Covid News: Omicron Variant Appears to Be Spreading Fast in Washington State

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Researchers testing coronavirus samples in Washington State have recorded a rapid rise in cases with a mutation that is characteristic of the Omicron variant, mirroring trends that have emerged in countries like South Africa, Britain and Denmark.

Researchers at the University of Washington found that 13 percent of 217 positive coronavirus case specimens collected on Wednesday had the mutation. That was up from about 7 percent of samples they had tested from the day before, and 3 percent from the day before that — in a region that had its first identified cases only two weeks ago.

“It’s clearly looking like it’s rising really quickly,” said Dr. Pavitra Roychoudhury, a researcher at the University of Washington.

Dr. Roychoudhury cautioned that the relatively small sample sizes provided only a limited window into the variant’s trajectory. But even so, she said, the results add to worries that Omicron may be highly transmissible.

As Omicron spreads around the globe, scientists have seen evidence that the variant can partially evade existing immune defenses. But they are still trying to determine how often the variant causes severe disease.

Dr. Trevor Bedford, who studies the spread and evolution of viruses at the Fred Hutchinson Cancer Research Center in Seattle, said the Omicron numbers are still too small to have a large impact on overall case numbers, but he said that would likely change by next week as it continues to displace the virulent Delta version of the virus.

“There is an inevitable very large wave of Omicron,” Dr. Bedford said. “It’s going to happen.”

What’s much less certain is how much the new variant could trigger hospitalizations. Dr. Bedford said there are signs that the variant is producing less severe infections, but he said the range of possibilities for the variant remains wide.

Washington State may have a clearer window into Omicron’s spread than other parts of the country do, because of research groups in Seattle that have invested in testing and sequencing the virus’s genomic structure. Those researchers helped identify the initial reported outbreak of the coronavirus in the United States early in 2020.

The UW Medicine virology lab has been screening samples of the virus from across the state, looking for a single mutation that indicates Omicron’s presence — a technique that Dr. Roychoudhury said helps provide rapid warning of the variant’s spread. Detailed genomic sequencing of each sample is definitive, but can take longer, she said, adding that so far, all the samples that were flagged by spotting the mutation last week and then were sequenced have come back confirmed as Omicron.

The lab gets about half its samples from King County, which includes Seattle and is by far the most populous in the state. A small portion comes from outside Washington State.

The total number of known coronavirus cases in the United States surpassed 50 million on Monday, according to a New York Times database.

Fifty million can be a difficult number to grasp. It is more than the combined populations of Georgia, Michigan, North Carolina and Ohio. More than the entire population of Spain. Nearly 18 times the number of dollars an American college graduate can expect to earn in a lifetime.

And it is almost certainly a substantial undercount of cases, since many infected people have no symptoms or mistake them for those of another illness, and not everyone gets tested — to say nothing of the huge shortage of available tests in the early weeks of the pandemic.

Daily reports of new cases, which fell steadily in the early autumn, have been rising sharply in the last few weeks as the prevalent Delta variant continues to spread, especially in the Midwest, Southwest and New England. And much remains unknown about the worrisome new Omicron variant.

Hospitalizations and deaths have started to rise as well, and experts say the holidays and winter weather will probably make matters worse. Though the increases and Omicron may have helped to prompt more vaccinations, more than one-quarter of the population still has not received even one dose, and about 61 percent are fully vaccinated.

Still, the official tally of 50 million cases and counting is one more painful marker in two years that have been riddled with them — one more occasion to take stock of what has been lost.

More than 796,000 people have died in the United States because of the virus — a toll unfathomable to most Americans when the pandemic began. The first 100,000 deaths hit like a gut punch. But as successive round-number milestones were passed, they attracted less and less notice.

Then there are the untold ranks of the walking wounded: loved ones of the dead, of course, but also people coping with long-haul symptoms. Many viral illnesses are capable of causing chronic disability in a small percentage of patients, but when the denominator is 50 million, even a small percentage is a lot of people. Many of them have struggled to find treatment in, or even to be believed by, a health care system that has sometimes buckled under the weight of the acutely ill.

There are the mental health struggles wrought by fear and isolation. There is the economy, which is better than it was in the worst depths of the pandemic, but not yet near where it was before March 2020.

And there are the changes to the very fabric of how we live our lives: how we work and where, and even whether we are employed at all. How our children learn, and who cares for them.

Eventually, the experts say, the pandemic will abate, as previous pandemics have done. Americans will someday forget numbers like 50 million. But their ripples will be everywhere.

California will once again require residents to wear masks in indoor public settings everywhere in the state, amid uncertainty surrounding the rapid spread of the Omicron coronavirus variant and rising case rates as the holidays approach.

The mandate will go into effect on Wednesday and will remain until at least Jan. 15, state officials said on Monday. The state will also require unvaccinated people attending so-called mega-events to show proof of a negative coronavirus test result from within a day, if it’s an antigen test, and within two days for a P.C.R. test, and formally recommended that travelers returning to California get tested within a few days of their arrival.

“We know people are tired and hungry for normalcy,” Dr. Mark Ghaly, the state’s secretary of health and human services, told reporters.

But he said that science has shown that even a relatively small increase in indoor masking can help prevent the virus from spreading, which can in turn help keep hospitals from filling.

Dr. Ghaly said that statewide, case rates have increased by 47 percent since Thanksgiving, but those increases have been concentrated in parts of the state — such as the Inland Empire, east of Los Angeles, and the vast Central Valley — where a smaller share of the population has been vaccinated.

Those are, by and large, the same places where mask mandates have not been in effect for some time. In other areas, such as Los Angeles County, residents have been required to wear masks indoors for months since the emergence of the Delta variant.

For Californians, the imposition of a fresh round of pandemic restrictions in mid-December is an unwelcome echo of last year’s catastrophic winter.

Last December, officials in the state — where residents had already been living under some of the most stringent lockdowns in the country for the better part of a year — imposed a curfew and new stay-at-home orders in a frantic effort to keep hospitals from being overwhelmed.

Dr. Ghaly said that the mask mandate was meant to head off the need for any further restrictions, and he urged Californians to adhere to it, even in the absence of strict enforcement.

“Part of what we’re doing today is making sure those conversations stay off the table,” he said, referring to other measures, such as business capacity limits. “I think that we have tools to keep California reasonably safe and protected.”

On Monday, New York State began requiring people wear masks indoors in public if proof of full vaccination was not required, a policy that is in effect at least until Jan. 15. Businesses that do not require patrons to be masked could face civil and criminal penalties, including fines of up to $1,000 per violation, and local health departments are responsible for enforcement.

The U.S. Air Force has dismissed 27 service members for refusing to get vaccinated against the coronavirus, the first members of the military believed to be forced out over the shots.

Since August when the Pentagon began requiring all troops to get the coronavirus vaccine or face dismissal, almost 96 percent of active duty members have had at least one shot; about 74 percent of the total force is now fully vaccinated.

Each service branch has a different deadline for shots, and the Air Force was the first to hit the deadline last month. While some military members have chosen to leave rather than be vaccinated, the 27 — all with less than six years of service — are the first believed to have been fired, Pentagon officials said.

The Defense Department has granted very few exemptions from the mandate, other than to people who were already leaving the military or those who have medical issues. So far, not a single service member has been granted a religious exemption.

The U.S. military routinely requires members to take vaccines to serve and considers being inoculated against the coronavirus essential for basic readiness.

Last month, the newly appointed head of the National Guard in Oklahoma said that his troops would not be required to get vaccinated. Lloyd J. Austin III, the secretary of defense, has told Gov. Kevin Stitt that the troops must comply with the requirement for all service branches.

The Pentagon is pondering requiring a booster shot for troops as well.

The Supreme Court on Monday refused to block New York’s requirement that health care workers be vaccinated against the coronavirus even when they cite religious objections.

As is often the court’s practice in rulings on emergency applications, its unsigned order included no reasoning. But Justice Neil M. Gorsuch filed a 14-page dissent saying that the majority had betrayed the court’s commitment to religious liberty.

Justice Samuel A. Alito Jr. joined Justice Gorsuch’s dissent. Justice Clarence Thomas also said he would have blocked the vaccine requirement, but he gave no reasons.

The Supreme Court in October refused to provide relief to health care workers in Maine who had made an essentially identical request in a challenge to a similar state requirement, over the dissents of the same three justices.

The court has also rejected challenges to vaccination requirements at Indiana University, for personnel in New York City’s school system and for workers at a Massachusetts hospital. The court also rejected a challenge to a federal mandate requiring masks for air travel.

All of those rulings were issued by just one justice, which can be a sign that the legal questions involved were not considered substantial. But those one-justice rulings did not involve religion.

The ruling came in a pair of challenges brought by doctors, nurses and other health care workers who said the requirement violated their right to the free exercise of religion. They argued that the availability of a medical exemption meant that the state was discriminating against religious practice.

Doja Cat, a popular singer and rapper who had previously downplayed the seriousness of Covid-19, tested positive for the coronavirus and canceled a number of upcoming performances, she said on Sunday.

The artist, whose legal name is Amala Zandile Dlamini, said in a statement on Twitter that she had tested positive after a few members of her production team had also tested positive.

It was the second time she confirmed she had contracted the virus, after she said in July last year that she had Covid.

Ms. Dlamini, 26, wrote in the statement on Sunday that her “spirits are down,” but that “I’m doing ok and look forward to recovering and getting back out there as soon as I can!”

She said she was canceling the rest of her appearances on this year’s iHeartRadio Jingle Ball Tour. She was set to perform four shows over the next week in Philadelphia, Washington, Atlanta and Miami.

Two days before her announcement, she had canceled her Jingle Ball performances in New York on Friday and Boston on Sunday after members of her production team had tested positive.

The Jingle Ball is a nationwide tour, sponsored by the radio conglomerate iHeartRadio, that brings together some of the country’s most popular musical acts. Ms. Dlamini was scheduled to be a part of lineups this week that included Saweetie, Megan Thee Stallion and the Black Eyed Peas.

Ms. Dlamini is a Grammy Award-nominated artist who found success with hits such as “Say So” and “Need to Know.” She is known for interacting with her fans on social media, including the time in March last year when she said on Instagram Live that she was “not scared of a coronavirus.”

“I’m going to get corona and then I’m going to get a Corona,” she said, likely referring to both the virus and the beer. She said she didn’t care about the virus, using an expletive, and added: “It’s a flu.”

She also said that people who contracted the virus should “take some Mucinex and drink water and tea and sleep. That’s all you’ve got to do.”

In July last year, she told Capital Xtra, a radio station in Britain, that she contracted the virus.

“It was a four-day symptom freak out, but I’m fine now,” she said.

Hours after she said she had Covid on Sunday, she posted a video, on Twitter, of herself dancing. She coughed twice.

Businesses across New York City were mixed on Gov. Kathy Hochul’s new mask mandate, with some welcoming the new rule while others groaned over even tighter restrictions.

The statewide mandate, which went into effect Monday, requires all indoor businesses to ask customers for proof of full vaccination or enforce mask-wearing at all times. The new rule comes as the state grapples with the threat of a winter surge in coronavirus cases.

Individuals are considered fully vaccinated two weeks after receiving either the second shot of the two-dose Pfizer-BioNTech or Moderna vaccines or the one-dose Johnson & Johnson vaccine, according to the state and the Centers for Disease Control and Prevention. Children ages 5 to 11 statewide will only need to show proof of one dose to be admitted to places requiring full vaccination, the state said.

“I’m not telling them to put a mask on,” said Eva Dayton, the owner of Consignment Brooklyn in Boerum Hill. “I’m not telling you what to do. I’m not a law enforcement person, I’m a business owner.”

Ms. Dayton said she thinks her customers are often fully vaccinated anyway. Still, she said she knew she was taking a risk given possible fines.

“I’m not OK with a fine, I think it’s actually quite ridiculous,” Ms. Dayton said, adding how difficult it has been for small businesses to survive during the pandemic. “I think that that can hurt us even more.”

George Helewa, the store manager of Danice, a clothing store in Harlem, said he was tired of enforcing mask mandates in general.

“I’m over it,” Mr. Helewa said.

On Monday, Mr. Helewa was busy putting up signs around the store about the state’s new mask policy. He said he was fed up with having to tussle with customers coming into the store without a mask. On several occasions, employees have had to ask customers to leave.

“We’ve had issues in the past,” he said. “At times we get lashed at, cursed at.”

Other businesses welcomed the new rules. Michael Han, general manager of Apollo Beauty Land in Harlem, said the store already had a mask policy in place, and customers who came in without a mask were encouraged to purchase one there.

“We have a lot of different customers,” Mr. Han said. “We don’t know who’s vaccinated, who’s not.”

For many businesses in the city, the state’s new mandate will seem like status quo. Engracia Bravo, a waitress at El Zasón, a Mexican restaurant in Boerum Hill, said employees were already requiring that customers be fully vaccinated. Some customers even show her their vaccination card before she asks for it, she said.

“Most people, they understand,” Ms. Bravo said, adding that many customers have also had their booster shots. “I need to take care of the place, the guests, the customers.”

But the new state rule creates some complications for restaurants in the city. Last week, Mayor Bill de Blasio announced he was strengthening vaccination requirements for indoor dining, entertainment and fitness venues, requiring them to ask people ages 12 and older to show proof they had gotten two doses of a vaccine starting Dec. 27 rather than just one dose, unless they had gotten the Johnson & Johnson vaccine.

But Ms. Hochul’s state policy requiring customers to be fully vaccinated or wear a mask has already gone into effect.

Pedro Ramirez, store manager of Harlem Shake, a burger restaurant in Harlem, said he was confused by how quickly the rules have been changing. He said he wasn’t concerned about the discrepancy between the governor and the mayor’s policies, however, since the majority of his customers have been fully vaccinated.

But a handful of customers have given his employees trouble, he said, and he’s unsure whether there will be stronger pushback in a few days once more businesses and customers learn about the new state policy.

“95 percent have been fine, but this 5 percent is annoying to us,” Mr. Ramierez said. “But I’d like to be safe.”

Public health authorities in Denmark and Norway on Monday released grim projections for the coming wave of the Omicron coronavirus variant, predicting that it will dominate both countries in a matter of days. Although scientists don’t yet know how often the variant causes severe disease, they say its rapid rate of spread will lead to an explosion of cases and could potentially increase pressure on hospitals, even if it proves to be mild.

The reports follow similarly worrisome findings from England released over the weekend, although researchers caution that the trend could change as the variant comes into clearer view. It’s not yet certain how often Omicron infections will send people to the hospital, or how many hospitalized patients are likely to die. And while Omicron can partly evade immune defenses, researchers have yet to determine how well vaccinations and previous infections will protect people against severe disease.

The authors of both new reports also observed that swift actions now, such as booster campaigns and reducing opportunities for Omicron to spread, could lessen the variant’s impact.

American researchers have yet to release models of Omicron’s rise in the United States. But experts point out that the country is similar to Norway and Denmark in terms of vaccination levels and certain Covid risk factors, like the average age of the population.

“It would be naïve to think the United States would be any different than Denmark,” Mads Albertsen, a microbiologist at Aalborg University, said. “Denmark is likely a best-case scenario.”

In recent weeks, many epidemiologists have been paying close attention to Denmark, a country of 5.8 million residents, about the population of Wisconsin.

Early in the pandemic, the country set up a sophisticated surveillance system combining large-scale coronavirus testing with genetic sequencing of many samples. That strategy has allowed Denmark to spot newly emerging variants, even when they’re at low levels, and adjust public health policies to prepare for new surges.

The first Omicron sample from Denmark was sequenced on Dec. 3. The specimen was collected on Nov. 23, around the same time researchers in South Africa first told the world about a rise in cases there.

Because sequencing genetic material from coronavirus samples can take days, Danish researchers developed a quick genetic test that picks up a few key mutations found only in Omicron. Every positive test result in Denmark is now screened for the new variant, resulting in an exceptionally comprehensive picture of Omicron’s spread.

In the report released on Monday by the Statens Serum Institute in Copenhagen, researchers estimated that Omicron cases in Denmark were doubling every two days. Omicron is spreading much faster than Delta, which means that the new variant will become dominant by midweek, the report found.

Three-quarters of the Omicron cases are in people who have received two vaccine doses, which is about the same fraction of the entire country that’s fully vaccinated. That high percentage indicates that vaccines are providing little protection from infection, though most scientists believe that the shots will still fend off severe disease and death.

The Danish data are consistent with a smaller report of Omicron infections in the United States. Out of 43 documented cases, 34 — or about 79 percent — were people who were fully vaccinated.

“This thing can spread, and it can spread whether or not you were vaccinated,” Christina Ramirez, a biostatistician at the University of California, Los Angeles, said.

In England, researchers also found that full vaccination provided low protection against a breakthrough infection. But they found that booster shots restored defenses to much higher levels.

In these European countries, Omicron will not simply replace Delta: It will drive up cases. Currently, Denmark is seeing around 6,000 cases a day — already a record for the country and driven almost entirely by Delta. The Danish researchers project that Omicron will drive the daily cases to 10,000 by the end of the week, and the numbers will continue to climb from there.

The Chicago Bulls’ next two games — against the Detroit Pistons and Toronto Raptors — have been postponed because 10 Bulls players, as well as other staff members, are in the league’s Covid-19 health and safety protocols, the N.B.A. announced Monday. With so many players unavailable, the Bulls faced the prospect of not being able to field enough healthy players to take the floor.

This marks the first postponement of an N.B.A. game this season and a reminder of the coronavirus pandemic’s continuing prevalence. Players enter the protocols when they test positive for the coronavirus or if they are possibly exposed to someone who has. Once players are in the protocols, they must quarantine for 10 days or until they have two negative P.C.R. test results at least 24 hours apart.

The league has seen a striking uptick in the number of players in protocols since increasing testing, even among vaccinated players, after Thanksgiving. Last week, the Indiana Pacers and Raptors separately canceled a practice out of what both teams said was “an abundance of caution.”

Other teams affected by the recent upward swing in cases include the Charlotte Hornets, who had five players listed in protocols last week. On Monday, the team named only two, including their top player, LaMelo Ball.

Before the season, Arturas Karnisovas, the executive vice president of the Bulls, said the team was “getting pretty close” to being fully vaccinated. The league and team did not immediately respond to an inquiry from a reporter about whether all the Bulls players had received the Covid-19 vaccine.

Last season, the pandemic disrupted the N.B.A. right from the start, with dozens of games postponed throughout the season, mostly in January. Only three teams did not have a game postponed: the Los Angeles Lakers, Los Angeles Clippers and the Nets.

Chicago’s next scheduled game is tentatively scheduled for Sunday, when the Bulls host the Lakers. As of Monday, the Bulls were 17-10, and, ranked third in the Eastern Conference, were in the midst of a surprisingly strong start to the season. In the off-season, they added the four-time All-Star guard DeMar DeRozan; guard Lonzo Ball, who had been with the New Orleans Pelicans; and guard Alex Caruso, who had been with the Lakers. DeRozan has missed the past three games because he was in the protocols.

Meanwhile, the N.H.L. postponed three Calgary Flames games after six players and a staffer entered Covid protocols. The Flames are the third N.H.L. team to miss games because of Covid, after the New York Islanders and Ottawa Senators.

Starting Monday, when New Yorkers run into a store for a quick purchase, they will again have to make sure they have a face mask. A new statewide mandate requires masks at all indoor public spaces that do not require proof of full vaccination against the coronavirus for entry.

Gov. Kathy Hochul announced the mandate on Friday, which is in effect until Jan. 15 when the state will reassess. Businesses that do not demand that patrons be masked could face civil and criminal penalties, including fines of up to $1,000 per violation, and local health departments are responsible for enforcement.

New York City, with 71 percent of its residents fully vaccinated against the coronavirus, already requires proof of at least one dose of a coronavirus vaccination to eat indoors at a restaurant or see a movie. But now masks will also be required unless full vaccination is mandated in those and all other indoor public places, including offices, stores and residential building lobbies.

Individuals are considered fully vaccinated two weeks after the second shot of the two-dose Pfizer-BioNTech or Moderna vaccines or the first shot of one-dose Johnson & Johnson vaccine, according to the state and the Centers for Disease Control and Prevention. Children ages 5 to 11 statewide will only need to show one dose to be admitted to places requiring full vaccination, the state said.

Considering that former Gov. Andrew M. Cuomo lifted most virus-related restrictions in June, including a requirement to wear masks in most settings, the new mandate is likely to be a big change, particularly in some rural and more conservative areas of the state.

The new measure comes at a time when the nation is confronting a spike in Covid-19 cases, and scientists are unsure of the effect of the arrival of the Omicron variant. The seven-day average of new Covid cases in the United States on Saturday was 119,325 per day, an increase of 40 percent in just 14 days. In New York State, the average was 9,716 on Saturday, a 51 percent jump over 14 days.

New York City has also seen a steep increase in cases since Thanksgiving, with an average of more than 2,600 new cases per day, according to city data, up from an average of less than 1,500 per day three weeks ago, according to city data. Regions of upstate New York are being even harder hit, with some 30 upstate hospitals ordered by the governor to suspend elective surgeries to alleviate the strain.

A handful of county executives, many of them Republicans upstate, have been skeptical of the mandate, with some even vowing not to enforce it. Ms. Hochul addressed them on Monday, saying: “I encourage the county leaders, especially those who are asking me for help, to help alleviate the crisis they have in their health care systems, to look at their own actions and to see what else they can be doing to be a better partner.” She noted: “This is self-induced, in one sense.”

On Sunday, at a briefing in Hamburg in western New York about the damage and power outages from storms the night before, Ms. Hochul was asked about the mask mandate.

“Just wear a mask,” Ms. Hochul said, adding, “I know tomorrow is a big day; it doesn’t have to be that big a deal. It truly doesn’t. I’m just asking people to do something that is common sense, that we believe will help save lives and ultimately drive down the infections.”

Dr. Anthony S. Fauci, President Biden’s top adviser on the pandemic, also strongly urged people to wear masks whenever they are indoors with people whose vaccination status is not known.

“Masking is not going to be forever,” he said Sunday on ABC’s “This Week,” “but it can get us out of the very difficult situation we’re in now.”

New York City had already planned to tighten the rules for dining and entertainment for children ages 5 to 11 starting Tuesday to have one dose to enter restaurants and theaters, and for adults starting on Dec. 27 to go from one dose of a vaccine to two except for those who initially received the one-shot Johnson & Johnson vaccine. But the state’s new mandate supersedes both those rules for now.

A sweeping coronavirus vaccine mandate for all private employers in New York City takes effect on Dec. 27.

Mayor Bill de Blasio said Monday that the city planned to educate and work with business owners as the new state mask mandate rolls out, instead of emphasizing fines and enforcement. For weeks, he has resisted calls to implement a citywide mask mandate despite rising cases, fearing it would weaken the city’s vaccination-focused strategy.

“The strategy of this city has been first and foremost vaccination, and that will continue to be the case,” Mr. de Blasio said in a news briefing Monday. “But we are going to work with the state to implement this mask mandate. What we found is when we communicate with businesses, treat them with respect and a spirit of cooperation, we get a very good result.”

Grace Ashford contributed reporting.

As the coronavirus pandemic approaches the end of a second year, the United States stands on the cusp of surpassing 800,000 deaths from the virus, and no group has suffered more than older Americans.

Seventy-five percent of people who have died of the virus in the United States — or about 600,000 of the nearly 800,000 who have perished so far — have been 65 or older. One in 100 older Americans has died from the virus. For people younger than 65, that ratio is closer to 1 in 1,400.

The heightened risk for older people has dominated life for many, partly as friends and family try to protect them.

The brutal toll on older Americans has persisted even though they are vaccinated at a much higher rate. The share of younger people among all virus deaths increased this year, but, in the last two months, the portion of older people has risen once again, according to data from the Centers for Disease Control and Prevention. More than 1,200 people in the United States are dying from Covid-19 each day, most of them 65 or older.

In both sharp and subtle ways, the pandemic has amplified an existing divide between older and younger Americans. In interviews, older Americans say that they have continued to endure the isolation and fear associated with the pandemic long after tens of millions of younger and middle-aged people have largely resumed normal lives.

Older people are still falling seriously ill in great numbers, particularly if they are unvaccinated, and hospitals in the Midwest, New England and the Southwest have been strained with an influx of patients this month. Worried about their risks, and the ongoing warnings from health officials about the added dangers for older people, many of them are still curtailing travel and visits with grandchildren, and are dining out less.

“After seeing a couple of people we knew die, we weren’t going to take any chances at all,” Rob Eiring, 70, a semiretired sales executive in Mill Creek, Wash., said of the way he and his wife had responded to the pandemic. “We really retreated. Everything turned inward for us.”

Customers and workers at bars and restaurants in Philadelphia, where new cases of coronavirus infections are rising rapidly, will have to be fully vaccinated starting next month, city officials announced on Monday.

“I don’t want to close restaurants or other types of businesses that serve food,” Cheryl Bettigole, Philadelphia’s health commissioner, said in a video news conference. “They’ve been through too much, and they’re an important part of the life of our city.”

“Since we can’t make people wear masks when they’re eating,” Dr. Bettigole added, “we need to increase the vaccination rate of people in those situations.”

Philadelphia’s mandate comes after New York City, San Francisco and New Orleans put similar regulations into effect.

New Covid cases and hospitalizations have been rising in Philadelphia in recent weeks. The average number of new cases reported each day reached 702 on Sunday, compared with 291 on Dec. 1, according to a New York Times database. The city decided to act before the onset of a predicted “winter wave,” when Dr. Bettigole said she expects colder weather and holiday gatherings to fuel even more infections.

Jim Kenney, Philadelphia’s mayor, said on Monday that “with winter just around the corner, we must do more to protect our residents.”

The first phase of the mandate takes effect Jan. 3. At first, establishments that sell food or drinks for consumption on the premises must require proof of either full vaccination or a negative test administered in the last 24 hours. Starting on Jan. 17, however, negative tests will no longer be accepted, Dr. Bettigole said.

The two weeks before the second, tighter requirement should help give people who are not yet vaccinated time to get either the single-shot Johnson & Johnson vaccine or the two required doses of the Moderna or Pfizer-BioNTech vaccines, she said.

The mandate will apply to bars, restaurants, sports venues that serve food, bowling alleys, movie theaters, casinos where food and drinks are allowed on the gambling floor, catering halls and cafes within larger establishments, officials said.

It will not apply to schools, day care facilities, convenience stores, grocery stores, hospitals, soup kitchens and other places that serve “vulnerable populations,” she said.

People with “proof of valid religious or medical exemptions” and young children who are not yet eligible for vaccination will be exempt, according to the Health Department’s website.

Workers at affected establishments, and children between 5 and 11, will have to receive at least one dose of vaccine by Jan. 3 and be fully vaccinated by Feb. 3, Dr. Bettigole said.

About 71 percent of Philadelphia’s more than 1.5 million residents and 76 percent of the city’s adults have been fully vaccinated, city officials announced on Monday.

PARIS — A recent cartoon in the French daily Le Monde featured a bedraggled man arriving at a doctor’s office for a Covid-19 vaccine. “I am here for the fifth shot because of the third wave,” he says. “Or vice versa.”

His bewilderment as France suffers its fifth wave of the pandemic, with cases of the Delta variant rising sharply along with Omicron anxiety, captured a mood of exhaustion and simmering anger across the world two years after the deadly virus began to spread in China.

Uncertainty bedevils plans. Panic spreads in an instant even if, as with the Omicron variant, the extent of the threat is not yet known. Vaccines look like deliverance until they seem a little less than that. National responses diverge with no discernible logic. Anxiety and depression spread. So do loneliness and screen fatigue. The feeling grows that the Covid era will go on for years, like plagues of old.

Even in China, with no reported Covid deaths since January, some confess weariness with the measures that have kept them safe when so many others perished.

“I’m so tired of all these routines,” Chen Jun, 29, a tech company worker in the southern Chinese city of Shenzhen, said the other day. He was forced to take three Covid-19 tests in June following an outbreak in the city, and then had to quarantine for 14 days. Thumbtacks he used to pin on a world map to trace his travels have stopped multiplying. “I’m starting to think we’ll never see an end to the pandemic.”

This sense of endlessness, accompanied by growing psychological distress leading to depression, was a recurrent theme in two dozen interviews conducted in Asia, Europe, Africa and the Americas. After two years of zigzagging policy and roller coaster emotions, terrible loss and tantalizing false dawns, closing borders and intermittently shuttered schools, people’s resilience has dwindled.

That is sure to pose new challenges for leaders trying to protect their people and their economies. Will the weary obey new restrictions, or risk seeing family and friends after months of forced separation? The question of just how draconian leaders can be when people’s mental health has become so fragile appears to be a core dilemma as the pandemic enters its third year.

The appearance of the new Omicron variant has made many more Americans worry about contracting the coronavirus, but that worry has not translated into taking more safety precautions, according to a new poll released Friday by The Associated Press and NORC.

Thirty-six percent of survey respondents said they were extremely worried or very worried about either themselves or a family member getting the virus, a sharp jump up from October, when 25 percent said they were very or extremely worried. The figure had not been that high since the Delta surge was reaching its peak in late summer.

Another 31 percent said in the latest survey that they were somewhat worried, about the same proportion as in October. The share who said they were not too worried or not worried at all fell 10 points in the latest survey, to 33 percent.

For all the added worry, though, the share of survey respondents who reported taking safety precautions, like wearing a face mask or avoiding nonessential travel, remained about the same as it was in June, when fear of infection was at a low of just 21 percent.

“I think right now, people are trying to figure out, ‘OK, it’s not going to be a Covid-free normal — how are we going to navigate this?’” said Tara Kirk Sell, an expert on public health policy at the Johns Hopkins Center for Health Security who was not involved in the survey. “I think that means some of the precautions people were taking before, they are peeling back.”

The survey of 1,089 adults in the United States began on Dec. 2, a week after the existence of the Omicron variant first made headlines. The poll, which had a margin of error of 4.1 percent, found wide gulfs in attitudes about the pandemic which seemed to be correlated with the respondent’s vaccination status and political party.

Some 71 percent of vaccinated people said they were at least somewhat worried about infection, while 55 percent of the unvaccinated said they were either not too worried or not at all worried. Vaccinated people were also more likely to be taking other precautions than unvaccinated people. And on the partisan spectrum, 81 percent of Democrats in the survey were at least somewhat worried, compared with 49 percent of Republicans.

There were few signs in the survey of any significant changes in precautionary behavior since the summer. About 41 percent of those polled said they were avoiding other people as much as possible, 53 percent were avoiding nonessential travel, 57 percent were always or often staying away from large groups and the same proportion said they were always or often wearing face masks in public settings. All those results were within a few points of earlier findings in June and August.

While many respondents remained wary of going to crowded events like movies, concerts and shows, or of exercising at a gym, a majority said they were engaging in activities like shopping, going out to bars or restaurants, using public transportation and visiting friends and family about as much as they ordinarily would.

“If we wanted to 100 percent prevent ourselves from having any exposure to Covid, we’d never leave our house,” Ms. Sell said. “But we’re kind of saying, ‘OK, we’re going to balance the risks from Covid and the things we want to do.’”

Massachusetts said on Monday that it would offer free at-home coronavirus tests to some of its residents, joining several other states around the country.

Gov. Charlie Baker announced that the state had secured more than two million rapid at-home tests that would be delivered to 102 towns with high poverty rates. The tests will be distributed by each municipality with an emphasis on getting them to the people who are in the greatest financial need.

Mr. Baker, a Republican, said at a news conference on Wednesday that the state was also working toward making bulk purchasing deals with test makers for broader distribution.

As of Sunday, the seven-day average of new cases in Massachusetts was up 78 percent from two weeks ago, according to a New York Times database.

Neighboring New Hampshire offered home delivery of rapid tests at the end of November, and all of the tests were claimed almost immediately. Maryland also announced last month that it was distributing 500,000 test kits through local health departments.

At-home tests are available to Colorado residents on a state website. Likewise, Iowans can order tests from a website called Test Iowa, but only the sampling for those tests is done at home. Once collected, the samples must be taken to a UPS drop-off location, and results are later returned online.

In Ohio, the state has taken advantage of existing public infrastructure by giving out free tests at hundreds of public libraries.

The spotty availability of at-home tests in the United States stands in contrast to the situation in some countries in Europe. Rapid tests can be picked up for free at pharmacies in Britain, and packs can be ordered for free online. And in Germany, the government put hundreds of millions of dollars into the creation of thousands of rapid test sites.

A new Covid-19 pill from Merck has raised hopes that it could transform the landscape of treatment options for Americans at high risk of severe disease but the Food and Drug Administration is still weighing Merck’s application. One of the biggest questions facing regulators is whether the drug has the potential to cause mutations in human DNA as it wreaks havoc on the virus’s genes.

Scientists are especially worried about pregnant women, they said, because the drug could affect a fetus’s dividing cells, theoretically causing birth defects. Some members of the F.D.A. expert committee which narrowly voted to recommend authorizing the drug expressed those same concerns during a public meeting on Nov. 30.

Here’s what scientists know about how the drug works and its potential risks.

How does molnupiravir work?

When the drug is processed in the body, it creates compounds that closely resemble one of the building blocks of RNA, the genetic material inside the coronavirus. That causes problems for the coronavirus as it makes copies of itself, inserting enough errors into the virus’s RNA and that it cannot survive.

The problem is that the same compound that interferes in the replication of the virus’s genetic material can also be transformed into one that resembles a building block of DNA. Some scientists worry that could cause errors in a patient’s own DNA, or in that of a developing fetus.

How serious a problem is that?

A team of researchers at the University of North Carolina studied the use of molnupiravir in isolated hamster cells over 32 days and found that the drug did induce mutations in DNA.

Those mutations could “contribute to the development of cancer, or cause birth defects either in a developing fetus or through incorporation into sperm precursor cells,” the authors of that study wrote.

The drug targets only dividing cells, which are relatively sparse in an adult. That poses a narrower risk than other so-called mutagens, like radiation, which can damage DNA in all types of cells. Still, the authors of the study said adults had enough dividing cells to cause concern.

Merck scientists said that hamster cells were exposed to the drug for considerably longer than Covid patients would be. The company said that it tested the drug in rodents and found no signs of DNA mutations.

What are the risks during pregnancy?

Cells in a fetus are dividing all the time, heightening the risk of mutations. As a result, Merck excluded pregnant and breastfeeding women, as well as women likely to become pregnant, from its clinical trial.

“Human development in utero is an absolutely astounding sequence of events,” said Dr. John Mellors, an infectious disease specialist at the University of Pittsburgh Medical Center. “You start tinkering with that in any way, you can end up with a disaster.”

In Britain, health authorities have said that Merck’s pill should not be given to pregnant or breastfeeding women. Women who could become pregnant, they advised, should use contraception while taking the drug and for four days after.

What comes next?

Scientists have urged Merck to publish the full findings of its rodent studies examining the risk of DNA mutations.

Several experts also urged that researchers be allowed to study the long-term health outcomes of people who receive molnupiravir. That data could indicate whether people who take the drug develop cancer or have children with birth defects at higher rates than would be expected.

Merck executives told the F.D.A. advisory committee that the company would enact a surveillance program to monitor women who take molnupiravir during pregnancy.

Rebecca Robbins contributed reporting.

Less than a week after Nicaragua broke diplomatic relations with Taiwan in favor of Beijing, the Latin American country received the first part of a vaccine donation from China, the latest sign of how China has turned to vaccines in a charm campaign across the world.

The shipment of 200,000 doses made by Sinopharm, a Chinese vaccine maker, was delivered to Nicaragua aboard an Air China plane on Monday, according to Chinese state media. It is the first part of a donation of 1 million doses.

Last week, Nicaragua’s foreign minister said that the country would no longer recognize Taiwan and instead would establish formal diplomatic ties with China, the latest blow to Taiwan’s efforts to win broader international support, if not official recognition.

Although Nicaragua’s foreign minister, Denis Moncada Colindres, did not explain the reasons for the decision, China and Taiwan have often vied over diplomatic ties with extensions of aid and support. It’s not clear how much the vaccine donation might have played into the decision.

Since the outbreak of Covid-19, China has donated and extended credit to help sell its domestic-made vaccines across the developing world in a diplomatic blitz that signals the country’s rise as a scientific leader. Yet the vaccine diplomacy has had mixed results. In some countries that have relied on Chinese vaccines, outbreaks have nonetheless occurred, leading to concerns about the effectiveness of the shots.

In recent years China has pressured Taiwan’s official allies to sever ties with the island, which Beijing claims as a territory under what it calls the “one China” policy. It is part of a campaign to keep Taiwan isolated, in the hope that it will eventually accept unification with China as an unavoidable necessity. Nicaragua’s move left only 13 nations and the Vatican recognizing Taiwan, down from 21 in the beginning of 2017.

China’s Communist Party-run Global Times quoted an adviser to Nicaragua’s president calling the vaccine donation “great news.”