U.S. Health Worker Mandate Deadlines Loom as Omicron Overwhelms Hospitals

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Credit…Shannon Stapleton/Reuters

Health care workers in two dozen states must be fully vaccinated against the coronavirus by March 15 after a Supreme Court decision last week, a ruling that has left some already understaffed hospital systems bracing to possibly lose workers just as the highly contagious Omicron variant is inundating them with patients.

The new guidance was issued on Friday by the Centers for Medicare & Medicaid Services after the court upheld President Biden’s vaccine mandate for health care workers. It will affect about 10 million people at about 76,000 health care facilities participating in the Medicaid and Medicare program, including hospitals and long-term care facilities.

Experts say mandates are effective in persuading more people to become vaccinated, which they say is essential to helping prevent the spread of the virus. And President Biden has continued to push for more vaccinations and testing, reiterating that schools should remain open and the time for lockdowns was over.

“We’re moving toward a time when Covid-19 won’t disrupt our daily lives,” Mr. Biden said at a news conference Wednesday. He called a recent Supreme Court decision to block a vaccination-or-testing mandate for large private employers “a mistake.”

The C.D.C.’s guidance on Friday meant that health care workers in 24 states where vaccine mandates were not yet in effect must receive at least one shot of a coronavirus vaccine within 30 days and must be fully vaccinated by March 15, a spokesman for the Centers for Medicare & Medicaid Services said.

The states affected are Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming. For these states, the federal vaccine requirement had been blocked by a lower court.

The guidance does not yet apply to Texas, where a preliminary injunction still prevents such requirements.

The Supreme Court’s decision does not affect timelines already in place for the other 25 states, Washington, D.C., and U.S. territories, where health care workers must by fully vaccinated by Feb. 28, according to the Centers for Medicare & Medicaid Services.

The requirements come as hospitals across the country are being pushed to their limits by a steep rise in cases and staff shortages. Many health care workers are falling ill with the virus and others who quit under the pressure of the pandemic have not been replaced.

Local and regional hospitals, as well as multistate hospital chains, have wrestled with resistance to vaccination among some nurses and other staff. Many of the larger groups, including the Cleveland Clinic and HCA Healthcare, suspended their own vaccination mandates last month while they awaited the Supreme Court’s decision.

While a study by federal researchers found that 30 percent of hospital workers were not fully vaccinated as of mid-September, overall immunization rates rose in the following months as mandates took effect.

Some health care systems, such as HCA Healthcare, have acknowledged that the mandate could pose a challenge. HCA Healthcare, which employs about 275,000 workers, said in a statement last week that if workers refused to be vaccinated, that “could compromise our ability to serve our communities and provide care to patients under the Medicare and Medicaid programs.”

A spokesman for HCA added that more than 90 percent of its workers were vaccinated or had qualified for an exemption.

Although there are signs that new cases have peaked in some Northeastern states, such as New York, they remain dangerously high across the country. And hospitalizations nationwide have broken records.

Dr. Josh Sharfstein, vice dean of the Johns Hopkins Bloomberg School of Public Health whose work focuses on promoting public health strategies, said the policy could create “potential challenges in the short term” with hospitals that are short staffed.

“It may require some flexibility to get through this period,” he said, “but that doesn’t make the underlying policy less than a good idea.”

Dr. Peter Hotez, a pediatrician and scientist at the Baylor College of Medicine who studies vaccines, said the mandate was the best way to keep medical workers healthy.

“Vaccines represent the most assured way to keep the health care work force, actually in the health care work force,” he wrote in an email.

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New Jersey Mandates Boosters for Health Care and Prison Workers

Gov. Philip D. Murphy of New Jersey said workers in high-risk congregate settings like hospitals, prisons and nursing homes would be required to be fully vaccinated, including a booster. He said there would no longer be an option to satisfy the mandate through testing.

I am signing an executive order today requiring all workers in health care settings and high-risk congregate living facilities, including our correction — correctional facilities, to be up to date on their vaccinations. That means both primary course and booster with no test out option. It is important — it is important to remember that for those working in health care settings, the test out option is already coming to an end due to the Biden administration’s vaccine mandate, which the U.S. Supreme Court upheld last week. But the science tells us that it’s no longer good enough to just receive your primary series, as being boosted as necessary to protect yourself and those around you. The only exemptions will be granted for disability or other medical reasons, or for deeply held religious beliefs. Anyone found in non-compliance will be subject to their workplaces disciplinary process up to and including termination of employment.

Gov. Philip D. Murphy of New Jersey said workers in high-risk congregate settings like hospitals, prisons and nursing homes would be required to be fully vaccinated, including a booster. He said there would no longer be an option to satisfy the mandate through testing.CreditCredit…Bryan Anselm for The New York Times

Employees of New Jersey hospitals, nursing homes, prisons and jails will be required to be fully vaccinated against the coronavirus — with a booster — or risk losing their jobs, Gov. Philip D. Murphy announced on Wednesday.

Workers at most medical facilities in the state were already required to be vaccinated by Feb. 28 under President Biden’s mandate for health care workers at entities receiving federal money, which recently withstood a Supreme Court challenge.

But Governor Murphy’s requirement goes further, mandating health care workers to get booster shots as well, and it represents a significant shift for the state’s prison and jail system, where staffing levels are already strained and vaccination is well below the statewide rate.

Mr. Murphy, a Democrat who was sworn in to a second term on Tuesday, had given workers the option to satisfy the state’s earlier vaccination requirement by getting regularly tested for the coronavirus.

“Testing out will no longer be an option,” Mr. Murphy said outside a testing site in South Jersey. “We are no longer going to look past those who continue to put their colleagues, and, perhaps, I think, even more importantly, those who are their responsibility, in danger of Covid. That has to stop.”

The governor said that there were no plans to expand the new rule, issued by executive order, to the state’s teachers.

New Jersey’s requirement comes two weeks after New York State said it would require health care workers to get booster shots within two weeks of becoming eligible for one. California has a similar requirement that will go into effect on Feb. 1.

Mr. Murphy acknowledged the recent decline in new virus cases, but noted that people who had not received booster shots were far more likely to be hospitalized with Covid-19 than residents who were fully vaccinated. New infections in New Jersey, while lower than they were a week ago, are still at some of the highest levels since the start of the pandemic.

“The booster rates are unacceptable,” he said.

In some settings, the policy change will make little difference. Many big private hospital chains in New Jersey already require staff members to be fully inoculated.

But it is expected to have a significant impact on the correctional system.

William Sullivan, the president of a union that represents about 5,000 prison guards, said his phone began ringing with calls from angry officers soon after the governor’s announcement.

He said roughly 40 percent of prison employees report being fully or partly vaccinated — less than half the statewide rate of residents who have received at least one dose of a coronavirus vaccine.

“They’re skeptical of people mandating, forcing them to do things,” Mr. Sullivan said, noting that prisoners in the state facilities are not required to be vaccinated.

A rise in early retirements, in part caused by pandemic fatigue, has left the prison system at “critical staffing levels,” he said.

“What happens if 60 percent of our 5,000-strong members won’t comply?” he asked.

Unvaccinated health care workers have until Jan. 27 to get their first dose; employees in prisons and jails have until Feb. 28. Those who do not comply will be subject to disciplinary action, including termination, Mr. Murphy said.

Republicans bristled at the governor’s decision to issue the mandate by executive order, bypassing the Legislature.

“We’re at the stage of the pandemic where there’s no excuse to circumvent the legislative process,” said State Senator Holly Schepisi, Republican of Bergen County.

She said the mandate could intensify existing shortages of nurses and other health care workers at hospitals.

“After nearly two years, they’re tired,” Ms. Schepisi said in a statement. “Instead of giving them extra support, they’re getting another new mandate.”

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Credit…Doug Mills/The New York Times

WASHINGTON — Two years into the coronavirus pandemic, Americans who have had a hard time getting their hands on masks and at-home tests are suddenly being showered with offers of freebies — courtesy of taxpayers and the Biden administration, which had come under sharp criticism for not acting sooner.

On Wednesday, the administration announced that it would make 400 million nonsurgical N95 masks available free of charge at community health centers and retail pharmacies across the United States. The White House said that to “ensure broad access for all Americans,” there would be a limit of three masks per person.

The news came a day after the administration rolled out covidtests.gov, its new website where Americans can order at-home coronavirus tests at no cost.

Taken together, the moves represent a stepped-up effort by the White House to combat Omicron, the fast-moving coronavirus variant that first appeared in November and has fueled a spike in cases, hospitalizations and deaths across the country. But some public health experts said that while the efforts were welcome, they were too late.

“It will not be as impactful as it would have been had we done it at the beginning of the Omicron surge or the beginning of the Delta surge,” said Julia Raifman, a health law and public policy expert at the Boston University School of Public Health.

The White House called the distribution of masks the “largest deployment of personal protective equipment in U.S. history.” Wednesday’s announcement came days after the Centers for Disease Control and Prevention updated its mask guidance to acknowledge that cloth masks do not offer as much protection as surgical masks or respirators.

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Credit…Randy Hoeft/The Yuma Sun, via Associated Press

Arizona officials on Wednesday threatened to take legal action against the Biden administration if the Treasury Department follows through on a warning that it could withhold future pandemic aid payments to the state, which has been using the money to undercut mask requirements in schools.

The response was the latest escalation in a wide-ranging battle between the Biden administration and some Republican-led states, whose officials have argued that the federal government should not control how they spend their share of the $1.9 trillion stimulus funds that Congress approved last year.

In a letter to Treasury Secretary Janet L. Yellen on Wednesday, Arizona’s attorney general said that a Treasury Department warning about the funds last week was “blatant federal encroachment” and that the state was prepared to take the matter to court.

“We will not be intimidated by the heavy-hand of the Biden Administration forcing Arizona to comply with ambiguous and unrealistic national standards created and ‘enforced’ by federal bureaucrats,” Mark Brnovich, Arizona’s attorney general, wrote to Ms. Yellen.

Arizona was awarded $4.2 billion of pandemic relief money last year and has received about half of that so far. States, cities and tribal governments were allocated $350 billion out of the $1.9 trillion relief package.

Many Republican-led states have attempted to use the money in ways that the Biden administration says are at odds with the intent of the law, such as cutting taxes or undercutting initiatives that are intended to promote public health.

Gov. Doug Ducey, a Republican, announced last year that he was rolling out two education programs intended to undercut mask requirements that some school districts in the state put in place.

A $163 million program using the federal relief money provides up to $1,800 in additional funding per pupil in public and charter schools. However, these schools must be “following all state laws” and open for in-person instruction. Schools that required masks would not be eligible.

A separate $10 million program funds vouchers worth up to $7,000 to help poor families leave districts that require face coverings or impose other Covid-related “constraints.”

The Treasury Department said that the programs undermine evidence-based efforts to stop the spread of Covid-19. It said last week that if Arizona does not cease or change the programs within 60 days, it could start a process to recoup the money that is being misused. It also said that it could hold back the second installment of relief money that Arizona is scheduled to receive this year.

Mr. Brnovich noted in his letter that Arizona is already involved in a lawsuit that several other Republican-led states filed last year to block a requirement in the law that states cannot use pandemic relief money to subsidize tax cuts. He suggested that restricting how the state can use the money on school programs is also a threat to state sovereignty.

“It shouldn’t surprise anyone that the U.S. Department of Treasury, under your leadership, is again trying to overstep its constitutional bounds and dictate to Arizona how our state should run and fund our schools,” Mr. Brnovich said.

The Treasury Department did not immediately respond to a request for comment.

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Credit…Ralph Tedy Erol/Reuters

Known coronavirus cases are spreading “more actively than ever” in the Americas, and particularly in the Caribbean island countries, World Health Organization officials said Wednesday.

The Caribbean countries “are witnessing the steepest increase in Covid-19 infections since the start of the pandemic,” Dr. Carissa F. Etienne, the director of the Pan American Health Organization, a division of the W.H.O., said at a news conference.

Cases have at least doubled in more than 17 countries and territories in the Caribbean, “which is especially concerning as hospital capacity in many islands remains limited,” Dr. Etienne said.

Across the Americas, she said, Covid-19 “is spreading more actively than ever before” and leading to “new peaks.”

Several countries in Central and South America also are suffering sharp increases in cases, and hospitalizations are growing in a few of them, including Paraguay, Uruguay and Argentina.

The increase in cases in the Caribbean is worrisome partly because of high levels of vaccine hesitancy in the region, driven by “fake news, rumors about vaccines,” Dr. Jarbas Barbosa, the P.A.H.O.’s assistant director, said.

In Latin America and the Caribbean, 61 percent of the population has been fully vaccinated against Covid-19, a percentage that P.A.H.O. aims to increase to 70 percent by the middle of the year, Dr. Etienne said.

Haiti lags all others in the region, with less than 1 percent of its population fully vaccinated. The second least-vaccinated country in the Caribbean and Latin America is Jamaica, at 20 percent.

As cases accelerate and testing capacity becomes more strained, countries should give priority to testing people who have symptoms and are more likely to spread the virus, Dr. Etienne and others said.

Demand for virus testing “is higher than ever,” particularly because the region is also going through flu season. “So it’s critical that countries use tests smartly,” Dr. Etienne said.

Dr. Sylvain Aldighieri, the P.A.H.O.’s incident manager for Covid-19, said the organization was “making a call to the rational use of resources” so tests are used efficiently.

The most effective way for countries to increase testing is to use rapid antigen tests that can offer results quickly and do not require specialized training. But these simple at-home tests are less accurate at confirming infections than the more complex tests used at clinics and hospitals.

People “must be very careful with the indiscriminate use” of at-home antigen tests, Dr. Aldighieri said, mainly because of “the possibility of an inadequate sample and a false-negative result that can generate a false sense of security.”

Daniel Politi

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All primary and secondary schools in Algeria will close for 10 days starting on Thursday, in an effort to rein in a rise in coronavirus cases, the government announced.

The statement, released on Wednesday by the national news agency, described the school closure as a way to stave off “the rapid spread of Covid-19 infections, especially in schools.”

Universities will be allowed to decide for themselves whether to close, depending on their exam schedules, the government said.

Algeria has taken a strict approach to combating the virus throughout the pandemic. President Abdelmadjid Tebboune ordered all schools and universities closed in mid-March 2020 following the first report of a Covid-related death in Algeria. The country’s borders were kept closed for more than a year before being partly reopened last summer.

In contrast, some other countries, like France, have bet that they can keep schools open while managing surges of new coronavirus variants.

7–day average

730

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.

Algeria, with a population of about 44 million, reported about 1,400 new coronavirus cases on Wednesday, well above its recent average of about 620 cases a day. The Pasteur Institute of Algiers, a health research center, said last week in a statement that while the Delta variant was still dominant in the country, accounting for some 67 percent of new cases, the Omicron variant was on the rise.

The health ministry statement on Wednesday stressed the importance of vaccination and noted that 94 percent of the people who had died from Covid-19 complications in the country had not been vaccinated. But so far, only about one in eight residents has been fully vaccinated.

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Credit…Alex Menendez, via Associated Press

Florida’s top public health official in Orlando has been placed on administrative leave after sending an email to his employees noting their lackluster coronavirus vaccination rates and urging them to get the shots.

The official — Dr. Raul Pino, the administrator for the Florida Department of Health’s office in Orange County — sent the email on Jan. 4, in the thick of a surge in cases caused by the Omicron variant.

In the email, Dr. Pino said that he had asked a staff member to pull out the vaccination rates for the office, and that the figures were alarming: Of the office’s 568 employees, only 219 — fewer than half — had completed a full vaccination series, and just 77 of them had received a booster shot, a number he called “SUPER LOW.”

“I am sorry, but in the absence of reasonable and real reasons, it is irresponsible not to be vaccinated,” Dr. Pino wrote in the email, which was first reported by WFTV, the local ABC News affiliate. He called the office’s vaccination rate “pathetic.”

“I have a hard time understanding how we can be in public health and not practice it,” he added.

Jeremy T. Redfern, the press secretary for the Department of Health, confirmed in a statement that Dr. Pino was on administrative leave, and that the department was “conducting an inquiry to determine if any laws were broken in this case.”

The decision to get vaccinated “is a personal medical choice that should be made free from coercion and mandates from employers,” Mr. Redfern wrote.

Florida has enacted a law banning Covid vaccine mandates, including for government employees. Gov. Ron DeSantis, a Republican, has raised his national political profile by curtailing virus restrictions of all kinds in the state.

It is unclear whether Dr. Pino was placed on leave for urging employees to get vaccinated, for compiling their vaccination status, or for both. The Department of Health did not respond to specific questions about the matter, including whether Dr. Pino’s leave is paid or unpaid. Dr. Pino did not respond to calls seeking comment.

In Florida, local public health offices are centrally run by the state Department of Health, not by individual counties as in many other states.

Dr. Pino, a former commissioner of the Connecticut Department of Public Health, was appointed to head the Orange County health office in 2019. He is Cuban-American and speaks Spanish as well as English, an asset in multicultural Orlando.

Dr. Pino has been a fixture at regular news briefings updating Orange County residents about the Covid-19 pandemic, making him one of the most visible public health officials in the state. His counterparts in other large counties have tended to appear mostly at county commission meetings or to avoid the spotlight altogether.

The news briefings in Orlando have been organized by Mayor Jerry L. Demings, a Democrat, who has criticized Mr. DeSantis for impeding local governments from taking actions to limit the spread of the virus. A spokeswoman for Mr. Demings announced on Wednesday that the mayor had tested positive.

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Credit…Libby March for The New York Times

The Supreme Court’s ruling last week shutting down the Biden administration’s effort to enlist large employers in its vaccination campaign, experts said, would trigger a new wave of uncertainty about how companies keep workers safe from Covid-19.

Now Starbucks, with 9,000 U.S. coffee shops and 200,000 workers, has became one of the first major retailers to backtrack on vaccine plans since the ruling.

Starbucks told its employees in a memo on Tuesday that they would no longer be required to be fully vaccinated or submit to weekly coronavirus testing. Just two weeks earlier, the company had detailed the requirement and set a deadline of Feb. 9.

The Supreme Court’s decision did not prohibit companies from keeping their vaccine rules in place, and many will continue rolling out stringent Covid-19 safety protocols, especially as Covid case counts remain high.

Starbucks’s move to drop its vaccine-or-test deadline highlights how the court’s ruling has put the responsibility for determining vaccination rules squarely on employers. And companies face a patchwork of federal, state and local laws, which range from vaccine mandates that are stricter than the federal government’s to laws blocking companies from requiring workers to wear masks.

“For most employers, it has proved to be a day-to-day crisis because when they think they know the answer, the rules change,” said Domenique Camacho Moran, a labor and employment lawyer with the firm Farrell Fritz.

Retailers and their advocates had been among the most vocal critics of the federal government’s vaccine rule, saying it would have exacerbated their struggles to hire or hold on to workers when millions of unemployed Americans remain on the sidelines of the job market.

Some labor lawyers say they believe other companies will follow Starbucks in relaxing or undoing their company mandates.

“A lot of companies were pursuing the vaccine or test requirement only because they were being required to do so,” said Brett Coburn, a lawyer at Alston & Bird.

The Occupational Safety and Health Administration, at the request of President Biden, had issued its so-called emergency temporary standard in November. It told businesses with 100 or more workers to require employees to be vaccinated or test weekly.

John Culver, the chief operating officer at Starbucks, said in his memo Tuesday announcing the change in the company’s plans that more than 90 percent of Starbucks workers in the United States had disclosed their vaccination status and that “the vast majority” were fully vaccinated.

“I want to emphasize that we continue to believe strongly in the spirit and intent of the mandate,” Mr. Culver wrote.

The company’s move comes as it faces a growing effort among its work force to unionize. Two weeks ago, employees at a unionized Buffalo-area store walked out, protesting what they said were unsafe working conditions. Some said they were dismayed to see the vaccine rule dropped.

Starbucks Workers United, a union that represents two Buffalo-area stores, expressed frustration that the decision was made without their comment.

“Starbucks reversed their vaccine mandate without discussing the issue, or negotiating about it, with the unionized partners,” the union said in a statement.

For its part, Starbucks maintained that its vaccination requirement had been introduced only because of the federal government’s standard, which the Supreme Court then blocked.

“It was not our own independent policy,” said Reggie Borges, a spokesman for the company. “We knew OSHA was requiring it, the Supreme Court hadn’t ruled on it one way or the other and we needed to make sure our partners were supported and prepared to be in compliance.”

Some major employers, including Walmart and Amazon, had held off on issuing broad vaccine requirements while OSHA’s rule was entangled in legal proceedings. Others, including United Airlines and Tyson Foods, made their own rules. A November poll of 543 companies by the consulting firm Willis Towers Watson found that 57 percent either required or planned to require Covid vaccines, including 32 percent that would do so only if OSHA’s rule took effect.

“It’s pretty divided in corporate America,” said Amanda Sonneborn, a partner at the law firm King & Spalding. “There’s those that have chosen to do mandates on their own, those that were following the government’s mandate and those that challenged it.”

Companies weighing vaccine requirements have grappled with a number of factors, according to Ms. Sonneborn, including concerns about labor shortages, the political perception of mandates and the need to keep workers safe.

Starbucks said this month that workers would have to disclose their vaccination status by Jan. 10.

“It made me feel a little bit better knowing I was working with people who were vaccinated,” said Kyli Hilaire, 20, a barista who participated in the unionized store’s walkout over safety concerns.

“You see people every day, you work closely with them, there’s not much of an opportunity for distancing,” Ms. Hilaire said. “The number of customers coming into the space makes you cautious. I try to double mask, but sometimes it can be difficult to breathe.” Starbucks “strongly recommends” customers wear facial coverings in stores, and requires them where mandated by local laws.

Starbucks also announced a variety of new Covid-19 safety protocols on Tuesday. Workers are now required to wear three-ply medical grade masks, which the company said are available in stores, and isolation guidelines have been expanded to cover anyone who has been exposed to Covid-19, even if they are fully vaccinated.

The company continues to encourage its employees to get the vaccine and booster, and offers two hours of paid time off for getting the shots.

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Credit…Stefani Reynolds for The New York Times

WASHINGTON — In an unusual joint statement on Wednesday, Justices Sonia Sotomayor and Neil M. Gorsuch sought to rebut reports that Justice Gorsuch’s refusal to wear a mask at Supreme Court arguments has created tensions between them.

“Reporting that Justice Sotomayor asked Justice Gorsuch to wear a mask surprised us,” the statement said. “It is false. While we may sometimes disagree about the law, we are warm colleagues and friends.”

A few hours later, Chief Justice John G. Roberts Jr. issued his own statement. “I did not request Justice Gorsuch or any other justice to wear a mask on the bench,” he said.

Since the justices returned this month from their holiday break, all of them started to wear masks in the courtroom except Justice Gorsuch. At the same time, Justice Sotomayor, who has diabetes and had been the only member of the court to wear a mask since the justices returned to the bench in October, started to participate in arguments remotely from her chambers. Justice Sotomayor sits next to Justice Gorsuch on the bench.

The justices’ statement appeared to be carefully worded and seemed to be primarily directed at a report by Nina Totenberg of NPR on Tuesday attributed to “court sources.” In it, Ms. Totenberg said that Justice Sotomayor “did not feel safe in close proximity to people who were unmasked.”

Later on Wednesday, Ms. Totenberg said in a report addressing the justices’s statements that “NPR stands by its reporting.”

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Credit…Evert Elzinga/EPA, via Shutterstock

Dozens of theaters and museums in the Netherlands planned to open as hair salons and gyms on Wednesday in what was billed as a playful protest over a continued nationwide lockdown in the arts sector even as restrictions on some businesses were reduced.

The country entered a full lockdown in December, fearing that a rise in cases would overwhelm its relatively small intensive care capacity. And although the government relaxed some of the measures last week — reopening nonessential shops until 5 p.m. as well as gyms, hairdressers, nail salons and brothels — Prime Minister Mark Rutte said that cinemas, museums, theaters and concert venues would remain closed.

7–day average

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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.

In response, dozens of arts organizations joined a protest that they named “Theater Hairdresser,” in which theaters open as hair salons and some museums are opening their doors as gyms. The Van Gogh Museum in Amsterdam was offering beard trims, haircuts and manicures, with an option of “Van Gogh inspired nail art.”

“And waiting at the hairdresser’s has never been more fun,” the organizers’ website said, referring to events being organized at theaters involving several Dutch celebrities. People even received haircuts while listening to classical music at Amsterdam’s royal concert hall.

The Netherlands reported almost 243,000 new virus cases over the past week, up from almost 202,000 the week before, according to government data. But hospitalizations are falling: Last week, 647 Covid patients were admitted to the hospital, down from 940 the week before.

“The priority isn’t clear,” Sanne Wallis de Vries, a comedian who is an organizer of “Theater Hairdresser,” told a Dutch talk show on Tuesday, saying that she didn’t understand why theaters had to remain closed while stores were allowed to open.

Mayor Femke Halsema of Amsterdam said she that would not allow the protest and that lockdown rules would be enforced in the city.

But Ms. Wallis de Vries said: “This is only playful. This only fun.”

“What do you gain by prohibiting it?” she asked.

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Credit…Alex Welsh for The New York Times

Just after 1 p.m. on Tuesday last week, my phone buzzed with a text message from my mother: “Well, came down with cold, aches, cough etc over wknd.” She had taken an at-home coronavirus test. It was positive.

Having spent the past year writing about Covid-19 vaccines and treatments for The New York Times, I knew a lot about the options available to people like my mother. Yet I was about to go on a seven-hour odyssey that would show me there was a lot I didn’t grasp.

My mother, Mary Ann Neilsen, is fully vaccinated, including a booster shot, which sharply reduced the odds that she would become seriously ill from the virus. But she has several risk factors that worried me. She’s 73. She has twice beaten breast cancer.

Her age and cancer history made her eligible to receive the latest treatments that have been shown to stave off the worst outcomes from Covid. The trouble, as I knew from my reporting, was that these treatments — including monoclonal antibody infusions and antiviral pills — are hard to come by.

Demand for the drugs is surging as the Omicron variant of the coronavirus infects record numbers of Americans. But supplies are scarce. The two most widely used antibody brands don’t appear to work against Omicron, and the antiviral pills are so new and were developed so quickly that not many have reached hospitals and pharmacies.

I set out to track down one of two treatments: GlaxoSmithKline’s antibody infusion or Pfizer’s antiviral pills, known as Paxlovid. Both have been found to be safe and highly protective against severe Covid when given to high-risk patients within a few days of the onset of symptoms. Both are potent against Omicron.

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Credit…Jim Wilson/The New York Times

Previous infection with the coronavirus appeared to provide stronger protection against the Delta variant than did vaccination in a large sample of patients, the Centers for Disease Control and Prevention reported on Wednesday.

But there are significant health risks to infection, and in the long term, vaccination still offers the best defense against the virus, the researchers said.

The data were gathered before the widespread rollout of booster shots and the emergence of the Omicron variant, so the findings may not be relevant to the current surge, the agency cautioned.

“These findings cannot be generalized to the current Omicron wave,” Benjamin Silk, an epidemiologist at the C.D.C., told reporters on Wednesday. “It’d be like comparing apples and oranges.”

By the end of November, one in six U.S. deaths from Covid were occurring in New York and California. Scientists analyzed testing, surveillance and immunization data from the two states to gauge the level of protection offered by vaccines and previous infection.

Unvaccinated people were at the highest risk of infection or severe illness with Covid throughout the study period, the scientists found. But the relative protection afforded by vaccination or prior infection changed with the arrival of the Delta variant.

During the week beginning May 30, 2021, vaccinated people who had not experienced Covid had the lowest risk of coronavirus infection and hospitalization, followed by unvaccinated people who had been previously diagnosed with Covid.

By the week beginning Oct. 3, however, vaccinated people with a prior diagnosis fared best against the Delta variant. Unvaccinated people with a history of Covid also had lower rates of infection and hospitalization than those protected by vaccines alone.

The data are consistent with trends observed in international studies, the researchers said.

Waning of vaccine-derived immunity may explain why vaccinated people were less protected from infection with the Delta variant than those who had a prior diagnosis, the researchers said.

A recent study of employees at the Cleveland Clinic suggested that while vaccination does not add much benefit to a prior bout for the first many months, it may offer better protection against symptomatic illness over the long term than does immunity from a previous infection.

“The totality of the evidence suggests really that both vaccination and having survived Covid each provide protection against infection and hospitalization,” said Eli Rosenberg, deputy director for science at the New York State Department of Health.

But having Covid carries significant risk, so “becoming vaccinated and staying up to date with boosters really is the only safe choice,” he said.

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Credit…An Rong Xu for The New York Times

As Broadway continues to reel from the economic effects of the coronavirus pandemic, Gov. Kathy Hochul is proposing to expand and extend a pandemic tax credit intended to help the commercial theater industry rebound.

Ms. Hochul on Tuesday proposed budgeting $200 million for the New York City Musical and Theatrical Production Tax Credit, which provides up to $3 million per show to help defray production costs.

“They were starting to recover before Omicron, and then, as you have all seen, a lot of these performance venues had to shut down again, and those venues are critical for the economy,” the state budget director, Robert Mujica, told reporters.

The tax credit program, which began last year under Gov. Andrew Cuomo, was initially capped at $100 million. Early indications are that interest is high: Nearly three dozen productions have told the state they expect to apply, said Matthew Gorton, a spokesman for Empire State Development, the state’s economic development agency.

The Hochul administration decided to seek to expand the tax credit program — and to extend the initial application deadline, from Dec. 31, 2022, to June 30, 2023 — as it became clear that Broadway’s recovery from its lengthy pandemic shutdown would be bumpier than expected.

Shows began resuming performances last summer, and many were drawing good audiences — Ms. Hochul visited “Chicago” and “Six” in October, while Mr. Gorton saw “The Lehman Trilogy” and “To Kill a Mockingbird.”

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Credit…Samuel Aranda for The New York Times

Western European countries now have some of the highest coronavirus infection rates in the world. In Spain, new cases rocketed from an average of fewer than 2,000 a day in early November to more than 130,000 daily in the past week.

And while the country has tightened some of its rules in recent weeks, its message to tourists has remained largely the same as before the surge: Please come.

Like other countries, Spain is trying to balance how much economic pain it can tolerate as it tries to keep its people safe. But here, memories of recent financial ruin are especially raw. The Spanish economy contracted more than 11 percent in 2020 — the worst decline since the Civil War of the 1930s.

Yet keeping the door open to visitors comes with risks that are well remembered in Spain. In 2020, eager to open to tourism, Spain relaxed its restrictions before summer, helping trigger a deadly second wave of the coronavirus.

7–day average

129,364

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 number of international tourists fell from around 84 million in 2019, to roughly 19 million in 2020, a drop of more than 77 percent.

Spain’s government has said that with its successful vaccination campaign, the country has already taken the biggest measures it can toward curbing the impact of the virus.

“We are going to have to learn to live with it as we do with many other viruses,” Prime Minister Pedro Sánchez said recently.

The island of Lanzarote, which sits 80 miles off the northwestern coast of Africa, offers a window into tourism where the coronavirus is accepted as endemic and the circulation of foreign visitors continues much as it did before the pandemic.

Six months ago Juan Antonio Torres Díaz took over as the owner of Palacio Ico, a restaurant and hotel, betting that there would be a tourism recovery. “This has to be the way ahead, Spain has to accept that the virus isn’t going away and that we need to continue on doing business,” he said.

Nicholas Casey and José Bautista