Covid-19 Live: Vaccines, Reopening Updates and Mandates

Jonea Jones, 26, right, receives her second dose of the Covid-19 vaccine at a free vaccination clinic in San Antonio.
Credit…Matthew Busch for The New York Times

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.

Students arriving for the first day of the school year at P.S./I.S. 323 in Brooklyn on Monday.
Credit…Chang W. Lee/The New York Times

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.

New York City’s classrooms reopened on Monday to roughly a million children, most of whom were returning for the first time since the United States’ largest school system closed in March 2020.

While the city reopened schools last fall for part-time learning, the vast majority of students chose to keep learning remotely. But with no remote option now available to almost all parents, classrooms will be full for the first time in a year and a half.

For months, Mayor Bill de Blasio had forecast the first day of school to be a triumphant coda in New York City’s long recovery from the pandemic. But the spread of the highly contagious Delta variant has complicated the city’s push to fully reopen schools and left many families and educators anxious about what the next few months will hold.

At a news conference on Monday morning, Mr. de Blasio asked parents to put aside their worries and focus on reorienting their children to in-person learning. “I‘m appealing to all parents right now,” he said. “Work past the fear, help your kids move forward.”

Earlier in the day, Tiffany Smith, 37, was on the subway, taking her 8-year-old daughter, Neriyah, and 4-year-old son,Khyree, to their school and daycare center in East New York, Brooklyn, for the first time in 18 months.

Ms. Smith said both had had a hard time focusing when they could not be around their teachers and classmates. “When they’re interacting in person it helps them with their communication skills,” she said.

She said that she had trained her children to keep their masks on that she felt confident in the school’s social-distancing measures. “They have a lot of safety protocols,” Ms. Smith said.

Across the city in Queens, incoming freshmen lined up outside Bayside High School to get a first glimpse inside their new school.

Nate Hernandez, 14, a freshman from Jamaica, Queens, boarded the Q31 bus at 6 a.m. on Monday with his mother to make sure he wouldn’t be late. Nate, who learned fully remotely during his last year of middle school, said online classes made him feel “a little sad and kind of lonely as well,” he said of learning remotely. “It was hard to get to know people.”

He hopes that the new school will offer a fresh start.

“I can’t believe I made it to ninth grade, to high school,” he said. “I’m like, ‘I’m going to high school now.’ It’s crazy.”

The first day of school in a system as large as New York’s can be chaotic even during normal times. This year is anything but. Even before schools opened their doors on Monday morning, the city was scrambling to fix the first problem of the new school year: The online health screenings that families are required to fill out each morning had crashed by about 8 a.m., as hundreds of thousands of parents attempted to log on at the same time.

That led to long lines outside some schools, as educators were forced to complete their own screenings of how each child was feeling that morning.

Monday’s reopening capped months of planning and anticipation for the third consecutive school year disrupted by the pandemic.

In May, amid a brisk vaccine rollout and rapidly declining virus case counts, Mr. de Blasio announced that the city would no longer offer remote instruction to most students. (A few thousand children whom the city considers medically vulnerable will still be able to learn from home.) His announcement triggered little political resistance in the spring, but his administration has faced growing pressure from parents and politicians to reconsider.

About 600,000 families, most of them Black and Latino, kept their children learning from home last year. This year, while parents are much more receptive to reopening schools, some say they would like to wait at least until their young children are eligible for the vaccine. Only children 12 and older are currently eligible, and younger children may not be until later in the year, at the earliest.

Mr. de Blasio has acknowledged that he does not expect all children to return this week, since some parents have informed their principals that they want to wait a few days or even weeks to see how reopening goes.

Emma Goldberg and Chelsia Rose Marcius contributed reporting.

Carla McIntire and Camille Johnson, both of Urbandale, Iowa, at a rally last month opposing a state law banning local governments and school districts from implementing mask mandates.
Credit…Kelsey Kremer/The Des Moines Register, via Associated Press

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.




New York City Schools Fully Reopen for In-Person Learning

New York City schools started the 2021 academic calendar fully in-person for the first time since March 2020, when coronavirus restrictions were put in place.

“It’s so good to see all our kids coming back to school in person where they can learn best, where they can be with their friends, where they can be with the teachers and the staff who care for them, love them, do so much for them. Kids coming to school today all across the city are going to experience a gold standard of health and safety measures. And as everyone knows, in the coming days, every single adult in our schools is going to be vaccinated. Over two-thirds of our kids 12 to 17 years old, vaccinated. So, so many good things are happening to move us forward, and it’s because people pulled together, because we care about our kids.” “We are in this together. This is our moment. This is our time for our babies. Our message to all of the families that are dropping off your children at school today, bringing them to bus stops or if they’re older, they would, you know, too cool to be seen what you — I had to sneak a picture before my daughter left. I’m waving at you all from a distance, wishing you an amazing first day. Your babies are safe with us because they’re our babies. They’re our children. This is our time. This is our city.”

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New York City schools started the 2021 academic calendar fully in-person for the first time since March 2020, when coronavirus restrictions were put in place.CreditCredit…Anna Watts for The New York Times

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

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,” Mayor Bill de Blasio says.

March 23

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.


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

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.


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

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

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

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 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

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

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

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

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

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

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

Rachel Shaw, a student in Gwinnett County, Ga., between lunch and her next class, felt safer with the mask mandate in effect at the school.
Credit…Jesse Lopez for The New York Times

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.

Gov. Ron DeSantis of Florida said Monday that Florida cities and counties that require public employees to get vaccinated against the coronavirus will face fines of $5,000 for each employee fired over the mandate.
Credit…Joe Burbank/Orlando Sentinel, via Associated Press

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.

More than 70 percent of workers for the Metropolitan Transportation Authority have received at least one dose of the vaccine. 
Credit…Karsten Moran for The New York Times

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 shows in New York City are scheduled to return this week, including “The Lion King,” on Tuesday.
Credit…Jutharat Pinyodoonyachet

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 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.

The maternity department at Lewis County Health System in upstate New York will pause deliveries on Sept. 25, the chief executive said.
Credit…Eric Gay/Associated Press

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 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 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.

Milwaukee Bucks forward Giannis Antetokounmpo arguing with a referee, Ken Mauer, during the N.B.A. playoff series against the Brooklyn Nets in June.
Credit…Kathy Willens/Associated Press

Late last month, the N.B.A. sent out a short news release announcing an agreement with the union representing the league’s referees to mandate Covid-19 vaccines. It stipulated that all referees must to be fully vaccinated to work games, including “recommended boosters.”

The agreement stands out in the sports world, where Covid vaccinations remain largely a point of contention. And it is unusual even for pro basketball itself: No such mandate exists with N.B.A. players, creating a potentially awkward situation where some league employees are mandated to take the vaccine and others aren’t.

Marc Davis, the union’s president and a referee himself for more than two decades, said in an interview that the agreement was born of a strong relationship with the N.B.A., and that the referees were broadly in favor of the mandate.

“When you have a collaborative environment between management and labor, I think you’re constantly always working through issues and there’s a constant dialogue back and forth,” Davis said.

“It’s a shared view of vaccines that they are probably one of the top three inventions in the history of humankind. And to have this access to this innovative vaccine and allow us to continue to work, to do our business and to continue to work collaboratively, it’s not that difficult of a conversation to begin and to work through.”

Jordan Strait, 17, receives a Covid-19 vaccine during a free vaccination clinic held by San Antonio’s Metropolitan Health District on Saturday.
Credit…Matthew Busch for The New York Times

Earlier this year, as Covid-19 vaccines became more widely available, some women and girls went on social media to describe changes in their menstrual cycles after receiving the shots, including irregular cycles, painful periods and heavy bleeding.

Some postmenopausal women shared stories about getting their periods for the first time in years. Many wondered whether the vaccines might be the reason.

Now researchers at five institutions, backed by funding from the National Institutes of Health, will be conducting yearlong studies to examine any possible connections between vaccination and irregular menstruation, and to help allay concerns that might prevent women from getting their shots.

The evidence around abnormal periods is so far purely anecdotal. There is no known link between vaccination and changes in menstruation, and public health experts reiterate that vaccines are safe, effective and necessary to end the pandemic.

But the stories underpin a persistent data gap about reproductive health and women’s menstrual cycles that is not collected during clinical trials, including during trials of the Covid vaccines. There have also been no scientific studies published examining a potential relationship between the two.

“This is an important, overlooked issue,” said Dr. Hugh Taylor, chair of the department of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, who added that he has heard from his own patients about differences in their periods after receiving the vaccine.

“A lot of people have irregular menstruation for all sorts of reasons, so is this really different in people with the vaccine, or is it just that when people have it, they are linking it to the vaccine?”

The research will be undertaken by teams at Boston University, Harvard Medical School, Johns Hopkins University, Michigan State University and Oregon Health and Science University. The studies will include participants of all ages and backgrounds who have not yet been vaccinated, including those who plan to get the shots and those who do not, in order to study their menstrual cycles before and afterward.

Menstrual health can be a reflection of women’s overall health, doctors say. But they point out that a number of different factors can temporarily affect a woman’s period, including stress, illness or lifestyle changes. Periods, including length and flow of a menstrual cycle, also vary widely from person to person.

A hospital staffer tending to a Covid-19 patient at Providence Sacred Heart Medical Center in Spokane, Wash., on Friday.
Credit…Grant Hindsley for The New York Times

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 Consumer Brands Association sent a letter on Monday to President Biden, who left for a trip to the West.
Credit…Doug Mills/The New York Times

A trade group representing some 2,000 consumer brands sent a letter to President Biden on Monday asking for clarification about his announcement last week that all companies with more than 100 employees will soon need to require vaccination or weekly testing.

Mr. Biden said last week that the Department of Labor and its Occupational Safety and Health Administration would draft the rules, which would affect some 80 million workers.

But the mandate has raised vexing issues for employers as they deal with the practicalities of vaccination policies, said Geoff Freeman, the president of the trade group, the Consumer Brands Association.

On Monday, Mr. Freeman called on Mr. Biden to “create immediate clarity” about how private businesses should carry out aspects of the White House’s plan to achieve “our shared goal of increased vaccination rates.”

He shared 19 questions that represented a “small sampling” of those raised by the trade group’s members. Among them:

  • What proof-of-vaccination documentation will the companies need to collect, and will booster shots also be required?

  • Must employees be fully vaccinated?

  • Will workers who have had the coronavirus still have to be vaccinated or get tested?

  • Will the requirements apply only to vaccines that are fully approved by the Food and Drug Administration? (The Pfizer-BioNTech vaccine is currently the only shot with full approval.)

  • Who is responsible for vaccination tracking — the government or the individual businesses?

  • What are the consequences of falsifying a vaccination status?

Other questions, on testing and other policy details, covered similar ground, touching on how federal guidelines interact with state-level initiatives, who will be responsible for paying for testing and whether waivers would be allowed if employee absences or attrition resulted in supply chain disruptions.

Also of concern, Mr. Freeman said in an interview, is the slow pace at which government tends to move, compared with the quick decisions that private businesses are used to making. This has been a problem during the pandemic, he said.

“For 19 months, we’ve been working with either the Trump administration or the Biden administration and all of the agencies involved in this,” he said. “And the simple truth is that they have been slow to keep up with the pace of change.”

He added: “All of us want to get to the other side of this thing as quickly as possible. It’s not going to work in this scenario unless an entity like OSHA can move at the pace of the business environment.”

A spokesperson for the White House said the specific provisions of the rule were still being determined. The White House has said it will provide more guidance on Sept. 24 for the federal contractors affected by the executive order. Jeffrey D. Zients, Mr. Biden’s coronavirus response coordinator, has said the rule-making process for the OSHA component will take weeks.

Major business trade groups have generally been supportive of the mandate, which gives otherwise wary businesses the cover to require inoculation.

The U.S. Chamber of Commerce, the nation’s largest business lobbying group, has said it “will work to ensure that employers have the resources, guidance and flexibility necessary to ensure the safety of their employees and customers and comply with public health requirements.” Another major business advocacy group, the Business Roundtable, has said it “welcomes” the Biden administration’s actions.

But they have also been racing to understand the details and implications, which can vary depending on a company’s size. Does a company’s worker count include part-time employees? What is the deadline for compliance? Will potential lawsuits slow the process down?

At this point, “there are more questions than answers,” said Ian Schaefer, a partner at the law firm Loeb & Loeb who specializes in labor issues.

Even as companies are calling their lobbyists and lawyers for more insight, many are discussing at a senior level the realities of putting a mandate in place, despite not yet knowing exactly what that might entail, he said.

“In the absence of actionable intelligence that gives a little bit more guidance and direction, I think they’re sort of controlling for what they can control, which is a lot of internal politics at this point,” Mr. Schaefer said.

Global Roundup

President Frank-Walter Steinmeier of Germany, center left, at a pop-up vaccination center in a school in Berlin on Monday.
Credit…Pool photo by Bernd von Jutrczenka

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.

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