Editor's Note: On December 1, 2020, 134 patients with confirmed or suspected Covid-19 were hospitalized in Alameda County. As of December 28, 2020, 473 patients with confirmed or suspected Covid-19 were hospitalized in the county, including 117 in ICU. As of today, December 30th, the Bay Area region’s available intensive care capacity was down again, to 7.5%, after inching up to over 10% a day earlier.

Editor's Note: While it has been reported that the number of new Covid-19 cases in Alameda County have been dropping since their mid-December peak, the number of daily tests in the county has also decreased substantially over the past week.

Britain on Wednesday became the first country to authorize a coronavirus vaccine from the University of Oxford and the British-Swedish pharmaceutical firm AstraZeneca, adding a second shot to the fight against a surging outbreak here driven by a highly infectious variant of the virus.

The Oxford-AstraZeneca doses are cheaper than other Covid-19 vaccines and easier to transport, as they can be stored at normal fridge temperatures.

Health Minister Matt Hancock praised the homegrown vaccine as a "game-changer" and said clinical trials have proved the vaccine is safe and effective — but he did not put to rest questions about how effective.

Public health officials say there is much to recommend the new vaccine, as it costs as little as $3 a dose, is relatively easy to manufacture at huge scale and does not require special handling. The Pfizer vaccine, which uses a different technology, must be kept in special freezers and dry ice at extremely low temperatures.

The Trump administration has shipped more than 11 million doses of the two available Covid-19 vaccines, but just over 2.1 million people nationwide have received a shot since vaccinations began December 14, according to data from the CDC. In interviews earlier this month, Moncef Slaoui, the chief advisor for the vaccine development and distribution effort known as Operation Warp Speed, had pledged 20 million Americans would be inoculated against Covid-19 in December.

California broke the single-day record for Covid-19 deaths yet again Tuesday, logging 442 fatalities in a Times county-by-county tally of local health jurisdictions — a number equivalent to someone dying of the disease every three minutes.

More than half of those deaths — 242 — were of Los Angeles County residents, according to The Times’ survey. That’s a record high in a single day for the nation’s most populous county, a count boosted in part by a backlog of reports from the Christmas weekend.

At that rate, cumulative Covid-19 deaths will likely exceed 25,000 in California on Wednesday and 10,000 in L.A. County by New Year’s Day. As of Tuesday night, California had a cumulative 24,987 deaths and L.A. County, 9,806. Over the past week, the state averaged 240 deaths a day, and L.A. County, 111.

California will extend its stay-at-home order for two regions of the state — Southern California and San Joaquin Valley — where intensive-care unit capacity is strained from an onslaught of Covid-19 patients, the state’s Health and Human Services Secretary Dr. Mark Ghaly said on Tuesday. The regional order, which Gov. Gavin Newsom first announced on Dec. 3 and was set to expire Monday.

Even as the surge of infections that followed Thanksgiving appears to be leveling off in the Bay Area and much of Northern California, another wave could take shape during this normally quiet week between Christmas and New Year’s. It’s the worry of “exposure upon exposure,” state Health and Human Services Secretary Dr. Mark Ghaly said Tuesday: Infections could “become amplified” if people who caught the virus during holiday celebrations last week wind up spreading it during New Year’s Eve parties this week.

Health officials who have pleaded with people not to travel or gather with one another for Thanksgiving and Christmas are now repeating those requests as people ring in 2021.

California’s coronavirus case rate now far outpaces every other state in the nation, and it is one of just a handful of states where cases per day are still increasing.

While the nation is still suffering the effects of the latest pandemic surge, with at least 1,899 deaths and 189,044 new cases recorded Dec. 28, average cases per day have decreased nationwide by about 13% from two weeks earlier. But California is among the half-dozen states where past-week average cases per day have increased — and its rate of 24% is by far the highest. Texas and Maine grew by 18%, Georgia by 12%, South Carolina by 11% and New York by 10%.

As California surpasses 2 million Covid-19 cases, Health and Human Services Secretary Dr. Mark Ghaly on Tuesday said some Southern California hospitals have begun making choices that affect patient care. Hospitals are diverting ambulances and making decisions about whether to provide certain treatment for patients who are likely to die. He said more than 95% of Los Angeles hospitals have diverted ambulances in the last 24 hours.

Many of the hundreds of thousands of California gig workers and independent contractors won’t have to repay part of their unemployment aid, under a provision in the new Covid-19 stimulus package signed by President Donald Trump. The bill allows California and other states to waive their effort to collect overpaid Pandemic Unemployment Assistance payments from their recipients, if a repayment “would be contrary to equity and good conscience.”

The U.S. on Tuesday broke its record for the most number of coronavirus-related deaths in a single day with 3,725 reported, according to data compiled by Johns Hopkins University. Tuesday surpassed the country’s previous single-day death toll high of 3,656 set on Dec. 16. 

As of Wednesday morning, the U.S. has now recorded a total of 338,656 deaths due to Covid-19. This comes as more than 82 million people worldwide have been infected with the virus, with the U.S. continuing to have the highest number of infections with approximately 19.5 million. 

Texas, Florida and some other Republican-led states are bucking federal advice to provide early doses of the new coronavirus vaccines to frontline workers, choosing instead to prioritize the elderly — a decision exposing fissures in the nationwide immunization campaign.

Federal recommendations give priority, in the second tier, to grocery store employees, transit staffers and other front-line workers, along with people 75 and older. But officials in Florida and Texas, where a combined 50 million people live, are moving ahead with a different strategy, offering vaccine to a broader segment of their elderly populations and asking front-line workers to wait.

The choices reflect distinct needs in a highly diverse nation where the coronavirus has killed unevenly, but they also highlight an emerging patchwork that could pose obstacles to the national effort to curb the pandemic. The divergence is coming into view as states face delays in the administration of vaccine doses, with each operating on its own timeline based on the capacities of local health departments and hospital systems.

From the moment the virus began to spread across the U.S., experts and epidemiologists predicted that incarcerated people would be particularly vulnerable. Risk factors they face include the close proximity in which inmates live and congregate, prison transports, where inmates tend to be shackled close together, and a lack of consistent access to cleaning supplies. “They are basically the perfect conditions for superspreading events,” Dr. Thomas Inglesby, director of Johns Hopkins’ Center for Health Security, told NPR.

Many of the worst projections have since come true: there have been outbreaks at more than 850 jails and prisons in the country, putting many of the over 2 million people incarcerated in the U.S. at risk of infection. A December study reveals that the infection rate has been three times higher in the prison population compared to that of the general public, while the mortality rate has been double. At least 275,000 incarcerated people have tested positive for Covid-19, and more than 1,700 have died. The true toll is likely to be higher still, as data sets are inconclusive due to a lack of consistency across states in sharing prison and jail data.

Treasury Secretary Steve Mnuchin tweeted on Tuesday evening the department "has delivered a payment file to the Federal Reserve for Americans' Economic Impact Payments." His tweet continued: "These payments may begin to arrive in some accounts by direct deposit as early as tonight and will continue into next week." Americans who have direct deposit set up through the Internal Revenue Service could be receiving their stimulus payment as early as Tuesday night. Paper checks will begin to be mailed Wednesday, according to a press release from the Treasury Department.

AstraZeneca has promised to supply hundreds of millions of doses to low- and middle-income countries, and to deliver the vaccine on a not-for-profit basis to those nations in perpetuity.

AstraZeneca says it's working with partners, including the Serum Institute of India, to build manufacturing capacity of up to 3 billion doses in 2021 on a rolling basis.

For comparison: Pfizer expects to produce as many as 50 million vaccine doses in 2020 and up to 1.3 billion doses in 2021. Moderna said last month that it's on track to manufacture 500 million to 1 billion doses next year.

In September, India was reporting almost 100,000 Covid-19 cases a day, with many predicting it would soon pass the U.S. in overall cases. Instead, its infections dropped and are now at one-fourth that level.

India has brought down its virus numbers, despite often being too crowded for social distancing, having too many cases for effective contact tracing and an economy that isn’t well equipped to weather long lockdowns. One of the main reasons, Indian health officials say, is that the country has managed to encourage and enforce almost universal acceptance of masks without much debate.

From the moment the pandemic landed in this South Asian nation, politicians and health experts have been united about the importance of masks, including Prime Minister Narendra Modi.

When Covid-19 initially blazed through Asia, Europe and then the United States, global public health experts worried that it could be catastrophic for Africa, with its crowded cities, poorly funded health sector and lack of testing facilities.

The U.N. Economic Commission for Africa in April predicted up to 300,000 deaths this year if the virus couldn’t be contained on the continent. Yet it was the U.S, with its superior health system, that hit that grim milestone first, and so far, Africa has been largely spared the worst of the devastation experienced by the rest of the world. As of Dec. 29, the Africa Centres for Disease Control and Prevention was reporting total 2.6 million cases and 63,300 deaths for a population of 1.2 billion. That’s roughly one case for every 500 people, compared to one in 20 in the U.S.

However, those numbers might not actually reflect the reality on the ground. Overall, testing for Covid-19 cases has been comparatively limited on the continent, which could be contributing to lower case numbers. If official numbers are to be believed, the African continent trails much of the rest of the world when it comes to case fatality rates, and there have been fewer scenes of overwhelmed hospitals and funeral parlors coming from the continent compared to other parts of the globe. Nevertheless, some countries across the continent are currently seeing increases in Covid-19 cases amid concerns of a second wave. 

Doctors and nurses across Britain are sounding the alarm as confirmed cases of Covid-19 reach record highs, with experts urging the government to implement a stricter lockdown to prevent the health system from being overwhelmed.

Some health-care workers are issuing their own public warnings, detailing how hospitals in London and the southeast of England are already setting up tents to increase their capacity. They say ambulances are waiting outside hospitals for hours because there is no space inside.

The pandemic’s geography is fracturing again. Hospitalizations in the Midwest peaked on December 1, and have maintained a precipitous decline ever since. The hardest-hit areas right now, as indicated by hospitalizations per million residents, are in the South and Southwest. The hotspots are primarily in the Sun Belt, including California, Nevada, Mississippi, Alabama, Tennessee, and Georgia. New York is also a cause for concern again. In other words, we’re returning to a patchwork pandemic.

California is one of the five states—along with Arizona, Florida, Tennessee, and Texas—that account for 40 percent of new cases from December 17 to December 23. Of the five, California has by far the highest number of hospitalizations, which beyond their general stress on the health-care system augur high death tolls to come. California had 21,240 people in hospitals on December 29, accounting for 17 percent of all hospitalizations nationwide. Twice as many Californians were hospitalized on December 29 as on December 6. 

Many of the 30 epidemiologists, physicians, immunologists, sociologists, and historians whom I interviewed for this piece are cautiously optimistic that the U.S. is headed for a better summer. But they emphasized that such a world, though plausible, is not inevitable. Its realization hinges on successfully executing the most complicated vaccination program in U.S. history, on persuading a frayed and fractured nation to continue using masks and avoiding indoor crowds, on countering the growing quagmire of misinformation, and on successfully monitoring and countering changes in the virus itself.

While all hospitals across Los Angeles County are being slammed by waves of Covid-19 patients, those in lower-income, densely populated and nonwhite communities have been hit hardest and face the greatest challenge in providing care, according to a Times data analysis.

Hospitals in South Los Angeles, the cities in Southeast L.A. County along the 710 Freeway and in parts of the southern San Gabriel Valley are experiencing the greatest capacity problems, the data showed. Many of these facilities are relatively small and are less able to add intensive care staff or expand bed capacity than the county’s biggest hospitals. The data underscores how communities of color have been disproportionately hit by the pandemic, with Latino and Black residents far more likely to get the virus and die of it compared with whites. Low-income essential workers often get sick while on the job and then spread Covid-19 to family, officials have said.

To Tom and Amy McNamara, the pandemic wasn’t something to get too stressed out about. For most people, they imagined, having Covid-19 was like having a bad cold, a sentiment similar to one the president himself had expressed.

Their daughter Caroline didn’t have that luxury. As an ICU nurse at the University of Pittsburgh Medical Center’s hospital in Williamsport, where her father had been taken, the pandemic was anything but abstract. For her, it was pushing someone’s breathing tube to the side of the mouth so she could swab the pink ridges inside with an antimicrobial. It was jostling pads and pillows under a sedated face to prevent the skin from blistering. It was rubbing a patient’s hand with a gloved finger so nobody had to die alone.

The Wuhan lockdown earlier this year was the first decisive step in saving China. But in a pandemic that has since claimed more than 1.7 million lives, it came too late to prevent the virus from spilling into the rest of the world. The first alarm had actually sounded 25 days earlier, exactly a year ago, on Dec. 30. Even before then, Chinese doctors and scientists had been pushing for answers, yet officials in Wuhan and Beijing concealed the extent of infections or refused to act on warnings.

There is no silver lining to a pandemic that has killed more than 1.5 million people globally. But as Covid-19 barraged us with new challenges, it also forced adaptation that in the design world translated to faster, lighter, cheaper and more flexible buildings and landscapes. This kind of grass-roots change has been called many things: ad hoc architecture, guerrilla architecture, pop-up architecture, tactical urbanism.