Covid Live Updates: Spain, Italy Register Almost 50,000 Virus Cases Daily

ImageFrance began vaccinating children aged 5-11 on Wednesday.
France began vaccinating children aged 5-11 on Wednesday.Credit…Sebastien Bozon/Agence France-Presse — Getty Images

Officials in Spain said they would announce an outdoor mask mandate on Thursday, shortly after the country reported almost 50,000 new coronavirus cases, its highest daily total since the pandemic began.

Italy is considering making the country’s Covid health pass, a document that is required to work and to participate in many social activities, valid for just six months rather than nine; making masks mandatory outdoors; and banning parties or events, indoors or out, until the end of January.The country registered 44,595 new cases on Thursday — up from 33,600 on Wednesday — and 168 deaths.

And Greece said on Thursday that masks would be required in all outdoor and indoor areas where they are not already mandatory, like gyms. Greece’s health minister also banned all public events until Jan. 3.

European officials hope that new restrictions and greater access to vaccines will blunt the latest rising wave of coronavirus cases reported in the days leading up to Christmas and New Year’s. Colder weather and holiday traditions are bringing people from different households together indoors, where health experts say the virus spreads most readily.

Vaccinations for children under 12 started last week in much of Europe. The French authorities said on Wednesday that they were making all children 5 to 11 eligible, and a vaccine advisory committee in Britain recommended inoculating children that age who are in certain risk groups.

Recent data from France suggests that unvaccinated children are helping drive the accelerating spread of the virus there. The incidence of infection among children aged 6 to 10 is now twice that for the population as a whole, according to a study published last week by the French health authorities. A similar pattern was seen in Italy, where schoolchildren and young adults account for the majority of recent cases, experts there said.

“Vaccination of children is a necessity,” Prime Minister Jean Castex of France said last month. “It was my 11-year-old daughter who gave me the virus a few weeks ago.”

France reported an average of 54,256 cases a day last week, according to the Center for Systems Science and Engineering at Johns Hopkins University. About 73 percent of eligible residents are fully vaccinated, according to Our World in Data.

European nations like Germany, Greece and Spain already offer pediatric vaccination doses for younger children; so does the United States.

Other countries are also expanding access to vaccines. In Turkey, where the Pfizer-BioNTech and Sinovac vaccines are already in use, government officials granted emergency-use approval on Wednesday for a domestically developed Covid vaccine known as Turkovac.

And officials are weighing more mandates. Prime Minister Mario Draghi of Italy has said the country’s vaccine requirement for health care workers may be extended. And the Vatican said on Thursday that anyone who works in Vatican City must be vaccinated or have recovered from Covid; a negative test result will no longer be accepted as an alternative.

Reporting was contributed by L?ontine Gallois, John Yoon, Yan Zhuang, Isabel Kershner, Raphael Minder and Patrick Kingsley.

Israel is considering a fourth Covid-19 shot as it faces rising rates of cases due to the omicron variant.Credit…Oded Balilty/Associated Press

Israel’s Health Ministry was weighing on Thursday whether to approve giving people a fourth Covid-19 vaccine dose to try to contain the fast-spreading Omicron variant, after the experts who recommended it said they believed they had to act even before much scientific data was available to support another booster.

Despite the uncertainty, the pandemic response panel advising Israel’s government concluded that the potential benefits outweighed the risks, pointing to signs of waning immunity a few months after the third shot. They said that any delay in additional vaccines might prove too late to protect those most at risk.

If the Health Ministry approves the panel’s recommendation — which could happen as early as Thursday — Israel would be well ahead of other nations in administering a fourth dose. Health Minister Nitzan Horowitz has suggested that a new round of boosters could get underway by Sunday.

“The price will be higher if we don’t vaccinate,” Dr. Boaz Lev, the head of the advisory panel, said at a news conference late Wednesday. Describing the spread of Omicron as “a kind of tsunami or tornado,” he added, “We don’t have a lot of time to make decisions.”

Still, the experts’ recommendation for a fourth dose to those most at risk drew criticism from other scientists and medical professionals within Israel as premature and perhaps even counterproductive. Some scientists have warned that getting too many shots may eventually lead to a sort of immune system fatigue, compromising the body’s ability to respond to the virus.

A few members of the advisory panel raised a concern about a fading or exhausting of the immunological response in the elderly following multiple vaccinations within a short period of time, according to a written summary of the discussion obtained by The New York Times.

Along with the generally sparse knowledge about Omicron, the effect of a fourth dose against the new variant is also untested and unknown.

Israel was among the first countries to offer its residents a third shot, starting last summer. Now, the country’s medical experts are pointing to waning of immunity in those 60 or older, who were the first to receive the third shot starting in August.

Israel has confirmed only a few hundred cases of Omicron, but officials say they believe that the new variant is much more widespread, and that it could overtake Delta as the dominant strain in the country within two or three weeks.

Israeli researchers from the Health Ministry and several academic institutions presented data to the advisory team that made the recommendation for the fourth shot on Tuesday. The presentation, obtained by The New York Times, showed a doubling of the rate of infection from Delta among the 60-plus age group within four or five months of the third shot.

There is no clear indication of reduced efficacy against severe illness. But given the fear of a major Omicron outbreak during the winter months, when the hospitals are already overflowing with patients with complications of flu and other respiratory ailments, the advisory panel members voted overwhelmingly to recommend a fourth dose for people aged 60 and over and the immuno-compromised, as well as health workers, to be administered at least four months after their third shot.

The panel did not recommend a fourth shot for the wider population at this stage. It did favor bringing forward the third shot to three months after the second dose, as opposed to the previous recommendation of five months.

While there are some initial indications from South Africa and other countries that Omicron infections more often result in mild illness than earlier variants, the Israeli officials said that by the time they had clearer information, it might be too late to protect the people most at risk.

“We can sit in our academic armchairs and wait for research from abroad,” said Dr. Tal Brosh, another member of the advisory panel, “but that’s a kind of privilege we don’t feel we have.”

The Omicron variant, which is now dominant in the United States and spreading faster than any variant yet, has already pushed daily coronavirus case counts higher than the peak of the recent Delta wave. By most estimates, the country is in for a significant winter surge.

Although there are early positive signs out of South Africa and Britain that Omicron infections more often result in mild illness than previous variants, officials are warning that the new variant could swiftly overtax the health care system and bring significant disease to many communities.

The highly transmissible variant is causing near-vertical case growth in multiple U.S. cities, with figures doubling about every two to three days. Officials expect it to break records. The all-time high for average daily cases was 251,232, set in January. By some estimates, the United States could reach one million cases a day, even before the end of the year.

While Omicron’s speed now speaks for itself, scientists are still racing to understand its threat. Preliminary studies out of Scotland and England suggest that infections from the variant could be milder, but scientists caution that Omicron infections must be observed in the U.S. population before drawing conclusions.

Even if these early results hold and Omicron does cause mostly mild illness, the sheer magnitude of cases it causes could still escalate hospitalizations at a time when many medical centers are already full.

“When we have millions and millions and millions of people, all sick, all together at one time, it doesn’t take a large percentage of those people to topple over the hospitals,” said Dr. Hallie Prescott, associate professor of internal medicine at the University of Michigan.

And experts say not enough people are boosted, or vaccinated at all. The variant is thought to evade immunity from both vaccination and prior infection, but early research suggests that a booster provides the best protection against infection. And vaccination, even without the booster, is expected to maintain strong protection against hospitalization and death.

The Royal Caribbean cruise ship the Odyssey of the Seas at port in Fort Lauderdale, Fla., in June.Credit…Joe Raedle/Getty Images

Dozens of people aboard a Royal Caribbean International cruise ship tested positive for the coronavirus after it set sail from Fort Lauderdale, Fla., on Saturday, according to the cruise line.

Fifty-five fully vaccinated passengers and crew members on the ship, the Odyssey of the Seas, tested positive, the cruise line said in a statement on Thursday, noting that the number represented 1.1 percent of those on board.

The ship, which was on an eight-night cruise, will not sail to Cura?ao and Aruba as planned and will remain at sea until it returns to Fort Lauderdale on Sunday, Royal Caribbean said.

“The decision was made together with the islands out of an abundance of caution due to the current trend of Covid-19 cases in the destinations’ communities as well as crew and guests testing positive on board,” the company said. All of the people on the ship who tested positive “are fully vaccinated and mildly symptomatic or asymptomatic,” the cruise line added.

The Odyssey of the Seas, one of Royal Caribbean’s newest ships, made its maiden voyage in July. It can carry more than 5,500 guests and more than 1,600 crew members.

The health episode was reported shortly after a similar one on another Royal Caribbean ship, the Symphony of the Seas. The cruise line said this week that 48 people on that ship tested positive for Covid-19 after it set sail from Miami on Dec. 11. The ship returned to port in Miami on Dec. 18 after a seven-night Caribbean cruise.

Those cases were identified because of contact tracing after a guest tested positive, the cruise line said, adding that 95 percent of the passengers aboard the Symphony of the Seas were fully vaccinated against Covid-19 and 98 percent of the people who tested positive were fully vaccinated.

Royal Caribbean requires travelers 12 and older to be fully vaccinated against Covid-19 and to test negative before boarding. Younger children who are not vaccinated must provide a negative P.C.R. test result before sailing and test negative at the terminal before boarding.

The company said that all of its crew members were fully vaccinated against Covid-19 and were tested weekly.

At the beginning of the pandemic in 2020, outbreaks on cruise ships sickened people and upended the tourism industry.

Since the cruise industry restarted operations in the United States this June, efforts to keep the coronavirus at bay have been largely successful. Most companies require full vaccination for crew members and most passengers, and they put strict health and safety protocols in place.

But as the highly contagious Omicron variant drives up coronavirus cases in much of the United States and Europe, and criticism of cruise lines has mounted over a lack of transparency in reporting positive cases to passengers and crew members, many lines have adjusted their rules for masking, testing and vaccines.

The Merck & Company headquarters in Kenilworth, N.J.Credit…Andrew Kelly/Reuters

The Food and Drug Administration on Thursday authorized a second antiviral pill for Covid but said it should not be a preferred treatment.

The F.D.A. cleared the pill, developed by Merck and known as molnupiravir, for adults who are vulnerable to becoming severely ill from Covid and for whom alternative Covid treatment options authorized by the F.D.A. are “not accessible or clinically appropriate.”

The F.D.A.’s decision reflects concerns that Merck’s pill is only modestly effective while also carrying the possible risk of causing reproductive harm. But in the coming weeks, it is expected to be more available in the United States than other treatment options.

Older people and those who have conditions like obesity, diabetes and heart disease would be eligible to get a prescription for Merck’s pills if they get sick from the coronavirus and cannot get treatments such as Pfizer’s newly authorized pills or monoclonal antibody treatments. Both vaccinated and unvaccinated people will be eligible.

The treatment — to be taken as 40 pills over five days — is expected to be available within a few weeks.

Even before the F.D.A.’s decision, some doctors and health officials had tempered expectations for Merck’s drug. Studies indicate that it is far less effective than Pfizer’s version, which received F.D.A. authorization on Wednesday and is expected to become more widely available in the United States starting in a few months.

In a key clinical trial, Merck’s drug reduced the risk of hospitalization or death by 30 percent when given to high-risk unvaccinated people within five days of the onset of symptoms. Pfizer’s pill was found to reduce that risk by 88 percent.

“I don’t think Merck’s version is going to be the game changer,” said Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.

Dr. Dean Li, a Merck executive, said on Thursday that preliminary preclinical studies suggest that the drug is equally as effective against the Omicron variant as it was against earlier versions of the virus. The company and independent researchers have been running laboratory experiments on how well the drug can stop the Omicron variant from replicating.

The pills from Merck and Pfizer can be taken at home and are expected to reach many more people than monoclonal antibody treatments, which are typically given via intravenous infusions by a health care provider.

Until this week, the antibody drugs have been the only authorized treatment options for Covid patients who are at high risk of becoming severely ill. But Omicron has wreaked havoc on the country’s supply of the antibodies. Some hospitals have stopped using several of the antibody drugs because they are not likely to work against Omicron, and the only potent antibody treatment remaining against the variant is in very limited supply.

Merck’s treatment — which it developed with partner Ridgeback Biotherapeutics — is expected to be in greater supply sooner than Pfizer’s. By the end of January, Merck is expected to make available to the federal government enough pills for 3.1 million people, at a cost of about $700 a person. The first 378,000 treatment courses are expected about two weeks after authorization.

Pfizer is expected to supply before the end of January enough of its product, known as Paxlovid, for 265,000 people in the United States. Initial supplies are expected in the next few days.

To get Merck’s pills, the F.D.A. said, patients will need to test positive for the virus and get a prescription from a health care provider, all no more than five days after symptoms start.

Merck’s pill works by introducing errors into the virus’s genes to stop it from replicating, which has raised concerns about the risk that it could cause reproductive harm.

The F.D.A. said that women who were pregnant should generally not take the pills, but that there could be exceptions. The agency said that women who may become pregnant should use contraception while taking the pills and for at for at least four days after. The male partners of women who could become pregnant should use contraception while taking the pills and for at least three months after, the agency said.

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China’s Winter Games organizing committee announced elaborate precautions to prevent spreading the coronavirus to its population or the athletes.CreditCredit…Kevin Frayer/Getty Images

ZHANGJIAKOU, China — Spectators at the Winter Olympics next February should clap but not shout in support of athletes. Waiters, cleaners and other support staff will not be allowed to leave Olympic venues to visit their families. And any Olympic participants leaving the vicinity for the rest of China will be required to spend at least one week in quarantine, followed by at least two weeks of isolation at home.

As the Omicron variant spreads rapidly around the globe, China is taking elaborate precautions to prevent the coronavirus from reaching its own population or participants in the Winter Games. Chinese officials are also bracing the public for the inevitability that some infections will emerge at the Olympics, where everyone will face daily P.C.R. tests.

“A certain number of positive cases will become a high probability event,” Han Zirong, the secretary general of Beijing’s Winter Games organizing committee, told reporters on Thursday.

China has barred overseas spectators from entering the country. It is allowing vaccinated foreign athletes, trainers, coaches, referees, journalists and a few others to enter without enduring the usual two or more weeks of quarantine followed by a week of home confinement.

The exemption, however, comes with a stringent requirement that foreigners not leave a “closed loop” of hotels and sports venues, linked by special buses and trains.

“We must never go outside the closed loop, let alone reach the city level — this is our bottom line,” said Huang Chun, deputy director of the Olympic organizing committee’s Office of Epidemic Prevention and Control.

China has reported dozens of coronavirus cases daily this week. On Thursday, the local authorities locked down Xi’an, a city of 13 million people. At least 242 cases have occurred there in an outbreak this month. Beijing has not divulged how many involve the Omicron variant.

The country has been mostly successful in controlling the virus by quarantining hundreds of close contacts of infected people, and in some cases contacts of contacts. But similarly broad measures at the Olympics could make it hard to hold the Games.

Some precautions are already visible at a ski resort in the mountains near Zhangjiakou, about 100 miles northwest of Beijing, where nearly half of the Olympic events will be held. Thick, clear plastic sheeting from floor to ceiling separates bus drivers from their passengers.

At the resort’s high-speed-rail station, visitors must provide proof of a negative P.C.R. test in the preceding 48 hours. Also required is proof on a smartphone app that the traveler has not visited any Chinese city in the previous two weeks that has had a recent infection.

For construction workers putting the finishing touches on the venues, the authorities already do nucleic acid tests once every three days, Jia Maoting, the general manager of the Olympic Sports Construction and Development Company, told reporters during a visit to the Olympic ski jump venue.

Mr. Han, the secretary general of the Olympic organizing committee, cautioned that further measures may be added in the weeks to come. “Everything depends on the changes in the global and Chinese epidemic situation,” he said, “especially the infectiousness of the new mutant strain, Omicron.”

Liu Yi and Li You contributed research.

Americans who are 65 or older have the highest vaccination rates but are also the most at risk from Covid-19.Credit…Greg Lovett/The Palm Beach Post, via Associated Press

HOUSTON — Mary Kesterson, 67, was strolling maskless through Houston’s teeming Galleria mall this week, among a sea of shoppers hunting for last-minute gifts.

She was aware of the mounting anxiety across the country over the highly transmissible Omicron variant of the coronavirus, and as an older American, she was a member of a group at heightened risk from the virus. But she saw no reason to do anything but forge ahead with her Christmas plans.

“I’m not worried about it,” Ms. Kesterson said. “I’m just going along with my life. We’re all vaccinated, everyone in the family.”

For the second year in a row, Americans have hurtled into the holiday season under a cloud of escalating coronavirus cases, forced again to decide whether to carry on or cancel celebrations that had, only weeks ago, appeared so promising and so certain.

Such calculations are particularly fraught for older Americans. They are a highly vaccinated group in the United States — 88 percent of them are fully vaccinated, well above the national average of 62 percent.

But they have also been the most vulnerable to the pandemic since the beginning and more likely to get seriously ill and die from the virus: Seventy-five percent of people who have died of Covid in the United States, or about 600,000 of the more than 800,000 who have perished, have been 65 or older.

In rural towns in Maine and Oregon and in urban centers in Texas and New York, holiday plans have been upended for many older Americans. Travel itineraries canceled. Gatherings postponed.

Morgan Van Ancken gets tested in Brooklyn on Wednesday.Credit…Janice Chung for The New York Times

Testing is essential to stopping the spread of Omicron. But nearly two years into the pandemic, many people are still confused about the best way to get tested for Covid-19, or frustrated that they can’t find a test.

We asked public health experts for answers to some common questions about coronavirus testing during the Omicron surge.

When is the best time to take a rapid home test before seeing family for the holidays?

Home tests can tell you whether you are infected with coronavirus right now. So you should test as close as possible to the time of the gathering, preferably about an hour or two before everyone gets together, advises Dr. Ashish K. Jha, dean of the Brown University School of Public Health.

Dr. Michael Mina, a former Harvard epidemiologist who is now the chief science officer for eMed, a company that distributes at-home tests, advises an even tighter window. He suggests you take the test in your car just 15 minutes before the event, if that’s practical.

A negative test does not lower your risk to zero. But taking a test does significantly reduce the risk of transmission. “A test will not protect you from getting infected,” said Dr. Mina. “A test will protect you from infecting other people.”

If you’re flying, or taking a train, you should test the day you travel to make sure you’re not infecting your fellow passengers. Once you arrive, you should test in two or three days.

What if I can’t find home tests before the holidays?

The most important precaution is that everyone at a gathering who is eligible be fully vaccinated and have a booster shot. But since even vaccinated people can spread Omicron, rapid testing a few hours before an event can prevent an infected person from unknowingly spreading the virus.

If you can’t find rapid home tests, try to get a lab test as close as possible to the event, timing it so you get the results back before you see everyone. “Any test is better than no test,” said Mara Aspinall, an expert in biomedical diagnostics at Arizona State University who is also on the board of OraSure, which makes rapid Covid tests.

Limit other activities and try to isolate as you wait for the lab results so you don’t get infected in the interim.

If everyone at the party can’t get tested, then you’ll need to assess the risk. If a vulnerable person — someone very old or who has significant health risks — will be at the party, you may decide to scale it back or cancel.

When is the best time to test if I was exposed to an infected person?

Many public health experts say people with potential exposures to the Omicron variant should test sooner than advised for previous variants.

A recent outbreak of Omicron infections in Norway after a holiday office party in November gives us clues about the best time to test based on how quickly an Omicron exposure can “convert” to an infection, said Dr. Wachter. The party was held in a restaurant on a Friday, and everyone was vaccinated. Of 80 confirmed and suspected cases, nearly 75 percent were detected on the Sunday, Monday and Tuesday after the party. That suggests that the best times to test are on days 2, 3 and 4 after exposure.

People in Miami waited in line Tuesday to be tested for the coronavirus. Demand for tests has surged recently as the Omicron variant has spread and the holidays have approached.Credit…Saul Martinez for The New York Times

As Americans prepare for out-of-state travel and multigenerational indoor gatherings over the holidays, many people who need to get tested for the coronavirus are running into shortages, long lines and other deterrents — while many others are avoiding getting tested altogether.

“The fact they’re hard to come by suggests that there is a portion of people who really do put a lot of confidence in these tests,” said Preeti Malani, a professor and chief health officer at the University of Michigan. “But are the people who most need to be tested being tested?”

As the government has concentrated mainly on pushing more people to get vaccinated, she said, testing remains “not anywhere near where it needs to be.”

A forthcoming study in South Carolina suggests that some of the same groups that were slow to embrace vaccination are also less likely than others to get tested, often for reasons like mistrust of the medical system or fear of missing work and wages if they test positive.

When people are willing to take a test, there is often confusion about when to do it, what to do while waiting for results and what a negative reading does and does not signify.

“Tests can’t see what’s in the future,”said Gigi Gronvall, a professor at the Johns Hopkins Center for Health Security. “Some people look at it as a get-out-of-jail-free card, when in fact it’s just a moment in time.”

Minnesota National Guard Members checked on a resident at North Ridge Health and Rehab in New Hope, Minn., on Dec. 16.Credit…Tim Gruber for The New York Times

NEW HOPE, Minn. — Pfc. Shina Vang and his fellow soldiers in the Minnesota National Guard have had an exceptionally busy year. They helped process Afghan refugees fleeing Kabul for the United States, provided security at American military bases across the Horn of Africa and stood sentinel in Washington, D.C., following the Jan. 6 attacks on the U.S. Capitol.

They also deployed across Minnesota during the civil unrest prompted by the police killings of George Floyd in Minneapolis and Daunte Wright in nearby Brooklyn Center.

But none of those experiences prepared Private Vang and his fellow Guard members for their latest deployment: collecting bedpans, clipping toenails and feeding residents at North Ridge Health and Rehab, a sprawling nursing home in suburban Minneapolis that is the largest in the state.

“I’ve had protesters throw apples and water bottles at me but that doesn’t compare to the challenge of giving someone a bed bath,” Private Vang said.

Over the past two weeks, 30 Guard members have been working as certified nursing assistants at North Ridge, which has been so badly hobbled by an exodus of employees that administrators have been forced to mothball entire wings, severely limiting new admissions.

As a result, hospitals cannot send patients to long-term care centers like North Ridge, creating a backup that is eroding Minnesota’s capacity to treat people with Covid-19 and other medical emergencies. Similar backlogs are choking health systems across the country.

“It’s beyond a crisis,” said Katie Smith Sloan, the president of LeadingAge, an association of nonprofit long-term care facilities.

On Tuesday, President Biden announced that 1,000 military medical professionals would be dispatched to hospitals across the country this winter to help overwhelmed doctors and nurses.

Public health experts fear the worst is yet to come as the highly transmissible Omicron variant spreads to communities where health care workers are already straining to handle the surge of patients sickened by Delta. Maine, New Hampshire, Indiana and New York have deployed the National Guard to overburdened hospitals and nursing homes in recent weeks, but Minnesota’s initiative may be the most ambitious, with 400 guard members who have no previous nursing experience going through rapid-fire training before being sent to long-term care facilities across the state.

States, businesses and religious groups have challenged a Biden administration rule requiring larger businesses to mandate vaccines or weekly testing for employees.Credit…Gabby Jones for The New York Times

The Supreme Court said on Wednesday evening that it would hold a special hearing next month to assess the legality of two initiatives at the heart of the Biden administration’s efforts to address the coronavirus in the workplace.

The court said it would move with exceptional speed on the two measures, a vaccine-or-testing mandate aimed at large employers and a vaccination requirement for certain health care workers, setting the cases for argument on Friday, Jan. 7. The justices had not been scheduled to return to the bench until the following Monday.

Both sets of cases had been on what critics call the court’s shadow docket, in which the court decides emergency applications, sometimes on matters of great consequence, without full briefing and argument. The court’s decision to hear arguments on the applications may have been a response to mounting criticism of that practice, Adam Liptak reports for The New York Times.

The more sweeping of the two measures, directed at businesses with 100 or more employees, would affect more than 84 million workers and is central to the administration’s efforts to address the pandemic. The administration estimated that the measure would cause 22 million people to get vaccinated and prevent 250,000 hospitalizations.

The second measure requires health care workers at hospitals that receive federal money to be vaccinated against the virus. It “will save hundreds or even thousands of lives each month,” the administration wrote in an emergency application.

The Supreme Court has repeatedly upheld state vaccine mandates in a variety of settings against constitutional challenges. But the new cases are different, because they primarily present the question of whether Congress has authorized the executive branch to institute the requirements.

The answer will mostly turn on the language of the relevant statutes, but there is reason to think that the court’s six-justice conservative majority will be skeptical of broad assertions of executive power.

The last time the Supreme Court considered a Biden administration program addressing the pandemic — a moratorium on evictions — the justices shut it down.

“Our system does not permit agencies to act unlawfully even in pursuit of desirable ends,” the court said in August in an unsigned opinion, over the dissents of the three liberal justices.

The vaccination-or-testing requirement for large employers was issued in November by the Labor Department’s Occupational Safety and Health Administration, or OSHA.

Employers are allowed to give their workers the option to be tested weekly instead of getting the vaccine, though they are not required to pay for the testing. The rule makes an exception for employees who do not come into close contact with other people at their jobs, like those who work at home or exclusively outdoors.

Under a 1970 law, OSHA has the authority to issue emergency rules for workplace safety, provided it can show that workers are exposed to a grave danger and that the rule is necessary.

States, businesses and religious groups challenged the measure in appeals courts around the nation, and a unanimous three-judge panel of the U.S. Court of Appeals for the Fifth Circuit, in New Orleans, had ruled in favor of some of the challengers, blocking the measure.

Last week, after the challenges were consolidated before the U.S. Court of Appeals for the Sixth Circuit, in Cincinnati, a divided three-judge panel reinstated the measure.

Almost immediately, more than a dozen challengers asked the Supreme Court to block the measure. READ THE FULL ARTICLE ->

A man receiving the AstraZeneca Covid-19 vaccine as a booster dose at a hospital in Phnom Penh, Cambodia, in August.Credit…Cindy Liu/Reuters

In laboratory tests, a booster dose of the Oxford-AstraZeneca coronavirus vaccine raised antibody levels enough to suggest that it may offer protection against the Omicron variant, AstraZeneca reported on Thursday, citing an independent study by researchers from the University of Oxford.

Tests using samples taken from 41 people one month after receiving a third AstraZeneca shot showed that the neutralizing antibodies needed to prevent infection from the virus were at levels similar to those observed after a second dose against the Delta variant.

“These results support the use of third-dose boosters as part of national vaccine strategies, especially to limit the spread of variants of concern, including Omicron,” Prof. Sir John Bell, one of the investigators in the study, said in a statement.

The study has not been peer-reviewed. More research would be needed to determine whether the results seen in the laboratory translate into real-world effectiveness.

The study follows findings from Pfizer-BioNTech and Moderna, which reported that third doses of their vaccines had initial success at stopping infection and severe illness from Omicron.

Vaccines from all three companies have been authorized as “safe and effective booster doses” by Britain’s Medicines and Healthcare Products Regulatory Agency. Britain’s booster campaign has been built around Pfizer-BioNTech and Moderna doses, but people who cannot get one of them can receive an AstraZeneca booster, according to the National Health Service.

The study comes on the heels of a real-world effectiveness study published by British government scientists last week that found that after six months, the regular two-dose AstraZeneca vaccination alone offered little to no protection against Omicron infection, though it still helped prevent serious disease from the variant. Giving people who started with two doses of AstraZeneca a Pfizer booster dose increased the effectiveness against symptomatic infection from the variant to 71 percent, the study found.

A growing body of preliminary research has indicated that most of the world’s vaccines provide protection against serious illness from Omicron. But many of them, including those manufactured in China or Russia as well as the Johnson & Johnson vaccine, seem to do little or nothing to stop the variant’s spread.

Three doses of the Chinese vaccine Sinovac offer almost no protection from Omicron infection, researchers in Hong Kong said in a study released on Wednesday. Sinovac is one of the most widely used vaccines in China, as well as in low- and middle-income countries like Mexico and Brazil.

Abbott Laboratories makes the BinaxNOW Covid-19 Antigen Self Test. It destroyed thousands of tests — now in great demand — earlier in the year.Credit…Andrew Kelly/Reuters

President Biden has promised to make 500 million coronavirus tests available free of charge, but help is at least weeks away — if not longer — as new cases surge in the United States.

As a candidate, Mr. Biden excoriated the Trump administration for what he called “a failure of planning, leadership and execution” where tests were concerned. But the Omicron variant caught the White House off guard, as this president has acknowledged, and cases have far outstripped available tests.

The president’s pledge, which he made on Tuesday, was the centerpiece of a new aggressive effort, announced as Americans scramble to locate the hard-to-find tests for use over the holidays. Purchase contracts for tests could be completed as soon as next week, officials said.

“That’s not a plan — it’s a hope,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, which tracks testing trends. She said that if tests arrived in January and February, they might be useful. But if they trickle in over months, she said, “I’m not sure what kind of impact it is going to have.”

Whether manufacturers can ramp up production quickly enough is unclear. John M. Koval, a spokesman for Abbott Laboratories, said he was seeing “unprecedented demand” for its tests, “and we’re sending them out as fast as we can make them.”

A sign offering free Covid-19 vaccinations and booster shots at a pop-up clinic in the international arrivals area of Los Angeles International Airport on Dec. 22.Credit…Frederic J. Brown/Agence France-Presse — Getty Images

A few months ago, confirming full vaccination status against the coronavirus was as simple as showing a card or QR code with proof that the required number of shots had been completed within six months.

But as evidence grows that the Delta and Omicron variants of the coronavirus are causing breakthrough infections in people who were once considered “fully vaccinated,” momentum seems to be growing to change the definition of that term to include booster shots.

Now, in a world of multiple vaccines with varying effectiveness, and a variety of mixing and matching strategies, it will soon be harder to say who is “fully vaccinated.” Here is what some health experts had to say.

What is the official definition of ‘fully vaccinated’?

For now, U.S. health officials say a person is fully vaccinated two weeks after a second shot of a two-dose vaccine like Pfizer’s or Moderna’s or after a single-dose vaccine like Johnson & Johnson’s.

They have not (yet) expanded that definition to include a booster shot.

How effective is being ‘fully vaccinated’ at this point?

“It depends on what it is you’re trying to prevent,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center who has advised the Biden administration.

A booster is more effective than just the first two shots at preventing hospitalization or death, she said.

If the definition changes, how does that work?

Like so much else since the pandemic started, expect a period of confusion as a patchwork of local, national and international governments evolve at different speeds.

The Coalition for the Homeless, which said it was seeing evidence that the coronavirus was “spreading quickly” in congregate shelters, has called on Mayor Bill de Blasio to move people to hotels.Credit…John Minchillo/Associated Press

With the Omicron variant flooding New York City, advocates for homeless people are bracing for a surge in cases at shelters for single adults where about 12,000 people sleep in barrackslike dorms that often have upward of 20 people in a room.

The operator of one shelter in the city said on Thursday that in recent days, 14 out of 200 residents, or 7 percent, had tested positive and that most residents had not been tested at all in the last two weeks. At least four workers at the shelter, out of about 40, had also tested positive, said the operator, who spoke on the condition of anonymity because the city forbids shelters to talk to reporters without clearance.

If 7 percent of the residents of congregate shelters got the coronavirus, that would be over 800 people, which would far exceed the shelter system’s current supply of isolation and quarantine rooms.

Current data on coronavirus in shelters is hard to come by. The city releases it only once a week and has not done so since last Friday, when it reported 82 new cases among the 46,000 residents of the main shelter system, more than double the number it reported Dec. 2.

The Coalition for the Homeless said Wednesday that it was seeing evidence from talking to clients that the virus was “spreading quickly” in congregate shelters and called on Mayor Bill de Blasio to move people from shelters back to the hotels where the city placed them during the early waves of the pandemic.

Mr. de Blasio said the city had no such plans. “What we’re seeing so far in Omicron: intense surge but less impact, and we also believe it’ll be for a brief period of time,” the mayor said on Wednesday. “So that does not suggest doing things the way we did last year.”

He added, “We also have a hell of a lot more people vaccinated than we did when we went through the challenges last year.”

At least 11,000 out of 20,000 adult shelter residents have been vaccinated directly through the shelter system, in addition to an unknown but large number vaccinated elsewhere, the Department of Homeless Services said.

As of Tuesday, the shelter system had about 70 vacant beds in isolation units, where people are sent after testing positive or showing Covid-like symptoms, and about 130 beds in quarantine rooms, said Isaac McGinn, a Homeless Services spokesman. Typically, if someone in a congregate shelter tests positive, the people sleeping nearest to them are sent to quarantine. Mr. McGinn said the department was “on standby to bring on more beds pending additional needs.”

On Wednesday, Housing Works, the nonprofit that runs most of the shelter system’s isolation and quarantine units, declined to provide medical services at a new isolation hotel the city is using because the city was insisting on putting two people in a single isolation room, said Charles King, Housing Works’s executive director.

At a women’s shelter in College Point, Queens, one resident, Alison Gibney, said that three women that she knew of had tested positive in recent days.

“It’s a nightmare situation,” Ms. Gibney said. “There are 15 women to a room, and I must sleep with a mask, and that is the only time I’m not double masked.”

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