Barbara Sibley’s four New York restaurants had already weathered the city’s initial Covid-19 wave, the prevaccine surge last winter and this summer’s Delta spike when last weekend it finally happened: Fearing an outbreak and struggling with staffing after one of her workers got sick with Covid, she temporarily shut down one of her locations.
That was only the start of Ms. Sibley’s worries. She also had to weigh how long the employee, who was fully vaccinated, should isolate before returning to the job. And the messaging from public health experts was not clear-cut.
In the early days of the pandemic the Centers for Disease Control and Prevention recommended that most people who tested positive for the coronavirus isolate for 14 days. It later reduced its recommended isolation period to 10 days. But these policies were based on data from unvaccinated individuals and were implemented before the widespread availability of rapid tests. An increasing number of health and policy professionals now suggest that vaccinated people can end their isolation after five to seven days, so long as they are not symptomatic and they test negative.
On Thursday, the C.D.C. reduced, in some circumstances, the number of days it recommends that health care workers who test positive for the coronavirus isolate themselves, but it did not address other businesses.
said on Friday that fully vaccinated critical workers could return to work five days after testing positive, so long as they have no symptoms or their symptoms are resolving and they have had no fever for 72 hours. Those workers will also have to wear a mask, she said.
Omicron has intensified staffing shortages across industries, and the spike in cases has disrupted travel during the holidays, stranding thousands of customers and underscoring the economic toll of employees needing to isolate. Already, some economists are warning about the potential impact that shutdowns can have on consumer spending.
Delta Air Lines asked the C.D.C. on Tuesday to cut isolation time to five days for fully vaccinated people, warning that the current 10-day period may “significantly impact” operations. It was followed by JetBlue and Airlines for America, a trade group that represents eight airlines.
eliminated weekly testing for vaccinated players who are asymptomatic, with its chief medical officer saying the pandemic had reached a stage in which it’s unnecessary for vaccinated players to sit out if they feel healthy.
canceled performances through Christmas. CityMD, the privately owned urgent care clinic, temporarily shut 19 sites in New York and New Jersey because of staffing shortages. At least a dozen New York restaurants have temporarily closed in response to positive tests.
“I think lots of companies are looking at a lot of disruption in the next month and trying to put in policies right now, because they know their employees are going to get infected in very high numbers,” said Dr. Jha.
The United States might take direction from policy shifts abroad. Britain said on Wednesday that it was reducing to seven from 10 the days that people must isolate after showing Covid-19 symptoms.
After the British government lifted nearly all its pandemic restrictions in July, hundreds of thousands of workers were pinged by the National Health Service’s track-and-trace app and told to isolate because they had been exposed to the coronavirus. Businesses complained of being short-staffed, and economists said the “pingdemic” may have slowed economic growth in July.
In the United States, new tools to help manage through the pandemic are on the way.
The Food and Drug Administration this week authorized two pills to treat Covid, from Pfizer and Merck. Those treatments have been shown to stave off severe disease and have potential to reduce transmission of the virus, though supply of both pills, especially Pfizer’s, will be limited in the next few months.
President Biden said on Tuesday that he planned to invoke the Defense Production Act to buy and give away 500 million rapid antigen tests, a crucial tool in detecting transmissibility, though those tests will not be available for weeks or longer.
If a combination of the antiviral pills and rapid tests is able to get individuals back to work faster, “that’s a big economic point,” said Dr. Eric Topol, a professor of molecular medicine at Scripps Research.
Molly Moon Neitzel, who owns an ice cream business in Seattle with just over 100 employees, said she had kept guidelines for isolation conservative.
“I’m on the side of protecting people over getting them back to work right now,” she said, adding that if it were summer and her business were busier, she might consider a shorter isolation period. “It’s the slowest time of the year for an ice cream company, so that is in my favor.”
Some public health experts worry that if the C.D.C. shortens its guidelines on isolating, employers could pressure workers to get back before they’re fully recovered.
“What I don’t want to see happen is for this to be used as an excuse to force people to come back while they are unwell,” Dr. Ranney of Brown said.
And even with clearer guidelines, putting policies in place can be tricky. While some experts suggest different isolation rules for vaccinated and unvaccinated employees, some companies do not yet have a system for tracking which of their workers have gotten a vaccine. The question of whether the C.D.C. will change its definition of fully vaccinated to include booster shots adds another layer of complexity.
It’s not just sick employees who may have to stay home: Companies are also grappling with whether vaccinated workers should quarantine after exposure to someone with Covid-19, which C.D.C. guidelines do not require.
“It becomes a challenge for employers to choose between providing a safer environment and keeping staff intact, or going with the C.D.C. guidance,” said Karen Burke, an adviser at the Society for Human Resource Management.
But Judge Joan L. Larsen, a Trump appointee, dissented, arguing — as had the Fifth Circuit panel before her — that the agency had exceeded its legal authority.
The Coronavirus Pandemic: Key Things to Know
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Pfizer vaccine in younger children. The company said that a low dose of its coronavirus vaccine did not produce an adequate immune response in 2- to 5-year-olds in ongoing clinical trials. The setback threatens to keep the vaccine from younger children for longer than many had hoped.
U.S. surpasses 800,000 deaths. This past week, Covid deaths in the United States surpassed 800,000 — the highest known number of any country. About 75 percent of those deaths have involved people 65 or older. One in 100 older Americans has died from the virus.
“The mandate is aimed directly at protecting the unvaccinated from their own choices,” Judge Larsen wrote. “Vaccines are freely available, and unvaccinated people may choose to protect themselves at any time. And because the secretary likely lacks congressional authority to force them to protect themselves, the remaining stay factors cannot tip the balance.”
All of the judges on the Fifth Circuit panel that had blocked the rule were conservative Republican appointees.
Challengers to the decision could appeal directly to the Supreme Court, which is controlled by a conservative bloc of six Republican appointees. (The Supreme Court this month refused to block New York’s requirement that health care workers be vaccinated against the coronavirus even when they cite religious objections.)
Challengers could also appeal to the full U.S. Court of Appeals for the Sixth Circuit. Of its 16 sitting judges, five were appointed by Democrats and 11 were appointed by Republicans. (However, one of the Republican appointees, Judge Helene N. White, was originally a nominee of a Democratic president, Bill Clinton, before being renominated by a Republican one, George W. Bush, as part of a political deal.)
Conditions on the ground are rapidly changing, with new cases surging, apparently because of the more-infectious Omicron variant. The Justice Department last month warned that keeping the mandate from coming into effect “would likely cost dozens or even hundreds of lives per day, in addition to large numbers of hospitalizations, other serious health effects and tremendous costs.”
The OSHA rule, alongside a separate requirement for federal contractors, has helped drive a number of large companies to announce a form of vaccine mandate, including Procter & Gamble, IBM and American Airlines. Others, like Tyson Foods and Google, introduced mandates on their own, in the face of the rising risk of the Delta variant.
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Scott Kirby, the chief executive of United Airlines, reached a breaking point while vacationing in Croatia this summer: After receiving word that a 57-year-old United pilot had died after contracting the coronavirus, he felt it was time to require all employees to get vaccinated.
He paced for about half an hour and then called two of his top executives. “We concluded enough is enough,” Mr. Kirby said in an interview on Thursday. “People are dying, and we can do something to stop that with United Airlines.”
The company announced its vaccine mandate days later, kicking off a two-month process that ended last Monday. Mr. Kirby’s team had guessed that no more than 70 percent of the airline’s workers were already vaccinated, and the requirement helped convince most of the rest: Nearly all of United’s 67,000 U.S. employees have been vaccinated, in one of the largest and most successful corporate efforts of the kind during the pandemic.
The key to United’s success, even in states where vaccination rates are at or below the national average, like Texas and Florida, was a gradual effort that started with providing incentives and getting buy-in from employee groups, especially unions, which represent a majority of its workers.
praise from President Biden, who weeks later announced that regulators would require all businesses with 100 or more workers to require vaccinations or conduct weekly virus testing. And the company drew scorn from conservatives.
Other mandates are producing results, too. Tyson Foods, which announced its vaccine requirement just days before United but has provided workers more time to comply, said on Thursday that 91 percent of its 120,000 U.S. employees had been vaccinated. Similar policies for health care workers by California and hospitals have also been effective.
charge its unvaccinated employees an additional $200 per month for health insurance.
A Year in the Making
United had been laying the groundwork for a vaccine mandate for at least a year. The airline already had experience requiring vaccines. It has mandated a yellow fever vaccination for flight crews based at Dulles International Airport, near Washington, because of a route to Ghana, whose government requires it.
In January, at a virtual meeting, Mr. Kirby told employees that he favored a coronavirus vaccine mandate.
Writing letters to families of the employees who had died from the virus was “the worst thing that I believe I will ever do in my career,” he said at the time, according to a transcript. But while requiring vaccination was “the right thing to do,” United would not be able to act alone, he said.
The union representing flight attendants pushed the company to focus first on access and incentives. It argued that many flight attendants couldn’t get vaccinated because they were not yet eligible in certain states.
Mr. Kirby acknowledged that widespread access would be a precondition. The airline and unions worked together to set up clinics for staff in cities where it has hubs like Houston, Chicago and Newark.
was calling on all employers to do so. A mandate would strike workers as unfair and create unnecessary conflict, the flight attendants’ union argued.
“The more people you get to take action on their own, the more you can focus on reaching the remaining people before any knock-down, drag-out scenario,” said Sara Nelson, the president of the Association of Flight Attendants, which represents more than 23,000 active workers at United.
In May, the pilots reached an agreement that would give them extra pay for getting vaccinated and the flight attendants worked toward an agreement that would give them extra vacation days. Both incentives declined in value over time and typically expired by early July.
vaccinated by Oct. 25 or within five weeks of a vaccine’s formal approval by the Food and Drug Administration, whichever came first. The timing was intended to ensure that the airline had adequate staffing for holiday travel, said Kate Gebo, who heads human resources.
This time, the unions were more resigned.
“For those 92 percent of pilots who wanted to be vaccinated, we captured $45 million in cash incentives,” said Captain Insler, whose union is challenging the decision to fire employees who don’t comply. “For those who did not want to be vaccinated, we were able to hold off a mandate for several months.”
Getting Over the Finish Line
The success of the incentives — about 80 percent of United’s flight attendants were also vaccinated by the time the airline announced its mandate in August — inspired the company to expand them to all employees, offering a full day’s pay to anyone who provided proof of vaccination by Sept. 20.
The company hadn’t surveyed its workers, but estimated that 60 to 70 percent were already vaccinated. Getting the rest there wouldn’t be easy.
Margaret Applegate, 57, a 29-year United employee who works as a services representative in the United Club at San Francisco International Airport, helps illustrate why.
Ms. Applegate normally does not hesitate to get vaccines, noting that her late father was a doctor and that her daughter does research in nutritional science.
Her daughter urged her to get vaccinated, but she remained deeply ambivalent. Friends and co-workers “were feeding me stories about horrible things happening to people with the vaccine,” she said. She worried about the relatively new technology behind the Pfizer and Moderna vaccines, and whether her heart condition could pose complications, though her cardiologist assured her it wouldn’t.
six employees sued United, arguing that its plans to put exempt employees on temporary leave — unpaid in many circumstances — are discriminatory. United has delayed that plan for at least a few weeks as it fights the suit.
Still, United’s vaccination rate has continued to improve. There was another rush before the deadline to receive the pay incentive and one more before the final Sept. 27 deadline. Toward the end of September, the company said 593 people had failed to comply. By Friday, the number had dropped below 240.
“I did not appreciate the intensity of support for a vaccine mandate that existed, because you hear that loud anti-vax voice a lot more than you hear the people that want it,” Mr. Kirby said. “But there are more of them. And they’re just as intense.”
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Then came the Delta variant. Despite keeping their countries largely sealed off, the virus found its way in. And when it did, it spread quickly. In the summer, South Korea battled its worst wave of infections; hospitals in Indonesia ran out of oxygen and beds; and in Thailand, health care workers had to turn away patients.
With cases surging, countries quickly shifted their vaccination approach.
Sydney, Australia, announced a lockdown in June after an unvaccinated limousine driver caught the Delta variant from an American aircrew. Then, Prime Minister Scott Morrison, who had previously said vaccination “was not a race,” called in July on Australians to “go for gold” in the country’s inoculation drive.
He moved to overcome a supply shortage, compounded by the slow regulatory approval. In August, Australia bought one million Pfizer doses from Poland; this month, Mr. Morrison announced a purchase of a million Moderna shots from Europe.
When the Delta outbreak emerged, fewer than 25 percent of Australians over the age of 16 had received a single shot. In the state of New South Wales, which includes Sydney, 86 percent of the adult population has now received a first dose, and 62 percent of adults are fully vaccinated. The country expects to fully inoculate 80 percent of its population over the age of 16 by early November.
“There was great community leadership — there were people from across the political divide who came out to support vaccination,” said Greg Dore, an infectious-disease expert at the University of New South Wales. “It really helped us turn around a level of hesitancy that was there.”
Many governments have used incentives to encourage inoculations.
In South Korea, the authorities eased restrictions in August on private gatherings for fully vaccinated people, allowing them to meet in larger groups while maintaining stricter curbs for others. Singapore, which has fully vaccinated 82 percent of its population, previously announced similar measures.
Researchers there have also analyzed the pockets of people who refuse to be inoculated and are trying to persuade them.
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