KABUL, Afghanistan — Amena, 7 months old, lay silently in her hospital crib amid the mewling of desperately ill infants in the malnutrition ward.
Her mother, Balqisa, had brought the child to Indira Gandhi Children’s Hospital in Kabul, Afghanistan’s capital, the night before. “Her body was so hot,” she said, stroking her daughter’s emaciated leg.
The baby had a high fever, convulsions and sepsis, said Dr. Mohammad Iqbal Sadiq, a pediatrician, glancing at her chart.
“Her chances are not good,” the doctor said. “We got her too late.”
At the Indira Gandhi hospital, and in faltering hospitals across Afghanistan, famished children arrive by car and taxi and ambulance every day and night. Acute malnutrition is just one of a cascade of maladies that threaten to topple the country’s fragile health system.
acute poverty, with 4.7 million Afghans likely to suffer severe malnutrition this year, according to the United Nations. Last month, the organization made its biggest appeal ever for a single country, asking international donors to give more than $5 billion to fend off a humanitarian disaster.
doubled since August, with 40 children dying in December on their way to receive medical care.
Jonas Gahr Store, the prime minister of Norway, whose country hosted meetings between Taliban representatives and Afghan civil society groups last week, spoke to the Security Council about the urgency to expedite aid.
“We need new agreements and commitments in place to be able to assist and help an extremely vulnerable civil population, and most vulnerable among them, the children who face hunger and suffering,” he said.
Before the U.S.-backed Afghan government disintegrated in August as the Taliban overran the country, the health system relied on international aid to survive. But much of that funding has been frozen to comply with sanctions imposed on the Taliban.
As a result, the International Rescue Committee recently predicted that 90 percent of Afghanistan’s health clinics were likely to shut down in the coming months. The World Health Organization has said that outbreaks of diarrhea, measles, dengue fever, malaria and Covid-19 threaten to overwhelm overburdened hospitals.
including $308 million in relief authorized by the United States, they have not been enough to cover 1,200 health facilities and 11,000 health workers.
Though the drastic decline in war-related casualties has relieved the burden of such patients on many hospitals, the suspension of operations by private facilities and the ability to safely travel Afghanistan’s roads has left other hospitals overrun with people.
On a recent morning, the corridors of Indira Gandhi hospital were crammed with beds as patients’ family members squatted on floors amid parcels of food bought at the local bazaar.
Patients’ meals consist of an egg, two apples, a milk packet, rice and juice, so many families supplement them with outside food. Some buy medicine at local pharmacies because the hospital can provide only about 70 percent of required medication, Dr. Sadiq said.
has now claimed more than 900,000 lives across the country, and the Covid death rates remain alarmingly high. The number of new infections, however, has fallen by more than half since mid-January, and hospitalizations are also declining.
Boosters. New data from the Centers for Disease Control and Prevention confirmed that booster doses are most beneficial to older adults. For younger Americans, vaccination decreased the risk of hospitalization and death so sharply that the additional shot did not seem to add much benefit.
Around the world. Several countries are easing their pandemic protocols, though public health leaders at the World Health Organization continued to urge caution about relaxing restrictions. In Austria, a sweeping Covid vaccine mandate is set to become law.
Few Afghans wear masks — even at the Ministry of Public Health in Kabul. There, officials clustered in groups on a recent weekday, greeting visitors with hugs and kisses, and ignoring faded signs saying masks were required throughout the building.
At the Afghan-Japan Communicable Disease Hospital in Kabul, the only remaining Covid-19 facility in the capital, few staff members or patients complied with worn stickers on the floors that proclaimed: “Let’s Beat Coronavirus — Please keep at least 2 meters from people around you.”
“When I try to talk to people about Covid-19, they say we have no food, no water, no electricity — why should we care about this virus?” said Dr. Tariq Ahmad Akbari, the hospital’s medical director.
Dr. Akbari suspected that the Omicron variant had entered the country, but the hospital lacked the medical equipment to test for variants. He and his staff had not been paid for five months, he said, and the hospital was critically low on oxygen supplies and health care workers.
Seven of the hospital’s eight female doctors fled after the Taliban takeover in August, part of a hollowing out that reduced the staff from 350 to 190 the past five months. Four of the five staff microbiologists quit. And only five of the country’s 34 Covid-19 centers were still operating, Dr. Akbari said.
Several staff members lived in the hospital in Kabul because, without salaries, they cannot afford rent, he said.
The hospital was recently buoyed by a two-month stopgap grant of $800,000 from an affiliate of Johns Hopkins Hospital, Dr. Akbari said. And Afghanistan’s relative isolation following the Taliban takeover had likely helped contain the spread of Covid-19, he said.
Up to 20 patients died per day during the previous wave, but just one or two a day now. And the hospital tests about 150 patients a day now, down from 600 to 700 daily tests during the second wave, Dr. Akbari said.
He speculated that Afghans are so overwhelmed by other survival issues that they are less likely to seek treatment for Covid-19.
Before the Taliban takeover, the Ministry of Public Health published detailed daily charts showing the number of coronavirus cases, hospitalizations and deaths — and the positivity rate for testing. But now the poorly funded ministry struggles to keep tabs on the pandemic.
Of the more than 856,000 tests conducted since the first wave of Covid-19 in early 2020 — of an estimated population of nearly 40 million — roughly 163,000 were positive, a health ministry spokesman said. More than 7,400 Covid-19 deaths had been confirmed since 2020, he said.
But because testing is extremely limited and the cause of death is not recorded in many instances, particularly in rural areas of Afghanistan, no one knows the pandemic’s true scale.
Dr. Akbari shook his head in frustration as he described how little was known about the virus in Afghanistan.
Looking defeated, he said, “If we have a surge like we had during the second and third wave, we would not be equipped to handle it.”
Long checkout lines. Closed fitting rooms. Empty shelves. Shortened store hours.
Plus the dread of contracting the coronavirus and yet another season of skirmishes with customers who refuse to wear masks.
A weary retail work force is experiencing the fallout from the latest wave of the pandemic, with a rapidly spreading variant cutting into staffing.
While data shows that people infected with the Omicron variant are far less likely to be hospitalized than those with the Delta variant, especially if they are vaccinated, many store workers are dealing with a new jump in illness and exposures, grappling with shifting guidelines around isolation and juggling child care. At the same time, retailers are generally not extending hazard pay as they did earlier in the pandemic and have been loath to adopt vaccine or testing mandates.
“We had gotten to a point here where we were comfortable, it wasn’t too bad, and then all of a sudden this new variant came and everybody got sick,” said Artavia Milliam, who works at H&M in Hudson Yards in Manhattan, which is popular with tourists. “It’s been overwhelming, just having to deal with not having enough staff and then twice as many people in the store.”
said last week that it would shorten store hours nationally on Mondays through Thursdays for the rest of the month. At least 20 Apple Stores have had to close in recent weeks because so many employees had contracted Covid-19 or been exposed to someone who had, and others have curtailed hours or limited in-store access.
At a Macy’s in Lynnwood, Wash., Liisa Luick, a longtime sales associate in the men’s department, said, “Every day, we have call-outs, and we have a lot of them.” She said the store had already reduced staff to cut costs in 2020. Now, she is often unable to take breaks and has fielded complaints from customers about a lack of sales help and unstaffed registers.
“Morale could not be lower,” said Ms. Luick, who is a steward for the local unit of the United Food and Commercial Workers union. Even though Washington has a mask mandate for indoor public spaces, “we get a lot of pushback, so morale is even lower because there’s so many people who, there’s no easy way to say this, just don’t believe in masking,” she added.
Store workers are navigating the changing nature of the virus and trying their best to gauge new risks. Many say that with vaccinations and boosters, they are less fearful for their lives than they were in 2020 — the United Food and Commercial Workers union has tracked more than 200 retail worker deaths since the start of the pandemic — but they remain nervous about catching and spreading the virus.
More broadly, the staffing shortages have put a new spotlight on a potential vaccine-or-testing mandate from the Biden administration, which major retailers have been resisting. The fear of losing workers appears to be looming large, especially now.
While the retail industry initially cited the holiday season rush for its resistance to such rules, it has more recently pointed to the burden of testing unvaccinated workers. After oral arguments in the case on Friday, the Supreme Court’s conservative majority expressed skepticism about whether the Biden administration had legal authority to mandate that large employers require workers to be vaccinated.
The National Retail Federation, a major industry lobbying group, said in a statement last week that it “continues to believe that OSHA exceeded its authority in promulgating its vaccine mandate.” The group estimated that the order would require 20 million tests a week nationally, based on external data on unvaccinated workers, and that “such testing capacity currently does not exist.”
When the top managers at Mr. Waugh’s Stop & Shop store began asking employees whether they were vaccinated in preparation for the federal vaccine mandates that could soon take effect, he said, a large number expressed concern to him about being asked to disclose that information.
“It was concerning to see that so many people were distressed,” he said, though all of the employees complied.
Ms. Luick of Macy’s near Seattle said that she worked with several vocal opponents of the Covid-19 vaccines and that she anticipated that at least some of her colleagues would resign if they were asked to provide vaccination status or proof of negative tests.
Still, Macy’s was among major employers that started asking employees for their vaccination status last week ahead of the Supreme Court hearing on Friday and said it might require proof of negative tests beginning on Feb. 16.
“Our primary focus at this stage is preparing our members for an eventual mandate to ensure they have the information and tools they need to manage their work force and meet the needs of their customers,” said Brian Dodge, president of the Retail Industry Leaders Association, which includes companies like Macy’s, Target, Home Depot, Gap and Walmart.
As seasonal Covid-19 surges become the norm, unions and companies are looking for consistent policies. Jim Araby, director of strategic campaigns for the food and commercial workers union in Northern California, said the retail industry needed to put in place more sustainable supports for workers who got ill.
For example, he said, a trust fund jointly administered by the union and several employers could no longer offer Covid-related sick days for union members.
“We have to start treating this as endemic,” Mr. Araby said. “And figuring out what are the structural issues we have to put forward to deal with this.”
On Dec. 29, The Gateway Pundit, a far-right website that often spreads conspiracy theories, published an article falsely implying that the Centers for Disease Control and Prevention had withdrawn authorization of all P.C.R. tests for detecting Covid-19. The article collected 22,000 likes, comments and shares on Facebook and Twitter.
On TikTok and Instagram, videos of at-home Covid-19 tests displaying positive results after being soaked in drinking water and juice have gone viral in recent weeks, and were used to push the false narrative that coronavirus rapid tests don’t work. Some household liquids can make a test show a positive result, health experts say, but the tests remain accurate when used as directed. One TikTok video showing a home test that came out positive after being placed under running water was shared at least 140,000 times.
And on YouTube, a video titled “Rapid antigen tests debunked” was posted on Jan. 1 by the Canadian far-right website Rebel News. It generated over 40,000 views, and its comments section was a hotbed of misinformation. “The straight up purpose of this test is to keep the case #’s as high as possible to maintain fear & incentive for more restrictions,” said one comment with more than 200 likes. “And of course Profit.”
Previous spikes in pandemic-related falsehoods focused on the vaccines, masks and the severity of the virus. The falsehoods help undermine best practices for controlling the spread of the coronavirus, health experts say, noting that misinformation remains a key factor in vaccine hesitancy.
The categories include falsehoods that P.C.R. tests don’t work; that the counts for flu and Covid-19 cases have been combined; that P.C.R. tests are vaccines in disguise; and that at-home rapid tests have a predetermined result or are unreliable because different liquids can turn them positive.
These themes jumped into the thousands of mentions in the last three months of 2021, compared with just a few dozen in the same time period in 2020, according to Zignal Labs, which tracks mentions on social media, on cable television and in print and online outlets.
The added demand for testing due to Omicron and the higher prevalence of breakthrough cases has given purveyors of misinformation an “opportune moment” to exploit, said Kolina Koltai, a researcher at the University of Washington who studies online conspiracy theories. The false narratives “support the whole idea of not trusting the infection numbers or trusting the death count,” she said.
policies that prohibit misinformation that could cause harm to people’s physical health. YouTube said it was reviewing the videos shared by The New York Times in line with its Covid-19 misinformation policies on testing and diagnostics. Twitter said that it had applied a warning to The Gateway Pundit’s article in December for violating its coronavirus misinformation policy and that tweets containing false information about widely accepted testing methods would also violate its policy. But the company said it does not take action on personal anecdotes.
Facebook said it had worked with its fact-checking partners to label many of the posts with warnings that directed people toward fact checks of the false claims, and reduced their prominence on its users’ feeds.
“The challenges of the pandemic are constantly changing, and we’re consistently monitoring for emerging false claims on our platforms,” Aaron Simpson, a Facebook spokesman, said in an email.
No medical test is perfect, and legitimate questions about the accuracy of Covid-19 tests have abounded throughout the pandemic. There has always been a risk of a false positive or a false negative result. The Food and Drug Administration says there is a potential for antigen tests to return false positive results when users do not follow the instructions. Those tests are generally accurate when used correctly but in some cases can appear to show a positive result when exposed to other liquids, said Dr. Glenn Patriquin, who published a study about false positives in antigen tests using various liquids in a publication of the American Society for Microbiology.
“Using a fluid with a different chemical makeup than what was designed means that result lines might appear unpredictably,” said Dr. Patriquin, an assistant professor of pathology at Dalhousie University in Nova Scotia.
Complicating matters, there have been some defective products. Last year, the Australian company Ellume recalled about two million of the at-home testing products that it had shipped to the United States.
But when used correctly, coronavirus tests are considered reliable at detecting people carrying high levels of the virus. Experts say our evolving knowledge of tests should be a distinct issue from lies about testing that have spread widely on social media — though it does make debunking those lies more challenging.
said in July that it would withdraw its request to the Food and Drug Administration for emergency-use authorization of one specific test at the end of the year. Hundreds of other Covid-19 tests are still available from other manufacturers, the C.D.C. later clarified.
Still, posts claiming that the agency had withdrawn support of P.C.R. tests went viral on Facebook. The most widely shared post pushing the falsehood in July collected 11,500 likes, shares and comments, according to data from CrowdTangle, a Facebook-owned social media analytics tool. The post added the falsehood that the C.D.C.’s advisory meant that P.C.R. tests could not distinguish between the coronavirus and the flu, when in fact the agency had simply recommended the use of tests that could simultaneously detect and distinguish between the flu and Covid-19.
Despite being fact-checked within days, the claim never fully went away. The Gateway Pundit article revived the claim at the end of the year, collecting nearly double the earlier post’s likes, shares and comments on Facebook. On Instagram, screenshots of the article also went viral, collecting hundreds of likes.
Mr. Gregory said a similar phenomenon had occurred with social media posts claiming various liquids turned at-home coronavirus tests positive.
On Dec. 23, 2020, a video on YouTube showed coronavirus tests turning positive after being tested on kiwi, orange and berry fruit juice. It collected over 102,000 views. In the same month, a video producing the same results with Coca-Cola was posted on YouTube, collecting 16,800 views.
One year later, a spate of similar videos with the same theme appeared on TikTok and Instagram.
For Ms. Koltai, the re-emergence of false narratives even after social media companies labeled them a year earlier shows the power of misinformation to “thrive when it can latch on to a current event.”
“That is how narratives can peak at different times,” she said.
In the United States, over 204 million people are fully vaccinated, but that’s still only 62 percent of the population, much lower than in most other wealthy countries.
At the county level, vaccination rates range from about 83 percent in places like Montgomery County, Md., a populous area just outside Washington, D.C., to around 15 percent in rural places like McPherson County in northern South Dakota.
As the Omicron variant surges, and experts say that vaccinations strongly protect against severe illness, U.S. public health officials are closely examining ways to reach the least-vaccinated areas. But the roadblocks are not the same everywhere. Some clearly have to do with politics: Republican-leaning areas have generally been vaccine laggards. But pockets of the country can have their own quirks unrelated to partisanship.
Here is a look at the challenges faced by three counties where, according to Centers for Disease Control and Prevention data, vaccination rates are among the lowest in the nation. (State figures for those counties may vary from the C.D.C. data because of differences in methodology, reporting lags and other factors.)
LaGrange County, Ind.
Resistance to vaccines is not new in LaGrange County, a rural area along Indiana’s border with Michigan. Just 22 percent of residents are fully vaccinated against the coronavirus, and, according to Dr. Tony Pechin, the county health officer, only 15 percent of children in the county are up-to-date on standard vaccines by the age of 2.
Dr. Pechin said that he had encountered the usual conspiracy theories about vaccines, and that even some longtime patients would not heed his advice to get the shots.
But the most important factor, he said, is that about half the county’s 40,000 residents are Amish, a group that overwhelmingly rejects the vaccines. Among non-Amish residents, he said, the vaccination rate is 45 to 48 percent.
Dr. Pechin said that a pharmacy frequented by Amish residents was among the first in LaGrange County to receive doses but had vaccinated just eight people in six months.
The state health commissioner sent a delegation to meet with Amish leaders in the spring, and the C.D.C. sent another over the summer.
“When they were done,” Dr. Pechin said of the envoys, “they called me and just said, ‘Good luck, Tony.’”
Cameron Parish, La.
When Hurricane Laura made landfall near Cameron Parish in August 2020, many residents left damaged homes behind and took refuge inland — and have yet to return.
According to the C.D.C., the vaccination rate is just 17 percent. But Louisiana health officials say that those figures do not take account of the population shift.
“Although the numbers look awful, they’re not as bad as they appear, because of an outflux of people due to the natural disasters,” said Dr. Lacey Cavanaugh, a regional health officer for the Louisiana Department of Health.
But if the statistics were calculated to reflect the current populations of Cameron Parish and others ravaged by recent storms, she said, they would probably still show vaccination rates below national averages. Laura destroyed much of the parish’s limited health infrastructure, so for months, health officials administered vaccines in a tent in a hospital parking lot. And for residents consumed by the work of repairing homes and businesses, getting vaccinated fell low on the priority list.
State health officials have worked to bring vaccines directly to disaster recovery events, and advised residents that getting sick with Covid-19 could make the road back even harder.
“Once you’re protected” from the virus, Dr. Cavanaugh said, “that’s one less thing for you to worry about.”
Winston County, Ala.
A rural county with a history of going its own way — it refused to join Alabama in seceding from the Union during the Civil War —faces many of the challenges that have hampered the state’s vaccine uptake.
Vaccine misinformation is still spreading on social media, said Dr. Karen Landers, a regional officer with the state’s Public Health Department, despite months of efforts with local leaders, faith-based organizations and pharmacies. The county’s vaccination rate has stalled at around 21 percent, according to the C.D.C.
Persuading young people that they are vulnerable to the disease and need a vaccine can be a particularly acute problem, she said. But Dr. Landerssaid she remained determined: “We know that not everyone will listen to us, but that does not alleviate our responsibility.”
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 almost two years into the pandemic, that’s the position that employers continue to find themselves in, amid an ever-flowing cascade of new data, guidelines and considerations.
“Every moment, you’re making life or death decisions,” Ms. Sibley said. “That’s not what we signed up for.”
MADRID — Covid-19 infections were rising all across Spain, but the message from the country’s leader was clear: The government was not entering 2022 with the restrictions of 2020.
“The situation is different this time, and because of that, we’re taking different measures,” Pedro Sánchez, the prime minister, said this week, adding that he understood his people had grown impatient with the pandemic and that he was “fully aware of the fatigue.”
Across Europe, that fatigue is as palpable as the dampened Christmas spirit. The fatigue of another named variant of the coronavirus and another wave of infections. The fatigue of another grim year watching New Year’s Eve gatherings get canceled or curtailed, one by one.
But along with the exhaustion, another feeling is taking root: that the coronavirus will not be eradicated with vaccines or lockdowns, but has become something endemic that people must learn to live with, maybe for years to come.
reducing the risk of severe disease and hospitalization, according to recent studies.
Pfizer and Merck. The new drugs, which can be taken at home with a doctor’s prescription, will be available to some Covid patients who are at higher risk of becoming severely ill.
“I worry a bit because we don’t know much about Omicron,” Susanne Sesterer, 63, a retiree in Hanover, Germany, said on Thursday as she was doing her last shopping before Christmas. “But how much worse can it get?”
Others were giving up.
Dorotea Belli, a 42-year-old Italian who has had two vaccine doses, said she would not go to a family gathering for Christmas and instead stay home in Rome. Many of her colleagues had tested positive for the virus, she said, and her children, 4 and 1, are not eligible for vaccination.
“They and I will miss my parents very much,” she said. “But I don’t want to bring Covid around, and even if my husband and I are vaccinated, who knows?”
Spain’s calculus on new restrictions is not only factoring in the all-important holidays, but also legal barriers that emerged after measures taken by the government in 2020.
In July, Spain’s Constitutional Court ruled that the government did not have the authority to impose the lockdown measures that began in March 2020, which restricted Spaniards from leaving their homes except for essential trips like food shopping. Instead, the judges said, the measures required a full parliamentary vote, which few see passing with a majority in the future given how controversial the previous restrictions were.
“The government has its hands tied now,” said Luis Galán Soldevilla, a law professor at the University of Córdoba.
Spain’s lighter measures announced on Thursday received criticism from some sectors, like the Spanish Society of Public Health and Health Administration, a group that includes many health professionals.
“These measures don’t help much,” said Ildefonso Hernández, the group’s spokesman, saying limiting capacity indoors would be more effective. “It makes no sense that people walk the street with a mask and then take it off when they enter a bar.”
In Madrid, residents were charging ahead with their Christmas plans, despite the rising caseload and risks.
Fernando Sánchez, 55, a taxi driver, lost his mother and brother to Covid-19 six months ago. Nevertheless, he was unwilling to cancel his Christmas plans, which this year take place at the home of his in-laws, much as they had before the pandemic.
Antonio Jesús Navarro, 33, a software engineer, had been looking forward to spending Christmas with his girlfriend, who had traveled to Spain for the holidays from the United States. The two had not seen each other since before the pandemic began.
But then Mr. Navarro learned he had come into contact with someone who had tested positive for the coronavirus. The couple were isolating until he could get his own test results. He said he was frustrated with public messaging on how to stay safe from Omicron.
“Is an antigen test acceptable?” he said by telephone. “What happens if there are no symptoms?”
Hours later, Mr. Navarro called back to say he and his girlfriend had tested positive for Covid-19.
Nicholas Casey and José Bautista reported from Madrid, and Constant Méheut from Paris. Reporting was contributed by Raphael Minder from Geneva; Gaia Pianigiani from Rome; Christopher F. Schuetze from Hanover, Germany; and Léontine Gallois from Paris.
“You can’t really mandate booster shots yet,” he said. “It hasn’t been signed off on by any federal agency.”
JPMorgan Chase, whose decision to require vaccines is complicated by its sprawling retail operations across the United States, declined to comment on how the court’s most recent decision, along with the recent spike in cases, affects any plans to mandate vaccines. But the bank on Friday told its American employees who do not work in bank branches that “each group should assess who needs to come into the office, work priorities and who should revert to working from home on a more regular basis over the next few weeks.”
Walmart, which has mandated vaccines for mainly its corporate staff, also did not have any comment on broadening that requirement. Only 66 percent of its roughly 1.6 million U.S. employees are vaccinated, according to data compiled by the Shift Project at the Kennedy School of Government at Harvard.
Legal questions about the OSHA rule are far from resolved. Immediately after the U.S. District Court of Appeals for the Sixth Circuit ruled on Friday, several of the many plaintiffs who have challenged that rule asked the Supreme Court to intervene as part of its “emergency” docket. Appeals from the Sixth Circuit are assigned for review by Justice Brett Kavanaugh, who under Supreme Court rules could in theory make a decision on his own but is more likely to refer the matter to the full Supreme Court. With the Labor Department now delaying full enforcement of its rule until Feb. 9, the justices have several weeks to ask for abbreviated briefings if they want them.
“Things are going back and forth literally in a matter of hours,” said Sydney Heimbrock, an adviser on industry and government issues at Qualtrics, who works with hundreds of clients on using the company’s software to track employee vaccination status. “The confusion stems from the on-again-off-again, is it a rule or isn’t it a rule? The litigations, appeals, reversing decisions and making decisions.”
Even the spread of Omicron hasn’t changed the position of some of the vaccine rule’s most ardent opponents. The National Retail Federation, one of the trade groups challenging the administration’s vaccine rule, is among those that have filed a petition with the Supreme Court. The group is in favor of vaccinations but has pushed for companies to get more time to carry out mandates. Still, even as it fights the administration’s rule, the federation is also holding twice weekly calls with members to compare notes on how to carry it out.
“There’s no question that the increased number of variants like Omicron certainly don’t make it less dangerous,” said Stephanie Martz, the group’s chief administrative officer and general counsel. “The legitimate, remaining question is, is this inherent to the workplace?”
LONDON — Deborah Tudhope was growing anxious. An American lawyer living in London, she was hoping to fly back to the United States in two weeks to see her 96-year-old mother, who lives in a retirement home in Maine. But the Omicron-driven travel restrictions announced on Thursday by the White House have her worrying that the trip may not happen.
Ms. Tudhope, 72, has had to reschedule her required coronavirus test for the day before her flight, which the airline had already pushed back a day. With the rules seemingly shifting by the hour, she said she faced multiple hurdles: getting out of Britain, getting into the United States and visiting her mother in the home.
“I don’t know how this whole thing is going to work out,” said Ms. Tudhope, who described herself as disheartened, if not surprised, by the turmoil. “But I did make sure the flights are re-bookable.”
Such private dramas are playing out all over the world, as thousands of people — Americans living abroad and foreigners hoping to visit the United States — grapple with the new complexities of holiday travel in the age of Covid.
Biden administration shortened the time frame for international travelers to the United States to take a Covid test within a day before departure, regardless of vaccination status.
That has left would-be travelers nervously calculating whether they will get test results back in time to make their flights or worrying that their home countries could impose more stringent travel bans while they are away.
new pandemic strategy that includes hundreds of family-centered vaccination sites, booster shots for all adults, new testing requirements for international travelers and insurance reimbursement for at-home tests.
Shifting views on boosters among experts. For months, many public health experts have opposed plans to roll out Covid booster shots to all adults. But as Omicron gains ground, researchers are changing their minds, and now believe that the shots may offer the best defense against the new variant.
Officials in Italy said the country was well-prepared to handle a surge in tests for passengers bound for the United States. In the weeks since the government began requiring frequent, negative tests for all unvaccinated Italian workers, pharmacies have processed up to one million rapid tests a day.
“The prospect of more rapid swabs for travelers to the U.S. is not a problem for pharmacies here,” said Marco Cossolo, president of Italy’s largest association of private pharmacies, Federfarma.
South Korea built up the capacity to administer an average of 68,000 P.C.R. tests a day in November, according to Seung-ho Choi, the deputy director of risk communication at the Korea Disease Control and Prevention Center. Results almost always come within 24 hours, he said, though travelers catching early-morning flights when clinics are closed might have to seek out hospitals that administer tests.
Britain is among several countries that have recently required tests for incoming travelers within a day or two after arriving. Randox Laboratories, a British company that provides Covid tests for travel, said on Thursday that since the changes were announced for travelers entering Britain last weekend, it had ramped up P.C.R. testing capacity to its pandemic peak of 180,000 tests per day.
That would also help with processing tests for travelers to the United States, the company said.
For Europeans with ties to the United States, the new rules are merely the latest wild card in a life already lived perpetually in flux.
“What a nightmare — enough!” said Alice Volpi, 28, when told of the impending American restrictions.
An Italian who was living in New York at the outset of the pandemic, Ms. Volpi recounted how she could not return home to Italy for several months because of her country’s travel ban. When she finally got home, a travel ban imposed by the United States prevented her from returning to see her boyfriend in New York.
“The most frustrating part is that you can never make a plan more than one week in advance because everything can change every day,” said Ms. Volpi, who insisted she would press on with plans to visit her boyfriend at Christmas. “That doesn’t allow me to be serene.”
For some Americans living abroad who fear that borders may close again if Omicron proves to be a lethal threat, the solution is to move up their travel timelines. The testing requirements are stressful, they said, but not as much as the possibility that the Biden administration might eventually cut off travel pathways completely.
“That’s what I’m most worried about — not getting to see my family,” said Sarah Little, 25, who moved from New York to London in September to study. She had originally planned to fly home closer to Christmas, but is now trying to book a flight early next week.
“It would just be devastating if I couldn’t get home,” Ms. Little said.
Gaia Pianigiani and Emma Bubola contributed reporting from Rome; Saskia Solomon and Isabella Kwai from London; Aurelien Breeden from Paris; John Yoon from Seoul and Sheryl Gay Stolberg from Washington.
LONDON — As the still-mysterious Omicron variant reached American shores, the World Health Organization on Wednesday scolded wealthy countries that imposed travel bans and dismissed those that poured resources into vaccine booster campaigns when billions in poor countries had yet to receive their first shots.
The comments by W.H.O. officials reopened fraught questions of equity in how the world has handled the coronavirus pandemic since a stark divide over the availability of vaccines emerged between rich and poor countries earlier this year.
But amid fears of a new wave of Covid-19, that seemed unlikely to sway leaders in Europe, Asia, and the United States, which reported its first confirmed Omicron case, in California, on Wednesday. They are scrambling to shield their populations from the variant — about which much remains unknown — by topping up their protection and tightening restrictions on incoming travel.
Travelers reacted with confusion and dismay to news that the United States plans to toughen testing requirements and the screening of inbound passengers. That decision came after Japan, Israel, and Morocco barred foreign travelers and Australia delayed reopening its borders for two weeks.
revealed to the world — and Dr. Tedros warned that the number would rise.
The W.H.O. also voiced skepticism about ambitious booster plans that it claimed come at the expense of first-time vaccinations in less wealthy nations. Britain this week announced a massive new campaign to deliver booster shots to all adults by the end of January. Other European countries and the Biden administration are also pushing these shots as a first line of defense against the variant, buying time for scientists to unravel its genomic code.
Japan joined Israel and Morocco in barring all foreign travelers, and Australia delayed reopening its borders for two weeks. The C.D.C plans to increase testing and screening of international fliers to the U.S.
A patchwork of regulations. As the new Omicron variant spread around the world, two KLM flights from South Africa became emblematic of the scattershot and lax global approach to coronavirus containment. Of the more than 60 people who tested positive for the virus, at least 14 had Omicron.
A new type of treatment. An expert panel voted to recommend that the F.D.A. authorize a Covid pill from Merck for high-risk adults, the first in a new class of antiviral drugs that could work against a wide range of variants, including Omicron. The pill could be authorized within days, and available by year’s end.
Vaccine hesitancy in Africa. The detection of the Omicron variant in Africa signals the next stage of the battle against Covid-19: getting more people inoculated in poorer nations. But though vaccine supplies are becoming sufficient, the new hurdle is overcoming local skepticism or outright hostility.
The borderless nature of the virus, Mr. Guterres said, means that “travel restrictions that isolate any one country or region are not only deeply unfair and punitive — they are ineffective.”
Although the United States is not weighing the kind of blanket travel ban on foreign visitors imposed by Japan, the restrictions being weighed by the Centers for Disease Control and Prevention in the United States are stirring widespread concern. The agency is considering requiring travelers to provide a negative result from a test taken within 24 hours before departure, a spokesman said on Tuesday night.
Though the C.D.C. has yet to officially announce the changes, the prospect sent travelers searching for updates, booking pre-emptive tests where they could, and scouring airline websites for reservation changes, as the pandemic threatened to upend another December travel season.
Carlos Valencia, a dual Spanish-American citizen whose Seville-based company operates a study abroad program for American students, had planned to return to the United States in January. But he said that he would put the trip on hold until “there is at least some clarity about whether the new rules make a trip feasible.”
Whatever shape the restrictions take, he said, they are “way overdone — especially when you consider how lax the U.S.A. has been with getting people to wear face masks and its own health safety measures.”
Emanuela Giorgetti, a teacher in northern Italy, was hoping to join her fiancé, whom she has not seen for almost two years, for Christmas in Chicago. “When I heard the news,” she said, “I thought, ‘Here we go again.’”
Given the potential threat posed by Omicron, she said she understood the impulse to tighten the rules. But it still seemed unfair.
“We have more vaccinated people in Italy than in the U.S., we wear masks indoors and try to go by the rules,” Ms. Giorgetti said.
Reporting was contributed by Nick Cumming-Bruce, Rick Gladstone, Raphael Minder, Gaia Pianigiani, Michael D. Shear and John Yoon.
The world reacted with alarm on Friday to the highly mutated new coronavirus variant discovered in southern Africa, as the United States, the European Union and nations across the globe imposed new travel restrictions, financial markets swooned and visions of finally emerging from the pandemic started to dim.
Just two days after the world learned of the variant, the World Health Organization officially labeled it a “variant of concern,” its most serious category — the first since the Delta variant, which emerged a year ago. The designation means that the variant has mutations that might make it more contagious or more virulent, or make vaccines and other preventive measures less effective — though none of those effects has yet been established.
suffered terribly when Covid first hit Europe early last year.
On Friday, Israel, Singapore, several European nations individually, and then the European Union as a whole, the United States and Canada followed the lead set by Britain on Thursday night, temporarily barring foreign travelers who have recently been in South Africa or any of several neighboring countries. As with past travel bans, countries are allowing their own citizens and permanent residents to return home if they test negative for the virus, with some requiring additional testing and quarantine after arrival.
fights over vaccines and social restrictions have grown increasingly harsh.
world’s highest case rates for their populations are all European — several of them about six times as high as the U.S. rate.
South Africa, whose last coronavirus wave peaked in July, has recently reported case rates far below the worldwide average. But last week the rate more than doubled from the week before.
Reporting was contributed by Sheryl Gay Stolberg, Zolan Kanno-Youngs, Carl Zimmer, Lynsey Chutel and Nick Cumming-Bruce.