The crush of new Covid patients this week at Mercy Hospital in Springfield, Mo., was unlike anything the staff had seen during the past 16 months. Officials resorted to borrowing ventilators from other hospitals and pleaded on social media for help from respiratory therapists.
The run on ventilators subsided, but this week Mercy Springfield cared for more Covid patients than it has seen in any week since the pandemic started. The city is in Greene County, where only about 35 percent of residents have been fully vaccinated and the highly contagious Delta variant is spreading.
“Six weeks ago, we had 10 patients and now it’s 128 on Friday, which is greater than the third wave back in December,” said Dr. John Mohart, Mercy’s senior vice president of clinical services.
Missouri has been averaging about 1,000 new cases per day, a 44 percent increase over the past two weeks, though a fraction of the state’s November peak when its average topped 5,000, according to a New York Times database. Hospitalizations are up 25 percent from two weeks ago.
The Delta variant of the coronavirus has driven this outbreak in Missouri’s Southwest, around Springfield and Joplin, according to the Centers for Disease Control and Prevention. This week, an epidemiologist with the C.D.C. arrived in Springfield, as part of a “surge response team” requested by the state.
Delta became the dominant variant in the United States this week, accounting for about 52 percent of cases. The C.D.C. estimates the variant was behind nearly three-fourths of the new cases in Missouri.
Studies suggest that vaccines remain effective against the Delta variant. But public health experts say Delta poses a serious threat to unvaccinated populations, and studies suggest that a single shot of a two-dose vaccine regimen provides only weak protection against the variant.
At the same time, the gap in vaccination rates between counties that voted for Donald J. Trump and those that voted for Joseph R. Biden Jr. is widening, according to a new survey released by the Kaiser Family Foundation.
The number of Missourians seeking the vaccine has dwindled. Nearly 50,000 were getting vaccinated each day in mid-April; on Thursday, it was 7,000.
The drop off in vaccinations is true across the country. As of Friday, providers were administering about 590,000 doses per day on average, about a 82 percent decrease from the peak of 3.38 million reported on April 13.
Hospitalizations are rare among the fully vaccinated. Dr. Mohart said that 95 percent of the 128 Covid patients at Mercy Springfield on Friday had not been immunized and tests show that most cases were of the Delta variant.
It was a similar picture at Cox Medical Center South in Springfield, which admitted 19 new patients for Covid-19 treatment on Thursday. From June 1 through July 8, there were 29 coronavirus deaths there.
“The staff is exhausted and overwhelmed,” said Ashley Casad, vice president of clinical services for CoxHealth, which has six hospitals in southwest Missouri and northwest Arkansas. “This is going to go on for a month. The light at the end of the tunnel seems incredibly far away.”
She said the rise in cases seemed to be a caused by three factors: the area’s low vaccination rate, the arrival of the Delta variant and Springfield’s recent decision to lift its mask mandate. Ninety percent of Covid patients at the Cox Medical Center South in Springfield have the Delta variant, and they are trending younger, she said.
Ms. Casad said the hospital was sending patients to other medical centers because it lacked enough staff to care for them, though the supply of respirators was adequate.
A state health official said on Friday that 500 ventilators were stockpiled in the capital, Jefferson City, and were available to be sent out to hospitals, but that so far there had been no requests for them.
The rise of new cases in southwest Missouri prompted Springfield public schools to mandate masks for summer session, and Mercy health system said that it would require its staff to be immunized by Sept. 30.
PATTAPUR, India — In a small, colorful house on India’s eastern coast, a 14-year-old girl cooks meals and feeds her younger siblings by day. At night, she rocks them to sleep, hoping to ease their fears, just as her mother would.
Several years ago, her father took his own life after the failure of the family’s business selling spare trolley parts. Then in May, her mother contracted Covid-19 as a calamitous wave of infections swept across India. She died within hours of reaching a hospital.
“My mother kept us safe like an umbrella does, from the heat and rain of life,” the girl, G. Sonali Reddy, said, holding back tears. “I imagine her being close to me. That’s what keeps me going.”
Sonali and her siblings are among more than 3,000 Indian children orphaned as the coronavirus has erased hundreds of thousands of lives across the country, according to state governments.
Even with all that has been lost, the orphans’ plight has touched the public consciousness, an acknowledgment of the profound challenges facing a country already full of vulnerable children.
Indian states have announced compensation of about $7 to $68 per month for each orphan, along with promises of food and free education. Prime Minister Narendra Modi vowed in a tweet to “ensure a life of dignity and opportunity” for the children.
But advocates fear that when the attention inevitably fades, the orphans will be susceptible to neglect and exploitation.
Already, the children, shellshocked in some cases from the loss of their entire families, have found it difficult to obtain death certificates they need to qualify for government benefits. Some will also find it hard to return to school.
In the longer term, the many orphans from poor families in remote areas face the threat of human trafficking and child marriage. Trafficking of children is rampant in India, where they are enslaved for work or sex. And the country has the largest number of child brides in the world, according to Unicef.
The Centers for Disease Control and Prevention is urging schools to fully reopen in the fall, even if they cannot take all of the steps the agency recommends to curb the spread of the coronavirus.
The new guidance from the C.D.C. was a departure from its past recommendations and marked a major turning point in a public health crisis in which childhood education has long been a flash point. School closures have been extremely divisive since the outset of the pandemic, and advising districts has been a fraught exercise for the C.D.C.
The agency also said school districts should use local health data to guide decisions about when to tighten or relax prevention measures like masking and physical distancing. With the highly contagious Delta variant spreading and children under 12 still ineligible for vaccination, it recommended that unvaccinated students and staff members keep wearing masks.
The guidance was a blunt acknowledgment that many students have suffered during long months of virtual learning and that a uniform approach is not useful when virus caseloads and vaccination rates vary so greatly from place to place.
“This a big moment,” said Dr. Richard E. Besser, a former acting director of the C.D.C. “It’s also a recognition that there are real costs to keeping children at home.”
Some experts criticized the agency’s decision to leave so much up to local officials, however, and said more specific guidelines would have been more helpful.
Virtually all of the nation’s major school districts plan to return to regular in-person instruction in the fall. Some, like New York City, will not offer a remote learning option in the fall.
Others are not inclined to follow the new advice. In California, for example, state officials have announced that they would continue requiring masks for everyone in school settings.
One major shift in the federal recommendations concerns physical distancing. The agency continues to advise that students be spaced at least three feet apart, but with a new caveat: If maintaining such spacing would prevent schools from bringing all students back, they could instead rely on a combination of other strategies, like indoor masking, testing and enhanced ventilation.
In another shift, the C.D.C. made clear that masks could be optional for vaccinated people.
With less than a month to go before many schools begin reopening for the fall, the Centers for Disease Control and Prevention on Friday released new guidelines for preventing Covid-19 transmission in schools.
The guidelines outline numerous strategies, including masking, weekly screening testing and social distancing. But the agency also said schools should fully reopen even if they cannot take all of the measures. The agency left much of the decision-making up to local officials.
Here are answers to some common questions about the new guidance.
Can my child go back to school full-time in the fall?
Almost certainly. The new recommendations make clear that reopening schools is a priority and that schools should not remain closed just because they cannot take all of the recommended precautions.
Transmission rates have generally been very low in schools, especially when additional precautions are in place.
Will they have to wear a mask?
The guidelines recommend that children ages 2 or older who are not fully vaccinated should wear a mask indoors — but imply that fully vaccinated students generally do not need to wear masks in the classroom.
The C.D.C. also notes that some schools may choose to require everyone to wear masks. On Friday, California said it planned to do just that. (At least eight states, on the other hand, have already forbidden mask mandates.)
Masks are not generally needed outdoors, the agency said.
What about social distancing?
The agency recommended that students remain at least three feet apart from one another in the classroom. Schools that do not have enough space to keep students so far apart should reopen anyway, the agency said. In those cases, it is particularly important to adopt other precautions, including masking, frequent virus testing and improved ventilation.
The guidelines also recommend that students remain at least six feet apart from teachers and staff and that unvaccinated teachers and staff remain six feet apart from one another.
Will vaccines be mandated?
There is currently no major effort to mandate vaccines in K-12 schools, though that could change over time.
Right now, only children 12 and up are eligible for the vaccine, and the shots were approved under emergency use authorization. Until they are given full approval, it’s unlikely that vaccines will be required for school. Still, the United States has a long history of mandating students be vaccinated for certain diseases — from polio to measles — and experts believe Covid-19 is likely to join the list at some point.
In the meantime, it’s possible that schools could ask if older students eligible for the vaccine have their shots. Chicago Public Schools, for example, has said it plans to ask families to submit Covid-19 vaccine information.
As for teachers, employers generally have the right to inquire about immunization status and even require vaccination for employees, experts say, though the effort in schools may be complicated by teachers’ unions.
When can my elementary schooler be vaccinated?
Probably sometime this fall. Pfizer has said that it plans to apply this fall for emergency authorization of its vaccine for children between 5 and 11.
Moderna has said that the results from its clinical trial of young children are expected before the end of the year. The company last month applied for authorization for use of its vaccine in 12- to 17-year-olds.
Mississippi health officials, in a stark reversal, announced new recommendations on Friday to combat the spread of the more contagious Delta variant, urging older and chronically sick residents to avoid crowded indoor spaces.
The highly contagious Delta variant became the dominant variant in the United States this week, accounting for about 52 percent of infections. It is spreading just as states have lifted most, if not all, pandemic restrictions.
Studies suggest that vaccines remain effective against the Delta variant but public health experts say it poses a serious threat to unvaccinated populations. Only 33 percent of Mississippi residents in the state are fully immunized, tied for last with Alabama.
“We have seen an entire takeover of the Delta variant for our transmission,” Dr. Thomas Dobbs, the state health officer, said Friday afternoon. The state is asking that:
All residents over 65 years of age avoid all indoor mass gatherings (regardless of vaccination status).
All residents with chronic underlying medical conditions avoid all indoor mass gatherings.
All unvaccinated residents wear a mask when indoors in public settings.
All residents 12 years of age and older receive a Covid-19 vaccination.
In addition to asking people to get vaccinated as soon as possible and to wear a mask in public until they do, the state is now asking vulnerable people to take extra precautions, Dr. Dobbs said.
“For the time being, if you’re in one of these high-risk groups, it is very wise for you to avoid indoor mass gatherings where we are going to see significant transmission,” Dr. Dobbs said.
Health officials said that they hope that the new guidelines will help slow the transmissions they’ve seen spreading out from church groups, summer school classes, enrichment programs and outbreaks in nursing homes.
“We’re going to remain vulnerable for a long time,” Dr. Dobbs said. “I don’t think we’re going to have some miraculous increase in a vaccination rate the next few weeks.”
Over the last week, the state has averaged about 250 cases per day, a 91 percent increase from the average two weeks ago, according to a New York Times database.
Hospitalizations have increased by 34 percent from two weeks ago. No county has reached the mark of 50 percent of its residents fully vaccinated, and Smith County has the lowest vaccination rate, at 21 percent.
Gov. Tate Reeves, a Republican, has no intention of putting in place mask mandates, or restrictions, a spokesman said Friday night, emphasizing that these were simply recommendations.
Dr. Paul Byers, the state epidemiologist, offered a grim forecast of increased cases and hospitalizations in the coming weeks. He said 95 percent of the cases identified in the last month and 90 percent of hospitalizations and deaths have been among unvaccinated people in Mississippi.
“It’s a disturbing and concerning trend that we’re seeing,” he said. “We’re certainly moving in the wrong direction.”
Earlier this week, Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases and President Biden’s chief coronavirus advisor, said if he were in a place with vaccination rates as low as Biloxi, Miss., he would consider wearing a mask.
Dr. Fauci is fully vaccinated. But on Sunday in an interview on NBC’s “Meet the Press,” he said that in parts of the country with low levels of vaccination and rising coronavirus caseloads, he might “go the extra mile to be cautious enough to make sure that I get the extra added level of protection.”
IN CASE YOU MISSED IT
The highly contagious Delta variant is now the dominant version of the coronavirus in the United States, according to figures released this week by the Centers for Disease Control and Prevention.
Delta now accounts for more than half of infections across the country, a benchmark health experts had predicted it would pass. Delta is believed to be about 60 percent more transmissible than Alpha, a variant first detected in Britain that became dominant in the United States this spring. Alpha now accounts for just 28.7 percent of cases, the C.D.C. reports.
Despite Delta’s growing presence, the average numbers of new virus cases and deaths across the country, as well as hospitalizations, are significantly down from the devastating peaks during previous surges.
While there is limited data on the threat Delta poses to current vaccines, studies so far suggest that several of the leading shots, including those authorized in the United States, are proving effective against the variant.
Still, Pfizer and BioNTech this week announced plans to develop a vaccine that specifically targets Delta, with clinical trials expected to begin in August.
U.S. vaccination rates have flattened, with just under 160 million Americans, or nearly half the population, fully vaccinated. President Joseph Biden outlined strategies to get more people vaccinated, calling on employers to set up clinics at work and to offer paid time off for workers.
In other news this week:
With the 2020 Tokyo Olympics just weeks away, organizers announced that they would ban most spectators from the Games following a sudden rise in cases across Tokyo that put the city into a state of emergency. In June, organizers had announced that domestic spectators would be permitted, albeit with tight restrictions. Polling shows that a large majority of the Japanese people support further delaying the Olympics.
Nearly all pandemic-era restrictions in England will be lifted on July 19 after more than a year and a half of regulations and various levels of lockdowns. But Prime Minister Boris Johnson is facing backlash after saying he would leave the decision to wear masks on trains and in other crowded, indoor spaces up to the public. Critics warned that such a casual approach could leave vulnerable people at heightened risk as the virus continues to spread.
A third, dangerous wave of the coronavirus is sweeping across much of southern and eastern Africa. Officials from the World Health Organization have called it the continent’s “worst pandemic week ever.” Africa is also short of vaccines. The rise in infections has been driven largely by the Delta variant, which has driven up hospitalization rates and deaths and crippled health care systems.
The Centers for Disease Control and Prevention released new guidance for schools on Friday, urging them to fully reopen and calling on local districts to tailor their public health measures to local coronavirus data. The news, which won support from two of the largest educators’ unions, marks a departure from the C.D.C.’s past guidelines for schools and arrives less than a month before the first day of school for some districts.
Making a life in the arts was always going to be hard. But not like this.
Over 16 months of pandemic and social unrest, students at the University of North Carolina School of the Arts watched almost all stage actors lose their jobs and witnessed widespread layoffs at regional theaters. They heard the footsteps of another year of young artists coming up right behind, and wondered whether there would still be room for them.
“I call us the Class of Covid-19,” said David Johnson III, who is back home in Michigan, driving for Grubhub, “even though we’re the Class of 2020.”
The school is on the grounds of a former high school a few miles outside downtown Winston-Salem, a onetime tobacco and textile town now trying to position itself as a tech hub. Its drama program, which is all undergraduate, is highly regarded — in a recent informal survey The Hollywood Reporter declared it the fourth best in the world.
As the students’ senior year evaporated, many of them stayed in Winston-Salem and made their own rituals. Then they scattered: Most went back to wherever they had grown up, shelving plans to move to New York or Los Angeles.
A few have landed short-term projects with notable companies. One was in the ensemble for an audio production of “Row,” a new musical that the prestigious Williamstown Theater Festival made for Audible.
Carlo Feliciani Ojeda, a directing student from South Florida, moved to London to pursue further education.
“I didn’t want to use someone else’s story,” he said, “so I started writing my own adaptation, about how I was feeling in 2020 and 2021, and, after the murder of George Floyd, about what it means to be a person of color in the theater world.”
In June, the European Union officially recommended its member countries reopen their borders to American tourists after more than a year of tight restrictions.
But residents of Europe’s Schengen area — spanning 29 countries, city-states and micro-states — as well as those in the United Kingdom and the Republic of Ireland are still barred from traveling to the United States, unless they are a U.S. citizen or they have spent 14 days before arrival in a country that is not on the Centers for Disease Control and Prevention’s prohibited list. Certain family members are also exempt.
The restrictions were first put in place in March 2020.
Discussions about when to resume inbound travel have been opaque. In late June, Secretary of State Antony Blinken said it was too soon to say when the United States would lift travel curbs for European Union citizens.
“We are anxious to be able to restore travel as fully and as quickly as possible — we’re very much guided by the science, by our medical experts,” Mr. Blinken said in Paris in June, adding that he “can’t put a date on it.”
Transportation Secretary Pete Buttigieg said on July 8 that the United States was not yet ready to lift restrictions on international travel.
“A lot of this is based on what’s going on with progress on the vaccines,” Mr. Buttigieg said in an interview with Bloomberg TV. “Obviously we see good news and bad news out there in terms of the variants. One moment, you’re reading about a variant happening across the world, the next you know, it’s becoming the dominant strain here in the U.S.”
An unwillingness to get the Covid vaccine, complicated as both a matter of politics and psychology, has increasingly become concerning to public health officials as the Delta variant has begun to spread.
Although 52 percent of New Yorkers are completely vaccinated, that statistic is misleading. In most parts of Central Brooklyn only a third of residents have been fully immunized. In affluent parts of the city, the figure is more than twice as high.
To entice people to get the vaccine, the city has offered incentives such as giveaways from Krispy Kreme, and the chance to win an annual membership to the Public Theater or tickets to see the Brooklyn Cyclones.
The reasons for refusing the vaccine differ by community and demographic, dooming any unified approach. In Staten Island, where some of the highest Covid rates in the city have surfaced again lately, the data has shown that young people are the ones exempting themselves. Among Caribbean immigrants, skepticism about the vaccine has fomented around concerns that it will endanger fertility, said Dave Chokshi, the city’s health commissioner.
But the work of convincing Guyanese women in Crown Heights that the vaccine is not a threat to pregnancy is different from the work of convincing 17-year-olds in Tottenville that it is worth getting off the couch and going to CVS.
It is not clear what succeeds. The city’s approach to correcting vaccine disparities can seem blind to the broad range of anxieties born of the long-term dismissal of poor urban communities.
In an effort to move the process along, doctors and public health officials have worked to engage community leaders — “trusted community messengers,” for instance — to deliver the word on the importance of vaccination.
“There is all this language — ‘vaccine hesitancy’ — people aren’t ‘hesitant,’” said Dionne Grayman, the president and a co-founder of We Run Brownsville, a women’s health organization. “They don’t trust a system that has never worked for them before.”