Covid updates: The lack of a quick test to diagnose Omicron or Delta is complicating treatments.

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Credit…Chandan Khanna/Agence France-Presse — Getty Images

Most U.S. doctors have no way to determine which variant of the coronavirus a patient is carrying, a distinction that could mean the difference between life and death.

High-risk patients carrying the Delta variant could benefit greatly from two particular monoclonal antibody treatments shown to reduce hospitalization and death. But those medications would most likely do nothing for patients with Omicron, who would only respond to a third antibody treatment that is in very short supply.

While U.S. officials have endorsed using a workaround test that can identify Omicron’s genetic signature, experts say it’s not feasible for large health systems facing a crush of patients to employ in each case.

That makes treating patients challenging in places like Maryland, where cases are spiking and Omicron accounts for roughly 58 percent of them. The Delta variant is also holding strong in the Great Plains and swaths of the West, including California.

While there is no approved test to determine each individual’s variant, a national network of state and other labs use genome-sequencing tests to track variants broadly in communities. Health systems then use those regional estimates or their own data to decide which antibody treatments to use in their clinics and hospitals.

Many of them concluded that a community of largely Delta patients would benefit most from the antibody drugs made by Regeneron and Eli Lilly, while communities where Omicron patients are predominant would benefit from antibodies from GlaxoSmithKline and Vir Biotechnology.

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Credit…Ted S. Warren/Associated Press

Federal officials have dabbled with making the decision for the nation. On Dec. 23, they stopped shipments of antibody treatments by Eli Lilly and Regeneron after the Centers for Disease Control and Prevention said 73 percent of U.S. Covid cases were Omicron.

An outcry followed from Republican political leaders, who argued that some people in their states were still infected with Delta. And on Tuesday, the C.D.C. slashed its estimate of national Omicron cases to 59 percent. On Dec. 31, federal officials resumed national shipping all of the antibody treatments.

For the next few weeks, as the country grapples with this uneven mix of both variants, tailoring treatments to each patient will be “extraordinarily difficult,” said Dr. Alex Greninger, assistant director of the clinical virology laboratories at the University of Washington Medical Center.

Dr. Greninger is credited with developing one of the first tests to detect the coronavirus in the United States. But he is pessimistic that health systems can pivot quickly to sort out which patients have Delta or Omicron. And although a shortcut test can detect Omicron, there’s no simple way to report the results in bulk, he said.

What’s more, the genome sequencing used by public health officials takes nearly a week — too long to target the early antibody treatments that have been found to reduce the need for hospitalizations. That makes patient care particularly difficult right now, said Dr. Mark Siedner, an infectious disease clinician and researcher at Massachusetts General Hospital.

In Massachusetts and nearby states, an estimated 44.5 percent of cases are Omicron. Dr. Siedner said his health system has stopped using the Regeneron and Eli Lilly antibodies that are not effective against Omicron and are “anxiously awaiting” more doses of the effective treatment by GlaxoSmithKline and Vir Biotechnology.

“We’re in a holding pattern and it’s a terrible time to be in that place,” he said.

Christina Jewett

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Credit…Nicole Craine for The New York Times

Officials across the United States, from President Biden on down, have been insisting that they are no longer in the shutdown business, and will not order any closures to contain the latest surge in coronavirus cases.

But Omicron may be taking the decision out of their hands. So many workers are testing positive or calling in sick that businesses, schools, government agencies and more are being crippled by staff shortages that may force them to close some operations anyway.

Airlines began canceling flights in large numbers on Christmas Eve for lack of crews, and the problems have continued into the new year. Broadway shows have been canceled because of outbreaks backstage. Major companies have delayed or entirely jettisoned return-to-office plans. Many colleges are switching back to virtual classes to start the semester.

And public school leaders are struggling to respond to a situation that has changed greatly from when students went on holiday breaks before Christmas, barely a week ago. Four large city school systems — Cleveland, Detroit, Milwaukee, and Newark — have joined a growing list of public schools around the country that put off reopening on Monday, switched to remote instruction, or both. Covid-19 outbreaks and staffing shortages forced their hands.

Omicron has driven case numbers to staggering new heights: The United States is averaging more than 484,600 daily cases over the past week, a 238 percent increase from two weeks ago. Hospitalizations are up 41 percent in the past two weeks, while deaths are down by 3 percent.

In some cases, the very resources needed to cope with Omicron’s staffing disruptions are themselves being disrupted, from the call-center agents who rebook canceled flights to the frontline medical professionals who care for sick workers.

Infected police officers, firefighters, paramedics, and transit workers are leaving shifts unfilled. In New York City, subway lines have been delayed by staff shortages, and the Fire Department has asked residents not to call 911 except in a real emergency.

Many elected leaders of both parties have discarded their sharpest pandemic-curbing tools, like closing government offices, schools and businesses, which have come with staggering economic, social and political costs. Instead, elected officials have stressed the importance of vaccination, booster shots and mask-wearing.

“I am not prepared to shut down schools or the economy at this time,” Gov. Kathy Hochul of New York, a Democrat, said before New York suffered a string of new daily case records last week. “I will not overreact and send this economy spiraling out of control once again.”

Many leading public health experts aren’t seeking shutdowns, either. If anything, many appear to be taking an opposite tack.

The Centers for Disease Control and Prevention announced new guidelines to help schools stay open, by allowing children who are exposed to the coronavirus to “test to stay” instead of automatically having to quarantine at home. And it has said that some Americans who test positive can leave isolation after five days, half as long as previous recommendations.

Jin Yu Young contributed reporting.

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Credit…Calla Kessler for The New York Times

The coronavirus is spreading faster than ever at the start of 2022, but the last days of 2021 brought some encouraging news about the latest wave of infections.

With growing evidence that the Omicron variant produces less severe illness than in earlier waves, governments are redoubling their focus on vaccinations and boosters, which are increasingly seen as the world’s ticket to “living with Covid.”

Dr. Anthony S. Fauci, the U.S. government’s top infectious disease expert, said on Sunday that hospitalizations, which are not rising as fast, were a more important barometer than reported cases for the severity of the Omicron wave, a sharp distinction after nearly two years of tallying daily case counts.

“As you get further on and the infections become less severe, it is much more relevant to focus on the hospitalizations as opposed to the total number of cases,” Dr. Fauci said.

Still, the case numbers remain staggering. The world is recording an average of nearly 1.5 million new cases every day, twice as many per day as were recorded nearly a week ago, although the figures in many places may have been distorted by holiday reporting delays. In the United States, experts forecast that the Omicron wave could crest in mid-January, but not before millions were infected every week. Across Europe, caseloads have soared to new highs and ushered in another bitter winter of social restrictions, mask mandates and shifting travel rules.

The holidays made things worse as colder weather and festive gatherings drove people indoors, where the virus circulates more easily. Airports and mass transit hubs were snarled with travelers after many people stayed home last year. And with many government offices closed, testing and case data were not being compiled as regularly, leaving officials and experts, at least temporarily, with an incomplete picture of how bad things were getting.

As much of the world returns to work this week, however, several trends are becoming clearer:

  • Omicron seems milder: A large British study determined that people who contract Omicron are far less likely to be hospitalized than those infected with the Delta variant. Other studies found that Omicron may not spread as easily to the lungs, a possible explanation of why its effects appear less severe.

  • Vaccines, especially boosters, help: The British study also underlined that the risk of hospitalization was significantly lower for people who had received two or three vaccine doses, compared with unvaccinated people. Among Covid cases who developed symptoms, people who had three doses were 88 percent less likely to be hospitalized than those who had not had any shots.

  • Delta remains a threat: The earlier variant still accounts for a large share of new infections in many countries — including more than 41 percent in the United States, according to federal data from the week ending on Christmas Day — and is significantly more virulent.

Although many governments are loath to lock down again, officials are tweaking rules to account for Omicron’s blazing spread. Paris last week became the latest European city to reimpose an outdoor mask mandate. South Korea joined France and others in setting an expiry date for its vaccine passes, hoping to push more people to get boosters.

Here are some other trends to watch for:

  • Hospitalizations rising: Experts warn that with so many infections, the sheer number of patients needing care will strain health systems already frayed by two years of Covid. In Australia, hospitalizations from the virus have more than doubled over the past week, to nearly 2,000. Worldwide, more health workers are likely to be sidelined by infections, adding to the stress on hospitals.

  • Risks to older people: Much of the early data, including the British study, covers younger patients, leaving significant questions about how Omicron will affect older people. On Monday, Britain’s education secretary, Nadhim Zahawi, told BBC radio that Omicron cases were rising among those 50 and older, but added that they were well protected since more than 90 percent of such people in Britain had booster shots. In the United States, according to the Centers for Disease Control and Prevention, less than half of fully vaccinated people over 50 have received a booster dose.

  • More countries considering a fourth dose: As studies suggest that immunity from boosters wanes against Omicron, Israel said it would offer a fourth vaccine dose to people age 60 and older, even though there is so far little evidence about its effectiveness. On Monday, French officials said that they would decide as early as mid-February whether to offer a fourth dose.

  • Trouble for the less vaccinated: As wealthy nations rush to offer additional doses, experts fear that poorer nations will be left even farther behind, and ever more vulnerable to Omicron. Many of the countries with the fastest rising case counts — including Ivory Coast, Ghana and Angola — are in Africa, the continent with the lowest vaccination rates.

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‘We Are Staying Open,’ New York City Mayor Says of Schools

Mayor Eric Adams of New York City insisted schools would remain open despite surging Omicron cases in the city. He said remote learning has been too damaging, especially to children in low-income neighborhoods and homeless students.

We’re really excited about the opening of our schools, and we want to be extremely clear: The safest place for our children is in a school building. And we are going to keep our schools open, and ensure that our children are safe — in a safe environment. Our children were exposed to an environment of crime and of uncertainty. It really traumatized parents that did not have child care. The remote learning aspect of it was terrible for in poorer communities, particularly those children that lived in homeless shelters or that lived — were housing insecure. The food aspect — schools provide primary meals for many students in this city. And then the socialization. We saw an increase in suicide, attempted suicides. We’re not sending an unclear message of what is going to happen day to day. I’m going to tell you what’s going to happen day to day. We are staying open. We’re going to do everything that we have to do to keep our schools open. And I know there’s questions about staffing. I know this question about testing. There’s a lot of questions, but we’re going to turn those question marks into an exclamation point. We’re staying open.

Mayor Eric Adams of New York City insisted schools would remain open despite surging Omicron cases in the city. He said remote learning has been too damaging, especially to children in low-income neighborhoods and homeless students.CreditCredit…Dave Sanders for The New York Times

Mayor Eric Adams insisted on Monday morning that New York City’s schools would stay open despite an extraordinary surge in Omicron cases. But about a third of city parents did not send their children back to classrooms on the first day after the holiday break. Attendance was just over 67 percent, slightly higher than the low point of 65 percent the system reached on the day before winter break.

Throughout the day on Monday, Adams was adamant that the system would remain open. He repeated the message in a series of television interviews and after his first official school visit since taking office on New Year’s Day.

“We’re really excited about the opening of our schools,” Mr. Adams said outside the school, Concourse Village Elementary School in the Bronx. “We want to be extremely clear: the safest place for our children is a school building.”

Mr. Adams said that remote learning had been disastrous for too many of the city’s nearly one million schoolchildren in the nation’s largest school district, and had been particularly harmful for children in low-income neighborhoods and homeless students.

But the calm that Mr. Adams sought to project was not shared by the many parents and educators who greeted Monday morning with profound trepidation. After roughly a year of remarkably low virus transmission in schools, Covid cases soared in the week before the winter break, prompting the closures of 11 schools and over 400 classrooms, and the contact tracing system for city schools effectively collapsed amid the surge.

New York City reported 35,650 new virus cases on Sunday, with a 7-day average test positivity rate of nearly 22 percent, according to state data.

Some families and elected officials have called on Mr. Adams to delay the start of school by a few days to allow every child and educator to get tested. And teachers have raised questions about how schools will be properly staffed with so many teachers sick with the virus or quarantining due to exposures.

“This is an all hands on deck moment,” Mr. Adams said, acknowledging that administrators who are not normally in the classroom would be used to address staff shortages if necessary.

Mr. Adams has endorsed a plan created by former Mayor Bill de Blasio that is designed to keep more classrooms open as the surge continues. The plan calls for distributing 1.5 million rapid at-home test kits to schools.

Starting Monday, the city is also doubling its random in-school testing program to give P.C.R. tests to 20 percent of consenting children in each school weekly. But most families have not opted in to allow their children to be tested, which has made the testing pool very small at some schools.

The mayor and the new schools chancellor, David C. Banks, are betting that their plan to increase testing will prevent major outbreaks.

“We’re going to turn those question marks into an exclamation point: we’re staying open,” Mr. Adams said.

Mr. Adams and Mr. Banks have so far resisted calls to mandate booster shots for educators or vaccines for children. The mayor has said a decision will be made this spring about mandating vaccines for students for the fall.

“We’re not at the point of mandate,” Mr. Adams said Monday, as he encouraged eligible New Yorkers to get vaccinated and boosted.

Michael Mulgrew, president of the city’s teachers’ union, said in an email to members that he had encouraged Mr. Adams to start the year remotely. But on Monday morning, Mr. Mulgrew said he was working closely with the new mayor and that schools had been some of the safest places in the city throughout the pandemic.

Later on Monday, Gov. Kathy Hochul reiterated her commitment to keeping New York’s children in schools.

“My view is that every child should be back in school unless they are testing positive,” she said.

The state has distributed 5.2 million at-home test kits to schools thus far, and another 3.8 million arrived yesterday and have yet to be distributed.

Under the current rule, test kits will only be provided to students for known exposures that occur in classrooms, although Ms. Hochul said that policy was under review.

She also cautioned against a return to remote learning. “The teachers did the best they could. The parents did the best they could,” she said. “But we ask too much.”

In particular, she spoke about the effects of remote learning on children in communities of color, those who lacked resources and those without high-speed internet access — an existing digital divide that she said had widened into a “digital canyon.”

“We cannot have that,” Ms. Hochul said. “That was an injustice. We cannot have that anymore.”

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Credit…Andri Tambunan for The New York Times

SACRAMENTO — With the Omicron variant raging across California, millions of schoolchildren returned to classrooms on Monday, ending the holiday break as many had spent it — masked, distanced, apprehensive and in long lines with their parents, scrambling for coronavirus tests.

Few schools were closed in a state whose Covid-19 precautions have been among the most aggressive in the nation. California has managed to maintain comparatively low rates of virus-related deaths and hospitalizations.

But infections have soared recently because of the highly contagious variant, which appears to result in less severe cases. In hundreds of districts, in-person instruction was conditioned on heightened health requirements and fraught with the understanding that even those might not prevent a return to remote learning.

“Frankly, the disruption I’m worried about isn’t Day 1 — it’s Day 2, 3 or 4 if we get 30 or 40 or 50 positive cases,” said Alex Cherniss, the superintendent of the Palos Verdes Peninsula Unified School District, where, after days of impassioned community debate, some 10,000 students in coastal Los Angeles County returned to class on Monday.

“People are exhausted here,” he said.

California’s largest school district, Los Angeles Unified, was not scheduled to resume classes until next week. But on Monday, the district issued new rules requiring baseline testing as a condition of returning to campus, regardless of vaccination status. Previously, testing had been optional for vaccinated and asymptomatic students and employees.

7–day average

6,288

Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.

In many other districts, reopening classrooms on Monday also hinged on fresh rounds of coronavirus testing.

In Marin County, students had been given kits to test for the virus before re-entering campus. In Sacramento County, families stood for hours over the weekend at testing sites hastily erected by school districts or took advantage of an infusion of six million take-home tests the state supplied to districts across California as Omicron was starting to spike.

“We did two tests at home and he’s fine,” Emily Ramey said as she dropped off her younger child at a middle school in suburban Sacramento. “I’m just hoping that everyone else tested, too.”

Los Angeles Unified already conducts the nation’s largest weekly school-based coronavirus testing program, but health officials in the county have ratcheted up other measures that will affect the hundreds of thousands of students and employees in the school system, along with those in private schools and nearly 80 other public school districts.

New health rules starting Jan. 1 mandate, for example, that returning students at all of the county’s districts wear face masks not only indoors but also outside at recess, and that school employees upgrade to medical-grade N95 or KN95 face coverings.

Gov. Gavin Newsom has reiterated that the state is “committed” to keeping classrooms open and promised last month to make home testing kits “available to every K-12 public school student as they head back to the classroom from winter break.”

But not all districts had received their allotment by Monday. San Francisco schools increased mobile testing sites throughout the city and strongly encouraged students to get tested before returning, in part because they will not receive their allotment of tests from the state until later this week.

In Palos Verdes, Mr. Cherniss said concern over Omicron almost prompted the district to delay reopening until next week. But when he announced he was considering it, he said, the outcry from parents was fierce. Eventually, the district opted to reopen as scheduled, but to strongly encourage students to test before returning.

“We did a big push over the weekend,” he said. “We handed out 2,000 home tests in less than three hours and did another 2,000 live tests. More than 100 were positive.”

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Credit…Kenny Holston for The New York Times

The top medical official at the U.S. Capitol urged lawmakers and their staff members on Monday to work remotely and take additional precautions against the coronavirus, after the seven-day positivity rate at the building’s on-site coronavirus test center rose rapidly from less than 1 percent to more than 13 percent.

In a letter to congressional offices obtained by The New York Times, Dr. Brian P. Monahan, the attending physician, informed lawmakers that there had been an “unprecedented number of cases” among hundreds of people who work in the Capitol complex, with dozens testing positive daily.

Of the cases detected, 65 percent were symptomatic, the letter said. As of Dec. 15, a majority of the infections were breakthrough cases, with 61 percent caused by the Omicron variant and 38 percent caused by the Delta variant.

The building offers daily testing for lawmakers, their staffs, Capitol workers and journalists who work in the building, and lawmakers were among the first wave of eligible people to receive vaccinations and boosters in the country. The breakthrough infections, Dr. Monahan said, had not led to any hospitalizations, serious complications or deaths.

“I urge all individuals also to continue essential measures to reduce the spread of coronavirus,” Dr. Monahan wrote in his letter, encouraging lawmakers to maximize the amount of remote work done in their offices and advising all people in the building to use medical-grade masks.

With the Senate set to hold votes on Tuesday, Democrats have now decided to meet virtually for their weekly caucus lunch, according to a senior aide. The House is not set to return until Jan. 10.

Dr. Monahan has little authority to enforce his guidance, in an institution where individual congressional offices can set their own policies and guidelines. Mask-wearing in recent months has largely been divided along party lines, with two Republicans, Marjorie Taylor Greene and Andrew Clyde, incurring more than $100,000 combined in fines for flouting the mask mandate on the House floor.

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Credit…Rachel Woolf for The New York Times

The Food and Drug Administration on Monday authorized booster doses of Pfizer-BioNTech’s coronavirus vaccine for 12- to 15-year-olds, a group that became eligible for initial shots in May.

Regulators also shortened by a month the amount of time that adult and adolescent recipients of Pfizer’s vaccine should wait between their second and third doses, allowing them to seek booster shots five months after their second injections.

And they allowed some children aged 5 to 11 with immune deficiencies to seek a third shot, including those who have undergone solid organ transplants or have conditions that amount to “an equivalent level of immunocompromise,” the agency said in a statement.

The Centers for Disease Control and Prevention’s vaccine advisory committee is set to meet Wednesday to review the F.D.A. moves and decide whether to recommend the changes. If it does, the C.D.C.’s director, Dr. Rochelle P. Walensky, is expected to quickly sign off on them.

The F.D.A. said that it examined data from Israel on more than 6,300 people in the 12- to 15-year-old age group who received booster shots at least five months after a second dose. That data “enabled the F.D.A. to reassess the benefits and risks of the use of a booster in the younger adolescent population in the setting of the current surge in Covid-19 cases,” the agency said.

The review showed no new safety concerns, including no new cases of myocarditis, a rare heart-related side effect that has been tied to the Pfizer and Moderna vaccines, particularly in younger men. The condition involves inflammation of the heart muscle.

Dr. Peter Marks, who oversees the agency’s division that regulates vaccines, said that the risk of myocarditis was substantially lower after a booster dose than after a second dose, citing U.S. safety monitoring data. The benefits of a third shot outweighed the potential risks, he said, because it may better protect individuals against both the Delta and Omicron variants.

Regulators also relied on Israeli data in shortening the interval between second and third doses of the Pfizer vaccine. No new safety issues have emerged in the United States among more than four million people 16 and older who got a third dose at least five months after a second, the F.D.A. said.

Because studies have shown that a Pfizer booster dose increases protection against the Omicron variant, a shorter interval might offer “better protection sooner,” the agency said. Other studies have shown that the potency of two doses of Pfizer’s vaccine ebbs over time.

“We do know that waning has occurred by five months,” Dr. Janet Woodcock, the F.D.A.’s acting commissioner said at a Monday morning news conference at which she and Dr. Marks gave updates on their deliberations about whether to further expand authorizations for Covid vaccines.

The F.D.A. has not received sufficient dataon the benefits of a booster shot of Moderna’s vaccine at five months, and so is sticking to the six-month interval for that vaccine. “We will obviously be receptive to data that are submitted to us from Moderna and we’ll take action on those data with all due speed,” Dr. Marks said.

He declined to say whether authorization of a third shot was in the offing for those who received one dose of Johnson & Johnson and a second dose of either Pfizer or Moderna’s vaccine. He said the combination appears “to give a very good immune response,” but that more data is needed over time.

Asked about booster shots for 5- to 11- year olds, Dr. Marks said that only about a quarter of them have been vaccinated, mostly in the last two months. “It would be great to get a larger percentage of those kids vaccinated, and then we’ll see how many months afterward we need to get them boosted,” he said.

No vaccine is yet authorized for children under five. “We certainly understand that there is a pressing need in that age range,” Dr. Marks said, promising that the F.D.A. “will move with appropriate speed with the appropriate data in hand.”

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New York State Reports Rapid Rise in Covid Hospitalizations

Gov. Kathy Hochul of New York said coronavirus cases and hospitalizations have surged sharply across the state, with the number of deaths reported in a single day rising above 100 for the first time since last March.

We’re not in a good place — I’m going to be really honest with you. This is the winter surge we predicted. We know that particularly after families gathered Dec. 25 over that weekend, another weekend holiday we just completed with New Year’s, there’s a lot of human interaction and what happens when humans gather, they spread the virus and we fully anticipate on top of the surge that’s already been ongoing, that there’s going to be another wave that’s occurring as a result of these holidays. Right now, we can say with certainty that the cases are not presenting themselves as severely as they could have or we had feared. So that is the silver lining, if you will. And what we’re looking at, hospitalizations continue to rise. That is a trend that is, again, troubling. We are looking at the percentages of each region, how many cases, as well as how many hospitalizations. This is not that wave we saw last year. It kind of kept going up and up. This is straight up, and love to see it come straight down. We just don’t have a time on that, but we’re doing all we can. And again, we have much — we have many more defenses this time. So unfortunately, this is the sad part of what we say is that 103 people are no longer with us, people that started out the holiday weekend with their families that have passed over the weekend. And it’s just so sad to think about the pain and anguish that they’re going through because of this.

Gov. Kathy Hochul of New York said coronavirus cases and hospitalizations have surged sharply across the state, with the number of deaths reported in a single day rising above 100 for the first time since last March.CreditCredit…Anna Watts for The New York Times

Hospitalizations for the coronavirus are rising steeply in New York State, approaching the peak of last winter’s surge and driving the number of deaths reported in a single day above 100 for the first time since last March, Gov. Kathy Hochul said Monday.

Hospitalizations have now surpassed last winter’s peak in New York City, the governor said. She added that there were some signs that this wave of hospitalizations may not be as severe as past surges, but she said the rapid rise was still “a trend that is troubling.”

“We’re not in a good place, I’m going to be really honest with you,” Ms. Hochul said at a news briefing in Rochester, as she announced additional testing sites and the arrival of millions of rapid tests to help schools stay open through the virus spike.

Hospitalizations are being closely watched in New York City, one of the first places to be hit hard by the Omicron variant, as a bellwether for the nation as a whole. Omicron was first reported in New York City a month ago, and led to an enormous surge in new cases, from less than 2,500 per day to nearly 50,000 per day on New Year’s Eve.

But in the past 10 days, hospitalizations have started to rise even more steeply than cases in New York City, leaping 130 percent between Christmas Eve and New Year’s Eve, compared to a 60 percent rise in cases over the same period, state data shows.

As of Sunday, more than 4,500 people were hospitalized in the city, 500 of them in intensive care units. Statewide, nearly 9,000 people were hospitalized, and 103 people were reported to have died on Sunday.

7–day average

7,774

Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.

The number of Covid patients in New York City intensive care units is still lower than the peak of last winter’s surge, before vaccines were widely available, when about 750 people were in intensive care. And hospitalizations remain much lower than when Covid-19 first swept the city in spring 2020 and 12,000 people were hospitalized on the worst days, 3,000 of them in intensive care.

Unvaccinated people are far more likely to be hospitalized with Covid-19 than vaccinated people, state data shows. In the week ending Dec. 20, the rate of unvaccinated people hospitalized for Covid statewide was 30 per 100,000, compared to a rate of 2 per 100,000 for the fully vaccinated.

The hospitalizations are threatening to wear down a health care system whose ranks are already thinned by infections and attrition during the pandemic, and hospitals are readying emergency staffing plans. More than 20 hospitals across the state have been ordered to stop elective surgeries because they lack the capacity to perform them.

But Ms. Hochul said that some hospital executives have told her between 20 and 50 percent of their Covid patients are not suffering from severe symptoms, but that they are testing positive in the hospital incidentally, after being admitted for other reasons such as car accidents.

As a result, beginning Tuesday, the state will begin to ask hospitals to break down how many patients are being admitted for acute Covid-19 symptoms, in an effort to further decipher this wave’s severity.

“I just want to always want to be honest with New Yorkers about how bad this is,” Ms. Hochul said. “Yes, the sheer numbers of people infected are high, but I want to see if hospitalizations are correlated to that.”

With schools open in New York City and much of the state on Monday, and masks still optional in certain fully vaccinated settings, some are calling on the city and state to do more to slow the hospitalizations down.

Mark Levine, the Manhattan borough president, called on policymakers to immediately urge people to work from home and avoid large gatherings for the next two weeks, as part of a 16-point plan he released Monday.

“Hospitalizations in NYC are rising faster than at any point since March 2020,” he wrote on Twitter. “We can’t just accept this. We have to do more to slow this wave.”

Hospitalizations in NYC are rising faster than at any point since March, 2020.

With a healthcare workforce which is now exhausted and depleted.

We can’t just accept this. We have to do more to slow this wave. pic.twitter.com/LuMFgSDJMj

— Mark D. Levine (@MarkLevineNYC) January 3, 2022

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Credit…Stefani Reynolds for The New York Times

The Omicron surge has prompted sharp new limits on the number of journalists allowed to attend White House news briefings.

The board of the White House Correspondents Association voted on Sunday to limit attendance to 14 reporters, sitting spaced apart in a room with 49 chairs. Three major news agencies will always be represented, two spots are earmarked for major U.S. television networks, and there will be one pool reporter each for print, radio, TV and foreign outlets. The remaining five seats will be rotated on various schedules among 48 news organizations, including The New York Times.

The president of the association, Steve Portnoy of CBS Radio, wrote in an email to members, “Given the virulence of the spread, medical experts have once again advised that it would be prudent to substantially reduce the number of people working in the cramped, poorly ventilated work space that we share.” He said that standing in the briefing room’s aisles, a common practice for reporters without assigned seats, “is not welcome at this time” because photographers need room to maintain social distance as they work.

The association is also urging its members to stay away from the White House when not on a specific assignment, to minimize the chances of “an outbreak that might limit our ability to cover the president in close quarters,” Mr. Portnoy wrote.

“I promise this won’t last a day longer than necessary,” he said in the email, adding that the board would revisit the situation by Jan. 21.

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Credit…Cheriss May for The New York Times

As hospitals already strained by the Delta variant threaten to buckle under a crush of patients infected with the even more contagious Omicron, Dr. Anthony S. Fauci said Americans should focus more on the threat the winter wave poses to hospitals and less on the record number of cases.

Over the past week, an average of more than 401,200 cases has been reported each day in the United States, tripling from two weeks ago and the first time the number has topped 400,000, according to a New York Times database (new case numbers are slightly depressed because fewer states are reporting after the New Year holiday). Hospitalizations were by comparison up 33 percent, however, to 92,300, while deaths had dropped 4 percent to an average of 1,249 daily.

7–day average

97,847

Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.Holiday interruptions to testing and data reporting may affect case and death trends.

It’s unclear how many hospitalizations are patients infected with Omicron rather than the Delta variant, which scientists believe is significantly more virulent. According to the latest data from the Centers for Disease Control and Prevention, for the week ending Dec. 25, Omicron accounted for over 58 percent of new cases versus over 41 percent for Delta.

Dr. Fauci, the government’s top infectious disease expert, noted on Sunday on ABC’s “This Week with George Stephanopoulos” that many new infections, especially in people who are vaccinated and boosted, result in no symptoms or mild symptoms, making the absolute number of cases less important than it was for previous versions of the virus.

“As you get further on and the infections become less severe, it is much more relevant to focus on the hospitalizations as opposed to the total number of cases,” Dr. Fauci said.

That advice is in keeping with what many epidemiologists have said all along. Despite the daily drumbeat of case counts, the number of positive tests has never been a perfect indicator of the course of the epidemic.

The number of cases has exploded because the Omicron variant seems to be much more contagious and able to evade vaccines than other earlier variants, which has spurred more widespread testing. What’s more, the official numbers are almost certainly an undercount, because many people are testing positive on rapid at-home tests or carrying the virus without any symptoms.

Yet, as Dr. Fauci told Mr. Stephanopoulos, the concern is not so much the mild or asymptomatic Omicron cases as it is the number of people with severe or fatal infections.

“The real bottom line that you want to be concerned about,” he said, “is are we getting protected by the vaccines from severe disease leading to hospitalization?”

So far, vaccines and boosters appear to be providing that protection. But the unvaccinated remain at risk.

“I’m still very concerned about the tens of millions of people who are not vaccinated at all because even though many of them are going to get asymptomatic and mildly symptomatic, a fair number of them are going to get severe disease,” Dr. Fauci said.

The Louisiana Department of Health tweeted on Sunday that hospitalizations in the state have topped 1,000, and that 76 percent of those hospitalized “are not up to date” on their vaccination status.

Also, even if Omicron is milder, as most evidence suggests, a higher caseload means more health care workers who cannot work because they test positive as well as more chances that people could get sick enough to require medical care.

“We have got to be careful about that, because, even if you have a less of a percentage of severity, when you have multi-multi-multi-fold more people getting infected, the net amount is you’re still going to get a lot of people that are going to be needing hospitalization,” Dr. Fauci said.

Hospitals in several states are showing signs of strain and experiencing staffing shortages.

“At the moment, the major concern is the effect of Omicron on hospital staffing in conjunction with fatigue and increasing admissions for Covid-19 as well as other things,” said Julio Figueroa, chief of infectious diseases at the Louisiana State School Health Sciences Center.

Hawaii has requested 700 additional health care workers from the Federal Emergency Management Agency, while some hospitals in the St. Louis area have started to limit visitors again. Leaders in Illinois have urged hospitals to postpone elective surgeries and procedures.

The Maryland Hospital Association said that the number of hospital patients had surpassed the state’s Covid peak from last winter.

“We believe that the next four to six weeks are really going to be a terrible point in this crisis, and it’s potentially going to be the worst part of the whole two-year fight,” Gov. Larry Hogan of Maryland said on the CNN program “State of the Union.”

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Credit…Andrew Dolph for the New York Times

Large city school systems in Cleveland, Detroit, Milwaukee and Newark have joined a growing list of public schools across the country that have postponed reopening after the holiday break, switched to remote instruction, or have taken both steps because of Covid-19 outbreaks and staffing shortages.

Some of the announcements came abruptly, as school leaders struggled to respond to a rapidly changing situation.

  • On Sunday night, the 75,000-student Milwaukee Public Schools system said it would temporarily switch to remote instruction beginning Tuesday, citing “an influx of reported positive Covid-19 cases among district staff.” The system said it hoped to resume in-person instruction on Jan. 10.

  • School officials in Madison, Wis., a district of 27,000 students, delayed the start of classes until Thursday and said they would be held online until Jan. 10.

  • The Detroit school system, citing what officials called a record high test positivity rate of 36 percent in the city, has announced that no school would be held Monday through Wednesday, with more information to follow later in the week. The school system said on Friday that it would test its staff early this week and would distribute laptop computers to students, a sign that more remote learning could be in store.

  • Elsewhere in Michigan, schools in Pontiac will be remote until Jan. 18, and in Ann Arbor through Jan. 10.

  • In Ohio, Cleveland’s public schools, with 35,000 students, were scheduled to be remote this week following an announcement last week by Eric S. Gordon, the school chief. Schools in Lorain and several other northern Ohio districts also were moving to remote instruction.

  • Arthur Culver, the superintendent of schools in East St. Louis, Ill., a 5,200-student district, said in a Facebook post on Friday that classes would begin remotely on Tuesday, citing “very high Covid-19 positivity rates over the winter break within our serving ZIP codes.” The district planned to remain remote through Jan. 14.

  • The 35,000-student Newark schools announced last week that they would shift to remote learning for at least the next two weeks, returning to classrooms on Jan. 18. It is the largest of several New Jersey school systems moving to remote instruction, including Irvington, Cranford and South Orange-Maplewood (until Jan. 10) and Paterson (until Jan. 18).

Some school systems that are open for in-person instruction this week have nonetheless had to shut some school buildings for lack of staff, including eight schools in Columbus, Ohio, and 12 in Pittsburgh.

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Credit…Kriston Jae Bethel for The New York Times

An increasing number of people with compromised immune systems in the U.S. are sidestepping government guidelines to receive unauthorized fourth or fifth shots.

The Food and Drug Administration and the Centers for Disease Control and Prevention are in charge of determining when additional doses should be administered, but some patients and their doctors feel that federal agencies have acted too slowly to protect the most vulnerable.

Israel has already begun officially offering fourth shots — Prime Minister Naftali Bennett announced on Sunday that the country would offer additional shots to people age 60 and over, as well as to medical workers, becoming the first country to start administering an additional booster so broadly.

In the United States, the Centers for Disease Control and Prevention updated its guidelines in late October to say that immunocompromised people would be eligible for a fourth dose six months after a third. For those who followed the rules, the earliest eligibility for a fourth would be in late February.

But as new variants like Omicron arise and vaccination rates continue to be sluggish in many areas, worrying those with weak immune systems, many of them are getting extra shots without being certain of whether they are safe or effective.

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Credit…Jon Super/Associated Press

All secondary school students in England must be tested for the coronavirus before returning to classrooms after the holidays, the British government announced on Monday, in the latest measure aimed at controlling a rise in infections driven by the Omicron variant.

Schools have been provided with rapid test kits to administer on site when pupils begin returning to classes this week, officials said, adding that students should continue to test themselves at least twice a week. Older students, including those at universities, had already been advised to test themselves at home before returning to campuses.

“We are doing all we can to minimize disruption this virus causes to everyday life, including keeping children in school, and regular testing is a key way to support schools and protect face-to-face teaching,” Britain’s health minister, Sajid Javid, said in a statement.

Self-administered rapid antigen tests — known in Britain as lateral-flow tests — have become a ubiquitous part of British life over the past year, provided free by the government through the mail and at pharmacies. Over the holidays, however, supply difficulties and surging demand have often made them more difficult to obtain, with officials blaming a “worldwide shortage.”

Officials said on Monday that schools would have access to “a separate supply route” to order additional tests.

The government also said that English secondary school students, though not their teachers, would be required to wear masks in classrooms until at least Jan. 26. Masks are already recommended for students in Northern Ireland, Scotland and Wales, where separate devolved governments decide on their own Covid measures.

While those governments reintroduced restrictions on gatherings after Christmas, Mr. Javid and other British officials have said that further restrictions on everyday life in England are not necessary because cases of severe illness are not rising as fast as in previous waves.

Even as Britain recorded its all-time highs in daily cases last week, the health secretary said that the country has “some of the least restrictive measures in Europe,” and argued that high vaccination rates, including a scaled-up booster program, would allow Britons to live with the virus.

7–day average

173,261

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

“Curbs on our freedom must be an absolute last resort and the British people rightly expect us to do everything in our power to avert them,” Mr. Javid wrote in The Daily Mail newspaper on Friday.

Data released by British health officials last week added to findings that Omicron might produce less severe illness than previous variants. Still, some experts warned that the sheer number of cases would strain Britain’s health system. Government data showed a 50 percent rise in both hospitalizations and deaths from Covid-19 over the past week, with nearly 1,000 people having died within 28 days of a positive test.

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Credit…Anthony Wallace/Agence France-Presse — Getty Images

As of Monday, South Korea’s vaccine passes will have a six-month expiration date, as the health authorities seek to manage the country’s “living with Covid” strategy.

Under the vaccine pass system, which started in mid-December, visitors to public places like restaurants, cafes, sports facilities and movie theaters must present proof of vaccination to gain access. (Proof of a recent negative P.C.R. test is also accepted.)

With the tightened rules, those who received two doses of the coronavirus vaccine must get a booster shot within six months, or their vaccine passes — issued 14 days after getting a second dose — will be void. (Negative test results issued within 48 hours will still be accepted.)

Fines or administrative action against violators will begin starting on Jan. 10, according to Yonhap News Agency. Both people who flout the rule and venues that fail to enforce it could face punishment.

7–day average

3,811

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

The vaccine pass system has spurred debate in South Korea over whether it is forcing people to take the vaccine. The country has fully vaccinated 83 percent of its population, according to Our World in Data, and on Monday Korean health officials reported 3,129 new daily cases of the virus. After weeks of record-breaking case counts, the country has had a 34 percent drop in daily cases over the past week.

Other countries have also begun adding expiration dates to a primary vaccine regimen. Starting in February, the European Union Covid Certificate will have a validity period of nine months, and booster shots will be mandatory for travel across several countries on the continent.

And beginning next week, the United Arab Emirates is set to bar people from leaving the country unless they have received three doses of a coronavirus vaccine, according to the state news agency WAM.

Britain announced a goal to administer boosters to all adults by the end of the month, and Israel last week approved of a fourth shot for people with weak immune systems and others at high risk, including those 60 and over, and health care workers.

The United States has been slower in its booster rollout, with only one-third of fully vaccinated adults receiving another shot as of mid-December. Chile will also offer its eligible residents a fourth coronavirus vaccine dose from February, President Sebastián Piñera announced. Health care workers, older people and those with chronic diseases would be given shots first.

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Credit…via Reuters

Vietnam has urged China, one of its major trading partners, to ease the measures local Chinese officials put in place at a key border crossing to fight the coronavirus, saying that the restrictions were leading to congestion and stranding thousands of trucks with goods.

Earlier this month officials in Guangxi, an autonomous region in southern China, moved to curb rising coronavirus cases by enforcing more stringent border rules, such as extra checkpoints, mass testing and 24-hour security patrols, and suspending border gate operations and fruit imports.

Those measures have disrupted supply chains in Vietnam, “adversely impacted the bilateral trade and caused great losses to businesses and people of both sides,” according to the state-run Vietnam News Agency.

7–day average

16,062

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

Vietnamese and Chinese trade officials held talks online and by phone to address the congestion late last month, V.N.A. reported. Vietnamese officials suggested “restoring customs clearance at the border gates and increasing the time for customs clearance,” the agency reported. Guangxi officials said they would ease customs clearance and convey other proposals to more senior officials, according to local news outlets.

Fruit exports from Thailand to China — such as durians and longans — have also been held up by the tightened controls at Guangxi, Thai officials said in a statement on Sunday.

After urgent talks with Thai officials, the Chinese authorities agreed to open another land checkpoint, the Pingxiang railway crossing in Guangxi, to allow Thai fruit into the country starting Tuesday, according to the Thai Office of Agricultural Affairs at Guangzhou.

Drivers, cars and goods must be free of contamination or the Chinese authorities will immediately close the checkpoint again, Thai officials said.

More than two million tons of Thai fruit worth $4.4 billion were exported to China from January to October 2021.

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Credit…Chang W. Lee/The New York Times

As a surge of coronavirus cases driven by the Omicron variant takes a growing toll on live performance, the Public Theater announced recently that it would cancel its Under the Radar festival, originally scheduled to begin on Jan. 12.

In a statement, the theater cited “multiple disruptions related to the rapid community spread of the Omicron variant,” including effects on staff availability, cancellations by artists and audience members, flight interruptions and visa processing delays.

Mark Russell, the festival’s director, said in a video interview that his team had worked on plans to streamline Under the Radar — the Public’s annual showcase for experimental work, and one of several New York festivals that have formed around the Association of Performing Arts Professionals conference — so that it could proceed despite the surge. But on Thursday morning, Russell said, he took stock of the test positivity rate and number of cases in New York, and decided it would be irresponsible to press on.

“It was not a time for a festival,” he said. “A festival is a celebration. It’s supposed to be a coming together to celebrate this work, and it was not going to be a celebration.”

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Credit…Courtesy Coalition for the Homeless

New York City is doubling the capacity of its free quarantine hotel program for people with the coronavirus, the agency that runs the program said Monday, after complaints from people who said their attempts to get a room through a city hotline met with endless waits on hold and delays of days for the rooms themselves.

A spokesman for the city’s Test and Trace Corps, which runs the quarantine program, said in an email Monday, “We will have nearly a thousand beds available this week, and will continue to scale as needed.”

The city has also been dealing with problems in a separate quarantine hotel program for people in homeless shelters after 11 women with the coronavirus were crammed into one room with just a few mattresses on the floor and some chairs.

As the number of new virus cases in the city has skyrocketed, the spokesman, Adam Shrier, said that demand for the hotels had “quickly increased due to the rapidly transmissible Omicron variant.”

He said that program had “several hundred beds available,” even as “our work force is suffering the same kind of illness and exposure as our other colleagues on the frontlines.” But he declined to say whether there was a wait for rooms, citing agency policy not to “disclose information about our locations or guests to protect their confidentiality.”

Nearly 30,000 people have stayed in hotels since the program started in June 2020. The city calls it “the only free, major hotel isolation program in the country.”

But four people who tried to take advantage of the main hotel-quarantine system told The New York Times late last week that they had either waited days before getting a room, given up and paid for one themselves, or been stuck on hold for hours on a city hotline without anyone ever picking up. Others posted on Twitter about long waits.

Brittny Gaston of Brooklyn, 26, a medical assistant, said that five days after she requested a hotel room and was not given one, she finally spoke to someone, only to be told that she no longer qualified for the program because she no longer needed to quarantine, even though she still had Covid-19 symptoms and two people in her household had underlying health issues.

“I really wanted to cry on the phone,” she said, adding that when she had Covid last February, she was able to get a quarantine hotel room without delay.

Inside a homeless shelter in Brooklyn last week, meanwhile, 11 women who had tested positive for the virus were crowded into a small room, two of the women said.

One of the women, Anna Ortiz, who has chronic asthma, heart problems and uses a walker, said she had to sleep on an uncarpeted floor without a blanket or pillow.

“I felt like I was being treated like an animal,” said Ms. Ortiz, 51.

The city Department of Homeless Services described that situation as an “isolated incident” caused by the nonprofit that operates the shelter, Camba.

Isaac McGinn, a spokesman for the Department of Homeless Services, said that Camba staff had not followed proper procedure and that the city had “conveyed to providers and staff the proper process for connecting clients who need it to isolation services to prevent this from happening.” He said that the system had abut 160 vacant beds in isolation units for people who are infected and another 210 beds in quarantine rooms for people who were exposed.

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Credit…Frederic J. Brown/Agence France-Presse — Getty Images

Laura Parker Russo, a 54-year-old public-school science teacher in Nassau County, N.Y., was arrested after being accused of giving a minor a Covid-19 vaccine without parental consent. She has since been removed from the classroom and is scheduled to appear in criminal court on Jan. 21.

According to a news release from the Nassau County police, on New Year’s Eve a 17-year-old was at Ms. Russo’s house in Sea Cliff, on Long Island, and she gave him a dose of what appeared to be a Covid vaccine. He later went home and told his mother, the release said, and the mother said she did not authorize the vaccination. She called the police, who then arrested Ms. Russo.

The police did not say how she obtained the vial.

Ms. Russo is not authorized to administer vaccines, the police said. She is a teacher at Herricks High School in New Hyde Park, according to a biography on the school’s website. She has since been reassigned, Fino M. Celano, the superintendent of Herricks Public Schools, said in a statement.

Ms. Russo did not respond immediately to an email sent by The New York Times.

The majority of states, including New York, require parental consent for Covid vaccinations. Some parents have prevented their children from getting inoculated because of concerns about possible side effects and general anxiety about the newness of the shots.

Scientists say the vaccines are safe for children, and they urge vaccinating them because children are able not only to contract the virus and spread it, but can also experience serious illness. The spread of the highly contagious Omicron variant has led to an increase in pediatric hospitalizations.

And because broad immunity cannot be reached unless minors are vaccinated, federal and state officials hope that more parents will vaccinate their children, especially as many students return to school.

Coronavirus cases have increased 301 percent in Nassau County in the past two weeks, according to The New York Times’s tracker. Hospitalizations have risen 47 percent in Nassau County in the past two weeks.

Seventy-six percent of residents in Nassau County are vaccinated, according to The Times’s tracker. Roughly 72 percent of 12- to 17-year olds in the county are fully vaccinated, according to state data.

There is no statewide Covid vaccine mandate for schoolchildren in New York. But some private schools require vaccination, and New York City requires it for certain sports and extracurricular activities.

In September, Los Angeles became the first school district to mandate vaccines for children 12 and older, with a plan to require vaccination by Jan. 10, but those plans have since been delayed. The Washington, D.C., Council voted to mandate vaccines for students 16 and older starting March 1.

“This is a major source of tension between what is important for public health and what is important in terms of individual liberties and parental autonomy,” said Denis Nash, an epidemiologist at the CUNY Graduate School of Public Health and Health Policy.

Schools require other vaccines for enrollment, like vaccination against measles.

“That’s the big question: Does Covid-19 fall into the same category as some of these other vaccine preventable diseases that we do require for school entry or does it not?” Dr. Nash said.