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.
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 were having 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. 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.
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. The state health department said that St. Luke’s Health System, which has a network of hospitals across the state, requested that the crisis standards be expanded statewide.
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.
“Our hospitals and health care systems need our help,” he said.
Mitch Smith and Charlie Smart contributed reporting.
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.
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 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.
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.
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.
After months of delay, the Federal Emergency Management Agency has agreed to reimburse New York City’s public hospital system almost $1 billion for its expenses treating patients during the city’s brutal first wave of Covid-19 in 2020.
Senator Chuck Schumer, the majority leader, and Representative Ritchie Torres, both of whom represent New York, announced the news Wednesday outside of Lincoln Hospital in the Bronx, one of the city’s 11 public hospitals. The hospital is in Mr. Torres’s congressional district.
Mayor Bill de Blasio, also in attendance, praised the work the public hospital system has done during the pandemic, calling the system “the tip of the spear.” Nearly 3,000 patients died of Covid-19 in the system’s hospitals between March and September of 2020, according to state data. He added, “What I saw from all of you was extraordinary courage, strength, resiliency, incredible commitment.”
In October 2020, the system, known as NYC Health + Hospitals, requested roughly $900 million from FEMA to cover costs related to hiring extra staff and expanding its capacity to treat coronavirus patients. FEMA had initially agreed to reimburse only $260 million, less than one-third of the request, arguing that the remainder consisted of costs that were not necessarily related to the virus.
But the public hospital system, backed by the lawmakers, maintained that it was impossible to separate specific Covid-related expenses at a time when the system was swamped by the disease.
Mr. Torres’s office said Wednesday that after the lawmakers got involved, FEMA relented and agreed to send the system an additional $620 million.
In a June letter to FEMA, the head of NYC Health + Hospitals, Dr. Mitchell Katz, wrote that the system had spent about $2 billion in its response to Covid-19, and that it needed more reimbursement immediately “to provide critically needed cash flow to our safety net system.”
The reimbursement will cover staffing, equipment and patient care efforts that were necessary during the surge of Covid-19 cases, according to Mr. Torres’s office.
FEMA did not immediately respond to a request for comment.
At the Wednesday announcement, Dr. Katz thanked Mr. Schumer and Mr. Torres for “proving that the federal government can work.”
“We were short on supplies,” he said, recalling the worst days of the first Covid wave. “We were short on staffing, and the mayor never questioned whether or not we would get fully reimbursed. He always said, ‘Mitch, do what you need to do.’”
Pope Francis on Wednesday urged people to get vaccinated against Covid-19, adding that it was “ironic” that a cardinal who was not vaccinated had been hospitalized with the virus.
The pope, who has said that getting the vaccine is an “act of love,” made the comments to reporters on his plane. He seemed to be referring to an American cardinal, Raymond Burke, who spread vaccine misinformation and then was treated for Covid-19 at the Mayo Clinic in Rochester, Minn.
“Even in the College of Cardinals,” Francis said, “there are some anti-vaxxers, and one of them, poor man, is in hospital with the virus. But life is ironic.”
He said he didn’t know how to explain why people don’t trust the vaccines.
“Humanity has a history of friendship with vaccines,” he said. “As children, we got them for measles, for other things, for polio. All the children were vaccinated, and no one said anything. Then this happened.”
Francis added that everyone in the Vatican, “except for a small group,” was inoculated against the virus.
Los Angeles County next month will require proof of coronavirus vaccination to enter bars, nightclubs and other drinking establishments, as it joins the list of places putting pressure on people to get vaccinated, the county authorities said.
The county will require customers and employees at such establishments, which also include wineries, breweries and lounges, to show proof that they have at least one dose of the vaccine starting on Oct. 7 and both doses by Nov. 4. The move was announced on Wednesday by Dr. Barbara Ferrer, the director of the Los Angeles County Department of Public Health, at a meeting of the Los Angeles County Board of Supervisors.
“This is a reasonable path forward that could position us to be better able to break the cycle of the surges,” Dr. Ferrer said.
The requirement also extends to “outdoor mega events,” where attendees and employees starting on Oct. 7 must show either proof of a vaccine or of a negative Covid test within the past three days, the authorities said. Restaurants will not be included in this mandate, although the county recommends that restaurants follow it anyway. It wasn’t clear why restaurants were omitted.
The county already requires people to wear masks indoors, regardless of vaccination status.
County authorities did not specify how they would ask people to prove they were vaccinated. In New York, which last month became the first U.S. city to require proof of at least one dose for a variety of activities, workers and customers can either show their paper vaccination card or present evidence via one of the city’s two apps: NYC Covid Safe or Excelsior Pass.
In France, as of Aug. 1, anyone without a “health pass” showing they have been vaccinated or recently tested negative will not be admitted to restaurants, cafes or movie theaters, and they will not be able to travel long distances by train. The Italian government announced in July that it would require people to show proof of vaccination or a recent negative test in order to participate in certain public activities, including indoor dining, visiting museums and attending shows.
The move in Los Angeles County comes as debate is heating up over how far governments should — or can — go in circumscribing the life of the unvaccinated. That debate has intensified after many areas, including Los Angeles County, saw a wave of new coronavirus infections fueled by the Delta variant.
The seven-day average of new cases in the county has decreased slightly after reaching a peak of 3,477 on Aug. 18, according to a New York Times database. Of the county residents eligible for a vaccine, 58 percent are fully vaccinated.
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.
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.”
This summer, prompted by vaccine rollouts, budget travelers began wading back into hostel life, snatching up dorm beds and relearning how to share spaces and conversations with strangers.
As hostels re-emerged, they did so under local guidelines that were gradually eased or lifted, enabling many to start looking and feeling like hostels again. There was chatter in the common rooms, fully booked dorms, and some activities were back in session.
But travel has significantly changed, and hostels, the backbone of affordable travel, barely survived. The future for many is uncertain. Hostels — the majority of which are small businesses — are built on community and camaraderie, places where people go from introducing themselves to sharing meals and beers or planning the next leg of their journeys together.
They are a petri dish for friendships, but in a global pandemic, there was concern they could also be a petri dish for Covid-19. Border restrictions, lockdowns and social distancing were particularly devastating.
And the challenges are not yet over: The more contagious Delta variant of the virus brings uncertainty for the fall travel season.
Earlier this month, the European Union removed the United States from a safe list of countries, leading the way for some member states to impose restrictions, particularly on unvaccinated travelers, or banning nonessential American travelers altogether. Countries outside of the bloc, too, including Norway, have taken similar steps.
Health officials are investigating a cluster of at least 16 Covid cases linked to an electronic music festival earlier this month on Randalls Island in New York City and urging everyone who attended the event to get tested.
The city’s Department of Health and Mental Hygiene said in a statement on Wednesday that the cases were connected to Electric Zoo, a three-day music festival that started Sept. 3. The department also identified eight people who may have attended the event while they were contagious.
“Anyone who attended this festival should get tested immediately, regardless of whether or not they have been vaccinated,” Dr. Dave A. Chokshi, New York City’s health commissioner, said in the statement.
Electric Zoo’s organizers did not immediately respond to a request for comment.
On Aug. 19, the festival announced that attendees would need to show proof of at least one vaccination or a negative Covid-19 test taken within 72 hours of the event. Masks were encouraged but not required.
New York City is grappling with a late-summer surge fueled by the Delta variant. The city reported a seven-day average of 1,489 new cases daily on Tuesday, despite the fact that 61 percent of its eligible residents are fully vaccinated.
News of the cluster comes as the concert industry faces a reckoning over how to rebound safely amid the highly contagious Delta variant.
After being shut down for more than a year, the industry’s comeback started promisingly. Restrictions were being eased and fans were snapping up tickets to events. But as the spread of the Delta variant accelerated, concerns mounted over safety. Artists including Stevie Nicks and Fall Out Boy canceled shows.
For those moving forward with concerts or festivals, a loose consensus took shape that fans should be required to provide proof of vaccination, or at least a negative test. But anecdotal reports suggest that the rigor of vaccine checks can be lacking, and the question of who bears responsibility for setting and enforcing those rules — especially when governments in major markets like Texas and Florida oppose such mandates — remains a matter of debate.
