ImageThe waiting room at Starr County Memorial Hospital, a rural hospital treating Covid patients, in Rio Grande City, Texas, last year.Credit…Christopher Lee for The New York Times
The Department of Health and Human Services has begun distributing billions of dollars to rural health care providers to ease the financial pressures brought by the coronavirus pandemic and to help hospitals stay open.
The agency said on Tuesday that it had started doling out $7.5 billion to more than 40,000 health care providers in every state and six U.S. territories through the American Rescue Plan, a sprawling relief bill that Congress passed in March. The infusion of funds will help offset increased expenses and revenue losses among rural physicians during the pandemic, the agency said.
Xavier Becerra, the health and human services secretary, said that the coronavirus pandemic had made clear the importance of having timely access to quality medical care, especially in rural America.
“When it comes to a rural provider, there are a number of costs that are incurred, that sometimes are different from what you see with urban providers or suburban providers,” Mr. Becerra said. “And oftentimes, they’re unique only to rural providers.”
Rural physicians serve a disproportionate number of patients covered by Medicaid, Medicare or the Children’s Health Insurance Program, which often have more complex medical needs. Many rural hospitals were already struggling before the pandemic; 21 have closed since 2020, according to data from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.
Under the program, every eligible provider that serves at least one Medicare, Medicaid, or C.H.I.P. beneficiary in a rural part of the country will receive at least $500. Payments will range up to $43 million, with an average of $170,700; the size is based on how many claims a provider submitted for rural patients covered by these programs from January 2019 through September 2020.
Rural America is home to some of the country’s oldest and sickest patients, many of whom were affected by the pandemic.
The new funding is supposed to help rural hospitals stay open in the long run and improve the care they provide, building on efforts the Biden administration has already made to help improve access to health care in rural communities, which it considers crucial to its goal of addressing inequities in access to care.
The money can be put toward salaries, recruitment, or retention; supplies such as N95 or surgical masks; equipment like ventilators or improved filtration systems; capital investments; information technology and other expenses related to preventing, preparing for or responding to the pandemic.
The administration has also allocated billions of dollars through the American Rescue Plan for coronavirus testing for the uninsured, increased reimbursement for Covid vaccine administration, improving access to telehealth services in rural areas, and a grant program for health care providers that serve Medicare patients.
On Monday, Vice President Kamala Harris said that the administration would be investing $1.5 billion to address the shortage of health care workers in underserved tribal, rural and urban communities. The funds — which will provide scholarships and pay off loans for clinicians who commit to jobs in underserved areas — come on the heels of a report from the White House’s Covid Health Equity Task Force that made recommendations on how inequalities in the health care system could be fixed.
Cars waiting to enter a drive-through coronavirus testing site in Buffalo, N.Y., last year.Credit…Libby March for The New York Times
With daily coronavirus case rates reaching record numbers and area hospitals more than 90 percent full, local officials in the Buffalo area have reinstituted a mask mandate for all indoor public spaces beginning on Tuesday.
“We really need to keep the hospitals from being inundated,” Mark Poloncarz, the Erie County executive, said on Monday in a news conference announcing the new policy. “These numbers are not good.”
The mask mandate applies to all staff and patrons at stores, restaurants, bars, salons, and other public indoor spaces in the county, regardless of their vaccination status. It is the first phase of what Mr. Poloncarz warned would be increasing restrictions if virus numbers do not begin to stabilize.
Erie County, which encompasses the city of Buffalo, is the first New York county to impose a blanket mask mandate for public indoor spaces since May, when the Centers for Disease Control and Prevention recommended that vaccinated people could safely take off their masks in most settings.
Federal officials eventually reversed that recommendation as the Delta variant spiked, but New York did not reinstitute a statewide mask mandate. Currently, most of the state, including New York City, only requires masks in specific locations such as in schools, on public transportation, and in medical settings.
Western New York, a bustling five-county region of some 1.4 million people along the Canadian border and the Great Lakes, has seen cases spike dramatically in recent weeks. In Erie County, cases have doubled in the last month. Hospitalizations are up 50 percent in the last two weeks.
Vaccination rates have not been high enough to head off the surge, even though about 75 percent of adults in Erie County have received at least one dose. County officials said that local case numbers now are actually higher than they were at this time last year. Rates among children and staff in schools are also at the highest levels since the start of the pandemic, Mr. Poloncarz said.
“Until we can get through this, masking is necessary,” he said.
Erie County decided to institute a mask mandate instead of requiring people show proof of vaccination for entering most indoor public places, after hearing concerns from local business leaders that requiring masks would be less harmful to trade.
But if the mask rule fails to curb virus rates, the county will require vaccination for indoor dining and entertainment, as New York City has. If that fails to work, it will bring back capacity restrictions in restaurants and other indoor public settings. And if that also fails, shutdowns will occur, Mr. Poloncarz said.
Local officials said they were most closely watching the load in hospitals, which are already strained because of staff shortages. The wait time at emergency rooms for people who are not critically ill has risen to eight hours or more, officials said. And seasonal flu has yet to hit hard in New York State, according to the latest data from the Centers for Disease Control and Prevention.
“Our hospitals are in dire straits,” the Erie County health commissioner, Dr. Gale Burstein, said.
Danae Vitkin, 9, receiving her first Covid vaccine at Clalit Health services in Tel Aviv on Tuesday.Credit…Oded Balilty/Associated Press
JERUSALEM — Israel began a campaign to vaccinate 5- to 11-year-olds against the coronavirus on Tuesday ahead of expected gatherings over next week’s Hanukkah holiday, but the initial response from parents appeared to be slow.
By Monday night, parents had made appointments for only a little over 2 percent of children in that age group, according to figures published by the country’s main health services. Health officials said they were trying to persuade parents of the benefits of vaccinating their children without applying pressure or any form of coercion.
In a bid to reassure the public, Prime Minister Naftali Bennett accompanied his son David, 9, to a vaccination center of the Clalit Health Services in the seaside town of Herzliya, north of Tel Aviv.
“I call on all Israeli parents to come and have their children vaccinated,” Mr. Bennett said. “It is safe and it safeguards our children.” In a video posted on the prime minister’s official Twitter account, David said he had agreed to be filmed to encourage other children to get vaccinated. He said he was a little afraid at first but assured other children that “it really didn’t hurt.”
Earlier this month, the United States also began vaccinating 5- to 11-year-old children. A number of countries have approved vaccinations for children starting at 12 years old, but few aside from China, Israel and the United States are vaccinating younger children.
Israel has emerged in recent weeks from a fourth wave of the virus, with new daily cases dropping to several hundred from a peak of 11,000 in mid-September. Israeli officials attribute the sharp decrease in cases to a booster shot campaign, suppressing a wave driven by a combination of waning immunity five or six months after the second injection, together with the spread of the highly infectious Delta strain.
At least 80 percent of Israelis ages 16 and older have been vaccinated against the virus, but the numbers are lower in the younger age groups. More than four million Israelis have received a booster shot since August, out of a total population of nine million.
In the Palestinian-administered territories, after a late start and some early hesitancy, about three million doses have been administered, enough to cover about a third of the population with two doses.
A Ukrainian Orthodox priest performing a funeral service for someone who died of Covid at a cemetery in Kakhovka, Ukraine, in October.Credit…Evgeniy Maloletka/Associated Press
Europe’s death toll from Covid will exceed two million people by next spring, the World Health Organization projected on Tuesday, adding that the continent remained “firmly in the grip of the Covid-19 pandemic.”
Covid is now the leading cause of death in Europe, the W.H.O. said in a statement, with almost 4,200 new deaths a day, double the number at the end of September. To date, Europe, including the United Kingdom and Russia, has reported 1.5 million deaths. Between now and spring, hospital beds in 25 countries and intensive care units in 49 countries are predicted to experience “high or extreme stress,” the W.H.O. said.
Dr. Hans Kluge, a regional director for the W.H.O., said Europe faces a challenging winter. “In order to live with this virus and continue our daily lives, we need to take a ‘vaccine plus’ approach,” he said.
That means getting vaccinations or booster shots if offered and taking other preventive measures to avoid the reimposing of lockdowns, like calling on the public to wear masks and maintain physical distance, he said.
Over one billion vaccine doses have been administered in Europe; about 53 percent of the population is fully vaccinated. But countries have gaping disparities in vaccination rates, the organization said, and it was essential to drive the lagging rates up, the officials said.
In recent days, European countries have imposed restrictions to try to curb the highest surge of new cases in the region since the pandemic began. Austria on Monday began its fourth lockdown and Germany is pressuring its citizens to get vaccinated. Slovakia, Liechtenstein and the Czech Republic have the world’s highest rates of new cases compared to their populations.
The W.H.O. considers Europe to include not only the countries of the European Union, but also the United Kingdom, Iceland, Norway, Switzerland, Turkey, Israel, Russia, Ukraine, and several countries in the Balkans and Central Asia.
Children waiting in the observation area after receiving their first dose of the Pfizer-BioNTech vaccine at Southfield High School in Southfield, Mich., earlier this month. Credit…Emily Elconin for The New York Times
Coronavirus cases in children in the United States have risen by 32 percent from about two weeks ago, a spike that comes as the country rushes to inoculate children ahead of the winter holiday season, pediatricians said.
More than 140,000 children tested positive for the coronavirus between Nov. 11 and Nov. 18, up from 107,000 in the week ending Nov. 4, according to a statement on Monday from the American Academy of Pediatrics and the Children’s Hospital Association.
These cases accounted for about a quarter of the country’s caseload for the week, the statement said. Children under 18 make up about 22 percent of the U.S. population.
“Is there cause for concern? Absolutely,” Dr. Sean O’Leary, the vice chair of the academy’s infectious diseases committee, said in an interview on Monday night. “What’s driving the increase in kids is there is an increase in cases overall.”
Children have accounted for a greater percentage of overall cases since the vaccines became widely available to adults, said Dr. O’Leary, who is also a professor of pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado.
Though children are less likely to develop severe illness from Covid than adults, they are still at risk, and can also spread the virus to adults. Experts have warned that children should be vaccinated to protect against possible long-Covid symptoms, Multi-system Inflammatory Syndrome and hospitalization.
At the end of October, about 8,300 American children ages 5 to 11 have been hospitalized with Covid and at least 172 have died, out of more than 3.2 million hospitalizations and 740,000 deaths overall, according to the Centers for Disease Control and Prevention.
At a news conference on Friday, Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, said hospitalizations and deaths among 5- to 11-year-olds were “really startling.”
Dr. O’Leary said it did not help that many schools had softened their safety protocols in the last few months.
“So any protection that might be happening in schools is not there,” he said.
Vaccinations of younger children are likely to help keep schools open. Virus outbreaks forced about 2,300 schools to close between early August and October, affecting more than 1.2 million students, according to data presented at a C.D.C. meeting on Nov. 2.
Dr. O’Leary said that he was especially concerned about case increases in children during the holiday season.
With the pace of inoculations stagnating among U.S. adults, states are rushing to encourage vaccinations for children 5 through 11, who became eligible earlier this month after the C.D.C. authorized the Pfizer-BioNTech vaccine for that age group. In May, the federal government recommended making the Pfizer-BioNTech vaccine available to children ages 12 to 15. Teenagers 16 and older became eligible in most states a month earlier.
The White House estimated on Nov. 10 that nearly a million young children had gotten vaccinated; 28 million are eligible. They receive one-third of the adult dose, with two injections three weeks apart.
All of the data so far indicates that the vaccines are far safer than a bout of Covid, even for children.
Still, about three in 10 parents say they will definitely not get the vaccine for their 5- to 11-year-old child, according to a recent poll by the Kaiser Family Foundation. Only about three in 10 parents said they would immunize their child “right away.”
Pfizer vaccines being prepared at a mobile vaccine clinic in McMinnville, Ore., in October.Credit…Alisha Jucevic for The New York Times
The Biden administration has asked a federal appeals court to let the government proceed with a federal mandate that all large employers require their workers to get vaccinated against the coronavirus or submit to weekly testing starting in January.
In a 52-page motion filed on Tuesday, the Justice Department urged the U.S. Court of Appeals for the Sixth Circuit, in Cincinnati, to lift a judicial stay on proceeding with the rule while it is being challenged in court, saying the requirement would “save thousands of lives and prevent hundreds of thousands of hospitalizations.”
The Occupational Safety and Health Administration, or OSHA, issued the “emergency” rule earlier this month at the direction of President Biden as one of several vaccine mandates he announced in September. The OSHA rule applies to employers with at least 100 workers, although it exempts those who work at home or exclusively outdoors.
The rule was immediately challenged by employers around the country and several Republican-controlled states. In court papers, they argued that the rule exceeded the agency’s authority under law to issue regulations to protect workers from toxic hazards at work, arguing the law was meant to address dangerous substances like asbestos but not exposure to the virus.
Earlier this month, a three-judge panel on the Court of Appeals for the Fifth Circuit, in New Orleans, agreed with the plaintiffs in several of those cases and temporarily blocked the government from proceeding with the rule. But since then, those cases and many others from around the country have been reassigned to the Sixth Circuit in order to consolidate the litigation.
“The Fifth Circuit’s stay should be lifted immediately,” the Justice Department said in its filing. “That court’s principal rationale was that OSHA allegedly lacked statutory authority to address the grave danger of COVID-19 in the workplace on the ground that COVID-19 is caused by a virus and also exists outside the workplace. That rationale has no basis in the statutory text.”
Migrant workers harvesting apples at a farm in Ontario, Canada, last year. Canada is one of many of the world’s wealthier nations seeking to increase their work force with foreign migrants.Credit…Brett Gundlock for The New York Times
As the pandemic heads into a third year, a global battle for the young and able has begun. With fast-track visas and promises of permanent residency, many of the wealthy nations that drive the global economy are sending a message to skilled immigrants all over the world: Help wanted. Now.
In Germany, where officials recently warned that the country needs 400,000 new immigrants a year to fill jobs in fields ranging from academia to air-conditioning, a new Immigration Act offers accelerated work visas and six months to visit and find a job.
Canada plans to give residency to 1.2 million new immigrants by 2023. Israel recently finalized a deal to bring health care workers from Nepal. And in Australia, where mines, hospitals and pubs are all short-handed after nearly two years with a closed border, the government intends to roughly double the number of immigrants it allows into the country over the next year.
The global drive to attract foreigners with skills, especially those that fall somewhere between physical labor and a physics Ph.D., aims to smooth out a bumpy recovery from the pandemic.
Covid’s disruptions have pushed many people to retire, resign or just not return to work. But its effects run deeper. By keeping so many people in place, the pandemic has made humanity’s demographic imbalance more obvious — rapidly aging rich nations produce too few new workers, while countries with a surplus of young people often lack work for all.
New approaches to that mismatch could influence the worldwide debate over immigration. European governments remain divided on how to handle new waves of asylum seekers. In the United States, immigration policy remains mostly stuck in place, with a focus on the Mexican border, where migrant detentions have reached a record high.
Still, many developed nations are building more generous, efficient and sophisticated programs to bring in foreigners and help them become a permanent part of their societies.
“Covid is an accelerator of change,” said Jean-Christophe Dumont, the head of international migration research for the Organization for Economic Cooperation and Development, or O.E.C.D. “Countries have had to realize the importance of migration and immigrants.”
— Damien Cave and Christopher F. Schuetze
Activists rallying for increased global access to coronavirus vaccines outside the headquarters of Pfizer in Manhattan in July. Credit…Brendan Mcdermid/Reuters
Seeking to increase the supplies of coronavirus vaccines, treatments and diagnostic tests needed to quell the pandemic around the globe, 15 human rights groups have asked President Biden to apply maximum pressure on the World Trade Organization to grant an intellectual property exemption for the vaccines.
The exemption would mean that any country or company that has the ability to produce a vaccine could do so without having to worry about running afoul of the world economic body’s property right protections. Some public health experts see a W.T.O. exemption as key to bolstering the production of vaccine in developing countries, allowing drugmakers around the world access to closely guarded trade secrets on how viable vaccines have been made.
“The stakes could not be higher,” the groups wrote in a letter to the White House dated Nov. 19. “Failure to enact a waiver will prolong the pandemic leading to more death, illness, economic hardship, and social and political disruption.”
Only 5 percent of people in low-income countries have received at least one dose of a coronavirus vaccine, according to the Our World in Data project at the University of Oxford, a figure that is dwarfed by rates in wealthier countries.
Public Citizen, Oxfam, Amnesty International, Human Rights Watch, Doctors Without Borders and Partners in Health are among the organizations listed on the two-page letter.
“There are people talking about whether or not we should take boosters,” Dr. Joia Mukherjee, chief medical officer of Partners In Health, a global public health nonprofit, said at a news conference on Tuesday. “This, to me, is even a false argument because that plays into the narrative that this is a scarce commodity.”
“It is only a scarce commodity because Pharma wants it to be a scarce commodity so that they can maximize profit,” she said, using shorthand for the pharmaceutical industry. “And we just need to say enough is enough. This is the time for us to show leadership.”
The increase in pressure on the Biden administration comes one week before hundreds of officials converge on Geneva for the W.T.O.’s major ministerial conference on Nov. 30.
In May, the White House said that it supported waiving intellectual property protections for coronavirus vaccines, as it sought to bolster production amid concerns about vaccine access in developing nations.
But the rights groups said in their letter that they were disappointed that the administration had since “been unwilling to take further leadership.” They noted that more than 100 W.T.O. member nations supported a waiver.
Six times as many booster shots of coronavirus vaccine are being administered in wealthy countries around the world each day than primary doses are being given in low-income countries, according to the World Health Organization. The group’s director general, Dr. Tedros Adhanom Ghebreyesus, has called that disparity “a scandal that must stop now.”
The Biden administration said last week that it planned to spend billions of dollars to expand vaccine manufacturing capacity, with the goal of producing at least one billion additional doses a year beginning in the second half of 2022.
Prime Minister Jean Castex of France, left, tested positive for the virus after returning from an official trip to Belgium.Credit…Olivier Hoslet/EPA, via Shutterstock
France’s prime minister, Jean Castex, said on Tuesday that he had only “mild symptoms” after testing positive for the coronavirus, as the French news media criticized him for apparent past failures to follow the government’s social-distancing recommendations.
“I am well and am continuing to carry out my duties in isolation, strictly following the health protocol,” Mr. Castex said on Twitter.
On that same social network, however, many users shared videos of him appearing to flout distancing recommendations, including one from last week that showed a maskless Mr. Castex shaking hands with elected officials indoors.
The government itself has urged the French in recent weeks not to drop their guard and to continue observing distancing practices as much as possible, even when vaccinated.
Élisabeth Borne, the labor minister, recently warned companies not to become complacent about health guidelines. “Maybe we have lapsed a bit, barrier measures are being less respected,” she told the news channel BFMTV this month.
On Monday, Mr. Castex had just returned from an official trip to Belgium, where he met with Prime Minister Alexander De Croo, when he learned that his 11-year-old daughter had tested positive, his office said in a statement. He immediately took a test, which turned out positive.
President Emmanuel Macron of France chose Mr. Castex, 56, as prime minister in July 2020. Mr. Castex had previously been the top official in charge of lifting the strict nationwide lockdown France imposed during the first wave of the coronavirus pandemic.
Mr. Macron himself was sick with Covid-19 late last year.
Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.
The number of daily infections has shot up in France, which is one of several European countries experiencing a new wave of cases.
On Monday evening, Mr. Castex met virtually with elected officials from Guadeloupe, a Caribbean archipelago governed by France that has been rocked by violent unrest over the past few days because of protests against French vaccination mandates.
In a televised statement after the meeting, Mr. Castex condemned the violence and said the government would try to “convince and assist, individually, humanely,” health workers who are reluctant to get vaccinated.
“Vaccination is necessary for protection, most notably against serious forms of the illness,” said Mr. Castex, who is fully vaccinated. “There is no other way.”
In other news from around the world:
Officials in South Korea said on Tuesday that they had shut down a religious facility in the city of Cheonan after 210 of its 427 residents tested positive for the coronavirus this week, an outbreak that comes as the country’s cases surge to record highs. At least 191 of those infected in Cheonan were unvaccinated, a health official said. Officials did not release the name of the religious organization, citing disease control laws meant to protect privacy.
Germany’s military is set to require service members to be vaccinated after a committee of soldier-representatives and defense ministry staff approved such a step on Monday. The move still requires formal approval. German soldiers abroad have already been required to be vaccinated since the spring. On Tuesday, the defense ministry announced that it would send 6,000 soldiers to help districts dealing with a spike in coronavirus cases.
A court in Spain rejected a plan by the government of the Basque region to make it compulsory to show a vaccination passport to enter restaurants, concert halls and other public spaces. The judges ruled on Monday that the latest Covid numbers did not justify the blanket obligation. The regional government said it found the ruling incomprehensible, but that it would not appeal. At least three other regions of Spain had been preparing similar measures.
Most public health experts agree that it’s OK to make holiday plans with your favorite people, as long as you’re taking precautions. Answering a few simple questions can help you make safer decisions.
You can take the quiz by clicking below, or keep reading for an overview.
Will everyone be vaccinated?
If yes — or if the only unvaccinated people are young children — that will make the party safer for everyone, though if you want to reduce the risk even further, you may want to encourage every adult to get a booster shot. If unvaccinated adults will be there, on-the-spot rapid tests are a great way to lower risk. You can also improve ventilation by opening windows, using exhaust fans, adding portable air cleaners or moving the event outdoors if weather allows.
Are any guests at higher risk from Covid?
If everyone is at relatively low risk, you may decide that being vaccinated is enough, and that additional precautions aren’t needed. But if any of your guests are older or have underlying conditions that put them at higher risk, it’s important to plan the event around the most vulnerable person. That could mean using rapid tests and improving ventilation, or having the party at their home so they don’t have to travel.
Are you traveling?
Staying local is the lowest-risk option, and if you’re traveling farther, driving is safer in terms of Covid risk than taking public transportation.
If you have to fly or take a bus or train, you should take extra precautions. A high-quality medical mask like an N95, KN95 or KF94 can keep you safer; if those aren’t available, double mask with a surgical mask and quality cloth mask. If possible, you should keep it on the whole time. At airports and train or bus terminals, try to avoid crowds, keep your distance in screening lines and use hand sanitizer often.
What’s the Covid situation where you’re celebrating?
Check local Covid conditions like you would the weather, looking at vaccination rates, case counts and hospitalizations. If you’re headed to a Covid hot spot, it’s best to wear a mask in public spaces, and you may want to avoid indoor dining, especially if someone in your group is at high risk.
What’s it like where you live?
If you live in a Covid hot spot, the chance of bringing the virus with you when you travel is higher. Be vigilant about masking and avoid crowds in the days before you leave. Using rapid tests can also reassure everyone that you’re not infectious.
How big is the gathering?
When you limit a gathering to two households, it’s easier to keep track of risky behaviors and potential exposures. This doesn’t mean large families shouldn’t gather, but you may want to take extra precautions if more than two households will be present. Those precautions could include opening windows, turning on exhaust fans and using portable air cleaners. And the bigger the party, the more useful it is to have rapid tests on hand for everyone.
How long until your event?
Risk is cumulative. The choices you make before the party can help lower the risk for everyone. If you’ve been invited to other gatherings before you leave, consider skipping them, and be vigilant about reducing your exposures during travel.