Thousands of women stocked up on abortion pills just in case they needed them, new research shows, with demand peaking in the past couple years at times when it looked like the medications might become harder to get.

Medication abortion accounts for more than half of all abortions in the U.S., and typically involves two drugs: mifepristone and misoprostol. A research letter published Tuesday in JAMA Internal Medicine looked at requests for these pills from people who weren’t pregnant and sought them through Aid Access, a European online telemedicine service that prescribes them for future and immediate use.

Aid Access received about 48,400 requests from across the U.S. for so-called “advance provision” from September 2021 through April 2023. Requests were highest right after news leaked in May 2022 that the Supreme Court would overturn Roe v. Wade — but before the formal announcement that June, researchers found.

Nationally, the average number of daily requests shot up nearly tenfold, from about 25 in the eight months before the leak to 247 after the leak. In states where an abortion ban was inevitable, the average weekly request rate rose nearly ninefold.

“People are looking at looming threats to reproductive health access, looming threats to their reproductive rights, and potentially thinking to themselves: How can I prepare for this? Or how can I get around this or get out ahead of this?” said Dr. Abigail Aiken, an associate professor at the University of Texas at Austin and one of the letter’s authors.

Daily requests dropped to 89 nationally after the Supreme Court decision, the research shows, then rose to 172 in April 2023 when there were conflicting legal rulings about the federal approval of mifepristone. The Supreme Court is expected to rule on limits on the drug this year.

Co-author Dr. Rebecca Gomperts of Amsterdam, director of Aid Access, attributed this spike to greater public awareness during times of uncertainty.

Researchers found inequities in who is getting pills in advance. Compared with people requesting pills to manage current abortions, a greater proportion were at least 30 years old, white, had no children and lived in urban areas and regions with less poverty.

Advance provision isn’t yet reaching people who face the greatest barriers to abortion care, said Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, who was not involved in the research.

“It’s not surprising that some people would want to have these pills on hand in case they need them, instead of having to travel to another state or try to obtain them through telehealth once pregnant,” he added in an email, also saying more research is needed into the inequities.

Recently, Aiken said, some other organizations have started offering pills in advance.

“It’s a very new idea for a lot of folks because it’s not standard practice within the U.S. health care setting,” she said. “It will actually be news to a lot of people that it’s even something that is offered.”

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WASHINGTON (AP) — Since the pandemic began, the United States has been using a public health rule designed to limit the spread of disease to expel asylum-seekers on the southern border.

Title 42, as it’s called, has been used more than 2.5 million times to expel migrants since March 2020, although that number includes people who repeatedly attempted to cross the border.

The Supreme Court said in a ruling Tuesday that it would keep Title 42 in place indefinitely. The case will be argued in February, and the stay will be maintained until the justices decide the case.

In November, a federal judge ruled that immigration authorities could no longer use Title 42 to quickly expel prospective asylum-seekers and set a Dec. 21 deadline for its use to end. That set off a legal back-and-forth with a group of conservative-leaning states pushing to keep Title 42 in place and the federal government and immigration advocates say its time is over.

The change comes as surging numbers of people are seeking to enter the country through the southern border and with Republicans intent on making immigration a key issue when they take control of the House in January.

A look at Title 42 and the potential impact of the ruling:

HOW IT STARTED

In March 2020, the U.S. Centers for Disease Control and Prevention issued an order limiting migration across the southern and northern borders, saying it was necessary to reduce the spread of the coronavirus. The virus was ravaging the U.S., schools were shutting down and hospitals filling up, and President Donald Trump was trying numerous ways to limit migration, his signature political issue.

The order authorized Customs and Border Protection to immediately remove migrants, including people seeking asylum, to prevent the spread of the virus. The order said areas where migrants were held often weren’t designed to quarantine people or allow for social distancing and could put border personnel and others at risk.

“The public health risks of inaction are stark,” it said.

The Biden administration continued the policy. While many Democrats pushed President Joe Biden to overturn Trump’s anti-immigration measures, some — especially in border states — have advocated to keep Title 42, saying the U.S. is unprepared for an increase in asylum-seekers. When the CDC moved to lift it earlier this year, moderate Democrats — including Sens. Mark Kelly of Arizona and Raphael Warnock of Georgia — wanted it to stay.

THE COURT FIGHT

In 2021, a group representing immigrants who were denied the right to seek asylum sued to end the use of Title 42.

As that case made its way through the courts, the CDC announced last April that the rule was no longer needed because vaccines and treatments were becoming much more widespread.

That sparked Republican-leaning states to file their own lawsuit aimed at keeping Title 42 in place. The states argued that ending the rule would lead to a surge in migrants to their states that would in turn take a toll on their services. That argument found favor with a Trump-appointed judge in Louisiana who ordered keeping the restrictions in place. The judge found Biden’s administration failed to follow administrative procedures requiring public notice and time to gather public comment on the plan to end the restrictions.

But that ruling was effectively blocked by another federal judge in a separate lawsuit in Washington. That judge, appointed by Democratic President Bill Clinton, ruled on Nov. 15 that the Biden administration must lift the asylum restrictions by Dec. 21. That ruling, addressing broader questions about Title 42, took precedence over the Texas ruling, cheering immigration advocates. In a key development, the federal government did not appeal to keep the public health restrictions in place.

“The court was correct to find that banning migrants, while allowing the rest of the country to open up, is unlawfully arbitrary, causes grave harm to desperate asylum-seekers, and overrides the United States’ legal commitments to provide a safe haven for those fleeing persecution,” said Lee Gelernt, a lawyer for the American Civil Liberties Union.

Then a group of conservative states tried to intervene to keep Title 42 in place. They argued that the cancellation of pandemic-era policy “will cause an enormous disaster at the border” and the additional migrants will increase the states’ costs for law enforcement, education and health care. They’ve also argued that they had to intervene after the federal government did not push to keep Title 42 in place. The case has gone all the way up to the U.S. Supreme Court, who last week ordered a temporary stay keeping Title 42 in place so it could thoroughly study each side’s arguments.

The Supreme Court’s decision Tuesday extended the temporary stay indefinitely as it set a February timetable for hearing arguments.

DOES TITLE 42 AFFECT ALL ASYLUM-SEEKERS?

Not really. The Biden administration has not used it with children traveling alone, only single adults or families. And the ban has been unevenly enforced by nationality, falling largely on migrants from Guatemala, Honduras and El Salvador — in addition to Mexicans — because Mexico allows them to be returned from the United States. Last month, Mexico began accepting Venezuelans who are expelled from the United States under Title 42, causing a sharp drop in Venezuelans seeking asylum at the U.S. border.

Some other nationalities are less likely to be subject to Title 42 because costs or frayed relations with their home countries, Cuba for example, make it difficult for the U.S. to send them back. People from these countries have become a growing presence at the border, confident they will be released in the United States to pursue their immigration cases.

According to the most recent figures released by Customs and Border Protection officials, illegal border crossings by Cubans and Nicaraguans rose sharply in November while overall migration flows were little changed from October.

WHAT HAPPENS IF TITLE 42 ENDS?

If it goes away, asylum-seekers will be interviewed by asylum officers who will determine if they have a “credible fear” of being persecuted in their home countries. If they’re found to face a credible threat, they can stay in the U.S. until a final determination is made.

That can take years. Although some are detained while their asylum process plays out, the vast majority are freed into the United States with notices to appear in immigration court or report to immigration authorities.

The Department of Homeland Security said in a memo outlining their preparations for the end of Title 42′s use that the current system is not designed “to handle the current volume of migration nor the increased volume we expect over the coming weeks and months.”

It said it is preparing for a possible surge by cracking down on smuggling networks, speeding removal of those found to have little basis to stay in the U.S., and working with international partners to stem migration. It said it’s also seeking more money from Congress. Meanwhile, as temperatures plummeted last week, thousands of migrants were gathered on the Mexican side of the border waiting to see what happens if and when Title 42′s use ends.

Republicans, who will control the House come January, are expected to make immigration a major issue. Already there have been calls to impeach the Homeland Security Secretary Alejandro Mayorkas.

Some Democrats have also voiced concern about what happens when Title 42 goes away. In a letter to Biden this week, Sen. Joe Manchin of West Virginia and Rep. Henry Cuellar of Texas joined two Texas Republicans — Sen. John Cornyn and Rep. Tony Gonzales — in asking Biden to keep Title 42 in place, saying there was a crisis at the southern border and that DHS hadn’t presented a plan to maintain control there.

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WASHINGTON (AP) — The Food and Drug Administration on Thursday permanently removed a major obstacle for women seeking abortion pills, eliminating a long-standing requirement that they pick up the medication in person.

Millions of American women will now be able to get a prescription via an online consultation and receive the pills through the mail. FDA officials said a scientific review supported broadening access, including no longer limiting dispensing to a small number of specialty clinics and doctor’s offices.

But prescribers will still need to undergo certification and training. Additionally, the agency said dispensing pharmacies will have to be certified.

The decision is the latest shift in the polarized legal battle over medication abortion, which has only intensified amid the disruptions of the COVID-19 pandemic. It is certain to spur legal challenges and more restrictions in Republican-led states.

Earlier this year the FDA stopped enforcing the in-person requirement because of the pandemic. Under Thursday’s decision, the agency permanently dropped the 20-year-old rule, which has long been opposed by medical societies, including the American Medical Association, which say the restriction offers no clear benefit to patients.

The FDA’s latest scientific review stems from a 2017 lawsuit led by the American Civil Liberties Union, which argued that the agency’s restrictions block or delay medical care, especially for people in low-income and rural communities.

The ACLU hailed the elimination of the strictest requirements but said regulators should have gone further and allowed prescribing by any physician and broader pharmacy dispensing. Abortion opponents said the FDA decision would result in more drug-related side effects and complications for women.

Physicians who prescribe the drug, mifepristone, will have to certify that they can provide emergency care to deal with potential adverse effects, including excessive bleeding, FDA officials said Thursday.

The change still means many more doctors will be able to write prescriptions and American women will be able to fill their orders at far more pharmacies, including via online and mail-order services.

The effect will vary by state. More than a dozen Republican-led states have passed measures that limit access to the pills, including outlawing delivery by mail.

Increased use of mail-order abortion pills could pose a dilemma for the anti-abortion movement, given that its leaders generally say they don’t favor criminalizing the actions of women seeking abortions and because mail deliveries can be an elusive target for prosecutors.

The latest policy shift comes as advocates on both sides of the abortion debate wait to see whether the conservative Supreme Court will weaken or even overturn the Roe v. Wade decision that guarantees the right to abortion nationwide.

Roe’s demise would likely prompt at least 20 Republican-governed states to impose sweeping bans while perhaps 15 states governed by Democrats would reaffirm support for abortion access. More complicated would be politically divided states, where fights over abortion laws could be ferocious.

Medication abortion has been available in the United States since 2000, when the FDA first approved mifepristone to terminate pregnancies up to 10 weeks. Taken with another drug called misoprostol, it constitutes the so-called abortion pill.

About 40% of all abortions in the U.S. are now done through medication — rather than surgery — and that option has become more pivotal during the COVID-19 pandemic.

At the time of approval, the FDA imposed limits on how the drug could be distributed, including barring it from regular pharmacies and requiring that all doctors providing the drug undergo special certification. Women were also required to sign a form indicating they understood the medication’s risks. The FDA said Thursday there have been 26 deaths associated with the drug since 2000, though not all of those can be directly attributed to the medication due to underlying health conditions and other factors.

Common drug side effects include cramping, bleeding, nausea, headache and diarrhea. In some cases excess bleeding needs to be stopped with a surgical procedure.

Near the beginning of the outbreak, the FDA waived in-person requirements for virtually all medications, but left them in place for mifepristone.

That triggered a lawsuit from the American College of Obstetricians and Gynecologists, which successfully overturned the restriction in federal court. The Trump administration then appealed the ruling to the Supreme Court, which reinstated the requirement in January.

The point became moot — at least temporarily — in April when the FDA said it would not enforce the dispensing limits during the current public health emergency.

“The FDA’s decision will come as a tremendous relief for countless abortion and miscarriage patients,” said Georgeanne Usova, a lawyer with the ACLU. “However, it is disappointing that the FDA fell short of repealing all of its medically unnecessary restrictions on mifepristone and these remaining obstacles should also be lifted.”

Jeanne Mancini, president of the March for Life Education and Defense Fund, said the decision “will lead to more lives lost to abortion, and will increase the number of mothers who suffer physical and psychological harm from chemical abortions.”

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BOSTON (AP) — The nation’s second-largest city called off its New Year’s Eve celebration Monday, and its smallest state re-imposed an indoor mask mandate as fears of a potentially devastating winter COVID-19 surge triggered more cancellations and restrictions ahead of the holidays.

Organizers of the New Year’s Eve party planned for downtown Los Angeles’ Grand Park say there will not be an in-person audience. The event will be livestreamed instead, as it was last year. In Rhode Island, a mask mandate took effect Monday for indoor spaces that can hold 250 people or more, such as larger retail stores and churches.

And in Boston, the city’s new Democratic mayor announced to howls of protests and jeers that anyone entering a restaurant, bar or other indoor business will need to show proof of vaccination starting next month.

“There is nothing more American than coming together to ensure that we’re taking care of each other,” Mayor Michelle Wu said at City Hall as protesters loudly blew whistles and shouted “Shame on Wu.”

Across the Atlantic, British Prime Minister Boris Johnson on Monday said officials have decided against imposing further restrictions, at least for now.

“We will have to reserve the possibility of taking further action to protect the public,” Johnson said. “The arguments either way are very, very finely balanced.”

The conservative government re-imposed face masks in shops and ordered people to show proof of vaccination at nightclubs and other crowded venues earlier this month. It is also weighing curfews and stricter social distancing requirements.

Johnson’s warning threw into stark relief the unpalatable choice government leaders face: wreck holiday plans for millions for a second consecutive year, or face a potential tidal wave of cases and disruption.

In the U.S., President Joe Biden is set to address the nation on the latest variant on Tuesday, less than a year after he suggested that the country would essentially be back to normal by Christmas.

His top medical adviser, Dr. Anthony Fauci, made the rounds on television over the weekend, promising that the Democrat will issue “a stark warning of what the winter will look like” for unvaccinated Americans.

Cases are surging in parts of the U.S., particularly the Northeast and Midwest, though it’s not always clear which variant is driving the upswing.

In New York City, where the mayor has said the new variant is already in “full force,” a spike is scuttling Broadway shows and spurring long lines at testing centers, but so far new hospitalizations and deaths are averaging well below their spring 2020 peak.

The city is also weighing what to do with its famous New Year’s Eve bash in Times Square. Mayor Bill de Blasio has said a decision will be made this week about whether the event will come back “full strength” — with attendees providing proof of vaccination — as he promised in November. Last year’s bash was limited to small groups of essential workers.

Much about the omicron coronavirus variant remains unknown, including whether it causes more or less severe illness. Scientists say omicron spreads even easier than other coronavirus strains, including delta, and it is expected to become dominant in the U.S. by early next year. Early studies suggest the vaccinated will need a booster shot for the best chance at preventing an omicron infection but even without the extra dose, vaccination still should offer strong protection against severe illness and death.

Even if it is milder, the new variant could still overwhelm health systems because of the sheer number of infections. Confirmed coronavirus cases in the U.K. have surged by 60% in a week as omicron overtook delta as the dominant variant.

But many political leaders are reluctant to impose the stiff measures they resorted to earlier in the pandemic — often because they promised their people that vaccines would offer a way out of such restrictions, and it may be politically untenable to impose them again.

France, for example, is desperately trying to avoid a new lockdown that would hurt the economy and cloud President Emmanuel Macron’s expected re-election campaign.

In Britain, the government hopes vaccine boosters will offer more protection against omicron, as the data suggests, and has set a goal of offering everyone 18 and up an extra shot by the end of December. More than 900,000 booster shots were delivered on Sunday, as soccer stadiums, shopping centers and cathedrals were turned into temporary inoculation clinics.

U.S. vaccine maker Moderna said Monday that lab tests suggested that a booster dose of its vaccine should offer protection against omicron. Similar testing by Pfizer also found that a booster triggered a big jump in omicron-fighting antibodies.

But many scientists say boosters along are not enough and tougher action is needed.

The speed of omicron’s spread in the U.K., where cases of the variant are doubling about every two days, is decimating the economy in the busy pre-Christmas period.

Usually teeming theaters and restaurants are being hit by cancellations. Some eateries and pubs have closed until after the holidays because so many staff are off sick or self-isolating. The Natural History Museum, one of London’s leading attractions, said Monday that it was closing for a week because of staff shortages.

Other countries are warily watching the U.K., which reported 91,743 more lab-confirmed COVID-19 cases on Monday, close to the record high for a single day set last week.

The Dutch government began a tough nationwide lockdown on Sunday to rein in sharply rising infections. The World Economic Forum, meanwhile, announced Monday that it is again delaying its annual meeting of world leaders, business executives and other elites in Davos, Switzerland, because of omicron uncertainty.

But many European leaders have opted for something less.

France and Germany have barred most British travelers from entering, and the government in Paris has also banned public concerts and fireworks displays at New Year’s celebrations. Ireland imposed an 8 p.m. curfew on pubs and bars and limited attendance at indoor and outdoor events, while Greece will have 10,000 police officers on duty over the holidays to carry out COVID pass checks.

In Spain, the national average of new cases is double what it was a year ago. But authorities in the country with one of Europe’s highest vaccination rates are betting primarily on mandatory mask-wearing indoors and the rollout of booster shots, with no further restrictions planned.

Neighboring Portugal is telling most nonessential workers to work from home for a week in January, but the country has no other new measures in the pipeline.

Hendrik Wuest, governor of North Rhine-Westphalia, Germany’s most populous state, said more restrictions could be on the horizon shortly after Christmas.

“I don’t think big New Year parties can happen this year — unfortunately, again,” he added. “Omicron won’t forgive us any carelessness if we aren’t cautious.”

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FORT WORTH, Texas (AP) — The U.S. Centers for Disease Control and Prevention will issue an order this week about how migrant children are treated under a public health order that has prevented people from seeking asylum at the nation’s borders, a Justice Department attorney said Tuesday.

The comment by Assistant U.S. Attorney Brian Stoltz at a court hearing in Fort Worth, Texas, comes as the Biden administration faces pressure from pro-immigration allies to lift the last major Trump-era restrictions on asylum at the border.

Stoltz told a federal judge that the CDC will release “a new order on the subject of the children” by the end of the week. It will revise a Biden administration policy announced in February that exempts children crossing alone from the ban on asylum.

Stoltz did not offer additional details on the changes during a hearing on a lawsuit that Texas brought to compel enforcement of the public health order that former President Donald Trump’s administration used to quickly expel people from the country during the coronavirus pandemic.

The government attorney said the CDC order this week will largely render Texas’ arguments moot. He did not elaborate, and CDC spokesman Tom Skinner said the agency had “nothing more to add right now.”

The CDC, in a three-paragraph order signed by its director, Dr. Rochelle Walensky, on Feb. 11, exempted unaccompanied children from being expelled to Mexico until “a forthcoming public health reassessment,” which has yet to be published. Texas argues in its lawsuit that the administration’s justification was insufficient.

Higher COVID-19 vaccination rates have brought increasing pressure on the Biden administration to lift the public health order that was always intended as a temporary measure during the pandemic. While the administration has exempted unaccompanied children, some families and nearly all adults traveling alone are expelled from the United States — often to Mexico within two hours — without a chance to seek asylum.

The Associated Press reported last year that then-Vice President Mike Pence directed the CDC to use emergency powers to effectively seal America’s borders, overruling agency scientists who said there was no evidence the action would slow COVID-19.

Lifting the ban could encourage more people to come to the border to seek asylum at a time when the U.S. is under mounting strain. The U.N. refugee agency reported last month that the U.S. was once again the top destination for asylum-seekers in 2020, with about 250,000 new claims filed, more than twice as high as second-place Germany.

Texas, which has the busiest corridor for illegal border crossings, is seeking a court order forcing the federal government to cease what state Deputy Attorney General Aaron Reitz called “de facto non-enforcement” of the asylum ban. Reitz argued that the Biden administration’s posture “threatens the health and safety of all Texans.”

U.S. District Judge Mark Pittman, a Trump appointee, questioned Stoltz about the timing of the new order and asked that the government inform him as soon as it is issued. Pittman did not rule on the request for an injunction but said he will put out a decision “as quickly as I can.”

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LOS ANGELES (AP) — A substantial number of California counties could see fewer restrictions on business operations starting next week as coronavirus infections, hospitalizations and deaths continue to fall, Gov. Gavin Newsom said Tuesday.

“The good news: Parts of the state are already beginning to open back up,” Newsom said.

He spoke at the site of a new federally supported mass vaccination site in Los Angeles, which opened Tuesday along with a similar site in Oakland. The two sites are expected to get about 6,000 doses of vaccine a day, and are intended to vaccinate people in communities hit hard by the pandemic.

The openings of the mass vaccination sites, heralded by a number of state and federal officials, came as California’s virus numbers continue to improve even as demand for vaccine far exceeds capacity.

About 3.5% of people being tested for coronavirus are getting back positive results, Newsom said, a rate that’s dropped precipitously in recent weeks. The numbers of people in hospitals and intensive care units and case rates are declining — all factors in determining when counties can begin further reopening.

By next week, a “substantial” number of counties are likely to enter the “red” tier, which allows indoor dining at 25% capacity, and the opening of other indoor spaces such as movie theaters, museums and gyms with limits.

California got about 1.08 million vaccine doses from the federal government this week, the governor said. The state expects 1.28 million doses next week and 1.31 million doses after that. The slow increase in the number of doses continues to frustrate local and state officials.

Under a new vaccine distribution contract with insurer Blue Shield, the state set a goal of being able to administer 3 million doses a week, according to contract details released Monday.

But in recent days, mass vaccination sites like Dodger Stadium in Los Angeles and the Moscone convention center in San Francisco were temporarily closed due to lack of supply. Newsom said the state’s goal is to build enough capacity so the state can quickly vaccinate people when more doses arrive.

“We’re building the infrastructure where the only constraint is supply,” Newsom said. “But when the supply is ample, then we’re able to move aggressively and quickly.”

The mass vaccine sites opened in conjunction with the federal government on Tuesday will not draw from the same state supply, Newsom said.

The sites opened on the east side of the nation’s second-largest city at California State University, Los Angeles, and on the east side of the San Francisco Bay Area at Oakland Coliseum. At Cal State LA, groups of cars pulled up to tents manned by military personnel. People were able arrive on foot or public transportation.

The Federal Emergency Management Agency is hoping to open similar sites in Texas and New York, said Bob Fenton, FEMA regional administrator in California. When opening the sites, the government is focusing on areas where minorities make up more than 40% of the population, poverty rates, and lack of housing or vehicle access. The sites will also run mobile clinics that can go out to people who lack transportation.

“We’re looking at high population areas among the states, but also ensuring that data drives us to the most socially vulnerable,” Fenton said.

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LANSING, Mich. (AP) — States are loosening their coronavirus restrictions on restaurants and other businesses because of improved infection and hospitalization numbers but are moving gradually and cautiously, in part because of the more contagious variant taking hold in the U.S.

While the easing could cause case rates to rise, health experts say it can work if done in a measured way and if the public remains vigilant about masks and social distancing.

“If the frequency goes up, you tighten it up. If the frequency goes down, you loosen up. Getting it just right is almost impossible,” said Dr. Arnold Monto, a public health professor at the University of Michigan. “There’s no perfect way to do this.”

As Michigan’s coronavirus rate dropped to the nation’s fifth-lowest over the last two weeks, Gov. Gretchen Whitmer said bars and restaurants can welcome indoor customers next week for the first time in 2 1/2 months. But they will be under a 10 p.m. curfew and will be limited to 25% of capacity, or half of what was allowed the last time she loosened their restrictions, in June.

The state previously authorized the resumption of in-person classes at high schools and the partial reopening of movie theaters.

“We’re in a stronger position because we’ve taken this pause,” Whitmer said. “But we are also very mindful of the fact that this variant is now here in Michigan. It poses a real threat.”

The COVID-19 death toll in the U.S. has climbed past 425,000, with the number of dead running at close to all-time highs at nearly 3,350 a day on average.

But newly confirmed cases have dropped over the past two weeks from an average of about 248,000 per day to around 166,000. And the number of people in the hospital with COVID-19 has fallen by tens of thousands to 109,000.

At the same time, health experts have warned that the more contagious and possibly more lethal variant sweeping Britain will probably become the dominant source of infection in the U.S. by March. It has been reported in over 20 states.

Other mutant versions are circulating in South Africa and Brazil. The Brazil variant has been detected for the first time in the U.S., in Minnesota.

Chicago and surrounding suburbs allowed indoor dining over the weekend for the first time since October. Major cultural attractions including the Field Museum and Shedd Aquarium reopened with crowd limits.

Steve Lombardo III, an owner of a Chicago-area restaurant group, called being able to seat customers indoors a “huge boost.” One of its most famous restaurants, Gibsons Bar & Steakhouse, has been using hospital-grade air filtration systems in the hopes of staying afloat, he said.

“Will we be making money? Probably not,” Lombardo said. “But we won’t be hemorrhaging money like we have the last three months.”

Washington, D.C., also recently ended its monthlong ban on indoor dining, but one in New York City remains in effect.

California Gov. Gavin Newsom this week lifted stay-at-home orders he imposed last month when hospitals were so overwhelmed with virus patients that they were on the verge of rationing lifesaving care. Restaurants and places of worship will be able to operate outdoors, and many stores will be able to have more shoppers inside.

Jen Diaz, a 38-year-old technical writer from Santa Clarita, California, who works remotely and has not left her home since a trip to the supermarket in March, said she was “horrified” when she heard the governor’s announcement. She has rheumatoid arthritis, and her treatments suppress her immune system, but she has yet to receive a vaccination because she is under 65.

“I was really, really proud of California’s response at first” in the early months of the pandemic, she said. “Suddenly we’re just opening everything. `Let’s go to the mall!’”

She added: “The government doesn’t seem to be taking this as seriously as it once did, on a state level.”

In Oregon, Gov. Kate Brown announced that some indoor operations such as gyms and movie theaters can reopen Friday with limited capacity. Indoor dining is still banned in the hardest-hit counties.

Not all places are taking as cautious an approach.

After North Dakota dropped to the nation’s second-lowest case rate, Republican Gov. Doug Burgum this month not only relaxed limits on the number of people who can gather at restaurants and bars but also allowed a statewide mask mandate to expire last week.

“The fight is far from over, but we can certainly see the light of the end of the tunnel from here,” Burgum said.

Dr. Joshua Sharfstein, vice dean for public health practice and community engagement at Johns Hopkins University and Maryland’s former health department chief, cautioned such a step can carry heavy risk.

“I don’t think it’s unreasonable to start to reopen, but if people think that’s the green light to pretend the virus doesn’t exist, then we’re going to be right back to where we were,” Sharfstein said. “If you do restrictions, the virus goes down. You can open up and see how it goes. But if the variants really take hold, that may not be so easy.”

Many restaurants say they cannot survive offering only takeout during the winter, when the cold makes it difficult if not impossible to offer outdoor dining.

Rick Bayless, one of the most decorated chefs in the U.S., said allowing indoor dining at his Mexican restaurants in Chicago may buy him some time.

“With 25% indoor we might be able to make it to the spring, when people will want to go outdoors,” he said.

Bayless said the business survived a previous shutdown only because his landlord allowed him to stay rent-free for three months. The uncertainty has taken a toll on his workers, he said.

“It’s been touch-and-go. When they allowed us to open up on Saturday, we had staff in here that were literally in tears,” Bayless said.

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IOWA CITY, Iowa (AP) — The deadly rise in COVID-19 cases across the U.S. is forcing state and local officials to adjust their blueprints for fighting the virus, with Republican governors adopting mask mandates — skeptically, in at least one case — and schools scrapping plans to reopen classrooms.

The steps face blowback from those who question the science behind mask wearing and social distancing and fear the new restrictions will kill off more jobs and trample on their civil liberties.

In Iowa, Gov. Kim Reynolds had pushed back against a mask mandate for months but imposed a limited one Tuesday, becoming the latest GOP holdout to change course on face coverings. At the same time, she claimed “there’s science on both sides” about whether masks reduce the spread of the coronavirus.

With Thanksgiving coming up next week, public health officials are bracing for a holiday-fueled surge. Doctors are urging families to stick to small gatherings.

Governors in Ohio, Maryland and Illinois imposed restrictions on business hours and crowd sizes Tuesday, and their counterparts in Wisconsin and Colorado proposed economic relief packages.

A DEADLY SURGE

The key measures of the country’s effectiveness in managing the pandemic are all heading in the wrong direction. Hospitalizations, deaths and cases are all skyrocketing in the U.S.

More than 73,000 people — an all-time high — were hospitalized with the virus in the U.S. as of Monday, an increase of over 3,000 from just a day earlier, according to the COVID Tracking Project. Hospitals are running out of space, and nurses and doctors in Kansas are converting waiting areas to patient rooms and spending upwards of eight hours on the phone trying to secure beds at other hospitals.

More than 166,000 newly confirmed infections were reported on Monday, according to Johns Hopkins University. The average number of new cases per day has more than doubled over the past few weeks.

The virus is blamed for more than 1.3 million deaths worldwide, including over 247,000 in the U.S. Deaths per day in the U.S. have climbed to an average of 1,145, up from 828 two weeks ago.

The national death toll is on pace to keep climbing in the coming days as states set new records. Wisconsin reported 92 new deaths Tuesday, shattering its daily record of 66 set last week.

MORE MASK MANDATES

Since the election, Republican governors in hard-hit Iowa, North Dakota and Utah have reversed course and put in place requirements on masks, and others have extended or expanded earlier orders.

Plenty of other elected officials and residents are balking at such requirements despite the surge. And some local law enforcement authorities have refused to enforce mask requirements.

In Utah, dozens of people opposed to a statewide mask mandate protested outside the home of Gov. Gary Herbert. In South Dakota, the state with the highest rate of COVID-19 deaths per capita in November, Republican Gov. Kristi Noem has no plans to issue mask requirements.

Doctors serving Idaho and eastern Oregon spent hours Tuesday trying to sway health districts, city leaders and the public to do more to stop the spread of coronavirus, warning that rationed care is looming in Idaho’s future. But in Idaho, they were met with skepticism, as some residents in attendance either denied the existence of the virus or disputed its severity. Idaho is experiencing a severe and unchecked community spread of COVID-19 in much of the state.

In Iowa, Reynolds cast some doubt on the science behind masks even as she imposed a limited mask rule. She noted that neighboring states with mask mandates, like Illinois and Minnesota, have seen rising numbers of cases, although not as severely as Iowa.

“Oh, there’s science on both sides and you know that. If you look, you can find whatever you want to support wherever you are at,” she said.

The Centers for Disease Control and Prevention says masks can help protect you and those around you.

A more stringent mask mandate took effect on Tuesday in California, where Democratic Gov. Gavin Newsom said residents will be required to cover up outdoors, with limited exceptions.

And in New Orleans, officials took the drastic step of canceling the beloved, but traditionally packed Mardi Gras and Carnival parades that draw visitors from around the world because the city has a 250-person cap on outdoor crowds to limit the virus’s spread. The next Mardi Gras is Feb. 16; the parades usually run for about two weeks.

“You can’t have traditional parades with that small a group,” city spokesman Beau Tidwell said Tuesday.

SCHOOL SHUTDOWNS

The rising infection rates are prompting some school districts to revert to remote learning or postpone a return to classroom instruction.

In South Dakota, the Rapid City-area school system plans to close all schools and move to virtual instruction on Wednesday. The district’s latest data showed 94 students and 47 staff with an active case of COVID-19, while 105 staff and 676 students were in quarantine following exposure.

In metro Las Vegas, the Clark County school district postponed plans to resume partial in-class instruction and will continue with remote learning through at least the end of the calendar year.

West Virginia’s largest teachers organization urged Republican Gov. Jim Justice to make public schools online-only. The state recorded more than 4,400 cases during the week ending Sunday, a 63% increase from the previous week.

The governor already has barred in-person instruction from Thanksgiving through Dec. 3 to avoid outbreaks from holiday travel.

VACCINE VOLUNTEERS

The world received welcome news in the past week with positive preliminary results on two COVID-19 vaccines from Pfizer and Moderna, but scientists are worried that volunteers will stop coming forward take part in studies of other vaccines under development. Thousands are still needed.

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