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Covid News: Arkansas Expands Booster Access to All Adults


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Credit…Kelsi Brinkmeyer/The Texarkana Gazette, via Associated Press

Arkansas on Monday joined Colorado, California and New Mexico in broadening access to Covid-19 boosters, getting ahead of federal regulators who are close to making a decision on expanded eligibility.

Gov. Asa Hutchinson of Arkansas said at a news conference on Monday that he had directed the state health department to issue new guidelines on boosters to allow all adults to get one, provided they meet the timing rules. The move made Arkansas the latest state to issue a decision on boosters ahead of a federal ruling.

State leaders have found themselves in a conundrum since August, when President Biden’s plan to make boosters available to all adults was halted by regulators. The leaders have had to decide: Do they wait for a federal directive, or do they make their own vaccination rules?

The decisions they make are more timely than ever, as the United States braces for a possible winter surge. As of Monday night, reported new cases in the United States have averaged nearly 85,000 a day for the past week, a 14 percent increase from two weeks ago, according to a New York Times database. Reported new deaths are down 14 percent, to 1,129 a day; hospitalizations have decreased seven percent and are averaging more than 46,000 a day.

And in Europe, where the Covid trends are often a harbinger of those in the United States, a fourth case wave has been driven by the unvaccinated.

Four states, including Arkansas, aren’t waiting for a federal decision on boosters, and, on Monday, New York City became one of the first major cities to tell all adults to get a booster if they want one regardless of whether they are eligible.

In Arkansas, a spokeswoman for the Arkansas health department said it had updated its recommendations and would be advising health care providers that they can administer the boosters to an expanded pool of adults.

“What we’re finding is that we want more people to get their booster shot and that this is somewhat confusing and limiting as to the eligibility,” Mr. Hutchinson said, adding, “we’re changing that.”

However, a spokeswoman for the governor’s office said that Mr. Hutchinson had no plans to issue an executive order to expand booster eligibility.

According to the health department guidelines, Arkansas adults are now eligible for the vaccine booster if it has been at least six months since their second shot of the Pfizer or Moderna vaccine, or at least two months since they received the single-dose Johnson & Johnson vaccine.

A growing body of early global research has shown that the vaccines remain highly protective against hospitalization and death, but that their effectiveness against infection wanes over time. Public health experts say this does not mean the vaccines are not working.

Last week, Pfizer and BioNTech requested that the Food and Drug Administration expand eligibility of their booster to all adults, a request the agency is expected to grant before the winter holiday season.

Ahead of a formal recommendation from the federal authorities, several other states have taken different approaches to expand booster eligibility.

The governors of Colorado and New Mexico signed executive orders last week expanding eligibility to all adults. In California, Dr. Tomás J. Aragón, the state’s public health director, issued a letter last week that said anyone 18 or over is eligible.

The authorities in New York and West Virginia on Monday encouraged all adults to get the booster, but stopped short of a formal policy change. New York City health officials told health providers to give booster shots to all adults who want them, — guidance that was echoed by Gov. Kathy Hochul. In West Virginia, Gov. Jim Justice said adults should “absolutely get” a booster.

Credit…Rebecca Blackwell/Associated Press

At the request of Gov. Ron DeSantis, a Republican who has used his opposition to vaccine and mask mandates to build up his national political profile, Florida lawmakers kicked off a special legislative session on Monday to take up legislation aimed at restricting such measures.

Mr. DeSantis, who is seen as a possible presidential candidate in 2024, has cast the session as a high-profile effort to counter the vaccination rules set by the Biden administration.

The Biden administration has ordered federal employees and contractors to be vaccinated, as well as employees of health care companies that receive Medicare and Medicaid. The federal government also plans to put in place workplace-safety rules in January mandating that all businesses with 100 or more employees require them to be vaccinated or be tested frequently.

Several states with conservative governors, including Florida, have already challenged those federal mandates in court. To also pass laws curtailing them would put Florida at the forefront of what has become a highly politicized fight between G.O.P.-led states and the White House.

“Nobody should be losing their jobs because of these jabs,” Mr. DeSantis, who has taken to calling the vaccinations “jabs” or “injections,” said last week.

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

About 60,700 people have died of Covid-19 in Florida. The state was hit hard by the virus this summer, when the Delta strain filled hospitals in much of the state with more patients than at any time during the pandemic. That wave has burned itself out, and in recent days new cases and hospitalizations have fallen to some of the lowest levels in the country. Just over 60 percent of Florida’s population is vaccinated, according to a Times database.

Critics of the governor have said that his fight against mandates resulted in needless deaths. Florida experienced its worst daily death tolls during the summer surge, when vaccines were already widely available.

As cases surged, Mr. DeSantis fought local school districts and governments that required masks or vaccines, withholding funds, fining them or taking them to court. (Most school districts have now loosened their mask restrictions, in light of the falling virus levels.)

The special session is intended to carry the state Republican Party’s opposition to mandates even further.

Business leaders, however, have expressed fears that any new Florida laws might force them to face conflicting state and federal mandates.

Democrats have decried the move as mere political theater. “This entire special session is a political stunt,” Representative Fentrice Driskell, a Tampa Democrat, said on Monday.

But the governor, who formally announced his 2022 re-election last week, is too popular among conservatives in the Republican base for his wishes to be ignored. “We don’t believe that the federal government should be in a position to force vaccines,” House Speaker Chris Sprowls said in the State Capitol on Monday.

None of the four proposed bills under consideration would ban employee vaccine mandates outright. Private employers would be able to require vaccinations, but they would also have to allow for exemptions for medical issues or pregnancy, and religious reasons. Employees willing to be periodically tested or wear protective equipment could also opt out. Employers would have to pay for the tests or provide protective equipment, like masks.

Public school districts and local governments would be prohibited from requiring vaccinations. Lawmakers would also give parents the sole discretion over whether students should get vaccinated or wear masks.

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N.Y.C. Encourages All Adults to Seek Boosters

Dr. Dave A. Chokshi, New York City’s health commissioner, encouraged those 18 years or older who want to receive a Covid-19 booster to seek out the shot if they meet timing rules, and asked health care providers not to turn them away.

Today, I’m issuing a commissioner’s advisory to all health care providers, emphasizing our guidance and ensuring that there are no access barriers. First, clinicians should allow adult patients to determine their own risk of exposure based on their individual circumstances. In practice, this means that providers should not turn a patient away if they request a booster, so long as they are 18 and older and it has been at least six months since the Moderna or Pfizer dose, or at least two months since a Johnson & Johnson dose. Second, I’m advising that health care providers proactively reach out to their eligible patients, particularly those 65 and older, those with medical conditions and those who received a Johnson & Johnson dose. Booster doses are available at sites across the city, or you can have someone come directly to your home. Remember that booster doses of all three vaccine types — Pfizer, Moderna or J.&J. — are now available. Please visit nyc.gov/covidvaccine for more information or call 212-Covid19 to speak with a health care professional. In my own conversations with patients and family members, I know that booster doses can provide one more layer of reassurance, allowing us to breathe a bit easier either for ourselves or our loved ones, particularly as we gather and travel around the holidays. So let’s use every means at our disposal to make this a safe and healthy winter season.

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Dr. Dave A. Chokshi, New York City’s health commissioner, encouraged those 18 years or older who want to receive a Covid-19 booster to seek out the shot if they meet timing rules, and asked health care providers not to turn them away.CreditCredit…Dave Sanders for The New York Times

New York City health officials on Monday encouraged all adults who want to receive coronavirus vaccine boosters to seek them out, and asked health providers not to turn them away, a move that comes as federal regulators consider expanding the eligibility pool for Pfizer-BioNTech’s booster.

Anyone who is 18 or older and seeking a booster shot in New York City should not be turned away, said Dr. Dave A. Chokshi, the city’s health commissioner, provided it has been at least six months since their second shot of the Pfizer or Moderna vaccine, or at least two months since they received the single-dose Johnson & Johnson shot.

“Clinicians should allow adult patients to determine their own risk of exposure based on their individual circumstances,” said Dr. Chokshi.

Federal regulators currently allow booster shots for people who are 65 and older, as well as adults who live in long-term care settings, have underlying medical conditions, or work or live in high-risk settings. Last week, Pfizer and BioNTech requested that the Food and Drug Administration expand eligibility of their booster to all adults.

“For qualifying for a booster, if you’re over 18, one of the specific criteria is being at higher risk and I view all New Yorkers, because of the density of our city, of being at higher risk,” said Dr. Mitchell Katz, the head of the city’s public hospitals.

A growing body of early global research has shown that the vaccines available in the United States have remained highly protective against the disease’s worst outcomes over time.

But a number of published studies show that their protection against infection, with or without symptoms, has fallen. Public health experts say it does not mean the vaccines are not working. But the significance of waning effectiveness — and whether it suggests that all adults should be eligible for a booster — is still up for debate.

Mayor Bill de Blasio and Dr. Chokshi encouraged New Yorkers and health providers to interpret the current federal guidelines more loosely to allow more adults to get the booster now. More than 630,000 New Yorkers have already received a booster shot, Dr. Chokshi said Monday.

The move is part of an effort to slow the spread of the virus before the winter and ahead of the holiday season, when spending more time indoors amid dropping temperatures may increase exposure.

In New York City, new cases have increased recently, according to a New York Times database: The average of daily cases stood at 1,074 as of Sunday, which is 32 percent higher than it was two weeks ago. Average hospitalizations have fallen 17 percent over the same time period.

The city’s encouragement comes after California, Colorado and New Mexico have broadened access to boosters.

On Monday afternoon, Gov. Kathy Hochul of New York echoed city leaders’ pleas. “I am strongly encouraging all New Yorkers who live or work in a high-risk setting to get the booster,” she said in a statement. “I received the booster, and believe no one who feels they are at risk should be turned away from getting a Covid-19 booster shot.”

In Arkansas, Gov. Asa Hutchinson said on Monday that he had directed the state health department to issue new guidelines on boosters to allow all adults to get one, provided they meet the timing rules.

In an statement, a spokeswoman for the department said it had updated its recommendations and would be advising health care providers that they can administer the boosters to adults.

“What we’re finding is that we want more people to get their booster shot and that this is somewhat confusing and limiting as to the eligibility of those that ought to be getting their booster shot and so in consultation with the Department of Health, this, we’re changing that,” Mr. Hutchinson said.

If federal regulators sign off on Pfizer and BioNTech’s request, it would make official what health authorities say they already see happening frequently — that many people appear to be getting boosters whether or not they are technically eligible. In mid-August, President Biden announced plans to make boosters available to all adults, but the beginning of the campaign was delayed after regulators insisted they needed more time to review data.

On the news show “Fox News Sunday,” Dr. Vivek Murthy, the surgeon general, said that “millions of people are eligible who have not yet gotten their booster shot, and we want to focus on that.” He also acknowledged that some states were seeking “broad protection” for their residents in making their own moves, and that the F.D.A. will weigh in after analyzing the data and ensuring that the booster shots are safe and effective for those not yet eligible.

Dr. Chokshi also advised health care providers to continue reaching out to vulnerable populations about booster shots, especially those who are 65 and older, those who have underlying medical conditions, and those who received a Johnson & Johnson vaccine.

Dan Levin contributed reporting.

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The lockdown, expected to last 10 days, requires those age 12 and older who are not vaccinated for Covid-19 or immune from a past infection to stay in their homes except for essential reasons, such as doctor visits or grocery shopping.CreditCredit…Barbara Gindl/Agence France-Presse, via Apa/Afp Via Getty Images

Unvaccinated Austrians ages 12 and older awoke on Monday morning confined to their homes for all but essential activities, as one of the strictest coronavirus lockdowns in Europe went into effect to battle a surge in infections.

Under new rules announced by the government on Sunday, adults and minors 12 and older who have not been vaccinated or recovered from a coronavirus infection cannot go outside except to buy groceries, seek medical care or travel to school or work. They are the toughest of a new wave of restrictions across Europe, as governments try to contain near-record numbers of cases.

“Our task as the federal government is to protect the people of Austria. We are fulfilling this responsibility,” Chancellor Alexander Schallenberg told a news conference on Sunday.

The move was described as temporary, but the government did not immediately say how long it would remain in effect.

About 65 percent of Austria’s 8.9 million people are vaccinated, one of the lowest rates in western Europe, according to the Our World in Data Project at the University of Oxford. Over the past two weeks, average daily cases have risen by 134 percent to nearly 11,000, the highest since the pandemic began.

Mr. Schallenberg said that the vaccination rate was a significant cause of the spike in infections, and added that cases among the vaccinated were decreasing. Since February, unvaccinated people account for 83 percent of symptomatic infections, according to Austrian officials.

Speaking on Monday, Mr. Schallenberg said that there were no immediate plans to expand restrictions for vaccinated people. That ran counter to a suggestion by his health minister, who said that the government might consider a more generalized lockdown, such as closing bars or restaurants.

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.

“My aim is very clearly to get the unvaccinated to get themselves vaccinated and not to lock down the vaccinated,” Mr. Schallenberg told Austria’s Ö1 radio, according to The Associated Press. “In the long term, the way out of this vicious circle we are in — and it is a vicious circle, we are stumbling from wave to lockdown, and that can’t carry on ad infinitum — is only vaccination.”

Europe, which threw off lockdowns this summer but has seen vaccination rates level off, is “back at the epicenter of the pandemic globally,” Hans Kluge, the regional director for the World Health Organization, said last week. The continent accounted for 59 percent of the world’s newly reported coronavirus cases last week, and for nearly half the world’s Covid-related deaths, the organization said.

Over the weekend, the three parties that are set to form the next government in Germany agreed to impose stricter rules against unvaccinated people, including mandating that they obtain a negative coronavirus test before traveling on buses or trains, as infection rates reach new records. Spain’s Basque region is also expected on Tuesday to announce new restrictions on gatherings in municipalities with the highest infection rates.

But Austria’s move stands out as among the toughest imposed in Europe or elsewhere in the world, experts said. In Britain, where cases have risen sharply since May, the Conservative lawmaker Oliver Dowden said on Sky News on Monday that the government would not follow Austria’s lead, saying that “we have no plans to have that kind of differentiated approach between” between those who are vaccinated and those who are not.

Robert West, a professor of health psychology at University College London, said that Austria’s rules might encourage more people to get vaccinated, but risked eroding trust in the government.

“It’s sort of like jumping in with the nuclear option without having considered the other options,” he said, adding that it would have been better to address the causes of vaccine skepticism among parts of the Austrian public.

“I think this is a disaster on all fronts,” he said.

Isabella Kwai and Raphael Minder contributed reporting.

Credit…Marc Desrosiers/USA Today Sports, via Reuters

The National Hockey League postponed three Ottawa Senators games this week as 10 players tested positive for Covid-19, making the team the first in North America to reschedule games this fall because of the virus.

Ten players and the associate coach, Jack Capuano, had tested positive for Covid in the last few weeks, according to the N.H.L. The league canceled the team’s games at least through Saturday after a “continued spread in recent days,” the N.H.L. said in a statement on Monday.

The N.H.L. is the first North American sports league to postpone games this fall because of Covid. Major League Baseball postponed a handful of games this summer after players and staff members tested positive.

Several N.H.L. teams have struggled at times this year to contain the virus. Seven Vancouver Canucks games were postponed in March and April after half the team was sidelined because of Covid protocols.

The Senators were set to play an away game on Tuesday against the New Jersey Devils and home games on Thursday and Saturday against the Nashville Predators and the New York Rangers. It was not clear when the games would be rescheduled.

The Senators had canceled four practices in the last week “for precautionary reasons,” and its training facilities have been closed. They played without several key players in a win over the Pittsburgh Penguins on Saturday and a loss to the Calgary Flames on Sunday.

The Senators’ next game is expected to be on Nov. 22 in Denver against the Colorado Avalanche.

Seven San Jose Sharks players and three members of the coaching staff were placed on the N.H.L.’s Covid protocol list between the end of October and last week, according to the league. Players for the Colorado Avalanche and Pittsburgh Penguins have also spent time on the protocol list, which is based on testing and contact tracing.

Credit…Young Kwak/Associated Press

As coronavirus infections inch up at the national level in the United States and spike significantly in some areas, more states and cities are enacting vaccination requirements for people to participate in aspects of public life, hoping to avoid a devastating surge like the one the country experienced last winter.

In Colorado, where cases have increased 11 percent in the past two weeks and deaths have increased 44 percent, according to a New York Times database, proof of vaccination will be required starting Friday for anyone attending an indoor, unseated event with more than 500 people in any of six counties in the Denver area, the most populous region of the state.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

There will be no option to submit a negative test result instead, though venues that currently offer that option will have until Dec. 1 to change their policy. The counties are Adams, Arapahoe, Broomfield, Boulder, Denver and Jefferson.

In Washington State, where cases and deaths are decreasing after a late-summer surge, indoor events with more than 1,000 people now require proof of vaccination or a negative test. The requirement, which was announced last month but took effect on Monday, also applies to outdoor events with more than 10,000 people.

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

Neither the Washington nor the Denver mandate applies to religious venues.

It has largely fallen to state and local governments to determine vaccination requirements for access to various venues, from restaurants to stadiums.

With the exception of the mandate in Washington, these requirements have generally applied to cities or counties, not entire states. The two largest cities in the country, New York and Los Angeles, require proof of vaccination to spend time in most indoor public spaces, including restaurants, gyms and movie theaters.

Credit…Friedemann Vogel/EPA, via Shutterstock

ROME — As temperatures drop and coronavirus infections spike across Europe, some countries are introducing increasingly targeted restrictions against the unvaccinated who officials say are driving another wave of contagion and putting economic recoveries, public health and an eventual return to prepandemic freedoms at risk.

On Monday, the Austrian government cracked down on its unvaccinated population over the age of 12, restricting their movement to traveling for work, school, buying groceries and medical care. New cases have more than doubled in Austria in the last two weeks.

Across Europe countries are passing rules and measures to make life harder for the unvaccinated with the goal of motivating them to get a shot.

In Italy, vaccination, recent recovery from the virus, or frequent negative swabs are required to work. In Germany, the incoming government has said it will impose stricter rules against unvaccinated people, including mandating that they obtain a negative coronavirus test before traveling on buses or trains. In France, booster shots will become requisite for people 65 and older who want to secure a health pass.

Taken together, the measures are a bleak sign that a virus is still a threat to Europe, which reported a 10 percent increase in deaths and a 7 percent increase in new infections in the first week of November, compared to the previous week. The World Health Organization warned recently that half a million people on the continent could die from Covid in the next few months.

While the hospitalizations and deaths were mostly in Eastern Europe, the new wave threatened economic recoveries and Christmas vacations across the continent. A return to normalcy predicated on the success of vaccination campaigns seemed increasingly threatened by the unvaccinated who offered the virus room to run.

This is especially the case in Eastern Europe. Romania, which has Europe’s second-lowest vaccination rate, recently reported the world’s highest per capita death rate from Covid-19. In Bulgaria, hospitals are inundated. Last month, the small Baltic nation of Latvia responded to its outbreak with a full lockdown. Russia and Ukraine, which each have vaccination rates below 50 percent, also introduced widespread restrictions.

Credit…Hagen Hopkins/Getty Images

At demonstrations against pandemic restrictions last week in Wellington, the New Zealand capital, some protesters performed the ceremonial Maori dance known as the Ka Mate haka, known internationally for its performance before rugby games.

Ngati Toa, the Maori tribe that owns the legal rights to that haka, on Monday called for them to stop. “We insist that protesters stop using our taonga immediately,” Taku Parai, a senior member of Ngati Toa, said in a statement, using the Maori word for a treasure. “We do not support their position.”

A law passed by the New Zealand government in 2014 recognized the tribe, or iwi, as the custodians of the haka. Ka Mate dates back to 1820 and recounts the story of the heroic escape of Te Rauparaha, a chieftain, from capture by a rival tribe. Ngati Toa has previously spoken out against its misuse for commercial gain.

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.

Historically, pandemics have posed a particular threat to Maori, New Zealand’s Indigenous people. The 1918 flu pandemic devastated Maori communities, killing Maori at a rate seven times that of the wider population, while in the 2009 H1N1 influenza pandemic, the rate of infection for Maori was twice that of white New Zealanders.

The present coronavirus pandemic has again hit Maori disproportionately. As of March, half of those in New Zealand who had ended up in intensive care because of the virus had been Maori, despite their making up only 14 percent of the population. The vaccination rate among Maori lags behind the rest of the country, with 77 percent of those eligible having received at least one dose of a vaccine, compared to 90 percent in the wider population.

In light of this history, and of the ancestors they have lost to these illnesses, the tribe has taken a proactive role in vaccinating its members against the coronavirus, said Helmut Modlik, a senior member of Ngati Toa.

“We are absolutely clear that the Covid-19 vaccine is the best protection we have available to us, and we are committed to supporting our whānau to get vaccinated as soon as possible,” Dr. Modlik added. He called for protesters to use a different haka, of which there are many.

Credit…Cory Weaver/San Francisco Opera

SAN FRANCISCO — As live performance finally returns after the pandemic shutdown, cultural institutions are confronting a long list of unknowns.

Will audiences feel safe returning to crowded theaters? Have people grown so accustomed to watching screens in their living rooms that they will not return to live events? And how will the advent of work-from-home policies, which have emptied blocks of downtowns and business districts, affect weekday attendance at theaters and concert halls?

Nowhere is that last question more urgent than here in San Francisco, where tech companies have led the way in embracing work-from-home policies and flexible schedules more than in almost any other city in the nation.

“As people work from home, it is going to change our demographics,” said Matthew Shilvock, the general director of the San Francisco Opera. “It’s something that could be a threat.”

Arts groups are trying to gauge what the embrace of more flexible work-from-home policies will mean for their ability to draw audiences. Close to 70 percent of the audiences at the San Francisco Opera and the San Francisco Symphony live outside the city, according to data collected by the two organizations.

There were some patches of empty seats across the Davies Symphony Hall the other night, as the San Francisco Symphony presented the United States premier of a violin concerto by Bryce Dessner. Attendance in October was down 11 percent compared to before the pandemic, though the symphony said advance sales were strong, suggesting the spring might bring normal audiences.

“Some nights have been a little thinner than others,” said Esa-Pekka Salonen, the symphony’s new music director. “By and large, the energy is good. Our worst fears have been dispelled.”

The San Francisco Opera began its new season with a new music director, Eun Sun Kim, the first woman to hold the position. She conducted a new production of Beethoven’s “Fidelio” this fall that incorporated chain-link fences and flickering video screens to update the story of the liberation of a political prisoner.

Even so, the opera, which can seat 2,928 with Covid restrictions, sold an average of only 1,912 tickets per show for “Fidelio.”

Attendance has been spotty in other venues as the city’s art scene climbs back. Just 50 percent of the seats were filled the other night for a performance of “The Displaced,” a “gentrification horror play” by Isaac Gómez, at the Crowded Fire Theater.

“We had sold-out houses on Friday, Saturday and Sunday and much lower participation on Wednesday and Thursday night,” said Mina Morita, the artistic director. “It’s hard to tell if this is the new normal.”

Credit…Kristopher Radder/The Brattleboro Reformer, via Associated Press

Last year, fear of simultaneous coronavirus and influenza pandemics drove more Americans than usual to get their flu shots. That, combined with distancing and masking measures, made the 2020-21 flu season remarkably tame.

This year, the numbers look less promising.

As of Oct. 29, 158.7 million flu vaccine doses had been distributed in the United States, according to the Centers for Disease Control and Prevention. That is down roughly 8 percent from the 172.3 million doses that had been distributed at the same time last year, and health officials across the country — in Michigan, in San Diego, in Ventura County, Calif., and elsewhere — have been sounding alarms.

“I think any indication that we’re going to have lower flu vaccination rates is of concern,” said Dr. Richard Webby, a faculty member of the Infectious Diseases Department at St. Jude Children’s Research Hospital.

Dr. Webby said that because of the highly abnormal flu season last year, scientists don’t have a good grasp on how severe the coming season is likely to be. Since flu hasn’t been circulating for a season and a half, he said, fewer people may have lingering immunity to the virus than in a normal year.

“We’re just headed into, really, an unknown,” he said. “We’re certainly not the best at predicting flu seasons in a typical year, and this is anything but a typical year.”

Even without the coronavirus also circulating, a bad flu season could strain health care systems. And the United States has seen many times over how quickly a surge in Covid-19 cases can overwhelm hospitals entirely, making it impossible for them to properly care for patients with other medical emergencies, like severe influenza. The prospect of both viruses surging at the same time has horrified doctors from the start.

With coronavirus case rates plateauing at a high level nationally — and rising in some states — and with coronavirus vaccination rates still lagging behind the rates in most other wealthy countries, American hospitals are hardly in a position to handle more stress.

But Dr. Webby said that the good news is that the flu season has not yet begun in earnest — which means there is still time for people to get their shot.

Credit…Emily Elconin for The New York Times

State governments in the United States are offering incentives for coronavirus shots for children, just as they did for adults earlier in the year.

Since the Centers for Disease Control and Prevention formally endorsed the Pfizer-BioNTech vaccine on Nov. 2 for children ages 5 to 11, more than a million have received doses, according to a White House estimate released last week.

With the pace of inoculations stagnating among U.S. adults, states are rushing to encourage vaccinations among newly eligible younger children, despite some questions about the effectiveness of incentive programs.

Such programs proliferated over the summer as progress on vaccinations began to decline. They often involved cash payments or lotteries, sometimes to win items like customized pickup trucks or rifles, and free tickets to baseball games, drinks and even joints.

The rewards announced for children so far are mostly cash and scholarships, but in some areas, local attractions are also being dangled.

Visa gift cards worth $100 are available to children in Louisiana and Chicago. In New York City, $100 prepaid debit cards are also available, as are tickets to the Statue of Liberty and Brooklyn Cyclones baseball games.

In San Antonio, parents who have their children vaccinated at city clinics are eligible for a $100 gift card to H-E-B, the grocery store chain that is an institution in Texas. Around New York State, parents can enter children ages 5 to 11 in a series of drawings for full-ride college scholarships to any two- or four-year public college or university in the state. There will be a total of 50 winners.

Ohio is running a program called Vax-2-School in which there will be drawings for 150 scholarships to Ohio colleges worth $10,000 each, as well as five $100,000 scholarships. Older children in Minnesota, those 12 to 17, can get a $200 Visa gift card and enter a series of drawings for one of five $100,000 Minnesota college scholarships.

West Virginia is offering children a chance to win educational savings funds, and as a grand prize in the program, one school will receive $100,000 and a holiday party featuring Gov. Jim Justice and Babydog, his English bulldog. One hundred lifetime hunting and fishing licenses are also up for grabs.

In a similar vein, children aged 5 to 17 in Maine are being asked to be creative to encourage their peers to get vaccinated. The state is soliciting 30-second videos from them on the benefits of getting a Covid shot, with an emphasis on “original music or humor,” information on the vaccines’ safety and efficacy, and the dangers of being unvaccinated. The prizes, which will be donated to the filmmakers’ schools, are $50,000 for first place, $25,000 for second place and $10,000 for third place.

Credit…Carl Court/Getty Images

Japan’s economy continued to wobble in the third quarter of 2021, tipping back into contraction, but the success of its coronavirus vaccination campaign suggests that brighter days may be ahead, at least in the near term.

In the July-to-September period, the country’s economy, the third largest after the United States and China, shrank by an annualized rate of 3 percent, government data showed on Monday. The result, a quarterly drop of 0.8 percent, indicated an economy struggling to find its footing in the face of coronavirus restrictions and a supply chain crunch that hit its biggest manufacturers. The previous three-month period saw a slight expansion.

But Japan now has one of the highest vaccination rates among major nations, and it has lifted virtually all restrictions on its economy as its virus caseload has fallen in recent weeks to one of the lowest levels in the world.

Seventy-five percent of the country is fully vaccinated. And coronavirus case counts have hovered in the low hundreds since mid-October, a decline of about 99 percent since their August peak, heralding the return of long-suppressed consumer spending.

Bolstering the positive outlook, policymakers, fresh off an election, are preparing a new round of stimulus that would provide support to ailing businesses and put cash in the hands of people nationwide.

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 country started the July-to-September period on the back foot because of a clunky vaccine rollout that left it far behind its peer countries. The Delta variant caused cases to surge just as Tokyo prepared to kick off the Summer Olympics, which were conducted without spectators and failed to deliver the economic boost that had been promised when the country was chosen as host.

As the virus spread, Japan entered a new state of emergency. Restaurants and bars closed early and travel dried up, with many people deciding to stay home rather than brave record-high case counts.

Since the country ended its state of emergency last month, however, foot traffic has nearly returned to prepandemic levels, said Tomohiko Kozawa, a researcher at the Japan Research Institute.

“There’s a risk that infections could begin to spread again, but for the moment, the outlook points to recovery,” he said, adding that “we can expect high growth” in domestic consumption in the coming months.

Credit…Evelyn Hockstein/Reuters

Dr. Vivek Murthy, the U.S. surgeon general, said on Sunday that if courts continue to block the Biden administration’s efforts to soon compel large companies to require a Covid vaccine or face weekly testing, it would be “a setback for public health.”

A federal appeals court issued a ruling on Friday that continued to block the administration’s rule, saying the federal agency that drafted the order had “grossly” exceeded its purview.

The Occupational Safety and Health Administration, an agency within the Labor Department, issued a rule this month that companies with 100 or more employees must put a vaccine mandate in place by Jan. 4 or comply with weekly testing, as well as mandatory masking in December.

The administration’s attempts — which could affect 84 million private-sector workers, 31 million of whom were believed to be unvaccinated — have met with considerable resistance. A diverse group of states and business organizations immediately contested the order and the Court of Appeals for the Fifth Circuit in New Orleans issued a stay. The ruling by a three-judge panel on Friday affirmed the stay, turning aside a challenge by the Justice Department.

On “Fox News Sunday,” Dr. Murthy said that vaccine mandates are well-established and highly successful in achieving more widespread vaccination. Schools, the military and workplaces such as hospitals have long required vaccines. Many companies have leapt ahead of a federal order, he noted, and imposed one on their own employees.

At the heart of the vaccine mandate strategy, he said, is the creation of “safer workplaces for workers, for customers and to increase vaccination rates overall, because that’s ultimately how we’re going to end this pandemic.”

But Ken Paxton, the attorney general of Texas, one of the plaintiffs that challenged the mandate, said on the same news program that the ruling was a victory against the Biden administration’s attempt at what he has called “bullying” of businesses. Texas employers, he has stated, should be allowed to make their own decisions about the vaccine.

Chris Wallace, the host of the program, pointed out that Gov. Greg Abbott of Texas has banned businesses from ordering vaccine mandates. He asked Mr. Paxton to address the seeming incongruity between his attack on the federal mandate and his support of the state ban of individual employers’ mandates.

Mr. Paxton refused to say whether he thought that, unlike the federal government, a state had the right to tell a private business what to do. He replied: “The federal government has limited authority.”

He continued: “States have a lot of authority to deal with what’s going on in their states.”

Credit…Michael M. Santiago/Getty Images

Several dozen New York City workers have been suspended without pay as a part of an investigation into the use of fake Covid vaccine cards at the Department of Sanitation, a city official with knowledge of the investigation said.

The investigation will include a thorough review of vaccination records to determine how widespread the fraud might be, said the official, who was not authorized to comment on the investigation and spoke on the condition of anonymity. The development is the latest in a protracted debate over the city’s vaccine mandate for municipal workers.

The mandate took effect on Nov. 1, and roughly 9,000 city workers who had not received the shot were placed on unpaid leave, with thousands more applying for exemptions on medical or religious grounds. In the past month, vaccination rates have risen across city agencies, particularly in places like the Fire and Police Departments where opposition to the mandate had taken a strong hold.

The Department of Sanitation garnered particular attention for a single-day increase of nine percentage points — taking its ranks to 76 percent vaccinated from 67 percent almost overnight, according to City Hall.

“Very encouraging progress,” Mitch Schwartz, a spokesman for Mayor Bill de Blasio, tweeted on Oct. 29.

The possibility that some of those vaccinations might have been fraudulent has shaken the department. A vast majority of the roughly 10,000 sanitation workers — over 87 percent — have received at least one shot, according to a city spokesman.

“These are very concerning allegations, and we take them very seriously,” Vincent Gragnani, press secretary for the sanitation department, said on Sunday. “Getting vaccinated is important to public health, and we do not tolerate anyone faking something that is a requirement of city employment.”

He confirmed that the department was “actively investigating this situation,” in coordination with the city’s Department of Investigation.

The investigation department said that it was “aware of allegations involving the issuance of bogus vaccination cards” and declined further comment.

The allegations were first reported in The New York Post on Saturday. It remains to be seen if criminal charges will be pursued. New Yorkers have been criminally charged for creating or using fake vaccine cards.

Harry Nespoli, president of the Teamsters Local 831 union representing sanitation workers, said that the investigation was still in its early stages, and he was not yet sure how many workers might be involved.

“It could be 50, it could be 15,” he said. “Everything has to be proven.”

Mr. Nespoli has been a critic of the mandate, arguing instead for a testing option. He said that while the union disavowed any falsification of records, it would defend its members.


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