September 20, 2021

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Biden Plans to Say Civilian Federal Workers Must be Vaccinated or Face Testing – The New York Times

26 min read
A medical technician administered a coronavirus test to a walk-in patient at a mobile testing site in Palmetto, Fla., last week.
Credit…Octavio Jones for The New York Times

In addition to revising its mask guidance on Tuesday, the Centers for Disease Control and Prevention also quietly updated its testing recommendations for people who are fully vaccinated against the coronavirus.

The agency now advises that vaccinated people be tested for the virus if they come into contact with someone with Covid-19, even if they have no symptoms. Previously, the health agency had said that fully vaccinated people did not need to be tested after exposure to the virus unless they were experiencing symptoms.

“Our updated guidance recommends vaccinated people get tested upon exposure regardless of symptoms,” Dr. Rochelle P. Walensky, the agency’s director, said in an email to The New York Times. “Testing is widely available.”

Fully vaccinated people should wear a mask in public indoor spaces after exposure, the agency said. Three to five days later, they should be tested for the virus.

If the results come back negative, they can stop wearing masks indoors. If results are positive, the infected should isolate at home for 10 days.

Although people who are fully vaccinated may still get infected with the virus, these breakthrough infections tend to be mild or asymptomatic. The vaccines authorized in the United States provide strong protection against the worst outcomes, including severe disease, hospitalization and death, including from the Delta variant.

The new testing recommendation came on the same day that the agency recommended that fully vaccinated people return to wearing masks indoors under some circumstances. When levels of community transmission are high, everyone, regardless of vaccination status, should wear masks indoors when they are in public, the agency now says.

The agency also recommended that vaccinated people in close contact with unvaccinated people, including children under age 12, consider wearing masks in public indoor spaces whatever the transmission rates in the local community. In a shift, the agency also recommended universal masking in schools.

For months, the C.D.C. had resisted recommending masks for vaccinated people, even as the highly contagious Delta variant spread and the World Health Organization recommended continued mask wearing.

The change was prompted by new data suggesting that even vaccinated people who are infected by Delta may carry large amounts of the virus and transmit it to others, Dr. Walensky said at a news briefing on Tuesday.

Apoorva Mandavilli contributed reporting.

Covid-19 vaccinations being offered Tuesday at the Rose E. McCoy Auditorium on the Jackson State University campus in Jackson, Miss. The state is seeing a steep rise in cases and deaths.
Credit…Rogelio V. Solis/Associated Press

Mississippi’s top state health officials warned on Wednesday of an “astounding” rise in Covid-19 cases that threatens to overwhelm some hospitals’ intensive care units. They ordered hospitals to forgo some elective surgeries and to adhere to a plan to transfer patients to other facilities with available beds when necessary.

The number of Covid-19 infections in the past two weeks was well over double the number recorded for the first half of July, the officials said at a news conference. Deaths rose by 51 percent over the same period and now average between three and four a day, according to the statistics presented.

Statewide, the statistics showed, more than 300 Covid-19 patients were in intensive care or on a ventilator, compared with a few dozen at the start of the month. Where intensive care units are full, some patients are being treated in emergency rooms, the officials said.

Rampant misinformation about the safety and effectiveness of vaccines is undercutting the state’s efforts, said Dr. Thomas Dobbs, the state health officer.

“We’re going to make the vaccine available, but you know, there’s a mountain of opposition to us from some folks,” he said. “We have gotten ourselves into this mess together, and we need to get ourselves out together.”

While the national outlook is also worsening quickly, Mississippi is one of a handful of states where the rate of infections is skyrocketing. Fewer than one half of adults have received at least one shot, putting the state at the bottom of the nation’s vaccination rate ranks and rendering much of its population vulnerable to the highly contagious Delta variant.

Dr. Dobbs said the flood of Covid-19 patients means hospitals in the state must forgo elective surgeries that require overnight stays and must be prepared to fly Covid-19 patients to other facilities if beds run short. He said that many health professionals are “absolutely worn out” from previous surges and that some hospital nurses are quitting — a trend that could make it harder to handle the ongoing spike.

Dr. Paul Byers, the state epidemiologist, called the rise in the number of daily infections “astounding.” He cited 72 long-term-care facilities where unvaccinated staffers have been largely spreading the virus, but he also mentioned settings like summer schools and cheerleading camps.

He said he expects cases to continue to escalate in the coming weeks. Asked to identify where in the state outbreaks are most severe, he said: “We are covered up with outbreaks.”

The bad news for baseball fans, posted outside the ballpark in Philadelphia on Wednesday. The Phillies-Nationals game was postponed by a Covid-19 outbreak.
Credit…Laurence Kesterson/Associated Press

The Washington Nationals postponed their Wednesday night game against the Philadelphia Phillies after a dozen players and staff members tested positive for coronavirus.

In a statement, the Nationals said the game was postponed to “allow for continued testing and contact tracing involving members of the National organizations.”

The wave of infections came after a Nationals shortstop, Trea Turner, left during the first inning of Tuesday night’s game against the Phillies after testing positive for the virus.

Dave Martinez, manager of the Nationals, told reporters that four players, including Turner, and eight staff members were among the positive cases, ESPN reported.

Mr. Martinez also told reporters he believed that one of the dozen cases was a person who is unvaccinated, according to ESPN.

The Nationals are among many M.L.B. teams that have been able to loosen safety protocols after reaching the 85 percent vaccination threshold set by the league. Players and coaches on these teams do not have to wear masks in the dugout or bullpen during games, can work out without masks in weight rooms and are subject to less frequent testing for the virus.

The Nationals had a previous outbreak at the beginning of the season when their series against the Mets was postponed in April after four Nationals players and a staff member tested positive for the virus.

And after several Yankees players tested positive for the virus, that team had to postpone its July 15 game against the Red Sox.

The Nationals and Phillies are set to make up the Wednesday game as part of a doubleheader on Thursday.

A medical worker administered a shot of the Johnson & Johnson vaccine to Fulvio Fraschini at a cultural center on the outskirts of Milan, Italy, on Wednesday.
Credit…Antonio Calanni/Associated Press

The Food and Drug Administration on Wednesday agreed to allow Johnson & Johnson to extend the shelf life of its coronavirus vaccine to six months.

The F.D.A.’s decision came as state health officials were growing increasingly concerned about whether doses of the vaccine would expire and go to waste. The vaccines were previously set to expire after four and a half months.

In a letter, the F.D.A. said its decision was “applicable to batches that might have expired prior to the issuance of this concurrence letter” and had been stored at the proper temperature, between 2 to 8 degrees Celsius, or 35.6 and 46.4 Fahrenheit.

The single-dose Johnson & Johnson vaccine can be stored at normal refrigeration, which has helped states reach more isolated communities where it may be difficult to manage a two-dose vaccine like those made by Pfizer-BioNTech and Moderna. Both of those must be stored at much lower temperatures.

As of Wednesday, more than 13 million Americans had received the one-shot Johnson & Johnson vaccine, according to data from the Centers for Disease Control and Prevention.

The Pfizer-BioNTech vaccine has been the most widely administered in the United States, with more than 87 million Americans fully vaccinated with it. More than 63 million people in the United States have been fully vaccinated with the Moderna formula.

President Biden on Tuesday.
Credit…T.J. Kirkpatrick for The New York Times

President Biden will formally announce on Thursday that all civilian federal employees must be vaccinated against the coronavirus or be forced to submit to regular testing, social distancing, masking requirements and restrictions on most travel, two people familiar with the president’s plans said Wednesday.

White House officials said the administration is still reviewing the specific details of the policy, which the president is expected to announce in a speech from the White House. In a statement on Tuesday, Mr. Biden said his remarks will reveal “the next steps in our effort to get more Americans vaccinated.”

The president’s move is expected to be similar to an announcement on Wednesday by Gov. Andrew M. Cuomo of New York, who said that tens of thousands of state employees would be required to show proof of vaccination or submit to weekly testing. Mr. Cuomo also said that “patient-facing” health care workers at state-run hospitals would be required to be vaccinated as a condition of their employment. Two days earlier, New York City announced that all 300,000 municipal employees must be vaccinated or submit to weekly testing.

The federal plan will not force employees to get a shot unless they work directly with patients at hospitals run by the Veterans Affairs department. But public health officials are hoping that the prospect of extra burdens for the unvaccinated will help convince more people to get one.

Mr. Biden’s decision to embrace stricter vaccine rules for federal workers follow days of deliberations and reflect growing concern among top federal health officials about the spread of the highly contagious Delta variant, which poses a special threat to children, older Americans and those with weakened immune systems, including cancer patients. But that concern, officials said, must be balanced against the threat of a backlash that could drive opposition to vaccination. Recent research has shown that vaccines remain effective against the worst outcomes of Covid-19, including those involving the Delta variant.

Asked by a reporter on Tuesday whether he would require vaccinations for the nation’s nearly two million federal workers, Mr. Biden was blunt.

“That’s under consideration right now,” he said, adding, “But if you’re not vaccinated, you’re not nearly as smart as I thought you were.”

Mr. Biden did not provide details, but administration officials said the idea being debated was similar to the New York City mandate.

It was not clear if Mr. Biden was planning something similar for the military, although he does have the authority to do so. Defense Secretary Lloyd J. Austin III has said he would not be comfortable with a mandate until the Food and Drug Administration had fully approved the vaccine.

The officials said that this was not a matter of simply firing federal employees who refused to be vaccinated, but that the government could add burdens or restrictions — like extensive testing or a ban on all but essential travel — for those who did not willingly get the protections. They said there was evidence that making life inconvenient for those who refuse the vaccine works reasonably well to increase inoculation rates.

The move underscores the need by Mr. Biden and his top health advisers to grapple with the limits of his legal authority when it comes to forcing Americans to be vaccinated. Aides say the president has no power to order all Americans to get a shot, nor can he require children to be vaccinated as a condition of attending school; that is a function reserved for state or local governments.

A student received a second dose of the Pfizer vaccine at the Family Life Academy Charter School Middle School in the Bronx on Tuesday.
Credit…James Estrin/The New York Times

Pfizer reported on Wednesday that the power of its two-dose Covid vaccine wanes slightly over time, but nonetheless offers lasting and robust protection against serious disease. The company suggested that a third shot could improve immunity, but whether boosters will be widely needed is far from settled, the subject of heated debate among scientists.

So far, federal health officials have said boosters for the general population are unnecessary. And experts questioned whether vaccinated people should get more doses when so many people have yet to be immunized at all.

“There’s not enough evidence right now to support that that is somehow the best use of resources,” said Natalie Dean, a biostatistician at Emory University in Atlanta.

Still, the findings raise questions about how much the Pfizer vaccine will prevent infection in the months to come. And with coronavirus cases surging again in many states, the data may influence the Biden administration’s deliberations about delivering boosters for older people.

If third shots are cleared for the general population, the boosters would likely represent a multi-billion-dollar business for Pfizer.

In a study posted online but not yet peer-reviewed or published in a scientific journal, Pfizer and BioNTech scientists reported that the vaccine had a sky-high efficacy rate of about 96 percent against symptomatic Covid-19 for the first two months following the second dose. But the figure declined by about 6 percent every two months after that, falling to 83.7 percent after about four to six months.

Against severe disease, however, the vaccine’s efficacy held steady at about 97 percent.

“It’s not a big drop, but it is noteworthy,” Dr. Dean said. “Overall, they find that the vaccine is still performing very well, at very high efficacy.”

The study period ended before the rise of the Delta variant, the highly contagious version of the virus that now dominates in the United States and makes vaccines somewhat less effective against infection.

The findings come from 42,000 volunteers in six countries who participated in a clinical trial that Pfizer and BioNTech began last July. Half of the volunteers got the vaccine, while the other half received a placebo. Both groups received two shots spaced three weeks apart.

The researchers compared the number of people in each group who developed symptoms of Covid-19, which was then confirmed by a P.C.R. virus test. When the companies announced their first batch of results, the vaccine showed an efficacy against symptomatic Covid-19 of 95 percent.

In other words, the risk of getting sick was reduced by 95 percent in the group that got the vaccine, compared with the group that got the placebo. That result — the first for any Covid-19 vaccine — brought an exhilarating dose of hope to the world in December when it was riding what had been the biggest wave of the pandemic.

Since then, the Pfizer-BioNTech vaccine has made up the majority of shots that Americans have received, with more than 191 million doses given so far, according to the Centers for Disease Control.

In the new study, the researchers followed the volunteers for six months after vaccination, up to March 13. Over the entire period, the researchers estimated, the vaccine’s efficacy was 91.5 percent against symptomatic Covid-19. (The study did not measure the rate of asymptomatic virus infections.)

But within that period, efficacy did gradually drop. Between one week and two months after the second dose, the figure was 96.2 percent. In the period from two to four months following vaccination, efficacy fell to 90.1 percent. From four months after vaccination to the March cutoff, the figure was 83.7 percent.

Those figures still describe a remarkably effective vaccine, however, and may not convince critics that booster shots are widely needed.

Earlier on Wednesday, Pfizer reported that a third dose of its vaccine significantly increases blood levels of antibodies against several versions of the virus, including the Delta variant.

Results were similar for antibodies produced against the original virus and the Beta variant, which was first identified in South Africa. Pfizer and BioNTech expect to publish more definitive research in the coming weeks.

The announcement was a preliminary snapshot of data contained in an earnings statement. The finding has not been peer-reviewed nor published in a scientific journal. And although antibody levels are an important measure of immunity, they are not the only metric. The body has other defenses that turn back infection.

Pfizer also said in its statement that vaccines for children ages 5 through 11 years could be available as early as the end of September. The vaccine is already authorized in the United States for everyone ages 12 and up.

Pfizer’s vaccine brought in $7.8 billion in revenue in the last three months, the company said, and is on track to generate more than $33.5 billion this year.

The vaccine is poised to generate more sales in a single year than any previous medical product, and by a wide margin. The sales figures are poised to translate into billions of dollars in profit for the drugmaker.

Patrons in Grand Central Market in Los Angeles wore masks on Tuesday. California’s Department of Public Health recommended on Wednesday that people wear masks indoors regardless of vaccination status.
Credit…Alex Welsh for The New York Times

The new guidance about mask-wearing that the Centers for Disease Control and Prevention issued on Tuesday is not legally binding, leaving it up to state and local officials to decide whether and how to implement it. And that in turn depends greatly on local politics.

The C.D.C.’s recommendation that all adults in areas where the coronavirus is spreading rapidly go back to wearing masks indoors, even if they are fully vaccinated, was met with a sharp backlash in some areas, especially from political leaders in Republican-leaning states where mask mandates have been banned.

Officials in some states took the new guidance and swiftly ran with it. Others decided to take a wait-and-see approach.

In New Jersey, where eight of 21 counties meet the C.D.C.’s threshold, Gov. Philip D. Murphy, a Democrat, “strongly recommended” that all residents wear masks in indoor settings where the risk of spread may be high. In California, the public health department recommended residents wear masks in indoor public spaces, regardless of vaccination status. The moves came a day after the officials in Illinois joined the C.D.C. in recommending face coverings, and after Nevada issued a mask mandate.

Dr. Ngozi Ezike, director of the Illinois Department of Public Health, said that even though current vaccines are effective, including the highly contagious Delta variant, “we are still seeing the virus rapidly spread among the unvaccinated,” increasing the risk for everyone.

Gov. Steve Sisolak, a Democrat of Nevada, went further, reinstating a mask mandate set to take effect on Friday for all residents in indoor public spaces in counties with high rates of transmission, including Clark County, home to Las Vegas.

In Washington State, Gov. Jay Inslee urged all residents on Wednesday to follow the C.D.C.’s new mask guidance, but did not issue a mandate.

Other jurisdictions, including Delaware, the District of Columbia, and New York, were among the jurisdictions saying that said they would review the C.D.C.’s guidance before making any decisions. While all of New York City currently exceeds the coronavirus transmission threshold that the C.D.C. set to determine where indoor masking is needed, Mayor Bill de Blasio said at a news conference on Wednesday that the city was still evaluating the guidance and the research and data that underpinned it.

And several Republican governors just said no, including Greg Abbott of Texas, Doug Ducey of Arizona, Pete Ricketts of Nebraska, Kim Reynolds of Iowa, and Brian Kemp of Georgia. Conservatives in those states have often cast public health measures as an attack on freedom.

“I’m concerned that this guidance will be used as a vehicle to mandate masks in states and schools across the country, something I do not support,” Ms. Reynolds said in a statement.

Mr. Abbott, who signed an executive order in May preventing local governments from requiring masks, said that wearing a face covering was a matter of personal responsibility.

“Every Texan has the right to choose whether they will wear a mask or have their children wear masks,” Mr. Abbott wrote in a tweet.

Meanwhile, Apple said it will start requiring employees and customers to wear masks regardless of their vaccination status in certain stores across the country in accordance with the new C.D.C. guidelines.

C.D.C. officials also called on Tuesday for universal masking for teachers, staff, students and visitors in schools, regardless of vaccination status and transmission rates of the virus. Some school districts in Alabama and Georgia did not wait for state governments to weigh in, and immediately instituted their own mask requirements. Mr. Inslee of Washington said his state would retain its school mask mandate for students and staff.

In Florida, where new case reports have surged nearly tenfold over the last month to an average of more than 10,000 a day, Gov. Ron DeSantis of Florida, a Republican, issued a statement encouraging parents in his state to decide what’s best for their children when it comes to masking.

The governor did not address the new guidance about vaccinated adults at a news conference in Milton, Fla., on Wednesday. Florida never had a statewide mask mandate.

Mayor Daniella Levine Cava of Miami-Dade County, Fla., said at a news conference on Wednesday that masks would be required for employees and visitors at all indoor county facilities.

“I have pledged from the beginning that if we see a spike in the positivity rates that we would take all the necessary steps to protect the community, including making updated recommendations,” she said.

Other jurisdictions, like Los Angeles County and St. Louis County, Mo., had reinstated mask mandates even before the C.D.C.’s announcement.

But in a sign of the political challenges some local officials face, the St. Louis County Council voted on Tuesday evening to repeal the order. The move came a day after Attorney General Eric Schmitt of Missouri, a Republican, filed a lawsuit seeking to halt implementation of the county mandate, which is still in effect in the city of St. Louis.

On Wednesday, Mr. Schmitt wrote on Twitter that he plans to sue Kansas City, Mo., as well, following an announcement by Mayor Quinton Lucas that he would reimpose a mask mandate.

In Georgia, Mayor Keisha Lance Bottoms of Atlanta on Wednesday issued a mask mandate in indoor public spaces, even after Gov. Kemp said he opposed them.

“Georgia is not moving backwards,” he said on Twitter.

The Biden administration asked White House staffers on Tuesday to wear masks indoors, and the Office of Management and Budget detailed new mask rules for federal agencies. In an email obtained by The New York Times, the agency said, “In areas of substantial or high community transmission, agencies must require all federal employees, on-site contractors, and visitors, regardless of vaccination status, to wear a mask inside of federal buildings.”

Alan Rappeport and Michael Gold contributed reporting.

Orange County, Fla., home to Disney World, has issued a state of emergency due to rising cases. 
Credit…John Raoux/Associated Press

Starting Friday, Disney World in Florida will require guests older than 2 to wear masks in indoor spaces, reversing its policy that allowed fully vaccinated guests to go without them.

The change was announced after the Centers for Disease Control and Prevention on Tuesday recommended that Americans, regardless of vaccination status, wear face masks in indoor public spaces in areas with high rates of transmission.

It also came as Orange County Mayor Jerry L. Demings on Wednesday signed an executive order declaring a state of local emergency as cases rose in the county, which is home to Disney World.

“I urge residents and visitors — vaccinated and unvaccinated — to wear a mask while indoors and to follow updated C.D.C. guidelines,” Mr. Demings wrote on Twitter.

Over the past two weeks, coronavirus infections in Orange County have increased by 184 percent, and hospitalizations have risen by 116 percent, according to New York Times data.

Disney World’s new policy could draw some backlash from Gov. Ron DeSantis, who after the C.D.C.’s announcement said it was up to parents to decide whether their children should wear masks.

On Wednesday, Gov. DeSantis doubled down on his comments, saying that making children wear masks is “bad policy.”

“Parents are best equipped to decide whether they want their kids to wear a mask in school,” the governor wrote on Twitter. “Neither bureaucrats in Washington nor local authorities should be able to override the decision of the parents.”

Disney World was not the only company that reversed course in response to the C.D.C.’s advice. Apple also said it will start requiring employees and customers to wear masks regardless of their vaccination status in certain stores across the country, in accordance with the new C.D.C. guidelines.

Gov. Andrew Cuomo of New York announced a vaccine or testing mandate for all public employees on Wednesday.
Credit…Mary Altaffer/Associated Press

Responding to lagging vaccination rates and a rise in coronavirus cases, Gov. Andrew M. Cuomo said on Wednesday that New York’s tens of thousands of state employees would be required to show proof of vaccination or face weekly testing.

The governor also announced a much stricter mandate for state-run hospitals, saying that all “patient-facing” health care workers at those facilities would be required to be vaccinated, without the option of regular testing instead.

Mr. Cuomo’s announcement comes two days after Mayor Bill de Blasio announced a similar requirement for New York City’s government work force of 300,000 employees.

Much of the nation is grappling with the rapid spread of the Delta coronavirus variant. Earlier this week, Gov. Gavin Newsom of California announced his own requirement that would cover 246,000 state government employees, as well as two million health care workers in the public and private sectors.

The North Carolina Department of Health and Human Services will require all workers and volunteers at state-operated facilities to be fully vaccinated or receive an approved medical or religious exemption by Sept. 30, according to a statement sent to The New York Times on Wednesday. Officials did not respond to questions about whether those with exemptions will be required to undergo testing.

President Biden plans to formally announce on Thursday that all civilian federal employees must be vaccinated against the coronavirus or be forced to submit to regular testing, social distancing, mask requirements and restrictions on most travel, two people familiar with the president’s plans said Wednesday. Such a policy would be a stark shift for a president who has grappled with the authority he has to force Americans to get vaccinated. Mr. Biden is expected to say more about his plans later this week.

The increasing support among government officials for vaccine mandates, which have met with pushback from some unions, underscores their concern with a far more contagious variant that poses a special threat to children, and older and unvaccinated people.

“We’re working with our unions to implement this quickly and fairly,” Mr. Cuomo, a third-term Democrat, said during remarks to a state business group on Wednesday.

The new state policy will go into effect by Labor Day, he said.

Earlier this week, Mr. Cuomo had shied away from imposing such a requirement on the state’s work force, arguing that most “public-facing” employees were municipal workers, and suggesting it was more of a decision for localities.

But Mr. Cuomo’s shift in stance appeared inevitable following Mr. de Blasio’s announcement and news that a similar move was under consideration at the federal level.

Mr. Cuomo highlighted the urgency behind the change, noting the steady rise in coronavirus cases statewide: About 2,200 new cases were reported on Tuesday, up from 275 on a month ago, on June 28.

Currently, most New York State employees are not subject to regular testing, except for those working in some congregate settings like colleges and universities.

For example, staff and faculty members at the State University of New York and the City University of New York are required to get tested for the coronavirus weekly unless they are fully vaccinated, a policy similar to the one Mr. de Blasio announced this week.

The public universities will require proof of vaccination from students attending in-person classes once the Food and Drug Administration fully approves the vaccines, although that could be months away. The vaccines are now being administered under an emergency use authorization.

Dan Levin contributed reporting.

Most people wore masks at Grand Central Terminal in Manhattan on Tuesday.
Credit…Brittainy Newman for The New York Times

All of New York City currently exceeds the threshold for coronavirus transmission outlined by the Centers for Disease Control and Prevention on Tuesday in its guidance recommending that vaccinated people resume wearing masks in public indoor spaces in areas where the virus is raging.

Agency officials said that Americans should wear masks indoors in parts of the country that have recorded more than 50 new infections per 100,000 residents over the previous week, or where more than 8 percent of tests are positive for infection over that period.

All five counties in New York City fall under those parameters. Staten Island, which has again become a virus hot spot and has some of the lowest vaccination rates in the city, recorded 109 cases per 100,000 residents last week, according to the C.D.C. In Brooklyn and Manhattan, 78.1 and 70.4 cases were recorded, respectively, while the Bronx (58.6) and Queens (56.4) are both closer to the 50-case benchmark set by the C.D.C.

The agency’s recommendations are not binding, and on Wednesday, it remained unclear whether New York City would alter its mask requirements to reflect the new guidelines.

Mayor Bill de Blasio said at a news conference that the city was still evaluating the guidance and the research and data that underpinned it.

“We got it less than 24 hours ago, and it is complicated information,” Mr. de Blasio said. “So our health team is reviewing and we’ll have more to say on it in the next few days.”

As they weighed the C.D.C.’s suggestions, city health officials continued to urge residents to get vaccinated. Starting Friday, the city will give $100 to residents who get their first dose of a vaccine at city-run vaccination sites.

Mr. de Blasio has in recent days emphasized the need for vaccine mandates as the pace of inoculations has slowed in the city. But on Wednesday, he said that the city still believed incentives could work hand-in-hand with more forceful vaccine guidance.

“There are a huge number of New Yorkers open to vaccination but just haven’t quite gotten there,” he said. “I think when someone says here’s $100 for you, that’s going to make a big impact.”

Officials at the C.D.C. also called for universal masking in schools, a policy that New York City’s public school system, the nation’s largest, had already said it would keep in place.

Currently, vaccinated individuals are largely not required to wear masks in New York State, though they are required on the city’s buses, subways and trains.

Google’s campus in Mountain View, Calif. The company will delay its return to office and mandate vaccines for its workers.
Credit…Christie Hemm Klok for The New York Times

Google said Wednesday that it would require employees who returned to the company’s offices to be vaccinated against the coronavirus. It also said it would push back its official return-to-office date to mid-October from September, joining a host of other companies whose plans have been scrambled in recent days by the spread of the highly contagious Delta variant.

Sundar Pichai, the chief executive of Alphabet, Google’s parent company, announced the news in a note to employees, which was reviewed by The New York Times.

“Getting vaccinated is one of the most important ways to keep ourselves and our communities healthy in the months ahead,” Mr. Pichai wrote. He added that the vaccine mandate would apply to U.S. office locations “in the coming weeks” and to other regions “in the coming months.”

Google has more than 144,000 employees globally. A Google spokeswoman said the company did not have any current vaccination rates to share, though Mr. Pichai wrote that it was “encouraging to see very high vaccination rates” among employees in places where vaccines were widely available.

Mr. Pichai also said in the note that Google’s voluntary work-from-home policy was being extended through Oct. 18. Previously, employees had been planning to return in September, though no specific date had been set.

“We recognize that many Googlers are seeing spikes in their communities caused by the Delta variant and are concerned about returning to the office,” Mr. Pichai wrote. “This extension will allow us time to ramp back into work while providing flexibility for those who need it.”

The decision followed a similar announcement from Apple, which said last week that it would push back to October, from September, the date by which employees would need to return to its offices.

The companies are among many in tech that are changing their office plans as coronavirus cases spike. Lyft said on Wednesday that it would not require employees to return to the office until February, while Twitter said it would close its newly reopened offices in San Francisco and New York and indefinitely postpone other reopening plans.

Some Google employees have been returning to work in the office on a voluntary basis. In California, as the Delta variant of the coronavirus has surged, workers began donning masks in Google offices again.

Silicon Valley tech companies like Google led the push to remote work in the beginning of the pandemic, but Google has not fully pivoted away from office work, and it has said it expects most employees to eventually return to in-person work at least three days a week.

The company said in March that it would spend $1 billion on California developments this year, including two office complexes in Mountain View. It is also building a 7.3 million-square-foot office space in San Jose.

A child receiving a yellow fever vaccine in Sao Paulo, Brazil, in 2018. Routine  childhood vaccinations have dropped off in Latin America since the pandemic began.
Credit…Andre Penner/Associated Press

The coronavirus pandemic is opening the way for other preventable diseases to surge across Latin America and the Caribbean, interfering with routine inoculations and medical treatment in one of the world’s hardest-hit regions, World Health Organization officials warned on Wednesday.

There has been a sharp decline in measles vaccinations throughout the region, and a recent survey found that the pandemic has slowed efforts to diagnose and treat viral hepatitis B and C infections throughout Latin America and the Caribbean.

“More than 300,000 children, mostly in Brazil and Mexico, missed out on their routine immunizations last year, leaving them vulnerable to deadly yet preventable infections,” said Dr. Carissa Etienne, the director of the Pan American Health Organization, a part of the W.H.O.

“If we do not reverse these trends we risk an avalanche of worsening health issues in the Americas,” she added. “Soon, Covid-19 will not be the only health crisis demanding countries’ attention.”

Though overall caseloads have declined in the region since the spring, Covid-19 continues to take a devastating toll, and several Latin American nations, including Argentina, Colombia, Cuba, Ecuador and Paraguay are “among the countries reporting the world’s highest weekly death rates,” Dr. Etienne said at a weekly briefing. She warned that “too many places have relaxed the public health and safety measures that have proven so effective against this virus.”

Officials voiced particular concern about Cuba, which is reporting its highest rates of new cases and deaths since the pandemic began. Hot spots have also been detected in parts of Argentina, Colombia and Mexico, and new cases have risen sharply in the United States.

Though vaccines have been plentiful in the United States, Canada, Chile, Uruguay and a few other countries in the Americas, they have been scarce elsewhere. Only one-sixth of the population of Latin America and the Caribbean has been fully vaccinated.

One of the most extreme examples is Haiti, which was only recently able to begin its vaccination campaign after a donation of shots from the United States.

Maureen McKinney’s husband was one of fifteen residents who died from a coronavirus outbreak at the Prestige Post-Acute and Rehab Center in Ellensburg, Wash.
Credit…Chona Kasinger for The New York Times

As the Delta variant raises fresh concerns about the safety of the nation’s nursing homes, the Biden administration has quietly reversed a Trump administration policy that limited the fines levied on facilities that endangered or injured residents.

Deaths in nursing homes account for nearly one-third of the U.S. pandemic’s overall death toll. They peaked at the end of last year, but have plummeted since the introduction of the Covid-19 vaccines.

Even so, advocates and some officials say, inadequate staffing, shortages of protective equipment and poor infection control remain concerns at the nation’s 14,000 skilled nursing facilities.

While 81 percent of nursing home residents are now fully vaccinated, only 58 percent of workers in the homes are immunized, according to federal data, heightening the risk of outbreaks even among vaccinated residents.

There are signs of a creeping rise in infections in nursing homes, particularly among workers. The Centers for Disease Control and Prevention is investigating the source of outbreaks in Colorado nursing homes where vaccination rates may be low.

The policy favoring lower penalties, adopted in 2017 by the Trump administration, directed regulators at the Centers for Medicare and Medicaid Services to shift away from fining a nursing home for each day it is out of compliance with federal standards. The relaxed policy reduced many penalties to a single fine, effectively lowering the penalties to a maximum of $22,000, instead of amounts running into hundreds of thousands of dollars.

Many of the nursing homes that are cited for poor infection controls, failing to protect residents from avoidable accidents, neglect, mistreatment and bedsores, are repeat offenders. Larger fines act as a deterrent and are more likely to signal strong enforcement of the rules, according to Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy.

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