As the coronavirus has surged through the winter, some ambulance crews have struggled to keep pace with the number of patients requiring emergency care, and staffing and bed shortages at hospitals have led to hours of waiting to unload patients.
Ambulance crews have been transporting the relentless tide of Covid-19 patients as the post-holiday surge accelerated: On Friday, 300,594 new U.S. cases were reported, as were more than 4,100 deaths, both single-day records. Hospitalizations remained at near-record levels, with 130,777 patients on Saturday, according to the Covid Tracking Project, while the nationâs vaccine rollout is off to a slow start.
In the Augusta, Ga., area, all three major hospitals were out of beds last week, said Steven Vincent, the vice president of Gold Cross EMS in Augusta.
Waiting until a bed is available can sometimes take hours, he said, so ambulance crews have often opt to continue driving to other hospitals or trauma centers many miles away. Some hospitals have erected medical tents outside so that emergency medical service crews can split up, one member waiting with the patient and while the ambulance leaves to answer another call.
âRight now, our hospitals are completely full,â Mr. Vincent said. âWeâre trying to get creative, because it is rough right now.â
The intensity has taken an emotional and physical toll on the emergency medical workers, he said. âThey are stressed, they are overworked. Itâs been a struggle, no doubt about it.â
In Habersham County, in the stateâs northeast, the average number of calls per day for emergency medical service crews has been far higher than usual, said Chad Black, the director for emergency services for the county and the board chairman of the Georgia E.M.S. Association. About every other call is related to Covid, he said, and ambulances have had to wait upward of two hours to unload patients.
The county has had staffing problems for years, he said, a complication aggravated when employees contract the virus and must isolate. Some days, ambulances are at 50 percent staffing, Mr. Black said.
âThey know when they come in, in the morning, that thereâs a great chance theyâre going to be up for 24 straight hours,â Mr. Black said about the ambulance workers. âYouâve got to worry â is there a breaking point?â
And in the Atlanta area, Mr. Black said, emergency crews are often âhospital shoppingâ â calling multiple facilities in the metro area and driving around until one agrees to admit their patient.
In Arizona, which has a higher rate of new cases per capita than any other state, according to a New York Times database, E.M.S. workers worry about being exposed to the virus, then bringing it home to their families and getting severe symptoms, said Brian Moore, the central region director of the Arizona Ambulance Association.
âThis whole thing has put a lot of fear in folks who are on the front lines,â Mr. Moore said.
Emergency medical service dilemmas are particularly acute in Los Angeles County, where understaffed hospitals are overwhelmed and a Covid-related death happens every eight minutes. The nationâs most populous county has urged ambulance crews not to take people they cannot resuscitate to hospitals.
The countyâs memo on the matter reflected a relatively small change from its previous policy, which already discouraged emergency personnel from transporting most people whose heartbeats could not be restored. But after the memo gained widespread attention, medics felt compelled to post on social media to try to quell anxieties that they believed were unfounded.
Kari Dickerson, a paramedic in Kentucky who tweets as @MedicTrommasher, said the memo had particularly alarmed people of color, who have been disproportionately harmed by the pandemic.
She said she worried that her fellow workers could face wrenching situations whenever they broke the news that someone had died, perhaps causing families to wonder: âDid they do this on purpose, did they not work as hard as they would have for somebody that looks like them?â
At leading research hospitals in the United States, administrators and young graduate students have been inoculated with some of the earliest supplies of coronavirus vaccines, in a contradiction of federal and state guidelines.
The Centers for Disease Control and Prevention has issued recommendations intended to ensure that the nationâs vaccines first reach those at highest risk: health care workers who interact with Covid-19 patients, and residents and staff members at nursing homes, followed by people 75 and older and certain essential workers.
Each state has established its own version of the guidelines, but with the rollout proceeding at a glacial pace, pressure has been growing for a more flexible approach. Officials at the C.D.C. and the Food and Drug Administration have recently suggested that it might be wiser to simply loosen the criteria and distribute the vaccine as widely as possible.
But a handful of the nationâs most prestigious academic hospitals have already taken the notion much further.
A 20-something who works on computers. A young researcher who studies cancer. Technicians in basic research labs. These are some of the thousands of people who have been immunized against the coronavirus at hospitals affiliated with Columbia University, New York University, Harvard and Vanderbilt University in Tennessee, even as millions of frontline workers and older Americans are waiting their turns.
Some of the institutions were among the first recipients of the limited supplies in the United States.
The C.D.C. never intended to include workers who donât interact with patients, like administrators and graduate students, in the first tier of priority vaccinations, said Dr. Stanley Perlman, an immunologist at the University of Iowa and a member of the committee that issued the recommendations.
âThis all got so confusing,â he said. âIn retrospect, I think it probably needed to be a little more exact on what we were thinking, because we were never thinking about hospital administrators.â
When the City of San Antonioâs Covid-19 vaccination registration site went live at 9 a.m. on Saturday, the 9,000 available slots filled up in six minutes. In Michigan, more than 20,000 people tried to enter a health systemâs portal for Covid vaccinations at the same time, crippling the system.
As states try to scale up vaccine rollouts that have been marred with confusion and errors, the online registration sites â operated by a welter of agencies and using a range of technologies â are crucial. But the problems they are experiencing reveal yet another challenge to getting Americans inoculated: There are many, many more people who want to be vaccinated than there are opportunities to get the shot.
âThe registration system worked as designed, but there is far greater demand than available supply at this time,â Dr. Colleen Bridger, an assistant city manager, said in a statement. âWhen we receive more doses from the State of Texas, we will have more appointments available in the coming days and weeks, and we will keep the public informed about registration opportunities.â
Michiganâs largest health care system, Beaumont Health, had problems with its website on Friday, said Hans Keil, the systemâs chief information officer. Beaumont Health, which operates several hospitals in the Metro Detroit area, had recently announced plans to offer residents 65 and older vaccinations, and about 25,000 people tried to gain access to the online portal simultaneously, Mr. Keil said. The portal didnât crash, but many users couldnât enter.
âWeâre really having to rethink how we have to do our capacity planning,â Mr. Keil said.
On Thursday, Miami-Dade County introduced an online registration tool for appointments. County officials had said they would have a limited number of slots for people 65 and older. The available slots were filled in 20 minutes, said Luisana PÃ©rez FernÃ¡ndez, a spokeswoman for the mayorâs office.
In Georgia, officials tried to roll out vaccines to individuals 65 and older, beginning Monday in DeKalb County. On Thursday, the DeKalb County Board of Health website was experiencing âlatency issuesâ as individuals signed up for the shot.
High demand was apparent offline as well.
In Montgomery County, Tenn., more than 1,000 appointments were scheduled on Tuesday via a phone system before the lines crashed in the afternoon, officials said. On Wednesday, a new website and phone number were added to help handle the load.
Even in states where online registration seemed to go well, some people were stuck with long waits.
In Indiana, more than 21,000 people 65 and older signed up for appointments in the first 90 minutes that registration was open on Friday, and a total of 35,000 people had signed up by an hour later. Officials from the stateâs Department of Health said that some 200 people experienced delays.
âIndividuals may encounter wait times due to a high volume of interest,â a statement from the department said. âThe registration system was designed to put visitors into a holding queue when volume is high.â
With 6,000 prekindergarten and special education students preparing to return to Chicagoâs public school buildings on Monday for the first time since March, a question looms: How many of their teachers will be there to greet them?
Mayor Lori Lightfoot of Chicago has argued that giving parents the option of sending their children to school in person is critical to preventing some of the cityâs mostly poor and Black and Latino students from falling permanently behind.
But the teachersâ union has fiercely resisted the plan, arguing that schools are not safe while the coronavirus is circulating at its current level. Over the past week, fewer than 60 percent of the roughly 2,000 teachers who were expected to return to their buildings to prepare for the arrival of students actually showed up.
Janice K. Jackson, the chief executive of the school system, said on Friday that she was optimistic that most teachers would go to work on Monday. She warned that any who stayed home without permission would not be paid, raising the prospect of a heightened clash with the union, which has suggested it may strike if teachers are not permitted to stay home if they want to.
Across the country, many big cities like New York have struggled to resume even limited in-person instruction, while a number, including Los Angeles, have simply given up on the idea, choosing to stick with all-remote education into the spring.
Few places have seen as much acrimony over the issue as Chicago, whose public school system. the nationâs third-largest, serves about 350,000 students.
âThis is probably the most contentious and unpleasant reopening, in terms of how the different sides are interacting with each other,â said Emily Oster, an economics professor at Brown University who has collected data on coronavirus cases in schools and has argued that reopening schools is safe under many circumstances.
Interviews with parents and officials in Chicago indicate that many families are torn between concerns that their children are losing out educationally and fears that they will bring the virus home.
Katrina Adams, who lives on the South Side, said she wanted to send her oldest daughter, who is in the fourth grade, back to school, but said she didnât think the district was ready to open. Ms. Adams said her views had not been influenced by the teachersâ union, but she acknowledged feeling unsettled by many teachersâ concerns about in-school transmission of the coronavirus.
âIf they donât feel safe coming back, most definitely thatâs an alert, to a parent or anyone,â she said.
The last step in the long journey to adopt a child through the foster care system is the courtroom finalization. Itâs traditionally provided an important opportunity for loved ones to gather and pose for pictures as a judge blesses the creation of a new âforever familyâ with a smack of the gavel.
But, like so many other things in the Covid-19 era, this tradition has gone virtual. âWe finalized our adoption over the phone,â said Celeste Scott, who last May adopted her three youngest children â who were 4, 5 and 6 when they first came to live with her in the spring of 2019. âIt was kind of anticlimactic.â
Still, Scott, of The Dalles, Ore., knows she is fortunate to have finalized the adoptions at all. If she lived elsewhere in the country, she could very well still be waiting. The pandemic has created new challenges in the foster care system and worsened old ones â creating delays in placements and adoptions and forcing some older youth to exit the system amid a public health and economic crisis.
âThe child welfare system is extremely complex and can vary widely by state, and even by county,â said Celeste Bodner, executive director and founder of FosterClub, an advocacy organization for foster youth. âEach of these systems is navigating the pandemic on its own, meaning the experience of a child in one county can be completely different from the one right next to it.â
Soon after the pandemic took hold, for instance, Floridaâs child welfare system began conducting the bulk of the work certifying foster parents and placing children in their homes remotely.
In New York, the system ground to a halt. âFor a long while, the courts here were just not doing anything virtually,â said Shantell Lewis, a recruiter with the Wendyâs Wonderful Kids program, which focuses on finding placements for older foster youth, at a Brooklyn nonprofit called MercyFirst. Though New York has more recently allowed work to be conducted virtually, the state has a considerable backlog.
Many child welfare professionals are also concerned about older youth âemancipatingâ from foster care, when local governments are no longer bound to provide financial assistance. This abrupt transition into adulthood, between 18 and 21 depending on the state, in the very best of times represents a significant challenge for roughly 20,000 young people each year. But today, those aging out of foster care are aging in to a country gripped by an ongoing pandemic and crippled economy.
âWhen a young person ages out of the system, we have in many ways already failed them,â said Rita Soronen, president and chief executive of the Dave Thomas Foundation for Adoption. âBut this is even more true right now â thereâs nothing like a crisis to show how truly vulnerable this group of young people are as they transition to adulthood.â
Dr. Anthony S. Fauci, the top U.S. infectious disease expert, told performing arts professionals at a virtual conference on Saturday that he believed that theaters and other venues could reopen âsome time in the fall of 2021,â depending on the vaccination rollout, and suggested that audiences might still be required to wear masks for some time.
At the conference, held by the Association of Performing Arts Professionals, Dr. Fauci sought to assure people in the industry that the end of their acute economic pain was in sight, while emphasizing that the timeline hinged on the country reaching an effective level of herd immunity, which he defined as vaccinating from 70 percent to 85 percent of the population.
âIf everything goes right, this will occur some time in the fall of 2021,â Dr. Fauci said, âso that by the time we get to the early to mid-fall, you can have people feeling safe performing onstage as well as people in the audience.â
The industry conference, which typically draws thousands of attendees and features hundreds of live performances, was moved entirely online this year because of the coronavirus pandemic, underscoring the seismic impact the outbreak has had on the performing arts. According to the results of a survey released this week by Americans for the Arts, a national advocacy group, financial losses nationally in the field are estimated to be $14.8 billion, more than a third of nonprofit arts and cultural organizations have laid off or furloughed their staff, and a tenth are ânot confidentâ they can survive the pandemic.
Speaking to Maurine Knighton, the program director for the arts at the Doris Duke Charitable Foundation, Dr. Fauci said that if vaccine distribution succeeded, theaters with good ventilation and proper air filters might not need to place many restrictions for performances by the fall â except asking their audience members to wear masks, which he suggested could continue to be a norm for some time.
âI think you can then start getting back to almost full capacity of seating,â he said.
Dr. Fauci was asked about a frustration among some performing arts professionals that restaurants, bars, gyms and places of worship have been allowed to open in some states while theaters and other performance venues have remained shuttered. In response, Dr. Fauci urged them to do more research on the ventilation quality of their theaters and to explore how improving air flow might affect transmission.
Every day, Tan Eng Chye, the president of the National University of Singapore, scans his online dashboard to see how crowded the cafeterias are.
If the real-time map shows that one cafeteria is too packed, he has administrators send out an advisory to avoid it and to remind students that there are campus-run food delivery services, free of charge.
Following the governmentâs lead, universities in Singapore, a semi-authoritarian city-state of almost six million people, have taken a top-down approach to managing the coronavirus. The result: Since the start of the pandemic last year, not one person has been found to have contracted the virus at any of Singaporeâs three major universities.
While Singaporeâs universities have benefited from a generally low caseload in its broader population, their experience and stringent measures stand in stark contrast to many campuses across the United States. A number of American universities experienced an explosion in cases almost as soon as students returned last fall.
The National University of Singapore, or N.U.S., describes its strategy as containment, decongestion and contact tracing. The university has harnessed technology to enforce social distancing measures, assigned students to different zones on campus and imposed tough penalties for flouting the rules. Like some American colleges, it is testing people extensively and even sifting through sewage for traces of the virus.
The goal, Professor Tan said, âis to make sure there are no infectionsâ among the students, faculty and staff members at N.U.S.
If youâre in a relationship (or havenât been out much since March), it may be news to you that despite a raging pandemic, people are meeting up, cuddling, making out and having sex with new partners, often weighing their emotional and physical needs against safety concerns.
Some have gone about their private lives quietly, out of fear that those in their social circles â especially established couples â would judge their choices. Others have been more conspicuous when hooking up. In November, New York sheriffs broke up an 80-person party at a sex club in Queens. That same month, a swingersâ convention in New Orleans led to 41 people testing positive for the coronavirus.
Going on dates has involved a mental calculus not unlike the kind applied to other social interactions in the Covid-19 era: Will I feel safe? What is the likelihood of infection? How many people could this hurt? But hookups have been viewed with particular scrutiny.
âEven pre-pandemic, there was a lot of stigma around sexuality and sex in general,â said Dr. Oni Blackstock, the former assistant commissioner at the New York City Department of Healthâs Bureau of H.I.V. âWith the pandemic, thereâs another layer of expectations and judgment.â
It took Alison Stevenson eight months to find a pandemic friend with benefits. Along the way, she had an intense, short-lived texting relationship that ended when the man on the other end told her he was getting back together with his ex. Then came two disappointing outdoor dates, including one with a guy who made fun of her for asking him to keep his mask on.
âI needed a âsituationship,ââ said Ms. Stevenson, a 31-year-old comedian and writer in Los Angeles. âA person I can rely on and trust to hang out with once a week.â
The effort could mean setting boundaries and conditions from the outset, like regular testing (keep in mind that tests can show false negatives, especially if the amount of the virus in the body is too small to be detected, and that whoever is taking the test could be infected while waiting for results), quarantining before meeting and sticking to a single partner.
As they negotiate, people are finding that the key to dating now is what itâs always been: trust. And ultimately for many single people, hooking up has been worth the increased risk of contracting the virus.
âEverything I enjoy doing has been taken away from me,â said Emmy Nicholson, a 26-year-old publicist in Brooklyn. âBut thereâs one thing they canât take away, and thatâs having sex.â