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Pfizer Asks the F.D.A. for Emergency Approval of Its Virus Vaccine
Pfizer Asks the F.D.A. for Emergency Approval of Its Virus Vaccine avatar

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Pfizer has said its coronavirus vaccine is 95 percent effective.Credit…Bebeto Matthews/Associated Press

The drug maker Pfizer said on Friday that it had submitted an application to the Food and Drug Administration to authorize its coronavirus vaccine for emergency use, setting in motion an accelerated regulatory process that could allow the first Americans to get a vaccine by the middle of December.

Pfizer and its German partner, BioNTech, announced on Wednesday that the vaccine was safe and 95 percent effective, and that it also worked well in older people and in preventing severe Covid-19. Another front-runner, Moderna, said on Monday that its vaccine, which uses similar technology, was 94.5 percent effective and that the company also expected to apply soon for emergency authorization.

An emergency authorization would allow limited groups of Americans to get the vaccines before the F.D.A. has completed the typical monthslong approval process. Agency officials have made clear through new guidelines that their bar for emergency authorization will be high.

The F.D.A. regulators plan to take about three weeks to review Pfizer’s vaccine, which spans thousands of pages, before an outside panel of experts meets to review the application. That meeting has been scheduled for Dec. 10.

The agency typically, though not always, follows the advice of its advisory committees. If committee members reach a consensus about the effectiveness of Pfizer’s vaccine, the company could receive emergency clearance by mid-December.

Because Moderna is also on the verge of submitting its vaccine for emergency approval, the outside panel could review the company’s vaccine soon after Pfizer’s.

If both vaccines are authorized for emergency use, federal and company officials have said, there could be enough doses to immunize about 20 million Americans before the end of the year, a group that would most likely include health care workers and nursing home residents. There are an estimated 17 million to 20 million health care workers in the United States, and about a million people living in nursing homes.

In a video message Friday, Pfizer’s chief executive, Dr. Albert Bourla, called it a “historic day,” and said, “It is with great pride and joy — and even a little relief — that I can say that our request for emergency use authorization for our Covid-19 vaccine is now in the F.D.A.’s hands.”

Pfizer said on Friday that the company has begun regulatory submissions in Australia, Canada, Europe, Japan and Britain, and that it planned to apply in other countries “in the immediate future.”

An employee setting up for outdoor dining in Oakland, Calif. on Thursday. Gov. Gavin Newsom ordered a new overnight curfew on Thursday to stem the increase in coronavirus cases. 
An employee setting up for outdoor dining in Oakland, Calif. on Thursday. Gov. Gavin Newsom ordered a new overnight curfew on Thursday to stem the increase in coronavirus cases. Credit…Jim Wilson/The New York Times

California joined several other states and cities across the United States this week in issuing an overnight curfew, a measure more often imposed to calm public unrest than for the sake of public health. But in 2020, it has become a tactic deployed by officials in hopes of stopping the coronavirus from leaping person to person at bars, parties and other nocturnal events.

Gov. Gavin Newsom of California, a Democrat, issued the order for most of the state’s counties on Thursday, requiring that, beginning Saturday, people not leave their homes between 10 p.m. and 5 a.m. except for essential reasons, and that restaurants close for dining then as well. Gov. Mike DeWine of Ohio, a Republican, issued a similar curfew that went into effect on Thursday.

At the local level, some areas have also imposed curfews, such as Pueblo, Colo., and Miami-Dade County, Fla., while several cities, including New York and Chicago, have shut down bars and restaurants at 10 p.m.

The measures also show how widely the response to the virus can vary by state. None of the states where the virus is spreading at the fastest rates — South Dakota, North Dakota, Wyoming, Iowa and Nebraska — have issued curfews, even as governors of some of those states have begun to require face masks indoors for the first time.

The changes come as the virus has, in the past week, killed more than 1,300 people and infected more than 166,000 new people each day, on average as of Thursday.

Public health officials have repeatedly warned that the virus can spread more easily at late-night gatherings as people shout, sing, get closer to each other or, perhaps, flout the rules as they drink. In June, health officials in Ada County, Idaho, which includes Boise, determined that half of the area’s newly sick were people who had likely gotten the virus from bars and nightclubs.

“The rules for when bars are open are supposed to be that you can come down with your group and you don’t interact with others,” said Mayor Nicholas Gradisar of Pueblo, Colo., a city of about 112,000 people where a curfew has been extended to Nov. 27. But people are sometimes don’t follow those rules after they have been drinking, he added. “That’s how this virus spreads.”

Public health experts also caution that it can take several weeks for measures like mask mandates, restaurant closings and restrictions on gathering to influence people’s behavior and start to flatten the epidemic curve. The effect may be delayed because the incubation period for the disease is 14 days, so some proportion of the public is already infected.

A spokesman for Mr. DeWine said he believed Ohio’s three-week curfew “can make a dent” in the state’s rising cases while letting bars and restaurants continue to make money by serving people earlier in the evening.

Dr. Mark Ghaly, the secretary of California Health and Human Services, said that the state’s curfew was targeted to stop the most harmful behaviors.

“We’ve seen in the past that Covid goes from zero to 60 miles per hour very quickly,” he said at a news conference on Thursday. “We know that those who are out, who might be engaging in higher-risk behaviors, that those infections can quickly spread to other settings.”

Andrew Giuliani, the son of Rudolph W. Giuliani, announced he had tested positive for coronavirus on Friday. 
Andrew Giuliani, the son of Rudolph W. Giuliani, announced he had tested positive for coronavirus on Friday. Credit…Al Drago for The New York Times

Andrew Giuliani, a White House official and the son of President Trump’s personal lawyer, announced on Twitter on Friday that he had tested positive for the coronavirus. He is the latest in a string of administration officials, including Mr. Trump himself, to contract the virus.

“This morning, I tested positive for COVID-19. I am experiencing mild symptoms, and am following all appropriate protocols, including being in quarantine and conducting contact tracing,” Mr. Giuliani said.

Mr. Giuliani, who is not known to wear a mask at the White House, attended a news conference on Thursday with his father, Rudolph W. Giuliani, the president’s personal lawyer who is leading efforts to overturn the results of the 2020 election.

People infected by the coronavirus are thought to be at their most contagious in the two or three days before and after their symptoms start. A spokeswoman for the elder Mr. Giuliani did not immediately respond to a question about whether he tested positive or is in quarantine.

The elder Mr. Giuliani, who was not wearing a mask and was sweating profusely while standing at the podium, made a series of baseless allegations about fraud, for which he provided no evidence. There were dozens of people crammed into the small space where the news conference was held.

Andrew Giuliani is only the latest case in what one White House official not authorized to speak publicly described on Friday as another outbreak at the complex. There are at least four other people who have tested positive in recent days in addition to the younger Mr. Giuliani, said the official.

Those test results have come as the dining room in the Navy Mess was reopened this week with limited seating, the official said.

Judd Deere, a White House spokesman, said Friday, “Any positive case is taken seriously. Contact tracing has been conducted by the White House Medical Unit consistent with C.D.C. guidelines to stop further transmission and appropriate notifications and recommendations have been made.”

Senator Rick Scott of Florida, at a campaign rally for two Republican Senate candidates in Georgia last week.
Senator Rick Scott of Florida, at a campaign rally for two Republican Senate candidates in Georgia last week.Credit…Brynn Anderson/Associated Press

Senator Rick Scott, Republican of Florida, said Friday he had tested positive for the coronavirus, the latest prominent lawmaker to contract the rapidly spreading virus that has infected at least eight members of Congress over the past week.

Mr. Scott, 67, said he has been in quarantine at his home in Naples since last Friday, after he came into contact with someone in Florida who later tested positive for the virus. He said he took multiple rapid tests earlier in the week that came back negative, but a P.C.R. test he took Tuesday came back positive Friday.

P.C.R.-based tests are slower, but much more accurate than rapid tests, which are prone to missing the virus when it is present at only low levels in the body. It can also take several days after an exposure for someone to turn positive on a coronavirus test, even if they are already infected.

In a statement, Mr. Scott said he was “feeling good” and experiencing only “very mild symptoms.” He said he would work from home until it is safe to return to Washington. The Senate is not expected to resume work until the end of the month.

He encouraged Americans to wear masks, keep their distance from others and go into quarantine if they encounter someone who is positive for the virus.

“As we approach Thanksgiving, we know this holiday will be different this year,” he said. “But, listen to public health officials and follow their guidance. We will beat this together, but we all have to be responsible.”

Some months ago, Mr. Scott opposed a mask mandate but argued that everyone should choose to wear them. Like most lawmakers, he has taken off his mask when speaking at a microphone. In the past month, reporters at news conferences have started insisting that lawmakers keep their masks on.

Since Nov. 12, eight members of Congress — including two senators, Mr. Scott and Chuck Grassley of Iowa — have reported testing positive for the virus.

Mr. Grassley, 87, a Republican who announced that he had tested positive on Tuesday, wrote on Twitter on Wednesday that he remained “symptom free & in isolation.”

Members of the House who tested positive over the past week include six Republicans: Don Young, 87, of Alaska; Tim Walberg, 69, of Michigan; Dan Newhouse, 65, of Washington; and Doug Lamborn, 66, of Colorado; and two Democrats, Cheri Bustos, 59, of Illinois; Ed Perlmutter, 67, of Colorado.

Refrigerated temporary morgue trailers parked next to a cemetery in El Paso last week.
Refrigerated temporary morgue trailers parked next to a cemetery in El Paso last week.Credit…Joel Angel Juarez for The New York Times

Maps tracking new coronavirus infections in the continental United States were bathed in a sea of red on Friday morning, with every state showing the virus spreading with worrying speed and health care workers bracing for more trying days ahead.

More than 250,000 people have died in the United States, a number that grew by another 1,962 on Thursday. The Covid Tracking Project reported that more than 80,000 people were in the hospital, the highest number since the pandemic began.

An urgent message from officials in El Paso County, Texas, seeking to hire temporary morgue attendants drove home the reality of what the soaring numbers will mean for communities across the country.

“All applicants must be able to lift between 100 to 400 pounds, with assistance,” the job notice said, according to The Texas Tribune. “Not only is the assignment physically taxing, but it may be emotionally taxing as well."

As the picture across the country grew more dire, and the Centers for Disease Control and Prevention warned people against traveling and visiting family for the Thanksgiving holiday, the White House coronavirus task force appeared in public for the first time in months, along with Vice President Mike Pence, who said the country was in fine shape.

“America has never been more prepared to combat this virus than we are today,” Mr. Pence declared. “We approach this moment with the confidence of experience. We know the American people know what to do.”

He did not wear a mask and did not take questions.

By contrast, the Trump administration’s coronavirus response coordinator, Dr. Deborah L. Birx, appearing at the same news briefing, issued a dire assessment of the pandemic, urging Americans to “increase their vigilance” as they await the approval of a vaccine.

Dr. Birx came armed with alarming statistics and a still-more-alarming map of the country that was a vast expanse of bright red.

She implored Americans to practice social distancing and to wear masks, one of which she wore herself as she delivered her remarks.

“Every American needs to be vigilant in this moment,” she said, “because we know when you are we can mitigate this virus and stop the spread together.”

But togetherness eluded the politically divided nation. State and local governments continued to go their own way in fighting the pandemic, and President-elect Joseph R. Biden Jr. was still arguing in vain for the access that might prepare him to do his job.

After meeting with health care workers on Thursday, he lambasted President Trump for blocking “access to all the information we need” about vaccinations and other virus data.

“There is no excuse not to share the data and let us begin to plan,” he said.

Mr. Biden vowed quick action after he takes office but promised not to impose a national shutdown. Asked about the president’s erratic behavior as he fights to overturn the results of a free and fair election, Mr. Biden responded with two words: “Totally irresponsible.”

Lining up at a drive-through testing site at Dodger Stadium in Los Angeles on Wednesday.
Lining up at a drive-through testing site at Dodger Stadium in Los Angeles on Wednesday.Credit…Ringo H.W. Chiu/Associated Press

The pandemic had been raging for months when the United States reported 100,000 daily coronavirus cases for the first time on Nov. 4.

It was a stunning number that showed a virus spreading out of control.

Less than three weeks later, the country is edging closer to reporting 200,000 newly detected infections every day — at the very moment that cold weather is driving people indoors in many parts of the country and the holiday season beckons people to gather together.

More than 187,000 cases were announced nationwide on Thursday, another single-day record, and daily tallies have been rising in 47 states, according to a New York Times database.

In discussing the current spread on CNN on Friday, Dr. Deborah L. Birx, the White House coronavirus coordinator, said, “This is faster, it is broader and, what worries me, is it could be longer.”

In California alone, officials reported more than 13,000 cases, a single-day record, prompting the state to announce a 10 p.m.-to-5 a.m. curfew for all but essential workers.

Even if the current seven-day national average of about 166,000 daily cases were to hold until the end of the year, nearly seven million more people would contract the virus. That is roughly equivalent to about 2 percent of the U.S. populations.

The potential consequences — in a nation where 250,000 people with the coronavirus have already died — are devastating.

Many health care systems are close to buckling under the strain, and soaring hospitalizations inevitably mean more fatalities. The Covid Tracking Project reported on Thursday that there were more than 80,000 Covid-19 patients in U.S. hospitals, more than ever before.

A recent study by the Kaiser Family Foundation noted that Covid-19 had become the nation’s third-leading cause of death, behind heart disease and cancer. If current trends continue, the death toll could reach 300,000 by New Year’s Eve.

Though talk of effective vaccines has dominated the news cycle in recent days, they are not yet available.

“We are in for a rough period through the end of February,” said Dr. Jessica E. Justman, a professor of epidemiology at Columbia University. “It looks hard to find a way to break it.”

To some extent, the upward curve in new cases had been expected as colder weather drove people to spend more time indoors, where the virus spreads more readily. But wintry conditions are not the only culprit.

Epidemiologists and other experts say the equation for reining in the runaway spread of the virus ought to be simple: The more people wear masks, keep a physical distance from others, wash their hands and avoid crowds (especially indoors), the better the chances of bending the infection curve downward.

But as each state and many cities set their own rules and make their own plans, the nation has no unified approach and no coordinated strategy for balancing the pandemic’s economic and human effects.

People on the New York City subway on Thursday.
People on the New York City subway on Thursday.Credit…Stephanie Keith for The New York Times

The number of new coronavirus cases in New York City has climbed to the point where officials are struggling to untangle chains of transmission and make sense of how the virus is spreading. Now they are facing the reality that they are dealing with a surge that will linger for weeks, if not months.

“Just a matter of time,” Mayor Bill de Blasio said of new restrictions on indoor activities and businesses at his news conference on Thursday.

After a summer of dwindling transmission, New York City is in the grips of a second wave.

On Wednesday, after the seven-day rolling average positivity rate in the city hit 3 percent, Mr. de Blasio ordered the closing of public schools and hinted that other changes were coming. Despite opposition from the Trump administration, school systems around the country have also stopped in-person classes, including those in Chicago, Los Angeles, Chicago, Philadelphia and Detroit.

On the same day, Gov. Andrew M. Cuomo warned that citywide restrictions on mass gatherings, indoor dining and houses of worship could follow in the coming weeks if the numbers continued to worsen.

More than 10,000 new cases of the coronavirus have been diagnosed this past week. At hospitals, doctors who worked through the surge in the spring are growing anxious once again, as more than 700 people in the city are hospitalized with the virus. Over the past week, there have been 44 deaths in the city.

In numbers released on Thursday, 38 ZIP codes in the city had a seven-day average positive test rate of more than 4 percent. Nine had rates above 5 percent.

While cases are surging, epidemiologists and public health experts do not expect the second wave to be as bad as the first, when ambulance sirens filled the air, emergency rooms overflowed with patients, and more than 20,000 New York City residents died. But there is growing concern.

Last week, a group of health organizations and doctors sent a letter to Mr. de Blasio and Mr. Cuomo warning that they were waiting too long to impose new restrictions “to reverse the tide of new infections.”

The group, which calls itself the Covid-19 Working Group-New York, had urged Mr. de Blasio in early March to impose social-distancing measures and restrictions, only to see the city wait, possibly costing thousands of lives. Now the group sees the current hesitancy for new restrictions — including the closures of indoor dining and gyms, which are both thought to give rise to a disproportionate number of infections — as a repeat of the spring.

“I’m shocked that City Hall seems to have learned so little from what happened in March,” said James Krellenstein, an H.I.V. activist and member of the Covid-19 working group who helped organize the Working Group-New York letters. “We don’t have time in an epidemic to dither.”

Lisa Montgomery was scheduled to be executed next month. 
Lisa Montgomery was scheduled to be executed next month. Credit…via Attorneys for Lisa Montgomery

A federal court judge on Thursday delayed the execution of the first woman scheduled to be executed by the federal government in nearly 70 years because her public defenders contracted the coronavirus.

Lisa Montgomery was slated to be the ninth person to be put to death this year after the federal government ended its 17-year hiatus on executions. The Trump administration has pressed ahead with executions despite signals from President-elect Joseph R. Biden Jr. that he will end the federal use of capital punishment.

Two of Ms. Montgomery’s lawyers, Kelley Henry and Amy Harwell, both assistant federal public defenders, tested positive this month after visiting Ms. Montgomery at the federal prison hospital in Texas where she is being held.

The lawyers asked Randolph D. Moss, a federal court judge, to postpone Ms. Montgomery’s Dec. 8 execution because they are suffering from “extreme fatigue” and “impaired thinking and judgment,” according to the court order delaying the execution.

The lawyers also said their symptoms had prevented them from communicating with Ms. Montgomery in recent days and had also stopped them from filing a clemency petition on her behalf.

Judge Moss gave them until Dec. 24 to submit a clemency petition. He did not schedule a new execution date.

“The public’s interest in seeing justice done lies not only in carrying out the sentence imposed years ago but also in the lawful process leading to possible execution,” Judge Moss wrote in the order.

In 2004, Ms. Montgomery was convicted of strangling a Missouri woman who was eight months pregnant, and then cutting the baby out of the dead woman’s body. The baby survived.

Ms. Montgomery’s lawyers say she was frequently raped as a child and that her mother had forced her into prostitution. They also say she has brain damage and suffers from multiple mental illnesses.

Global Roundup

Shoppers on the streets of Tehran this week. The government is shutting thousands of businesses and enacting travel restrictions this weekend to try to curb the rise in coronavirus infections. 
Shoppers on the streets of Tehran this week. The government is shutting thousands of businesses and enacting travel restrictions this weekend to try to curb the rise in coronavirus infections. Credit…Abedin Taherkenareh/EPA, via Shutterstock

The Iranian government announced its toughest restrictions yet this week as new cases rose, but avoided imposing a total shutdown as recommended by the health minister.

Starting Saturday, some 160 cities, including Tehran, will shut down nonessential businesses and public places and impose travel restrictions, with a 9 p.m. curfew in some places. Travel by car between those cities will be banned. Another 208 cities will be subject to partial restrictions, and masks will be required in public in all cities.

The rules will be in place for two weeks, and officials said that violations could incur steep fines.

“The optimism of some of our officials has led to another coronavirus surge,” Saeed Namaki, the health minister, said at a coronavirus committee meeting this week. “If we cave, we will have four-digit death rates. These two weeks are our last chance.”

Nearly 500 deaths were reported in Iran on Friday, and the average number of new cases reported each day over the past week exceeds 12,600. Since the beginning of the pandemic, the country has recorded 815,117 cases and more than 43,000 deaths, according to a Times database. Experts say the real tallies are likely several times higher because of inconsistent testing and reporting.

Many Iranians were already ignoring the government’s new rules heading into the weekend. Video footage showed interstate highways with bumper-to-bumper traffic as people rushed to travel before the ban took hold, particularly to the northern provinces along the Caspian Sea, where many residents of Tehran like to vacation.

Health and government officials have been blaming one another for mismanagement of the pandemic. On Friday, the health minister’s deputy for research and development, Dr. Reza Malekzadeh, resigned in protest of his boss’s handling of the crisis, according to official Iranian news media. Dr. Malekzadeh had formerly served as health minister himself.

President Hassan Rouhani also announced that about a third of Iran’s population would receive financial aid of about one million rials, or about $5, per month per person for four months. That amount might buy a day’s worth of household staples like bread, eggs and tomatoes. Those families would also qualify for 10 million rial loans, Mr. Rouhani said.

Mr. Rouhani has resisted a total shutdown from the start of the pandemic, saying it would amount to an “enemy plot.”

In other news around the world:

  • A state-owned drugmaker in China reported promising results for one of its two vaccine candidates after administering doses to nearly a million people outside of the traditional testing process, as part of an emergency-use policy. The chairman of the company, Sinopharm, told local news media on Tuesday that only a few people had reported mild symptoms from one of the vaccines, and that no one had suffered serious adverse reactions.

  • France’s government announced that it was postponing Black Friday, the quasi-official kickoff to the Christmas shopping season, moving to quell a nationwide rebellion by shopkeepers who say that Amazon has been stealing business from them during the country’s lockdown. The government wrested an agreement from Amazon and the country’s biggest retailers to delay their discounts in France until Dec. 4.

  • The U.S. and Canada, both facing serious spikes in infections, extended their bar on nonessential cross-border travel for another month, to Dec. 21. “The situation is serious,” the Canadian prime minister, Justin Trudeau, said on Twitter. His country’s seven-day average of new daily cases has risen by 46 percent over the last two weeks and is well above 4,700.

  • The World Health Organization has recommended against using the antiviral remdesivir, a drug that had generated intense interest as a treatment for Covid-19 and was among the drugs administered to President Trump after he was hospitalized with the disease last month. An expert panel “concluded that remdesivir has no meaningful effect on mortality or on other important outcomes for patients, such as the need for mechanical ventilation or time to clinical improvement,” the W.H.O. announced. The panel’s report did not rule out the use of the drug for Covid-19 altogether, but said evidence was lacking to recommend its use.

  • The leader of the Serbian Orthodox Church, Patriarch Irinej, 90, died of the coronavirus on Friday, according to the church, three weeks after he attended a packed funeral for a senior bishop who had died after contracting the virus. He had been admitted to a military hospital in Serbia on Nov. 4, days after he and thousands of unmasked people gathered in neighboring Montenegro to honor the country’s most senior bishop, Metropolitan Amfilohije Radovic. Mourners kissed his body, which lay in an open coffin.

  • Officials in South Australia abruptly ended a tight lockdown after two days, reporting that an infected man had been lying when he told contact tracers he had been only briefly in the pizza shop where he was exposed, suggesting virulent transmission. The man was in fact an employee.

Credit…Illustration by Mark Weaver, Photograph by Erin Schaff/The New York Times

Elisabeth Rosenthal, a former New York Times correspondent, worked as an emergency room physician before becoming a journalist. She interviewed Dr. Anthony S. Fauci, the top infectious disease expert in the United States, for the Times’s Opinion section.

As a health journalist, a physician and a former foreign correspondent who lived through SARS in Beijing, I often get questions from friends, colleagues and people I don’t even know about how to live during our current pandemic. Do I think it’s safe to plan a real wedding next June? Would I send my kids to school, with appropriate precautions? When will I trust a vaccine?

To the last question I always answer: When I see Tony Fauci take one.

He’s a straight shooter, with no conflicts of interest — political or financial — or, at 79, career ambition. He has no interests, other than yours and mine.

So I asked him how Americans might expect to live in the next six to nine months. How should we behave? And what should the next administration do? Some answers have been edited for clarity and brevity.

Are there two or three things you think a Biden administration should do on Day 1?

There were some states in some regions of the country that somehow didn’t seem to have learned the lessons that could have been learned or should have been learned when New York City and other big cities got hit. And that is to do some fundamental public health measures. I want to really be explicit about this, because whenever I talk about simple things like uniform wearing of masks, keeping physical distance, avoiding crowds (particularly indoors), doing things outdoors to the extent possible with the weather, and washing hands frequently, that doesn’t mean shutting down the country. You can still have a considerable amount of leeway for business, for economic recovery, if you just do those simple things. But what we’re seeing, unfortunately, is a very disparate response to that. And that inevitably leads to the kind of surges that we see now.

Do you think we need a national policy like a national mask mandate? The current administration has left a lot of Covid-19 management to the states.

I think that there should be universal wearing of masks. If we can accomplish that with local mayors, governors, local authorities, fine. If not, we should seriously consider national. The only reason that I shy away from making a strong recommendation in that regard is that things that come from the national level down generally engender a bit of pushback from an already reluctant populace that doesn’t like to be told what to do. So you might wind up having the countereffect of people pushing back even more.

When do you think we’ll all be able to throw our masks away?

I think that we’re going to have some degree of public health measures together with the vaccine for a considerable period of time. But we’ll start approaching normal — if the overwhelming majority of people take the vaccine — as we get into the third or fourth quarter [of 2021].

At a pharmacy in Lviv, Ukraine, in March. The potential overuse of antibiotics in the country — where they are available without a prescription — has concerned public health officials.
At a pharmacy in Lviv, Ukraine, in March. The potential overuse of antibiotics in the country — where they are available without a prescription — has concerned public health officials.Credit…Pavlo Palamarchuk/EPA, via Shutterstock

Early in the pandemic, the World Health Organization warned that the spread of the coronavirus held within it the seeds of another public health crisis: the overuse of antibiotics, which over time gives rise to resistant forms of sometimes lethal bacterial disease.

That problem has now come into clear focus in Ukraine, health officials and outside experts said, as antibiotics are sold without prescriptions and doctors have also prescribed the drugs widely.

Antibiotics are not needed to treat Covid-19 unless patients contract a secondary, bacterial infection. Nonetheless, grasping at straws in a disease without many effective treatments, Ukrainians took advantage of over-the-counter sales to consume vast quantities.

Sales of all types of antibiotics doubled since the start of the pandemic, the head of pharmaceutical supply department of the Ukrainian Health Ministry, Oleksandr Komarida, said in a briefing this month. “Our main task now is to take control over the panic” buying of antibiotics in the population, he said. Sales of one type tripled in October alone, he said.

More than half of all patients with coronavirus infection have been prescribed antibiotics without an obvious need for it, Serhiy Makarov, a member of an online doctors’ group opposed to misuse of antibiotics, said in a telephone interview.

“There are cases in Ukraine where patients take up to five kinds of antibiotics during the first weeks of the infection without any reason,” Dr. Makarov said. Antibiotics, he said, are handed out “like a vitamin.”

The W.H.O. warned in June of the risk of doctors and patients turning to antibiotics in desperation during the pandemic, accelerating the decline in the effectiveness of these drugs, the miracle cures of an earlier era. The United Nations has estimated drug resistant bacteria will kill 10 million people annually within 30 years.

In Ukraine, current and former health officials have been raising alarms. “Many people are afraid of getting Covid-19 and embark on a path of radical self-medication,” Zoriana Skaletska, a former minister of health, wrote in a warning published in the Ukrainian news media. “I’m not talking about herbal teas but about antibiotics.”

Patty Schachtner, the medical examiner of St. Croix County, Wis., fought to ready her community to face coronavirus. But no amount of precautions could have prepared her for what followed.
Patty Schachtner, the medical examiner of St. Croix County, Wis., fought to ready her community to face coronavirus. But no amount of precautions could have prepared her for what followed.Credit…Erinn Springer for The New York Times

The pandemic was a faraway nightmare — a catastrophe on the coasts — when Patty Schachtner, the medical examiner in St. Croix County, Wis., began preparing.

She delivered masks to funeral homes. She installed showers in an unused warehouse for frontline workers. And on the grim chance that the virus did come, and that there were more deaths than the county morgue could handle, she rented a refrigerated truck to store bodies.

“I pray that I never have to use it,” Ms. Schachtner said in March. “But this Covid can get out of control really quick.”

All summer long, coronavirus barely rose above a trickle in St. Croix County. Then came fall.

“It was like a snowball,” Ms. Schachtner said. “Just all of a sudden the reality of what everyone said was going to happen, was happening.”

The Daily Poster

Listen to ‘The Daily’: When the Pandemic Came to Rural Wisconsin

As the coronavirus spread, a public servant tried to prepare her conservative community for the worst-case scenario. Now it’s here.

The outbreak in Wisconsin spiraled beyond control, with rates of new cases that have consistently been among the country’s worst. On Thursday, all but one of the state’s 72 counties was seeing a “critically high” level of case activity, the highest level of concern, according to the state’s own designations.

In October, Ms. Schachtner’s sister-in-law tested positive — then, in quick succession, her brother-in-law, her sister and a niece, who was an aide in the nursing home where Ms. Schachtner’s father lived.

Two weeks ago, he got it too.

He died last Saturday, as Ms. Schachtner huddled with her siblings in the cold, peering at their father one last time through his window.

“There’s so many families that are going through the same thing we are,” she said. “And it’s hard now. It’s hard not to be angry.”

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