The largest health care provider in the New York region is frantically prepping for the arrival of the vaccine.

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UPS said it would transport doses of the vaccine from storage sites in Michigan and Wisconsin to its air cargo hub in Louisville, Ky.
Credit…John Sommers Ii/Reuters

UPS and FedEx, normally rivals, are working side by side to ship the coronavirus vaccine developed by Pfizer and BioNTech, the first of the vaccines to win U.S. government approval.

The two shipping companies said they had put plans they had been working on for months into action after the Food and Drug Administration gave the vaccine emergency authorization late Friday.

Delivery of the first vaccines comes as the virus continues to rage across America. Officials reported more than 236,000 new cases on Friday, yet another single-day case record. More than 3,000 deaths were reported for the first time on Wednesday and the country’s total is approaching 300,000.

At a news conference on Saturday, Gen. Gustave F. Perna, the chief operating officer of Operation Warp Speed, the federal effort to bring a vaccine to market, said that boxes were being packed at Pfizer’s plant in Kalamazoo, Mich., and would be shipped to UPS and FedEx distribution hubs, where they would be dispersed to 636 locations across the country. Pfizer said shipping would start early Sunday morning.

Mr. Perna specified that 145 sites would receive the vaccine on Monday, 425 on Tuesday and 66 on Wednesday.

“Make no mistake, distribution has begun,” he said. UPS said it expected to start transporting the vaccine on Sunday morning, when employees stationed at Pfizer’s facility in Michigan will affix special Bluetooth- and radio-enabled tracking tags to each shipment. An aircraft waiting nearby will take the vaccine to the company’s Worldport air cargo hub in Louisville, Ky., a sprawling 5.2 million-square-foot sorting facility. Future shipments of the vaccine will also be transported by truck to the Louisville hub, which is up to a six-hour drive from Michigan.

“This is the moment we’ve been waiting for,” Wes Wheeler, president of the company’s health care division, said in an interview on Saturday. “We’ve been planning for months with daily calls, drilling down to really quite minute details.”

Mr. Wheeler said he planned to oversee the first vaccine shipments from a newly established 24/7 command center in Louisville, which will be staffed at any given time by teams of five to 10 people who will monitor each vaccine package as it moves through UPS’s network.

Once the vaccine shipments arrive at the Louisville hub, they will be sorted alongside other packages and distributed to hospitals and other medical facilities. Every truck driver or airplane pilot will know if they are carrying a vaccine package, Mr. Wheeler said. Both UPS and FedEx have said that doses will arrive at their destinations a day after leaving the Pfizer facilities.

Even before the vaccine was approved, UPS had already started shipping out kits with the medical supplies needed to administer it, such as alcohol wipes and syringes, Mr. Wheeler told a Senate subcommittee this week. UPS and FedEx will split distribution of the vaccine throughout the country. After those shipments arrive, all Pfizer dosing sites will receive another shipment from UPS of 40 pounds of extra dry ice to keep the vaccines at a frigid temperature, he said.

“You have two fierce rivals here, and competitors, in FedEx and UPS, who literally are teaming up to get this delivered,” Richard Smith, a FedEx executive, told the Senate’s Subcommittee on Transportation and Safety on Thursday.

Both companies said the shipments would be closely tracked and monitored, and would be given priority over other packages. To ship its vaccine, Pfizer designed specialized containers packed with enough dry ice to keep a minimum of 975 doses cool for up to 10 days. Each comes with a tracking device.

Like UPS, FedEx said it would also affix its own tracking tags to vaccine shipments. Each UPS truck carrying the doses will have a device that tracks its location, temperature, light exposure and motion, Mr. Wheeler told the senators. The company’s trucks will have escorts, too, he said on Thursday. It is not clear whether he meant the local police or other government officials, or possibly private guards, and he declined to elaborate on that and other details in the interview, citing security concerns. But the trucks leaving Pfizer’s facility will be tracked “by the minute,” he said.

The vaccine has been approved for use in 16 and 17-year-olds. Students at the Mast Academy in Miami arrived for classes in October.
Credit…Lynne Sladky/Associated Press

An independent committee of experts advising the Centers for Disease Control and Prevention on Saturday afternoon recommended the Pfizer coronavirus vaccine for people 16 years of age and older. That endorsement, which now only awaits final approval by Dr. Robert Redfield, the director of the C.D.C., is a key signal to hospitals and individual health care providers that they should proceed to inoculate patients.

The endorsement follows Friday night’s emergency use authorization of the vaccine by the Food and Drug Administration, which oversees licensing of medical products.

“Based on everything we saw from looking at the data, we’re very comfortable that the safety profile that was observed in 17 and 16-year-olds was acceptable,” said Dr. Peter Marks, the F.D.A.’s top vaccine regulator, at a news conference on Saturday.

The C.D.C. advisory committee, which typically meets three times a year to review amendments to routine schedules for child, adolescent and adult vaccines, has been engaged in numerous marathon-length sessions this fall to discuss a plethora of issues surrounding the introduction of limited supplies during a pandemic of the novel vaccine.

In meetings on Friday and Saturday, the panel’s heated discussion centered mainly on three areas: whether to recommend the vaccine for patients 16 and 17 years old, for pregnant and lactating women, and for patients who have had an anaphylactic reaction to other vaccines.

C.D.C. officials and scientists will review the debate and post more precise guidance about those specific groups and others on Sunday and throughout next week, as more information about the vaccine becomes known.

Vail Health Hospital placed mock coronavirus vaccines into the hospital’s ultracold freezer on Tuesday in Colorado.
Credit…Helen H. Richardson/The Denver Post, via Associated Press

This weekend, 2.9 million doses of the Pfizer and BioNTech vaccine are to begin traveling by plane and guarded truck from facilities in Michigan and Wisconsin to designated locations, mostly hospitals, in all 50 states.

The first injections are expected to be given by Monday to high-risk health care workers, the initial step toward the goal of inoculating enough Americans by spring to finally halt the spread of a virus that has killed nearly 300,000, sickened millions and upended the country’s economy, education system and daily life. There are now more than 16 million virus cases reported in the United States, according to a New York Times database.

The rapid development of the vaccine, and the F.D.A.’s emergency authorization of it on Friday night based on data showing it to be 95 percent effective, has been a triumph of medical science, but much in this complicated next stage could go wrong.

States say they have only a fraction of the funding they need from the federal government for staffing to administer the shot, for tracking who has received both doses of the vaccine — a booster is needed three weeks after the initial injection — and for other crucial pieces of the effort.

But for all the planning that has been done and contingencies that have been put in place in recent months, there is still a good deal of confusion. States are receiving initial allocations according to a federal formula based strictly on their adult population, but many hospitals say they still don’t know exactly how much they will get or when shipments will arrive. Some hospital systems are reeling from the news that their initial allocations will be much smaller than they had hoped.

One reason for the shortfall in initial supply is that federal officials decided to send out fewer than half of the 6.4 million doses they had planned for the first wave.

Although there is some variation among their plans, states are largely planning to follow recommendations from the Centers for Disease Control and Prevention about who gets vaccinated first: health care workers at high risk of exposure to the virus and residents of nursing homes and other long-term-care facilities, a population that has died from the virus at disproportionately high rates.

On Thursday, as an F.D.A. advisory committee debated whether to recommend authorization of the Pfizer vaccine, the first packages of supplies to administer it — vaccination record cards, masks, visors, information sheets and syringes — arrived at UPMC Presbyterian, a hospital in Pittsburgh.

Charley Pride performing in New York in 1975.
Credit…Bettmann Archive, via Getty Images

Charley Pride, who was celebrated as a country music’s first Black superstar and known for hits such as “Kiss an Angel Good Mornin’” and “Is Anybody Goin’ to San Antone,” died on Saturday at age 86 while in hospice care in Dallas.

The cause of his death was complications of Covid-19, said Jeremy Westby, the singer’s publicist.

Lauded as a star who paved the way for other country music artists of color, Mr. Pride was praised for his contributions to the country music canon. In November, he received the Country Music Association’s Lifetime Achievement Award at the 54th annual Country Music Association Awards, where he also performed.

Some guests at the show, which was Mr. Pride’s last public event, were not wearing masks. However, event organizers said all protocols from the Centers for Disease Control and Prevention were followed.

Born March 18, 1934 in Sledge, Miss., Mr. Pride served in the army before moving to Montana to try to make it as a baseball player. There, he worked at a smelting plant and played semiprofessional baseball in East Helena, where he was paid $10 to sing the national anthem before games.

He began his country music career in the 1960s after signing with RCA Records, later quitting his factory job after his 1967 song “Just Between You and Me” became a Top 10 country hit.

As a Black man entering the country music industry in the 1960s, Mr. Pride’s career did not escape prejudice. Once radio stations learned he was Black, many refused to play his music, and during a 1970s award show, singer Loretta Lynn was told not to embrace him should he win an award she was presenting. (She did so anyway.)

“We’re not colorblind yet,” Mr. Pride wrote in his memoir, “Pride: The Charley Pride Story” (1994). “But we’ve advanced a few paces along the path, and I like to think I’ve contributed something to that process.”

During his career, Mr. Pride recorded over 50 hits that made it to Top 10 on the country charts, with over 20 hitting No. 1. Mr. Pride also racked up notable awards: Country Music Association’s male vocalist of the year in 1971 and 1972, Country Music Association’s entertainer of the year in 1971 and a lifetime achievement Grammy Award in 2017.

Dolly Parton said on Saturday she was “heartbroken” over Mr. Pride’s death, calling him one of her “dearest friends.”

“What a horrible, horrible virus,” she said on Twitter. “Charley, we will always love you.”

Mr. Pride is survived by his wife, Ebby Rozene Cohran Pride, and his children, Carlton, Charles and Angela.

Freezers at Northwell Health at New Hyde Park, N.Y., awaiting doses of the coronavirus vaccine.
Credit…Northwell Health

The emergency authorization of the Pfizer-BioNTech vaccine on Friday night has set off a frenzy of preparations at hospitals and doctors’ offices across the United States. Among them is Northwell Health, the largest health care provider in the New York region, once the coronavirus epicenter in the United States.

Organizing the receipt and further distribution of the vaccine is a mammoth task. Northwell has set up nine vaccination centers equipped with ultracold freezers at or near its hospitals in Manhattan, Staten Island, Westchester County and Long Island, and plans to start vaccinating tens of thousands of employees as soon as the vaccine shipments arrive, probably on Monday, said Dr. Mark Jarrett, Northwell’s chief quality officer.

The health system, which has 56,000 employees who interact with patients, has already received shipments of kits with supplies for administering the vaccine, including syringes, alcohol swabs and gloves.

Northwell expects to have all of its workers — not just care providers like doctors and nurses, but also others such as cleaning personnel who work in intensive care units and patient rooms — vaccinated within five weeks with the Pfizer-BioNTech or the Moderna vaccines, Dr. Jarrett said.

Employees will be given appointments to come in for shots so they won’t have to stand in line and can maintain social distancing. A backup list of additional recipients will be drawn up in case anyone has to cancel an appointment at the last minute.

“The one thing we don’t want to do is ever waste vaccine,” Dr. Jarrett said. The Pfizer-BioNTech vaccine, which is transported on dry ice, has to be stored at minus 94 degrees Fahrenheit, and then prepared for use.

“Once you’ve defrosted and diluted it, you only have six hours to use it,” Dr. Jarrett said. “You want to certainly use every dose that’s in a vial.”

The health system is carefully scheduling employees for vaccination in various units and hospitals to prevent staffing problems from overburdening any single unit. The idea is to evenly spread staff out in case they have adverse reactions to the shot — such as fever, fatigue or muscle pain — that require them to stay home from work.

That will be even more important when the second dose of the vaccine is administered, three weeks after the first shot; the rate of side effects among clinical trial participants was reported to be higher after the second dose of the vaccine.

Priority will be given to older employees and those who make a request because of medical conditions that leave them especially vulnerable to the coronavirus, Dr. Jarrett said.

No employee will be forced to take the vaccine, Dr. Jarrett said — a decision influenced in part by the fact that the vaccine received an emergency use authorization and has not gone through the F.D.A.’s standard approval process. But he expects demand to be high.

“There will be a certain percentage who are afraid to take the vaccine,” he said. “After they see team members get it and be fine, I suspect most of those will then decide to take it.”

Ingham County, Mich., which includes Michigan State University, went from reporting about 300 new infections in August to about 1,800 in September.
Credit…Sylvia Jarrus for The New York Times

As coronavirus deaths soar across the country, deaths in communities that are home to colleges have risen faster than the rest of the nation, a New York Times analysis of 203 counties where students compose at least 10 percent of the population has found.

In late August and early September, as college students returned to campus and some institutions put into place rigorous testing programs, the number of reported infections surged. Yet because serious illness and death are rare among young coronavirus patients, it was unclear at the time whether the growth of infections on campus would translate into a major health crisis.

But since the end of August, deaths from the virus have doubled in counties with a large college population, compared with a 58 percent increase in the rest of the nation.

Few of the victims were college students but, rather, older people and others living and working in the community.

Since the pandemic began, a Times survey has identified more than 397,000 infections at more than 1,800 colleges and universities. Those cases include more than 90 deaths involving college employees and students.

The link between an outbreak at a college and a coronavirus death in the wider community is often indirect and difficult to document, according to public health experts, especially without extensive contact tracing, which many local health departments in the United States lack resources to pursue.

But researchers have begun finding evidence of ties to college students. Using genetic sequencing to track cases around the University of Wisconsin-La Crosse, Paraic Kenny, a cancer geneticist at the Kabara Cancer Research Institute of the Gundersen Medical Foundation, has found links between infections at the university and cases and deaths in the surrounding region.

That trend highlighted a central fear of health officials — that young adults with limited symptoms might unwittingly transmit the virus, increasing the possibility it would ultimately spread to someone more vulnerable.

Experts suggest an array of ways such spread might happen, including one simple possibility: More than 1.1 million undergraduates work in health-related occupations, census data shows, including more than 700,000 that serve as nurses, medical assistants and health care aides in their communities.

But spread of the virus may also be more invisible, through layers of separation.

“All it really takes is one cavalier interaction,” said Tali Elfassy, an epidemiologist at the University of Miami.


Members of the Public Health Agency of Canada held a drill for the rollout of the coronavirus vaccine in Ottawa on Friday.
Credit…Pool photo by Sean Kilpatrick

With the F.D.A.’s authorization of a coronavirus vaccine on Friday, the United States became the third highly developed Western country — after Britain and Canada — to approve such a drug.

But the three countries have different health care systems and face different challenges in the race to get the vaccine to millions of people. Here are some similarities and differences:

For now, yes.

The first vaccine authorized by American regulators, and their British and Canadian counterparts, is the one developed by Pfizer and BioNTech.

But several other vaccines are close behind, particularly one developed by Moderna and the National Institutes of Health, and another from AstraZeneca and the University of Oxford. It could well be that half a dozen or more vaccines are approved in the coming months.

In Britain, very. In the United States, not. In Canada, somewhere in between.

With a strong central government and a National Health Service that covers all of its people, Britain is directing the process from London. The national government chose 50 hospitals that would initially get the vaccine and made sure they were prepared; decided how much each one would receive; and drafted rules determining what order people would be eligible to get it.

In the U.S., the federal government is having the vaccine distributed to each state based on population. It will be up to states to decide how to divide the doses among hospitals, clinics and, ultimately, drugstores and doctors’ offices.

Canada has a universal health care system, but it is decentralized, administered by provinces and territories. For vaccine distribution, the central government plans to work through those regional governments. Ottawa will play a large role in directing the process.

That remains a bit murky.

Canada ordered enough of the Pfizer-BioNTech vaccine for all of its people, Britain enough for 30 percent and the United States enough for 15 percent. But those numbers reflect deliveries that are expected to take months to complete, and Pfizer, like other companies, has hit snags in ramping up production.

All three countries made advance purchases from other companies, as well, so the pace of vaccine approval could significantly affect the speed of rollout. That speed will also be affected by the need for vaccination sites to be equipped with the right freezers, staff, and enough syringes and protective gear.

Initial shipments are a fraction of the pre-purchases — 800,000 doses to Britain and an expected 249,000 this month to Canada. U.S. officials said they hoped to have 40 million doses of the vaccine by the end of the month, which may be optimistic.

In Canada, the government is sending shipments to all 10 provinces. The three northern territories will have to wait. In America, FedEx and UPS will ship vaccines from distribution centers to every part of the country.

That is even murkier.

Britain, Canada and the United States have followed similar strategies, pre-ordering huge numbers of doses — more than enough to inoculate everyone — from multiple makers, hedging their bets in case some of the vaccines are not approved or some manufacturers have production breakdowns.

Relative to their populations, the United States has ordered far fewer doses than Canada or Britain, and last summer it passed up an offer to increase its advance order from Pfizer. Administration officials say the numbers are misleading, because the government has signed options to buy far more of the vaccine if it sees the need.

But in the face of intense global demand, it is not clear how fast pharmaceutical companies will be able to fulfill the orders they have, much less any additional orders.

In other global developments:

  • In Brazil, the number of people unwilling to take any Covid-19 vaccine has grown to 22 percent, up from 9 percent in August, Reuters reports. President Jair Bolsonaro, a virus skeptic who has continued to critique coronavirus restrictions, said he would not take a coronavirus vaccine. He has been particularly skeptical of China’s Sinovac vaccine. In November, Brazil suspended a late-stage trial of the vaccine. Although Brazil’s cases fell during the fall, there’s been an uptick since early November. It’s now averaging about 43,000 cases a day, about double from a month ago.

  • Brittanya Karma, a Vietnamese-German rapper and reality television star, died on Nov. 29 in Hamburg, Germany, where she was born and lived. She was 29. The cause was complications of Covid-19, her agent said.

U.S. Roundup

The Illinois National Guard, at a testing center in May, are assisting with coronavirus testing and screening at the LaSalle Veterans’ Home. At least 38 residents have tested positive for the virus.
Credit…Nam Y. Huh/Associated Press

A coronavirus outbreak at a veterans’ home in Illinois has killed more than a quarter of its residents, prompting the state to mobilize the Illinois National Guard to the home, Gov. J.B. Pritzker said at a news conference on Thursday.

Mr. Pritzker said that 38 residents at the home, LaSalle Veterans’ Home, had contracted the virus out of its 93 total residents, and three staff members were also infected. The governor emphasized that every employee was tested with rapid result antigen tests before each shift, and that residents were being tested every day.

Still, some are criticizing the handling of the outbreak, which was first detected at the home on Nov. 1. Since then, 89 percent of the residents have tested positive for the virus, State Senator Sue Rezin, a Republican, said in a letter on Friday addressed to the veterans at the home. Ms. Rezin said that National Guard medical staff would be assisting with testing and screening, and she noted that the move to mobilize the National Guard was made five weeks after the initial outbreak.

“The fact that this virus was able to run rampant in the facility should be considered unacceptable,” Ms. Rezin wrote in the letter. “With so many unanswered questions remaining, it is critical that the legislature continue its legislative hearings into what happened at the LaSalle Veterans’ Home,” she said.

There are continuing investigations into the outbreak. On Monday, the governor’s office fired the administrator at the LaSalle home and the director of nursing had also been placed on administrative leave. The Illinois Department of Veterans’ Affairs released reports in November, in partnership with the state department of public health and the U.S. Department of Veterans Affairs, detailing several problems in the home.

Alcohol-free sanitizer — which is not effective in eradicating the virus — was stocked in mounted dispensers, a report said. Some staff members were seen in the kitchen area with masks pulled down to their chins and not social distancing. There were staff members wearing gloves, who were seen touching patients and multiple surfaces “without changing or performing hand hygiene,” the report said. “Opportunities for transmission among some staff may have occurred due to reported laxity of masking and social distancing while off duty and also during break periods.”

Illinois has seen a 10 percent decline in cases over the past 14 days, and a 14 percent decline in hospitalizations, after setting seven-day case records at the beginning of November. Yet deaths in the state are up 42 percent in the past two weeks.

The F.D.A. authorized Pfizer’s vaccine for emergency use on Friday, allowing for millions of people to start getting the vaccine within days. Still, the virus continues to decimate the lives of residents at the LaSalle Veterans’ Home, even as residents of nursing homes and long-term-care facilities — and health care workers at high risk of exposure — are at the top of the vaccine waiting list.

In other news around the United States:

  • Dr. Nicole Alexander-Scott, the director of the Rhode Island’s Department of Health, tested positive for the coronavirus on Saturday. The results came from routine testing, a spokesman for Gov. Gina Raimondo said. Dr. Alexander-Scott was asymptomatic. Ms. Raimondo, who last saw Dr. Alexander-Scott in person during a Covid-19 press briefing on Thursday, is quarantining. She tested negative on Saturday, spokesman Josh Block said. Rhode Island leads the country in coronavirus cases per capita, averaging about 1,240 cases a day this past week, or about 117 cases per 100,000 people. The state has begun issuing temporary licenses to doctors and nurses who are retired, are visiting the state or have recently completed training programs.

  • As many as 300,000 coronavirus cases across the United States can be traced to a two-day conference in Boston attended by 175 biotech executives in February, according to a study published in the journal Science.

A vaccination station in Cardiff, England, where the Pfizer and BioNTech vaccine was given to patients this week.
Credit…Andrew Testa for The New York Times

British drug regulators recommended on Wednesday that people with severe allergic reactions to food and medicine not receive Pfizer’s coronavirus vaccine after two health care workers, both with such a history, had a serious reaction.

The initial report on the British cases set off alarm and confusion, and left many people with allergies wondering whether the new vaccine would be safe for them.

Here’s what we know so far:

The workers both experienced anaphylaxis, a life-threatening reaction that impairs breathing and can drop blood pressure within minutes or even seconds after exposure to an allergen. Both workers were treated with epinephrine and have recovered, the regulators said.

People with a history of an anaphylactic reaction to any vaccine were excluded from Pfizer’s studies, company officials said on Thursday.

Among those who participated in the Pfizer trials, a very small number of people had allergic reactions. A document published by the F.D.A. on Tuesday said that 0.63 percent of participants who received the vaccine reported potential allergic reactions, compared with 0.51 percent of people who received a placebo.

In Pfizer’s late-stage clinical trial, one of the 18,801 participants who received the vaccine had an anaphylactic reaction, according to safety data published by the F.D.A. None in the placebo group did.

I have allergies, should I be concerned?

Dr. Anthony Fauci, the nation’s leading expert on infectious diseases, said on Wednesday that the allergic reactions were concerning but most likely rare, the kind of effects that show up when a vaccine moves out of testing and into broader distribution.

“If I were a person that had an underlying allergic tendency, I might want to be prepared that I might get a reaction, and therefore be ready to treat it,” Dr. Fauci said, in a webcast moderated by Dr. Sanjay Gupta of CNN, sponsored by Harvard and The New England Journal of Medicine.

Dr. Fauci acknowledged that the problem could turn out to affect a lot of people, but he said that other vaccines would eventually become available for those affected.

Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, said the initial, broad recommendation in Britain mentioning severe allergic reactions seemed to be an overreaction that could needlessly scare many people away from a desperately needed vaccine in the middle of a raging pandemic.

Fewer than one in a million recipients of other vaccines a year in the United States have an anaphylactic reaction, Dr. Offit said. Those reactions are treatable and much easier to control than a severe case of Covid-19, he said.

The stolen ventilators, worth $3 million, were being transported to a Covid-19 intensive care center in El Salvador to treat critically ill patients as part of a federal aid program.
Credit…Go Nakamura/Getty Images

Two men have been charged with stealing 192 ventilators owned by the US government in Miami, authorities said on Friday. When they were stolen, the ventilators — worth $3 million — were being transported to a Covid-19 intensive care center in El Salvador to treat critically ill patients as part of a federal aid program.

Yoelvis Denis Hernandez, who is known as Guajiro, and Luis Urra Montero, who goes by the name Flaco, were indicted on charges of federal conspiracy, possessing stolen goods that were being shipped across state lines and the theft of government property.

According to the indictment, Mr. Hernandez, 42, and Mr. Montero, 24, stole a tractor-trailer in August that was being used to transport the ventilators to Miami International Airport. The tractor-trailer had been left in a lot overnight. After an investigation, most of the ventilators were found, the authorities said.

At the onset of the pandemic, medical professionals and government authorities were concerned about the shortage of ventilators in the United States and in other countries. Since then, however, the country’s medical device manufacturers have ramped up production of the machines. The U.S. now has more than 200,000 critical care ventilators — 155,000 of them in the Strategic National Stockpile — but there aren’t enough specialists to operate them.

In June, a man was charged with stealing ventilators from a Veterans Affairs medical center in Seattle and selling them on eBay.

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