COLUMBUS, Ohio -- States faced a deadline Friday to place orders for the coronavirus vaccine as many reported record infections, hospitalizations and deaths, while hospitals were pushed to the breaking point.
The number of Americans hospitalized with covid-19 hit an all-time high in the U.S. on Thursday at 100,667, according to the Covid Tracking Project. That figure has more than doubled over the past month, while new daily cases are averaging 210,000 and deaths are averaging 1,800 per day, according to data compiled by Johns Hopkins University.
Arizona reported more than 5,000 new cases for the second-straight day Friday as the number of available intensive care unit beds fell below 10% statewide. Hospital officials have said the need will exceed hospital capacity this month.
The state expects to get enough doses of vaccines by the end of the year to inoculate more than 383,000 health care workers and long-term care facility residents, the state's health director said Friday. Next in line are teachers and other essential workers, followed by older Arizonans or people otherwise at higher risk of serious cases.
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Nevada reported 48 deaths from the coronavirus Thursday, marking the deadliest day since the onset of the pandemic as cases and deaths continued to rise more than a week after new restrictions were implemented on businesses. One hospital was so full that it was treating patients in an auxiliary unit in the parking garage.
State officials said Friday that they expect to receive 164,000 vaccine doses this month.
North Carolina reported a record 5,600 new confirmed cases Thursday and 2,100 hospitalizations, as it awaited nearly 85,000 doses of the Pfizer vaccine, perhaps as early as Dec. 15.
Health care workers at a limited number of mostly large hospitals will be the first in line to receive the vaccine, prioritizing those who are at highest risk of exposure to the virus, officials said. Future doses will be distributed to more hospitals and to local health departments, followed by nursing home staff and residents.
Health officials fear the pandemic will get worse before it gets better because of delayed effects from Thanksgiving, when millions of Americans disregarded warnings to stay home and celebrate only with members of their household.
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At the same time, hospitals -- and their workers -- were stretched to the limit.
In Pennsylvania, almost half of all hospitals in the south-central region and a third of those in the southwest anticipated staffing shortages within a week, according to the state Department of Health.
The state's top health official, Dr. Rachel Levine, said Thursday that 85% of the state's intensive care beds were occupied and modeling shows they'll be full this month. Meanwhile, nurses in the Philadelphia area said the overwhelming number of covid-19 patients was affecting the quality of care they can provide.
"I hear from physicians and from hospital leadership all the time about how strained the hospitals are," Levine said.
Officials also are concerned that Americans will let down their guard once states begin administering vaccines.
Nationwide, the coronavirus is blamed for more than 278,000 deaths and 14 million confirmed infections.
An influential modeling group at the University of Washington said Friday that the expected U.S. vaccine rollout will mean 9,000 fewer deaths by April 1. The Institute for Health Metrics and Evaluation predicts that warmer temperatures and then rising vaccination rates will lead to steady declines in the daily death toll starting in February.
But even with a vaccine, the death toll could reach 770,000 by April 1 if states do not act to bring current surges under control, the group said.
PLANNING, ADJUSTING
States learned this week how many doses to expect and when, and received guidance from the Centers for Disease Control and Prevention recommending that health care workers and nursing home patients get the first doses. That meant that some had to make last-minute adjustments.
"2020 has taught us to plan for what you can and then expect something to happen that you never dreamed would happen," Dr. Michelle Fiscus, medical director of the Tennessee Department of Health's immunization program, said during a Friday webinar. "I can't tell you how many plans we've crumpled up and thrown away."
Connecticut Gov. Ned Lamont said nursing home residents, along with front-line health care workers, will get the first doses in his state.
"These are the folks most likely to suffer complications. These are the older folks who most likely suffer fatalities. And these are the folks most likely to go into the hospital," Lamont said Thursday. Connecticut expects to receive its first shipment of 31,000 doses of vaccine from Pfizer on Dec. 14 and its first shipment of 61,000 from Moderna on Dec. 21.
Texas health officials Friday moved nursing home residents to the front of the line for vaccines after initially deciding that only health care workers would have access to the first round of doses.
But states also were balancing concerns about the economy and protecting essential workers.
Kansas Gov. Laura Kelly said the state's vaccine plan calls for the first shots to go to front-line health care workers with a high risk of coronavirus exposure, including workers in nursing homes, as well as nursing home residents. Meatpacking plant workers and grocery store employees will be next in line, along with first responders.
In Ohio, health care workers and others caring for covid-19 patients and emergency medical responders will be first in line for the vaccine, Republican Gov. Mike DeWine said Friday. Vulnerable people who live together and those who care for them, including nursing home and assisted-living facility residents and staff, will be next.
RAMPING UP PRODUCTION
Meanwhile, BioNTech SE said it's on track to produce 50 million doses of covid-19 vaccine with partner Pfizer this year, easing concerns that they might miss production targets.
As of Friday, the companies had made the majority of the promised supply for this year, BioNTech said in a statement. For next year, they're looking for ways to increase production capacity beyond a promised 1.3 billion doses.
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The companies' output is under close scrutiny after Pfizer and BioNTech won the Western world's first marketing approval for a vaccine with sign-off from the U.K this week. The U.S. and Europe are expected to follow later this month.
The partners had originally hoped to produce as many as 100 million doses this year, a target they cut in half Nov. 9 after changes in regulatory and approval time lines, among other factors, BioNTech said. A Wall Street Journal report Thursday on the adjustment prompted concerns about whether the companies would be able to meet their goals.
"We're ramping up production extremely quickly," Chief Commercial Officer Sean Marett said this week.
Meanwhile, a Wyoming Department of Health official involved in the state's response to the coronavirus questioned the legitimacy of the pandemic and described a forthcoming vaccine as a biological weapon at a recent event.
The "so-called pandemic" and efforts to develop a vaccine are plots by Russia and China to spread communism worldwide, department readiness and countermeasures manager Igor Shepherd said at the Nov. 10 event held by the group Keep Colorado Free and Open.
Shepherd was introduced as and talked about being a Wyoming Department of Health employee in the over hour-long presentation in Loveland, Colo.
Department Director Mike Ceballos and State Health Officer Dr. Alexia Harrist did not answer questions Friday, including when they became aware of Shepherd's talk and what if anything they have done in response.
OTHER NATIONS PRIMED
In Germany, officials said Friday that they are taking the potential for attacks on mass vaccination centers into consideration as they set up sites to prepare for European Union regulators authorizing the first coronavirus vaccines.
Britain gave the green light Wednesday for emergency use of the BioNTech and Pfizer vaccine. The European Medicines Agency has indicated it may not decide whether to grant its authorization until Dec. 29, about two weeks later than Germany had expected to launch a national immunization drive.
The former head of Germany's civil protection agency, Albrecht Broemme, was tasked with setting up six mass vaccination sites in Berlin. He said security questions still need to be resolved.
Elsewhere, the island kingdom of Bahrain said Friday that it has become the second nation in the world to grant an emergency-use authorization for the vaccine made by Pfizer and BioNTech.
The state-run Bahrain News Agency made the announcement Friday night.
"The confirmation of approval by the National Health Regulatory Authority of the kingdom of Bahrain followed thorough analysis and review undertaken by the authority of all available data," the kingdom said on its state-run Bahrain News Agency.
Bahrain did not say how may doses it has purchased, nor when vaccinations would begin. It did not immediately respond to questions.
Pfizer later said the details of its sales agreement with Bahrain, including the "timing of delivery and the volume of doses," was confidential and declined to comment.
MASKS URGED INDOORS
The Centers for Disease Control and Prevention, meanwhile, is urging "universal mask use" indoors for the first time as the country shatters records for coronavirus hospitalizations and deaths ahead of the holiday season.
The CDC has for months encouraged mask-wearing in public spaces with people outside the household. The new guidance, published Friday, asks people to put on masks anywhere outside their homes.
In its weekly Morbidity and Mortality report, the CDC warned Friday that the U.S. has entered "a phase of high-level transmission" as colder weather and the holiday season push Americans indoors, and said that "consistent and correct" use of masks is critical to taming the virus.
Mask use is most crucial indoors, and in outdoor spaces where social distancing cannot be maintained, the CDC said in the report. The agency recommended mask use at home when a member of the household has been infected or potentially exposed to the virus, including those with high-risk occupations such as meatpacking or agricultural processing.
"Compelling evidence now supports the benefits of cloth face masks for both source control [to protect others]," the report said, "And to a lesser extent, protection of the wearer."
Mitigation measures are particularly essential in light of recent research that suggests roughly 50% of transmission of the coronavirus is from asymptomatic people, the report said. It also recommended that communities make a plan for distributing masks to people who might struggle to access them.
In five San Francisco Bay Area counties, health officers issued a new stay-at-home order Friday requiring some businesses to close and banned all gatherings.
The changes take effect for most of the area at 10 p.m. Sunday and last through Jan. 4. Most of the counties have not yet reached Gov. Gavin Newsom's threshold requiring the closures when 85% of ICU beds at regional hospitals are full.
"We don't think we can wait for the state's new restrictions to go into effect. ... This is an emergency," Contra Costa Health Officer Chris Farnitano said.
Information for this article was contributed by Farnoush Amiri, Bob Christie, Paul J. Weber, Bryan Anderson, Carla K. Johnson, Edith Lederer, John Hanna, Michael Rubinkam, Paul Davenport, Sam Metz, Susan Haigh, Tammy Webber, Olga R. Rodriguez, Juliet Williams, Jocelyn Gecker, Brian Melley, Jon Gambrell and staff members of The Associated Press; by Taylor Telford of The Washington Post; and by Naomi Kresge of Bloomberg News.
