during the investigation determined that at least 14 of the 17 debit cards were loaded with at least $133,000 in unemployment insurance benefits, later determined to have been issued under the Coronavirus Aid, Relief, and Economic Security Act passed by Congress in March, and had been issued in the names of third-parties, including identity theft victims.

The California Employment Development Department distributes unemployment insurance benefits under the CARES Act, which expanded unemployment benefits to cover those who were previously ineligible, including business owners, self-employed workers and independent contractors, who were put out of business or significantly reduced their services because of the COVID-19 pandemic.

According to the affidavit, Mateer admitted to obtaining the unemployment benefits debit cards by using “thousands” of identity profiles in his possession, that each debit card was loaded with $14,500, and that he used the fraudulently obtained unemployment benefits to purchase the Maserati.

Mateer also admitted that he withdrew the $197,711 in cash found in his Maserati from ATMs across the Los Angeles area, the affidavit states.

Mateer also allegedly withdrew $13,840 from the EDD debit cards in his possession from Sept. 19 to Sept. 25.

Mateer was taken into federal custody on Oct. 21 and was ordered detained pending trial.