Coronavirus UpdatesCovid News: Idaho Hospitals Prepare to Ration Care

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Idaho allows overwhelmed hospitals across the state to ration care if necessary.

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Attending to a Covid-19 patient at St. Luke’s Boise Medical Center in Boise, Idaho, last month.Credit...Kyle Green/Associated Press

With its hospitals struggling to cope with a flood of patients, Idaho officials activated “crisis standards of care” across the state on Thursday, allowing overwhelmed facilities to ration treatment if needed.

“The situation is dire — we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for Covid-19 or a heart attack or because of a car accident,” Dave Jeppesen, the director of the Idaho Department of Health and Welfare, said in a statement.

Crisis standards of care lay out guidelines for hospitals to follow when they cannot meet demand and must ration services. Idaho officials noted that patients may find themselves being treated in repurposed rooms, or that needed equipment is not available. Some patients may have to wait for beds to become available.

If the situation worsens, rationing could get more drastic, with hospitals having to decide which patients will get priority for limited supplies of oxygen or ventilators, potentially sending some patients with a low likelihood of survival to palliative care.

Though states around the country have prepared plans for how to allocate critical resources in a crisis during the pandemic, few have formally implemented such plans even when hospitalizations have soared. Alaska’s largest hospital said this week that it was operating under crisis standards, and that some emergency-room patients had to wait in their vehicles for hours to be seen by a physician.

Nationwide, new coronavirus cases and hospitalizations have declined slightly in recent weeks, but much of the progress seen in hard-hit Southern states is being offset by growing outbreaks in the Upper Midwest and Mountain West, including Idaho.

One in four hospitals across the country reports that more than 95 percent of its intensive care beds were occupied as of the week ending Sept. 9, up from one in five hospitals last month. Experts say hospitals may have difficulty maintaining standards of care for the sickest patients when all or nearly all I.C.U. beds are occupied.

Idaho adopted crisis standards for hospitals in the northern part of the state earlier this month. Nurses there are caring for higher patient loads than usual and are authorized not to check vital signs as often as they otherwise would.

“We are being absolutely crushed by Covid,” Chris Roth, the president and chief executive of St. Luke’s Health System, which has a network of hospitals across the state, said at a Thursday afternoon news conference.

Mr. Roth warned that if this continues, “we will consume every single bed, and every single resource we have, with Covid patients in our hospitals.”

Dr. Jim Souza, the chief physician executive at St. Luke’s Health System, described the worsening conditions of hospitals. Many are resorting to treating patients in waiting rooms, and even sending some Covid patients that they would normally hospitalize back home, with oxygen prescriptions and instructions for their caregivers.

Hospitalizations for Covid-19 have continued to surge across Idaho, and are now running nearly 40 percent above the previous peak of the pandemic, according to federal data.

“We are out of actual hospital beds,” Sandee Gehrke, the chief operating officer for St. Luke’s Health System, said at the news conference, saying that patients are now being treated on stretchers.

Covid patients in hospitals and I.C.U.s
Early data may be incomplete.
Apr. 2020
Oct.
Apr. 2021
Oct.
Apr. 2022
Oct.
200
400
600 hospitalized
Hospitalized
In I.C.U.s
0
Source: U.S. Department of Health and Human Services. The seven-day average is the average of a day and the previous six days of data. Currently hospitalized is the most recent number of patients with Covid-19 reported by hospitals in the state for the four days prior. Dips and spikes could be due to inconsistent reporting by hospitals. Hospitalization numbers early in the pandemic are undercounts due to incomplete reporting by hospitals to the federal government.

Despite the spreading crisis, Gov. Brad Little has resisted imposing new coronavirus restrictions or mandating mask-wearing and vaccinations. That has led to growing frustration in neighboring Washington State, which has an indoor mask mandate and other safety protocols, and where hospitals have been strained by numerous patient transfers from Idaho.

Idaho has one of the lowest vaccination rates in the country. Mr. Jeppesen said the best way to end the use of crisis standards of care is for more people to get vaccinated.

“And I am scared, I am scared for all of us,” Dr. Steven F. Nemerson, the chief clinical officer for Saint Alphonsus Health System, in Boise, Idaho, said on Thursday, adding that hospitals are just “able to tread water” at the moment.

“It’s going to decline simply because a caregiver can’t get to a patient fast enough,” he said.

Mitch Smith and Charlie Smart contributed reporting.

At U.S. nursing homes, aides were the least likely workers to be vaccinated, a study shows.

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Erika Shaver-Nelson, left, the activities director at Chaparral House, a nursing home in Berkeley, Calif., speaking with a resident in March.Credit...Jeff Chiu/Associated Press

Nursing home aides — the staff members who provide the most direct care to residents — were the least likely to be fully vaccinated against the coronavirus by mid-July, according to a new analysis of U.S. facilities.

The study underscores the influence that President Biden’s new federal mandate for all health care workers may have on populations like the elderly in nursing homes who are vulnerable to coronavirus infections, experts say.

The findings are “alarming and reason for pause,” said Brian McGarry, a health researcher at the University of Rochester and one of the authors of the analysis, which appeared in a research letter in JAMA Internal Medicine on Thursday.

Low vaccination rates among nursing home workers in some areas have fueled concern about fresh outbreaks among staff and residents in these facilities, even with high numbers of vaccinated residents. Covid deaths among nursing home staff and residents accounted for nearly one third of the nation’s pandemic fatalities as of June 1, and vaccination rates among staff average around 63 percent, according to the latest federal data.

But slightly under half of the certified nursing assistants were fully vaccinated, according to the analysis, which looked at federal vaccination data through July 18. That was before many nursing homes, states and cities began imposing mandates.

According to the study, in nursing homes overall, 61 percent of nurses, both registered nurses and licensed practical nurses, were vaccinated, compared with 71 percent of therapists and 77 percent of doctors and independent practitioners like physician assistants or nurse practitioners.

Some large nursing homes were starting to mandate vaccinations as the Delta variant began tearing through their communities and coming into nursing homes. Genesis HealthCare, one of the nation’s largest nursing-home operators, required vaccinations in August and said it had “met our deadline of 100 percent vaccinated staff, as promised — excluding the small number of individuals who received medical or religious exemptions.”

Nationally, about two-thirds of adults are now fully vaccinated, according to federal data.

David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors, said few nursing homes have mandates in place so far. While homes’ vaccination rates have ticked up slightly, the overall rate for nursing homes has hovered at just a little above 60 percent in the last couple of months even as the Delta variant took hold and drove up new cases among staff and residents.

The nursing home industry, which had been opposed to a mandate aimed specifically at its workers, favors the broader U.S. mandate. “We applaud President Biden for expanding Covid-19 vaccination requirements to all Medicare and Medicaid-certified health care settings as well as larger businesses,” said Mark Parkinson, the chief executive of the American Health Care Association, a major nursing home trade group, in a statement at the time.

“Despite rampant misinformation spreading online, the industry has made significant progress toward increasing the number of nursing home staff who are vaccinated since the beginning of the year,” the group said.

The researchers also looked at characteristics of the nation’s 15,000 nursing homes to determine which facilities had the most success in vaccinating their workers. While the vaccination rates of the county where they were located played a significant role, the researchers also found that traits like higher quality ratings from the Medicare program, the nonprofit status of the facility and a long-tenured staff also seemed to lead to higher rates.

“That gives us some suggestion that facility culture and leadership may play a role,” Dr. McGarry said, and management at these nursing homes may be better able to work with their staff to increase vaccine acceptance.

But none of those factors alone appeared to be critical in a nursing home’s success. “A lot of things seemed to matter a little bit,” he said.

Most influential may be the president’s decision earlier this month to impose a new federal mandate requiring all health care workers to be vaccinated. Nursing home workers may no longer be able to “job shop” as easily to find employment where vaccines are not mandated.

“The mandate takes all those things off the board and says everyone has to do it,” he said.

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Italy extends its health-pass requirement to cover most workers, public and private.

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A teacher, left, presented her health certificate, known as a Green Pass, to be checked by a school worker at the Isacco Newton high school in Rome on Monday. Credit...Andrew Medichini/Associated Press

Italy will require its residents to show a health pass to go to work, the government announced Thursday. It is the first country in Europe to require coronavirus vaccination certificates so widely.

“It’s an extraordinary endeavor,” Italy’s public administration minister, Renato Brunetta, said Thursday night. “It’s all the human capital in the country.”

Starting in mid-October, a requirement that already applies to some essential workers will expand to cover anyone working in factories, public offices, shops, restaurants and other settings. That is 23 million people, Mr. Brunetta said.

Individuals will have to be able to show that they have received at least one dose of vaccine, or have recently recovered from Covid-19, or else take a swab virus test every two days. Those who test positive must stay home on sick leave. Employers will be in charge of checking certificates, and workers who do not comply with the health pass requirement can be suspended from their jobs and fined up to 1,500 euros ($1,760).

Earlier this year, Italy was the first country in Europe to make vaccination compulsory for health care workers. That measure was extended last week to cover anyone working in a hospital, nursing home or school, all university students, and all adults who enter school buildings.

After the government made health certificates compulsory for teachers over the summer, the proportion who were vaccinated increased substantially, government statistics show.

Italian officials have set a goal of fully vaccinating 80 percent of the eligible population by the end of September. Scientists differ on whether that proportion will be high enough to check the highly contagious Delta variant of the virus, which is predominant now in Italy.

Almost 75 percent of Italians have already received at least one dose of vaccine and at least 65 percent are fully vaccinated. But there are still 3 million people over 50 who are not protected yet, a figure that might undermine the effectiveness of the vaccination campaign as autumn approaches.

The health minister, Roberto Speranza, said on Thursday that the new policy was meant to make workplaces safer and to get more Italians vaccinated. “We are sure it will help us even more to push this vaccination campaign,” Mr. Speranza said.

French authorities plan to apply similar rules for essential and hospital workers. France’s health minister, Olivier Veran, said on Thursday that 3,000 health workers in the country had been suspended from their jobs for failing to comply with a vaccine requirement. France made vaccinations mandatory for nearly three million essential workers on Wednesday.

Since taking power in February, Italy’s prime minister, Mario Draghi, has stepped up the country’s vaccination campaign, making it one of the government’s top priorities and pushing all Italians to get inoculated.

The nationalist League party — which is part of Italy’s broad coalition government — opposed the extension of the vaccine certificate requirement, but found little popular backing. A few anti-vaccine activists were arrested recently and accused of plotting violent protests. But by and large, Italians have embraced the health pass.

Mr. Draghi said earlier this month that he was considering making vaccinations compulsory for everyone. The Pfizer-BioNTech, Moderna, AstraZeneca and Johnson & Johnson vaccines are authorized for use in Italy.

In the United States, after the Food and Drug Administration gave its first full approval to a coronavirus vaccine — the one from Pfizer BioNTech— for people 16 and older, a number of public agencies and private employers moved to make vaccination mandatory.

In Italy, health certificates showing immunity or a recent negative test are already required to enter cinemas, theaters and museums, to dine indoors at restaurants, or to travel on high-speed trains or airplanes.

A correction was made on 
Sept. 17, 2021

An earlier version of this item misstated the age group included in two statistics on coronavirus vaccination in Italy. The country reports that it has administered at least one dose of vaccine to nearly 75 percent — and has fully vaccinated 65 percent — of its entire population, not just people 12 and over. 

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The Seattle area will require Covid vaccinations or negative tests for most indoor activities.

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Fans at events like this Seattle Seahawks game at Lumen Field, with more than 500 people present, will be required to show proof of vaccination or a recent negative coronavirus test under a new mandate in Seattle, Wash.Credit...Elaine Thompson/Associated Press

King County in Washington State — which includes Seattle and its suburbs — announced coronavirus vaccine and testing requirements on Thursday, falling in line with similar indoor vaccine mandates recently ordered in Los Angeles, New York and San Francisco.

Beginning Oct. 25, people attending recreational activities in most public places in the county will be required to show proof of vaccination against Covid-19. The health order extends to outdoor events with 500 or more people and indoor activities of any size, such as performances, movie theaters, conferences, gyms, restaurants and bars.

People who are unvaccinated or cannot prove vaccine status will be required to show proof of a negative test.

“We are at a critical point in this pandemic, with high levels of new Covid-19 cases and hospitalizations, and no certainty as to what will follow the Delta variant,” said King County Executive Dow Constantine at a news conference.

Health officials said Washington State is experiencing record levels of coronavirus cases and hospitalizations. As of Wednesday, daily deaths have jumped 74 percent, according to a New York Times database.

New York last month became the first U.S. city to require proof of at least one dose of a coronavirus vaccine for a variety of activities for workers and customers, and enforcement began on Monday. San Francisco is requiring proof of full vaccination for most indoor recreation, and Los Angeles will require proof of vaccination to enter bars, nightclubs and other drinking establishments beginning next month.

King County and the city of Seattle have already enacted mask requirements and vaccination mandates for city and county workers.

“With over 85 percent of King County residents having received at least their first vaccine dose, vaccine verification will help keep people safe and keep businesses open,” said Mr. Constantine. “Vaccination is our best shield against this deadly virus.”

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African public health experts call for the U.N. General Assembly to speed the delivery of vaccines.

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A Kenyan man received a dose of the AstraZeneca coronavirus vaccine, donated by Britain, at the Makongeni Estate in Nairobi in August.Credit...Brian Inganga/Associated Press

As world leaders prepared to gather at the United Nations General Assembly, African public health experts called on Thursday for action to speed up delivery of Covid-19 vaccines to their continent, where according to the World Health Organization, only 3.6 percent of people have been fully inoculated against the disease so far.

Shortfalls in supplies from Covax, the global vaccine-sharing initiative, have left African countries with just half the doses they need to meet the global target of fully vaccinating 40 percent of their populations by the end of 2021. Inequities in the distribution of vaccines remain stark: Africa is home to about 17 percent of the world’s people, but only 2 percent of the nearly six billion shots administered so far have been given in Africa, according to the W.H.O.

“As the U.N. General Assembly meets next week, I urge African leaders to call on them to ensure equitable access to vaccines,” Dr. Ayoade Olatunbosun-Alakija, chairwoman of the African Vaccine Delivery Alliance, said in an online news conference on Thursday. “Ask the rich countries: Where are Africa’s vaccines? Where are the vaccines for the low- and middle-income countries of the world?”

Wealthy countries globally have supplied only a fraction of the doses they promised to Covax. That shortfall is one of the main reasons Covax slashed its forecast last week for the number of doses it would have available this year. Worldwide, 80 percent of shots that have been administered have been in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Only 0.4 percent of doses have been administered in low-income countries.

Another reason, experts said, is that India, with the world’s biggest pharmaceutical manufacturing industry, has halted coronavirus vaccine exports while it tries to inoculate more of its own people.

“Export bans and vaccine hoarding still have a chokehold on the lifeline of vaccine supplies to Africa,” Dr. Matshidiso Moeti, the W.H.O.’s director for Africa, said at the news conference. “As long as wealthy countries lock Covax and the African Union out of the market, Africa will miss its vaccination goals.”

Dr. Moeti repeated the W.H.O.’s demand that countries postpone administering booster shots to healthy people until the end of the year, so that more vaccine doses can be supplied to countries that are still struggling to administer initial doses. Yet a growing number of countries are proceeding with plans for booster programs.

Dr. Moeti added that African nations had significantly expanded their delivery capacity, administering 13 million doses last week, more than triple the figures from previous weeks. Even so, at their current pace the countries will not reach the 40 percent vaccination target until next March, she said.

China says it has fully vaccinated 1 billion people.

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University students waited to receive a coronavirus vaccine at a university in Wuhan, China, in April.Credit...Agence France-Presse — Getty Images

China said on Thursday that it had fully inoculated 1 billion people, a milestone for the world’s most populous country that brings it closer to its goal of vaccinating 80 percent of its population by the end of the year.

It was a significant accomplishment, representing 71 percent of China’s population of 1.4 billion. China has administered 2.16 billion doses, nearly triple that of India, which is ranked second for shots given and has doled out 752.7 million doses, according to Our World in Data, which tracks vaccination figures.

More than 200 million people ages 60 and older have been inoculated, while about 95 million children ages 12 to 17 have received shots, according to Lei Zhenglong, a senior official with China’s National Health Commission.

“The total number of doses and the number of people covered by vaccination in our country rank first in the world,” Mr. Lei said at a news briefing on Thursday.

Spooked by multiple Delta outbreaks, China recently expanded access to vaccines. Officials sent health care workers door to door to administer doses and dispatched “vaccination buses” to public spaces. In the countryside, nurses could be seen injecting farmers as they worked in the fields.

The Chinese government has no qualms about pushing a more forceful stance on vaccines. The government changed its messaging in July, telling local officials to shift their approach to targeting all those who “should be vaccinated” from those “willing to be vaccinated.”

In August, the authorities in at least 12 cities in China warned residents that those who refuse Covid-19 vaccinations could be punished if they are found to be responsible for spreading outbreaks. On Aug. 17, several cities in central Hubei Province announced that people who refused to be vaccinated would have that entered into their “personal credit score.” They could be barred from going to work or entering hospitals and train stations.

Although many Chinese people did not rush to get vaccinated earlier this year, that changed with the arrival of the Delta variant. Last month, China stamped out multiple Delta outbreaks that swept across half the country.

But it is now contending with a spike in cases that started in the southern province of Fujian. As of Thursday, there were a total of 201 infections, according to government data.

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Amid conflicting science on boosters, Biden’s plan for extra shots is in flux.

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Kevin Grellman, right, administering a booster dose of the Pfizer-BioNTech vaccine in August to Armida Gomez, 81, and her husband, Jose, 80, in Pasadena, Calif.Credit...Robyn Beck/Agence France-Presse — Getty Images

Almost a month ago, President Biden announced that coronavirus booster shots would be made available to most adults in the United States this month. But a week before that plan is to begin, its details remain up in the air, with dissenting opinions coming from inside and outside the government.

A series of conflicting reviews this week illustrates the fierce argument among scientists about whether booster shots are needed, and if so, for whom. In a review made public on Wednesday, regulators at the Food and Drug Administration raised caveats about third doses of the Pfizer-BioNTech. Meanwhile, a study in The New England Journal of Medicine, also released on Wednesday, indicated that recipients of a third shot of the Pfizer vaccine in Israel were far less likely to develop severe Covid than those who had received two injections.

And in The Lancet this week, an article by two of the F.D.A.’s top vaccine scientists, among others, argued that there was no credible evidence that the vaccines’ potency against severe disease declined substantially over time, undermining one of the key arguments in favor of boosters. The scientists, who were not writing on the F.D.A.’s behalf, had announced that they would leave the agency this fall, but their public opposition to the administration’s plan caught the agency’s leaders by surprise.

The White House had originally planned to offer boosters to recipients of both the Pfizer-BioNTech and the Moderna vaccine, but is now planning boosters only for the Pfizer shots.

Jen Psaki, the White House press secretary, stressed on Wednesday that the administration’s most senior health officials — including Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration, and Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention — had signed a statement announcing Mr. Biden’s plan. “Nothing has changed as it relates to the eight top doctors who put out that statement, almost a month ago,” Ms. Psaki said.

But the administration may have to change course again, depending on crucial meetings of expert advisory committees to both the F.D.A., which is responsible for authorizing vaccines, and the C.D.C., which typically has the final word on vaccination policies.

The F.D.A. committee will meet on Friday to discuss and vote on Pfizer-BioNTech’s application to offer boosters to people 16 and older. The C.D.C. panel is expected to meet next week. Agencies are not required to follow the panels’ recommendations, but they generally do so.

Depending on the experts’ response, the F.D.A. could decide to scale back an authorization. According to people familiar with the discussions, even if the agency approves the application as it stands, the C.D.C. might recommend boosters only for populations that are particularly at risk.

Vaccination problems may vex the U.N. General Assembly gathering.

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Vaccination Is Required at U.N. Meeting, N.Y.C. Mayor Says

Mayor Bill de Blasio of New York said he had told António Guterres, the United Nations secretary general, that the city’s vaccination requirement for entering convention centers would apply to participants in the annual General Assembly.

I spoke to Secretary General Guterres two weeks ago, and we had a very good conversation. He’s been outstanding in trying to push the highest health standards for the General Assembly. We’ll have vaccination sites available. Anyone who is not yet vaccinated can get vaccinated. Anyone who’s had a non-approved vaccine can get one of the ones that we’re using here that are effective. So I reached out to him proactively to say, “Hey, here are our standards in the city, and we understand the United Nations is a particular organization, has its own rules and its own jurisdiction.” But we, you know, I expressed to him how important it was to have continuity with what we’re doing in the city, just for the health and welfare of everyone. I don’t know what else was happening with the federal government, for example, but I do want to give the secretary general credit. I think he very much is trying to find every way to work cooperatively with his member states to maximize vaccination and to create the most protected environment for the General Assembly.

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Mayor Bill de Blasio of New York said he had told António Guterres, the United Nations secretary general, that the city’s vaccination requirement for entering convention centers would apply to participants in the annual General Assembly.CreditCredit...Angela Weiss/Agence France-Presse — Getty Images

The United Nations is facing a potentially disruptive wrinkle over New York City’s Covid vaccination requirements that could derail attendance by at least some participants in the annual General Assembly gathering, just as many world leaders are about to arrive.

While the 193-member organization requires that all staff members at its New York headquarters have proof of vaccination, it has been imposing less stringent rules for visiting dignitaries and diplomats, relying on an honor system for all guests to declare they are vaccinated or have tested negative for the virus.

But New York City municipal officials said this week that the General Assembly meeting, even though scaled down from prepandemic years, qualified as a “convention center” event and that under the city’s current health rules, all those who attend must show proof of vaccination.

In a letter to the newly chosen president of this year’s General Assembly, Foreign Minister Abdulla Shadid of the Maldives, municipal officials also said that under the host city’s pandemic rules, visitors must show proof of vaccination before indoor dining, drinking or exercising within the 16-acre U.N. campus.

U.N. officials have said the organization is obliged to follow the city’s health rules. It remained unclear as of Thursday exactly how many visiting diplomats and others who had planned to attend lacked vaccination proof.

But word that all visitors would need to show such proof generated confusion and anger. Russia’s ambassador, Vassily Nebenzia, called the rules a violation of the United Nations Charter, arguing that they were discriminatory.

While President Vladimir V. Putin of Russia had no prior plans to attend — and has been in isolation anyway for possible exposure to Covid from infected aides — more than 100 leaders including President Biden, President Jair Bolsonaro of Brazil, President Recep Tayyip Erdogan of Turkey and Prime Minister Boris Johnson of Britain have planned to deliver their speeches in person.

Others have opted to deliver them via prerecorded video, as was done by all leaders last year when vaccines were still under development and each delegation in the General Assembly hall was limited to two people. Nearly all events at the 2020 event were conducted virtually.

Mr. Bolsonaro, an avowed vaccine skeptic whose popularity has fallen in Brazil partly over what critics call his disastrous handling of the pandemic, is scheduled to be among the first leaders to speak in person when the speeches begin on Tuesday. News reports from Brazil have said that Mr. Bolsonaro does not intend to be vaccinated. He was infected with Covid more than a year ago and then claimed to have cured himself by taking hydroxychloroquine, an antimalarial drug that has not been shown to be effective in Covid treatment.

Asked how the problem would be resolved with just days to go before the speeches begin, Stéphane Dujarric, the chief U.N. spokesman, told reporters on Thursday that discussions were underway to continue the honor system “in a way that is acceptable for all.”

The United Nations has been aiming for at least a partial restoration of the person-to-person diplomacy at this year’s General Assembly that its leaders regard as critical for the organization’s ability to function. Still, many of the meetings will remain virtual or a hybrid mix this year.

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North and Central America are driving a surge in Covid cases.

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Elizabeth Gonzales tried to comfort her 14-year-old daughter, Cerena, suffering with Covid-19, at Children’s Hospital in San Antonio, Texas.Credit...Meridith Kohut for The New York Times

North and Central America are leading a surge of new coronavirus cases at a time when many other parts of the world have managed to slow the spread of the virus.

In the Western Hemisphere, new reported cases have risen by 20 percent in the past week, the World Health Organization warned on Wednesday. The increase has been driven by North America, where new cases are up by one-third.

New cases doubled in the Canadian province of Alberta, “where hospitals are experiencing a critical staffing shortage,” Dr. Carissa F. Etienne, the director of the Pan American Health Organization, a division of the W.H.O., said at a news conference. And with new cases in the United States reaching levels not seen since January, Dr. Etienne said, “hospital capacity in many southern U.S. states remains worryingly low.”

Several Central American countries are also experiencing infection surges, including Belize, Costa Rica and Guatemala, where vaccination rates lag those in North America. About 21 percent of the population is fully vaccinated in Belize, 34 percent in Costa Rica and 11 percent in Guatemala, according to our the World in Data project at the University of Oxford.

The spread of the virus has slowed somewhat in the Caribbean, but there are exceptions, including Jamaica, where only 6 percent of people are fully vaccinated, and new infections are at their highest level of the pandemic.

By contrast, in most of South America, which was very hard hit earlier in the year, reports of new infections and Covid-19 deaths are declining. The organization’s experts are not sure why, although they dismissed speculation that a decline in testing might be responsible.

“Laboratory vigilance has been maintained,” said Dr. Sylvain Aldighieri, P.A.H.O.’s incident manager for Covid-19.

Dr. Aldighieri said a number of factors could be at work in South America, including strict social distancing measures and reduced mobility in some countries. The change of season could also play a role, he added, noting that “the epidemiological curves for influenza between 2014 and 2019 in South America have a similar behavior to Covid-19 between 2020 and 2021.”

Although the highly infectious Delta variant is becoming predominant in the Caribbean, it has yet to make significant inroads in South America, Dr. Aldighieri said.

W.H.O. officials called on national governments to pay more attention to how the pandemic affects children, both directly and indirectly.

“At the beginning of the pandemic, the virus was having a disproportionate impact on our elderly,” Dr. Etienne said, “and as a result, too many children and young people still don’t think they’re at risk. We must change that.”

The strains that the pandemic has placed on health services also mean that many young people are not getting annual checkups, routine vaccinations and other services, including for reproductive health. That is helping to “fuel one of the largest jumps in teenage pregnancy that we’ve seen in more than a decade,” Dr. Etienne said.

And the closing of schools because of the pandemic “has triggered the worst educational crisis we have ever seen in this region,” she added.

The White House offers a call to Nicki Minaj to discuss vaccine safety.

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White House Offers to Call Nicki Minaj to Discuss Covid Vaccine

The White House offered Nicki Minaj a call with a doctor to answer questions about the safety of the Covid-19 vaccine, Jen Psaki, the press secretary said, after the rapper questioned its efficacy on Twitter this week.

“We engage all the time with people who have big public platforms or profiles, some of them we talk about, some of them are here. Some of them you don’t even know about because they’re just looking for questions to be answered. We offered a call with Nicki Minaj and one of our doctors to answer questions she had about the safety and effectiveness of the vaccine. This is pretty standard, and something we do all the time. It was a very early-stage call at a staff level, staff to staff, and we weren’t even at the point of discussing or we’re not even at the point of discussing, I should say at this point, the mechanisms or the format or anything along those lines. It was simply an offer to have a conversation.” Reporter: “What kind of responsibility. do you think someone like Nicki Minaj has, someone with a really big platform when it comes to talking about the vaccine?” “Well, our hope is that anyone who has a big platform is going to project accurate information about the effectiveness of the vaccine, the safety of the vaccine and the availability of the vaccine — at the same time — and both can be true. We also recognize that people have questions out there. They have questions they want to have answered by their doctors. We have doctors who can answer questions. I would say that if we believed that everybody who had skepticism about the vaccine wasn’t someone we should engage with or talk to, we wouldn’t have made the progress we’ve made. I mean, remember, back in December, only 33 percent of the American people were open to getting vaccinated. Now, more than 75 percent have had at least one shot. So part of our strategy and our objective from the beginning has been engaging with people who have questions to help answer their questions.”

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The White House offered Nicki Minaj a call with a doctor to answer questions about the safety of the Covid-19 vaccine, Jen Psaki, the press secretary said, after the rapper questioned its efficacy on Twitter this week.CreditCredit...Jamie Mccarthy/Getty Images

After the rapper Nicki Minaj questioned the efficacy of the Covid-19 vaccine in a Twitter post this week, the White House confirmed on Wednesday that it had offered her a call with a doctor to answer questions about the safety of the vaccine.

Ms. Minaj’s comments drew widespread attention after she said she would not attend the Met Gala on Monday because she had yet to receive the vaccine, which was required for attendees.

“As we have with others, we offered a call with Nicki Minaj and one of our doctors to answer questions she has about the safety and effectiveness of the vaccine,” a White House official said in a statement on Wednesday night.

Ms. Minaj appeared to believe that she was going to visit the White House. She said on Twitter on Wednesday that she would “be dressed in all pink like Legally Blonde so they know I mean business.”

“I’ll ask questions on behalf of the ppl who have been made fun of for simply being human,” she added.

Asked about the possibility of dialogue between Ms. Minaj and the White House, Jen Psaki, the White House press secretary, told reporters on Thursday that officials had proposed “a very early stage call” that amounted to an “offer to have a conversation” about the safety of the vaccine.

“If we believed that everybody who had skepticism about the vaccine wasn’t someone we should engage with or talk to, we wouldn’t have made the progress we’ve made,” Ms. Psaki said.

Ms. Psaki said she was unsure whether the call would take place.

On Monday, Ms. Minaj asserted that her cousin’s friend in Trinidad and Tobago “became impotent” after receiving the vaccine, a claim that nation’s minister of health, Terrence Deyalsingh, rejected.

“There has been no such reported either side effect or adverse event,” he said in a news conference online. “And what was sad about this is that it wasted our time yesterday, trying to track down, because we take all these claims seriously, whether it’s on social media or mainstream media.”

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That wedding invitation you got may include some pointed language about your vaccination status.

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Color-coded bracelets provided to help guests navigate social distancing at a wedding in Orleans, Mass.Credit...Julia Cumes

Asking wedding guests to leave their children at home used to be among the thornier requests a couple could make.

Now, Covid precautions are adding more sensitive appeals to wedding invitations.

Tucked inside many embossed envelopes, along with dinner choices and directions to the reception, are politely worded notes telling guests they must be vaccinated, get a Covid test or do both, according to wedding planners.

Couples are not shy about asking guests about their vaccination status, said Jamie Bohlin, a wedding planner and owner of Cape Cod Celebrations in Yarmouth Port, Mass.

“I don’t get an email saying, ‘Should I ask our guests if they’re vaccinated?’” she said. “They just say, ‘We’re asking our guests.’”

In a survey of 1,400 couples last month, 22 percent said they were requiring guests to be vaccinated, according to The Knot, a wedding planning site. That was a jump from the spring, when only 3 percent of couples surveyed said they would make vaccinations a requirement, said Lauren Kay, executive editor at The Knot.

Many couples are taking measures like setting up mobile testing sites the day before their weddings; informing guests that they will need to wear masks throughout the reception; and providing color-coded bracelets that indicate which guests are fine with hugging and which want to keep their distance, according to wedding planners.

What a near-empty Empire State Building says about the future of New York City.

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The Empire State Building, as seen from the Top of the Rock Observation Deck, faces an uncertain future following the pandemic.Credit...Todd Heisler/The New York Times

The Empire State Building, like the city it inhabits, relies on a steady stream of tourists, thriving retail businesses and companies willing to lease its vast amount of office space. The coronavirus pandemic emptied out the attractions, shops and offices, in both the building and the city, for months.

Now, as a promised return to normal has once again been put on hold, the plans being made by the building’s occupants reveal a meaningful cultural shift.

Interviews with dozens of the building’s tenants and an analysis of public records suggest that the role of the office building in America has changed, perhaps permanently, and that local economies once centered on the traditional 9-to-5 workday face an uncertain future. Read the full article at the link below:

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The U.S. virus surge appears to be declining in some states, but deaths are still increasing.

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Sgt. Katrina Byrne of the Kentucky National Guard, left, worked as a pharmacy technician at St. Claire Regional Medical Center in Morehead, Ky., on Thursday after Gov. Andy Beshear mobilized the Guard to help the hospital with a surge of Covid-19 patients.Credit...Jon Cherry/Getty Images

New coronavirus cases and Covid hospitalizations across the United States have started to show signs of decline, although they remain far higher than they were earlier in the summer, and the number of new deaths is still increasing.

As the Delta variant has ripped through unvaccinated communities, reports of new deaths have reached an average of more than 1,900 a day, up nearly 30 percent in the past two weeks, according to a New York Times database. Approximately one in every 500 Americans has died from the disease.

The pace of vaccinations remains relatively sluggish, with 64 percent of eligible people in the United States fully vaccinated, according to federal data. (No shots have been federally authorized for children younger than 12.)

Vaccination remains powerfully protective against severe illness and hospitalization because of Covid-19 in the vast majority of people in all of the studies published so far, experts say. Health officials say that most of the patients who are being hospitalized and dying are not vaccinated, while areas with higher rates of vaccination have generally fared better. Over the summer, masks were recommended indoors for everyone, regardless of vaccination status, in virus hot spots and in schools across the country.

Some states have seen their hospital intensive-care wards become overwhelmed with Covid-19 patients, and have called in National Guard help or set up overflow units in parking lots. Idaho officials activated on Thursday “crisis standards of care,” meaning that hospitals can ration treatment if necessary.

Across the country, one in four U.S. hospitals reported that more than 95 percent of intensive care beds were occupied as of the week ending Sept. 9, up from one in five in August. Experts say that hospitals could struggle to maintain standards of care for the sickest patients when all or nearly all I.C.U. beds are occupied.

Conditions are beginning to improve in some hard-hit regions. Southern states like Florida, Mississippi and Georgia are seeing some declines in new cases and hospitalizations.

But new outbreaks are spreading in the Mountain West and Upper Midwest. West Virginia, where a smaller percentage of residents are vaccinated than in any other state, now leads the country in new cases per capita.

Coronavirus cases in the United States by region

This chart shows how reported cases per capita have changed in different parts of the country. The state with the highest recent cases per capita is shown.

The Delta variant has caused record numbers of pediatric infections and hospitalizations, although children are far less likely than adults to die or become very ill from the virus. Some schools that reopened for in-person instruction have closed temporarily because of outbreaks and staff shortages.

For those who are vaccinated, a scientific advisory committee to the Food and Drug Administration on Friday recommended booster shots for recipients of the Pfizer-BioNTech coronavirus vaccine who are 65 or older or are at high risk of severe Covid-19, at least six months after the second shot.

The move came shortly after the panel overwhelmingly recommended against approving a Pfizer booster for people 16 and older.

Asked on Tuesday on the MSNBC program “Morning Joe” whether he thought the struggle against the coronavirus would become a “forever war,” Dr. Anthony S. Fauci, the nation’s top infectious disease expert, said, “I don’t believe it needs to be.” But he said success in reining in the virus will depend on as many people as possible getting vaccinated.

To those who resist the shots, Dr. Fauci said: “You’re not in a vacuum, you’re part of society. And do you want to be part of the component that propagates the virus and propagates the outbreak, or do you want to be part of the solution?”

Mitch Smith and Sarah Cahalan contributed reporting.

An F.D.A. panel recommends Pfizer boosters for those over 65 or at high risk of severe Covid.

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F.D.A. Panel Greenlights Pfizer Boosters for High-Risk Individuals

A Food and Drug Administration advisory panel recommended that Pfizer-BioNTech boosters be made available to people 65 and older and those at high risk of severe Covid, but voted against giving blanket boosters to people 16 and older.

“This is the voting question No. 2 that we will ask the committee to consider: Based on the totality of scientific evidence available, including the safety and effectiveness data from Clinical Trial C4591001: Do the known and potential benefits outweigh the known and potential risks of a Pfizer-BioNTech Covid-19 vaccine booster dose administered at least six months after completion of the primary series for use in individual 65 years of age and older, and individuals at high risk of severe Covid-19?” “We do have a unanimous 18 out of 18 who voted ‘yes’ for this question.”

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A Food and Drug Administration advisory panel recommended that Pfizer-BioNTech boosters be made available to people 65 and older and those at high risk of severe Covid, but voted against giving blanket boosters to people 16 and older.CreditCredit...Saul Martinez for The New York Times

A key advisory panel to the Food and Drug Administration overwhelmingly rejected recommending Pfizer booster shots for most recipients of the company’s coronavirus vaccine, instead endorsing them only for people who are 65 or older or at high risk of severe Covid-19.

The vote — the first on boosters in the United States — was a blow to the Biden administration’s strategy to make extra shots available to most fully vaccinated adults in the United States eight months after they received a second dose. The broader rollout was to start next week.

Committee members appeared dismissive of the argument that the general population needed booster shots, saying the data from Pfizer and elsewhere still seemed to show two shots protected against severe disease or hospitalization and did not prove a third shot would stem the spread of infection. Some also criticized a lack of data that an additional injection would be safe for younger people.

“It’s unclear that everyone needs to be boosted, other than a subset of the population that clearly would be at high risk for serious disease,” said Dr. Michael G. Kurilla, a committee member and official at the National Institutes of Health.

But the panel’s final recommendation left some room for the White House to argue that the core of its booster strategy remains intact. Depending on how “at high risk” is defined, tens of millions of Americans could conceivably wind up eligible for additional shots of the Pfizer vaccine.

The committee of largely outside experts voted 16 to 2 against a Pfizer booster for people 16 and older after a tense daylong public discussion that put divisions within the agency and the administration on public display. Officials from the Centers for Disease Control and Prevention and the National Institutes of Health joined infectious disease experts and doctors in voting against additional shots for such a broad swatch of the population.

Dr. Paul Offit, a committee member and the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, questioned whether extra shots would do much at all to change the arc of the pandemic. “We all agree that if we really want to impact this pandemic, we need to vaccinate the unvaccinated,” he said.

But the panel unanimously embraced a fallback position to limit additional shots to the elderly and others at high risk of severe Covid illness. Then, after an informal poll pushed by a senior F.D.A. official, committee members specified that health care workers, emergency responders and others whose jobs put them at special risk should also be eligible for the booster shots. The official — Dr. Peter Marks, who oversees the F.D.A.’s vaccine division — said the at-risk group would also include teachers.

Biden aides noted that under the White House’s plan to offer booster shots eight months after the second injections, that same group would be first in line because they were vaccinated earliest.

Pfizer praised the decision, with Kathrin U. Jansen, senior vice president and head of vaccine research and development, saying it underscored “our belief that boosters can be a critical tool in the ongoing effort to control the spread of this virus.”

The F.D.A. has the final word on vaccine approvals, and while it is not obliged to follow the committee’s recommendations, it typically does. The agency will likely issue a decision by early next week.

An advisory committee of the C.D.C. is scheduled to meet Wednesday and Thursday to discuss booster shots before that agency, which sets vaccine policy, issues recommendations on who should get them.

Critics of the administration’s booster strategy as overly broad or premature said the advisory committee acted as a necessary check Friday.

The meeting “put the F.D.A. back in the driver’s seat,” said Dr. Luciana Borio, a former acting chief scientist at the agency. The expert panel, she said, “was allowed to maintain its scientific independence. It understood there were significant limitations with the data presented and that the F.D.A. needs to review the data carefully before making a decision.”

Apoorva Mandavilli and Sheryl Gay Stolberg contributed reporting.

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The timing for possible Moderna and Johnson & Johnson boosters in the U.S. is murky.

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A health worker in Switzerland drew a dose of the Moderna vaccine for use in Zurich on Tuesday.Credit...Arnd Wiegmann/Reuters

A scientific advisory committee to the Food and Drug Administration on Friday voted to recommend authorizing booster shots for recipients of the Pfizer-BioNTech coronavirus vaccine who are 65 or older or are at high risk of severe Covid-19, at least six months after the second shot.

The move came shortly after the panel overwhelmingly recommended against approving a Pfizer booster for people 16 and older.

There is no clear timeline for when the F.D.A. might put the possibility of booster shots for the two other vaccines available for use in the United States through the same process.

Covid vaccines made by Moderna and Johnson & Johnson are the other shots the F.D.A. has authorized for emergency use for those 18 and older. (Pfizer’s vaccine is the only one that has been fully approved for use in people 16 and older; it has emergency authorization for 12- to 15-year-olds.)

The question of whether booster shots are necessary has been the subject of intense debate and multiple studies since August, when President Biden announced that he planned to make booster shots available to adult recipients of the Pfizer-BioNTech and Moderna vaccines in September.

Dr. Janet Woodcock, the acting commissioner of the F.D.A., had hoped that booster shots could be offered this month not only for Pfizer and Moderna recipients, but for recipients of Johnson & Johnson’s one-dose vaccine as well, according to people familiar with the deliberations. But the administration had to limit its plan to Pfizer recipients, officials said, because neither Moderna nor Johnson & Johnson delivered the necessary data to the F.D.A. in time.

Moderna submitted an application for its booster dose to the F.D.A. earlier this month. A spokeswoman for the company said in an email on Thursday that she did not have an update on when the F.D.A. might act on its application.

Johnson & Johnson has not yet applied for booster clearance. A Johnson & Johnson spokesman said in an email on Thursday that the company planned to file for federal authorization for the vaccine by the end of the year, but did not provide a timeline.

Sharon LaFraniere and Noah Weiland contributed reporting.

The F.D.A.’s day of lively debate revealed key questions about the evidence on boosters.

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A patient received a third booster dose of the Pfizer-BioNTech Covid-19 vaccine in August in Pasadena, Calif.Credit...Robyn Beck/Agence France-Presse — Getty Images

Advisers to the Food and Drug Administration on Friday questioned a key assertion by researchers in Israel and by the drug company Pfizer: that its coronavirus vaccine is waning in protection not just against infection, but against severe illness and hospitalization.

The advisers met to evaluate Pfizer’s application for approval of booster vaccine doses for all Americans over age 16. Among the details that surfaced during the lively debate: Israel and the United States define severe illness differently.

In Israel, anyone with an accelerated respiratory rate and an oxygen level of below 94 percent is severely ill. By contrast, the Centers for Disease Control and Prevention considers people who are sick enough to be hospitalized as having severe disease, Dr. Sara Oliver, a C.D.C. scientist, said at the advisory committee meeting.

The discrepancy might help explain why the two countries have reported vastly different outcomes in people who are fully immunized.

Israeli researchers said they have seen large numbers of hospitalized patients who had received two doses months earlier. But in the United States, the C.D.C. has reported that vaccinated patients make up just 2 percent of people hospitalized for Covid-19.

It is just one of many scientific discrepancies that came to light this week.

On Monday, in the journal The Lancet, an international team of scientists analyzed dozens of studies and concluded that boosters are not yet needed by the general population, and that the world would be better served by using vaccine doses to protect the billions of people who remain unvaccinated.

On Wednesday, scientists at the F.D.A. posted an assessment online hinting that they, too, are unconvinced that there’s enough evidence that boosters are needed.

“Overall, data indicate that currently U.S.-licensed or authorized Covid-19 vaccines still afford protection against severe Covid-19 disease and death in the United States,” according to their executive summary.

But some F.D.A. leaders have publicly endorsed booster shots. “The need for an additional dose at six months to provide longer-term protection should not come as a surprise, as it’s likely necessary for the generation of a mature for immune response,” Dr. Peter Marks, one of the agency’s top officials, said in the meeting on Friday.

Alarmed by the rise in cases, Israeli officials have offered third doses of the vaccine to everyone older than 12. Researchers from Israel published early results from that rollout on Wednesday in the New England Journal of Medicine — but few outside scientists found the study convincing.

The team collected data on the effects of booster shots from the health records of more than 1.1 million people over age 60. At least 12 days after the booster, rates of infection were elevenfold lower — and rates of severe disease nearly twentyfold lower — in those who received a booster compared with those who had received only two doses, the researchers found.

The results are unsurprising, experts said, and do not indicate long-term benefit.

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Dr. Celine Gounder, an infectious disease expert at Bellevue Hospital in New York and a former member of the Biden-Harris Covid-19 advisory council.Credit...Amr Alfiky/The New York Times

“We have known for some time that the vaccines elicit less robust immune responses in the elderly,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center and a former adviser to the Biden administration. “Recommending additional doses of vaccine for the elderly isn’t controversial.”

Vaccination remains powerfully protective against severe illness and hospitalization in the vast majority of people in all of the studies published so far, experts said. But the vaccines do seem less potent against infections in people of all ages, particularly those exposed to the highly contagious Delta variant.

The cumulative data so far suggest that only older adults will need boosters, a view underscored by the F.D.A.’s advisory committee, which voted on Friday to endorse boosters only for Americans aged 65 and older, and those who are at risk for severe illness.

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