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Nursing Properties Face Dilemma: Vaccinate Employees or Don’t Get Paid.

Nursing Homes Face Dilemma: Vaccinate Staff or Don’t Get Paid.

Marita Smith runs a nursing home in Seattle while Janet Snipes runs one in Denver. They share years of industry experience and painful memories of Covid-19, but have vastly different views on a new federal policy making vaccinations mandatory for all care home workers.

Ms. Smith said unvaccinated people should not be caring for a vulnerable population that has already been hit hard by the pandemic. The industry is seeing rising infection rates and deaths among residents again, but not reaching the highs of last year, and the mandate is expected to avert further increases.

“It’s great,” said Ms. Smith, administrator of the St. Anne Nursing and Rehab Center, calling the policy a “pretty big deal” that would “flush out health professionals who shouldn’t be in the health service.”

Such exits are exactly what worries Ms. Snipes, executive director of the Holly Heights Care Center in Denver. She, too, wants all homeworkers to be vaccinated, but not at the risk of losing employees who fail to do so in the midst of a labor shortage in an already high turnover industry.

Of the 1.5 million nursing home workers in the United States, approximately 540,000 – 40 percent of the workforce – are unvaccinated. Their fate could be directly affected by a directive announced by President Biden on Wednesday mandating vaccination of all nursing home workers, with the rules expected to go into effect in September. Institutions that fail to meet this goal could face fines or lose federal reimbursement, a major source of income for many.

The practical effect of the policy is that workers must be vaccinated or lose their jobs. Ms. Snipes said several employees told her they could leave. One who referred to her as her best nurse told her she was “very, very scared” of the vaccine, partly because she is black and worried about past medical experiments.

Getting vaccinated “is the safest thing for our residents and staff, but we believe he must contract all health care facilities,” Ms. Snipes said of President Biden. “We cannot afford to lose staff to hospitals and assisted living facilities.”

Several large nursing home chains and some states have already issued vaccination mandates. Industry officials said vaccinations were highly recommended, but their position on the new policy mirrored that of Ms. Snipes.

“We’re going to lose tens of thousands, maybe hundreds of thousands of workers,” said Mark Parkinson, president and chief executive officer of the American Health Care Association, a large nursing home trade group. He said he was hoping for policy changes and had already worked with Dr. Lee A. Fleisher, Chief Medical Officer of the Centers for Medicare & Medicaid Services, talked about it and looked for a meeting with Xavier Becerra, Secretary for Health and Human Services.

The most important change the industry is seeking is a signal from the administration that at some point there will be a mandate for all healthcare facilities so that nursing home workers can see there is nowhere else they can go. “Make it a commitment for everyone,” said Mr. Parkinson.

In fact, around 2,000 hospitals have already placed vaccination orders, reducing job opportunities for unvaccinated healthcare workers.

Dr. Fleisher said the CMS and the Centers for Disease Control and Prevention saw a “direct link” in the latest data between rising infections in nursing homes and unvaccinated staff.

Updated

Aug. 19, 2021, 6:01 p.m. ET

“The higher the percentage of unvaccinated workers, the higher the percentage of cases we have seen in these homes,” said Dr. Butcher. “There was a strong relationship.”

Currently, 60 percent of nursing home workers nationwide are vaccinated, well below the previous industry target of 75 percent by the end of June.

Parkinson said the industry is also lobbying the government to “launch a much more intense media campaign to influence workers” that vaccines are safe and effective. The trade organization also wants the government to create a grace period for hesitant employees.

Uy, a geriatrician and medical director of a Philadelphia nursing home, said he had seen the human resource challenges and was “excited about the mandate.”

“I’m exhausted,” he said. “The vaccine is like a small fortress around the weakest, in which the people inside remain safe even though a fire is raging outside.”

The mandate aims to avoid an increase in Covid cases and deaths in a high risk population.

Of the 625,000 Covid deaths to date in the US, almost a fifth – 133,700 – were residents of nursing homes, according to the CDC

Understand the state of vaccination and masking requirements in the United States

    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in public places indoors in areas with outbreaks, reversing the guidelines offered in May. See where the CDC guidelines would apply and where states have implemented their own mask guidelines. The battle over masks is controversial in some states, with some local leaders defying state bans.
    • Vaccination regulations. . . and B.Factories. Private companies are increasingly demanding coronavirus vaccines for employees with different approaches. Such mandates are legally permissible and have been confirmed in legal challenges.
    • College and Universities. More than 400 colleges and universities require a vaccination against Covid-19. Almost all of them are in states that voted for President Biden.
    • schools. On August 11, California announced that teachers and staff at both public and private schools would have to get vaccinated or have regular tests, the first state in the nation to do so. A survey published in August found that many American parents of school-age children are against mandatory vaccines for students, but are more supportive of masking requirements for students, teachers and staff who do not have a vaccination.
    • Hospitals and medical centers. Many hospitals and large health systems require their employees to receive a Covid-19 vaccine, due to rising case numbers due to the Delta variant and persistently low vaccination rates in their communities, even within their workforce.
    • new York. On August 3, New York City Mayor Bill de Blasio announced that workers and customers will be required to provide proof of vaccination when dining indoors, gyms, performances, and other indoor situations. City hospital staff must also be vaccinated or have weekly tests. Similar rules apply to employees in New York State.
    • At the federal level. The Pentagon announced that it would make coronavirus vaccinations compulsory for the country’s 1.3 million active soldiers “by mid-September at the latest. President Biden announced that all civil federal employees would need to be vaccinated against the coronavirus or undergo regular tests, social distancing, mask requirements and travel restrictions.

And a recent CDC study of 4,000 nursing homes found that the effectiveness of Pfizer and Moderna vaccines among nursing home residents dropped from 75 percent in the spring to 53 percent by midsummer, when the delta variant spread further. “The results underline the crucial importance of the Covid-19 vaccination for employees, residents and visitors,” stated the authors of the study.

Health experts fear that unvaccinated employees could bring Covid-19 into a nursing home and infect residents. Nationwide, more than 80 percent of residents of nursing homes are vaccinated, but the number of cases in this population group is already increasing. In the week ending August 15, 354 care home residents died of Covid-19, the highest number since mid-March, and 3,585 tested positive, according to the CDC

The CDC has found that more employees are getting sick. In the week ending August 15, 5,810 nursing home employees contracted Covid-19, five times more than a month earlier, and 25 employees died.

Earlier this month, the Good Samaritan Society, which operates 142 nursing homes nationwide, announced that all 15,000 employees must be vaccinated by November 1, a position the company took after in homes where unvaccinated workers also tested positive , an increase in infections among residents was recorded. So far, the workforce has remained stable, said Randy Bury, the company’s CEO, who has argued in the past that such mandates would create safe and desirable jobs.

However, he argued that the Biden government’s new policy was wrong unless it was applied to the health sector as a whole. “What’s the difference in a nursing home versus a hospital?” Said Mr. Bury. “They are susceptible to the virus when they come into contact with unvaccinated employees.”

LeadingAge, a non-profit organization that represents 2,000 nursing homes and had previously requested mandates in individual homes, criticized the Biden policy for its narrow focus.

“The administration is right,” said Katie Smith Sloan, president and chief executive officer of LeadingAge, in a released statement. “We are at war. It would be a tragic misstep for the nurses who continue to struggle on the front lines to withdraw funds. “

Ms. Snipes, the director of Holly Heights in Denver, said she spent months training the staff and promoting vaccinations. She said most of her unvaccinated employees agreed to obey the mandate, but she mentioned three that she feared might leave. One told her that she did not want to put anything strange in her body. A second Catholic said he did not want an mRNA vaccine for religious reasons and that he had a letter of support from his bishop.

The third was the black nurse, who “sounds the most fearful of all the people I have spoken to,” said Ms. Snipes. “I want to save you as an employee.”

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U.S. to require nursing houses workers get photographs or lose federal funding

U.S. to require nursing homes staff get shots or lose federal funding

President Joe Biden announced Wednesday that his government will require all nursing home workers to be vaccinated against Covid-19, the latest move to protect Americans if the Delta variant spreads.

“Today I announce a new step,” said Biden in a speech at the White House. “If you work in a nursing home and care for people on Medicare or Medicaid, you also need to get vaccinated.”

Biden’s remarks came after an administrative official confirmed to NBC News that the government will withhold federal funding from nursing homes that don’t fully vaccinate their employees.

The new policy, which would hold back funding for Medicare and Medicaid nursing homes that fail to comply, could go into effect as early as next month, the official said, although the timing is fluid. This would affect around 15,000 nursing homes, which employ more than 1.3 million people nationwide.

The move comes as the highly contagious Delta variant is causing a surge in new cases nationwide, and federal officials say they are starting to see signs of declining vaccine protection against mild and moderate illnesses.

According to data compiled by Centers for Medicare & Medicaid Services, roughly 60% of nursing home workers nationwide are vaccinated – much less than the 82.4% of residents who received the vaccinations. In some states, the percentage of nurses who have been vaccinated is even lower.

Some medical experts have asked the U.S. government to pressure nursing homes to vaccinate their staff, saying the unvaccinated staff put older residents at greater risk, who are more likely to become seriously ill or have something called a breakthrough infection.

“We have to go faster. So I’m taking vaccination measures where I can, ”Biden said in the speech.

The new rules for nursing homes are “all about keeping people safe and safe,” he said.

“This is no time to let our vigilance down. We just have to finish the job, with science, with facts and with confidence,” said the president.

Earlier in the day, federal health officials announced that they plan to provide booster shots to most Americans from the week of September 20th. They said it was “very clear” that immunity decreased after the first two doses, and with the dominance of the Delta variant, “we are gradually seeing signs of decreased protection against mild and moderate illnesses.”

“Based on our latest assessment, current protection against serious illness, hospitalization and death could decline in the coming months, especially for those at higher risk or who were vaccinated during the earlier stages of vaccination,” said the statement signed by CDC director Dr. Rochelle Walensky, Acting FDA Commissioner Dr. Janet Woodcock, White House Senior Medical Advisor Dr. Anthony Fauci, and other US health leaders.

Nursing home residents, health care providers, and the elderly – the first groups to be vaccinated in December and January – will be targeted, according to Dr. Francis Collins, director of the National Institutes of Health, likely prioritized to get extra vaccinations.

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Biden Ramps Up Virus Technique for Nursing Properties, Faculties

Biden Ramps Up Virus Strategy for Nursing Homes, Schools

WASHINGTON — The Biden administration moved on multiple fronts on Wednesday to fight back against the surging Delta variant, strongly recommending booster shots for most vaccinated American adults and using federal leverage to force nursing homes to vaccinate their staffs.

In remarks from the East Room of the White House, President Biden also directed his education secretary to “use all of his authority, and legal action if appropriate,” to deter states from banning universal masking in classrooms. That move is destined to escalate a fight with some Republican governors who are blocking local school districts from requiring masks to protect against the virus.

The shifts in strategy reflect the administration’s growing concern that the highly contagious Delta variant is erasing its hard-fought progress against the pandemic and thrusting the nation back to the more precarious point it was at earlier in the year.

Thus far, Mr. Biden has been reluctant to use the federal government’s power to withhold funding as a means of fighting the pandemic. But that changed Wednesday, when he said his administration would make employee vaccination a condition for nursing homes to receive Medicare and Medicaid funding. Officials said the decision would affect more than 15,000 nursing homes that employ 1.3 million workers.

“The threat of the Delta virus remains real, but we are prepared, we have the tools, we can do this,” Mr. Biden said in the East Room, adding, “This is no time to let our guard down.”

He accused politicians who were banning local school districts from requiring masks in the classroom of setting a “dangerous tone,” adding, “We’re not going to sit by as governors try to block and intimidate educators from protecting our children.” The administration is sending letters to eight states — Arizona, Florida, Iowa, Oklahoma, South Carolina, Tennessee, Texas and Utah — challenging their efforts to ban universal masking in schools.

For many Americans, the booster strategy will affect them the most. The government plans to offer third shots to adults who received the Pfizer-BioNTech or Moderna vaccines eight months after they received their second dose. About 150 million Americans have been fully immunized with one of those two vaccines.

“We are concerned that the current strong protection against severe infection, hospitalization and death could decrease in the months ahead, especially among those who are at higher risk” or who were inoculated in the early months of the vaccination campaign, Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said.

Assuming that regulators decide third shots are safe and effective, the effort will start Sept. 20. Officials said they were waiting on more data to decide whether the 14 million Americans who received Johnson & Johnson’s single-dose vaccine should also receive an additional shot, but suggested that they would be included as well.

Although some public health experts have said booster shots were prudent and expected, not all scientists are convinced it is the right move. And advocates for global health said it was morally wrong — and shortsighted — for the administration to give booster shots to Americans when so many people around the world were still waiting to be vaccinated.

For state officials and health care providers, already exhausted from an 18-month battle against a novel virus that seems to shift its shape the moment it seems under control, the booster-vaccination campaign will bring a fresh round of logistical challenges. Some worried it could sidetrack efforts to vaccinate the roughly 85 million Americans who were eligible for shots but remained unvaccinated.

“We now have to fight a war on two fronts,” said Dr. José R. Romero, the Arkansas secretary of health. “We have to continue to press the vaccine into those groups that have not accepted it, and then have another effort to vaccinate those at high risk.”

The move to make employee vaccination a condition for nursing homes to receive Medicare and Medicaid funding reflects months of frustration with the low vaccination rates among nursing assistants and other workers who care for highly vulnerable people.

Officials described it as the first time that Mr. Biden had threatened to withhold federal funding in order to force vaccinations.

In an interview before the president spoke, Education Secretary Miguel A. Cardona described another major turning point: his department will use its civil rights enforcement arm to allow schools to require masks. The move comes as many educators and parents fear a surge in cases as the school year is about to start and as pediatric Covid cases climb.

The C.D.C. has recommended that everyone in schools wears masks, regardless of their vaccination status, but some states and localities are refusing to issue rules requiring masks or preventing schools from imposing them.

“The president is appalled, as I am, that there are adults who are blind to their blindness, that there are people who are putting policies in place that are putting students and staff at risk,” Dr. Cardona said in the interview.

“At the end of the day,” he said, “we shouldn’t be having this conversation. What we’re dealing with now is negligence.”

Administration officials made clear that booster shots would depend upon a determination by the Food and Drug Administration that third shots are safe and effective — a ruling expected in the coming weeks. Whether those under the age of 18 will be eligible will also be up to the F.D.A. and a federal advisory committee of experts, they said.

Aside from some people with weakened immune systems who have already been authorized for third shots, officials advised that fully vaccinated people wait for what they promised would be a speedy but orderly national rollout of booster shots.

Updated 

Aug. 18, 2021, 7:51 p.m. ET

“Here’s what you need to know: If you are fully vaccinated, you still have a high degree of protection from the worst outcomes of Covid-19 — severe disease, hospitalization and death,” Dr. Vivek H. Murthy, the surgeon general, said at a White House briefing. “We are not recommending that you go out and get a booster today.”

Dr. Walensky presented a series of studies at the briefing that, she said, showed the vaccines’ efficacy wanes over time. Some doctors applauded the decision to offer booster shots.

“Given the prevalence we have of the Delta variant, doing everything we can to keep people out of the hospital — especially those at high risk — does make sense,” said Dr. Paul Biddinger, the director of the Center for Disaster Medicine at Massachusetts General Hospital.

But some scientists criticized the policy as overly broad, arguing that it is not clear that the general population needs a third shot.

Jennifer B. Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health, said the studies cited by administration officials showed that the vaccines were doing what they were intended to do — protect against severe disease and hospitalization.

“I don’t think the metric of, ‘We’re seeing more infection’ is the right metric to be judging the efficacy of the vaccines,” she said. “The right metric is, ‘Does it prevent severe disease?’”

The administration’s move follows similar actions by Israel, Germany and France but goes against the recommendation of the World Health Organization, which is arguing extra vaccine supply should go to countries that have vaccinated far fewer of their residents.

“Vaccine injustice is a shame on all humanity and if we don’t tackle it together, we will prolong the acute stage of this pandemic for years when it could be over in a matter of months,” Dr. Tedros Adhanom Ghebreyesus, the organization’s director general, said at a news conference before the White House’s briefing.

Jeffrey D. Zients, the White House pandemic coordinator, said the administration was already donating 600 million doses of vaccines to needy countries and would continue that effort — a point Mr. Biden reiterated in the East Room.

“We can take care of America and help the world at the same time,” Mr. Biden said.

Administration experts said the booster policy was the result of dual, disturbing trends: a decline in the vaccines’ potency over time and the apparent ability of the Delta variant to somehow bypass their protection better than its predecessors.

One study they cited found the vaccines’ effectiveness at preventing infections among nursing home residents dropped to about 53 percent from 75 percent between spring and summer, when the Delta variant became dominant.

Understand the State of Vaccine and Mask Mandates in the U.S.

    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
    • Vaccine rules . . . and businesses. Private companies are increasingly mandating coronavirus vaccines for employees, with varying approaches. Such mandates are legally allowed and have been upheld in court challenges.
    • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
    • Schools. On Aug. 11, California announced that it would require teachers and staff of both public and private schools to be vaccinated or face regular testing, the first state in the nation to do so. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.  
    • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
    • New York. On Aug. 3, Mayor Bill de Blasio of New York announced that proof of vaccination would be required of workers and customers for indoor dining, gyms, performances and other indoor situations, becoming the first U.S. city to require vaccines for a broad range of activities. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
    • At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

Dr. Walensky said preliminary data from another study of more than 4,000 frontline workers suggested that the vaccines might not work as well against the Delta variant than against prior variants. In that study, a decline in vaccine efficacy against infection appeared related to the variant, not to how long ago the workers were vaccinated, she said.

She also cited data from Israel showing a worsening in the infection rate among vaccinated people over time. Israel vaccinated much of its population faster than other countries, making it a potential harbinger of what is to come for the United States.

Dr. Murthy said there was “nothing magical” about the eight-month timeline for allowing boosters, describing it simply as the best judgment of health experts. He and other officials emphasized that the overwhelming majority of hospitalizations and deaths from Covid continued to occur among the unvaccinated.

“Protection against severe disease and hospitalization is currently holding up pretty well,” Dr. Walensky said.

First in line for booster shots will be health care workers, nursing home residents and other older adults, followed by the rest of the general population. Officials envision offering the extra shots at pharmacies and other sites where initial vaccinations are already underway, rather than reopening mass vaccination sites. More than five million people could be eligible for the shots as of late September.

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases and the president’s top medical adviser for the pandemic, said studies had shown that third shots of the Moderna and Pfizer vaccines could boost the levels of antibodies that fight the virus tenfold — an increase he called “remarkable.”

Although they promised the booster rollout would be orderly and thoughtful, federal officials are clearly racing against the clock to offer extra shots before those who were vaccinated earliest could be more vulnerable to the threat of severe disease.

The F.D.A. must first authorize third doses, and an advisory committee of the C.D.C. must review the evidence and make recommendations. But neither Pfizer nor Moderna has yet submitted all the necessary data showing that third shots are safe and effective.

Pfizer is expected to finish submitting its data this month. Moderna and the National Institutes of Health are studying whether a half dose or full dose works best. The company plans to submit its data next month.

On the plus side, federal and state health officials said that much of the infrastructure for a rollout was already in place. Tens of thousands of pharmacies and other sites are already offering shots on a daily basis, and many state officials said they could easily expand their work.

The nation’s vaccine surplus also makes it unlikely that Americans will experience the kind of frenzy seen in the early weeks of the vaccine effort last winter, when older Americans desperate for shots flooded mass vaccination sites. “The bottom line is that we are prepared for boosters, and we will hit the ground running,” Mr. Zients said.

Some state officials sounded less sure of a smooth operation. “It’s hard even to predict how strong the demand will be,” said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, which was briefed on the administration’s plans Wednesday morning by C.D.C. experts.

“The big question is, do we do community vaccination clinics again, which worked very well in the initial run,” he said, “or is the demand going to be a little bit more spaced out over time?”

Apoorva Mandavilli and Daniel E. Slotnik contributed reporting.

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Nursing Properties Confront New Covid Outbreaks Amid Requires Employees Vaccination Mandates

Nursing Homes Confront New Covid Outbreaks Amid Calls for Staff Vaccination Mandates

In saying last Friday that it was monitoring outbreaks at nursing homes related to the Delta variant, the C.D.C. said some measures under review would include “testing, quarantine, visitation, use of PPE and source control.”

Underscoring the concern of regulators about unvaccinated workers, Colorado just implemented a new rule that unvaccinated staff members at nursing homes must be tested for the virus, using a rapid test, every time they come to work. California is now requiring health care workers in the state to be vaccinated or undergo frequent testing.

Feelings are raw among nursing home staff and operators.

“I don’t want to lose anyone else,” said Marita Smith, administrator at Saint Anne Nursing and Rehab Center in Seattle. Eight of 32 residents died of Covid early on in the pandemic, including four who were already on hospice. Ms. Smith says the losses help explain why all 52 staff members have been vaccinated.

“I question their reason for being in the business if they don’t get it,” Ms. Smith said. “You just don’t want to turn your back.”

Some nursing home staff members resisting vaccination argue that they can protect residents without being inoculated. “I go home, stay home as much as possible, do grocery pickup instead of shopping, do a lot of hand washing. I’m not exposing myself to other people,” said Jessica M., a director of nursing at a home in Grand Junction, Colo., who is unvaccinated.

She declined to give her last name because she wasn’t authorized to speak to the media. She added that she wanted to make sure “the side effects aren’t worse than protecting someone from Covid.”

But consumer advocates and others point to the difficulties nursing homes have long had in protecting residents from infection. A government report issued in May found that nursing homes averaged three Covid outbreaks from May 2020 through January 2021, with two-thirds reporting the outbreaks began with an infected staff member testing positive.

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How a Nursing Scarcity Impacts Households With Disabled Kids

How a Nursing Shortage Affects Families With Disabled Children

Many had placed their hopes on the Biden government’s infrastructure plan, which would allocate $ 400 billion to improve home and community care. But with the President and Republicans arguing over the scope and scope of the proposal, it is unclear whether that part will survive.

Parents, meanwhile, are increasingly carrying an inexorable burden alone.

A nurse who cares for a medically weak child at home has the same duties as in a hospital, but no emergency medical assistance. It’s a tightrope, and experts say prevailing wages don’t reflect the difficulty.

Federal guidelines allow state Medicaid programs to cover home care for eligible children regardless of their families’ income, as the price of 24/7 care would ruin almost anyone. But states generally pay nursing staff at much lower rates than they would for equivalent care in a hospital or other medical center.

“They’re effectively setting a benchmark for employee compensation that puts this area at a competitive disadvantage,” said Roger Noyes, a spokesman for the New York State Home Care Association. In return, government-approved home health insurers that provide nursing families with nurses pay meager salaries and rarely offer health insurance or other benefits to the nurses they employ.

Although home care is better suited to medically ill children, hospitals get about half of Medicaid spending on these cases, compared with 2 percent on home care, studies show.

And Covid-19 created competing demands on care that further reduced the number of home care workers. In light of the pandemic, the state’s largest healthcare provider, Northwell Health, hired 40 percent more nurses in 2020 than the previous year, and hired 1,000 additional temporary nurses once the local hiring pool ran out.

Robert Pacella, the executive director of Caring Hands Home Care, the agency that oversees Henry’s case, noticed the change in January as nurses began reducing shift opportunities and decreasing new applicants.

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Covid Pandemic Forces Households to Rethink Nursing Dwelling Care

Covid Pandemic Forces Families to Rethink Nursing Home Care

Even before the pandemic began 14 months ago, nursing homes had become the source of rampant, antibiotic-resistant infections. The facilities also faced systemic problems, such as the high turnover of nursing home staff and the game of the federal government’s rating system, which made it difficult for families to judge the quality of the homes.

For years, federal health officials and some insurers have been trying to encourage more home care, and the pandemic has created a sense of urgency.

“It really changed the paradigm of how older adults want to live,” said Dr. Sarita Mohanty, the executive director of the SCAN Foundation, a nonprofit group that addresses issues older adults face. The vast majority of these adults would prefer to stay home in old age, she said.

“What happened is a welcome kind of market correction for nursing homes,” said Tony Chicotel, an attorney for California Attorneys for San Francisco Nursing Home Reform. Some families, he said, “eventually agreed to a nursing home without thinking too much about it.” But after many families tried to provide home care during the pandemic, they found that leaving an elderly relative at home was a viable alternative.

Nursing homes grew out of the poor houses in England and America caring for the poor. In the United States, the passage of the Social Security Act in 1935 provided money to states that care for the elderly. Thirty years later, the Medicaid program expanded funding and made nursing homes a central part of elderly care, said Terry Fulmer, president of the John A. Hartford Foundation, an advocacy group for older adults. “If you pay the nursing homes, go there,” said Dr. Fulmer.

It wasn’t until the 1970s that some programs to fund home care began, and nursing home residents across the country slowly began to decline, with occupancy falling to about 80 percent in recent years, according to the Kaiser Family Foundation.

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Attending to Sure: A Nursing Dwelling’s Mission to Vaccinate Its Hesitant Employees

Getting to Yes: A Nursing Home’s Mission to Vaccinate Its Hesitant Staff

To them, the half-hour Tyler Perry video that played repeatedly on a giant screen in the multipurpose room seemed to have no response.

Ms. Sandri, who is of Chinese descent, began to understand. “I’m Asian, but I’m not Japanese, Thai or Indian and they are very different people,” she said. “Unless we understand the cultural sensitivities beyond the major skin color groups, we will not be successful in achieving herd immunity with some of these subgroups.”

She planned to have her maintenance director, a vaccinated African immigrant, speak to reluctant colleagues about his experiences and concerns, and find leaders of local African churches who might be willing to do the same.

She also doubled down on what she thought works best: listening to and addressing her employees’ concerns one at a time – what she described as a “time-consuming, conversational advancement on a case-by-case basis.”

The key, she said, was to tailor her message to what would resonate most with each person.

“For analytical subjects, we provided data on the number of cases, the number of people in studies, and the percentage of people with an immune response,” she said. “For relationship-based thinkers, we asked if they had vulnerable friends or family members and how having or not having the vaccine might affect the relationship.”

However, as the date of the third vaccination event approached in early March, Ms. Proctor was tired – from the pandemic and the long loss of freedoms, but also from hearing at work every day the importance of getting the shot. Ms. Sandri, whose office was just around the corner, stopped by frequently to chat and gently point out the benefits of vaccination.

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Maggots, Rape and But 5 Stars: How U.S. Rankings of Nursing Houses Mislead the Public

Maggots, Rape and Yet Five Stars: How U.S. Ratings of Nursing Homes Mislead the Public

The pandemic has exposed the shortcomings in the state’s rating system.

State health inspections do little to punish homes with poor records of preventing and controlling infection. According to The Times, from 2017 to 2019 inspectors cited nearly 60 percent – more than 2,000 – of the country’s five-star facilities for failing to follow basic safety precautions such as regular hand washing. Nevertheless, they received top marks.

In San Bernardino, California, inspectors have written to Del Rosa Villa about four different infection control violations. It kept its five stars. Ninety residents at the 104-bed facility contracted the coronavirus and 13 have died.

Del Rosa Villa officials did not respond to requests for comment.

The Life Care Centers of Kirkland, Washington, the first nursing home in the United States to document coronavirus cases, reported poor infection control despite its five stars in 2019. State inspectors wrote it down because they “failed to consistently implement an effective infection control program”.

Thirty-nine residents of the facility have died from Covid-19. The house has 190 beds.

Leigh Atherton, a spokeswoman for Life Care, said the citation was the only infection control flaw that inspectors had found on more than 32 previous visits. She said the house quickly fixed the problem.

If the rating system had worked as intended, it would have provided indications of which houses were most likely to get out of hand and which houses would be likely to get messed up.

That didn’t happen.

The Times noted that there was little correlation between star ratings and the condition of homes during the pandemic. In five-star facilities, the death rate from Covid-19 was only half a percentage point lower than in facilities with lower ratings. And the death rate was slightly lower in two-star facilities than in four-star homes.

The location of a facility, the infection rate in the surrounding community, and the race of nursing home residents were all predictors of whether a nursing home would have an outbreak. The star rating didn’t matter.

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Covid-19: Biden Administration Opens Nursing House Doorways

A resident at the Good Shepherd nursing home in Wheeling, W.Va., in February. New guidelines from the Biden administration have loosened restrictions on visits to nursing home residents.

Here’s what you need to know:

Credit…Amr Alfiky/The New York Times

The Biden administration on Wednesday published revised guidelines for nursing home visits during the pandemic, allowing guests the freedom to go inside to see residents regardless of whether the visitors or the residents have been vaccinated.

The new recommendations, released by the Centers for Medicare & Medicaid Services with input from the Centers for Disease Control and Prevention, are the first revision to the federal government’s nursing home guidance since September. And they arrived as more than three million vaccine doses have been administered in nursing homes, the agency said.

The guidance was also the latest indication that the pandemic in the United States was easing, with Covid-19 cases continuing to decrease across the nation, though the seven-day average remains at more than 58,000. The C.D.C. on Monday released long-awaited guidance for Americans who have been fully vaccinated, telling them that it is safe to gather in small groups at home without masks or social distancing.

About 62.5 million people have received at least one dose of a Covid-19 vaccine, including about 32.9 million people who have been fully vaccinated with Johnson & Johnson’s single-dose vaccine or the two-dose series made by Pfizer-BioNTech and Moderna.

In a statement of the reasoning behind the updated recommendations, Dr. Lee Fleisher, the chief medical officer at C.M.S., cited the millions of vaccines administered to nursing home residents and staff and a decline in infections in nursing homes.

“C.M.S. recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” Dr. Fleisher said.

Earlier in the pandemic, the coronavirus raced through tens of thousands of long-term care facilities in the United States, killing more than 150,000 residents and employees and accounting for more than a third of all virus deaths since the late spring. But since the arrival of vaccines, new cases and deaths in nursing homes have fallen steeply, outpacing national declines, according to a New York Times analysis of federal data.

The eight pages of recommendations, which are not legally binding, did come with suggested limits, saying that “responsible indoor visitation” should be allowed at all times unless a guest is visiting an unvaccinated resident in a county where the Covid-19 positivity rate is higher than 10 percent and less than 70 percent of residents in the nursing home have been fully vaccinated. The guidance also says to limit visits if residents have Covid-19 or are in quarantine.

Federal officials said in the new guidance that outdoor visits were still preferable because of a lower risk of transmission, even when the residents and guests have been fully vaccinated.

So-called “compassionate care” visits — when a resident’s health has severely deteriorated — should be allowed regardless of vaccination status or the county’s positivity rate, the guidance said.

United States › United StatesOn March 10 14-day change
New cases 58,530 –16%
New deaths 1,477 –30%
World › WorldOn March 10 14-day change
New cases 467,404 +11%
New deaths 9,595 –11%

U.S. vaccinations ›

Where states are reporting vaccines given

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New Jersey Increases Indoor Capacity Limits to 50 Percent

On Wednesday, Gov. Philip D. Murphy of New Jersey announced that indoor dining, casinos, salons and gyms could open at half capacity starting March 19.

I am pleased to announce that effective next Friday, March 19, the indoor capacities for our restaurants, indoor recreational and amusement businesses, gyms and fitness clubs, and barbershops, salons and other personal care businesses will increase to 50 percent. These businesses have been capped at 35 percent for the past five weeks. Additionally, effective next Friday, same date, we are also announcing changes to our general gathering limits: indoor gatherings that are not religious services or ceremonies, political events, weddings, funerals, memorial services or performances will be capped at 25 individuals. That’s up from 10. And similarly, outdoor gatherings that are not religious services or ceremonies, political events, weddings, funerals or memorial services will be capped at 50 individuals, up from 25. We feel confident in these steps given the data that we’ve been seeing over the past five weeks since the last time we expanded the indoor reality.

Video player loadingOn Wednesday, Gov. Philip D. Murphy of New Jersey announced that indoor dining, casinos, salons and gyms could open at half capacity starting March 19.CreditCredit…Michael Loccisano/Getty Images

Restaurants in New York City and New Jersey will be able to increase indoor dining to 50 percent of capacity starting March 19, the governors of New York and New Jersey said on Wednesday.

The announcement of the relaxed limits comes as New York and New Jersey continue to lead the nation in the rate of new coronavirus cases per capita. The states are both reporting a seven-day average of 37 new virus cases a day for every 100,000 residents, according to a New York Times database.

The change — which will take effect two days after St. Patrick’s Day, traditionally a busy day for restaurants and bars — will bring both places into line with current dining limits in Connecticut and Pennsylvania.

Gov. Andrew M. Cuomo said that his decision to expand dining in New York City was made “in partnership” with Gov. Philip D. Murphy, a fellow Democrat.

“We will continue to follow the science and react accordingly,” Mr. Cuomo said in a news release issued by both governors.

Mr. Cuomo had already announced that capacity limits for restaurants statewide outside New York City could expand on March 19 to 75 percent, from 50 percent.

The new half-capacity limit in New Jersey will also apply to casinos, salons and gyms. In addition, the maximum number of people permitted at private indoor gatherings in New Jersey is also increasing to 25 people from 10. Outdoor gatherings can include 50 people, up from 25.

“We believe that when all factors are weighed, we can make this expansion without leading to undue further stress on our health care system,” Mr. Murphy said.

New Jersey was one of the last states to permit indoor dining to restart, and Mr. Murphy has faced pressure to expand capacity limits.

In New York City, restaurants have been operating with limited indoor capacity for months, including a shut down from December to February when cases started to rise again. Restaurants are currently allowed to serve diners inside at 35 percent capacity, up from 25 percent a few weeks ago.

The New York City Hospitality Alliance, an industry group, praised the new guidelines, saying they would provide much-needed relief to struggling restaurants.

“While city restaurants may not increase occupancy to 75 percent, like restaurants are safely doing throughout the rest of the state,” Andrew Rigie, the group’s executive director, said on Wednesday, being able to go to 50 percent capacity in the city “is still welcome news to the battered restaurant industry.”

After the announcement on Wednesday, employees at Pizza Moto, a pizzeria between Carroll Gardens and Red Hook in Brooklyn, gathered to discuss what it would mean for the restaurant. Pizza Moto opened for indoor dining for just a few weeks late last year before the shut down in December.

Joe Blissen, the restaurant’s general manager, said that he believed Pizza Moto could safely restart indoor dining at 50 percent capacity because most of the staff would have received their second vaccines by March 19.

“We are just trying to be cautious to make sure everything is nice, clean and safe,” said Mr. Blissen, who got his second shot this week. “It’s reassuring to us that at least our staff will be safe.”

Chris Labropoulos, who works at the Buccaneer Diner in East Elmhurst, Queens, said that an increase to 50 percent would have little impact because few people choose to dine indoors there. He could not recall the last time the diner, which opened in 1976, had reached max capacity under the state’s pandemic guidelines.

“A lot of people don’t come in as it is,” Mr. Labropoulos said, adding that most orders are for delivery or pickup.

In New Jersey, Mr. Murphy last eased restrictions on indoor dining before the Super Bowl, when he raised the limit to 35 percent and ended a 10 p.m. curfew.

Diners must continue to wear masks when not seated at tables, and seating at bars in New Jersey remains prohibited.

“Unlike some states, which are prioritizing, frankly, flat-out politics over public health — Texas and Mississippi come to mind — our mask mandate remains in place,” Mr. Murphy said.

Texas’ mask mandate ended on Wednesday, following Mississippi’s lead, which eliminated its mask rules a week ago over objections from federal health officials, who warned the step was premature.

Over the last week, there were an average of 3,322 new cases of the virus reported each day in New Jersey and 7,177 in New York, fueled in part by the spread of virus variants.

Researchers with the Centers for Disease Control and Prevention released a study on Friday that found that counties opening restaurants for on-premises dining — indoors or outdoors — saw a rise in daily infections about six weeks later, and an increase in Covid-19 death rates about two months later.

The study does not prove cause and effect, but the findings square with other research showing that masks prevent infection and that indoor spaces foster the spread of the virus through aerosols, tiny respiratory particles that linger in the air.

Gov. Larry Hogan of Maryland toured a vaccination site in Baltimore in February.Credit…Kenneth K. Lam/The Baltimore Sun, via Associated Press

Across Maryland on Wednesday, mayors, county executives, business owners and public health officials were parsing Gov. Larry Hogan’s surprise Tuesday announcement that he was loosening statewide Covid restrictions.

The order allows bars, restaurants, churches and gyms to open back up to full capacity starting Friday evening, though with certain social distancing regulations still in place. It also allows larger venues like banquet halls, theaters and sports stadiums to open to the public at 50 percent of capacity. The statewide mask mandate remains in effect.

“With the pace of vaccinations rapidly rising and our health metrics steadily improving, the lifting of these restrictions is a prudent, positive step in the right direction and an important part of our economic recovery,” Mr. Hogan said. He was joined at his announcement by Dr. Robert R. Redfield, a former director the Centers for Disease Control and Prevention, who is now a senior adviser to the governor.

Some business owners applauded the announcement as a sign that they may be able to begin crawling out of an economically punishing year. Public health experts were less welcoming.

“I was shocked, I thought it was a joke,” said Dr. Leana Wen, a public health professor at George Washington University and former Baltimore health commissioner.

City and state officials were surprised by the order, but they were particularly taken aback by one part of it, which seemed to say that starting Friday, the ability of local governments to make rules that are more restrictive than the state’s — a flexibility they have had throughout the pandemic — would be “null and void.”

That language seemed to conflict with Mr. Hogan’s remarks at the announcement, when he said that though he discouraged deviations, state law gave local jurisdictions “some powers to take actions that were more restrictive.” The governor’s spokesman said in a tweet that county “emergency powers and authorities” established during the pandemic were unaffected.

County and city officials spent Wednesday reading their local charters and talking with their lawyers about the situation.

In an emailed statement, Baltimore County Executive John A. Olszewski, Jr., said, “leaders across Maryland have been forced to scramble to meet with our legal teams, health officials, and neighboring jurisdictions to understand how this impacts our own executive orders and to determine if and how to use our own local authority moving forward.”

Maryland ranks in the middle of states in the percentage of its people who have been given at least one vaccine dose, according to a New York Times database, and somewhat above average in the number of new cases it has been reporting lately relative to its population — 13 per 100,000 residents. All three of the variants of the virus that are being tracked by the C.D.C. have been reported there, but only one in significant numbers: B.1.1.7, which was first identified in Britain and is more transmissible and possibly more lethal than earlier versions of the virus.

In the early days of the pandemic, Governor Hogan drew bipartisan praise for his aggressive response. He was among the first governors in the country to order schools closed, and he publicly criticized President Trump, a fellow Republican, for leaving states unprepared to deal with the pandemic. “I think a lot of us locally and around the country would have rated him very highly,” Dr. Wen, former Baltimore health commissioner, said.

Her estimation has fallen considerably since then. While she said she was pleased that Mr. Hogan did not lift his statewide mask order, as fellow Republican governors in Texas and Mississippi did last week, she called the broad lifting of capacity restrictions a dangerous gamble.

“It’s really disappointing, because we’ve come so far,” she said. “Why are we letting down our guard down when we’re so close?”

Main Street in Daytona Beach, Fla., this week. Some fear a superspreader event in the making. Credit…Stephen M. Dowell/Orlando Sentinel, via Associated Press

About 300,000 people are expected to descend on Daytona Beach, Fla., this week for an annual motorcycle rally despite the pandemic and a lack of restrictions to slow the spread of the coronavirus.

Excitement about the event has been tempered by some motorcycle enthusiasts in a Facebook group dedicated to the rally who worry it could turn into a superspreader event.

Last August, the Sturgis motorcycle rally in South Dakota drew more than 450,000 bikers, most of whom did not wear masks or appear to follow social-distancing guidelines. That rally was later blamed for outbreaks in other states.

Daytona Beach’s Bike Week typically draws almost half a million people, though because of the pandemic, numbers are estimated to be closer to 300,000 people this year, said Janet Kersey, the executive vice president and chief operating officer of the Daytona Regional Chamber of Commerce.

“We know because of continued Covid concerns and the loss of income many have had over this past year it will be less,” Ms. Kersey said. Good weather and the accelerating pace of vaccinations might increase attendance, she said.

At least 125 new coronavirus deaths and 4,426 new cases were reported in Florida on Tuesday, according to a New York Times database. Over the past week, there has been an average of 4,948 cases per day in the state, a decrease of 16 percent from the average two weeks earlier.

A more contagious and possibly more lethal variant of the coronavirus, known as B.1.1.7, which was first spotted in Britain, is spreading more widely in Florida as a share of total cases than in any other state, according to an analysis of data from Helix, a lab testing company.

Officials urged people attending Bike Week to exercise care.

“While our community is working hard to follow C.D.C. safety guidelines,” Ms. Kersey said, “the support of the visitors and participants is important in these efforts, as well, for everyone’s safety.”

Bike Week events include races, bike exhibitions, concerts and giveaways in and around Daytona Beach. Ms. Kersey said that officials had considered canceling the gathering but that the Daytona Beach City Council was “very meticulous in its decision to move forward.”

Masks were off in Bill Smith’s Cafe in McKinney, Texas, after Gov. Greg  Abbott issued a rollback of coronavirus prevention restrictions.Credit…Shelby Tauber/Reuters

HOUSTON — The plexiglass was down. The tables were crammed back into bars and restaurants. The masks were off.

There had been plenty of resistance to masks in Texas, even if many started to begrudgingly wear them. But now it is official: The state is no longer legally requiring people to cover their faces.

It is just one of the rules loosened by state officials eager to declare the pandemic over, even if the case numbers say otherwise.

“It is now time to open Texas 100 percent,” Gov. Greg Abbott declared in announcing the changes last week. And so on Wednesday, the signs reminding people about the mask mandate came down. So did barriers intended to curb the spread of the coronavirus.

On South Padre Island, it was like prepandemic times, with spring breakers drinking and dancing at a beachside bar. And the Texas Rangers announced that when the baseball season starts next month, they would allow the stadium — 40,518 seats — to be filled to capacity.

Not everyone was celebrating.

At Barflys in San Antonio, the “MASKS REQUIRED UPON ENTRY” sign outside may have been gone, but Britt Harasmisz’s face covering remained firmly in place as she tended customers at the patio bar.

“A lot of people have been vaccinated — Governor Abbott was vaccinated,” said Ms. Harasmisz, 24. “But a lot of us on the front lines have not.”

Texas has not rolled the calendar back entirely.

Businesses are still allowed to require employees and customers to cover their faces and limit capacity. Cities can choose to keep limits in place in municipal facilities, and masks remain required on federal property.

Hours before restrictions were lifted across the state, city officials in Austin announced they planned to defy the governor’s new orders and impose a citywide mask mandate. That puts this Democratic-led city on yet another likely collision course with the Republican-led state Legislature after years of clashes on a range of issues.

A City Council member, Greg Casar, said city officials believed their stance is “legal and it’s right.”

“If the state chooses to sue us, then it’s basically them going out of their way to undermine the health of Texas,” he said. “My hope is that they focus on vaccine distribution rather than messing with Austin and putting more lives at risk.”

Others welcomed the new rules.

On the smoky back patio of Barflys, Sophie Bojorquez, 47, sat at a table with friends. She is a vaccinated nurse and a self-proclaimed anti-masker.

“I’m happy about the governor’s decision. The masks impeded the herd immunity we need. Now they want to vax so fast,” she said, shaking her head.

The move to open Texas has faced intense resistance.

The governor’s medical advisers have said that they were not involved in the decision. And federal health officials and some experts are concerned that the moves, especially repealing the mask mandate, could intensify the spread of the virus during the vaccination process.

Texas, which is averaging about 5,500 new cases a day, has one of the lowest vaccination rates in the country.

Lina Hidalgo, the county judge in Harris County, which includes Houston, argued that lifting the mask mandate puts the burden on workers to enforce rules in retail establishments and restaurants.

“We know better than to let our guard down simply because a level of government selected an arbitrary date to issue an all-clear,” Ms. Hidalgo, a Democrat and a persistent critic of Mr. Abbott, said in an op-ed column published this week by Time magazine. “I am working to clearly explain to the residents of my county that we will spare ourselves unnecessary death and suffering if we just stick with it for a little bit longer.”

— Rick Rojas, James Dobbins and Dave Montgomery

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Biden Orders 100 Million More Johnson & Johnson Vaccine Doses

President Biden announced on Wednesday that the government would secure another 100 million doses of the Johnson & Johnson vaccine and touted a joint production deal between the company and the pharmaceutical giant Merck.

Today, we’re seeing two health companies, competitors, each with over 130 years of experience, coming together to help write a more hopeful chapter in our battle against Covid-19. During World War II, one of the country’s slogans was, “We are all in this together.” We are all in this together. And the companies took that slogan to heart. For example, one automaker didn’t have the capacity to build enough Jeeps. The competitors stepped in to help. The result is that we’re now on track to have enough vaccine supply for every American adult by the end of May, months earlier than anyone expected. And today, I’m directing Jeff and my H.H.S. team to produce another 100 million doses and purchase another 100 million doses of the Johnson & Johnson vaccine. On Saturday, we hit a record of 2.9 million vaccinations in one day in America. And beyond the numbers are the stories. A father says he no longer fears for his daughter when she leaves to go to work at the hospital. The children are now able to hug their grandparents. The vaccines bring hope and healing in so many ways. There is light at the end of this dark tunnel of the past year, but we cannot let our guard down now or assume the victory is inevitable. Together, we’re going to get through this pandemic, and usher in a healthier and more hopeful future.”

Video player loadingPresident Biden announced on Wednesday that the government would secure another 100 million doses of the Johnson & Johnson vaccine and touted a joint production deal between the company and the pharmaceutical giant Merck.CreditCredit…Doug Mills/The New York Times

President Biden said on Wednesday that he was directing the federal government to secure an additional 100 million doses of Johnson & Johnson’s Covid-19 single-shot vaccine, a move the White House said could help the country vaccinate children and, if necessary, administer booster doses or reformulate the vaccine to combat emerging variants of the virus.

Mr. Biden made the announcement during an afternoon event at the White House with executives from Johnson & Johnson and the pharmaceutical giant Merck, where he praised them for partnering to ramp up production of the Johnson & Johnson vaccine — a deal brokered by the White House.

“During World War II, one of the country’s slogans was, ‘We are all in this together,’” Mr. Biden said. “And the companies took that slogan to heart.”

In announcing the agreement between Merck and Johnson & Johnson last week, Mr. Biden said that the United States would now have enough vaccine available by the end of May to vaccinate every American adult — roughly 260 million people. But Jen Psaki, the White House press secretary, said on Wednesday that the administration was trying to prepare for unpredictable challenges, from the emergence of dangerous virus variants to manufacturing breakdowns that could disrupt vaccine production.

“We still don’t know which vaccine will be most effective on kids,” she said at the White House’s daily briefing. “We still don’t know the impact of variants, the need for booster shots and these doses can be used for booster shots, as well.” She said the decision to purchase a surplus of the Johnson & Johnson vaccine was driven by a desire for “maximum flexibility.”

“It’s a one-shot vaccine,” she said. “It can be stored in the fridge and not a freezer. It’s highly effective as the others are as well against hospitalization and death.”

Mr. Biden said on Wednesday he was directing the White House’s pandemic response team and the Department of Health and Human Services to finalize the supply increase.

The White House had initially intended to hold Wednesday’s event at the Baltimore manufacturing facility of Emergent BioSolutions, another company that partners with Johnson & Johnson to make coronavirus vaccine. But Mr. Biden canceled his trip after The New York Times published an investigation into how Emergent used its Washington connections to gain outsize influence over the Strategic National Stockpile, the nation’s emergency repository of drugs and medical supplies.

Ms. Psaki has since said that the administration will conduct a comprehensive audit of the stockpile.

Emergent officials did not attend Wednesday’s session. In explaining the change in plans, Ms. Psaki said that the administration thought the White House was a “more appropriate place to have the meeting,” which it is billing as a celebration of what Mr. Biden has called the “historic” partnership between Johnson & Johnson and Merck.

Last August, Johnson & Johnson signed an agreement with the government to deliver 100 million doses of its coronavirus, and in an emailed statement on Wednesday the company said it is “on track to meet that commitment.” The government has the option to purchase additional doses under a subsequent agreement.

The administration says the collaboration with Merck will increase manufacture of the vaccine itself, and will also bolster Johnson & Johnson’s packaging capacity, known in the vaccine industry as “fill-finish” — two big manufacturing bottlenecks that had put the company behind schedule.

Wednesday’s announcement is in keeping with Mr. Biden’s aggressive efforts to acquire as much vaccine supply as possible, as quickly as possible. Before Mr. Biden took office, he pledged to get “100 million shots into the arms” of the American people by his 100th day in office — a timetable that seemed aggressive at the time, but more recently has looked tame. He has been trying to speed it up ever since.

At the time, two vaccines — one made by Moderna and the other by Pfizer-BioNTech — had been authorized by the Food and Drug Administration for emergency use. In January, Mr. Biden said the administration would have enough vaccine to cover every American by the end of summer. Last month, the president announced his administration had secured enough doses from those two companies to have enough to cover every American by the end of July.

The recent addition of the Johnson & Johnson vaccine, which received emergency authorization in late February, opened a path for the administration to move up the timetable yet again. But Johnson & Johnson and its other partners, including Emergent, were behind schedule, which prompted the administration to reach out to Merck.

Noah Weiland and Annie Karni contributed reporting.

Covid-19 information pamphlets with a mask and disinfectant kit distributed in San Jose, Calif.Credit…Ulysses Ortega for The New York Times

Black and Hispanic communities are confronting vaccine conspiracy theories, rumors and misleading news reports on social media.

The misinformation includes false claims that vaccines can alter DNA or don’t work, and efforts by states to reach out to Black and Hispanic residents have become the basis for new false narratives.

“What might look like, on the surface, as doctors prioritizing communities of color is being read by some people online as ‘Oh, those doctors want us to go first, to be the guinea pigs,’” said Kolina Koltai, a researcher at the University of Washington who studies online conspiracy theories.

Research conducted by the nonprofit Kaiser Family Foundation in mid-February showed a striking disparity between racial groups receiving the vaccine in 34 states that reported the data.

State figures vary widely. In Texas, where people who identify as Hispanic make up 42 percent of the population, only 20 percent of the vaccinations had gone to that group. In Mississippi, Black people received 22 percent of vaccinations but make up 38 percent of the population. According to an analysis by The New York Times, the vaccination rate for Black Americans is half that of white people, and the gap for Hispanics is even larger.

The belief that doctors are interested in experimenting on certain communities has deep roots among some groups, Ms. Koltai said. Anti-vaccine activists have drawn on historical examples, including Nazi doctors who ran experiments in concentration camps, and the Baltimore hospital where, 70 years ago, cancer cells were collected from a Black mother of five without her consent.

An experiment begun in the 1930s (not conducted in 1943, as an earlier version of this item reported) on nearly 400 Black men in Tuskegee, Ala., is one of the most researched examples of medical mistreatment of the Black community. Over four decades, scientists observed the men, whom they knew were infected with syphilis, but didn’t offer treatments so that they could study the disease’s progression.

Researchers who study disinformation followed mentions of Tuskegee on social media over the last year. The final week of November, when the pharmaceutical companies Moderna and Pfizer announced promising results in their final studies on the safety of their Covid-19 vaccines, mentions of Tuskegee climbed to 7,000 a week.

Students waiting to be admitted to PS 189 Bilingual Elementary School in Brooklyn last December.Credit…Victor J. Blue for The New York Times

New York City’s public schools have seen remarkably low virus transmission compared with the citywide rate of positive test results in the months since the nation’s largest school system reopened for thousands of students, according to a major new peer-reviewed study in the medical journal Pediatrics.

Of over 200,000 people who were tested in city school buildings from October to December, only .4 percent of tests came back positive for the coronavirus. That was during a period when virus cases were spiking in the community.

And even when cases were detected, relatively few close contacts in the school ended up testing positive for the virus during the same period: .5 percent of school-based contacts who quarantined contracted the virus.

“In-person learning in New York City public schools was not associated with increased prevalence or incidence overall of Covid-19 infection compared with the general community,” the study’s authors wrote. The study was led by Dr. Jay Varma, Mayor Bill de Blasio’s senior health adviser.

Still, school-based testing has been random and therefore focused more on identifying asymptomatic cases, while many New Yorkers who got tested outside schools had symptoms or had been exposed to the virus.

Mr. de Blasio reopened classrooms last September, months before many other large districts, particularly in the Northeast and on the West Coast. The city closed schools in November as virus cases surged, and has gradually reopened throughout the winter and spring. Still, the vast majority of city school students, roughly 700,000 children, have elected to learn from home for the rest of the school year.

The mayor faced significant criticism for his push to reopen schools, and there was widespread fear among families and educators that it was not yet safe to return to school buildings. But the strict safety measures the city put in place, including required masking, social distancing between students and teachers, and weekly random testing seem to have helped keep positivity rates in schools extremely low, the study said.

“We’ve said that our public school buildings are some of the safest places in New York City — and we’ve got the numbers to back it up,” Mr. de Blasio said in a statement on Wednesday.

Chris Hemsworth stars in the Marvel movie “Thor: Love and Thunder,” which has begun production in Australia.Credit…Rob Grabowski/Invision, via Associated Press

The Hollywood brigade has gone to Australia, a country that has effectively stamped out the coronavirus.

As a result of the near absence of the virus, plus subsidies from the Australian government, the country’s film industry has been humming along at an enviable pace for months.

More than 20 international productions are either filming or set to start the cameras rolling in the coming year, including “Thor: Love and Thunder,” a Marvel film starring Chris Hemsworth in the lead role, with Christian Bale, Matt Damon, Natalie Portman, Tessa Thompson and Taika Waititi also starring; “Three Thousand Years of Longing,” a fantasy romance with Idris Elba and Tilda Swinton; and “Joe Exotic,” a spinoff of the podcast made after the popular Netflix series “Tiger King,” starring Kate McKinnon as the big-cat enthusiast Carole Baskin.

Ron Howard is directing “Thirteen Lives,” a dramatization of the 2018 rescue of a soccer team from a cave in Thailand. That movie is to be shot in Queensland (the northeastern coast of Australia makes a good stand-in for the tropics). And later this year, Julia Roberts and George Clooney are set to arrive in the same state to shoot “Ticket to Paradise,” a romantic comedy.

A spokeswoman said that the Australian government had helped 22 international productions inject hundreds of millions into the local economy.

Chances are the stars will keep showing up. They’ve have been spotted camping, heading out to dinner, and partying (like it’s 1989). Mr. Damon said in January that Australia was definitely “the lucky country.”

Residents of a nursing home near Paris waiting under observation after receiving their vaccines last month.Credit…Andrea Mantovani for The New York Times

The European Union exported 25 million doses of vaccines produced in its territory last month to 31 countries around the world, with Britain and Canada the top destinations, just as the bloc saw its own supply cut drastically by pharmaceutical companies, slowing down vaccination efforts and stoking a major political crisis at home.

The European Union — whose 27 nations are home to 450 million people — came under criticism last week, when Italy used an export-control mechanism to block a small shipment of vaccines to Australia. The move was criticized as protectionist and in sharp contrast to the bloc’s mantra of free markets and global solidarity in the face of the coronavirus pandemic.

The issue of vaccine production and exports has also created a bitter dispute between the European Union and Britain, which recently departed the bloc, prompting accusations that Brussels wants to deprive London of doses out of spite, in part because Britain is doing so much better with its rollout.

The tensions culminated in a diplomatic spat on Wednesday, after a top E.U. official accused the United States and Britain of implementing an “export ban” — a charge the British government vehemently denied.

Practically speaking, ban or no ban, Britain is not exporting vaccines authorized for use at home. The country has said that it would be prepared to give excess shots to neighboring Ireland but only after it was done with its own vaccination efforts.

The United States has also been hoarding doses, in part through a wartime mechanism known as the Defense Production Act which permits the federal government greater control over industrial production. President Biden last week promised each adult American at least one vaccine dose would be offered to them by May.

But information made public for the first time, recorded in detailed internal documents seen by The New York Times, shows that the European Union, far from being protectionist, is in fact a vaccine exporting powerhouse.

Of the nearly 25 million total vaccines made in the European Union that were exported from Feb. 1 — when the export mechanism came into force — to March 1, about a third, more than eight million doses, went to Britain.

And while the United States kept doses for itself, the European Union shipped 651,000 vaccines to the country last month, and made vaccines for others across the Atlantic: The country that received the second-largest number of shots made in the European Union was Canada, with more than three million doses last month, while Mexico received nearly 2.5 million.

GLOBAL ROUNDUP

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Chaos in the Streets: Protests Turn Violent in Athens

Around 6,000 people gathered to protest against police violence and officers’ coronavirus lockdown tactics in Athens on Tuesday night. Police said 10 officers were wounded and 16 people were arrested.

[shots fired] [explosions] [explosion]

Video player loadingAround 6,000 people gathered to protest against police violence and officers’ coronavirus lockdown tactics in Athens on Tuesday night. Police said 10 officers were wounded and 16 people were arrested.CreditCredit…Alkis Konstantinidis/Reuters

A protest in Greece turned violent on Tuesday night as anger grew about tactics used by police officers who were enforcing coronavirus lockdown restrictions.

The clashes came on the same day that Greece said it was aiming to open to vacationers in mid-May. Later, the country reported 3,215 new infections, its highest daily tally since mid-November.

The protest on Tuesday was provoked after a video emerged two days earlier seeming to show an officer beating a man with a baton in the Athens suburb of Nea Smyrni. The man was apparently among several who had expressed objections to officers issuing fines to people in the square. The officer has since been suspended, the police said on Wednesday.

Around 6,000 people gathered in the normally quiet suburb on Tuesday evening to protest against police violence. The demonstration began peacefully but spiraled into violence after about 500 people appeared to pelt officers with firebombs. The police said that 10 officers were wounded, one seriously after he was dragged off a motorcycle and set upon. Sixteen people were arrested and were to face a prosecutor on Wednesday on charges including attempted homicide, possession of explosives and arson.

Prime Minister Kyriakos Mitsotakis appeared on television on Tuesday night, calling for calm and restraint. The violent turn of the protest has fueled debate in the Greek media about police tactics in enforcing the lockdown.

The Greek ombudsman said on Tuesday that reports of police violence had increased by 75 percent over the past year. Alexis Tsipras, leader of the leftist opposition party Syriza, referred on Monday to a “crescendo of police violence on the pretext of enforcing health measures.” Mr. Mitsotakis countered by calling Mr. Tsipras’s support for large rallies at the peak of a pandemic “the height of irresponsibility.”

The conservative government of Mr. Mitsotakis has urged Greeks to be patient for a little longer so that it can start gradually reopening the country’s battered economy without provoking a new surge in infections. However, public tolerance appears to be waning as government officials have been accused of flouting restrictions that thousands of ordinary Greeks have been fined for violating.

Mr. Mitsotakis himself came under fire last month for apparently disregarding his own government’s restrictions for the second time in two months, violating limits on public gatherings by attending a lunch at a politician’s home on an Aegean island.

In other news from around the world:

  • Mauritius went into a two-week nationwide lockdown on Wednesday, Agence France-Presse reported, the second time that the Indian Ocean archipelago nation has imposed such a restriction since the pandemic began. “We had no other choice but total containment in order to prevent the spread of the virus and protect the population,” Prime Minister Pravind Kumar Jugnauth announced Tuesday evening in a televised address. Only essential services will be operational from Wednesday, including hospital services and emergency relief. As of Thursday, supermarkets, bakeries, petrol stations and pharmacies will have limited accessibility. The country, which has a population of about 1.4 million, has reported 641 cases of the virus and 10 deaths.

  • Kenya and Morocco have approved the Russian Sputnik V vaccine, according to RDIF, a Russian sovereign wealth fund, Reuters reported. The fund, which is promoting the vaccine globally, said that 48 countries had now approved Sputnik V.

Robbie Fairchild, a former dancer at New York City Ballet, lost his health insurance during the pandemic. He is now running a flower business to help with finances.Credit…Amr Alfiky/The New York Times

Across the United States, thousands of actors, musicians, dancers and other entertainment industry workers are losing their health insurance or being saddled with higher costs in the midst of the pandemic. Some were simply unable to work enough hours last year to qualify for coverage. Others were in plans that made it harder to qualify for coverage.

The insurance woes came as performers faced record unemployment. Several provisions in President Biden’s $1.9 trillion coronavirus relief plan, which passed the Senate on Saturday and is expected to pass the House on Wednesday, offer the promise of relief. One would make it a lot cheaper for people to take advantage of the federal government program known as COBRA, which allows people to continue to buy the health coverage they have lost. Another would lower the cost of buying coverage on government exchanges.

Many of the more than two dozen performers interviewed by The New York Times said that they had felt abandoned for much of the year — both by their unions and by what many described as America’s broken health care system.

“You never think it’s going to be you,” said Robbie Fairchild, a former dancer at New York City Ballet who was nominated for a Tony Award in 2015 for his star turn in “An American in Paris” on Broadway and who later appeared in the film adaptation of “Cats.”

Unlike other workers who simply sign up for a health plan when they start a new job, the people who power film, television and theater often work on multiple shows for many different employers, cobbling together enough hours, days and earnings until they reach the threshold that qualifies them for health insurance. Even as work grew scarce last year, several plans raised that threshold.

Musicians are struggling, too. Officials at Local 802 of the American Federation of Musicians, the New York local that is the largest in the nation, estimate that when changes to its plan take effect this month, roughly one in three musicians will have lost coverage.

Insurance plan officials say they were left with no choice but to make painful changes to ensure their funds survive because health care costs have been rising at rates that have outpaced contributions.

Delivering items in New York in January. Workers have often been targeted for their electric bikes, which can cost thousands of dollars.Credit…Hiroko Masuike/The New York Times

The delivery of restaurant orders and other goods has become a bigger part of daily life across the United States since the pandemic forced millions of people indoors. And in New York City — where the disease has taken nearly 30,000 lives — delivery workers have become a lifeline for people working from home and for vulnerable residents who have been warned against going outside.

On any given day, thousands of men, and a growing number of women, can be seen crisscrossing city arteries, transporting meals, groceries and medicine in plastic bags on top of their well-worn bikes.

But their visibility has also made them targets for criminals looking for a quick profit through robbery. The unemployment rate has surged into double digits and economic desperation has grown in the city’s less affluent neighborhoods, which had already been pummeled by the pandemic.

Stolen electric bikes can be easily sold on the streets for cash or dismantled for their parts, the police and workers say. The bikes can cost thousands of dollars and are vital tools for the workers, who often make less than $60 a day. Many have come to rely on the bikes, despite the steep price tag, because they can go about 20 miles per hour, enabling workers to travel farther and make more trips to increase their slim bottom lines.

The theft of electric bikes doubled during the first year of the pandemic, rising to 328 in 2020 compared with 166 the year before, according to police data obtained by The New York Times.

Investigators said robbers often use fraudulent credit cards to call in bogus orders and lure delivery workers to secluded locations. The delivery workers then are faced with two dire options: let go of the expensive bikes they need to remain employed, or risk injury and even death.

Ligia Guallpa, director of the Worker’s Justice Project, a nonprofit that represents immigrants working in low-wage jobs, said that many delivery workers did not report robberies and assaults. A large percentage of them lack the documentation to work in the country legally and don’t speak English fluently. Many fear filing a police report could lead to deportation.

The Covaxin vaccine in cold storage.Credit…Atul Loke for The New York Times

An Indian-made Covid-19 vaccine that was rolled out in an ambitious inoculation campaign even before some questions about it had been fully answered appears to be safe to use, a leading British medical journal reports.

Writing in The Lancet, researchers said the vaccine, Covaxin, did not produce any serious side effects in trials.

But the researchers said they were not yet able to say how well the vaccine works.

Covaxin was developed by Bharat Biotech and was authorized for use by India’s top drug regulators in January. That was done before it had been publicly established whether the vaccine was either safe or effective, prompting many people in India, including some front-line health care workers, to voice concerns.

Bharat Biotech said last week that initial results from its clinical trials indicated that the vaccine was both safe and effective, but many public health officials prefer to rely on independent assessments like that published in The Lancet, rather than a company’s own announcements.

Around the time that the Indian government green-lit Covaxin, it also authorized the use of the Oxford-AstraZeneca vaccine, which is known in India as Covishield and is manufactured there, among other places.

India has set out on one of the most ambitious and complex nationwide health campaigns in its history: immunizing 1.3 billion people against the coronavirus. It has also bet heavily on its growing pharmaceutical industry, which produces drugs and vaccines for export around the world as well as domestic use.

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Variants Comprise About Half of N.Y.C. Virus Cases, Officials Say

New York City health officials said genetic analysis suggested that 51 percent of the city’s coronavirus cases were now caused by two new variants, but emphasized that vaccines remained effective.

“Unfortunately we have found that the new variants of Covid-19 are continuing to spread. And when you combine the variant of concern, B.1.1.7., the one first reported in the U.K., and the new variant of interest, B.1.5.2.6., that was first reported here in New York, together these new variants account for 51 percent of all cases that we have in the city right now. So for the variant of interest, B.1.5.2.6., that was reported here first in New York, our preliminary analysis indicates that it is probably more infectious than older strains of the virus. You know, what I referred last week to ‘Covid Classic.’ It may be similar in infectiousness to the B.1.1.7., the U.K. strain, but we’re not certain about this yet. We need to understand and study it more. Very important: Our preliminary analysis does not show that this new strain, B.1.5.2.6., causes more severe illness or reduces the effectiveness of vaccines.” “The B.1.5.2.6. variant, in particular, is increasing in prevalence across New York City, representing about 39 percent of all samples sequenced by the pandemic response lab during the most recent week with full data, compared to 31 percent the week prior. The B.1.1.7. strain, sometimes known as the U.K. variant, which also spreads more easily, has increased to 12 percent of samples analyzed in the most recent week, up from 8 percent the prior week. We know the virus is a formidable foe, but we also know what has worked to curb its spread. And that’s true for the new variants too. It’s the Safe 6: masking, distancing, handwashing, getting tested, staying home if you’re feeling ill and getting vaccinated when it’s your turn.”

Video player loadingNew York City health officials said genetic analysis suggested that 51 percent of the city’s coronavirus cases were now caused by two new variants, but emphasized that vaccines remained effective.CreditCredit…James Estrin/The New York Times

Genetic analysis suggests that roughly half of coronavirus cases in New York City now are caused by two new forms of the pathogen, city officials reported on Wednesday.

One of the so-called variants, first detected in the city, now accounts for nearly 40 percent of all cases analyzed in local laboratories. The increase in the variant, B.1.526, was so striking that officials said they believed it was more infectious than the original form of the coronavirus.

Another more contagious variant, B.1.1.7, first discovered in Britain, also is spreading steadily in the city, accounting for 12 percent of cases analyzed in the last week of February, up from 8 percent the prior week. B.1.1.7 may be more lethal than earlier versions of the virus.

Rather than sound an alarm, officials said that they believed continued health practices — from masking to getting vaccinated — were sufficient to control the virus. Vaccines remain effective against these variants, as well as the original coronavirus.

So far, deaths and serious hospitalizations continued on a downswing in the city, the officials noted. “So far, thank God, what we’re finding is the variants are not posing the worse kind of problems that we might fear,” Mayor Bill de Blasio said at a news briefing on Wednesday.

Dr. David Chokshi, the city health commissioner, said that the B.1.526 variant had been detected in samples across the city, and not just in one community. The variant first appeared in samples in November, particularly those from Washington Heights in Manhattan, and was first described in academic papers released in late February.

The variant was detected in about one-quarter of samples analyzed by the two academic groups in mid-February, one led by a group at Caltech, the other by researchers at Columbia University.

But the city’s own analysis found that the prevalence of the B.1.526 variant was even higher, at 31 percent in the third week of February, and 39 percent by the end of the month, Dr. Chokshi said.

Dr. Anthony West, a computational biologist at Caltech, said in an interview on Wednesday that his ongoing research also showed that the B.1.526 variant was “increasing at a considerable pace in New York City” but that it remained “fairly localized” in the area.

He and his colleagues have found two subtypes of the B.1.526 variant: one with the E484K mutation seen in South Africa and Brazil, which is thought to help the virus partially dodge the vaccines; and another with a mutation called S477N, which may affect how tightly the virus binds to human cells.

Epidemiologists have expressed concern about the variant, but city officials said that despite the E484K mutation, they still had no evidence that the B.1.526 variant was partially evading vaccine protection. “Our preliminary analysis does not show that this new strain causes more severe illness or reduces the effectiveness of vaccines,” said Dr. Jay Varma, an adviser to Mr. de Blasio.

Earlier this year, experts had said the city’s capacity for genetic analysis was inadequate to understand the dynamics of New York’s outbreak. The United States’ overall ability to track variants is much less robust than in Britain, and federal health officials have expressed significant concern that variants may spread here undetected. New York has been increasing the number of samples it analyzes in recent weeks.

Nationally, epidemiologists have been sounding alarms about B.1.1.7, which is on track to be the dominant form of the virus in this country by the end of March. That variant is believed to have contributed to steep case increases and full hospitals in Britain and elsewhere.

“What we’ve seen in Europe when we hit that 50 percent mark, you’ll see cases surge,” said Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, on NBC’s “Meet the Press” on Sunday. He urged the public not to let up on health measures and to get vaccinated as quickly as possible.

Dr. Denis Nash, an epidemiologist at the City University of New York, said Wednesday that while he was worried about the new variants, more questions than answers remain about how they will impact the spread of the virus in New York City.

“It’s anybody’s guess, given the vaccine, the competition among the variants and everything we are trying to do to keep the virus low,” he said.

“The same things we always do have the ability to reduce the impact of the virus,” he added, urging continued vigilance and precautions. “If there is an exposure that gets past those defenses, there is potential that it could more easily take hold, or last longer. But if we keep doing everything we have been doing to prevent spread, we should be able to manage the variants too.”

Apoorva Mandavilli contributed reporting.

A resident of a nursing home near  Barcelona getting a second dose of vaccine last month.Credit…Samuel Aranda for The New York Times

Some of Spain’s largest regions are pressing the central government to speed up the country’s Covid-19 vaccination program, in particular by increasing access for older people to the vaccine developed by AstraZeneca and Oxford University.

When the vaccine was first approved in Europe in February, a number of countries — including Spain — set an age limit for its use, because there was relatively little data available then on its safety in older people. Spain set its age ceiling at 55.

Those limits have since been relaxed in countries like Germany and France, and on Wednesday, Spain’s neighbor Portugal announced that it would start allowing the Oxford-AstraZeneca vaccine to be given to people over 65.

That added to mounting pressure on the Spanish government to do the same.

The health minister of Catalonia, the northeastern region that includes Barcelona, issued an ultimatum on Wednesday, saying that if national officials did not soon follow Portugal’s example, Catalonia would do so unilaterally.

Isabel Díaz Ayuso, the leader of Spain’s capital region, has also been asking the central government to raise the age ceiling to at least 65.

Spain’s vaccination rollout has also come in for criticism from members of the main association of doctors, who have complain about red tape slowing the process and about people like teachers and police officers starting to get shots while some health care workers have not yet had a chance.

As of the start of this week, the health ministry said, some 3.4 million people in Spain, or about 7 percent of the population, had received at least one dose of vaccine. The Spanish government has pledged to vaccinate 70 percent of the population by the end of summer.

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U.S. Permits Indoor Visits in Nursing Houses. Right here’s What to Know.

U.S. Allows Indoor Visits in Nursing Homes. Here’s What to Know.

WASHINGTON – The Biden government on Wednesday released revised guidelines for visits to nursing homes during the coronavirus pandemic, which will allow guests to see residents whether they or the residents have been vaccinated.

The recommendations, published by the Centers for Medicare and Medicaid Services with comments from the Centers for Disease Control and Prevention, represent the first revision of the federal government guidelines for nursing homes since September. And they arrived after more than three million doses of vaccine had been administered in nursing homes, the agency said.

Federal officials said in the new guidelines that even if residents and guests have been fully vaccinated, outdoor visits are still preferable because of a lower risk of transmission.

The guidelines were also the latest indication that the pandemic in the United States was subsiding and coronavirus cases continued to decline across the country, although the seven-day average remained above 58,000. The CDC released the long-awaited guide for Americans fully vaccinated on Monday, telling them it was safe to gather at home in small groups with no masks or social distancing.

Approximately 62.5 million people have received at least one dose of a Covid-19 vaccine, including approximately 32.9 million people completely using the Johnson & Johnson single-dose vaccine or the two-dose vaccine manufactured by Pfizer-BioNTech and Moderna Series were vaccinated.

In a statement outlining the reasons for updating the recommendations, Dr. Lee A. Fleisher, the chief medical officer of the Centers for Medicare and Medicaid Services, reported the millions of vaccines given to nursing home residents and staff and a decrease in coronavirus cases in nursing homes.

“CMS recognizes the mental, emotional and physical stress that continued isolation and separation from family has placed on nursing home residents and their families,” he said.

At the start of the pandemic, the coronavirus raced through tens of thousands of long-term care facilities in the United States, killing more than 150,000 residents and employees, and responsible for more than a third of all virus deaths since late spring. However, since the introduction of vaccines, new cases and deaths in nursing homes have fallen sharply and have outpaced national declines, according to an analysis of federal data from the New York Times.

On the eight pages of recommendations, which are not legally binding, limit values ​​were suggested that “responsible indoor visits” should be allowed at all times, unless a guest visits an unvaccinated resident in a county where the Covid-19 -Positivity rate is more than 10 percent and less than 70 percent of the residents of the nursing home have been fully vaccinated. The guidance also states that visits should be limited if residents have Covid-19 or are in quarantine.

So-called compassionate care visits – if the health of a resident has deteriorated significantly – should be allowed regardless of the vaccination status or the positivity rate of the district, according to the guidelines.

If a positive case is found in a nursing home, visits should be canceled and residents and staff tested, the guidelines say. Visits can resume in other parts of the facility if there are no positive tests there. However, if cases are discovered in other areas, nursing homes should suspend all visits.