As Omicron spreads, the C.D.C. seeks to clarify its message on testing and isolation.
The flight monitors at George Bush Intercontinental Airport in Houston last week. The airlines continued to cancel flights into the weekend.Credit…Brandon Bell/Getty Images
Airlines canceled thousands more flights in recent days as the industry tried to move past its holiday hangover.
Bad weather and coronavirus outbreaks among workers continued to disrupt schedules across the United States, but airlines have also called off many recent flights, in advance, so they can correct course at a traditionally slow time for travel without surprising customers with last-minute cancellations.
About 5,000 flights were canceled from Friday through Sunday, according to FlightAware, a data tracking service, with the daily number of cuts declining steadily over that period. Southwest Airlines suspended over 1,000 flights, more than any other carrier. SkyWest Airlines, which operates flights for several major carriers, and United Airlines each canceled more than 500 flights.
The turmoil began before Christmas, caused by bad weather in the West and staff shortages because of virus outbreaks among employees. Snowfall in the Northeast continued to wreak havoc at major airport hubs across the country into the first weekend of this month.
“Given the ongoing surge in Covid cases and related sick calls, we’ve been working with each of our major partners to proactively reduce our January schedules,” SkyWest said in a statement. The airline operates flights for United, Delta Air Lines, American Airlines and Alaska Airlines and said the pullback is intended to “ensure we’re able to adequately staff our remaining flying as we work to recover in the coming weeks.”
After canceling flights at high rates over the holidays, JetBlue Airways said it would preemptively cut about 1,300 flights in the first half of January. Alaska said in a statement last week that it would slash about one in 10 flights planned for the month to gain “the flexibility and capacity needed to reset.”
As in many other industries, airlines are also contending with workers calling in sick at high rates as the Omicron virus variant spreads at astonishing speed.
“It has been one of the most difficult operational environments we’ve ever faced,” Allison Ausband, Delta’s chief customer experience officer, said in a statement last week apologizing to customers for the disorder.
To deal with staffing shortages, many carriers have started offering extra pay to those who were otherwise not scheduled to work. Southwest, for example, said last week that it was offering double pay for most of the month to employees who picked up extra shifts, incentives available to workers across its operation, including ground staff, flight attendants, customer service employees, flight schedulers and maintenance technicians.
The chaos comes at a frustrating time for the industry, which is preparing for a significant rebound this summer. That recovery rests largely on the hope that the pandemic will be mostly under control by then and that people will be more willing to travel internationally and for work.
Mass-vaccination sites are returning as several states have started or will soon start pop-up clinics amid a surge in coronavirus cases.
Driven by the fast-spreading Omicron variant, coronavirus cases have soared over the last month in the United States, averaging about 650,000 new known cases a day, according to a New York Times database, far more than last winter’s peak. Although Omicron appears to cause less severe illness, many local health care systems have been overwhelmed by the sheer numbers.
About 63 percent of the country has been fully vaccinated, according to federal data. Concerns over the variant have prompted many vaccinated people to seek out booster shots but do not appear to be persuading large numbers of the unvaccinated to roll up their sleeves, some recent survey data have suggested.
Mass vaccination sites played a vital role in the initial months of the vaccine rollout, but many had shut down by the summer as the effort became more targeted to reach unvaccinated people.
Large vaccination sites could help alleviate the burden on pharmacies and smaller clinics, health experts say, as surges in patient demand collide with staffing shortages brought on by coronavirus infections.
“It’s really got to be community by community, state by state, thinking through where the demand is and matching the gaps in delivery,” said Dr. Eric Goralnick, a medical director at Brigham and Women’s Hospital who had served as the medical director for mass-vaccination sites in Massachusetts.
“For example, all of our hospitals in Massachusetts are overcapacity every day, and many places are strained. So it’s quite challenging for health care systems to not only care for patients but also build a capacity to provide vaccines for the community.”
Massachusetts recently announced that it would open several mass-vaccination sites, including reopening Fenway Park, the home to the Boston Red Sox baseball team.
Illinois plans to start four mass-vaccination clinics to meet the growing demand for booster shots, Gov. J.B. Pritzker announced on Friday. The state is more than doubling personnel at regional vaccination sites.
The mass-vaccination clinics are “another step forward for safe schools, safe businesses and safe communities for all,” Mr. Pritzker said in a statement.
Oregon expects to have 10 mass-vaccination clinics running soon, with the largest administering up to 3,000 shots a day, Dean Sidelinger, the health officer and epidemiologist for the state, told The Wall Street Journal.
Dr. Peter Hotez, a vaccine expert at the Baylor College of Medicine, said the jump in booster shots reflected the reality that many people who had received two doses of vaccine were still suffering breakthrough infections.
“One shift you’re seeing now,” he said, “is that people are finally understanding that full vaccination really does mean three doses.”
The Centers for Disease Control and Prevention faced fresh blowback on Sunday for its muddled messaging on the agency’s new isolation and quarantine guidance.
The C.D.C.’s new guidelines, released on Dec. 27, say that people infected with the coronavirus can end isolation, in most cases, after five days instead of 10 and do not need a negative result on a virus test to do so. But some experts have said that five days might be too short, and that letting people mingle with others before first testing negative was risky.
On Sunday, Dr. Rochelle Walensky, the agency’s director, fielded questions about her decision to drop the testing requirement, and maintained that antigen tests are less sensitive to the Omicron variant, which is surging across the United States, than to previous versions of the virus.
“We have ever-evolving science with an ever-evolving variant, and my job is to provide updated guidance in the context of rapidly rising cases,” she told “Fox News Sunday.”
But other experts disagreed with that assessment, saying antigen tests, while flawed, only missed Omicron cases very early in the course of infection.
“I think they are a bedrock of our long-term strategy for managing this virus,” Dr. Ashish Jha, dean of the Brown University School of Public Health, said on ABC’s “This Week.”
The debate on testing reflects broader disagreement over how best to cope with a virus that seems here to stay. With only about 63 percent of the population fully vaccinated, the virus could seed large outbreaks and overwhelm hospitals for the foreseeable future.
On Thursday, six prominent health experts who advised President Biden’s transition team called for a new strategy to help Americans live with the virus long-term. Among the recommendations: easy access to affordable tests, more aggressive use of vaccine mandates, “comprehensive, digital, real-time” data collection by the C.D.C. and faster development of vaccines and treatments.
The Supreme Court seemed unlikely on Friday to allow a cornerstone of the Biden administration’s plan to fight the virus. While the court may greenlight a vaccine mandate for health care workers at facilities that receive federal funding, it seemed skeptical of the legal basis for a broader mandate that would affect 84 million American workers.
That mandate would compel all companies with 100 or more employees to require either vaccinations or weekly testing and masks.
“The Supreme Court has to recognize that Covid in the workplace is a real health threat,” said Dr. Zeke Emanuel, one of the authors of the proposed pandemic strategy and a medical ethicist at the University of Pennsylvania. Vaccine mandates are the best protection against the virus, particularly for frontline workers, he said.
“For the Supreme Court to take that away in the midst of an emergency seems to me to be very wrong,” he added.
Dr. Walensky did not respond to a question about the utility of a vaccine mandate but noted that unvaccinated children and adults are at significantly higher risk from the virus than people who are fully vaccinated and boosted.
In children 4 years old and younger, who are not yet eligible for vaccination, hospitalizations are at the highest levels since the beginning of the pandemic, the C.D.C. reported on Friday.
“The vast majority of children who are in the hospital are unvaccinated,” Dr. Walensky said on Sunday. “And for those children who are not eligible for vaccination, we do know that they are most likely to get sick with Covid if their family members aren’t vaccinated.”
Omicron is milder than previous variants, and even young children seem less likely to need ventilators than those admitted during previous surges, doctors have said.
Dr. Walensky also clarified confusion over the number of children hospitalized with Covid. On Friday, Justice Sonia Sotomayor mistakenly said that 100,000 children with Covid had been admitted to hospitals nationwide. The real number is closer to 3,500, Dr. Walensky said.
“While pediatric hospitalizations are rising, they’re still about 15-fold less than hospitalizations of older age demographics,” she added.
Some people with a weakened immune system can get a fourth dose of the coronavirus vaccine as early as this coming week, according to new recommendations from the Centers for Disease Control and Prevention.
The C.D.C. endorsed a third dose of the Pfizer-BioNTech and Moderna vaccines for moderately or severely immunocompromised people on Aug. 13, but said this would be considered a part of the primary immunization, not a booster shot.
In October, the agency said those immunocompromised people could receive a booster shot — a fourth dose of vaccine, six months after their third dose. These guidelines were consistent with its recommendation for other adults.
Last week, hoping to stem the surge of infections with the highly contagious Omicron variant, the C.D.C. shortened that interval to five months for a booster shot for Pfizer-BioNTech or Moderna recipients.
For immunocompromised people who received a single shot of the coronavirus vaccine made by Johnson & Johnson, the C.D.C. does not recommend additional primary doses, but advises that they get a booster shot of the Moderna or Pfizer-BioNTech vaccines two months after the first dose.
Some people are born with absent or faulty immune systems, and in others, treatments for some diseases like cancer diminish the potency of immune defenses. The C.D.C. estimates there are about seven million immunocompromised individuals in the country.
Many of them produce few to no antibodies in response to a vaccine or an infection, leaving them susceptible to the virus. When they do become infected, they may suffer prolonged illness, with death rates as high as 55 percent.
It is unclear what proportion of those people are protected by additional doses. Still, with the Omicron variant surging in the country, some immunocompromised people sought out fourth or even fifth shots of the vaccines even before the C.D.C. changed its guidelines. While receiving multiple doses of vaccines in a short period is unlikely to be harmful, it may produce diminishing returns, according to some experts.
The C.D.C. has said that any American 12 and older can receive a Pfizer-BioNTech booster — those 18 and older can alternatively receive a Moderna booster — five months after completing their initial shots with those vaccines. Israel has already begun offering fourth doses to high-risk groups including older adults. But the Biden administration has not yet said whether it plans to follow suit.
When asked on Friday about the possibility of a fourth shot for the general population, Dr. Rochelle Walensky, director of the C.D.C., said that focus remained on Americans eligible for their third shots.
She added that U.S. officials remained in close touch with Israel experts about their data. “We will be following our own data carefully as well, to see how these boosters are working in terms of waning effectiveness, not just for infection but, importantly, for severe disease,” she said.
Following a bumpy first week back for New York City public schools, Mayor Eric Adams, speaking on Sunday morning television shows, reiterated his commitment to keeping children in the classroom.
The mayor, citing educational outcomes and the struggle that working parents and those without access to reliable internet have faced over the past two years, trumpeted the cascading benefits of in-person learning.
“When you start to disrupt the stability of child care, of day care and education, it has a rippling impact throughout our entire city,” he said on CBS’s “Face the Nation.” “We have to ensure the financial ecosystem is healthy, as well as our children and our families are healthy at the same time.”
In the first week back to school after the winter holiday, classroom attendance floated around 70 percent, falling to 44 percent on Friday with the expectation of snow. This week marked the beginning of a new statewide “Test to Stay” policy that allows children to continue attending school after a coronavirus exposure provided they test negative for the virus. Proposals to require additional, mandatory testing for students are a possibility in the future, the mayor said, but he stressed that he did not want to create additional barriers for children to be in school and believed the current approach to be successful.
Beginning this fall, Los Angeles will require that children be vaccinated in order to attend classes in its public school system. On Sunday, when Mr. Adams was asked on CNN’s “State of the Union” whether he might consider a similar proposal, he was circumspect. “I am speaking with my health care professionals to do an evaluation to determine if that is what we do,” he said, noting that vaccinations for measles, smallpox and other diseases were already required for schoolchildren.
“Covid is a formidable and moving target,” the mayor said. “We have to pivot and shift based on that, and our policies have been rooted in ‘I need my children in school.'”
In Chicago, the labor standoff between teachers and the city continued, with the city facing the prospect of more canceled classes to open the week. Hundreds of thousands of students in the nation’s third-largest school district missed three days of class last week as a result of the dispute.
Officials in the northern Chinese port city of Tianjin, near Beijing, said on Sunday that its entire population of 14 million would be tested for the coronavirus after it was found in 20 residents, at least two of whom were infected with the fast-moving Omicron variant.
Mass testing over the weekend revealed another 20 people with the coronavirus, according to a report late Sunday by the city’s official news service.
The city also announced a raft of restrictions in an effort to contain the outbreak and trace its source. The first infections were confirmed on Saturday, in a 10-year-old girl and a 29-year-old woman who works at an after-school center. Tracing and testing later that day led to 18 more positive tests among their contacts, including 15 students.
Tianjin is about 70 miles from Beijing, so the burst of cases is especially worrisome for Chinese leaders, with the capital preparing to host the Winter Olympics in less than a month.
Li Hongzhong, the Communist Party secretary for Tianjin, vowed that the city would “fulfill to the utmost” its role as a “moat” protecting Beijing, official news outlets reported.
“The city’s pandemic prevention is at a crucial moment,” Mr. Li told officials, according to the state-run Tianjin Daily. “Tracing the source of the outbreak must be the most urgent and important task.”
Citywide testing is nothing new to China. But even with the country’s enormous resources for testing residents and tracing their movements, getting a handle on the outbreak in Tianjin might not be easy.
Zhang Ying, deputy director of the Tianjin Center for Disease Control and Prevention, said at a news conference that the virus may have “been already spreading in the community for some time” before detection. Neither the 29-year-old woman nor the 10-year-old girl who tested positive had recently left Tianjin.
Government experts also said the Omicron strain found in the two Tianjin residents might not be the same as that found in recent international arrivals in the city.
Many Chinese people have been proud that their country, since quelling the world’s first outbreak of the virus in Wuhan, has avoided the waves of infections that have swept most of the world. But the authoritarian state’s stringent controls, which have kept China largely sealed off, have not been able to keep the virus out entirely, and the extreme contagiousness of Omicron could present a new level of danger.
The Tianjin authorities ordered residents to limit their travel and not to leave the city unless absolutely necessary. They also put about 30 residential areas under comprehensive lockdowns and shut some subway stations.
But officials also seemed to try to reassure residents that Tianjin would not repeat the missteps of Xi’an, a city of 13 million in northwestern China. Xi’an saw a surge of public anger after a rushed lockdown led to food shortages and to some people being refused medical treatment, including at least one pregnant woman who suffered a miscarriage after being denied entry to a hospital.
Mr. Li, the Tianjin party chief, told local officials to ensure that residents received their daily needs, including medical care.
India’s election commission banned public campaign rallies for a week as coronavirus cases, fueled by the Omicron variant, soared in large parts of the country. But the local assembly elections in five states, representing a population of about 250 million, would proceed as planned starting in February, the commission said.
India recorded 160,000 known cases on Sunday, with the number of new cases rising sixfold in one week. The major urban centers of Mumbai, Delhi and Kolkata have been hit hardest.
Sushil Chandra, India’s chief election commissioner, said the moratorium on rallies would be reviewed on Jan. 15 based on the pandemic trends.
“Political parties and candidates are advised to conduct their campaign as much as possible through digital and virtual media platforms,” Mr. Chandra said on Saturday.
He noted that the commission had increased the number of polling stations, reduced the number of voters per booth and ensured that poll workers would receive booster vaccine shots. About half of the more than 180 million eligible voters across the five states are fully vaccinated, and more than 80 percent have received one dose, he said.
The spread of a new wave fueled by Omicron has mirrored that of the Delta wave that ravaged India in the spring, which also began in major cities before trickling to the rest of the country. Scientists are concerned that a repeat of that pattern in the coming weeks could coincide with preparations for elections. Already, the virus’s reproduction rate seems to be increasing in Punjab and Uttar Pradesh, the two most populous of the states up for elections.
The true number of infections was likely undercounted in official data as a large number of the infected people were asymptomatic or had mild symptoms and did not test.
The number of tests has increased in recent days, particularly in major cities. Nationwide, nearly one in every 10 test is returning positive. Some areas, including the city of Kolkata, had a test positivity rate of more than 50 percent. Fewer patients appear to be requiring hospitalization, compared to the spring wave. But health experts remain concerned that the fast rate of spread, with Omicron managing to infect even the vaccinated, could still overwhelm the health system.
New Delhi remained locked down for the weekend, as security forces operated a strict curfew. Several other states and cities across India are also enforcing nighttime curfews and movement limits. In Chennai, the capital of Tamil Nadu, officials moved to impose movement restrictions on Sunday. But it caused a crowded rush on shopping centers on Saturday, as people tried to squeeze in last-minute shopping ahead of a local harvest festival.
CHICAGO — With infection rates mounting, the Omicron variant has ushered in a new and disorienting phase of the pandemic, leaving Americans frustrated and dismayed that the basic elements they thought they understood about the coronavirus are shifting faster than ever.
There were reasons for heightened concern and reasons for consolation: Omicron is more transmissible than previous variants, yet it appears to cause milder symptoms in many people. Hospitalizations have soared to new highs in some states, but “incidental patients” — people who test positive for Covid-19 after being admitted for another reason — make up close to half of their cases in some hospitals.
Public health officials, in response to the new variant, have halved the recommended isolation period for people with positive tests to five days from 10 days, while also suggesting people upgrade their masks from cloth to medical-grade when possible.
“Omicron has turned, quickly, into something that is just different,” said Dr. Allison Arwady, Chicago’s top health official.
Amid shifting federal public health guidance and the new and distinct variant, President Biden’s own former transition team has called on the president to adopt an entirely new domestic pandemic strategy geared to the “new normal” of living with the virus indefinitely, not to wiping it out.
And Americans, confronted with these new sets of facts, warnings and advisories, have responded with a mix of confusion, vigilance and indifference. Left mainly to navigate it all on their own, they must sort through an array of uncertain risks — ride a bus? visit friends? eat inside? — hour by hour.
LONDON — Evelyn Forde hoped that January would bring some relief.
As the head teacher at Copthall School in north London, she spent the final weeks of 2021 dealing with major staffing shortages as the Omicron variant of the coronavirus began tearing across the city. But on Tuesday, as the all-girls secondary school reopened its doors, 13 of 120 teachers were absent.
One day later, another teacher tested positive.
“We were just hanging on for dear life and just thinking, ‘It’s going to be fine when we come back in January,'” Ms. Forde said, “only for the variant to kind of just spread like wildfire.”
Such scenes were repeated across London last week amid a record surge in coronavirus infections, even as the government has held back from imposing a national lockdown, choosing instead to “ride out” the wave.
The calculus in London, as in the rest of England and much of the United States, appears to be the same. Many parents, politicians and school administrators are desperate to keep schools open after two years of chaotic openings and closures. But the variant is raising questions about those hopes, at least in the short term.
In England, worries about staffing are dire enough that retirees — often older and therefore more vulnerable to severe illness from the coronavirus — have been urged to return to duty. Schools have been advised to merge classes to plug staffing gaps. And in a country that has long resisted the types of precautions taken in countries like Germany, secondary schools are now required to test all their students twice a week — adding to the burden of smaller staffs.
Even then, some parents question whether students should be back at all, given what they fear are inadequate precautions and promised changes in ventilation systems that they say are both too little, and too late.
Just as the Covid-19 crisis made amateur epidemiologists of people trying to go about their daily lives, it also forced human resources professionals, especially those at small and midsize businesses, into a new focus on public health.
As companies weighed when to return to the office, whether to require coronavirus vaccines and what sort of exemptions from those rules to allow, it was often H.R. directors who were asked to lead those efforts. It was no longer sufficient for these professionals to manage the job satisfaction and career development of their colleagues. Suddenly, they were also charged with monitoring their health, safety and views on immunization.
The added dimensions of H.R. jobs are coming into sharper focus now, as more organizations put vaccine mandates into effect. About 17 percent of American employers were requiring vaccinations or negative virus tests for employees returning to the office, according to a Gallagher survey of more than 500 employers conducted between August and October.
Hovering over company conversations about vaccines is the additional consideration of whether to mandate booster shots. The Centers for Disease Control and Prevention has not updated its definition of “fully vaccinated” but said that being “up to date” on vaccination includes a booster. Some state and local leaders like Gov. Kathy Hochul of New York have indicated that they plan to do so as well.
Then there’s the tug of war over return to office plans, with the pull of executives eager to see workers in person meeting the push of soaring Covid case counts. On top of that has come the challenge of retaining talent when workers are walking off the job, with 4.5 million leaving their roles voluntarily in November. The sources of stress, for some H.R. directors, seem to multiply by the month.
We spoke to experts to better understand what it could mean to test positive for both infections. Here’s what to keep in mind.
Will co-infection make me twice as sick?
A co-infection doesn’t immediately mean that a patient will be doubly sick. A strong immune response may actually help the body fight off pathogens of all types, so one infection could stimulate some additional protection.
“An infection to one might help to aid your immune response to another,” Dr. Grein said, “because it’s activating that same immune response that’s going to be effective in fighting both.”
Still, scientists don’t know for sure yet, because so few people have tested positive for both Covid-19 and influenza. But judging from past trends, doctors are not overly worried.
Who is most susceptible?
Dr. Saad B. Omer, the director of the Yale Institute for Global Health, identified two groups he thought could be most vulnerable to co-infection.
First: unvaccinated adults. “Based on previous work on vaccinations, people who refuse one vaccine might refuse others as well,” he said. He said he expected there to be a “significant overlap between people who refuse both vaccines.”
Second: children, especially those under 5, who are too young to get vaccinated against Covid. Kids are also petri dishes, as any parent will tell you, and have lived through fewer cycles of the flu. So even if a child got a flu shot, Dr. Omer said, “their library of protection is narrow” against the many viral flu strains that can emerge each year.
How can I prevent co-infection?
On this one, the medical advice remains consistent: Get vaccinated for both Covid and flu. And get vaccinated right now.
Both kids and adults can get both vaccines at the same time. Children ages 5 years and older are eligible for a Covid vaccine, and children older than 6 months can get vaccinated against the flu.
In addition, experts agree you should wear masks and maintain social distancing measures when appropriate. Both flu and the coronavirus are airborne viruses, so limiting your exposure cuts down on your chances of getting infected.
MELBOURNE, Australia — The people demonstrating outside the Park Hotel in Melbourne on Saturday were a disparate group.
Some were Serb-Australians and anti-vaccine campaigners, there to support Novak Djokovic, the tennis superstar who is in quarantine there as he challenges Australia’s decision to deny him entry over questions about a Covid-19 vaccine exemption.
A separate group of protesters held signs proclaiming “refugees welcome” and “nine years too long.” They were drawing attention to a very different cause: the well-being of about 30 asylum seekers who have been held at the Park Hotel much longer than Mr. Djokovic, the Australian Open champion.
Since December 2020, the Australian Border Force has used the hotel to house refugees who had been held for years on remote Pacific islands, under Australia’s much-criticized offshore detention policy for asylum seekers who try to reach the country by boat. Those at the Park Hotel were brought to Australia for medical treatment, but they cannot leave the hotel for any other reason, and they do not know how long they will be kept there.
For activists, Mr. Djokovic’s detention at the same hotel has been an opportunity to tell the world about the asylum seekers’ plight.
Mr. Djokovic’s family and the government of his country, Serbia, have denounced the conditions under which they say he is being held at the Park Hotel, a no-frills, four-story facility on the outskirts of Melbourne’s central business district. His family says Mr. Djokovic has been subjected to bugs in his room and terrible food. The Serbian government has demanded better accommodations.
Asylum seekers at the hotel have made similar complaints. Just after Christmas, some posted pictures of moldy and maggot-infested food they said they had received in their rooms. Earlier in December, some said that after a fire broke out at the hotel, they were confined to the lobby and not allowed outside.