One of the most aggressive vaccine mandates in the nation is set to take effect Friday evening in New York City, and it is expected to bring a flurry of last-minute legal wrangling, protests and possibly force some city services to be curtailed.
Though some of New York City’s more than 300,000 employees were already covered by earlier mandates, Mayor Bill de Blasio announced last week that “all city workers” needed to get at least one vaccine dose by 5 p.m. Friday, or they would face unpaid leave.
Most city workers have been vaccinated, but about 46,000 had not been as of last week, officials said. The highest percentage of unvaccinated employees is in the city’s Department of Corrections, where only half of the workers had been vaccinated.
More than a quarter of employees in other crucial departments — emergency medical services, fire, police and sanitation — remained unvaccinated as of last week.
Mr. de Blasio’s announcement of the mandates was met with protests and lawsuits.
On Monday, thousands of people, including police officers, firefighters and sanitation workers, marched across the Brooklyn Bridge, holding large American flags and chanting that they would not comply.
The city’s largest police union, the Police Benevolent Association, filed a lawsuit on Monday to halt the mandate, but a New York State judge on Wednesday denied the request.
The police union said it would appeal, and has previously instructed members on how to undermine City Hall edicts. Patrick J. Lynch, the president of the police union, said in a statement, “Today’s ruling sets the city up for a real crisis.”
Andrew Ansbro, the president of the Uniformed Firefighters Association, said recently that he had ordered his unvaccinated members to report to work and defy the mandate, Reuters reported. But the city’s fire commissioner said he expected about a 20 percent staffing reduction at firehouses and in ambulances because of the mandate, Gothamist reported.
Workers who do not show proof of vaccination by 5 p.m. Friday will be put on unpaid leave as of Monday. Requests for medical or religious exemptions were due on Wednesday, and workers who applied for those exemptions will be permitted to work if they undergo weekly testing while their cases are considered.
Because of a severe staffing shortage on Rikers Island, the city made an exception for uniformed corrections officers, giving them until Dec. 1 to get their first dose. The city’s health care workers and education department employees were already required to be vaccinated under earlier mandates.
Mr. de Blasio said Wednesday that the city had been preparing for the possibility of staff shortages and predicted that almost all workers would ultimately get vaccinated rather than lose their paychecks.
“These are agencies that have been preparing for months,” Mr. de Blasio said. “Every one of the commissioners has been absolutely confident that they can make the adjustments and every one of the commissioners has adamantly wanted us to move forward with a vaccine mandate. So, I feel ready.”
A large clinical trial has found that a common and inexpensive antidepressant lowered the odds that high-risk Covid-19 patients would be hospitalized. The results, published on Wednesday, could open the door to new guidelines for the drug’s use both in the United States and globally.
The drug, fluvoxamine, has been safely prescribed for nearly 30 years as a treatment for obsessive-compulsive disorder. But when the coronavirus started spreading, researchers were drawn to the medication because of its ability to reduce inflammation, potentially allowing it to quell the body’s overwhelming response to a coronavirus infection.
Several smaller studies of fluvoxamine earlier in the pandemic showed promising results, but none was as large or persuasive as the one published on Wednesday by a group of researchers in Canada, the United States and Brazil, outside scientists said. Among nearly 1,500 Covid patients in Brazil given either fluvoxamine or a placebo, the drug reduced the need for hospitalization or prolonged medical observation by one-third, the study found. It was published in The Lancet Global Health.
Some patients struggled to tolerate the drug and stopped taking it, the study said, raising a question among outside scientists about whether they had yet identified the ideal dose. But among those who had largely followed doctors’ orders, the benefits were even more striking. In those patients, the drug reduced the need for hospitalization by two-thirds and slashed the risk of dying: One Covid patient given fluvoxamine died, compared with 12 given a placebo.
“That’s really good,” said Dr. David Boulware, an infectious disease scientist at the University of Minnesota who worked on a smaller, real-world study of the drug in Covid patients in California. Plus, he added, “it’s not a shiny new, expensive drug. The nice thing about this is it has a known safety profile.”
Beyond proper dosing, the study left other questions unresolved, scientists said. Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London, noted that part of the drug’s benefit appeared to come from reducing the need for extended medical observation, which the study tracked alongside hospital admissions. And most patients in the study were unvaccinated, Professor Ward said, so it’s unclear how well the drug would work in the vaccinated.
The new study, coming nearly a year after smaller trials of the drug, was a reminder of the difficulty that many researchers have had running large tests of Covid treatments. The Biden administration has made more funding available for such trials, scientists said, but enrolling enough patients has only gotten more difficult: Most high-risk Americans are vaccinated, and vaccine-averse people may be less likely to participate in trials.
Because fluvoxamine is already approved for treating O.C.D., doctors can already prescribe it “off label” for Covid. But Dr. Boulware said that prescriptions of the drug had increased only slightly during the pandemic, unlike other repurposed drugs with far less scientific support, like hydroxychloroquine and ivermectin.
“It hasn’t really gotten any cult following,” he said.
Federal treatment guidelines say that larger trials are necessary to evaluate the use of fluvoxamine for Covid, and scientists said they expected those recommendations to change on the basis of the new study.
The new findings are also expected to boost the popularity of the drug in less wealthy countries: A 10-day course of the drug costs about $4.
Some American adults with weakened immune systems who received a third dose of either the Pfizer-BioNTech or Moderna coronavirus vaccine authorized just for them will become eligible for a fourth shot as a booster next year, according to updated guidelines from the Centers for Disease Control and Prevention.
“In such situations, people who are moderately and severely immunocompromised may receive a total of four vaccine doses,” with the fourth coming at least six months after the third, the C.D.C.’s guidelines said.
In August, federal regulators cleared a third dose of the Pfizer-BioNTech and Moderna vaccines for some immunocompromised recipients of those vaccines, instructing them to get it at least 28 days after their second shot. Federal agencies said that studies have shown that those people may not be adequately protected by just two shots.
The earliest that immunocompromised people who received that third mRNA vaccine shot can get a fourth shot as a booster would be February. The agency said that people could select that booster from any of the three coronavirus vaccines available in the United States.
The C.D.C. also recommends that moderately and severely immunocompromised adults who received Johnson & Johnson’s one-dose vaccine get another dose of any one of the three vaccine brands, at least two months after their initial shot.
The agency updated its guidelines on Monday, adding the possibility of a booster dose for many immunocompromised people, including those undergoing chemotherapy, recovering from a solid organ transplant or facing certain other medical issues, like infection with H.I.V.
The new recommendations also specified that a fourth dose of Moderna’s vaccine should be half the size of a normal dose.
Many health officials and experts in the United States and other countries have made a distinction between additional shots for immunocompromised people, who may not have mounted a strong immune response after their initial doses, and broader booster programs intended to shore up other peoples’ immunity, which can wane against infection naturally over time.
The World Health Organization has supported additional doses for people with weakened immune systems while calling for a global moratorium until the end of the year on booster programs for otherwise healthy people, so that more doses can be allocated to lower-income countries with low rates of vaccination.
Gov. Kay Ivey of Alabama issued an executive order this week directing state agencies to not cooperate, whenever possible, with federal vaccine mandates, describing the Biden administration’s actions as an “overreach.”
The governor’s directive comes as some Republican governors across the country, playing to their conservative bases, have taken actions aimed at countering President Biden’s attempt to raise the country’s overall vaccination rate through expansive mandates.
The White House has issued an order requiring all federal employees, workers for federal contractors, and people who work for health care companies receiving Medicare and Medicaid to be vaccinated. The administration also has plans to ask companies with more than 100 workers to adopt vaccine mandates or weekly testing.
The federal mandates, along with masks in schools, are unpopular among conservatives, many of whom see them as an infringement on personal freedoms, and Republican elected officials in some states have sought to capitalize on that sentiment.
“Alabamians are overwhelmingly opposed to these outrageous Biden mandates, and I stand with them,” Ms. Ivey said in a statement.
In Texas, the Republican governor, Greg Abbott, issued a broad executive order that bars virtually any coronavirus vaccine mandate in the state. And in Florida, Gov. Ron DeSantis, who is seen as a possible G.O.P. presidential contender, has adamantly opposed any measures that would require vaccines or masks, saying they infringe on personal liberties.
Ms. Ivey’s order says state agencies should prepare to assist with a lawsuit that the Alabama attorney general is expected to file challenging the federal mandate.
Legal experts say the federal government has broad authority to address the public health crisis created by the pandemic, and Mr. Biden has predicted that his health orders will survive legal challenges.
Beyond political symbolism, the impact of Ms. Ivey’s order is unclear. It directs state agencies not to punish businesses and people who do not comply with the federal vaccine mandate. It also states that if an agency is required to enforce the federal mandate, employees should inform those businesses or individuals that the state “does not approve, condone or otherwise endorse” such mandates.
“The federal government’s outrageous overreach has simply given us no other option but to begin taking action, which is why I am issuing this executive order to fight these egregious Covid-19 vaccine mandates,” Ms. Ivey said in a statement.
Ms. Ivey has walked a fine line on the issue of vaccinations. During the summer, she expressed frustration over unvaccinated people’s refusal to get a shot, saying that it was “time to start blaming the unvaccinated folks, not the regular folks.”
“It’s the unvaccinated folks that are letting us down,” she told reporters in July.
Still, Ms. Ivey said that she is “adamantly” opposed to issuing her own vaccine mandate in the state, adding that she believed the way to increase vaccination rates was through “persuasion.”
Pregnant and breastfeeding women respond to the first dose of the coronavirus vaccines more slowly than other women, and mount a less potent defense against the virus, according to a new study. After the second dose, however, their response looks almost normal.
The results, published this month in the journal Science Translational Medicine, suggest that pregnant and breastfeeding women remain susceptible to the virus for longer after vaccination. The study underscores the importance of giving these women the second dose in time, and monitoring them closely in the meantime for signs of infection.
During pregnancy, the immune system is modified to tolerate the fetus — effectively a foreign entity — leaving pregnant women particularly susceptible to pathogens like the coronavirus. Because of this, pregnant women are more likely to become severely ill and to die from Covid than other women of the same age.
Earlier research had suggested that pregnancy might also dampen the response to vaccines. But the initial trials of Covid vaccines did not include pregnant and breastfeeding women because of safety concerns, so there has been limited information about how well they respond to the inoculations.
The researchers analyzed the antibodies produced by 84 pregnant women, 31 breastfeeding women and 16 nonpregnant women of the same ages, immunized with the coronavirus vaccines made by Pfizer-BioNTech or Moderna.
After the first dose, pregnant and breastfeeding women had fewer antibodies than other women of the same age. And the antibodies were less effective at recruiting other parts of the immune system to fight the virus.
Two to six weeks after the second dose, pregnant and breastfeeding women had about as many antibodies as other women their age, consistent with results from other studies, and the qualitative differences also narrowed.
Breastfeeding women boosted their response more effectively than pregnant women after the second dose, and the quality of their immune response more closely resembled that of nonpregnant women.
The women in the study were immunized at different times during pregnancy. Future studies should analyze the optimal time during pregnancy to deliver the vaccines, the researchers said.
An experiment in Ukraine that pursued an aggressive campaign to vaccinate most inhabitants of one small town has yielded the expected results: very low infection rates and no hospitalizations for Covid-19.
In April, when Ukraine was still short on vaccines, only certain categories of the population, like teachers and doctors, were allowed to get vaccinations. But the Health Ministry made an exception for the town of Morshyn, in western Ukraine, allowing local health authorities to try to vaccinate all 6,000 residents.
Morshyn was chosen partly because its economy, which depends on tourism to resorts and spas, had essentially shut down because of the pandemic, and because it was thought people would be receptive to vaccination so they could resume working.
The plan was to give 70 percent of the town a first dose of vaccine in one month. But despite the economic incentive, distrust in vaccines was an obstacle. Nationwide, 56 percent of Ukrainians still say they will not be vaccinated.
Morshyn’s authorities went on the offensive.
“We realized that we need to call each person individually,” Dr. Henadiy Yukshynsky, the town’s chief doctor, said in an interview with local news media. “We created five special teams that called people and explained to everyone the need for vaccination.”
The local authorities posted billboards, set up tents with information tables inside, made videos for social networks and the news media, and created handouts advocating vaccination.
In the end, it took two months to vaccinate 72 percent of the town’s residents, far more than Ukraine’s nationwide rate of 16 percent, which is the lowest in Europe.
Across the country, infections and hospitalizations are soaring, with an average of 21,364 new cases a day over the past week. The death rate in Ukraine is higher now than during the first wave of Covid, with an average of 538 deaths per day. Panic is beginning to take hold, and more areas of the country have been designated “red zones” and placed under partial lockdown.
But life in Morshyn goes on as usual. It has no patients hospitalized with Covid and only 19 cases of the virus, 15 of them in people who were not vaccinated.
The health minister of Australia announced on Wednesday that fully vaccinated residents would finally be allowed to travel abroad starting on Nov. 1, a year and a half after borders were closed to most ingoing and outgoing travel.
“Fully vaccinated Australians will not require an exemption to depart Australia,” Greg Hunt, the country’s health minister, told reporters in Canberra. He added that they would also be able to return without restrictions.
The eased restrictions will be the first stage in Australia’s plan to reopen its international borders since slamming them shut on March 20, 2020, separating families and leaving thousands of Australians stranded overseas.
The second stage, Mr. Hunt said, will allow students and critical workers to enter the country and, eventually, see borders fully reopened to tourists and other visitors.
“It’s exciting,” said Kelsey May, 25, an Australian who returned home from Britain in March of 2020, and has been separated from her partner since. But, Ms. May added: “We’ve been told so many things over the past 18 months that haven’t come to fruition. We just want to see what happens.”
On Monday, the health authorities also approved Pfizer-BioNTech vaccine booster shots for those 18 and older. They said the decision would make the country among the most highly vaccinated places in the world.
Nationwide, 62 percent of eligible Australians have had two doses of the vaccine, and 74 percent have had one dose.
But Canberra, the capital, announced it had become the first jurisdiction in the country to fully vaccinate more than 90 percent of eligible residents age 12 and older.
Jab well done Canberra 💉💉
It’s not a race, but we’re happy to take the crown 👑 and be the first jurisdiction in Australia to have more than 90% (90.5%) of its residents aged 12+ who have received 2 doses of a COVID-19 vaccine.
Keep it up Canberra 🥇 💪 pic.twitter.com/tsH3ZLi3aR
— ACT Health (@ACTHealth) October 27, 2021
Merck has granted a royalty-free license for its promising Covid-19 pill to a United Nations-backed nonprofit group in a deal that would allow the drug to be manufactured and sold cheaply in the poorest nations, where vaccines for the coronavirus are in devastatingly short supply.
The agreement with the organization, Medicines Patent Pool — which works to make medical treatment and technologies globally accessible — will allow companies in 105 countries, mostly in Africa and Asia, to sublicense the formulation for the antiviral pill, called molnupiravir, and begin making it.
Merck reported this month that the drug halved the rate of hospitalizations and deaths in high-risk Covid patients in a large clinical trial. Affluent nations, including the United States, have rushed to negotiate deals to buy the drug, tying up large portions of the supply even before it has been approved by regulators and raising concerns that poor countries would be shut out of access to the medicine, much as they have been for vaccines.
Treatment-access advocates welcomed the new deal, which was announced Wednesday morning, calling it an unusual step for a major Western pharmaceutical company.
“The Merck license is a very good and meaningful protection for people living in countries where more than half of the world’s population lives,” said James Love, who leads Knowledge Ecology International, a nonprofit research organization. “It will make a difference.”
Charles Gore, director of the Medicines Patent Pool, said: “This is the first transparent public health license for a Covid medicine, and really importantly, it is for something that could be used outside of hospitals, and which is potentially going to be very cheap.”
Molnupiravir was developed by Merck and Ridgeback Biotherapeutics of Miami, based on a molecule first studied at Emory University in Atlanta. All three organizations are party to this deal, which will not require a fee from any sublicensing company.
Sandee Babb, 54, of Grand Rapids, Mich., has seen nearly two dozen doctors over the past year to figure out what is causing a range of symptoms, including cardiac arrhythmia, a chronic cough, shortness of breath and joint pain, which have kept her from returning to her job as a teacher and librarian.
She could not get a coronavirus test when she first got sick in March 2020. But a September progress note from her doctor said her symptoms “could be consistent with long-haul type syndrome.”
After months documenting her condition, she submitted her unemployment application in August and is not sure when she will get an answer. “If it doesn’t come through, then I’m really stuck,” she said. “Where do I go from here?”
The Biden administration has said people with the condition known as “long Covid” could qualify for federal disability protections and benefits, which can include health care, housing and unemployment benefits.
But with no widely agreed-on method of diagnosing the ailment, those who believe they have long Covid are finding it difficult to qualify under a system that is unfamiliar and already tricky to navigate.
Studies have shown that a significant number of Covid patients continue to seek treatment for a wide range of medical conditions many months after a diagnosis. The American Academy of Physical Medicine and Rehabilitation estimates that three to 10 million Americans may have long Covid.
Yet many of those seeking benefits cannot produce a positive coronavirus test, which were in short supply at the beginning of the pandemic. And lab results and scans often show nothing unusual for those continuing to experience symptoms.
Unequal access to coronavirus vaccines in developing countries is deepening a “great divergence” between rich and poor nations and slowing economic recovery from the pandemic, the United Nations organization that monitors labor market developments said on Wednesday.
Vaccination campaigns have proved critical in aiding recovery of working hours and economic productivity. But uneven access to vaccines has resulted in a two-speed recovery for rich and poor countries according to Guy Ryder, the director of the International Labor Organization.
“We are building back worse at least as looked at from the perspective of the developing world,” Mr. Ryder told reporters in Geneva, adding that he will be delivering that message to leaders of the Group of 20 summit, who will meet in Rome this weekend.
Worldwide, about 76 percent of shots that have gone into arms have been administered in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Only 0.5 percent of doses have been administered in low-income countries.
The I.L.O. estimated in a report released Wednesday that for every 14 workers who were fully vaccinated in the second quarter of the year, one full-time job was added to the global labor market. By early October, it said, 34.5 percent of the world’s population had been fully vaccinated but at rates that varied from 59.8 percent of the population in high-income countries to 1.8 percent in low income countries.
As a result, labor market recovery has stalled in 2021 and the number of hours worked this year are now expected to be far lower than previously estimated, the I.L.O. said.
Fiscal stimulus packages provided another key aid to recovery. But 86 percent of the stimulus available through these initiatives was concentrated in high-income economies, the organization said.
The I.L.O. said that with more equitable distribution of vaccines it would take low-income countries little more than three months to catch up with the pace of working hour recovery in rich countries.
The organization’s findings echo the alarm expressed repeatedly by Dr. Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, who has slammed the unequal delivery of Covid-19 vaccines as a “catastrophic moral failure” and set a target of vaccinating 40 percent of every country by the end of the year.
The pace of vaccinations is picking up in much of Latin America and the Caribbean, but disparities in access to vaccine supplies persist, the Pan American Health Organization reported on Wednesday.
Overall, 44 percent of people in Latin America and the Caribbean have been fully immunized against Covid-19, a figure that has doubled since August, the organization said, but the rates vary from country to country.
For example, five nations — Guatemala, Saint Vincent and the Grenadines, Jamaica, Nicaragua and Haiti — have vaccination levels below 20 percent.
“We have reason to be optimistic, but we must remain vigilant,” said Dr. Jarbas Barbosa, the assistant director of the agency, which is part of the World Health Organization.
More than three million doses of vaccine are expected to arrive in the region through the global Covax distribution program this week, and “deliveries are expected to pick up in these final months of the year,” he said, “so we can continue to address one of the biggest challenges affecting our region: vaccine inequity.”
Though many countries in the region are starting to administer booster shots and vaccinate children, P.A.H.O. said that health officials should focus first on getting the vaccine to older adults, the group most at risk of dying from Covid-19.
“We still have a long road ahead to protect the most vulnerable,” Dr. Barbosa said.
South Korea warned residents that it would strictly enforce Covid restrictions during Halloween, as the government remains wary of large outbreaks that might threaten its reopening plans next month.
Local authorities have raised alarms that parties leading up to Oct. 31 pose a potential risk as South Korea prepares to ease Covid restrictions the next day. Halloween is not widely celebrated in South Korea, but it is becoming more popular, especially in the capital, Seoul.
“We are concerned, especially ahead of Halloween this weekend, that there might be many violations of social distancing rules,” the minister of health, Kwon Deok-cheol, said on Wednesday, urging people to comply with the restrictions that remain in place.
The country still has a mask mandate, limits the size of social gatherings and requires restaurants and bars to close at 10 p.m. in Seoul.
To mitigate the risk of an outbreak, which might jeopardize South Korea’s reopening, health officials said on Friday that they would intensively check businesses’ and customers’ compliance with Covid rules for seven days starting Wednesday from 8 p.m. to midnight. The inspectors will focus on areas including Itaewon, Hongdae and Gangnam Station in Seoul, and parts of Incheon and Busan, where there are many young people and foreigners who are expected to celebrate.
Partygoers may let their guard down knowing that the restrictions are set to expire on Nov. 1, said Robert Joe, 43, who lives in Itaewon.
“Everyone knows everything is going to be lifted more or less,” he said. “The sense of urgency, I think, has probably lessened.”
Foreigners caught violating rules, the health officials said on Friday, may be subjected to deportation, and businesses violating rules may be prosecuted, suspended or fined.
South Korea’s approach to the Halloween festivities contrasts that of the United States, where many health departments have only recommended that people take precautions, like getting vaccinated and wearing masks, instead of threatening penalties. In Massachusetts, the towns of Lexington and Belmont will offer free Covid tests after Halloween.
Halloween festivities will continue with lifted restrictions in other places, too. Northern Ireland will lift restrictions on indoor dancing and permit nightclubs to reopen on Oct. 31, and trick-or-treating will be allowed in Australia’s capital, Canberra.
Here’s what else is happening around the world:
In Sweden, health officials announced that health care workers, nursing staff and people over 65 will be eligible for a booster. The extra shots will eventually be extended to 1.5 million Swedes, according to the minister of health and social affairs, Lena Hallengren.
Denmark is also offering a booster to medical workers, older people and people who are at high risk of contracting the coronavirus. Norway, which is experiencing a rise in cases, is urging those over 65 to get a booster at least six months after receiving their second shot.
Spain’s Constitutional Court on Wednesday struck down the government’s second state of emergency, which was introduced in late 2020. The decision opens the door to thousands more reimbursement claims from people who were fined for violating Covid-19 lockdown rules.
The ruling is in line with a decision from July, when the same court also declared unconstitutional the first state of emergency. That one was introduced in March of 2020, when Spain was initially hit by the pandemic.
Spain’s second state of emergency lasted about six months, from November 2020 to May of this year. The court ruled on Wednesday that Spain’s left-wing government overstepped its constitutional powers, in particular by limiting parliamentary oversight over the lockdown rules. The ruling followed a complaint filed by Spain’s far-right opposition party, Vox.
Germany’s new governing coalition plans to drop nationwide pandemic restrictions and hand responsibility back to state governments to set their own rules, which could vary from one region to another.
Representatives of the three parties that are expected to form the new federal government announced on Wednesday (not Tuesday, as an earlier version of this item said) that they intend to allow the country’s national epidemic status to lapse in late November. That status provides the legal framework for imposing national lockdowns, mask requirements and other measures.
The announcement could be considered the first public act of the new government, which is still in the complicated process of being formed by the three parties after the general election of Sept. 26. The new prime minister and cabinet are not expected to be inaugurated for several weeks yet. Officials warned that shifting responsibility to the states did not mean that restrictions would vanish.
“The 25th of November will not be a ‘Freedom Day’,” said Dirk Wiese, a deputy parliamentary group leader of the Social Democratic Party, which is expected to lead the new government, referring to a nickname used in Britain for the day nearly all virus restrictions were dropped there.
“We want to go through the fall and winter responsibly, so that by spring we have Covid-19 behind us,” Mr. Wiese said.
The other two parties working to form the new government are the Greens and the Free Democrats. All three gained seats in parliament in the election, while the party that led the outgoing coalition government, the Christian Democrats, lost ground.
The outgoing government remains in office in a caretaker role while the new one is formed. The departing health minister, Jens Spahn, a Christian Democrat, has said he too believed the national epidemic status should be allowed to lapse.
New coronavirus cases have risen by 80 percent over the past two weeks, according to a New York Times database, even though at least two-thirds of the population is fully vaccinated. The three coalition parties said on Wednesday that they would set up a federal panel to work on increasing the vaccination rate.
“We are of the common opinion that we are far from where we could and should be as far as vaccination is concerned,” said Katrin Göring-Eckardt, the parliamentary group leader for the Green party.