A vaccination in Atlanta.
Credit…Nicole Craine for The New York Times

That Covid-19 vaccine appointment may not just be hard to get — it may not even be all that secure.

Thousands of people across the country learned that their appointments had been abruptly canceled in the last few days, after vaccine shipments to local health departments and other distributors fell short of what was expected.

The health department in Erie County, N.Y., which includes Buffalo, canceled seven days of appointments this week, affecting 8,010 people, saying the state had sent far fewer doses than the county ordered. All future appointments should be considered “tentative, and are subject to vaccine availability,” the department said in a statement on Wednesday.

“We made appointments based on our hope and expectation that we would be able to fill those,” said Kara Kane, a department spokesperson. “There’s a lot of confusion, a lot of questions, a lot of concern.”

Dianne Bennett, 78, lost her first-dose appointment at the Erie County Medical Center because of the cancellations, and so did her husband. They were told to try again later, but Ms. Bennett said they had no idea when another appointment will be available.

“It’s such a lottery,” she said. “I just think it’s outrageous.”

Similar issues have cropped up across the country, as demand far outpaces supply and vaccine providers struggle to predict how many doses will actually arrive.

At Beaufort Memorial Hospital in South Carolina, hospital officials canceled 6,000 scheduled appointments through March 30 after they were notified that thousands of vaccine doses they expected were not coming.

San Francisco’s public health department expects to run out of vaccine on Thursday, The Los Angeles Times reported, because the city’s allocation dropped sharply from a week ago and the state did not replace doses that had to be discarded.

Local health officials throughout California say they have trouble scheduling appointments because they are unsure how much vaccine they will receive from week to week, the paper said.

In New York City, 23,000 vaccination appointments scheduled for Thursday and Friday were postponed because of a shipping delay, Mayor Bill de Blasio said Wednesday, a day after warning that the city’s supply would soon be exhausted.

“We already were feeling the stress of a shortage of vaccine,” the mayor said at a news conference. “Now the situation has been made even worse.”

Recent moves to open up eligibility have aggravated the situation.

After the state of Georgia announced that anyone 65 or older could get the vaccine, the 10-county Northwest Health District was swamped with more than 10,000 appointment requests in one weekend — far more than it could satisfy with the supply it had on hand. So it shut down its scheduling website, and told people to call their local health department to arrange an appointment instead, frustrating many people who thought they had already secured a slot.

“We’re having to schedule appointments at least a week out, based on anticipated delivery, but we don’t know what will show up on a daily basis,” said Logan Boss, the spokesman for the health district. “It’s difficult to explain that to the public.”

President Biden signing executive orders in his first minutes in the Oval Office on Wednesday.
Credit…Doug Mills/The New York Times

Within hours of his inauguration on Wednesday, President Biden signed 17 executive orders, memorandums and proclamations, five of which were aimed at helping the country bring the pandemic to heel.

In an effort to strengthen the nation’s response to the pandemic, which as of this week, has claimed more than 400,000 lives, Mr. Biden signed an executive order appointing Jeffrey D. Zients the official Covid-19 response coordinator, reporting to the president. Mr. Zients was the co-chairman of the Biden transition team, and led the National Economic Council under President Barack Obama.

That order also restores the National Security Council’s Directorate for Global Health Security and Biodefense, a group disbanded under then-President Trump in 2018.

Though Mr. Biden has not ordered a national mask mandate, which would probably become entangled in legal challenges, he is requiring social distancing and the wearing of masks by federal employees, contractors and others on federal property. He is also starting a “100 days masking challenge” urging all Americans to wear masks and state and local officials to implement public measures to prevent the spread of the coronavirus.

Mr. Biden is also reinstating ties with the World Health Organization after the Trump administration withdrew the nation’s membership and funding last year. Dr. Anthony S. Fauci will be the head of the U.S. delegation to the organization’s executive board and begin his role with a meeting this week.

Mr. Biden also took action to help Americans who are struggling economically as a result of the pandemic.

He is moving to extend a federal moratorium on evictions and has asked agencies, including the departments of Agriculture, Veterans Affairs and Housing and Urban Development, to prolong a moratorium on foreclosures on federally guaranteed mortgages that was enacted in response to the coronavirus pandemic. The extensions all run through at least the end of March.

The president is also moving to continue a pause of interest and principal payments on federal student loans through the end of September, although progressive groups and some congressional Democrats have pushed Mr. Biden to go much further and cancel up to $50,000 in student debt per person.

Laura Lima watching the inauguration at Martin Luther King Jr. Community Hospital in South Los Angeles.
Credit…Isadora Kosofsky for The New York Times

There is no shortage of screens in the intensive-care units treating Covid patients across America, but at one I.C.U. in Los Angeles on Wednesday, some of the screens showed not blood pressure and oxygen levels but images of the 46th president of the United States being sworn in.

“I just wanted to see and listen,” said Laura Lima, a nurse watching the inauguration on an iPhone propped on her work station. “It’s important stuff.”

Ms. Lima works at Martin Luther King, Jr. Community Hospital in South Los Angeles, and as she watched President Biden address the nation, a monitor beeped. She put on an isolation gown and gloves and entered the room of one of her patients, a man in his early 60s on a ventilator whose intravenous line needed to be adjusted.

Ms. Lima took note of the new president’s statements about hastening the rollout of vaccines.

“I think this community should be prioritized,” she said.

The neighborhood around the hospital, filled with low-income workers who often have poor access to health care, has been one of the hardest hit in Southern California’s surge.

Mario Torres Hernandez, a 63-year-old patient being treated with oxygen for Covid-19, had his television tuned to Telemundo during Mr. Biden’s visit to Arlington cemetery. “I hope he does more for us,” he said.

But it was another busy day at the I.C.U., and so the vast majority of its staff members were not watching the proceedings in Washington. One respiratory therapist said he had forgotten the inauguration was happening.

Some did think it was a day of hope.

“I’m so tired of zipping black body bags,” another I.C.U. nurse, Amanda Hamilton, said as the ceremony continued. “It’s exciting we have a president who actually cares and might do something about it.”

President Biden speaking on the livestreamed Celebrating America Primetime Special on Wednesday.
Credit…Biden Inaugural Committee via Getty Images

Like many other once-in-a-lifetime celebrations since the coronavirus pandemic began, President Biden’s inauguration didn’t have the traditional in-person fanfare, but it did bring evening festivities to viewers through a wide-ranging livestreamed program Wednesday night.

In a nod to the coronavirus pandemic and the new administration’s effort to model the public health behaviors it hopes Americans will adopt, President Biden’s inauguration did not feature the grand galas or star-studded balls that usually happen across Washington.

But presidential inaugurations are cultural touchstones, and are moments to engage millions of eyeballs on television and online. So the Presidential Inaugural Committee arranged a 90-minute musical celebration to mark the day — one that has the benefit of demonstrating Mr. Biden’s support from a wide array of A-list performers, something former President Donald J. Trump longed for but never received.

Credit…Biden Inauguaral Committee, via Associated Press

The special was carried live by the major networks and most cable news stations and featured a lineup including Katy Perry, Lin-Manuel Miranda, Jon Bon Jovi, Ant Clemons, the Foo Fighters, John Legend, Demi Lovato, Bruce Springsteen and Justin Timberlake, many of whom had campaigned for Mr. Biden and, in the past, for former President Barack Obama.

To open the program, Mr. Springsteen greeted Americans and said he was “proud” to be in Washington. Then he began to perform “Land of Hope and Dreams,” which he offered as “a small prayer for our country.”

Doses of the Moderna vaccine, which must be kept cold, had to be discarded in Ohio after SpecialtyRX found that it had not properly monitored or recorded storage temperatures.
Credit…Jae C. Hong/Associated Press

A pharmacy services company responsible for vaccinating residents at eight Ohio nursing homes allowed 890 doses of the Moderna vaccine — more than half its supply — to become spoiled by failing to make sure they were kept cold enough, state officials said.

The episode is being investigated by the Ohio State Board of Pharmacy, and the state Department of Health has cut the company off from any more allocations of vaccine.

Before the new year, the company, SpecialtyRX, was given 1,500 doses to vaccinate residents at the eight facilities. After administering a first round of shots, the company found that it had not properly monitored or recorded the temperatures in its refrigerators and freezers where the remaining doses were stored.

State investigators determined that the 890 stored doses were no longer viable, the Department of Health said in a statement. The nursing home residents are still awaiting their second shots, and the facilities will have to arrange with another provider to obtain them.

The Moderna vaccine can be stored for up to 30 days if it is kept between 36 and 46 degrees Fahrenheit. Officials with SpecialtyRX could not be immediately reached for comment.

Like many other states, Ohio has gotten off to a slow start with its vaccination program. About 456,100 Ohioans — less than 4 percent of the population — had received first doses as of Wednesday, according to The Cincinnati Enquirer.

Gov. Mike DeWine said at a news conference on Tuesday that most of the state’s frontline health care workers and nursing-home residents had received a dose. “We are trying to juggle a lot of things and do a lot of things with not enough vaccines,” Mr. DeWine said.

The state plans to open up eligibility next week to all residents 75 years and older, as well as to younger people who suffer from certain severe illnesses and disorders.

The number of new cases reported in Ohio has been declining over the past week, but death reports have remained high after jumping upward after Christmas.

A memorial in Lima for health care workers who died from Covid-19.
Credit…Rodrigo Abd/Associated Press

Leaders of a doctors’ union in Peru went on a hunger strike Tuesday to protest what they called the national authorities’ “shameless lack of preparation” for a second wave of coronavirus infections that has quickly overwhelmed the country’s hospitals, with reports of patients dying for lack of available ventilators.

As countries across Latin America gird themselves for a new round with the virus, the Peruvian union, made up of 12,000 doctors in the state-run EsSalud health care network, said that public hospitals were faced with the same problems that stymied their efforts early in the pandemic.

Once again, they are said, they are being asked to face a surge of Covid-19 patients without sufficient personal protective equipment, medical supplies or support staff. The union called for the chief executive of EsSalud, Fiorella Molinelli, who is under investigation for corruption, to be replaced.

Teodoro Quiñones, the secretary general of the union, said that instead of hiring more medical workers during the relative calm after the first wave of infections, EsSalud dismissed Covid specialists, and failed to hire them back when case counts started climbing in December. Now, he said, many hospitals lack both the ventilators that patients need and the staff to intubate the patients.

“We’re working with a deficit of 6,000 specialist doctors, at least 1,500 intensive-care physicians, and 6,000 to 8,000 intensive-care nurses,” Dr. Quiñones said.

Dr. Quiñones began the hunger strike along with a half-dozen other union leaders at a demonstration on Tuesday outside the labor ministry in Lima, the capital. The strikers said they would refuse to eat until their demands were met.

EsSalud did not immediately respond to a request for comment.

Peru is not the only South American country to be battered by the second wave.

The virus took a heavy toll on the region from May to August, and now coronavirus cases are surging once again in many countries, leading to widespread concern.

In Colombia, new cases have climbed to about 15,000 a day, twice the pre-Christmas number, and intensive care units are at or near 100 percent capacity. And widespread vaccination appears to be many months away in Colombia.

But Bogotá, the capital, like other major cities across South America, has not returned to a full lockdown, instead opting for a more flexible quarantine, with only some neighborhoods shuttered, and an 8 p.m. curfew in place.

In Brazil, health officials this week launched a nationwide vaccination campaign — but the rollout is expected to be painfully slow. The government is scrambling to buy more vaccine after months of taking a lackadaisical approach, as President Jair Bolsonaro argued that scientists and the media were hyping the seriousness of a virus that has killed more than 210,000 Brazilians.

Many doctors in Peru say the second wave of infections appears to be hitting the country as hard or harder than the first wave, when the country recorded one of the highest death tolls in the world relative to its population. Hospitals are overflowing, and intensive-care beds are scarce.

“In my hospital, for example, we have 20 patients on a waiting list and only have 11 I.C.U. beds,” said Dr. Manuel Vásquez, an EsSalud doctor from the Ica region who joined the protest in Lima. “You hear of the same phenomena in every hospital.”

The country’s interim president, Francisco Sagasti, acknowledged the new wave last week, but he said he would not impose a new lockdown except as “an extreme option,” because of the impact on employment.

Peru lags far behind its peers in securing vaccines for its population of 32 million. It announced a deal for one million doses from the Chinese company Sinopharm, but it does not yet have a delivery date.

Some officials expressed hope that antibodies carried by the large number of people who were infected in the first wave — nearly 40 percent of the population in Lima and up to 70 percent in some other cities, according to the government — might help contain a second surge. But the virus is spreading fast now, Dr. Vasquez said, and the patients needing hospitalization tend to be younger and in worse condition than before.

“And this is just the beginning,” he said.

A market in Baghdad this week.
Credit…Ivor Prickett for The New York Times

In the upscale shisha lounge in a new Baghdad restaurant, customers puffing on fragrant fruit-scented tobacco sit at gold-rimmed tables flanked by a giant video screen and views of the Tigris River. It’s a weekday night but the Dawa restaurant’s Sky Lounge is crowded with people partying like it’s 2019: no masks, no distancing, no problem.

“As Iraqis we don’t have a fear of death. It’s a psychological factor that can strengthen a human being’s immunity,” said Ali al-Khateeb, 37, a businessman, as he pulled smoke from a gold-embossed glass water pipe.

His friend Rami Riadh, 34, another businessman, said he threw away his mask at the airport when he returned from Jordan a week before.

As infection rates have fallen, Iraqis are flouting the recommended precautions, with many subscribing to a dubious belief in their own immunity an idea that has been publicly endorsed by some health officials and religious leaders.

“We have reached a type of herd immunity,” a senior health official, Dr. Jasib al-Hijami, wrote last month on Facebook. This week he said he stood by those comments.

Herd immunity offers a virus fewer potential hosts and provides some resistance to an outbreak. It is generally believed to occur when 70 percent or more of a population has been infected or vaccinated.

The misconceptions Iraqis have embraced, and the resulting disregard for safety measures, even as more contagious variants are coursing around the globe, may lead to a major outbreak, public health experts fear.

Iraq’s reported daily infection rate has been steadily falling, from more than 3,000 new cases in November to fewer than 800 in January. That decline has contributed to what experts call a false sense of security.

Ali Mokdad, director of Middle East Initiatives at the University of Washington’s Institute of Health Metrics and Evaluation, said lower infection rates can be explained in part by Iraq’s temperate winter, in which windows are kept open. The relatively young population could be the reason for fewer deaths and hospitalizations.

Other experts suspect that the real number is likely to be double to triple the reported rate. But as the official number has fallen, Iraqi officials have eased restrictions. At the height of the pandemic last year, Iraq locked down as its decrepit health care system struggled. Restrictions were loosened last fall as infection rates dropped.

Now the government is waging a losing battle to persuade Iraqis to wear masks and to stop shaking hands and kissing cheeks, the common same-sex greeting in Iraq.

The campaign has been undermined by local and provincial health officials who claim Iraq has achieved herd immunity.

But public health experts doubt that. Dr. Mokdad says the best estimate is that about 20 percent of the population has been infected.

At mosques, some worshipers are being told they should not fear the virus as long as they follow God.

Even Iraq’s health minister, Dr. Hassan al-Tamimi, neither endorsed nor rebutted the notion of herd immunity. He credited the fall in mortality rates to an increased ability to treat Covid-19 and the decline in infections to divine protection.

“The main factor is the mercy of God,” Dr. al-Tamimi said.

Iraq, with 40 million people, is ill-prepared for a second wave.

It has reserved 1.5 million doses of the Pfizer vaccine and expects to begin administering it in March. But Dr. Riyadh Lafta, an epidemiology professor at Al Mustansiriyah University in Baghdad and other experts said they doubted enough Iraqis would agree to be vaccinated for the campaign to succeed.

Jane Arraf, Falih Hassan and

The crowds and celebrations that normally attend an inauguration were nowhere to be seen on Wednesday.
Credit…Chang W. Lee/The New York Times

As cases of the coronavirus surged across the United States, officials organizing Joseph R. Biden Jr.’s presidential inauguration were forced to favor smaller audiences and virtual celebrations — and, in some cases, to cancel events altogether.

In an ordinary inauguration year, the Joint Congressional Committee on Inaugural Ceremonies would distribute some 200,000 tickets to official events at the Capitol, while public attendance in Washington might easily outstrip one million. The day would feature luncheons and parades, and conclude with balls and galas, held indoors.

But this inauguration was a far more sober affair, with extremely limited attendance.

While plans for some events continued almost as normal, including Mr. Biden’s address from the West Front of the Capitol, others were reimagined or axed entirely. A luncheon honoring the incoming president, held since the 1950s in the National Statuary Hall at the Capitol, was canceled in December over health and safety concerns, according to a Bloomberg report.

The Presidential Inauguration Committee asked the public not to gather for the ceremony. For 90 minutes on Monday, a section of the National Mall was flooded with 56 “pillars of light” and close to 200,000 flags in an art display representing those who had been unable to attend.

Tickets went only to certain high-ranking officials and members of Congress, who were each allowed to bring one guest, for a live audience of about 1,000, according to the committee.

Many lawmakers and high-profile guests were in attendance, including three former presidents, Barack Obama, George W. Bush and Bill Clinton; the 2016 Democratic presidential nominee, former Secretary of State Hillary Clinton; the top two Democrats in Congress, Senator Chuck Schumer and Speaker Nancy Pelosi; Senator Joe Manchin III of West Virginia, a centrist Democrat who is likely to be the deciding vote on many of the new administration’s priorities; and Senators Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts, two of Mr. Biden’s rivals for the Democratic nomination in 2020.

It appeared that everyone at the event — from the former residents of the White House to the Supreme Court justices, the lawmakers, guards and guests — wore masks, except when at the lectern. After taking his oath, Mr. Biden beseeched Americans to work with him to find a way out of the pandemic, and he explicitly acknowledged the devastating toll of the coronavirus in a way his predecessor never did.

“We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation,” Mr. Biden said. “We will get through this together.”

The new president then led a moment of silent prayer to remember the more than 400,000 Americans who have died after contracting the virus.

After the swearing-in, the Bidens set out for Arlington National Cemetery, where they laid a wreath at the Tomb of the Unknowns at Arlington National Cemetery with the Bushes, the Clintons and the Obamas. The Bidens were then escorted to the White House.

The traditional scramble to move the president-elect and his family into the White House was complicated by health and safety measures, with additional deep-cleaning precautions.

Early Wednesday morning, President Trump and his wife, Melania Trump, left the White House after previously declining to attend the inauguration. Neither was seen to wear a mask as they boarded a helicopter on the White House lawn, or during a farewell event the president held at Joint Base Andrews in Maryland, or after they flew to Florida on Air Force One.

In Mr. Trump’s remarks at the base, he claimed that virus cases were “skyrocketing downward.” According to a New York Times database, over the past week the nation has averaged 201,117 newly reported cases a day, about 11 percent fewer than the average two weeks earlier.

Still, the United States continues to lead the world in confirmed virus cases and deaths, surpassing 24 million total cases on Monday, and 400,000 total virus deaths on Tuesday. The Centers for Disease Control and Prevention has warned that a highly contagious variant of the virus, first identified in Britain, may soon accelerate the spread of the virus in the United States.

Mr. Biden is expected to sign a flurry of executive orders, memorandums and proclamations from the Oval Office on Wednesday afternoon, including several measures aimed at tackling the virus.

They will include an executive order making Jeff Zients the government’s official Covid-19 response coordinator, reporting to the president. The order will also restore the directorate for global health security and biodefense at the National Security Council, a group that Mr. Trump had disbanded.

Mr. Biden will also sign an executive order that Mr. Trump had steadfastly refused to issue during his tenure — imposing a national mandate requiring masks and physical distancing in all federal buildings, on all federal lands and by all federal employees, officials said.

And he will terminate Mr. Trump’s efforts to leave the World Health Organization, sending Dr. Anthony S. Fauci, the nation’s top infectious disease specialist, to participate in the group’s annual executive board meeting on Thursday.

Experts from China and the World Health Organization at hospital in Wuhan last week.
Credit…China Daily/Reuters

Seeking to unify the global response to the coronavirus, President Biden on his first day in office retracted a decision by the Trump administration to withdraw from the World Health Organization.

The Biden administration announced that Dr. Anthony S. Fauci, the nation’s top infectious disease expert, would be the head of the U.S. delegation to the W.H.O.’s executive board. Dr. Fauci will begin that role with a meeting this week.

In May, President Donald Trump announced that the United States would leave the organization. He had spent weeks accusing it of helping the Chinese government cover up the extent of the coronavirus in China.

The decision by a president who had already put the world on notice that he did not feel bound by longstanding U.S. commitments alarmed public health experts. And on Wednesday, his successor made clear that he views the organization as an ally — not an adversary.

“The W.H.O. plays a crucial role in the world’s fight against the deadly Covid-19 pandemic as well as countless other threats to global health and health security,” Mr. Biden said in a letter to António Guterres, the secretary-general of the United Nations. “The United States will continue to be a full participant and a global leader in confronting such threats and advancing global health and health security.”

In late May, shortly before declaring it was done with the W.H.O., the Trump administration made seven demands on the organization. Dr. Tedros Adhanom Ghebreyesus, the chief of the W.H.O., stood fast.

Just last week, experts from the W.H.O. arrived in the Chinese city of Wuhan, where the outbreak began a little more than a year ago. They plan to investigate how the virus jumped from animals to humans.

The investigators have already been met with challenges by the Chinese government, which has been wary of outside scrutiny and had repeatedly impeded the arrival of the team.

A shortage of vaccine doses has forced the city to postpone 23,000 appointments for new vaccinations for Thursday and Friday.
Credit…Brendan Mcdermid/Reuters

The limited supply of available doses continued to stymie New York’s Covid-19 vaccination efforts, with Gov. Andrew M. Cuomo saying the state was poised to temporarily run out of vaccine in the next few days while New York City officials postponed 23,000 vaccinations scheduled for the end of this week because of a shipping delay.

Despite a recent surge in coronavirus cases, Mr. Cuomo said that at the rate New York was receiving vaccine doses, it would take up to eight months for the state to vaccinate even the narrow bands of people currently eligible — including doctors, police officers and people over 65 — let alone the general public.

While Mr. Cuomo said he expected more vaccine next week, he said the state had 145,780 doses remaining and was administering about 65,000 a day. Among the more than 6 million eligible people who have not yet received a shot, 21 percent are health care workers; 27 percent are essential workers like doctors, firefighters or teachers; and 52 percent are people over 65.

He said the state was trying to distribute doses proportionally to each of those groups, but that supply was limited.

“What’s clear now is we’re going to be going from week to week,” he said. “You will see a constant pattern of basically running out, waiting for the next week’s allocation and then start it up again. We’re trying to smooth it out, but we’re also trying to get it out as fast as possible.”

The logistical challenges were apparent in New York City, where 23,000 vaccination appointments scheduled for Thursday and Friday were postponed because of a shipping delay, Mayor Bill de Blasio said Wednesday, a day after warning that the supply would soon be exhausted.

“We already were feeling the stress of a shortage of vaccine,” the mayor said at a news conference. “Now the situation has been made even worse.”

More than 100,000 doses of the Moderna vaccine that the city had expected to receive on Tuesday are now arriving on Wednesday and Thursday, Dr. Dave Chokshi, the city’s health commissioner, said at the news conference.

The appointments being postponed by the delay are all for people receiving the first of the vaccine’s two required doses, and will be rescheduled for next week, Dr. Chokshi said.

The city government would concentrate on the hardest-hit communities, the mayor said, announcing a goal to inoculate 50,000 public housing residents over 65 in the next few weeks, assuming the city can get more doses from the federal government.

Mr. de Blasio said he had faith that President Biden’s administration would step up vaccine production enough to make second doses available for the expanded pool of eligible people. Production of the Moderna and Pfizer vaccines authorized in the U.S. are running flat out, and it is not clear whether the administration could significantly expand the overall supply any time soon.

Though Mr. Biden has indicated his administration would release more doses as they became available and keep fewer in reserve, he said on Friday that he would not change the recommended timing for second doses: 21 days after the first dose for Pfizer’s vaccine, and 28 days for Moderna’s.

“We believe it’s critical that everyone should get two doses within the F.D.A.-recommended time frame,” Mr. Biden said while discussing his vaccine distribution plans.

New York City expects to have 140,000 first doses and 250,000 second doses on hand for use this week, Dr. Chokshi said on Wednesday. “We are going to very rapidly work through that supply.”

Despite the delivery delay, Mr. de Blasio said on Wednesday that New York City expected to have, by the end of the day, administered a total of 500,000 doses since it began doing so.

Mr. Cuomo said 1,032,291 doses had been administered statewide. Almost 90 percent of those were the first of the two required doses.

There were 9,273 hospitalizations in the state, more than double the number at the beginning of December. But despite the continued spread of the virus, the logistical challenges, and the threat of a new, more contagious variant of the virus spreading across the state, Mr. Cuomo said the seven-day average rate of positive test results appeared to be falling after the holiday surge.

As of Tuesday, that positivity rate was down to 6.3 percent, after it had risen to 7.9 percent in early January, according to data from the state.

“Overall the positivity rate has been dropping, and it’s been dropping across the state, and that is good news,” he said.

Coronavirus testing in Austin on Monday, when new cases in Texas were averaging over 20,000 a day.
Credit…Tamir Kalifa for The New York Times

The persistently rapid spread of the coronavirus in Texas, the second most populous state in the U.S., is threatening the gradual progress the country has been making toward flattening the curve of new cases.

Counties along the Mexican border in particular have seen steep spikes. The city of Laredo sent residents an emergency cellphone alert over the weekend — the second in three days — warning that local hospitals were near capacity.

“Our medical professionals and hospitals are overwhelmed with the surge in Covid-19 cases,” the message read. “The current situation is at its most critical level, and lives are at stake. We are asking you to stay home unless it is absolutely necessary.”

New cases in Texas were averaging more than 20,000 a day on Monday. The state has seen a steady increase in new cases since October, when there were approximately 4,000 a day on average, according to a New York Times database.

Since the start of the pandemic, Texas has reported more than 2.1 million cases, the second highest total in the country after California, which in recent weeks has been in the throes of a devastating flood of cases that has pushed hospitals to the brink.

Federal health officials have acknowledged that the vaccine rollout has had a slower-than-expected start. In the United States, about 14.3 million people have received at least one dose of a Covid-19 vaccine, and about 2.2 million people had been fully vaccinated, according to data reported on Wednesday by the federal Centers for Disease Control and Prevention. Federal officials had set a goal of giving at least 20 million people their first dose by the end of 2020.

The United States as a whole has been averaging more than 200,000 new virus cases a day since Jan. 2, with California and Texas fueling that surge. Arizona, Oklahoma and South Carolina have been swept by high numbers of cases for days, and New York now has the country’s fourth worst outbreak, though deaths per day in the state have not come close to the tragic levels seen in the spring.

On Monday, Texas reported 111 deaths, bringing the total number of people lost to the virus in the state to more than 32,000 — a sizable portion of the more than 400,000 total deaths reported in the United States.

For more than a month, Laredo has had 35 to 40 percent of its hospital beds filled with Covid-19 patients, a higher ratio than anywhere else in the state, a city spokeswoman said. On Tuesday, she added, the figure was nearing 50 percent.

In Del Rio, another border town, Dr. Laura Palau of the Val Verde County Health Authority said officials were still seeing cases emerge from maskless family gatherings and parties over the holidays. An alarming 30 percent of coronavirus tests performed in the city are coming back positive, she said. The sheriff’s office is issuing quarantine orders to people who test positive.

Dr. Palau said she was worried about the way deaths are rising.

“The people that were hospitalized in December or early January are starting to expire,” she said.

Texas has received more than 1.7 million doses of the coronavirus vaccine, and administered 1.3 million, Gov. Greg Abbott said on Tuesday. More than 800,000 more doses were expected this week, he said.

But Clay Jenkins, the top elected official in Dallas County, warned that a new, more transmissible variant of the virus, which is circulating in the United States after forcing Britain to lock down again, could make any progress in taming the pandemic fleeting.

“January and February will be our toughest months here in North Texas,” he said. “Right now, we just need everyone to avoid crowds, wear their mask, forgo get-togethers. Really think about ways to make patriotic sacrifices to protect the community.”

David Montgomery contributed reporting.

A passenger receives a temperature check at LaGuardia Airport in New York. Eastern Iowa Airport will screen all outgoing passengers for the coronavirus.
Credit…Victor J. Blue for The New York Times

The airport in Cedar Rapids, Iowa, will conduct mandatory coronavirus screenings for all outbound passengers starting on Monday, one of the first airports in the country to take advantage of a decision to allow such evaluations by the Federal Aviation Administration last month.

Under the new “Travel Well” program, the Eastern Iowa Airport will ask a handful of short screening questions and take the temperature of each departing passenger. Travelers who show no signs of having the coronavirus and have no exposure to it will be sent on to the Transportation Security Administration checkpoint.

“The Travel Well program will provide an efficient approach to screening passengers and employees,” Marty Lenss, the airport’s director, said in a statement.

Travelers who might be infected with or exposed to the virus will receive a private second screening. The ultimate decision on whether individuals may board their flight will rest with individual airlines. Eastern Iowa Airport offers nonstop service to 14 destinations on flights operated by American Airlines, Delta Air Lines, United Airlines and others.

It is not clear how useful the screenings will be. The value of screening passengers has diminished as the virus has become widespread throughout the country. A passenger who shows no symptoms on the day of travel could still infect others on their journey or at their destination.

The airport had first talked about its screening plan, which it developed with Mercy Medical Center and MercyCare Business Health Solutions, in July. But the plan’s implementation was put on hold pending approval by the F.A.A., which regulates airport spending. Earlier last year, the agency had said that airports could spend money to screen employees, but not passengers. In December, the agency approved passenger screening, too.

global roundup

Employees at a lab in the Serum Institute of India.
Credit…Francis Mascarenhas/Reuters

India said on Wednesday that it was starting to supply its locally manufactured version of the AstraZeneca vaccine to nearby countries, even as the government continues its mammoth effort to inoculate hundreds of millions of people at home.

The first doses were expected to be delivered to Bangladesh, Bhutan, the Maldives, Myanmar, Nepal and the Seychelles beginning on Wednesday, India’s Foreign Ministry said in a statement.

The vaccine, known as Covishield in India, has been approved for emergency use there. It was developed by AstraZeneca and Oxford University and is manufactured domestically by the Serum Institute of India, the world’s largest vaccine manufacturer.

India’s Foreign Ministry said that the doses sent on Wednesday were being donated. Some of the countries receiving the vaccine also have separate commercial vaccine arrangements, or are in talks, with the Serum Institute.

Bangladesh said that it expected to receive a shipment of two million doses of Covishield on Thursday as “a gift of India,” in addition to 30 million doses that it has ordered from the Serum Institute. Bhutan is expected to receive about 150,000 doses in its initial shipment, and the Maldives 100,000.

India’s other domestically produced vaccine, Covaxin, has faced criticism for being approved for emergency use in the country even before final trials have concluded.

India’s capacity for mass vaccine production will be central to efforts to curb the coronavirus in poor countries. The Serum Institute aims to distribute a billion doses of its coronavirus vaccine by the end of 2021.

In other news from around the world:

  • In China, the authorities in Beijing ordered all kindergartens closed from Thursday and high schools closed from the end of the week, officials said on Wednesday. The capital reported seven new cases on Tuesday and imposed passenger limits on public transportation, the state-run news media reported. Two local cases were of the more transmissible variant found in Britain. New rules also require overseas arrivals in the Chinese capital to quarantine for three weeks, instead of two, and impose testing and quarantine requirements on anyone visiting rural regions of China.

  • Tokyo’s Olympic organizing committee on Wednesday reaffirmed its commitment to hosting the Games this summer, a day after the former deputy chairman of the London 2012 Olympics, Keith Mills, told the BBC that the event was “unlikely” to take place because of the pandemic. Seiko Hashimoto, a Japanese cabinet minister for the Olympics, also said in Parliament on Wednesday that the government would “decide by spring the number of spectators, or foreign spectators, based on the situations both inside and outside of Japan.”

  • The Vatican vaccinated some two dozen homeless people on Wednesday. “Further groups are to follow in the coming days,” said a Vatican spokesman, Matteo Bruni. The shots were part of the Vatican City State vaccination program, and reflect a significant ramping up of the Vatican’s facilities for the homeless under Pope Francis and Cardinal Konrad Krajewski, the head of the Office of Papal Charities, who was himself hospitalized with the virus last month. Francis and Pope Emeritus Benedict XVI got their first vaccine doses last week.

  • The St. Patrick’s Day street parade in Dublin has been canceled for the second year in a row because of the coronavirus pandemic, organizers confirmed on Wednesday, promising a virtual event as a replacement. Festivities to mark St. Patrick’s Day on March 17 in Ireland, Boston and Manhattan were among the first major events to be canceled last year as the coronavirus spread. More than 2,700 people have died from Covid-19 in Ireland, and the country is one of many to have returned to a national lockdown.

The burial of a Covid-19 victim in Manaus, Brazil, last week. The Americas account for close to half of all coronavirus deaths.
Credit…Michael Dantas/Agence France-Presse — Getty Images

GENEVA — The global death toll from Covid-19 hit a record in the last week at the same time as the number of new cases declined, the World Health Organization reported on Wednesday.

The United Nations health agency said 93,000 people died in the week ending Jan. 17, a record and a 9 percent rise over the previous week, bringing the total global death toll from the pandemic to more than 2 million people.

Deaths rose in all of the W.H.O.’s six regional groups, it said in its latest weekly bulletin, but the Americas fared the worst, with a 15 percent rise in deaths in the past week. Led by the United States, where over 400,000 people have died, and Brazil, with more than 200,000 deaths, the Americas account for close to half the total number of people lost to the virus since the start of the pandemic.

Yet the number of new cases dropped slightly in the Americas in the last week and by 6 percent globally. The W.H.O. explained the diverging trends, noting that a high number of cases leads, after a short time lag, to increased hospitalizations and deaths.

Most of the decline in cases occurred in Europe, which registered a drop of 15 percent in the past week, according to the W.H.O. data. New cases dropped last week by 11 percent in the United States and 19 percent in Britain, two of the world’s worst affected countries. Britain is in lockdown, while the United States has a patchwork of state rules.

The decline occurred despite the emergence of new, more contagious variants of the virus. The W.H.O. said new variants had spread to 10 more countries in the past week, bringing the total affected countries to 60 across all regions.

Preparing a dose of coronavirus vaccine in Rome on Monday. On Friday, Pfizer announced a reduction in planned deliveries to E.U. countries this week.
Credit…Angelo Carconi/EPA, via Shutterstock

Italy plans to take legal action against the American drugmaker Pfizer for delays in the delivery of coronavirus vaccines, Domenico Arcuri, Italy’s special commissioner for the pandemic, said in a statement on Tuesday night.

On Friday, Pfizer and its German partner, BioNTech, said they would deliver fewer doses than expected to European Union countries this week because they were changing the production process to increase future supply. They said deliveries would return to the original schedule next week.

Italian officials discussed the situation with company officials on Tuesday.

“The result of today’s dialogue with Pfizer did not have the effect we were hoping for,” Mr. Arcuri wrote, announcing that Italy would press charges, both “civil and criminal, where possible” in coming days.

Mr. Arcuri said that Pfizer would not make up the shortfall in next week’s delivery, which would instead be smaller than previously expected. Italian officials worried that a shortage of doses could dangerously slow the country’s vaccination program, which has reached more than 1.2 million people so far, starting with health care workers and nursing-home residents.

Some regional governors announced that they would pause new vaccinations because of the shortage, and focus on distributing the second dose of the vaccine to people who had already received the first. But they warned that if the delays continued even the distribution of the booster doses would be at risk.

“The health care of Italian citizens is not a negotiable issue,” Mr. Arcuri said in the statement. “The vaccination campaign cannot be slowed down, especially for giving the second doses to the many Italians who already received the first.”

Pfizer did not immediately respond to a request for comment.