TOKYO — Tokyo Gov. Yuriko Koike is asking senior citizens 65 or older and those with underlying health conditions not to use the government’s GoTo discount campaign to travel in and out of Tokyo.

New cases in Tokyo and other major cities have spiked in recent weeks, with serious cases rapidly filling hospitals and impacting the treatment of other patients.

Koike says she is focusing on how to stop serious cases and prevent the medical systems from collapsing.

Koike issued a request for restaurants serving alcohol, bars and karaoke chains to close early until mid-December. Aichi, Osaka and Hokkaido have taken similar steps.

Prime Minister Yoshihide Suga’s government has been criticized for being slow to curb social and economic activity. Suga hasn't taken tougher steps beyond basic safety precautions and wearing masks.

Japan managed to avoid a high number of cases with stay at home and business closure requests under a non-binding state of emergency in the spring. Some experts say it’s time to scale back business activity and urged the government to act quickly to avoid another state of emergency.

The health ministry says Japan has nearly 149,000 confirmed coronavirus cases and more than 2,100 deaths.

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THE VIRUS OUTBREAK:

— BioNTech and Pfizer ask European regulator for expedited approval of coronavirus vaccine

— Americans face new COVID-19 restrictions after Thanksgiving

— At tiny rural hospitals, exhausted medical workers t reat friends and family

— Formula 1 champion Lewis Hamilton tests positive for coronavirus

— U.K. stocks up on vaccines, hopes to start virus shots within days

— Virus forces businesses to adapt or close down on the streets of London

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Follow AP’s coverage at https://apnews.com/hub/coronavirus-pandemic and https://apnews.com/UnderstandingtheOutbreak

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HERE’S WHAT ELSE IS HAPPENING:

BERLIN — Germany’s science minister says the same safety standards are applied in the approval process for coronavirus vaccines as for other drugs.

Anja Karliczek says ensuring the same standards is key to gaining the widest possible public acceptance for the COVID-19 vaccine.

Karliczek noted that the European Medicines Agency will be holding a public hearing on Dec. 11 on an approval request by German pharmaceutical company BioNTech and its U.S. partner Pfizer.

She says the vaccine will be voluntary and authorities will work hard to inform the public about possible side effects that might be excepted after immunization, such as headaches, localized pain and fever.

Marylyn Addo, a doctor at Hamburg’s UKE hospital who is involved in the trials for a rival vaccine, says the rapid development of a vaccine was the result of enormous efforts by scientists, early funding and experience from previous vaccines.

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BERLIN — German pharmaceutical company BioNTech and its U.S. partner Pfizer say they have submitted an application for expedited approval of their coronavirus vaccine with the European Medicines Agency.

The two companies say the submission, which occurred Monday, completes the rolling review process they initiated with the agency on Oct. 6.

The move comes a day after rival Moderna said it was asking U.S. and European regulators to allow emergency use of its COVID-19 vaccine.

BioNTech says if the vaccine, currently named BNT162b2, is approved, its use in Europe could begin before the end of 2020.

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ROUEN, France — Lockdowns that are forcing millions of people to once again stay home — cutting them off from families and friends, shuttering businesses they invested in, university classes that fed their minds and the nightspots where they socialized — has begun to turn back the coronavirus resurgence in France.

Still, in the country that passed the bleak milestone of 52,000 dead in November, the costs to mental health have been considerable.

With numbers now falling for COVID-19 patients in intensive care, psychiatrists are facing a follow-up wave of psychological distress. Health authorities’ surveys point to a surge of depression most acute among people without work, those in financial hardship and young adults.

The Rouvray Hospital Center in the Normandy town of Rouen is among places where psychiatrists are on the front line of the pandemic’s mental-health fallout. They are fearful that a growing crisis of depression, anxiety and worse may be on the horizon as more livelihoods, futures and hopes are lost to the pandemic.

Associated Press journalists spent 10 hours in the sprawling 535-bed facility, the day after French President Emmanuel Macron laid out a blueprint stretching into mid-January for the gradual lifting of lockdown restrictions.

“Being alone between four walls is terrible,” one patient says. “The halting of life like this, it reverberates on people. It is not good.”

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BRUSSELS — Nonessential shops in Belgium were reopening Tuesday in the wake of encouraging figures about declining daily coronavirus infection rates and hospital admissions.

However, the government is concerned the change might lead to massive gatherings in the nation’s most popular shopping centers and streets. Over the weekend, pre-Christmas light festivals already led to crowded scenes in several cities, prompting warnings from virologists about the dangers of reopening too soon.

Belgium, host to the headquarters of the 27-nation European Union, has been one of the hardest-hit countries in Europe during the pandemic. Belgium has reported more than 16,500 deaths linked to the virus during two surges in the spring and the fall.

Under the new rules, shopping time is limited to half an hour. Restaurants and bars remain closed.

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UNITED NATIONS — Nobel Peace Prize laureate Nadia Murad says the COVID-19 pandemic has increased trafficking of women and gender-based violence, leaving the health and safety of women “on the line.”

The 27-year-old activist, who was forced into sexual slavery by Islamic State fighters in Iraq, says curfews, lockdowns and travel restrictions imposed by governments to slow the spread of the virus “have had unintended consequences on women worldwide.”

Murad said domestic tensions have intensified in confined living spaces, and stay-at-home orders “are increasing human trafficking farther underground, out of sight of law enforcement.”

A member of Iraq’s Yazidi minority, Murad was among thousands of women and girls who were captured and forced into sexual slavery by Islamic State extremists in 2014. Her mother and six brothers were killed by Islamic State fighters. She became an activist on behalf of women and girls after escaping and finding refuge in Germany, and shared the Nobel Peace Prize in 2018.

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HANOI, Vietnam — Vietnamese authorities are conducting intensive contact tracing after the country’s first confirmed local transmission of the coronavirus in 89 days.

State media says a 32-year-old man in Ho Chi Minh City tested positive for the coronavirus on Monday after visiting a flight attendant who was undergoing self-quarantine following his return from Japan two weeks ago. The flight attendant tested positive on Saturday, the Tuoi Tre newspaper said.

Health authorities ordered 137 people who had been in close contact with the man to stay in a central quarantine facility and shut down an English center where the man works as a teacher.

Vietnam’s borders remain closed in an attempt to keep out the virus. Only limited international flights are operating to repatriate Vietnamese nationals and transport foreign diplomats and experts.

The country has reported 1,347 coronavirus cases, including 35 deaths.

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HONG KONG — Hong Kong leader Carrie Lam on Tuesday urged residents to stay home as the city grapples with a resurgence of the coronavirus, which has infected over 500 people in the past week.

Lam asked citizens to “refrain from social gatherings” and people, in particular the elderly, should remain at home.

“The latest wave of the epidemic is rather severe. Every one of us should do our best and exercise a high level of discipline to fight the pandemic,” she said at a news conference. “The coming two weeks is a crucial period.”

Many of the new infections in Hong Kong have been tied to dance studios, and outbreaks have also been found among staff and guests at several restaurants.

The new wave of infections has led authorities to tighten social distancing restrictions, including closing entertainment venues such as karaoke bars and game centers and limiting public gatherings to two people.

The growing number of cases has delayed a “travel bubble” between Singapore and Hong Kong initially slated for November.

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MANILA, Philippines — Coronavirus quarantine restrictions will remain imposed in the Philippine capital during the Christmas season this month and officials say they will ban big Christmas parties.

President Rodrigo Duterte said in televised remarks late Monday that aside from Metropolitan Manila, the bustling capital region of more than 12 million, the “general community quarantine” would be imposed in seven other cities and provinces in December.

The restrictions ban large public gatherings, in-school classes and entertainment businesses. It allows shopping malls, restaurants and essential shops, including barber shops, to operate with required safeguards. Those include wearing masks and shields and social distancing.

Duterte lamented the "hard-headedness" of some citizens who defy quarantine restrictions or wearing of masks.

The Philippines has more than 431,600 confirmed coronavirus infections, the second-highest in Southeast Asia. There's been 8,392 reported deaths.

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UNITED NATIONS — The head of the world’s largest humanitarian network is urging governments and institutions to combat “fake news” about COVID-19 vaccines and start building trust about the importance of vaccinating people.

Francesco Rocca, president of the International Federation of Red Cross and Red Crescent Societies, says “to beat this pandemic, we also have to defeat the parallel pandemic of distrust.”

He says there is “a growing hesitancy about vaccines in general, and about a COVID vaccine in particular” around the world, pointing to a recent Johns Hopkins University study in 67 countries that found vaccine acceptance declined significantly in most countries from July to October this year.

In a quarter of countries, Rocca said, the study found that the acceptance rate for a vaccine against the coronavirus was near or below 50 percent, with Japan dropping from 70 percent to 50 percent acceptance, and France dropping from 51 percent to 38 percent acceptance.

He stressed the lack of trust “is by no means a Western phenomenon,” citing the federation’s research in recent months in eight African countries showed a steady decline in the perceptions of the risk of COVID-19 infection.

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SACRAMENTO, Calif. — California could see a tripling of hospitalizations by Christmas and is considering stay-home orders for areas with the highest case rates as it tries to head off concerns that severe coronavirus cases could overwhelm intensive care beds, officials said Monday.

“The red flags are flying in terms of the trajectory in our projections of growth,” said Gov. Gavin Newsom. “If these trends continue, we’re going to have to take much more dramatic, arguably drastic, action.”

Hospitalizations have increased 89% over the past 14 days and nearly 7,800 coronavirus patients were hospitalized as of Monday. About 12% of Californians testing positive are likely to need hospital care within the next two to three weeks.

The biggest concern is intensive care cases, which have increased 67% in the past two weeks. If that continues, it would push ICU beds past capacity by mid-December.

That statistic is likely to drive state-mandated stay-at-home orders in 51 of California’s 58 counties that already are seeing the most restrictions on business activities, said Dr. Mark Ghaly, the state’s secretary of health and human services.

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TORONTO — Canadian Prime Minister Justin Trudeau’s government is vowing to spend tens of billions more dollars to help the country recover from the pandemic.

Deputy Prime Minister and Finance Minister Chrystia Freeland says the country is facing its most severe challenge since the second World War, the worst economic shock since the Great Depression and the worse health crisis since the Spanish flu over a century ago.

The cost to date has the federal deficit reaching a record $381.6 billion Canadian (US$294 billion) this year, but the government says it could close in on $400 billion Canadian (US$308 billion) if widespread lockdowns return in the coming weeks. Toronto, Canada’s largest city, is on lockdown.

The government’s fall economic update proposes to send extra child benefit payments to families next year. The government is proposing $25 billion Canadian (US$19 billion) in new spending.

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