Axios Vitals

Inauguration Day is 69 days away, but the coronavirus will not know there's a new president.

• It will simply keep spreading, and killing people, until we stop it. The challenge of stopping it will be President-elect Joe Biden’s first, most urgent order of business. And it will be incredibly difficult.

The big picture: Biden will have to manage an enormously complicated behind-the-scenes response, but his biggest challenge will be to get the public to take advantage of that response.

What we're watching: The Biden administration will be reorienting America's public health apparatus while it's still staffing up and the pandemic continues to get worse.

• More testing would help, as would aid to help people stay home, but what the U.S. needs most of all is to start taking the virus seriously and adopting the measures that control its spread.
• Biden has been clear about his intent to try to lead by example. But in a country where every aspect of the pandemic has already become a partisan flashpoint, and where governors control most of the decisions about what's open or closed, his hands will be tied.

The good news: If the early results from Pfizer's vaccine trial hold, and the rest of the process moves smoothly, the distribution of that vaccine would likely get going early next year and continue to ramp up from there.

• Hopefully, additional vaccines will also yield promising results and could also become available next spring.

It'll ultimately be the government's job to manage that process — and to persuade people to get vaccinated, once they have the opportunity.

• Existing anti-vaccine misinformation, coupled with good-faith questions about such an incredibly fast process, mixed with partisan attitudes toward the virus and the tools to fight it, could make it that much harder to eventually move past this pandemic.

When we say this crisis is going to keep getting worse, here's what that looks like; new infections were up 40% over the past week, and have been rising for months.

• The U.S. is now averaging roughly 119,000 new cases per day — by far the highest daily average of any point in the pandemic.
• Hospitalizations — a measure of severe infection — are at a record 62,000.

What's next: Experts have long believed that winter would be a dangerous time — not because temperature makes much of a biological difference for the virus, but because it spreads more easily indoors.

• More indoor socializing, and holiday travel, will likely cause cases to keep rising.
• Infections are also spreading widely in places where it's still warm, and the last big spike in cases happened over the summer. Winter is not our only problem — it just exacerbates our failure to stop the virus' spread.

The latest: The U.S. recorded 140,000 cases yesterday — another single-day record — as well as 1,421 deaths, according to the COVID Tracking Project.

Share the map.

Coronavirus patients with developmental disorders are the most at risk of dying, followed by those with lung cancer and intellectual disabilities, according to a new analysis by FAIR Health, in collaboration with the West Health Institute and Johns Hopkins' Marty Makary.

Why it matters: Information about who is most at risk for severe coronavirus infections could help determine who should be the first to a vaccine, or scarce treatments, Axios' Caitlin Owens writes.

• Yes, but: "There has always been some hesitancy to treat people with intellectual disabilities and people who are institutionalized as equal in terms of consideration for scarce medical resources," Arthur Caplan, director of medical ethics at the New York University Grossman School of Medicine, told NYT.
• "There will be some balking and battling, on grounds that I would consider discriminatory."

What they found: The overall mortality rate, determined by analyzing the claims of nearly half a million privately insured patients diagnosed with the virus, was -.59%.

• As many other studies have found, men and older patients are at higher risk.
• The vast majority of coronavirus patients who died — 83% — had a pre-existing condition. No children 18 or younger without a pre-existing condition died.

"We knew COVID mortality was skewed toward chronic conditions, but we didn't realized it was skewed this much," Makary said.

The Pfizer vaccine must be stored at temperatures well below freezing, and while large, urban hospitals are rushing to buy expensive ultra-cold freezers to store it, many rural hospitals can't afford them, STAT reports.

The big picture: A review of states' vaccine distribution plans found that many aren't ready to deal with the challenge of delivering the shots, per ProPublica.

• Health officials also must navigate the fact that Pfizer is expected to deliver the shots in boxes holding 1,000 to 5,000 doses.
• Needing to quickly administer this many doses "could rule out sending the vaccine to providers who don’t treat that many people, even doctors' offices in cities," ProPublica reports.
• "It's especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures."

The bottom line: "Early, when we don’t have lots of doses, I frankly do not anticipate that vaccine will be widely available in every rural community," Amanda Cohn, chief medical officer for the CDC's Vaccine Task Force, said during a call on vaccine implementation earlier this month, per ProPublica.

Wisconsin hospitals say they're nearing a "tipping point" after which they may not be able to save everyone who needs saving. (Milwaukee Journal Sentinel)

Pfizer's CEO sold $5.6 million of stock on Monday, after the company's vaccine news sent that stock soaring. (CNBC)

New York is imposing a curfew on certain businesses as rising cases threaten its success at keeping the virus in check. (Axios)

Some Republican governors say they would not impose or help enforce the mask mandate Biden has called for. (Fox News)

Novamax has a contract with Operation Warp Speed to develop a vaccine, although the federal government had not disclosed it. (NPR)