Fauci Endorses Covid Vaccine Mandate for Air Travel

School districts in Iowa will be able to issue mask mandates, at least for now, after a federal judge blocked the state on Monday from enforcing a ban on such policies. The case in Iowa is one of several disputes playing out across the country about the power of local officials to mandate coronavirus precautions and the authority of state leaders to block them.

Senior Judge Robert W. Pratt, in explaining his decision to issue a temporary restraining order, said that “if the drastic increase in the number of pediatric Covid-19 cases since the start of the school year in Iowa is any indication of what is to come, such an extreme remedy is necessary to ensure that the children involved in this case are not irreparably harmed.”

But Gov. Kim Reynolds, a Republican, said the ruling trampled on parental rights and suggested that the court fight was far from over.

“Today, a federal judge unilaterally overturned a state law, ignored the decision by our elected legislature and took away parents’ ability to decide what’s best for their child,” Ms. Reynolds said in a statement. “We will appeal and exercise every legal option we have to uphold state law and defend the rights and liberties afforded to any American citizen protected by our constitution.”

American schoolchildren have returned to classrooms in recent weeks, some for the first time since March 2020, as coronavirus cases have reached their highest levels since winter.

Unlike in some previous surges, case rates have been high among children, who tend not to become as sick but who can still have severe cases of Covid. With children under 12 still not eligible for vaccines and the highly infectious Delta variant circulating, health officials have recommended masking as a necessary step to curb transmission and keep schools open.

But the debate about how to hold class during a pandemic has become intensely divided, with combative school board meetings and accusatory language. Opponents of school mask mandates have described the measures as infringements on personal freedom, while supporters of the policies describe them as an easy way to prevent illness and save lives.

At least 15 states, almost all of them led by Democrats, have required masks in schools statewide. Iowa is among six Republican-led states to ban school districts from issuing mask mandates. In Florida, another of the states to ban such mandates, a state appellate court allowed a measure banning school mask mandates to again take effect last week after a lower-court judge briefly paused the policy.

Iowa has been averaging more than 1,300 new coronavirus cases a day over the last week, well below the state’s winter peak but far worse than this summer, when fewer than 100 cases were identified many days. About 53 percent of Iowans are fully vaccinated, roughly in line with the national rate.

Judge Pratt, who was appointed by President Bill Clinton to the Federal District Court for Southern Iowa, cited the Americans With Disabilities Act in his ruling on Monday. The Biden administration recently announced that it was investigating whether states with school mask bans were violating that law.

“A universal masking requirement instituted by a school is a reasonable modification that would enable disabled students to have equal access to the necessary in-person school programs, services, and activities,” Judge Pratt said.

None of the data on coronavirus vaccines so far provides credible evidence in support of boosters for the general population, according to a review published on Monday by an international group of scientists, including some at the Food and Drug Administration and the World Health Organization.

The 18 authors include Dr. Philip Krause and Dr. Marion Gruber, F.D.A. scientists who announced last month that they will be leaving the agency, at least in part because they disagreed with the Biden administration’s push for boosters before federal scientists could review the evidence and make recommendations.

The Biden administration has proposed administering vaccine boosters eight months after the initial shots. But many scientists have opposed the plan, saying the vaccines continue to be powerfully protective against severe illness and hospitalization. A committee of advisers to the F.D.A. is scheduled to meet on Friday to review the data.

In the new review, published in The Lancet, experts said that whatever advantage boosters provide would not outweigh the benefit of using those doses to protect the billions of people who remain unvaccinated worldwide. Boosters may be useful in some people with weak immune systems, they said, but are not yet needed for the general population.

Several studies published by the Centers for Disease Control and Prevention, including three on Friday, suggest that while efficacy against infection with the Delta variant seems to wane slightly over time, the vaccines hold steady against severe illness in all age groups. Only in older adults over 75 do the vaccines show some weakening in protection against hospitalization.

Immunity conferred by vaccines relies on protection both from antibodies and from immune cells. Although the levels of antibodies may wane over time — and raise the risk of infection — the body’s memory of the virus is long-lived.

The vaccines are slightly less effective against infection with the Delta variant than with the Alpha variant, but the virus has not yet evolved to evade the sustained responses from immune cells, the experts said. Boosters may eventually be needed even for the general population if a variant emerges that sidesteps the immune response.

The experts cautioned that promoting boosters before they are needed, as well as any reports of side effects from booster shots such as heart problems or Guillain-Barre syndrome, may undermine confidence in the primary vaccination.

Data from Israel suggest that booster doses enhance protection against infection. But that evidence was collected just a week or so after the third dose and may not hold up over time, the experts said.

Both elation and caution were palpable in New York City on Monday, as public schools in the country’s largest school system resumed full in-person classes for the first time since March 2020.

With the extremely contagious Delta variant of the coronavirus still tearing through unvaccinated populations in the city, as it is around the country, and much of New York’s school-age population under 12 and therefore ineligible for vaccination, at least some disruptions are likely.

Last year, the city schools experienced remarkably few outbreaks. But even with a final in-school transmission rate of just 0.03 percent, quarantines were still a regular occurrence. And that was when most schools operated at significantly reduced capacity.

Debra Gray, who took her 13-year-old son, Kamari, to Public School 323 in Brownsville, Brooklyn, on Monday, said that returning in person was a “50-50 feeling.”

“We gotta give this a chance,” she said. “The kids need time with their teachers. But I’m concerned. The kids can’t keep their masks on all day.”

Justin Chapura, who teaches English as a second language at Bronx River High School, was thrilled to see students in person for the first time in more than a year. But his excitement was tinged with concern over the prospect of a long and uncertain school year.

“Everyone I know is nervous, nerve-racked, can’t sleep, won’t sleep,” Mr. Chapura said. “But we’re getting there, we’re going to get there.”

The risk that infected children will become seriously ill is low, but if and when coronavirus cases do occur — indeed, if just one child tests positive in a classroom filled with students too young to be vaccinated — the city’s current policy means that others who might have been exposed will have to return to remote learning for 10-day at-home quarantines.

In middle and high schools, only unvaccinated students will have to quarantine if exposed to someone with the virus.

That quarantine protocol is stricter than the Centers for Disease Control and Prevention guidance — but the city schools’ testing plan is more modest than what the C.D.C. calls for.

A random sample of 10 percent of unvaccinated students will be tested in each school every other week; the city was testing 20 percent of people in all school buildings weekly by the end of last year. Experts have said that the city’s current testing plan will almost certainly be too small in scope to reliably head off outbreaks before they start.

Anissa Haniff, 15, who was standing in a long line of returning students outside Bayside High School in Queens, said that she lived with her parents, grandparents and 9-year-old sister and that she was worried about potentially infecting them with the coronavirus.

Returning to school felt “a little premature,” she said. “Maybe we should’ve been remote another year.”

Mayor Bill de Blasio insists that school this year will be a much-needed return to normalcy for children, who have suffered deeply in the isolation of remote learning. “Let’s not be governed by fear,” he said at a news conference Monday morning. “All of the people who know all of the facts are saying to parents consistently, from the president of the United States on down: Get your kids back to school.”

For Timothy Seiber, of the Bedford-Stuyvesant neighborhood of Brooklyn, the prospect of possible classroom shutdowns loomed large.

He said he found reassurance over the safety of his sons — at ages 6 and 10, still too young to be vaccinated — in the relatively low rate of infection among children and the low school transmission rate.

“I’m not worried” about them getting infected, Mr. Seiber said in a telephone interview. “My kids wear their masks.”

But schools would be better served, he said, by more regular testing than by quarantines and returns to remote learning, which rob children of the benefits of in-person instruction and socializing with peers while disrupting parents’ working lives.

“I think the amount of time they’ll pull your kid to remote is kind of ridiculous,” Mr. Seiber said. “Considering the rapid testing we have, it could be a lot less.”

Chelsia Rose Marcius, Emma Goldberg and Nate Schweber contributed reporting.

It’s been exactly 18 months since public schools in New York City  shut down because of the rapid initial spread of the coronavirus. Over that time, students, parents and employees in the New York City school system, the nation’s largest, have had to adjust to a series of abrupt changes that disrupted and reshaped the lives of about 1 million children and 1,800 schools in the district, eventually leading to a full reopening on Monday.

The city was not alone in facing twists and turns along the way as the pandemic swelled and ebbed, new variants emerged, vaccines were introduced and scientists and policymakers revised their guidance. New York was able to partially reopen last fall while other big-city peers remained all virtual for most of the year, and the city did not experience significant virus transmission in its schools.

Here are key dates and developments.

March 15, 2020

Shutdown

Under immense pressure, Mayor Bill de Blasio shuts down New York City’s public school system for in-person instruction. The move, taken after several other major school systems had already shut down, comes as attendance is plummeting and worried teachers are organizing sickouts to demand action. “This is not something in a million years I could have imagined having to do,” Mr. de Blasio says.

March 23

Remote learning begins

Students and teachers return to classes virtually instead of face to face, as everyone tries to get used to virtual instruction. Officials say they hope to get everyone back to in-person instruction later in the spring if the virus outbreak subsides.

APRIL 11

Spring is lost

Former Gov. Andrew M. Cuomo announces that schools in New York State will remain closed through the end of the academic year — confirming what other city leaders, including Mr. de Blasio, had been predicting for several weeks.

July 8

Plan for partial reopening

Mr. de Blasio says the city’s public schools will not fully reopen for the 2020-21 school year. Instead, he introduces a partial reopening plan calling for school leaders to work out staggered schedules and other measures to help schools enforce social distance and minimize virus transmission.

SEPT. 1

In-person and online options

Mr. de Blasio announces that New York City schools will offer both in-person and virtual instruction and allow families to opt for either mode.

SEPT. 21

A delayed start

Mr. de Blasio pushes back the start of in-person school for students amid logistical problems and political conflicts with the teachers’ union. The school year finally begins on Sept. 21, 10 days later than originally planned.

Nov. 19

Shut down again

With the virus spreading rapidly again outside of schools and the city’s test positivity rate climbing above 3 percent, the threshold the mayor had set for closure, New York City closes its schools after just eight weeks of in-person instruction.

Nov. 29

Grade schools will reopen

Mr. de Blasio abruptly announces that all public elementary schools would soon reopen in stages for students who had previously opted for in-person instruction, and that the city would abandon the 3 percent positivity threshold for closing schools. Middle and high schools remain closed for now.

January 2021

A new surge

A surge in virus transmission that took hold over the holidays drives the city’s test positivity rate above 9 percent, prompting demands from teachers’ unions that the city’s open elementary schools be closed again.

Feb. 25

Middle schools reopen

In-person classes resume at the city’s middle schools for at least part of the week for students whose families had previously chosen that option. Along with the elementary schools reopened earlier, about one-quarter of the city’s students are back in school buildings.

March 22

High schools reopen

The city’s staged reopening reaches its high schools, with about half offering full-time in-person instruction for most students and the others offering a mixture of in-person and remote learning.

may 24

No more remote learning option

Mr. de Blasio announces that when the new school year begins in the fall, the city will no longer offer a remote learning option — a major step toward a full reopening in September.

AUG. 23

Vaccine mandate for staff

Mayor Bill de Blasio says all employees of the city’s Department of Education will have to receive at least one dose of a coronavirus vaccine by Sept. 27. The requirement applies to every adult working inside public school buildings, including teachers and principals.

AUG. 26

New testing and quarantine rules

Mr. de Blasio released guidelines requiring random testing of 10 percent of unvaccinated people — including adult staff and students in first grade and above — every two weeks. When someone tests positive, close contacts who are unvaccinated will have to quarantine, but not necessarily whole classes. A negative test within five days will end the quarantine early. Parental consent is necessary for testing children.

Sept. 13

Reopened

All New York City public schools reopen to full in-person instruction.

New York City public schools are reopening at a time when some schools in other states are already several weeks into in-person teaching. Some districts seem to be doing well, but others are contending with mass outbreaks, hospitalizations and several reported deaths.

The data is showing that school reopenings tend to do well in areas with high vaccination rates.

San Francisco County in California boasts a 79 percent vaccination rate for those 12 years and up, and its Health Department reported last Thursday that there had been no school outbreaks since classes resumed on Aug. 16. Since the pandemic began, just 13 children in the area have been hospitalized.

That bodes well for New York City, where 70 percent of those 12 years and up are vaccinated, though some neighborhoods have lagging rates.

The picture is very different in areas with lower vaccination rates. Hillsborough County Schools, in the Tampa, Fla., area, where 58 percent of those 12 and older have been fully vaccinated, isolated or quarantined 8,000 of its students after a mass outbreak last month. Florida schools face a particular set of challenges, given that Gov. Ron DeSantis, a Republican, is adamantly opposed to vaccination and mask mandates, and the state’s Education Department has withheld funds from at least two school districts that mandated masks in schools.

In Georgia, the Griffin-Spalding County school district, outside of Atlanta, abruptly closed its classrooms temporarily after two bus drivers and a bus monitor died after contracting Covid-19 after school reopened on Aug. 4, according to its superintendent, Keith Simmons. Mr. Simmons said parents were “frustrated” over the short notice.

“We weren’t able to give them advanced notice,” Mr. Simmons said. “We made the announcement on a holiday, and parents may not have had enough time to ensure child care.”

Other states across the South where vaccine rates lag behind the national average — including Kentucky and Mississippi — are also reporting outbreaks at schools.

Florida cities and counties that require public employees to get vaccinated against the coronavirus will face fines of $5,000 each time they enforce their mandates, Gov. Ron DeSantis announced on Monday, escalating his opposition to such measures just as President Biden is expanding them.

“We are going to stand for the men and women who are serving us,” Mr. DeSantis, a Republican, said in Newberry, near Gainesville. “We are going to protect Florida jobs. We are not going to let people be fired because of a vaccine mandate.”

He noted that the violations could quickly add up to potentially millions of dollars for municipalities mandating the shots.

Once the mandates take effect, they would allow escalating discipline — including potential dismissal — against employees who do not get vaccinated.

Mr. DeSantis cited a state law enacted this year that prohibits governments and businesses from requiring proof of vaccination from their customers.

But the ban on so-called vaccine passports did not preclude businesses from mandating vaccinations of their employees — and many of the state’s largest employers, such as Disney, did just that. Some local governments, including the city of Gainesville, Orange County (home to Orlando) and Leon County (home to Tallahassee), decided to require the vaccines for public workers as well.

Gainesville’s mandate, which is scheduled to take effect in October, led to a protest from some workers and labor unions. More than 200 city employees sued over the requirement last month. Several spoke at Monday’s event with the governor.

“We feel betrayed and used,” said Lt. Jonathan Cicio of Gainesville Fire Rescue, one of the plaintiffs, who said he has natural antibodies from having Covid-19 and recovering months ago. “While we were heroes and selfless not long ago, now we’re selfish, and they’re just going to let us go.”

Ashley Moody, the Florida attorney general, said at the event that her office would file a legal brief in support of the plaintiffs. Mandating the vaccines would aggravate the state’s shortage of law enforcement officers, she said, “which will directly affect the safety of local communities.”

In a statement, a spokeswoman for the city of Gainesville stood by the requirement.

“The health, safety and welfare of the city’s work force and those we serve is our No. 1 priority,” Shelby N. Taylor said. “It is our belief that as an employer we retain the right to require vaccination as a condition of employment.”

Mr. DeSantis crisscrossed the state earlier this year in a big push to promote vaccinations, especially among older Floridians. But he later stopped the visits, and while he has continued to say he endorses getting vaccinated, Monday’s event before a cheering crowd featured not only people opposed to mandates but also vaccine skeptics.

One Gainesville employee said that the vaccine “changes your RNA,” an echo of skeptics’ claim about changes to the body’s DNA, which is false. His assertion went unchallenged.

New York’s Metropolitan Transportation Authority plans to extend a $500,000 death benefit to its employees who die of Covid-related causes through the end of 2021, a senior authority official said Monday. But the benefit will remain unavailable to those who decline to get vaccinated against the coronavirus.

The authority, which runs New York City’s subways, buses and commuter trains, has provided the $500,000 benefit to all of its 68,000 employees since last year. But in April, as vaccines became widely available, the authority decided that, starting in June, the benefit would be available only to the families of employees who had been vaccinated.

That requirement was one of several ways the authority used to urge its workers to get vaccinated. The authority was hit hard by the virus last year, with 171 employees dying of Covid-related causes since the pandemic started.

Only three of those deaths have occurred since June, said Tim Minton, a spokesman for the authority. Mr. Minton said that the authority had no indication that any of the three had been vaccinated. He said none of their families had tried to claim the death benefit and so far no family had been denied the benefit.

“We want each of our employees to get every single benefit that they are entitled to,” Mr. Minton said. He added that the authority and its officials had taken every step they could think of to encourage employees to get the vaccine, including allowing paid time off for each dose.

Tony Utano, president of Local 100 of the Transport Workers Union, said that his members had been notified in April, when the Covid death benefit was extended, that “vaccinations would be required to access the benefit as of June.”

The benefit is equal to the benefit for deaths in the line of duty under the union’s contract. Mr. Utano expressed pride in the union’s efforts to persuade the authority to provide the benefit because transit workers had to keep working through the early months of the pandemic.

The extended benefit was scheduled to expire on Aug. 31. But the authority’s board is expected to move this week to extend it again, to Dec. 31.

Mr. Minton said that more than 70 percent of the authority’s employees have gotten at least one does of the vaccine, mostly through programs run by the state. But the rates are lower for employees of some of the transit divisions, including subways and buses.

The authority has not made vaccines mandatory for its workers. But on Oct. 12, it plans to start requiring weekly testing of workers who cannot provide proof that they have been vaccinated.

Broadway is back. Or so it hopes.

A year and a half after the coronavirus pandemic forced all 41 theaters to go dark, silencing a symbol of New York and throwing thousands out of work, some of the industry’s biggest and best known shows are resuming performances on Tuesday.

Simba will reclaim the Pride Lands in the “The Lion King.” Elphaba and Glinda will return to Oz in “Wicked.” A young, scrappy and hungry immigrant will foment revolution in “Hamilton.” The long-running revival of “Chicago” will give ’em the old razzle dazzle. Plus there’s one new production, the childhood reminiscence “Lackawanna Blues,” offering a reminder that Broadway still provides a home for plays, too.

Broadway’s reopening is a high-stakes gamble that theater lovers, culture vultures and screen-weary adventurers are ready to return — vaccinated and masked — to these storied sanctuaries of spectacle and storytelling.

But it comes at a time of uncertainty.

Back in May, when Broadway got the green light to reopen, it seemed imaginable that the coronavirus pandemic was winding down, thanks to readily available vaccines. Since then, a combination of vaccine hesitancy and the Delta variant has sent cases skyrocketing again.

And while New York is doing better than much of the nation, the city is still facing a sharp drop in tourists, who typically make up two-thirds of the Broadway audience; many businesses in the region have postponed bringing workers back to their offices; and consumer appetite for live theater after months of anxiety and streaming remains unknown.

The industry’s recovery is enormously important to New York City, for symbolic as well as economic reasons.

There are reasons to hope. Four trailblazing productions — the concert show “Springsteen on Broadway,” the new play “Pass Over” and the musicals “Waitress” and “Hadestown” — started performances this summer, serving as laboratories for the industry’s safety protocols. None has yet missed a performance.

Dr. Anthony Fauci, the nation’s top infectious disease doctor, said in an interview with the theSkimm that he would support a vaccine mandate for air travelers.

“I would support that if you want to get on a plane and travel with other people, that you should be vaccinated,” Dr. Fauci told the site, which targets millennial women.

Dr. Fauci’s support for such a mandate follows President Biden’s recent announcement that all companies with 100 or more workers will require vaccination or weekly testing.

The sweeping actions from Mr. Biden reflect his frustrations with the roughly 80 million Americans who are eligible for shots but remain unvaccinated. Mr. Biden also moved to mandate vaccinations for health care workers, federal contractors and the vast majority of federal workers, who could face disciplinary measures if they refuse.

The president also said that the Transportation Security Administration would double fines on travelers who refused to wear masks.

When asked on Friday if the administration was considering vaccine or testing requirements for domestic flights, Jeff Zients, Mr. Biden’s coronavirus response coordinator, told reporters that they were “not taking any measures off the table.”

Some airlines, such as United Airlines and Frontier Airlines, have required that all U.S. employees get vaccinated. Delta has intensified pressures for employees to get vaccinated but has stopped short of a mandate.

President Biden will use the upcoming gathering of the United Nations General Assembly to set new targets for a global coronavirus vaccination campaign, including having 70 percent of the world’s population fully vaccinated one year from now, according to draft documents prepared by the White House.

Mr. Biden is convening a virtual global Covid-19 summit next week, when heads of state gather for the annual General Assembly meeting. Invitations to world leaders were sent out last week, according to one person familiar with the planning. Another round of invitations to stakeholders went out on Monday by email.

The invitation, obtained by The New York Times, told participants that Mr. Biden would “call on chiefs of state, heads of government and international organizations, business, philanthropic, and nongovernmental leaders to come together to commit to ending the Covid-19 pandemic.” It was accompanied by a draft detailing specific targets necessary to achieve that goal.

The 70 percent target “is ambitious but consistent with existing targets,” the draft document said. In June, the heads of the World Bank Group, International Monetary Fund, World Health Organization, and World Trade Organization set a target of having 60 percent of the world’s population vaccinated by the middle of 2022.

The draft also calls for countries “with relevant capabilities” to either purchase or donate one billion additional doses of coronavirus vaccines, beyond the two billion that have already been pledged by wealthy nations; and for world leaders to ensure that $3 billion is made available in 2021 and $7 billion in 2022 in financing “for vaccine readiness and administration, combating hesitancy, and procuring ancillary supplies.”

Mr. Biden has come under fierce criticism from advocates and public health experts who say he is not living up to his pledge to make the United States the “arsenal of vaccines” for the world. Expanding global vaccination efforts is necessary to protect not only the world, but the national security and health and safety of Americans.

Pressure is building as the United Nations meeting draws near. On Tuesday, two House Democrats — Representatives Jan Schakowsky of Illinois and Rosa DeLauro of Connecticut — are planning to host a news conference to call on Mr. Biden to unveil a global plan to end the pandemic, including a plan to transfer vaccine technology from pharmaceutical manufacturers to other vaccine makers around the world, and to ramp up manufacturing capacity.

Peter Maybarduk, who directs Public Citizen’s Access to Medicines program, said the draft looks promising but does not go far enough. His group has a plan calling for the government to invest $25 billion in developing regional manufacturing hubs around the world, which it says would produce enough vaccine for low- and middle-income countries in a year.

“It’s not asking very much of the private sector,” Mr. Maybarduk said. “It is trying to unify commitments rather than using the very significant power of the U.S. government to move very significant manufacturing capacity on its own. That still leaves tools unused. It’s not being the vaccine arsenal for the world.”

Global Roundup

The German health authorities on Monday started a weeklong drive to try to speed the pace of coronavirus vaccinations and combat the possibility of more infections as colder weather approaches.

“In order to get through autumn and winter in good shape and then also to get the virus permanently under control, we need to convince even more people to get vaccinated,” Chancellor Angela Merkel said in a video message on Sunday.

Currently, 62.2 percent of the population in Germany is fully vaccinated and 66.5 percent have had at least one shot, according to figures from the Our World in Data project at the University of Oxford. Those numbers are just above the averages for the European Union as a whole.

Germany made good progress in vaccinating its population in spring and early summer, but demand has slowed. While doctors and nurses routinely vaccinated more than a million people a day in May and June, last week’s busiest day drew just 256,559.

For the weeklong campaign, pop-up vaccination sites have been set up in places such as supermarkets, zoos, markets, churches, mosques, on buses and at soccer games, where those interested can get a shot without an appointment.

According to a recent poll conducted by the Robert Koch Institute, the German federal agency for disease control and prevention, about 88.5 percent of adults either have had their shots or are open to being inoculated.

“It’s never been easier to get vaccinated,” Ms. Merkel said in her address.

In other pandemic news around the world:

• Health officials in the United Kingdom on Monday authorized a Covid-19 vaccination program for 12- to 15-year-olds, clearing the way for the governments of England, Scotland, Wales and Northern Ireland to establish plans for that age group to receive the Pfizer-BioNTech vaccine.

• Authorities in China reported 22 new coronavirus cases, the country’s most in nearly a month and evidence that Beijing may need to rethink its zero-Covid strategy. The cases, all caused by the Delta variant in the southern province of Fujian, mark the country’s largest outbreak since Aug. 14, when it reported 24 cases.

• Cyril Ramaphosa, the president of South Africa, shortened the nationwide curfew and expanded hours for certain businesses there after coronavirus cases dropped across the country.

A small hospital in upstate New York is planning to suspend delivering babies starting in a few weeks because some of its labor and delivery nurses resigned rather than comply with the state’s Covid vaccine mandate.

The development underscores the challenges that many health care systems face amid a national shortage of nursing staff and vaccine hesitancy among some health care workers.

“The math is just not working,” said Gerald Cayer, chief executive officer of Lewis County Health System, at a news conference on Friday. “The number of resignations received leaves us no choice but to pause delivering babies.”

Six out of the 18 staff members in the maternity department at Lewis County General Hospital have resigned, and seven have not indicated whether they will get their shots, Mr. Cayer said in an interview on Monday. The hospital, located in Lowville, the county seat, had expected to deliver about 200 babies this year, he added.

At least 30 employees in the health system have resigned since former Gov. Andrew M. Cuomo mandated vaccinations by Sept. 27 for New York State’s health care workers, Mr. Cayer said. Of those who have resigned, 21 worked in clinical areas.

The maternity department at Lewis County General will pause deliveries on Sept. 25, Mr. Cayer said, and other units could be affected if more workers resign. Prospective parents in the area will have other options: There are hospitals with maternity departments in Carthage, about 15 miles from Lowville, and in Watertown, about 27 miles away.

The vast majority of workers in his health system have complied with the mandate. Mr. Cayer said that 464 employees, or 73 percent, have been fully vaccinated, and that he hoped that the staff members who quit would reconsider and take the shots before the deadline. “Anyone who has resigned who changes their mind will be welcomed back,” he said.

The resignations have taken place in a region with a dire staffing shortage. There has been a lack of experienced maternity nursing staff throughout upstate New York, said Dr. Sean Harney, the hospital’s medical director. Thousands of open nursing positions remain, Mr. Cayer said.

Lewis County, with about 27,000 residents, is among the least populous and most politically conservative counties in the state, and has one of the lowest Covid vaccination rates: 44 percent of residents were fully vaccinated as of Friday, compared with 61 percent statewide, according to data from the Centers for Disease Control and Prevention.

Reports of new cases more than doubled in Lewis County, and hospitalizations rose 35 percent in the past 14 days, according to a New York Times database.

In Idaho, where unchecked virus transmission has pushed hospitals beyond their breaking point, the state is sending some Covid-19 patients to neighboring Washington State.

But Washington hospitals are struggling with their own high caseloads, and some leaders in the state see Idaho’s outsourcing of Covid patients as a troubling example of how the failure to aggressively confront the virus in one state can deepen a crisis in another.

On the Washington side of the border, residents must wear masks when gathering indoors, students who are exposed to Covid face quarantine requirements, and many workers are under vaccination orders. On the Idaho side, none of those precautions are in place.

Last week, Idaho took the extraordinary step of moving its hospitals in the northern part of the state to crisis standards of care — the threshold at which facilities facing overwhelming caseloads are authorized to ration their resources.

Idaho now has more than 600 patients hospitalized with Covid-19, about 20 percent higher than a previous peak in December. Only 40 percent of the state’s residents are fully vaccinated, one of the lowest rates in the nation, compared with 61 percent in Washington State, one of the highest.

The strain on health care facilities is particularly evident in northern Idaho, where the vaccination rate is even lower. The area just hosted the North Idaho State Fair, and in a region where there is deep wariness of government, no mask orders or other strategies were adopted to halt the spread of the virus.

With the Delta strain of the virus sweeping the nation, Washington State has faced its own challenges and record hospitalizations, especially in areas on the eastern side of the state where vaccination rates are lower. This week, that state, too, began talking openly about the possibility that crisis standards of care could become necessary.

The annual General Assembly, the diplomatic mega-event that was held almost entirely virtually last year because of the pandemic, will be far more physical when it convenes for two weeks beginning on Tuesday.

Although strict pandemic rules will be enforced — including mandatory mask-wearing for all participants, required vaccinations for headquarters staff and severely limited access to its 16-acre campus on Manhattan’s East Side — the United Nations is aiming for at least a partial restoration of the person-to-person diplomacy that its leaders regard as critical.

The outgoing annual president of the General Assembly, Volkan Bozkir of Turkey, told reporters in his farewell news conference last week that at least 83 leaders were planning to attend this year’s event, albeit with slimmed-down entourages. (Mr. Bozkir will be succeeded by Abdulla Shahid, foreign minister of the Maldives.)

A provisional list of speakers provided by U.N. officials indicated that President Biden would attend, for what would be his first address as president to the 193-member world body. Mr. Biden, unlike his predecessor Donald J. Trump, is a United Nations enthusiast, and diplomats say a personal appearance would reinforce his “America is back” pledge.

The White House has not specified Mr. Biden’s plans, and U.N. officials said the speakers list could change up to the last minute.

According to the provisional list, top leaders from Brazil, Britain, Canada, India, Ireland, Israel, Italy, Japan, Mexico, Pakistan, Turkey and Venezuela also plan to personally deliver their speeches, all scheduled for the second week. China’s speech will be delivered by its deputy prime minister, the list indicated, and Russia’s by its foreign minister, Sergey V. Lavrov.

Iran’s new president has opted to send a prerecorded video, but diplomats said the country’s new foreign minister is expected to attend.

The rapid spread of the Delta variant of the coronavirus in New York City this summer has slowed in recent weeks, convincing some epidemiologists that the city’s third virus wave has begun to ebb. But others are bracing for an uptick in cases.

With the school year starting, and municipal agencies and some large companies mandating a return to the office, the old weekday rhythms are about to return for hundreds of thousands of New Yorkers, even as levels of the virus remain relatively high.

For the moment, the rates of new cases and hospitalizations are down from their summer peaks.

In mid-August, nearly 2,000 people a day on average were testing positive in New York City, a tenfold increase from earlier in the summer. The rate of new cases was highest among young adults, ages 18 to 34. More than 100 people were being hospitalized each day.

But over the past three weeks, new cases and other indicators have begun dropping. Staten Island has had by far the highest level of transmission, with one in every 417 people testing positive in a recent seven-day period. That was more than twice the rate in Queens, which had the lowest virus levels.

The surge in New York City and much of the Northeast has been mild compared to the South, largely because of diverging vaccination rates, epidemiologists say. On Thursday, the city reached a new milestone: five million New York City residents, about 60 percent of the population, are now fully vaccinated.

But there are still large pockets of New York City that remain unvaccinated. In particular, Black New Yorkers, who have far lower vaccination rates than other groups, have been hit hardest by the third wave.

So far, the third wave has been minor compared with the previous two. In early September, the number of people hospitalized with Covid-19 in New York City in a single day reached 900, before falling below 800 this weekend. In April 2020, there were more than 12,100 at the peak.

Like other Republican governors around the country, Tate Reeves of Mississippi reacted angrily to the coronavirus vaccine mandates President Biden imposed on private businesses. Declaring the move “terrifying,” he wrote on Twitter: “This is still America, and we still believe in freedom from tyrants.”

There is a deep inconsistency in that argument. Mississippi has some of the strictest vaccine mandates in the nation, which have not drawn opposition from most of its elected officials.

Not only does it require children to be vaccinated against measles, mumps and seven other diseases to attend school, but it goes a step further than most states by barring parents from claiming “religious, philosophical or conscientious” exemptions.

Resistance to vaccine mandates was once a fringe position in both parties, more the realm of misinformed celebrities than mainstream political thought. But the fury over Mr. Biden’s mandates shows how a once-extreme stance has moved to the center of the Republican Party.

Mr. Biden also imposed vaccine mandates on federal workers and many health care workers. But Republican outrage is really boiling over his plan to require all private-sector businesses with more than 100 employees to mandate vaccines or weekly testing for their work forces.

Gov. Greg Abbott of Texas called the president’s move “a power grab.” Gov. Henry McMaster of South Carolina promised to fight Mr. Biden in court, to “the gates of hell.” Gov. Greg Gianforte of Montana called it “unlawful and un-American.” Gov. Kay Ivey of Alabama called the move “outrageous” and “overreaching.”

But each of these states — like every state in the country — already mandates certain vaccinations for children, and sometimes for adults, including health care workers and patients in certain facilities.

Republican suspicion of vaccines was building before the pandemic; when Donald J. Trump was running for president in 2016, he rejected established science by raising the debunked claims that vaccines cause autism.

Now, some of the governors argue that given the country’s outsize divisions, and widespread suspicion of Washington, federal intervention would be counterproductive. It would be best, they say, to let state officials continue making the case that the vaccines are safe and effective, and to allow people to decide themselves.

Three-quarters of American adults have had at least one Covid-19 shot, which suggests growing acceptance of the vaccine. Mr. Biden’s move is aimed at the roughly 80 million Americans who are eligible but remain unvaccinated.

The Delta variant and breakthrough infections have complicated plans for a smooth return to the physical workplace, reigniting concerns over safety, even among vaccinated workers.

For those who developed a mental health condition during the pandemic, or whose existing disorders were worsened by a prolonged period of fear and isolation, working from home may have offered a refuge.

We spoke to experts about ways to ease anxiety for those heading back to their desks after a year and a half of split-screen meetings and a morning commute to the kitchen. It’s important to identify which elements of coming back to the office you’re afraid of, one expert said.

Another, Dr. Judson Brewer, author of “Unwinding Anxiety,” suggested keeping a sticky note handy that lists some coping mechanisms. Dr. Brewer, the director of research and innovation at Brown University’s Mindfulness Center, recommends a simple five-finger breathing routine for anxiety: Hold one hand in front of you, with your fingers spread out. Using your index finger, slowly trace the outside of your other hand, taking your time and breathing in when you trace up a finger, then out when you trace down. This helps ground people in their direct physical experience, while slowing down their breathing, he said. It’s also quick and discreet.

Health officials in the United Kingdom on Monday authorized a mass Covid vaccination program for 12- to 15-year-olds, amid widespread concerns that Covid-19 cases could spike with the return to school after the summer vacation.

The authorization, announced by the chief medical officers of England, Wales, Scotland and Northern Ireland, ended weeks of uncertainty and came despite some medical experts’ reservations over whether vaccinations would significantly benefit the age group. The four countries’ governments are now expected to put in place campaigns that will offer the Pfizer-BioNTech vaccine.

The campaigns are expected to be part of an address that the British prime minister, Boris Johnson, is scheduled to give on Tuesday, in which he will outline a strategy to prevent any new surge in coronavirus infections from overwhelming the national health service over a winter during which seasonal flu could add further strains. His focus is on protecting the country without resorting to the kind of severe lockdown restrictions imposed during earlier phases of the pandemic.

Those 16 and up are already eligible for vaccination, and so are younger children who have health conditions that put them at high risk. But otherwise healthy young people generally face only a small risk of suffering serious illness from the coronavirus, and that has prompted a debate over the ethics of vaccinating children to contain a virus that is mainly a threat to adults.

As a result — and to the frustration of government ministers — Britain has lagged behind some other countries, including the United States, in vaccinating those between the ages of 12 and 15.

The authorizations announced on Monday were presented largely as intended to minimize the disruption caused by outbreaks in schools. Chris Whitty, the chief medical officer for England, said school closings and remote learning had been “extraordinarily difficult for children and had a big impact on health,” including mental health. He acknowledged, however, that the decision to vaccinate children was a closer call than for older people.

The debate over extending vaccines to 12- to 15-year-olds exposed divisions within Britain’s medical and scientific community. Earlier this month, Britain’s Joint Committee on Vaccination and Immunization said that those in the age group would get only marginal benefits from a mass vaccination campaign. It noted concerns over a rare side effect of the Pfizer and Moderna vaccines that has occasionally caused heart inflammations and led to palpitations and chest pains.

“The margin of benefit, based primarily on a health perspective, is considered too small to support advice on a universal program of vaccination of otherwise healthy 12- to 15-year-old children at this time,” the committee concluded.

However, the health ministers of the four U.K. nations reacted by seeking advice from their chief medical officers that took into account “educational impacts” as well as health concerns.

Britain has recently been averaging around 35,000 new coronavirus cases a day —  among the highest rates in Europe relative to its population. Two-thirds of the population is fully vaccinated. Government ministers are bracing for the possibility of a further surge in cases after schools reopen and the weather worsens in the fall and winter.

South Africa is easing some of its coronavirus restrictions, with new infections dropping across all provinces, President Cyril Ramaphosa said on Sunday.

“While the third wave is not yet over, we have seen a sustained decline in infections across the country over the last few weeks,” Mr. Ramaphosa said. The seven-day average of daily new cases has decreased by 48 percent in the past 14 days, according to the Center for Systems Science and Engineering at Johns Hopkins University.

When the latest wave of cases surged in June, South Africa introduced some tough restrictions, then relaxed them as cases fell in July. For about a month, restaurants could only sell food by takeout or delivery, alcohol sales were banned and schools were closed.

New rules introduced on Monday further eased those restrictions. The nationwide curfew has been shortened by an hour, operating hours at restaurants, bars and fitness centers have been expanded and hours of alcohol sales have been extended. As many as 250 people may now meet indoors, and as many as 500 outdoors — changes that are expected to make political campaigning easier ahead of local elections in November.

While the easing of restrictions in other parts of the world has been driven by the accelerating pace of vaccinations, South Africa’s vaccination drive has been slow. But the government has secured enough doses to vaccinate the entire adult population, Mr. Ramaphosa said. About 18 percent of the country’s population has been partially vaccinated and 12 percent has been fully vaccinated, according to figures from Our World in Data.

Across Africa, new cases are falling. The continent recently recorded the sharpest seven-day decline in two months, the World Health Organization said this month. But the shortage of doses has left the continent vulnerable to surges, especially of more contagious variants.

Thailand and Vietnam, two countries whose economies rely largely on tourism, are pushing to reopen their travel industries despite surges in coronavirus cases and outbreaks of the Delta variant.

Late last week, the Vietnamese government announced a reopening of the island of Phu Quoc to fully vaccinated overseas tourists, with the goal of attracting two to three million international visitors to the island by the end of the year. Alongside that move, the chairman of the Vietnam National Administration of Tourism, Nguyen Trung Khanh, said that efforts to vaccinate residents on the island would be a priority.

In 2019, Vietnam saw more than 18 million international tourists. But in a sign of the profound effect of the pandemic, overseas arrivals in the month of March 2020, as the coronavirus began to hit hard, dropped steeply, to only about 32 percent of the number in the same month a year earlier, according to Vietnamese tourism statistics.

While Vietnam did a good job of containing the virus in the initial stages of the pandemic, like many other countries it has struggled to contain the Delta variant this year. The country is recording a daily average of 12,724 new cases, according to the Center for Systems Science and Engineering at Johns Hopkins University. Only 4.9 percent of the population is fully vaccinated, according to Our World in Data figures.

Thailand is also set to welcome back fully vaccinated tourists, to Bangkok and other major tourism destinations, starting in October, according to Reuters. It is the second phase of a reopening plan that began over the past two months, with the reopening of places including the island of Phuket.

Thailand had nearly 40 million international visitors in 2019. Tourism accounts for about a fifth of the country’s economic activity, according to the International Monetary Fund, and the pandemic contributed to a drop of 6.1 percent in the country’s G.D.P. in 2020.

Thailand is reporting about 14,000 new daily cases, according to the country’s tourism authority, and there have been public protests about the government’s handling of the pandemic. In 2020, Thailand registered fewer than 100 Covid-related deaths, but the toll in 2021 already exceeds 12,000.

Australia has opened up Covid-19 vaccinations to children as young as 12 as it races to inoculate the population amid an outbreak of the Delta variant.

Children ages 12 to 15 started receiving Pfizer-BioNTech vaccines on Monday. Appointments for the Moderna vaccine can be booked now for sessions starting next week.

Australia’s vaccine campaign is gaining speed after a sluggish first few months. Millions of doses that were ordered earlier this year are arriving, and the country will have enough supply by mid-October to vaccinate every eligible person, Prime Minister Scott Morrison said last week.

Currently, 55 percent of the population of 26 million has had at least one vaccine dose, and 34 percent are fully inoculated, according to the Our World in Data project at the University of Oxford. The number of new cases increased by 36 percent over the past two weeks to 1,493 cases, based on the seven-day average.

Australia will also receive its first shipments of the Moderna vaccine this week, with 11 million total doses expected to be delivered by the end of the year. The government also signed an agreement with other nations to swap vaccines, which will allow it to get 500,000 doses of the Pfizer shot from Singapore and four million from Britain. In return, Australia promised to ship the same numbers of doses to the two countries later this year.

Fully vaccinated people living in Sydney, the epicenter of the Delta outbreak in Australia, had some restrictions eased on Monday. Those who live outside 12 government areas “of concern” are now allowed to have outdoor picnics with up to four other people.

Schools in Sydney will reopen on Oct. 25, while pubs and gyms are expected to open in mid-October when the state fully vaccinates 70 percent of its population.

China has logged its highest number of coronavirus cases in nearly a month, prompting one county to shut down public transportation and test hundreds of thousands of people.

On Sunday, the Chinese authorities reported 22 new locally transmitted infections, all in the southern province of Fujian and caused by the Delta variant. The number was the highest since Aug. 14, when 24 cases were recorded.

China does not release enough data to make clear how prevalent Delta is there, but last month, the country stamped out multiple Delta outbreaks that swept across half the country through mass testing, contact tracing, and targeted lockdowns. Health experts have warned that such measures come at a punishing economic and social cost and may deepen pandemic fatigue among the public.

The outbreak over the weekend bucked a downward trend of cases, which had fallen for more than a month since Aug. 9, when China reported 109 infections. While Sunday’s case count is far below many other countries, the number reflects what health experts have long warned: that it is probably nearly impossible to completely eradicate the Delta variant, and that Beijing needs to rethink its zero-Covid strategy.

The government said that the Fujian outbreak started on Sept. 10 in a primary school in the county of Xianyou, and local authorities said that most of the cases involved young children. An initial analysis showed that the initial carrier was an adult who had arrived from Singapore.

The authorities in Fujian have ordered mass testing of all students and teachers to be completed within a week. The city of Xiamen has closed off two districts and a hospital after identifying Covid patients. In Xianyou, buses and taxi services have been suspended. More than 900,000 residents in the county have been called up for testing, with threats of criminal punishment for anyone who does not cooperate.

A team from the National Health Commission that has been sent to Fujian said that it would probably detect more cases, but added that the outbreak could be controlled before the weeklong National Day holiday at the start of October, according to CCTV, the state broadcaster.

Beijing is likely to be nervous about large numbers of people traveling and gathering during that holiday, as well as during the three-day Mid-Autumn Festival, which begins on Sunday.

Daily reports of new coronavirus cases grew tenfold in South Dakota in August, with the worst outbreaks concentrated in the western part of the state. Hospitalizations have increased swiftly in the last few weeks. National Guard soldiers were dispatched to aid with testing.

The increase came during and after the state’s annual Sturgis Motorcycle Rally, which drew more than 550,000 people from all over the country to South Dakota — even more than last year’s, which forged ahead while most large events were canceled. This year’s happened during a broad spread of the Delta variant that drove a spike in all 50 states.

Uncertain, experts said, was the role the rally may have had in spreading the virus in South Dakota. And unanswered was a larger question: How safe are major gatherings held at least partly outdoors — events like Sturgis, Lollapalooza and college football games.

Cases in Meade County, which includes Sturgis, began to rise in mid-August, just as the motorcycle rally was winding down. By the end of August, more than 30 county residents were testing positive most days, up from about one a day before the rally. Case levels have since started to decline.

But the vast majority of people at the rally came from elsewhere and, if they became infected, would be counted in the data in their home states.

As the Delta variant spreads widely, and as Americans yearn to go back to normal, health experts have debated the public health risks of large outdoor events and music festivals.

Outdoor events are far safer than those held in indoor, poorly ventilated spaces. But even gatherings where the main event is outside can include indoor opportunities for Covid to spread.

Dr. Ashish Jha, the dean of Brown University’s School of Public Health, said it may be too early to link the Delta variant surge that’s overwhelming hospitals and increasing case level to large outdoor events, including the rally in Sturgis.

“I haven’t seen any data so far that says outdoor gatherings themselves are pretty risky,” said Dr. Jha. “And what I’ve said about Sturgis is, I don’t think it was the rally itself, I think it was all the bars and restaurants and all the stuff and night and evenings and all the indoor stuff.”

Dr. Shankar Kurra, the vice president for medical affairs at Monument Health, which is headquartered in Rapid City, S.D., said last month that the number of coronavirus cases in the area was much higher at this time than they were following last year’s rally.

“It’s hard not to say these cases didn’t come from the rally,” Dr. Kurra. “The cases had to come from somewhere and we know these cases did not come from here.”

Local officials in Sturgis have pushed back against the scrutiny of the event, saying the rally has received unequal criticism compared to other large gatherings across the country.

“As the data illustrates, South Dakota’s current infection rate is mirroring the entire upper Midwest region,” said Dan Ainslie, the Sturgis city manager. “There was some spread of Covid from the rally, though the national media fixation on it is without merit given the fact that our experience is so similar to our neighbors.”