The latest:

• Quebec announces 4-week curfew as part of ‘shock therapy’ lockdown.
• U.S. tops 21 million COVID-19 cases with record hospitalizations.
• New federal rule on COVID-19 tests for air passengers kicks in tonight.
• New Brunswick reports record 31 new COVID-19 cases as province steps up restrictions.
• Manitoba reports 176 new cases, including 60 definitively linked to holiday gatherings, says health official.
• Ontario now offering free, voluntary COVID-19 testing for international arrivals at Pearson airport.
• Are you a Canadian struggling to get a COVID-19 test abroad? Or do you have a tip or question about the pandemic? Email us COVID@cbc.ca

Quebec is imposing a four-week curfew starting Saturday and extending other restrictions, the premier announced Wednesday, in an effort to curb rising COVID-19 cases, deaths and hospitalizations in the hard-hit province.

Premier François Legault described the lockdown measures for Quebec, which has seen more cases and deaths than any other province during the pandemic, as “shock therapy.”

“We are in a race against time,” he said. “Unfortunately, we seem to be losing the race right now.”

The provincewide curfew will be for the hours of 8 p.m. to 5 a.m., with those who break curfew risking a $1,000 to $6,000 fine. Under the public health orders, non-essential businesses will be closed, though curbside pickup will be allowed. Restaurants, gyms and theatres will remain closed.

For students, elementary schools will open as planned on Jan. 11, but children in Grades 5 and 6 will be required to wear a mask. High schools will remain closed for another week, opening Jan. 18.

The new restrictions come as Quebec reported 2,641 new cases and 47 additional deaths on Wednesday. Hospitalizations increased to 1,393 with 202 COVID-19 patients in intensive care, Quebec health officials reported.

Prior to the announcement, Dr. Matthew Oughton, an infectious disease physician at Jewish General Hospital in Montreal and an assistant professor at McGill’s department of medicine, told CBC News Network that something needed to be done to reduce the number of “face-to-face contacts the average citizen is having,” given the rates of community transmission and hospitalizations.

Ontario, which reported 3,266 new cases of COVID-19 and 37 additional deaths on Wednesday, is also dealing with increased stress on the health-care system. Health Minister Christine Elliott said in a tweet on Wednesday there were 805 new cases in Toronto, 523 new cases in Peel Region, 349 in York Region, 208 in Windsor-Essex and 206 in Waterloo.

Hospitalizations in Ontario increased to 1,463, with 361 COVID-19 patients in the province’s ICUs, the province said in data released Wednesday.

At a news conference Wednesday, Premier Doug Ford announced that the province is now offering free, voluntary COVID-19 testing for international travellers arriving at Pearson airport.

“We need to do everything possible to stop this virus from coming into Canada,” Ford said.

For months, however, travel-related cases have been among the lowest-reported causes of COVID-19 cases in Ontario. According to the province’s website, there were eight travel-related cases in Ontario on Jan. 5, while there were 221 cases attributed to community spread on that date, as well as 672 attributed to close contact, and 177 in outbreak settings.

WATCH | Ontario offers voluntary COVID-19 test for incoming travellers at Pearson:

The premier’s announcement about the Pearson initiative comes just ahead of a new federal rule on COVID-19 tests for air passengers that goes into effect tonight. As of midnight, every traveller — with very limited exceptions — must show a negative test result from a polymerase chain reaction (PCR) test before boarding a plane destined for Canada.

Ford also said the province will consider tougher lockdown measures, including possibly keeping schools closed.

The Elementary Teachers’ Federation of Ontario (ETFO) released a statement Wednesday calling on the province not to send kids back while the province is under lockdown measures.

– From CBC News and The Canadian Press, last updated at 5:30 p.m. ET

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What’s happening in Canada

As of  7 p.m. ET on Wednesday, Canada’s COVID-19 case count stood at 626,800, with 79,204 of those cases considered active. A CBC News tally of deaths stood at 16,369.  

In Atlantic Canada, New Brunswick set a new single-day record on Wednesday with 31 new cases of COVID-19. The update came on the first day of the entire province being back at the stricter orange level of its pandemic response.

Ninety-seven health-care workers are also off the job for COVID-19-related reasons, said Dr. Jennifer Russell, the province’s chief medical officer of health. “As grim as it looks today, things will likely get worse before they get better,” she warned.

WATCH | N.B. rolls entire province back to orange phase of COVID-19 recovery:

Newfoundland and Labrador Premier Andrew Furey has extended the Atlantic bubble hiatus for another month, which means anyone travelling from any other province in Canada must still self-isolate for 14 days. The province reported no new COVID-19 cases on Wednesday.

Prince Edward Island has now removed some of the pandemic restrictions it introduced in early December, including allowing spectators back at some sporting events. The province reported one new case on Wednesday. 

Nova Scotia reported 12 new cases on Wednesday. 

In the North, Nunavut launched its vaccination effort on Wednesday by offering doses of the Moderna vaccine to elders in Iqaluit. Vaccination efforts have already started in Yukon, while the Northwest Territories offered details Tuesday on how it plans to roll out the vaccine.

Yukon reported one new case on Wednesday, while Nunavut and N.W.T. both reported no new cases.  

In the Prairie provinces, Manitoba reported 176 new cases and 10 more COVID-19 deaths on Wednesday. Sixty of the new cases have been definitively linked to holiday gatherings, and more are likely, said Dr. Jazz Atwal, the acting deputy chief provincial public health officer.

Atwal said the full impact of the holidays remains to be seen, and as such, it is too early to make a call on relaxing the restrictions in public health orders set to expire on Jan. 8. 

Saskatchewan reported 277 new cases and nine new deaths on Wednesday. The number of COVID-19 hospitalizations stood at 172, including 29 in intensive care.

In Alberta, more than 200 doctors have signed an open letter calling on the province to prioritize the vaccination of all health-care workers caring for patients in the province’s dedicated COVID-19 wards.

In the letter addressed to Health Minister Tyler Shandro on Wednesday, the physicians say Alberta’s vaccination schedule has passed over critical workers on the front lines of the province’s battle against the virus.

Alberta reported 1,123 new cases and 25 deaths on Wednesday. Across the province, 911 people were being treated for COVID-19 in hospitals, including 141 in ICU beds.

British Columbia reported 625 new cases and eight new deaths on Wednesday. Health officials put the number of hospitalized patients at 381 people, 78 of whom are in intensive care.

A public health alert remains in effect for the Revelstoke region in southeastern B.C., where community transmission and new cases have increased substantially, surpassing 85 total cases in recent days.

– From CBC News and The Canadian Press, last updated at 7 p.m. ET

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What’s happening in the U.S.

More Americans were hospitalized with COVID-19 on Wednesday than at any time since the pandemic began, as total coronavirus infections crossed the 21-million mark, deaths soared across much of the country, and a historic vaccination effort lagged.

U.S. COVID-19 hospitalizations reached a record of 130,834 late on Tuesday, according to a Reuters tally of public health data, while 3,684 reported fatalities was the second-highest single-day death toll of the pandemic.

That toll on Tuesday translates to someone dying from COVID-19 roughly every 24 seconds in the U.S. With total deaths surpassing 357,000, one in every 914 U.S. residents has died from COVID-19 since the pandemic began, according to a Reuters analysis.

WATCH | COVID-19 cases overwhelm California hospitals:

In hard-hit California, public health authorities ordered hospitals in more than a dozen southern and central counties overwhelmed with COVID-19 patients to suspend elective surgeries for at least three weeks.

The order, issued late on Tuesday by the state’s Department of Public Health, applies to 14 counties, including Los Angeles, Orange and San Diego, where hospital critical care capacity has been severely stretched.

With many health-care systems approaching a breaking point, pressure mounted on state and local officials to speed up distribution of the two authorized vaccines from Pfizer-BioNTech and Moderna.

The lack of a federal blueprint for the crucial final step of getting the vaccines into tens of millions of arms has left state and local officials in charge of the monumental effort, creating a patchwork of different plans across the country.

Some states have summoned extra resources to help speed up the rollout. North Carolina Gov. Roy Cooper on Tuesday mobilized the state’s National Guard to “provide support to local health providers” to more quickly distribute the vaccines. Maryland Gov. Larry Hogan also announced that emergency support teams from the state’s National Guard will lend a hand to local health departments in their vaccination efforts.

In New York City, where Mayor Bill de Blasio and Gov. Andrew Cuomo have sparred over slow vaccine administration, officials said on Wednesday the city was ramping up its vaccine hubs to include 15 locations by Jan. 16, including five “mega sites.” The sites will have the capacity to vaccinate 100,000 New Yorkers a week, officials said.

The ambitious goal comes as the city administered roughly 10,000 shots on Tuesday, according to data posted on Wednesday.

– From Reuters, last updated at 4 p.m. ET

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What’s happening around the world

As of late Wednesday afternoon, there were more than 86.9 million cases of COVID-19 worldwide, with more than 48.6 million of those cases considered recovered or resolved, according to a tracking tool maintained by Johns Hopkins University. The global death toll stood at more than 1.8 million.

In Africa, millions of South Africans will have their vaccinations subsidized by medical schemes that pool health insurance premiums through an agreement with the government, a top medical scheme administrator said.

In Senegal, President Macky Sall has put the country’s capital and surrounding region on curfew as coronavirus cases surge. While the country has been commended for its handling of the pandemic, it experienced a December surge with some 3,200 confirmed cases, and the president said the number of deaths increased sixfold between November and December.

In Europe, the European Union’s medicines agency has given approval to Moderna’s COVID-19 vaccine.

The decision Wednesday gives the 27-nation bloc a second vaccine to use against the coronavirus rampaging across the continent. The approval recommendation by the European Medicines Agency’s human medicines committee, which must be OK’d by the EU’s executive commission, comes amid high rates of infection in many EU countries.

There’s also been strong criticism of the slow pace of vaccinations across the region of some 450 million people

Portugal’s President Marcelo Rebelo de Sousa said on Wednesday he would self-isolate after being in contact with someone who tested positive for the novel coronavirus.

The 72-year-old is campaigning to win a second term as the country’s president in an election on Jan. 24. He has several presidential debates scheduled before then.

Norway is preparing legislation that would allow it to introduce curfews after new cases hit record levels, its justice minister said.

Switzerland, meanwhile, plans to extend its lockdown restrictions by five weeks to the end of February.

In the Asia-Pacific region, authorities in Thailand say they plan to expand coronavirus testing to thousands of factories in a province near Bangkok as they reported 365 new cases around the country and one new death.

South Korea rolled out mass testing for 52 prisons in the country after a massive prison outbreak and may extend flight suspensions from Britain, the health minister said.

Chinese authorities imposed travel restrictions and banned gatherings in the capital city of Hebei province, which surrounds Beijing, to stave off another coronavirus wave.

The Philippines is negotiating with seven vaccine manufacturers to procure at least 148 million COVID-19 shots as it seeks to inoculate close to two-thirds of its population this year, a senior official said on Wednesday.

Carlito Galvez, a former general in charge of the country’s strategy to fight the coronavirus, said the government hopes to close deals with Novavax, Moderna, AstraZeneca , Pfizer, Johnson & Johnson, Sinovac Biotech and the Gamaleya Institute this month, although availability could be a challenge amid stiff competition.

In the Americas, the critical-care wards of major hospitals in Peru and Bolivia stand at or near collapse after end-of-year holidays, reflecting wider concerns as much of Latin America struggles to secure adequate vaccine supplies.

Brazilian President Jair Bolsonaro accused syringe makers of pushing up their prices after the government failed to buy hundreds of millions of syringes via auction for its vaccination drive, leading it to requisition surplus supplies.

Brazil has seen more than 7.8 million cases of COVID-19 since the pandemic began, according to Johns Hopkins, with more than 197,000 deaths.

Meanwhile, Colombia’s regulator has approved the Pfizer-BioNTech vaccine for emergency use.

In the Middle East, Lebanon has shattered its single-day record of coronavirus infections on the eve of the country’s third full lockdown, with 4,166 cases reported on Wednesday.

The country also reported 21 new COVID-19 deaths. First responders say they have been transporting nearly 100 patients a day to hospitals that are reporting near-full occupancy in beds and ICUs.

Meanwhile, Iran and Oman have now registered their first two cases of a highly contagious coronavirus variant that emerged in Britain.

– From The Associated Press and Reuters, last updated at 4 p.m. ET

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