90 Percent of U.S. Federal Employees Will Meet Vaccination Deadline

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A Long Island emergency room was forced to close its doors on Monday because of a nursing staff shortage, as a New York state rule took effect that bars unvaccinated medical workers from their jobs.

The free-standing Emergency Department at Long Beach, which is part of Mount Sinai South Nassau, said in a statement that patients would be directed to the hospital’s main campus in Oceanside, N.Y., about five miles north. An ambulance will be stationed at the shuttered facility, the statement said.

The hospital said the closure could last weeks or longer. But closing the Long Beach branch will allow the hospital to maintain adequate staffing at the Oceanside facility, the statement said.

“We regret having to take this step, but the safety of our patients is always our No. 1 priority,” said Dr. Adhi Sharma, the president of the medical center. “This closure should not be interpreted as anything beyond what it is — a temporary measure designed to relieve current staffing challenges in our emergency department. Our nurses, physicians and support staff have been on the front lines of the pandemic for more than 21 months. We will continue to be there for our patients.”

New York’s statewide vaccination mandate for health workers does not allow for religious exemptions, which spurred legal challenges. A federal court upheld the policy late last month.

Mount Sinai South Nassau said it had notified the state Health Department on Friday of the need to close the facility, and had submitted a formal closure plan. In a statement on Monday night, the Health Department said it was reviewing the plan and working with Mount Sinai South Nassau to “explore options.”

For now, Mount Sinai South Nassau is recruiting workers who can show proof of vaccination or valid medical exemptions in the hope of resuming full operations in mid-December.

Mount Sinai’s Oceanside emergency room is a designated trauma facility and sees about 70,000 patients a year, according to the medical center. The Long Beach branch, which opened in 2015, handles about 10,000 patients a year, most of whom are treated and discharged without being transferred to the hospital.

A Massachusetts state judge on Monday dismissed criminal charges against two administrators of the Holyoke Soldiers’ Home, where an outbreak of coronavirus led to 76 deaths, reasoning that the actions of administrators did not lead to the infections.

The state’s attorney general, Maura Healey, had sought criminal charges of criminal neglect and permitting body injury to an older person against the two administrators based on their decision to combine two understaffed dementia units, crowding together infected and uninfected men.

But Judge Edward J. McDonough Jr., of Hampden County Superior Court, wrote in his dismissal that he believed the five veterans named in the case had been exposed to the virus before the two units were merged, so the administrators could not be held legally responsible.

“There was insufficiently reasonably trustworthy evidence presented to the grand jury that, had these two dementia units not been merged, the medical condition of any of these five veterans would have been materially different,” he wrote.

Ms. Healey is weighing whether to appeal the decision, a spokeswoman said.

“We are very disappointed in today’s ruling, especially on behalf of the innocent victims and families harmed by the defendants’ actions,” said Jillian Fennimore.

The criminal charges against the two administrators — the superintendent Bennett Walsh and the medical director David Clinton — were believed to be the first in the country brought against nursing home staff, and the two could had faced years or even decades in prison if convicted.

Because of staffing shortages, the facility consolidated the units, which had a total of 42 residents who had different Covid-19 statuses, and residents who were positive or symptomatic were placed six in a room that typically held four veterans. An independent investigation of the deaths quoted nurses who said they knew that the move to combine units would prove deadly to many of their patients.

Relatives of the veterans who died at the facility expressed frustration at the judge’s decision on Monday.

“Absolutely disgusting, our veterans and their families apparently are a disposable commodity,” wrote Susan Perez, whose father, James Miller, died at the home, adding, “Apparently no one is responsible for the deaths of the veterans and trauma to their families.”

More than 90 percent of federal employees will have had at least one coronavirus vaccine shot by the end of Monday, the deadline set by President Biden when he announced vaccine mandates earlier this fall, according to a senior administration official.

The vast majority of those employees are fully vaccinated, and an additional 5 percent of employees are seeking or already have an exception or an extension, the official said. The news was first reported by Reuters.

This means the Biden administration will have achieved 95 percent compliance with the president’s requirement that federal employees have at least one shot or have an approved or pending exception or extension request by Nov. 22, according to the official, who spoke on the condition of anonymity to preview an announcement that White House officials will make later in the day.

Mr. Biden’s mandate for federal workers, announced in September, was part of an aggressive effort to combat the spread of the Delta variant, which has driven caseloads up to levels last recorded a year ago, before vaccines were widely available. The president also mandated vaccination for health care workers and ordered all companies with more than 100 workers to require vaccination or weekly testing for their employees.

“We’ve been patient,” Mr. Biden said then, in a pointed message to people who refused to be vaccinated. “But our patience is wearing thin. And your refusal has cost all of us.”

More than 3.5 million federal workers, both in the United States and around the world, are covered by Mr. Biden’s mandate. Employees who have not complied, and do not have a pending or approved exception or extension request, will be expected to undergo education and counseling, the official said, followed by “additional enforcement steps.”

On Wednesday morning, the Office of Management and Budget will release data on the percentage of employees at each agency who are in compliance with the requirement.

A personnel change in the White House’s coronavirus team is expected next week. On Monday, Dr. Bechara Choucair, the former Chicago health commissioner whom Mr. Biden brought in to oversee the vaccination effort, will leave the administration, according to Jeff Zients, the White House coronavirus response coordinator.

Dr. Choucair was a senior executive at Kaiser Permanente before joining Mr. Biden’s staff and is “returning to the West Coast after staying longer than originally planned,” Mr. Zients said.

A month ago, new coronavirus cases in the United States were ticking steadily downward and the worst of a miserable summer surge fueled by the Delta variant appeared to be over. But as Americans travel this week to meet far-flung relatives for Thanksgiving dinner, new virus cases are rising once more, especially in the Upper Midwest and Northeast.

Federal medical teams have been dispatched to Minnesota to help at overwhelmed hospitals. Michigan is enduring its worst case surge yet, with daily caseloads doubling since the start of November. Even New England, where vaccination rates are high, is struggling, with Vermont, Maine and New Hampshire trying to contain major outbreaks.

Nationally, case levels remain well below those seen in early September, when summer infections peaked, and are below those seen last Thanksgiving. But conditions are worsening rapidly, and this will not be the post-pandemic Thanksgiving that Americans had hoped for. More than 90,000 cases are being reported each day, comparable to early August, and more than 30 states are seeing sustained upticks in infections. In the hardest-hit places, hospitalizations are already climbing.

“This thing is no longer just throwing curveballs at us — it’s throwing 210-mile-an-hour curveballs at us,” said Michael Osterholm, an epidemiologist at the University of Minnesota. He said that the virus had repeatedly defied predictions and continues to do so.

The new rise in cases comes at a complicated moment. Last Thanksgiving, before vaccines were available, federal and local officials had firmly urged Americans to forgo holiday gatherings. But in sharp contrast, public health officials, including Dr. Anthony S. Fauci, the nation’s leading infectious-disease expert, have mostly suggested this year that vaccinated people could gather in relative safety.

The chief elected official in Dallas County celebrated a victory Tuesday in his legal battle over the governor’s ban on mask mandates, after a state appeals court upheld an earlier injunction against the ban.

The ruling by Fifth Court of Appeals in Dallas affirmed an August ruling by a district judge that Gov. Greg Abbott’s executive order banning mask mandates impeded the ability of Judge Clay Jenkins, the top elected official in Dallas County, to protect his constituents from Covid.

Partisan tensions are at a fever pitch over whether students, teachers and school staff members should be required to wear masks. Some Republicans have cast mask rules as an infringement on parental rights, while many Democrats hold that they are a matter of public health.

Mr. Abbott has faced a series of legal challenges since he signed an executive order in July barring mandates for both masks and vaccinations.

Officials in Dallas and elsewhere in Texas have defied the governor by requiring people to wear masks in schools and other indoor public settings.

BRUSSELS — European governments are toughening their measures against Covid in the face of soaring infection rates and popular resistance, with violent protests over the weekend in numerous countries.

Austria went into lockdown on Monday to try to break the fourth wave of Covid spreading across Europe, while the German health minister, Jens Spahn, warned that by the end of this winter, “just about everyone in Germany will probably be either vaccinated, recovered or dead.”

Tens of thousands of people protested official crackdowns and vaccine requirements in Austria, the Netherlands, Belgium, Denmark, Italy, Switzerland and Croatia, with scattered violence and police use of tear gas and water cannons. Some protesters were organized by far-right parties, but many were simply fed up with almost two years of intermittent state controls over their lives in the name of public health.

Europe has accounted for more than half the world’s reported Covid deaths this month, according to the World Health Organization. On Monday, the Centers for Disease Control and Prevention advised Americans not to travel to Germany or Denmark because of the rising case rates there.

Chancellor Angela Merkel of Germany told her Christian Democratic Party on Monday that the latest surge was worse than anything Germany had suffered so far. And neighboring Austria began its fourth lockdown, one of the few in Western Europe since vaccines became widely available.

Most stores, restaurants, sporting venues and cultural institutions shut down, leaving the streets cold and quiet in the weeks before Christmas. The lockdown, which allows people to leave home only to go to work or to procure groceries or medicines, will last at least 10 days and as many as 20.

Austria has also announced that vaccination will be compulsory as of Feb. 1 — the first Western country to take that step, and one of only a handful around the world. On Saturday, some 40,000 Austrians marched in Vienna to protest the new measures.

In France, President Emmanuel Macron has relied more on persuasion. Proof of vaccination or a recent negative test is required to patronize restaurants and cinemas, which has encouraged many reluctant French to get vaccinated without a national mandate. But anti-vaccination groups remain active in France, as well.

France’s prime minister, Jean Castex, has tested positive for the coronavirus and will work in isolation for the next 10 days, his office told Agence France-Presse on Monday evening.

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 told the news agency.

“He therefore immediately took a P.C.R. test, which turned out positive,” his office said.

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 before fully recovering.

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 French overseas department in the Caribbean that has been rocked by violent unrest over the past few days because of protests against France’s 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.”

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Violent protests over vaccine mandates have rocked France’s overseas department of Guadeloupe in the Caribbean over the past week, fueled by longstanding social and economic frustrations over inequality with the mainland and simmering anger at being overlooked by the French government.

Guadeloupe, an archipelago of islands, is one of several French overseas territories that have been hit hard by the pandemic over the past few months and where France’s vaccination campaign has been met with the most suspicion and resistance.

A mix of old grievances and new distrust over Covid-19 rules has made the unrest particularly volatile.

Demonstrations that started peacefully with road blocks and pickets in front of the main hospital in Pointe-à-Pitre, Guadeloupe’s largest city, grew increasingly violent over the weekend, as protesters burned cars, looted businesses and clashed with riot police officers, who responded with tear gas.

More than 30 people accused of violence or looting have been arrested, and the local authorities imposed a nighttime curfew. The central government also announced over the weekend that it was sending over 200 police reinforcements.

On Monday, the remains of charred cars littered roads and schools remained closed as President Emmanuel Macron of France appealed for calm and order.

“Our priority is to continue convincing that vaccination is the best protection,” Mr. Macron told reporters during a visit to Amiens, his hometown in northern France. “And to yield nothing to lies, disinformation and the manipulation by some of this situation.”

“There is a very explosive situation, tied to a very local context, to historical tensions that we know of,” Mr. Macron acknowledged, as he accused some of the government’s critics of “using this context and these anxieties” to aggravate the situation.

Over 40 percent of the adult population in Guadeloupe is fully vaccinated, but that figure is nearly 90 percent for all of France including overseas regions, according to official statistics.

The unrest started last week with a strike by local unions that are opposed to France’s vaccine mandate for health workers. Those unions say it was imposed by the central government with little consultation, and are particularly infuriated that unvaccinated health professionals are suspended without pay.

“That is an unheard level of violence against them and their families,” Jean-Marie Nomertin, the secretary general of the Confédération Générale du Travail de la Guadeloupe, one of the protesting unions, said in a statement last week.

Protesters have also rejected France’s health pass, which is needed to gain access to restaurants, museums and other public places and can only be obtained through full vaccination, proof of Covid recovery, or a recent negative test — which must now be paid for out of pocket for those who are not vaccinated and do not have a prescription.

As in other overseas departments like Réunion or French Guiana that are a legacy of France’s colonial empire, Guadeloupe has long felt overlooked by policymakers in Paris, with decades-old anger over stagnant unemployment, high living costs and dysfunctional public utilities that have fueled protests in the past.

Suspicion of public health policies is especially high in the French Caribbean, where the government authorized the use of a highly toxic pesticide called chlordecone on banana plantations for decades, despite repeated health warnings.

“People are afraid, they have no trust,” Harry Durimel, the mayor of Pointe-à-Pitre, told Franceinfo on Monday, adding that local residents were “ready for a confrontation” over vaccine rules if they felt they were being forced “to inject a product in their body.”

On the nearby island of Martinique, unions on Monday called for a general strike over similar concerns.

NAIROBI, Kenya — Kenya will require people to show proof of coronavirus vaccination to enter many businesses, restaurants and government offices starting next month, a major policy shift that has prompted outrage in a country where less than 5 percent of the total population is fully vaccinated.

Mutahi Kagwe, the cabinet secretary for health, said on Sunday that he was concerned about a slowdown in vaccinations and hoped the new rules would persuade more people to get their shots. With schools closing and the country heading into the festive season, he said there were concerns that people would become complacent about public health measures, including social distancing and wearing masks.

The new measure was swiftly criticized by lawyers, activists and the public, who cautioned against a stringent vaccine mandate just weeks after the lifting of a longstanding nationwide night curfew that dampened economic activity.

“It’s clearly unconstitutional,” Waikwa Wanyoike, a prominent constitutional lawyer, said of the mandate, adding that using “threats” to get more people to get inoculated will only create more apprehension about vaccines. “The requirement may be right in terms of asking as many people to be vaccinated but the approach is wrong,” he said in a phone interview.

Vaccination campaigns in Kenya have been hampered by a lack of funding. There have been few awareness campaigns. Nor are there widespread vaccination sites. The authorities at times have scrambled to access or purchase cold storage facilities needed to store the shots.

The new rules will also extend to those planning to visit hospitals, prisons, eateries, bars, national parks and any business serving 50 or more people daily. Drivers of public transportation, along with pilots and air hostesses, will be expected to always carry proof of vaccination. In addition, visitors from Europe will be required to be fully vaccinated to enter Kenya.

The new rules are the most expansive introduced in the continent yet, according to Dr. Githinji Gitahi, who serves on the governing board of the Africa Centres for Disease Control and Prevention. Zimbabwe has mandated that civil servants get shots and requires congregants at places of worship to produce proof of vaccination. Uganda requires all teachers and health care workers to be vaccinated while Namibia has flouted the idea.

Kenya has recorded over 254,700 cases and 5,328 deaths from the coronavirus. While average case rates have dropped in recent weeks, the lag in vaccinations and the spread of the more contagious Delta variant had overwhelmed the country’s health care system. Kenya hopes to vaccinate at least 30 million people before the end of 2022, but like many African countries, it has also struggled to gain access to vaccines.

The new restrictions were met with skepticism, with many lamenting its impracticality. Some pointed to the low vaccination rates among the adult population, with just 8.8 percent of them fully vaccinated. Others said the mandate could open the door to more corruption, bribery and the proliferation of fake vaccine certificates.

Critics said the government should not only make sure that vaccines are available to all but also should come up with better strategies to address misinformation and resistance to getting vaccinated.

Irungu Houghton, the executive director of Amnesty International Kenya, said the new mandate, in its current format, risked depriving people of their right to not only work but also access critical services like health and education.

“This proposal risks domesticating the global vaccine apartheid and creating those with rights and those without,” Mr. Houghton said in a statement.

The American Medical Association voted last week to allow only licensed physicians to write requests for patients seeking medical exemptions from vaccine mandates.

But the association does not have the power to enforce what is, in effect, a symbolic action intended to show concern as tens of thousands of people seek exemptions. While some states prohibit alternative practitioners like homeopaths, osteopaths, chiropractors and naturopaths from writing medical exemptions for vaccines, other states allow it.

“Science supports a vaccine mandate,” said Dr. Gerald E. Harmon, the president of the American Medical Association, “and we do not need to offer routes to evade mandates and undermine public health by seeking out practitioners who are not licensed or medically trained.”

The A.M.A.’s stance reflects increasing frustration among doctors with the spread of misinformation about Covid-19 vaccines and the virus. The association says that alternative practitioners are less likely than licensed physicians to recommend vaccines, and that they may even advise people not be vaccinated.

But removing power from alternative practitioners would not stop patients from getting invalid medical exemption requests. Licensed medical doctors are also writing bogus requests, according to doctors who are being asked to rule on them.

Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco, sees the problem with invalid exemptions firsthand. Although California prohibits alternative practitioners from writing vaccine exemptions, patients are finding licensed doctors who will write them.

Dr. Chin-Hong said the university often called on him to evaluate the requests.

“I have never seen one that passed muster,” he said.

Some patients seeking a medical exemption will simply hop from one doctor to another if they are turned down, said Lawrence O. Gostin, a global health law professor at Georgetown University. If the university denies their request, he added, people often turn up again with a request for a religious exemption.

Australia, 20 months after shutting its borders, will allow skilled workers and international students to enter the country next month, the government announced on Monday.

The move comes as the Australian government, faced with a severe labor shortage, turns its focus to economic recovery, with 72 percent of the country fully vaccinated.

The new rules go into effect on Dec. 1, the beginning of summer in Australia. Some categories of visa holders, including skilled workers, international students, and those on working holiday and prospective marriage visas, will be allowed to enter Australia for the first time since the start of the pandemic. Over 200,000 people will fall into those categories.

“The return of skilled workers and students to Australia is a major milestone in our pathway back,” Prime Minister Scott Morrison said on Monday at a news conference. “The steps that we are taking today are about securing our economic recovery.”

At the start of the pandemic, Australia shut its borders to noncitizens, leaving hundreds of thousands of visa holders stranded outside the country and contributing to a significant worker shortage. Australia has relied on temporary workers for many industries, such as hospitality and agriculture. The travel restrictions also created a severe funding shortfall for universities.

Most tourists are still barred from traveling to Australia, except those from Singapore, South Korea and Japan, all countries that have established travel bubbles with Australia.

Visitors entering Australia will need to be fully vaccinated and return a negative PCR test within three days of boarding their flight. Upon arrival, they will need to follow some quarantine restrictions, depending on the state in which they arrive.

On Sunday, the first planes from Singapore arrived in Sydney and Melbourne under the new travel bubble arrangement, bringing the first tourists into the country since the start of the pandemic.

The lines are getting longer at the Halal Guys food cart in the heart of Manhattan. The number of international visitors buying Statue of Liberty tickets has jumped more than 50 percent. And a few thousand more people are walking through Times Square.

After more than 18 months, the United States reopened its borders on Nov. 8 to vaccinated foreign travelers. Early indications suggest that they have been trickling back to New York, the top American destination city for international tourists.

But many businesses that depend on international visitors, including hotel operators and restaurants, see signs that even more tourists could start streaming in as the year-end holiday season approaches, providing a badly needed boost as the city’s labor force struggles to recover from the pandemic.

The tourism industry has increasingly become a pillar of New York’s economy. A record 66.6 million travelers visited the city in 2019, and their spending supported hundreds of thousands of jobs, from restaurant workers to museum security guards to bus drivers.

Some airlines reported that their first flights carrying tourists to New York in 20 months were fully booked.

“It really seems like the city is happy to show itself to the world again,” said Christiaan Vander Kuylen, who arrived recently from Brussels. “The energy is amazing.”

As a company in India tests a cheap and possibly highly effective Covid-19 vaccine, a large group of researchers, most of whom are at Harvard, made the same vaccine and figured out how and why it could work so well, especially in vulnerable older adults.

The Harvard group began with a crucial question about Covid: Which population is most important to protect?

The answer, of course, is older people who are most at risk for severe disease and death.

The Harvard group began testing the vaccine with old mice. Like older people, old mice are much more susceptible to the coronavirus and much more likely to die.

The researchers made a vaccine that included a fragment of the virus’s spike protein, the part that latches onto cells, allowing the virus to enter. Vaccines like the ones made by Moderna and by Pfizer-BioNTech spur cells to make complete copies of the spike, prompting the immune system to make antibodies to block it if a coronavirus tried to infect the person.

But those vaccines are expensive to make and store. In contrast, a snippet of the spike is cheap and can be stored at room temperature. The problem was that it does not elicit much of an immune response.

The Harvard group, led by David Dowling, turned to adjuvants — chemicals that enhance the immune system’s response to vaccines — trying one adjuvant combination after another until they found one that seemed spectacularly successful. With that adjuvant, the vaccine protected mice at least as well as the Pfizer vaccine, said Dr. Ofer Levy, the director of Harvard’s Precision Vaccines Program.

But what about people? Dr. Levy recruited volunteers from his Cambridge synagogue — people in their 60s, 70s and 80s — to provide blood for lab tests to see if the adjuvant that was so good in mice also stimulated the immune system in older people.

It did.

Now the question is what will happen in the trial in India? If the vaccine works, the hope is that it could help solve one of the thorniest problems in stemming the pandemic — how to make vaccines accessible to everyone worldwide.

The Indian government seems to be betting on success. In June, while clinical trials were in their early stages the government preordered 300 million doses. Its maker, Biological E Limited, estimates it will cost $3 a dose.

In contrast, Pfizer’s price is $19.50 a dose but is expected to rise after its pandemic pricing phase ends.

Papua New Guinea will have vaccinated only a third of its adult population by 2026 if it continues at its current rate, according to new research by an Australian think tank that predicts that some countries in the Pacific will take years to vaccinate their populations.

The research by the think tank, the Lowy Institute, using modeling based on existing vaccination rates and factors such as demography, vaccine acceptance rates and health sector capacity, found that while some countries in the Pacific are leading the world in vaccination rates, others are lagging far behind.

“The Pacific is divided when it comes to vaccinations,” said Alexandre Dayant, the author of the study and a Lowy Institute research fellow, warning that the slow vaccination speed in some nations raised the risk of new variants emerging.

Palau has given 99 percent of residents at least one vaccine dose. Tonga and Samoa are set to vaccinate their adult populations before the end of the year, according to the modeling, which is subject to change.

However, the Solomon Islands are not expected to fully vaccinate their adult population until April 2026, while it is estimated to take Vanuatu until then to vaccinate 86 percent of its adult population. And Papua New Guinea, the slowest in the region, will have vaccinated only about 16 percent of its population by December 2022.

These countries have been hampered by overstretched health care systems and rampant vaccine misinformation, Mr. Dayant said.

Facebook is often people’s primary source of information there, and unsubstantiated theories of Western plots to inoculate people with microchips and black magic circulate on social media, he said, adding: “misinformation spreads much quicker than the virus in the Pacific.”

He said wealthy countries could do more, like bolstering local health care systems. “It is in the interest of the world to vaccinate developing countries,” he said.