Pedestrians walking past a chestnut vendor in the City of London on Monday.
Credit…Tolga Akmen/Agence France-Presse — Getty Images

More than half of England is under the nation’s strictest lockdown measures, and people have been ordered to stay at home, but the coronavirus is still spreading at an alarming rate. Hospitals are treating more patients than at any time during the pandemic, and there is a growing debate about allowing tens of thousands of students to return to classrooms after the holiday break.

The nation’s scientists have said that a more contagious variant of the virus is driving the rise in cases and, having already imposed severe restrictions on more than 48 million people, it remains unclear what other tools the government has at its disposal to get the outbreak under control.

There were 41,385 new lab-confirmed cases reported on Monday, the highest figure yet on a single day. The National Health Service said there were now over 20,000 people in the hospital, more than at the peak of the pandemic in April.

With the government scheduled to meet to evaluate the current restrictions on Wednesday, Prime Minister Boris Johnson is under pressure to impose another national lockdown and move students — especially older ones in colleges and secondary schools, who may be more easily infected by the new virus variant — to remote learning.

The government said that it would rely on mass testing to keep the virus from spreading in schools, with military help. Some 1,500 soldiers are being dedicated to providing schools with the “guidance, materials and funding they need to offer rapid testing to their staff and students from the start of term,” according to the education secretary, Gavin Williamson.

But two teacher unions have said that staff had not been given adequate time to set up mass testing and the country’s board of scientific advisers, known as SAGE, has recommended against allowing classrooms to reopen, according to British media reports.

Even as the country’s health workers find themselves under growing pressure to treat the influx of patients, they are also being asked to speed up the largest mass vaccination program in the nation’s history.

Around 200,000 people are getting their first shot of the Pfizer-BioNTech vaccine every week. With the approval of a vaccine from AstraZeneca and the University of Oxford expected in coming days, the number of doses available will expand drastically. The AstraZeneca vaccine, which comes without the stringent temperature requirements of Pfizer’s, should also be easier to distribute.

There is no evidence that the vaccines are any less effective against the variant of the virus spreading in Britain, and they remain the best chance for the country to break the back of the current wave of infection.

But to meet the government’s promise to vaccinate all those over the age of 50 by spring, the speed of delivery would have to be 10 times as fast as it is now.

That will require not just supply, but the staff to deliver the vaccines. And that means even more pressure on N.H.S. workers.

Sir Simon Stevens, the head of the N.H.S. in England, delivered a message to health workers “back in the eye of the storm,” praising their dedication and urging them to press on through “the toughest year most of us can remember.”

“Many of us have lost family, friends, colleagues and — at a time of year when we would normally be celebrating — a lot of people are understandably feeling anxious, frustrated and tired,” he said, delivering his remarks from a vaccination center on Tuesday. “Therefore now is the right time, I believe, on behalf of the whole country to record our enormous debt of gratitude and our huge thanks.”

Health care workers treating a Covid-19 patient at Providence St. Mary Medical Center in Apple Valley, Calif., this month.
Credit…Ariana Drehsler for The New York Times

Dozens of research papers published over the past few months have found that people whose bodies were teeming with the coronavirus more often became seriously ill and were more likely to die, compared with those who carried much less virus and were more likely to emerge relatively unscathed. Now that information could help hospitals.

The results suggest that knowing the so-called viral load — the amount of virus in the body — could help doctors distinguish those who may need an oxygen check just once a day, for example, from those who need to be monitored more closely, said Dr. Daniel Griffin, an infectious disease physician at Columbia University in New York.

Tracking viral loads “can actually help us stratify risk,” Dr. Griffin said. The idea is not new: Managing viral load has long formed the basis of care for people with H.I.V., for example, and for tamping down transmission of that virus.

Little effort has been made to track viral loads in Covid-19 patients. This month, however, the Food and Drug Administration said clinical labs might report not just whether a person is infected with the coronavirus, but also an estimate of how much virus is in their body.

This is not a change in policy. Labs could have reported this information all along, according to two senior F.D.A. officials who spoke on condition of anonymity because they were not authorized to speak publicly about the matter.

Still, the news came as a welcome surprise to some experts, who have for months pushed labs to record this information.

“This is a very important move by the F.D.A.,” said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. “I think it’s a step in the right direction to making the most use of one of the only pieces of data we have for many positive individuals.”

The F.D.A.’s change followed a similar move by the Florida Department of Health, which now requires all labs to report this information.

The omission of viral load from test results was a missed opportunity not just to optimize strained clinical resources, but also to better understand Covid-19, experts said. Analyzing the viral load soon after exposure, for example, could help reveal whether people who die from Covid-19 are more likely to have high viral loads at the start of their illnesses.

And a study published in June showed that the viral load decreases as the immune response surges, “just like you’d expect it to be for any old virus,” said Dr. Alex Greninger, a virologist at the University of Washington in Seattle, who led the study.

An uptick in the average viral load throughout entire communities could indicate an epidemic on the rise. “We can get an idea of whether the epidemic is growing or declining, without relying on case counts,” said James Hay, a postdoctoral researcher in Dr. Mina’s lab.

Prudence Nonzamedyanti, a participant in a coronavirus vaccine trial, at the Desmond Tutu H.I.V. Foundation Youth Center near Cape Town this month.
Credit…Joao Silva/The New York Times

Over the past few months, rich nations like the United States and Britain have cut deals with multiple drug manufacturers and secured enough doses of coronavirus vaccine to inoculate their citizens many times over. China and Russia have conducted their own trials and begun mass vaccination programs.

Yet countries like South Africa, the African country hardest hit by the pandemic, are in a singular bind because they cannot rely on charity. Although its government is nearly insolvent and half of its citizens live in poverty, South Africa is considered too rich to qualify for cut-rate vaccines from international aid organizations.

And so, a few months from now, when a factory in South Africa is expected to begin churning out a million doses of coronavirus vaccine each day, those vials will probably be shipped to a distribution center in Europe and then rushed to Western countries that have ordered them by the hundreds of millions.

None have been set aside for South Africa, which does not expect to see the first trickle of doses until around the middle of next year.

“Where you’re not rich enough but you’re not poor enough, you’re stuck,” said Salim Abdool Karim, an epidemiologist who leads South Africa’s coronavirus advisory council.

Poor and middle-income nations, largely unable to compete in the open market, rely on a complex vaccine-sharing arrangement called Covax. A collaboration of international health organizations, Covax was designed to avoid the inequities of a free-market free-for-all. But its deals come with strings attached, and health advocates are questioning its transparency and accountability.

“The people at the top, they’re going to get the vaccine, the people who have power,” said Mtshaba Mzwamadoda, 42, who lives in a one-bedroom corrugated metal shack with his wife and three children. “Maybe we’ll get the vaccine in 2025.”

South Africa has recorded over one million cases and 26,000 deaths as of Monday, according to government figures.

With one of the strictest initial lockdowns in the world, South Africa avoided the high death toll that many experts feared. As restrictions eased in the last quarter of the year, however, the death toll climbed steadily, beginning to spike as the holiday season approached.

Scientists from the Nelson R. Mandela School of Medicine at the University of KwaZulu-Natal announced on Dec. 18 that the country was seeing a variant of the virus that accounts for the vast majority of samples tested in the current wave.

Lynsey Chutel and Sheri Fink contributed reporting.

Taniya Ria, 12, moved to the Bronx from Bangladesh in 2019. Her confidence in her English skills has plummeted with the shift to remote learning.
Credit…Ismail Ferdous for The New York Times

While the disruptions of 2020 have threatened learning loss for nearly all students across the country, the toll has been especially severe for students from immigrant homes where English is rarely if ever spoken.

In-person instruction is essential for these students, teachers, parents and experts say. Not only are they surrounded by spoken English in their classrooms; they also learn in more subtle ways, by observing teachers’ facial expressions and other students’ responses to directions. Teachers, too, depend on nonverbal gestures to understand their students. All these things are far more difficult to perceive through a screen.

And beyond the classroom, these students, known as English-language learners, absorb incalculable amounts of information about syntax, slang and vocabulary by simply hanging out in hallways and playgrounds with other students — experiences that have been lost for most New York schoolchildren this year.

“For English-language learners, if you’re not having those casual, informal, low-stakes opportunities to practice English, you’re really at a disadvantage,” said Sita Patel, a clinical psychology professor at Palo Alto University who studies the emotional health of immigrant youth.

Those concerns are playing out across the country. Parts of Virginia, California and Maryland are beginning to see E.L.L. students fall more behind than their peers, according to early fall data from each school district. In Connecticut, attendance is becoming a larger issue for English learners, who were second only to homeless students in their drop in attendance in virtual and in-person classes.

In New York City, the Department of Education does not yet have estimates on learning loss for the city’s roughly 142,000 English language learner students — among the largest populations of English learners in the country. It is also not clear how many of those students opted into hybrid as opposed to full-remote learning.

Officials with the city’s Department of Education said they had instructed schools to prioritize English learners in deciding who will be allowed to return to full-time in-person classes, and insisted they were leveraging every available resource to bolster remote learning.

Credit…Jackson Gibbs

In a typical year, New York employees of the magazine publisher Condé Nast must use their vacation days before late December or lose them — a common policy across corporate America.

But early in December, the company sent employees an email saying they could carry up to five vacation days into next year, an apparent acknowledgment that many scrimped on days off amid the long hours and travel restrictions imposed by the pandemic.

Condé Nast was not alone in scrambling to make end-of-year arrangements for vacation-deprived workers. Some employers, however, have been less accommodating.

Many companies that already allow employees to carry vacation days into the next year — including Goldman Sachs (generally up to 10) and Spotify (generally up to 10) — have not felt the need to change their policies.

The same is true for some companies that pay workers for their unused vacation days. Neither General Motors nor Ford Motor, whose hourly workers can cash out unused vacation days at the end of the year, is making changes.

A union official at the news organization Reuters said the company cited accounting concerns in sticking with its use-it-or-lose-it policy. The union had pleaded for leniency, noting that its contract allows management to roll over vacation days in “exceptional circumstances.”

A Reuters spokeswoman said that “our policy for U.S. employees for some years has not allowed for unused vacation days to be rolled over” and that “employees have been regularly reminded since the first half of this year.”

Several experts said a philosophical question loomed over vacation benefits: Is the point to ensure that workers take time off? Or are vacation days simply an alternative form of compensation that workers can use as they see fit, whether to relax, to supplement their income or to drag around with them as a monument to their productivity?

In the spring, the software company GitLab responded to a significant rise in hours put in by its more than 1,000 workers with so-called family-and-friends days, in which the company shuts down to discourage people from logging in. Google, Slack and the software company Cloudera have started similar policies.

Herald Square in New York on Friday.
Credit…Brittainy Newman for The New York Times

The retail industry was in the midst of a transformation before 2020. But the pandemic accelerated that change, fundamentally reordering how and where people shop, and rippling across the broader economy.

Many stores closed for good, as chains cut locations or filed for bankruptcy, displacing everyone from highly paid executives to hourly workers. Amazon grew even more powerful and unavoidable as millions of people bought goods online during lockdowns.

The divide between essential businesses allowed to stay open and nonessential ones forced to close drove shoppers to big-box chains like Walmart, Target and Dick’s and worsened the troubles of struggling department stores. The apparel industry and many malls were battered as millions of Americans stayed home and myriad dress-up events, including proms and weddings, were canceled or postponed.

This year’s civil unrest and its thorny issues for American society also hit retailers. Businesses closed because of protests over George Floyd’s killing by a white police officer, and they reckoned with their own failings when it came to race.

The challenges faced by working parents, including the cost and availability of basic child care during the pandemic, were felt keenly by women working at stores from CVS to Bloomingdale’s. And there were questions about the treatment of workers, as retailers and their backers treated employees shoddily during bankruptcies or failed to offer hazard pay or adequate notifications about outbreaks of Covid-19 in workplaces.

Many Americans felt the retail upheaval — the industry is the second-biggest private employment sector in the United States — and some shared their experiences this year with The New York Times.

The Life Care Center of Kirkland, a nursing home near Seattle, was the site of the first U.S. coronavirus outbreak. Residents and staff members received vaccinations on Monday.
Credit…Karen Ducey/Getty Images

A nurse at the suburban Seattle nursing home that was ravaged by the first U.S. cluster of coronavirus cases sat down beside a visiting pharmacist on Monday, pulled up her blue shirtsleeve and received the first dose of the Covid-19 vaccine administered at the facility.

It was the beginning of what residents, families and employees hope will be a turning point in a pandemic that has killed tens of thousands of people in long-term care facilities. Vaccination teams from Walgreens and CVS were fanning out to facilities across the country on Monday, the start of a long, difficult campaign to vaccinate some of the country’s most vulnerable people.

At the facility near Seattle, the Life Care Center of Kirkland, which is connected with 46 coronavirus deaths, relatives of residents got a text message on Monday morning alerting them that vaccinations were beginning.

Colleen Mallory had been waiting for this moment. Her mother has severe dementia, and since Life Care was locked down last winter, her family has visited her mostly by standing outside her window, waving and saying “I love you.”

Ms. Mallory’s family gave Life Care permission to vaccinate her mother, and Ms. Mallory said she had been calling and calling, anxious to know whether it had actually happened. “I can’t get a hold of anyone,” she said. “It would be nice to know.”

Alice Cortez, the first nurse vaccinated at the facility, said she felt “a new life, a new beginning, but a better life,” The Seattle Times reported. There were roses and cheers as she was injected just outside the facility, with cameras rolling.

The scene was starkly different last winter, when the quiet, shaded nursing home became a scene of grim vigil and daily updates about deaths and case counts. Journalists crowded outside the locked-down facility as ambulances whisked residents to the hospital and families peered through windows to check on parents and grandparents.

Life Care officials did not immediately reply to inquiries about how many staff members and residents were vaccinated on Monday, or how long it would take to vaccinate them all.



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