The U.S. is entering the second month of the biggest vaccination drive in history with a major expansion of the campaign, opening football stadiums, major league ballparks, fairgrounds and convention centers to inoculate a larger and more diverse pool of people.
After a frustratingly slow rollout involving primarily health care workers and nursing home residents, states are moving on to the next phase before the first one is complete, making covid-19 shots available to such groups as senior citizens, teachers, bus drivers, police officers and firefighters.
Emily Alexander, a fourth-grade teacher in hard-hit Arizona, got vaccinated in a round-the-clock, drive-thru operation that opened Monday at the suburban Phoenix stadium where the NFL's Arizona Cardinals play. She said she hopes it means she can be reunited in person with her students and colleagues before the end of the year.
"I miss the kids so much," said Alexander, 37. "I'm really looking forward to seeing them and their families, being able to hug them. That has just been so tough."
Across the U.S., where the outbreak has entered its most lethal phase yet and the death toll has climbed near 376,000, politicians and health officials have complained over the past several days that too many shots were sitting unused on the shelves because of overly rigid adherence to the federal guidelines that put an estimated 24 million health care workers and nursing home residents at the front of the line.
The nation's seven-day average of coronavirus-related deaths has broken past 3,000 a day, reaching 3,249 on Sunday. As of Monday morning, more than 22.4 million people in the United States had tested positive.
The dire statistics follow a surge in new cases and hospitalizations that has extended to every part of the country.
About 9 million Americans have received their first shot, or 2.7% of the population, according to the Centers for Disease Control and Prevention -- far short of the federal goal of 20 million people or more by Dec. 31.
Experts say as much as 85% will have to be inoculated to achieve herd immunity and vanquish the outbreak.
SHOT FOR BIDEN
President-elect Joe Biden received his own second injection Monday. His team said he would invoke the Defense Production Act if necessary to ensure that second doses can be given on schedule.
"My No. 1 priority is getting vaccine into people's arms," Biden said after taking a quick needle jab, adding that "3,000 to 4,000 people dying a day is just beyond the pale."
He said he and his advisers are finalizing a plan to accelerate mass vaccinations nationwide that he will release Thursday.
Biden lamented that mask-wearing continues to be a politically divisive issue and said he was "appalled" to hear that, during last week's storming of the U.S. Capitol, some Republican House members refused pleas from a Democratic colleague to don masks while they were crowded together in a secure protective location.
MOVING UP THE LINE
Many states are responding to the slow rollout by throwing open the line to other groups and ramping up the pace of vaccinations, in some cases offering them 24-7.
Arizona, with the highest diagnosis rate in the U.S., is offering vaccinations to people 75 and older, teachers, police and firefighters.
Detroit's call center was jammed with more than 100,000 calls Monday as the city took appointments for vaccinations at the city's convention center starting Wednesday. Officials plan to schedule 20,000 appointments over the next month for elderly people, and police officers and bus drivers can start getting shots at the end of the week.
The slow rollout has been blamed in part on inadequate funding and guidance from Washington and a multitude of logistical hurdles at the state and local level that have caused confusion and disorganization.
As Colorado moves into its next phase of vaccine distribution for people 70 and older, frustration is building among senior citizens who say they have received little or no communication from local public health officials.
Joyce Ballotti, 85, and her 94-year-old husband went to a vaccination site in Pueblo, Colo., on Monday that was supposed to begin at 9 a.m. But about 8:45 a.m., they were turned away because it had run out of vaccine.
"When we saw that exit locked, we said, 'Uh-oh, the city has screwed up again,'" Ballotti said.
A police officer managing traffic waved them away, and they received no guidance on other vaccine sites. Ballotti said she is angry and frustrated.
"I'm about ready to get it not at all," she said, noting that the couple's son had taken off from work to drive them. "I can't ask my son to spend his time on fruitless errands."
There were snags as well in Georgia, where the plan to expand access to people older than 65 got off to a rocky start. The websites of at least two public health districts crashed Monday, and other districts reported overwhelming demand for appointments.
Florida, the longtime retirement haven with one of the biggest concentrations of elderly people in the country, is using Hard Rock Stadium in Miami Gardens to dispense shots. About 402,000 doses have been administered in the state since mid-December, or just under 2% of its population.
Rather than wait for the first designated group of recipients under the federal guidelines to get their shots, Gov. Ron DeSantis has opened vaccinations to people 65 and older.
The move has been met with huge demand, with senior citizens standing in line in the overnight chill or sleeping in their cars -- a spectacle that has alarmed many people. DeSantis said drive-thru sites will be ramped up.
In New York City, two round-the-clock sites opened and several more are expected to be up and running over the next two weeks. Appointments for the midnight-to-4-a.m. shift Tuesday were snapped up quickly in what Mayor Bill de Blasio pointed out is, after all, "the city that never sleeps."
"It gives you hope," said David Garvin, who turns 80 next weekend and got a vaccination at a city-run site in Brooklyn on Monday, the first day the state made people older than 75 eligible along with various frontline workers. "I've been in my room for six months."
Saad Omer, director of the Yale Institute for Global Health, said it is reasonable to speed things up and move on to the next group of people as long as health workers and nursing home residents continue being given shots at the same time.
"Our country should be able to walk and chew gum when it comes to its immunization program," he said.
California's coronavirus catastrophe reached a staggering new level Monday as Johns Hopkins University data showed the nation's most-populous state has recorded more than 30,000 deaths since the pandemic started nearly a year ago.
Deaths have exploded since a surge began in October. It took California six months to record its first 10,000 deaths. But in barely a month, the total rose from 20,000 to 30,000.
Over the weekend, state officials reported a two-day record of 1,163 deaths. Hospitalizations also have exploded and many hospitals are stretched to the limit.
California ranks third nationally in coronavirus deaths, behind Texas and New York, which has nearly 40,000.
A drive-thru vaccination center was set up outside the San Diego Padres' ballpark, with plans to inoculate 5,000 health care workers a day. Dodger Stadium in Los Angeles will also be pressed into service by the end of the week.
"It really, truly was a hassle-free experience," said Julieann Sparks, a 41-year-old nurse who received a shot through her car window at the San Diego site. After getting inoculated, drivers had to stay there for 15 minutes so they could be watched for any reaction.
About 584,000 doses have been administered in California, or about 1.5% of the population.
Texas has seen surges in newly confirmed coronavirus cases, hospitalizations and deaths. Health officials report more than 13,000 covid-19 patients in hospitals statewide, and nearly 30,000 deaths since the pandemic started.
Gov. Greg Abbott said the state should be able to rapidly increase the rate of vaccinations by using new mass hubs for getting shots, but the effort is still limited by the supply of medicine coming from the federal government.
In response to frustrations over a slow and often confusing rollout of vaccines over the past month, Texas is shifting from its original model of using thousands of smaller vaccine providers to large-scale sites that can process thousands of shots per day.
"We have the structure to vaccinate Texans very swiftly," Abbott said after touring the new vaccine hub at the Esports Stadium Arlington & Expo Center. Other sites among the 28 hubs include the Alamodome in San Antonio, the state fairgrounds in Dallas and Minute Maid Park in Houston.
"The only limitation that we now face is the limitation of supply. The vaccination is not something that the state of Texas is in control of. The supply of the vaccination comes only from the federal government," Abbott said.
Texas will soon be receiving 300,000 more first-shot doses in the two-round process each week, Abbott said. As of midday Monday, Texas had received about 2 million doses, which had been given to nearly 880,000 people.
The state is currently vaccinating health care workers, first responders, nursing home residents, people 65 and older, pregnant women and anyone 16 or older who has a medical condition that would put them at a higher risk of death or severe illness if infected.
In Houston, Mayor Sylvester Turner said more than 3,800 people were vaccinated over the weekend at Minute Maid Park, where the Houston Astros play baseball. Like Abbott, Turner said Houston could move faster if it had more vaccine supply.
San Antonio health officials said the 9,000 appointments for shots this week at the Alamodome were filled within six minutes of registration opening.
Information for this article was contributed by Lisa Marie Pane, Patty Nieberg, Julie Watson, Jennifer Peltz, Terry Tang, John Antczak, Robert Jablon and staff members of The Associated Press; by Karen Zraick and Michael Crowley of The New York Times. The AP's Nieberg is a corps member of the Report for America Statehouse News Initiative, a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.