As coronavirus cases, hospitalizations and deaths soar to new heights in the United States, Tennessee has become one of the worst-hit states, spurring the governor to warn residents against gathering and traveling for the holidays.
The state is identifying cases at the highest per capita rate in the nation by a wide margin. At least 9,265 new cases and 65 deaths were reported in Tennessee on Monday, according to a New York Times database. Over the last week, there has been an average of 8,953 cases per day, an increase of 90 percent from the average two weeks earlier. Eight of the nation’s 20 metropolitan areas with the most recent cases per capita are in Tennessee.
“Tennessee is ground zero for a surge in sickness,” Gov. Bill Lee said in an address on Sunday from quarantine, the day after he announced that his wife has tested positive for the virus.
Arguing that Thanksgiving gatherings led quickly to a “record level of sickness,” Gov. Lee urged residents not to gather indoors with anyone outside their household over the upcoming holidays, despite the rollout of vaccines.
“We are in a war,” he said, stressing that the next few weeks would be critical for the state to avoid overwhelming hospitals already reeling from the Thanksgiving spike. “Tennessee cannot sustain a similar surge after Christmas or New Year’s.”
The stark warning comes as the virus explodes in the United States — parts of California are down to their last I.C.U. beds, and some hospitals in other states are at or over capacity — and the numbers are as alarming as they have ever been: At least 319,763 people have died, more than any other country in the world. On Monday, confirmed cases in the United States reached 18 million, just five days after surpassing 17 million.
Gov. Lee became the latest governor to try and starkly limit indoor public gatherings, with new restrictions on dining and sporting events. Yet he declined to issue a statewide mask mandate, which he called “controversial.” Instead, he urged residents to wear masks and stressed the role of local officials in imposing such rules.
Governors on both coasts are also moving to counter the spread of a newly discovered virus variant circulating in Britain. Alarm about the variant has prompted dozens of countries to put in place some sort of travel regulation.
Gov. Andrew M. Cuomo of New York announced on Monday that British Airways, Virgin Atlantic and Delta Air Lines have agreed to require a negative coronavirus test result from passengers boarding flights from Britain to New York. The arrangement adds the state to a list of at least 120 countries that mandate testing before arrival. The United States has yet to impose such a measure.
Gov. Jay Inslee of Washington State has stopped short of new testing requirements but ordered that travelers from Britain and South Africa, where a similar variant has also been seen, undergo a 14-day quarantine. He said more countries may be added to the travel proclamation.
Britain and France reopened their border to some travelers on Tuesday and inched closer to a deal that would allow freight trucks to resume moving between the two countries, raising hopes of relief for hundreds of drivers stuck near British ports and for supermarkets warning that they could soon run short of fruit and vegetables.
On Sunday, France closed its border for 48 hours, fearing the spread of a new and possibly more transmissible variant of the coronavirus in Britain. That left more than 1,500 trucks stranded in the southeast as the Port of Dover and the Eurotunnel were shut to outbound traffic. Some drivers slept in their trucks for two nights.
As talks to break the impasse continued, France announced on Tuesday night that select groups of people would be allowed to travel from Britain to France if they could produce proof of a recent negative coronavirus test.
Those now allowed to travel include French and European Union citizens, noncitizens with a permanent residence in France, and other people whose travel is deemed essential, They include diplomats, health workers helping in France’s fight against Covid-19, and the drivers and crew of passenger planes, trains and buses.
Dozens of nations had rushed to close their borders with Britain in recent days over concerns of a newly discovered coronavirus variant spreading there.
Prime Minister Boris Johnson of Britain said over the weekend that it had been shown to be more contagious than other variants. British officials said there was no reason to believe that the new variant caused more serious illness, and most experts doubt it will render the current vaccines ineffective.
The loosening on travel restrictions followed a call from the executive arm of the European Union for member states to lift blanket bans on air and train travel. It recommending testing or quarantines instead. The European Commission, the bloc’s executive arm, said on Tuesday that it was important to maintain travel and transport between Britain and the European Union.
“Flight and train bans should be discontinued given the need to ensure essential travel and avoid supply chain disruptions,” the commission said in a statement.
Hours earlier, Dr. Ugur Sahin, the co-founder of BioNTech, which, with Pfizer, developed the first vaccine approved in the West, said that it would be two weeks before results from laboratory studies would allow for a fuller understanding of how the mutations might impact the effectiveness of the vaccine.
“We believe that there is no reason to be concerned until we get the data,” he said.
If an adapted vaccine were necessary, it could be ready within six weeks, Dr. Sahin told a news conference on Tuesday. But it would require additional approval from regulators, which could increase the wait-time, he said.
The new variant, first detected several months ago, spread through southeastern England and has also been identified in small numbers in Denmark, the Netherlands and Australia, according to World Health Organization officials.
The W.H.O. sought to temper the growing sense of alarm over the new variant and the danger it poses. “There is zero evidence at this point that there is any increase in the severity associated with this disease,” Mike Ryan, the W.H.O. emergency director, said at a virtual news conference.
But fears of the newly discovered variant continue to ripple across the globe on Tuesday, with Nepal becoming the latest country to announce a flight entry ban on people arriving from Britain.
The United States has not put in place a travel ban on Britain. There are no confirmed cases of the variant circulating in the United States, but that does not mean it hasn’t already reached American shores.
On Tuesday morning, Gov. Andrew M. Cuomo of New York called for the U.S. to mandate testing prior to international arrival, a policy already enforced by at least 120 countries. The United States has yet to impose such a health measure.
“I think actually the United States should say we should test before anyone comes from any country, because the U.K. variant now has already migrated.” Mr. Cuomo said.
The rush to try to beat the pathogen by closing borders brought back memories of the world’s reaction after the coronavirus first emerged broadly in the spring. Most of those initial travel prohibitions came too late, after the virus had already seeded itself in communities far and wide.
Some experts say the frenzied rush to close borders this time around threatens to cause more economic and emotional hardship as the devastation wrought by the virus continues to grow. And since it is not known how widely the variant is circulating, the bans might not even slow it down much.
“It is idiotic,” was the blunt assessment of Dr. Peter Kremsner, the director of Tübingen University Hospital in Germany. “If this mutant was only on the island, only then does it make sense to close the borders to England, Scotland and Wales. But if it has spread, then we have to combat the new mutant everywhere.”
Dr. Anthony S. Fauci, the government’s top infectious disease expert, was vaccinated on Tuesday during a live broadcast of what the National Institutes of Health called a kickoff event showcasing Moderna’s vaccine, which was developed by scientists at the agency and received emergency authorization from the Food and Drug Administration on Friday.
Rolling up the sleeve of a blue dress shirt, Dr. Fauci called his public vaccination “a symbol to the rest of the country that I feel extreme confidence in the safety and the efficacy of this vaccine.”
“I want to encourage everyone who has the opportunity to get vaccinated so that we can have a veil of protection over this country that would end this pandemic,” he said.
Joining Dr. Fauci in an auditorium at N.I.H. to receive vaccinations were Dr. Francis S. Collins, the agency’s director, Alex M. Azar II, the health and human services secretary, and frontline workers at the N.I.H. Clinical Center. They will receive the second dose of the Moderna vaccine in 28 days.
The Moderna vaccine, which has received billions of dollars of support from the federal government, has become a triumphant symbol of the administration’s efforts to develop and distribute a vaccine. It was designed by scientists at N.I.H. and the company within two days of China’s releasing the genetic sequence of the coronavirus.
“What we’re seeing now is the culmination of years of research, which have led to a phenomenon that has truly been unprecedented,” Dr. Fauci said at the Tuesday event. “And that is to go from the realization that we’re dealing with a new pathogen, a virus that was described in January of this year, to less than one year later to have vaccines that are going into the arms of so many people, including myself.”
Dr. Fauci’s vaccination was long awaited by public figures and health experts. Former President Barack Obama recently said that if Dr. Fauci, who will also be the chief medical adviser to President-elect Joseph R. Biden Jr. once he takes office, endorses a coronavirus vaccine, that would be a signal to him that it is safe.
On Monday, Mr. Biden received a coronavirus vaccine on live television at the Christiana Hospital in Newark, Del., to send a message to Americans across the country that the vaccine was safe to take.
“Left’s good,” he told the nurse practitioner who administered the Pfizer-BioNTech Covid-19 vaccine, rolling up the sleeve of his black long-sleeve turtleneck and exposing his left arm. “You just go ahead anytime you’re ready.”
He credited the Trump administration for its work on Operation Warp Speed, which helped to deliver a quick vaccine.
“The administration deserves some credit getting this off the ground,” he said. “I’m doing this to demonstrate that people should be prepared when it’s available to take the vaccine.”
Mr. Biden, however, warned Americans that vigilance in the coming months was still necessary.
“It’s going to take time,” he said, encouraging people to continue to wear masks and socially distance. “If you don’t have to travel, don’t travel,” he said. “It’s really important.”
Since March, Mr. Biden’s team has been taking public health guidelines about social distancing and masks seriously, as President Trump and his aides have willfully disregarded them. But even Mr. Biden’s more careful circle has been infiltrated by the virus. Representative Cedric L. Richmond, Democrat of Louisiana and one of Mr. Biden’s closest advisers, tested positive for the coronavirus last week, the transition team announced.
Vice President-elect Kamala Harris is expected to receive her vaccine after Christmas, a spokeswoman said, following advice from doctors who recommended Mr. Biden and Ms. Harris stagger their first shots rather than receive them together.
Hundreds of dollars in direct payments may start going to American households as soon as next week after Congress overwhelmingly passed a $900 billion stimulus package sending billions of dollars to individuals and businesses grappling with the economic and health toll of the coronavirus pandemic.
The long-sought relief package was part of a $2.3 trillion catchall package that included $1.4 trillion to fund the government through the end of the fiscal year on Sept. 30. It included the extension of routine tax provisions, a tax deduction for corporate meals, the establishment of two Smithsonian museums, a ban on surprise medical bills and a restoration of Pell grants for incarcerated students, among hundreds of other measures.
Though the $900 billion stimulus package is half the size of the $2.2 trillion stimulus law passed in March that provided the core of its legislative provisions, it remains one of the largest relief packages in modern American history. It will revive a supplemental unemployment benefit for millions of unemployed Americans at $300 a week for 11 weeks and provide for another round of $600 direct payments to adults and children.
“I expect we’ll get the money out by the beginning of next week — $2,400 for a family of four — so much needed relief just in time for the holidays,” Treasury Secretary Steven Mnuchin said on CNBC. “I think this will take us through the recovery.”
President-elect Joseph R. Biden Jr., who received a coronavirus vaccine on Monday with television cameras rolling, has insisted that this bill is only the beginning, and that more relief, especially to state and local governments, will be coming after his inauguration next month.
Lawmakers hustled on Monday to pass the bill, nearly 5,600 pages long, less than 24 hours after its completion and before virtually anyone had read it. At one point, aides struggled simply to put the measure online because of a corrupted computer file.
The legislative text is likely to be one of the longest ever, and it became available only a few hours before both chambers approved the bill. In the Senate, the bill passed 92 to 6. It will now go to President Trump for his signature.
Hospitalizations and deaths have continued to soar in California as the state has emerged as the new epicenter of the coronavirus pandemic — and they don’t appear to be slowing down.
With just 2.5 percent of the state’s overall intensive care capacity available, officials have been rushing to get more so-called field hospitals, or alternative care sites, up and running. And while Gov. Gavin Newsom didn’t officially extend what were supposed to be three-week stay-at-home orders affecting most of the state’s 40 million residents, he said on Monday it was “self-evident” that the orders would need to be in effect well into January, in light of projections that more than 90,000 people in California could be hospitalized with the virus in coming weeks.
The state added 295,000 cases over the past week, according to a New York Times database, and is likely to reach 300,000 new cases this week, given the virus’s trajectory.
Dr. Mark Ghaly, the state’s secretary of health and human services, said on Monday that health care providers and state and local leaders were working frantically to prevent health care systems from tipping into what he and the governor described as crisis mode.
“We continue to build up our capacity,” he said. “When we look forward to that forecast of quite a few patients toward the end of January — that’s not a story that’s already been written.”
But as has been the case in the last couple of months, making sure health care facilities are sufficiently staffed has been the biggest hurdle. Nurses, doctors, janitors and so many others are exhausted. Help from other states and the federal government is scarce as so much of the nation suffers from the rapid spread of Covid-19.
In the next week or so, more Californians could hear that many hospitals are simply full. Patients who are unable to avoid going to the hospital will encounter hourslong waits in hallways.
The mere possibility that California’s caseload could overwhelm even the state’s emergency surge capacity is likely to harm workers, said Joanne Spetz, a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.
“The term psychologists use is ‘moral distress,’” she said. “And that is a huge, looming and developing issue among health professionals.”
Pulse oximeters are among the most commonly used tools in medicine. The small devices, which resemble a clothespin, measure blood oxygen when clipped onto a fingertip, and they can quickly indicate whether a patient needs urgent medical care.
Health providers use them when they take vital signs and when they evaluate patients for treatment. Ever since the pandemic started, doctors have encouraged Covid patients to use them at home.
But in people with dark skin, the devices can provide misleading results in more than one in 10 people, according to a new study.
The findings, published last week as a letter to the editor of a top medical journal, sent ripples of dismay through the medical community, which relies heavily on the devices to decide whether to admit patients or send them home.
The report also stirred concerns because the pandemic is taking a disproportionate toll on Black and Hispanic Americans, drawing attention to racial health disparities and prompting soul-searching among doctors about bias that permeates the practice of medicine. There have been several reports of acutely ill Black patients who sought medical care only to be turned away, and studies have found that African-Americans were hospitalized at higher rates, suggesting delays in access to medical care.
The researchers who conducted the oximeter study said they were surprised by the findings. Though scientific reports of the inaccuracies have been published in the past, they did not receive widespread attention or get incorporated into medical training.
“I think most of the medical community has been operating on the assumption that pulse oximetry is quite accurate,” said Dr. Michael W. Sjoding, an assistant professor of internal medicine at the University of Michigan Medical School and lead author of the new report, which appeared in The New England Journal of Medicine. “I’m a trained pulmonologist and critical-care physician, and I had no understanding that the pulse ox was potentially inaccurate — and that I was missing hypoxemia in a certain minority of patients.”
Antarctica is no longer the last continent free from the coronavirus after 36 people stationed at a Chilean research base tested positive, local media reported.
The virus was detected in 26 members of the Chilean military and 10 maintenance workers stationed at the Base General Bernardo O’Higgins Riquelme in the Antarctic Peninsula, the authorities said in a statement to 24 Horas, adding that they were tested after reports that some had developed symptoms.
They were among a group of 60 people who were evacuated from the base to the Chilean city of Punta Arenas over the weekend and have since been isolated, the program reported, and contact tracing was underway. Three cases have also been found in crew members of a Chilean Navy ship returning from the continent, La Prensa Austral reported.
The Chilean army and the Chilean Antarctic Institute did not immediately respond to requests for comment.
The U.S. National Science Foundation said it was aware of reports of virus cases among passengers who would have disembarked in the ports of Punta Arenas and Talcahuano from the Chilean Navy vessel Sargento Aldea, which had been traveling near the O’Higgins station.
“Personnel at U.S. Antarctic Program stations have had no interactions with the Chilean stations in question or the personnel who reside there,” a spokeswoman said, adding that the foundation “remains committed to not exchanging personnel or accepting tourists” at American stations.
Reports of the cases appear to end the continent’s nine-month escape from a virus that has been found in almost every other corner of the world. About 1,000 people have weathered a sunless winter on the continent, which contains about 40 bases, according to The Associated Press, and newcomers must quarantine and test frequently. Bases are small, with people living in close contact, and movement typically picks up in the austral summer, which began in November, when new supplies and people arrive to the continent as others leave.
Research and tourism on the continent have already been severely reduced, and experts say fallout from the pandemic is likely to have a longer impact on governance and travel there.
The Council of Managers of National Antarctic Programs has warned that the virus could have “catastrophic” consequences on the continent, given the extreme environment and limited medical and health resources there, according to The Associated Press.
Henry Fountain contributed reporting.
Key West, Fla., a small tourist town at the southernmost point of the continental United States, has watched its coronavirus numbers climb to more than 2,100 cases.
Last month a county commissioner, his wife and their 35-year-old daughter were infected and wound up in the intensive care unit at the same time. On Dec. 4, two days after the death of the commissioner’s wife, Cheryl Cates, the city enacted a strict three-night curfew for New Year’s weekend that forces all businesses to close and prohibits people from being on the sidewalk.
In an effort to keep throngs of holiday revelers off city streets, particularly for a popular public event featuring a drag queen that draws huge crowds, city leaders declared a 10 p.m. curfew beginning Thursday, Dec. 31, and continuing into Sunday morning. The penalty: 60 days in the county jail or a $500 fine.
A federal lawsuit filed late Monday in the U.S. District Court for the Southern District of Florida seeks a restraining order preventing the curfew, contending that it is a civil rights violation to disallow peaceful assembly.
The curfew was enacted despite more modest proposals, such as canceling large events, that were recommended by experts who had convened to review the issue, said William L. Athas, the lawyer who filed the suit. Mr. Athas said he hoped the court would consider a recent U.S. Supreme Court case that declared New York State’s church restrictions unconstitutional.
The curfew was unpopular among workers in the entertainment industry, which suffered huge losses during the lockdown earlier this year.
The suit was brought by Andrew T. Day, a veteran who works at a nearby military base and lives in Key West with his wife and two children, his lawyer said. Mr. Athas declined to say whether Mr. Day worked in an industry that was financially affected by the curfew.
Mr. Day’s Facebook profile shows he is a supporter of President Trump who has questioned the severity of the Covid-19 pandemic.
“His interest is he doesn’t want his constitutional rights taken away from him,” Mr. Athas said.
Alyson Crean, a spokeswoman for the city, declined to comment, citing pending litigation.
Public schools in many parts of the country are headed for a financial cliff, as the coronavirus drives up the costs of education while tax revenue and student enrollment continue to fall.
Schools can expect about $54 billion from the coronavirus stimulus plan approved by Congress late Monday night. But officials say that’s not nearly enough to make up for the crushing losses state and local budgets have suffered during the pandemic, or the costs of both remote learning and attempts to bring students back to classrooms.
Advocates for public education estimate that schools have lost close to $200 billion so far.
“We’re going to need way more investment both in the short term, to deal with Covid, and in the long term,” said Chip Slaven, a lobbyist for the National School Boards Association.
The pandemic has already forced schools across the country to fire nonunion employees, spending the money instead on remote learning technology, retrofitting buildings, testing and surveillance programs, and other coronavirus-related expenses. Education has been among the hardest hit parts of the economy, according to an analysis by the Pew Charitable Trusts, with employment down 8.8 percent in October from the year before and lower than at any point in the past two decades — a loss of millions of jobs.
The fiscal crisis is looming at a time when families fed up with pandemic-era education have increasingly turned to private and charter schools or chosen to educate their children at home. That’s potentially a major drain on public school budgets, because most states base school funding at least in part on enrollment numbers.
The school boards association estimated that as many as three million students — about 6 percent of the public school population — are not in classes right now, and that number could grow.
“We’ll have to see how many of those folks come back home after normalcy can be achieved,” said David Adkins, the executive director and chief executive of the Council of State Governments. But if the pandemic accelerates an exodus of affluent families from the public school system, he said, he fears the loss of enrollment and political support could trigger a “death spiral,” further weakening public schools at a time when poor and disadvantaged students are already lagging.
Spain’s government on Tuesday approved new legislation designed to help owners of bars and restaurants shuttered or crippled by the Covid-19 pandemic.
The legislation, which was passed by decree, will force landlords to reduce the rent by as much as half if they own more than 10 properties used by restaurants and bars in downtown areas.
If needed, owners of restaurants and bars will also be granted a moratorium on the payment of their rent until next May, when Spain’s current state of pandemic emergency is set to expire. The government estimated that as many as 19,000 owners could apply for the rent relief, paying any outstanding rent over the following two years.
But for now, Spain is not offering direct financial aid to its hospitality sector, as many restaurant owners had demanded.
The Socialist-led coalition government also agreed to give further protection to residents facing a possible eviction, by making it illegal for landlords to cut off their electricity or water.
Spain’s state of emergency was imposed in October as a second wave of infections took hold. Restaurants and bars are operating under strict constraints, and a nightly curfew is in effect, as well as travel restrictions in many regions. There have been at least 1.8 million confirmed cases of coronavirus in Spain, according to the Spanish Ministry of Health.
As of Tuesday morning, 49,260 people had died, and the seven-day average of new reported infections was 9,624 cases a day.
Some 700 foreigners in France who were exposed to the coronavirus through their work will be put on a fast track for naturalization as a reward for their commitment during the pandemic, the junior minister for citizenship said on Tuesday.
The beneficiaries, whom the ministry called “frontline foreign workers in the face of the health crisis,” include health care workers, child care professionals, housekeepers and cashiers.
“They have proved their commitment to the nation,” a statement from the office of the minister, Marlène Schiappa, said. “It is now up to the Republic to take a step toward them.”
In September, the French Interior Ministry asked regional officials to identify foreign workers who had “actively contributed” to the fight against the coronavirus and facilitate their application for fast naturalization.
“Some foreigners swung into action and were particularly exposed in the fight against the Covid-19 pandemic,” Ms. Schiappa wrote in a letter sent in September to regional authorities. “They actively participated in the national effort, with dedication and courage.”
More than 70 applicants have since then obtained citizenship and 693 more are in the final stage of the process, Ms. Schiappa’s office said in the statement on Tuesday.
The authorities have also been ordered to reduce the residency period in France required to obtain citizenship to two years from the usual five in the case of “great services rendered.”
Taiwan on Tuesday reported its first case of local coronavirus transmission in eight months, creating an unfamiliar sense of anxiety on the island, which has so far avoided mass lockdowns and had only a handful of Covid deaths.
The government’s Central Epidemic Command Center said that the infected person, a woman in her 30s, had come in contact with an airplane worker who arrived in Taiwan from the United States last week and was confirmed to be infected on Sunday.
The airplane worker, whom the government described as a man in his 60s from New Zealand, had worked on the same Dec. 12 flight, from Taiwan to the United States, as two other people who have since tested positive for the virus. The three had spent time drinking and dining together without protective equipment, the Taiwan authorities said. The man from New Zealand had also been coughing on the flight, the authorities said.
Taiwan’s epidemic command center said on Tuesday that the man had traveled with the woman who tested positive to two department stores in Taipei and a Costco in the nearby city of Taoyuan between Dec. 8 and Dec. 11.
The command center said it had identified 167 people who may have come into contact with the woman and was arranging testing for them.
Taiwan has enjoyed remarkable success at dodging the worst of the pandemic by enforcing quarantines on people who enter from abroad. The island has recorded seven deaths related to the coronavirus and 770 confirmed infections, nearly all of them overseas arrivals.
In recent days, the world has watched with curiosity and growing alarm as scientists in Britain have described a newly identified variant of the coronavirus that appears to be more contagious than, and genetically distinct from, more established variants. Initial studies of the new variant prompted Prime Minister Boris Johnson to tighten restrictions over Christmas, and spurred officials in countries around the world to ban travel from Britain.
Here’s what scientists have learned about it so far.
Is the British variant some kind of new supervirus?
No. It’s just one variation among many that have arisen as the coronavirus has spread around the world. Mutations arise as a virus replicates, and this variant — known as B.1.1.7 — has acquired its own distinctive set of them.
Is it more contagious than other viruses?
It appears so. In preliminary work, researchers in Britain have found that the virus is spreading quickly in parts of southern England, displacing a crowded field of other variants that have been circulating for months.
However, a virus lineage becoming more common is not proof that it spreads faster than others. It could grow more widespread simply through luck. For instance, a variant might start out in the middle of a crowded city, where transmission is easy, allowing it to make more copies of itself.
Still, the epidemiological evidence gathered so far from England does seem to suggest that this variant is very good at spreading. In places where it has become more common, the overall number of coronavirus cases is spiking. Neil Ferguson, an epidemiologist at Imperial College London, estimates that the variant has an increased transmission rate of 50 to 70 percent compared with other variants in Britain.
Does it cause more severe disease?
There is no strong evidence that it does, at least not yet. But there is reason to take the possibility seriously. In South Africa, another lineage of the coronavirus has gained one particular mutation that is also found in B.1.1.7. This variant is spreading quickly through coastal areas of South Africa. And in preliminary studies, doctors there have found that people infected with this variant carry a heightened viral load. In many viral diseases, this is associated with more severe symptoms.
Is the variant already circulating in the U.S.?
Not yet, as far as anyone knows. But that does not mean it hasn’t already reached the United States. British scientists have established a much stronger system to monitor coronaviruses for new mutations. It’s conceivable that someone traveling from Britain has brought it with them.
Will the variant render the new vaccines ineffective?
No. Most experts doubt that it will have any great impact on vaccines, although it’s not yet possible to rule out any effect.