Tue. Jun 15th, 2021

If the Food and Drug Administration’s vaccine advisory panel vote in favor of the Pfizer vaccine, it will clear the way for the F.D.A. to authorize the vaccine within days.
Credit…Pool photo by Jeff J. Mitchell

The Food and Drug Administration’s vaccine advisory panel, composed of independent scientific experts, infectious disease doctors and statisticians, as well as industry and consumer representatives, is meeting all day on Thursday to discuss whether Pfizer’s Covid-19 vaccine should be authorized by the agency. Although the F.D.A. does not have to follow the advice of the panel, it usually does.

If the experts vote in favor of the vaccine, it will clear the way for the F.D.A. to authorize the vaccine within days and for some health care workers and nursing home residents to begin receiving it early next week.

Earlier this week, career scientists at the F.D.A. published more than 100 pages of analysis of Pfizer’s clinical trial data that showed the vaccine was safe and effective across a variety of demographic groups and also began to show effectiveness after the first of two doses.

Panel members are likely to discuss how a broad authorization of the vaccine — the vote is whether it should be allowed in adults 16 and older — might affect the clinical trial, which will continue. Some experts have argued that, ethically, trial volunteers who received a placebo trial should be offered the real vaccine once it is authorized, but others worry this could tarnish the long-term results of the trial.

Experts could also bring up concerns over possible allergic reactions to the vaccine after two health care workers in Britain, who had histories of severe allergies, developed such reactions after they received the Pfizer vaccine. British regulators have recommended that people with a history of severe allergies not receive the vaccine while these reactions are investigated.

The formal blessing of this expert panel would be the high point of a contentious year for the agency, which has spent months fending off political interference from the White House as infections and deaths have surged to record highs. When public distrust of the vetting process grew over the summer and fall, the agency issued guidelines vowing to listen to the panel, whose deliberations are public, before making its decision.

If the vote is in favor of authorization, it would also be a milestone for Pfizer and its German partner BioNTech, which began working on the vaccine 11 months ago, shattering all speed records for vaccine development, which typically takes years.

The Pfizer vaccine has already been given to people in Bahrain and Britain, where it was authorized on Dec. 2. Canada approved it on Wednesday.

A patient being unloaded from an ambulance before entering the emergency room at University Hospital in Newark, N.J., on Friday.
Credit…Bryan Anselm for The New York Times

The onslaught has been relentless.

Late Wednesday in the United States, the daily death toll exceeded the record set just one week earlier, 2,885.

By midnight it had climbed to 3,053, and total deaths since the coronavirus spread into the country at the beginning of the year and began laying siege had reached 289,529.

If American hospitals were any guide, those numbers are unlikely to dip any time soon.

Hospitals across the country are operating near or above capacity as they cope with a growing flood of Covid-19 cases. New data released this week by the Department of Health and Human Services offered a detailed geographic picture of the crisis, with more than a third of Americans living in areas where hospitals are running critically short of intensive care beds.

With so many hospitals facing the same problems, the elasticity in the health care system is gone, and medical workers are being run ragged.

“There is not a lot of wiggle room,” said Loy Howard, president of the Tanner Health System. “I have been doing this for 35 years, and I have not seen this kind of wear and tear on the staff.”

The five-hospital Tanner Health System near Atlanta expanded the number of critical care beds to 30, but its officials are still scrambling from before dawn to the end of the day.

“The worry is,” said Deborah Matthews, the chief nursing officer, “what are you going to do with the 31st I. C.U. patient? What are you going to do with the next patient who needs to be on a ventilator? You have contingency plans for all of that, but you are just constantly thinking about those things.”

With no immediate relief in sight, the United States was bearing down on a ghastly mark likely days away: 300,000 deaths since the coronavirus outbreak began.

The milestones are being toppled as U.S. officials race to approve and distribute a Covid-19 vaccine for Americans. Britain began vaccinating its own citizens this week, and Canada appears near to doing the same.

But things have moved more slowly in a country still mired over a presidential election that took place more than a month ago, with many Republicans refusing to acknowledge the results and some working actively to undo them.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, testified before Congress in September.
Credit…Anna Moneymaker/The New York Times

The editor-in-chief of a weekly report from the Centers for Disease Control and Prevention has told House Democrats that she was ordered to destroy an email showing that Trump political appointees attempted to interfere with its publication — and that she believes the order came from Dr. Robert R. Redfield, the agency’s director.

The explosive allegation from Dr. Charlotte Kent, the editor of the C.D.C.’s Morbidity and Mortality Weekly Report — the so-called “holiest of the holy” of health reports — is contained in a letter that Representative James E. Clyburn of South Carolina, the No. 3 House Democrat, sent Thursday morning to Dr. Redfield and the health secretary, Alex M. Azar II.

Mr. Clyburn, who chairs a committee that is investigating political interference with the C.D.C., wrote that after Dr. Kent spoke to the panel on Monday, the Trump administration abruptly canceled four more interviews with top C.D.C. scientists and officials, a move the congressman said amounted to obstructing his investigation of political interference in C.D.C. decisions.

“I am deeply concerned that the Trump Administration’s political meddling with the nation’s coronavirus response has put American lives at greater risk,” Mr. Clyburn wrote, “and that Administration officials may have taken steps to conceal and destroy evidence of this dangerous conduct.”

He also told Mr. Azar and Dr. Redfield that if they do not produce documents requested by his panel by Dec. 15, he will subpoena the records.

C.D.C. officials did not immediately reply to email requests for comment.

In a statement issued after the letter was made public, the Department of Health and Human Services called the committee’s characterization of the conversation with Dr. Kent “irresponsible.”

“We urge the Subcommittee to release the transcript in full which will show that during her testimony Dr. Kent repeatedly said there was no political interference in the M.M.W.R. process,” the statement said.

“Moreover, during the interview referenced in the letter, a staff member on the Subcommittee chose to violate basic common practices of attorney-client privilege that protect the interests of the Department but, more importantly, the witness. Despite H.H.S. working diligently to accommodate the Select Subcommittee’s many requests, the Subcommittee is not operating in good faith.”

The issue of political interference in the weekly reports burst into the news in September, when current and former senior health officials disclosed that H.H.S. political appointees had repeatedly asked the C.D.C. to revise, delay and even scuttle reports on the coronavirus that they believed were unflattering to President Trump.

According to Mr. Clyburn’s 12-page letter, which includes a transcript of Dr. Kent’s interview, Dr. Kent told House Democratic investigators that she was instructed to delete an Aug. 8 email sent by Dr. Paul Alexander, then a senior H.H.S. adviser, in which Dr. Alexander demanded that the C.D.C. insert new language in a previously published scientific report on coronavirus risks to children, or “pull it down and stop all reports immediately.”

The letter quoted the email as saying: “C.D.C. tried to report as if once kids get together, there will be spread and this will impact school reopening. … Very misleading by C.D.C. and shame on them. Their aim is clear. … This is designed to hurt this Presidnet [sic] for their reasons which I am not interested in.”

Mr. Alexander was dismissed from the department in September.

The committee is now seeking to interview the four other C.D.C. officials whose appearances were canceled: Dr. Anne Schuchat, the principal deputy director; Nina Witkofsky, the acting chief of staff; Trey Moeller, the acting deputy chief of staff; and Kate Galatas, the acting associate director for communications.

Volunteers for coronavirus vaccine trials in Soweto, South Africa.
Credit…Jerome Delay/Associated Press

Wealthy nations have a firm upper hand in securing a coronavirus vaccine compared with developing countries, a global coalition of organizations and activists warned on Wednesday.

In about 70 developing countries, only one in 10 residents is expected to receive a Covid-19 vaccine within the next year, according to the People’s Vaccine Alliance, which consists of organizations such as Amnesty International, Frontline AIDS, Global Justice Now and Oxfam.

“The hoarding of vaccines actively undermines global efforts to ensure that everyone, everywhere can be protected from Covid-19,” said Steve Cockburn, Amnesty International’s head of economic and social justice. “Rich countries have clear human rights obligations not only to refrain from actions that could harm access to vaccines elsewhere, but also to cooperate and provide assistance to countries that need it.”

Rich countries representing 14 percent of the global population have bought over 50 percent of promising Covid-19 vaccines, according to data collected by Airfinity, a London-based software company tracking deals between countries and manufacturers. It looked at supply deals that included eight vaccine candidates in Phase 3 clinical trials.

The alliance called on pharmaceutical companies along with researchers to “share the science, technological know-how and intellectual property” of their vaccines. They also asked governments to ensure their Covid-19 vaccines are free to the public and equitably available.

Recently, countries including South Africa and India have pushed for loosened restrictions on intellectual property rights for Covid-19 vaccines, proposing that the World Trade Organization end global enforcement of the rights in the interest of accessibility.

“Governments must also ensure the pharmaceutical industry puts people’s lives before profits,” said Heidi Chow, a senior campaign and policy manager at Global Justice Now.

Developing countries that the alliance focused on currently have access to the vaccine only through Covax, a global initiative to vaccinate much of the world population. (The United States declined to be a part of the effort.)

The United Kingdom started vaccinations this week, after becoming the first Western country to authorize a Covid-19 vaccine. On Wednesday, the United Arab Emirates approved China’s coronavirus vaccine, signaling a win for that country’s vaccine ambitions. Canada approved Pfizer and BioNTech’s coronavirus vaccine, which was also approved in Britain. Both Pfizer and Moderna have submitted their applications for emergency approvals the U.S. Food and Drug Administration and vaccinations in the U.S. could start before next month.

However, the news of vaccination success in wealthy nations hasn’t necessarily equated to access for developing countries: Wealthy nations have purchased enough doses to vaccinate their populations three times over by the end of 2021, the alliance said.

“By buying up the vast majority of the world’s vaccine supply, rich countries are in breach of their human rights obligations,” Mr. Cockburn said. “Instead, by working with others to share knowledge and scale up supply, they could help bring an end to the global Covid-19 crisis.”

Pandemic Unemployment

Assistance claims

Pandemic Unemployment

Assistance claims

Applications for jobless benefits resumed their upward march last week as the worsening pandemic continued to take a toll on the economy.

More than 947,000 workers filed new claims for state unemployment benefits last week, the Labor Department said Thursday. That was up nearly 229,000 from the week before, reversing a one-week dip that many economists attributed to the Thanksgiving holiday. Applications have now risen three times in the last four weeks, and are up nearly a quarter-million since the first week of November.

On a seasonally adjusted basis, the week’s figure was 853,000, an increase of 137,000.

Nearly 428,000 applied for Pandemic Unemployment Assistance, a federal program that covers freelancers, self-employed workers and others who don’t qualify for regular state benefits.

Unemployment filings have fallen greatly since last spring, when as many as six million people a week applied for state benefits. But progress had stalled even before the recent increases, and with Covid-19 cases soaring and states reimposing restrictions on consumers and businesses, economists fear that layoffs could surge again.

“It’s very clear the third wave of the pandemic is causing businesses to have to lay people off and consumers to cut back spending,” said Daniel Zhao, senior economist for the career site Glassdoor. “It seems like we’re in for a rough winter economically.”

Jobless claims rose in nearly every state last week. In California, where the state has imposed strict new limits on many businesses, applications jumped by 47,000, more than reversing the state’s Thanksgiving-week decline.

The monthly jobs report released on Friday showed that hiring slowed sharply in early November and that some of the sectors most exposed to the pandemic, like restaurants and retailers, cut jobs for the first time since the spring. More up-to-date data from private sources suggests that the slowdown has continued or deepened since the November survey was conducted.

“Every month, we’re just seeing the pace of the recovery get slower and slower,” said AnnElizabeth Konkel, an economist with the job site Indeed. Now, she said, the question is, “Are we actually going to see it slide backward?”

Many economists say the recovery will continue to slow if the government does not provide more aid to households and businesses. After months of gridlock in Washington, prospects for a new round of federal help have grown in recent days, with congressional leaders from both parties signaling their openness to a compromise and the White House proposing its own $916 billion spending plan on Tuesday. But the two sides remain far apart on key issues.

The stakes are particularly high for jobless workers depending on federal programs that have expanded and extended unemployment benefits during the pandemic. Those programs expire later this month, potentially leaving millions of families with no income during what epidemiologists warn could be some of the pandemic’s worst months.

The European Medicines Agency, located in Amsterdam, did not disclose who was behind the cyberattack.
Credit…Remko De Waal/EPA, via Shutterstock

The European Medicines Agency, the European Union’s top drug regulator, whose approval is necessary for countries in the bloc to begin rolling out the coronavirus vaccine, has begun an investigation after it was hit by a cyberattack, it said on Wednesday.

The agency, which is reviewing vaccine candidates, did not provide details about the target or the date of the attack. But shortly after the announcement, Pfizer and BioNTech said in their own statement that some documents related to the regulatory submission of their vaccine and which were hosted on a server of the European agency, had been “unlawfully accessed.”

Pfizer and BioNTech said their systems had not been breached, and that no study participants appeared to have been identified as a result of the cyberattack.

The breach comes at a time of heightened threats faced by pharmaceutical companies, health care institutions and agencies involved in the production, approval and distribution of the vaccine.

Last week, IBM said it had detected a series of cyberattacks in September against companies involved in the distribution of coronavirus vaccines across the world and against a branch of the European Commission, the E.U.’s executive arm.

The European Medicines Agency is set to announce a decision on the Pfizer/BioNTech vaccine by Dec. 29. Although each country in the bloc will be in charge of its own rollout, the agency’s approval will pave the way for the largest vaccination campaign in the West, dwarfing the rollout that started this week in Britain and most likely posing more considerable logistical and security challenges.

Canada approved the Pfizer/BioNTech vaccine on Wednesday, becoming the second Western country to do so. Russia began the rollout of its own Sputnik 5 vaccine on Saturday.

The European Medicines Agency didn’t disclose who was behind the cyberattack, saying that it “cannot provide additional details whilst the investigation is ongoing.” Pfizer and BioNTech said in their statement that they were awaiting further information from the agency.

Cybersecurity experts have said that only state actors could carry out such operations. Microsoft revealed last month that hacker groups backed by Russia and North Korea had targeted several vaccine makers in the United States, Canada and France, among other countries.

“The intentions behind those attacks are to parasite Western efforts on the vaccine,” said Julien Nocetti, a researcher at the French Institute of International Relations who studies cybersecurity with a focus on Russian activities.

By breaking into the system of key actors involved in the vaccine or by disrupting distribution efforts, attackers could exact considerable damage, said Claire Zaboeva, a senior cyberthreat analyst at IBM’s Security X-Force.

Ms. Zaboeva said about the production and delivery of the vaccine: “If you manage to get the key to the whole kingdom, you have 500 options on the menu: collecting key timetables, which nations will get the vaccine, how it will get there, what companies will be associated with the delivery, or how it will be handled.”

Healthcare workers and the Connecticut National Guard administering coronavirus tests in Stamford, Conn., on Wednesday.
Credit…Dave Sanders for The New York Times

Months into the pandemic, many people still are frustrated and confused about virus testing.

Long lines at testing sites, delays in getting results and even surprise testing bills have discouraged some people from getting tested.

And many people don’t understand what a test can and can’t tell you about your risk, and wrongly think a test result that comes back negative guarantees they can’t spread the virus to others.

We asked some of the nation’s leading experts on testing to help answer common questions about how to get tested, what to expect and what the different tests and results really mean.

Among them:

  • When should be people be tested?

  • What are the tests like?

  • What type of test should people get?

  • And how do you interpret the results?

Quarantine orders for the passenger’s close contacts aboard the ship were rescinded after he tested negative.
Credit…Edgar Su/Reuters

An 83-year-old passenger who initially tested positive for Covid-19 on a “cruise to nowhere” from Singapore this week, forcing thousands of passengers and crew members to return to port a day early, did not have the virus after all, officials said on Thursday.

The passenger, who had diarrhea aboard the ship Quantum of the Seas and had taken a mandatory Covid-19 test, has since tested negative several times, Singapore’s Ministry of Health said in a statement.

“The sample taken from the individual this morning came back negative for the virus,” officials said on Thursday. It was the third negative test after two on Wednesday also came back negative.

Quarantine orders for the man’s close contacts and other passengers aboard the ship were then rescinded, the ministry said.

Singapore’s Tourism Board said that contact tracing began immediately after the man’s positive test and that all leisure activities on board were canceled. The ship’s captain had also ordered guests to remain in their cabins during the investigation.

Quantum of the Seas, which is owned by Royal Caribbean, returned to the Marina Bay Cruise Center in Singapore at 8 a.m. Wednesday. All remaining passengers and crew members were required to undergo mandatory testing upon disembarking, the tourism board said.

The board also asked that passengers monitor their health for 14 days and to undergo a swab test at a designated government center at the end of the monitoring period.

When the cruise left the city-state on Monday, all 1,680 passengers and 1,148 crew members had tested negative for Covid-19, according to the tourism board.

The incident underscores the uncertainties the global tourism industry, battered by the pandemic, faces as it struggles to restart. The cruise ship is one of two to operate out of Singapore this month while putting in place a long list of safety precautions to reassure passengers.

A New York Times reporter recently took a trip on the other one, the World Dream.

In February, the coronavirus infected more than 200 people board the Diamond Princess cruise ship, trapping its 3,600 passengers and crew. Governments later banned cruises, crews were sent home, and passengers canceled their bookings. But countries like Singapore, Japan and several in Europe have since allowed cruises to restart under the watchful eye of officials.

A market in Seoul, South Korea, on Tuesday. Health officials warned that ​the number of coronavirus cases could rise to record highs in coming days.
Credit…Kim Hong-Ji/Reuters

SEOUL, South Korea — For most of the year, South Korea has kept its coronavirus numbers so low it was the envy of the world. Now, the country is grappling with the most elusive wave of infections it has seen, just as other nations prepare to roll out vaccinations.

South Korea’s daily number of new cases was once as low as two per day. That number soared to​ 682 on Thursday, with health officials warning it could reach record highs in coming days. On Wednesday​, 686 new cases were reported, the highest daily count since Feb. 29.

“We must exert all we can, considering this our last hurdle to clear ​in our efforts to curb the coronavirus before vaccines and treatments come online,” President Moon Jae-in said this week. He has instructed his government to mobilize ​​soldiers​, police officers and civil servants ​to help epidemiologists’ contact-tracing efforts.

The country’s struggle to contain the recent surge is a race against time. Mr. Moon’s government announced this week that it had secured enough doses of coronavirus vaccines from companies like AstraZeneca and Pfizer to inoculate roughly 86 percent of the population, but that the first batch would not arrive until March.

South Korea has been hit by four waves of infections since its first case was reported in January. But the latest is by far the ​hardest to control, health officials said.

Previous waves included mass clusters that health officials were able to target and trace. The current wave spread through numerous small clusters that erupted in nursing homes, hospitals, saunas, bars, restaurants, music halls and factories, most of them in the Seoul metropolitan area, but also in towns farther away.

Daily cases continue to rise despite tightened social-distancing ​guidelines and other measures. Na Seong-woong, a deputy commissioner of the Korea Disease Control and Prevention Agency, warned that the daily caseload could surpass 900 next week.

“We are facing our biggest ever coronavirus crisis because the current wave is neither temporary nor regional, but steady and nationwide,” he said. “We don’t have one central cluster that we can shut down with a focused testing and isolating campaign, but it’s popping up here and there and everywhere through our daily lives.”

The empty Gendarmenmarkt in Berlin Mitte which would normally be filled with people who come to the Christmas market.
Credit…Lena Mucha for The New York Times

No groups of friends gripping mugs of steaming red wine spiced with cinnamon and cloves crowding Rothenburg’s medieval market square, or beneath Cologne’s towering cathedral. No brass brands playing carols before Berlin’s Charlottenburg Palace. No stars shining from the eaves of Seiffen’s wooden huts.

And in Nuremberg, the magical figure known as the Christkind did not spread her golden wings and welcome the world to the annual Christmas market.

Germany this December doesn’t feel right.

The coronavirus is muting Christmas celebrations around the world. But the absence of seasonal merriment and public cheer is particularly palpable, and painful, in Germany’s marketplaces and squares, largely devoid of their beloved Christmas markets because of the pandemic.

“When you walk through the streets of Munich or Nuremberg these days, without the bright lights and good cheer, without the smell of hot mulled wine — I just miss all of that,” said Oliver Pötzsch, 50, an author whose novels draw from his Bavarian family’s history.

Germans have gathered at outdoor markets in the weeks before Christmas since the 14th century, when vendors first built their stands in city centers to sell their wares to people coming from church services. They offer an array of foods, artisanal gifts and other provisions for the coming celebrations and the long winter months.

But as December drew near and the country’s number of new coronavirus infections remained dangerously high, cities across the country began canceling their markets, despite pledges made earlier in the year to do everything to keep them open.

A young girl with her sick sister in November 1918. An influenza pandemic that began that year overshadowed the holiday season.
Credit…Library of Congress, via Associated Press

The influenza pandemic of 1918-19, in which millions of Americans were sickened and 675,000 died, seemed to roll across the United States in waves, much like the coronavirus today. The winter holidays in 1918 were marked by grievous loss, and came during a relative lull after the deadliest wave, in the fall. Another, smaller surge would peak shortly after New Year’s Day.

But the national conversation around private family gatherings appeared to have been less charged in 1918 than it is today, as many weary from months of restrictions bristle at guidance from health agencies to stay home.

“Hundreds of thousands of people lost loved ones,” said J. Alexander Navarro, a medical historian at the University of Michigan and an editor of the online Influenza Encyclopedia. “But by the time of Thanksgiving, there really wasn’t much debate about whether or not they should get together.”

So they did, often with an empty chair at the table.

At the time, another major event was stealing newspaper headlines: the end of the First World War. Soldiers were returning to their homes, and the Allied victory was a cause for celebration.

“This year we have special and moving cause to be grateful and to rejoice,” President Woodrow Wilson said in a Thanksgiving proclamation, which did not mention the pandemic. “God has in His good pleasure given us peace.”

For many Americans in 1918, church services were a part of the holiday season, and one woman, Caroline Schumacher, was sad to miss them: “I suppose you’ve seen that the town is quarantined,” she said in a letter from Carroll, Iowa, dated Dec. 29 that was saved by her great-granddaughter. “Don’t know how long it will be closed yet. It is terrible when there is no church. It didn’t seem like Christmas at all.”

A medical assistant cleaning her hands at Hope Clinic in Providence, Rhode Island in November.
Credit…Elizabeth Frantz for The New York Times

Rhode Island, the smallest U.S. state in area, now has the fastest spread of coronavirus, with more new cases per capita being reported than any other state, according to a New York Times database.

While infection rates have climbed throughout the Northeast in recent weeks, Rhode Island has gotten much worse much faster than its neighbors. Over the past week, it has averaged more than 1,300 new cases a day, or 123.5 cases for every 100,000 people.

By contrast, Connecticut is averaging 78.2 cases for every 100,000, and Massachusetts 71. Midwestern states like South Dakota and Minnesota that had the worst spread in the nation a few weeks ago have fallen down into the 90s by this measure.

The state moved aggressively in the spring to try to keep the virus out, establishing quarantine rules and setting up checkpoints on major highways to stem the flow of refugees from hard-hit New York. Its case counts stayed relatively low for most of the summer. But after Labor Day and the start of the school year, infection numbers began climbing steadily, and have not slowed since.

Gov. Gina Raimondo has imposed a two-week “pause” on the economy, and with health care workers in short supply, the state Department of Health has begun issuing temporary licenses to doctors, nurses and others who have retired, are visiting the state or have recently completing training programs.

“We need you,” the governor implored on Twitter.

Experts attribute some of Rhode Island’s relative vulnerability to its compact size and the concentration of its population in Providence, the capital. In contrast, next-door Massachusetts has large rural areas where case rates are low, but in Rhode Island an outbreak is likely to spread quickly through densely packed urban households. Studies indicate that as many as half of Covid-19 cases arise through transmission from one member of a household to another.

“One of the things Rhode Island suffers from in the context of Covid is that it’s not a very big state in terms of its footprint,’’ said Samuel Scarpino, an assistant professor at the Network Science Institute at Northeastern University. “It’s as though Massachusetts was getting reported on in terms of only what’s happening in Boston.’’

On surveys that measure social distancing and masking, Rhode Island is about even with Massachusetts and other states in the Northeast, Dr. Scarpino said. But the nationwide mobility data that his laboratory tracks shows that people in Rhode Island, like those elsewhere, have been leaving home to go to work this month and last at a rate of about 60 percent of what was once normal, compared to only 40 percent in early September. Rhode Island also ranked above the U.S. average in mobility over the Thanksgiving holiday.

“All of those things contribute to more cases getting into households,’’ Dr. Scarpino said.

Other factors that might be contributing to the heavy Rhode Island caseload, Megan L. Ranney, an emergency room physician and associate professor at Brown University suggested on Twitter, include a large population of college students whose return in the fall seeded some transmission chains and — in a pandemic that has disproportionately affected low-income workers who cannot afford to stay home — the state’s high poverty rate compared with others in the region. Like some other states, Rhode Island only imposed new restrictions on restaurants, bars and gyms after case counts had begun to surge.

“At the end of the day, regardless of the reason,’’ Dr. Ranney tweeted, “our hospitals are overwhelmed & everyone knows someone who’s sick.”

Dr. Vivek H. Murthy advised the N.C.A.A. Board of Governors in the early days of the coronavirus pandemic.
Credit…Hilary Swift for The New York Times

President-elect Joseph R. Biden Jr.’s choice for surgeon general, Dr. Vivek H. Murthy, had a central role in the National Collegiate Athletic Association’s decision in March to cancel this year’s national basketball tournaments — one of the earliest and most culturally significant signs that the virus would upend ordinary life in America.

The work of Dr. Murthy, a member of the association’s powerful Board of Governors who was surgeon general during part of the Obama administration, offers a view into how he approached the pandemic’s initial threat in the United States, and how he might help shape the federal government’s response under Mr. Biden.

A newcomer to the insular world of college athletics, Dr. Murthy proved a cautious, deliberate expert who was wary of making drastic decisions prematurely, interviews with more than a dozen people who participated in the N.C.A.A.’s meetings suggest. But they said that as the tournaments approached and more data and scientific research emerged, Dr. Murthy was a forceful and effective champion of measures that had been unthinkable to most of society only days or weeks earlier.

Indeed, it was Dr. Murthy who urgently told board members that they risked fueling a deadly crisis if they allowed the tournaments to proceed as scheduled.

“He was instrumental in convincing the board that the time to act was now,” said Kenneth I. Chenault, a former chairman of American Express who sits on the N.C.A.A. board.

But board members like Mr. Chenault said that it was plain that Dr. Murthy understood the cultural and financial repercussions of a decision like canceling the basketball tournaments, which generate hundreds of millions of dollars.

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