As the speed of vaccinations has slowed around the United States, reported coronavirus cases are on the rise in several states, including Nevada, where nearly 40 percent of the adult population has not gotten a shot.
Nevada had the third-highest count of new coronavirus cases per capita of any state as of Wednesday, with 14 per 100,000 people, trailing only Missouri (where 45 percent of the population has had at least one shot) and Arkansas (where 42 percent have gotten at least one shot).
But Nevada had the highest increase in average number of hospitalizations, which had risen nearly 62 percent over the previous two weeks, to 441.
Dr. Fermin Leguen, the district health officer for Nevada’s southern district, which includes Clark County, said that about 95 percent of Covid patients hospitalized in the past three months had not been vaccinated.
Both Nevada and Missouri have asked for help from federal “surge response teams” that the White House announced last week to help states with largely unvaccinated populations cope with the highly transmissible Delta variant of the virus. The Centers for Disease Control and Prevention estimates that about 73 percent of the coronavirus infections in Missouri involve the Delta variant, as do about 40 percent of the cases in Nevada.
The C.D.C. now estimates that Delta has become the dominant variant across the United States. Only full vaccination affords significant protection against it.
Fifty-three percent of the country’s population has not been fully vaccinated, including many children under 12 who are not eligible. And persuading unvaccinated people to get inoculated is a critical challenge for the government.
President Biden this week renewed his call to the nation to get vaccinated — pressing employers to give employees paid time off to get inoculated and to offer vaccines at work — after the country failed to meet his goal of at least partly vaccinating 70 percent of American adults by July 4.
For most of the country, the virus has receded. The seven-day average of new reported cases has held steady at about 12,000 a day, the lowest totals since testing became widely available. That is a drastic drop from the worst days of the pandemic last winter, when new cases sometimes averaged more than 250,000 a day, according to a New York Times database.
The surge in Nevada has also not come near winter’s levels, but the Times database shows that the seven-day average of cases there is about double what it was a month ago when Gov. Steve Sisolak, a Democrat, relaxed most of the state’s coronavirus restrictions.
Most of the state’s surge in cases is in Clark County, home to Las Vegas and most of the state’s population. The city rejoiced when tourists were allowed return to the casinos, theaters and other entertainments on the strip without limitations after more than a year of economic stagnation.
In a statement last week, Mr. Sisolak connected the state’s rise in cases to the emergence of the Delta variant and the low rate of vaccination in Clark County, where only 39 percent of the population is fully vaccinated.
But Brian Labus, an infectious-disease epidemiologist at the University of Nevada, Las Vegas, linked the rise to the relaxation of restrictions.
“It’s not necessarily reopening the strip to tourists — it’s that our entire community is open 100 percent,” Dr. Labus said. “It’s not just the resort hotels. It’s every restaurant, store and business in southern Nevada.”
The California State Capitol in Sacramento has toughened its mask policy after finding nine recent cases of Covid-19 in the Assembly, including four cases in people who had been fully vaccinated, legislative officials said.
The Capitol’s mask mandate is being tightened at a time when the highly contagious Delta variant, with its enhanced capacity to sidestep vaccines, accounts for nearly a third of cases in the state and more than half of cases in the country, according to new estimates from the Centers for Disease Control and Prevention.
Under the new policy, legislators and staff members, regardless of their vaccination status, must wear masks at all times in the Capitol, the Legislative Office Building and district offices.
The policy, which went into effect on Tuesday, extends to lawmakers and staff members working in office suites. Under the previous policy, masks had been required only in public areas like hallways and hearing rooms.
In addition, the Senate and the Assembly will begin twice weekly Covid testing of employees who are not fully vaccinated, according to memos from administrators in both of the branches.
Over the last 10 days, nine Assembly staff members have tested positive, though one of them later tested negative, Assembly officials said. Eight of the cases were confined to one Assembly office, officials said.
“We take this very seriously,” Speaker Anthony Rendon said in a statement. “It’s our job to serve the people and protect our staff, so that’s what we’re doing. The good news is the great majority of our staff is vaccinated.”
Erika Contreras, the secretary of the California State Senate, said in a statement that the Senate “does not have any current cases and has a host of protocols in place that we will continue to adhere to.”
Ms. Contreras pointed out that even fully vaccinated people can be infected, although they are less likely to suffer the most serious symptoms.
Through the end of April, the C.D.C. had received 10,262 reports of such breakthrough infections from 46 states and territories, a number that was very likely “a substantial undercount,” according to the agency’s own report. In May, however, the C.D.C. stopped investigating breakthrough infections among the fully vaccinated except in cases of hospitalization or death.
Research suggests that full inoculation with the vaccines in use in the United States provides good protection against Delta — and remains highly effective at preventing hospitalizations and deaths.
But several studies have shown that while those vaccines used are effective against Delta, they are slightly less so than against most other variants. Researchers are concerned that fully vaccinated people may sometimes pick up asymptomatic infections and unknowingly spread the virus to others.
Britain could reach a record 100,000 new Covid cases per day, the country’s top health official acknowledged this week, even as he strongly defended the government’s plan to lift most virus restrictions on July 19.
The health secretary, Sajid Javid, said that vaccines had “severely weakened” the link between infections and hospitalizations and deaths.
About 51 percent of adults in Britain are fully vaccinated, according to data compiled from government sources by the Our World in Data project at the University of Oxford. And despite a surge driven by the highly contagious Delta variant that has pushed average new cases past 27,000 a day, hospitalizations are in the hundreds and daily deaths remain in the lower double digits.
“The vaccine has been our wall of defense — jab by jab, brick by brick, we have been building a defense against this virus,” Mr. Javid told the House of Commons on Tuesday.
Mr. Javid spoke forcefully in support of Prime Minister Boris Johnson’s bold experiment to jettison most virus restrictions — including capacity limits, social-distancing rules and mask mandates — even as cases are rising steeply and the highly contagious Delta variant is spreading globally.
Mr. Javid said modeling suggested that infections could be as high as 50,000 per day, double the current rate, on July 19, or “Freedom Day,” as it has been dubbed by the British press.
After that, Britain could reach 100,000 new cases per day, Mr. Javid said, although he cautioned that virus models are less certain further into the future.
Britain reported 27,334 new cases on Monday and 178,128 over the last week, an increase of 53 percent over the previous week.
In a speech to the House of Commons on Monday, Mr. Javid also warned that cases could rise, but said the vaccines would mitigate the worst effects of the virus.
“There is no risk-free — absolutely risk-free — way to move forward,” Mr. Javid said then. “But we do need to start returning things back towards normal and learning to live with Covid.”
The assassination of President Jovenel Moïse of Haiti on Wednesday could complicate efforts to contain the Covid-19 pandemic in the Caribbean nation, which has yet to begin vaccinating its citizens, officials from the World Health Organization warned.
Carissa Etienne, the director of the Pan American Health Organization, which is part of the W.H.O., said her organization had made Haiti a priority in recent weeks as reported cases have surged.
“I am hopeful that the arrival of vaccines in the country can start to turn the tide of the pandemic and bring some relief to the Haitian people during these very difficult times,” Dr. Etienne said. “We continue to stand with them now and will redouble our efforts.”
Haiti did not experience the kind of surge early in the pandemic that many experts feared could devastate the country, the poorest in the Western Hemisphere. But the pandemic has grown worse in recent weeks, with a rise in reported cases that experts say is almost certainly an undercount, considering the country’s limited testing capacity.
Last month, Covid-19 claimed the life of René Sylvestre, the president of Haiti’s Supreme Court — a leading figure who might have helped to establish order in the wake of an assassination that has plunged the country into even deeper political uncertainty.
Dr. Etienne’s organization said in an email that while it was too soon to evaluate the impact of the assassination, “further deterioration of the security situation in Haiti could have a negative impact on the work that has been done to curtail Covid-19 infections,” as well as on vaccination plans.
The organization said that Haiti was also facing challenges from the start of hurricane season and the recent detection of the Alpha and Gamma virus variants on the island. Though “vaccines are expected to arrive shortly” in Haiti, the organization said it did not have a specific delivery date.
In June, Dr. Etienne urged the global community to do more to help Haiti cope with rising coronavirus cases and deaths. “The situation we’re seeing in Haiti is a cautionary tale in just how quickly things can change with this virus,” she said.
Haiti is an extreme example of the “stark inequities on vaccine access,” Dr. Etienne said. “For every success, there are several countries that have been unable to reach even the most vulnerable in their population.”
Across Latin America and the Caribbean, there are millions of people who “still don’t know when they will have a chance to be immunized,” she said.
She said the inequitable distribution of vaccines posed practical and moral problems.
“If we don’t ensure that countries in the South have the ability to vaccinate as much as countries in the North, this virus will keep circulating in the poorest nations for years to come,” Dr. Etienne said. “Hundreds of millions will remain at risk while the wealthier nations go back to normal. Obviously, this should not happen.”
The highly contagious Delta variant of the coronavirus is now the dominant variant in the United States, accounting for 51.7 percent of infections, according to new estimates from the Centers for Disease Control and Prevention.
As health officials had expected, the Delta variant has rapidly overtaken Alpha, the variant that spread through the United States this spring. Alpha, first detected in Britain, now makes up just 28.7 percent of infections, according to the C.D.C.
Still, overall, 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 national surges.
Delta was first detected in India. Research suggests that most vaccines still provide good protection against it and remain highly effective at preventing hospitalizations and deaths.
In England, for instance, where the variant now causes almost all infections, case numbers have risen sharply in recent weeks, but hospitalization rates have increased more slowly and remain low. Next week, a final decision will be made about whether to lift most remaining restrictions in England, including mask rules, on July 19.
Studies suggest, however, that a single shot of a two-dose regimen provides only weak protection against Delta, and public health experts have been encouraging Americans to get fully vaccinated as soon as possible.
As of Wednesday, 67.2 percent of adults in the United States have had at least one vaccine dose, and 58.4 percent are fully vaccinated.
Still, vaccination coverage remains highly uneven, both in the United States and globally, and public health experts say Delta poses a serious threat to unvaccinated populations. On Tuesday, President Biden again urged Americans to get their shots, citing concerns about Delta. “It sounds corny, but it’s a patriotic thing to do,” he said.
Health experts say the Biden administration may need to take more aggressive action to encourage vaccination, including urging employers and schools to adopt vaccine mandates. As of Wednesday, administering about 0.73 million doses per day on average, about a 78 percent decrease from the peak of 3.38 million reported on April 13, according to federal data.
As for the virus itself, the country has been averaging fewer than 15,000 new coronavirus cases a day for nearly a month, the lowest levels since testing became widely available and a fraction of what was reported in January, when the nation routinely identified more than 200,000 cases in a day.
In recent days, however, the average number of new cases has started to trend slightly upward nationally, driven largely by localized outbreaks in places with low vaccination rates, including parts of Missouri, Arkansas and Nevada.
As the Delta variant has spreads across the globe, the World Health Organization recently reiterated its longstanding guidance that everyone, vaccinated or not, should wear masks as a precaution. In the United States, however, the C.D.C. has not changed its advice that those who are fully vaccinated can skip masks in most situations.
U.S. health officials have suggested that the W.H.O.’s blanket suggestion was informed by its global purview, since many countries have had far less access to vaccines than the United States.
In New York City, efforts to monitor the spread of the virus have been scaled back, reflecting a steadily low caseload and a sense held by many that the virus is less of a wide threat. More than 51 percent of residents are fully vaccinated, according to city data, though large parts of the city still have lower rates. Coupled with concerns about Delta, some public health experts and elected officials are worried that the city may be pulling back on its surveillance measures too soon.
On Tuesday, Jen Psaki, the White House press secretary, said that the Biden administration was unlikely to impose new national mitigation measures, even if cases rise.
“The states are going to have to make evaluations and local communities are going to have to make evaluations about what’s in their interests,” she said.
Mitch Smith and Sharon Otterman contributed reporting.
The Federal Reserve Bank of Minneapolis will require employees to be vaccinated against the coronavirus when they enter its office next month.
By the end of August, they must attest that they are fully vaccinated if they wish to remain employed, Neel Kashkari, the president of the Minneapolis Fed, wrote in a memo posted to its website on Wednesday. Only employees who cannot get vaccinated because of medical conditions or religious beliefs will receive accommodations.
“While some staff may be unhappy with this new requirement, we believe most will appreciate the actions we are taking on our collective behalf,” Mr. Kashkari wrote.
The requirement will affect the bank’s 1,100 workers, of which about 82 percent are already fully vaccinated, he wrote. The remaining 18 percent have not disclosed their vaccination plans or don’t plan to get vaccinated.
Mr. Kashkari said that the decision had been made out of a preference for face-to-face interactions in the office and that “there is no way for us to bring a critical mass of our staff back into our facilities and maintain social distancing.”
The federal Equal Employment Opportunity Commission has said that companies can require those returning to offices to be vaccinated. Employers may also ask employees about their vaccination status, according to the Commission’s ruling.
Other employers have announced vaccination requirements for their return-to-office plans. Morgan Stanley said last month that it would require vaccination for employees, contingent workers, clients and visitors at the bank’s buildings in New York City and Westchester County, N.Y.
As the Delta variant sweeps the world, researchers are tracking how well vaccines protect against it — and getting different answers.
In Britain, researchers reported in May that two doses of the Pfizer-BioNTech vaccine had an effectiveness of 88 percent protecting against symptomatic disease from Delta. A June study from Scotland concluded that the vaccine was 79 percent effective against the variant. On Saturday, a team of researchers in Canada pegged its effectiveness at 87 percent.
And on Monday, Israel’s Ministry of Health announced that the effectiveness of the Pfizer-BioNTech vaccine was 64 percent against all coronavirus infections, down from about 95 percent in May, before the Delta variant began its climb to near-total dominance in Israel.
Although the range of these numbers may seem confusing, vaccine experts say it should be expected, because it’s hard for a single study to accurately pinpoint the effectiveness of a vaccine.
“We just have to take everything together as little pieces of a puzzle, and not put too much weight on any one number,” said Natalie Dean, a biostatistician at Emory University.
In clinical trials, it’s (relatively) easy to measure how well vaccines work. Researchers randomly assign thousands of volunteers to get either a vaccine or a placebo. If the vaccinated group has a lower risk of getting sick, scientists can be confident that it’s the vaccine that protected them.
But once vaccines hit the real world, it becomes much harder to measure their effectiveness. Scientists can no longer control who receives a vaccine and who does not. If they compare a group of vaccinated people with a group of unvaccinated people, other differences between the groups could influence their risks of getting sick.
It’s possible, for example, that people who choose not to get vaccinated may be more likely to put themselves in situations where they could get exposed to the virus. On the other hand, older people may be more likely to be vaccinated but also have a harder time fending off an aggressive variant. Or an outbreak may hit part of a country where most people are vaccinated, leaving under-vaccinated regions unharmed.
One way to rule out these alternative explanations is to compare each vaccinated person in a study with a counterpart who did not get the vaccine. Researchers often go to great lengths to find an unvaccinated match, looking for people who are of a similar age and health. They can even match people within the same neighborhood.
“It takes a huge effort,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Health.
For its new study, Israel’s Ministry of Health did not go to such great lengths to rule out other factors. “I am afraid that the current Israeli MoH analysis cannot be used to safely assess it, one way or another,” Uri Shalit, a senior lecturer at the Technion — Israel Institute of Technology, wrote on Twitter.
Israel’s numbers could also be different because of who is getting tested. Much of the country is vaccinated. During local bursts of new infections, the government requires testing for anyone — symptoms or not — who came into contact with a person diagnosed with Covid-19. In other countries, it’s more common for people to get tested because they’re already feeling sick. This could mean that Israel is spotting more asymptomatic cases in vaccinated people than other places are, bringing their reported effectiveness rate down.
Fortunately, all the studies so far agree that most Covid-19 vaccines are very effective at keeping people out of the hospital and have generally protected against the Delta variant. Israel’s Ministry of Health estimated that the Pfizer-BioNTech vaccine is about 93 percent effective in preventing serious illness and hospitalization.
“Their overall implications are consistent: that protection against severe disease remains very high,” said Naor Bar-Zeev, an associate professor at the Johns Hopkins Bloomberg School of Public Health.
Because effectiveness studies are so tricky, it will take more work to determine how big a threat Delta poses to vaccines. Dr. Lipsitch said that studies from more countries would be required.
“If there are five studies with one outcome and one study with another, I think one can conclude that the five are probably more likely to be correct than the one,” Dr. Lipsitch said.
Richard Williamson, 86, was rushed from a Florida jail to a hospital last July. Within two weeks, he had died of Covid-19.
Hours after Cameron Melius, 26, was released from a Virginia jail in October, he was taken by ambulance to a hospital, where he died. The coronavirus, the authorities said, was a contributing factor.
And in New York City, Juan Cruz, 57, who fell ill with Covid while in jail, was moved from a hospital’s jail ward into its regular unit before dying.
None of these deaths have been included in official Covid mortality tolls of the jails where the men had been detained. And these cases are not unique. The New York Times identified dozens of people around the country who died under similar circumstances but were not included in official counts.
In some cases, deaths were added to facilities’ virus tolls after The Times brought missing names to the attention of officials. In other cases, people infected with the coronavirus while incarcerated were granted legal releases because of the severity of their illnesses but were not included in the death tallies of the jails where they got sick. Still other inmates’ deaths were left off facilities’ list of virus deaths for reasons that are unexplained.
More than 2,700 people are reported to have died of Covid-19 in connection to U.S. prisons, jails and immigration detention centers, but the additional cases raise the prospect that the known toll on incarcerated people falls far short of providing the full picture.
Concerns about how coronavirus deaths are documented have emerged throughout the pandemic, including a finding that the toll among nursing home residents in New York State was far higher than known because thousands who died in hospitals had not been included.
Public health officials say the prospect of overlooked virus deaths tied to the nation’s prisons, jails and immigration detention centers carries particular risks. It is challenging, the experts say, to prepare prisons for future epidemics without knowing the accurate toll. For now, the publicly known death totals connected to incarceration largely come from the facilities themselves.
“You can’t make good public policy if you don’t know what’s actually going on on the ground,” said Sharon Dolovich, director of the Covid Behind Bars Data Project at the University of California, Los Angeles, which tracks coronavirus deaths in American prisons.
Maura Turcotte, Rachel Sherman, Rebecca Griesbach, Ann Hinga Klein, Brendon Derr and
GLOBAL ROUNDUP
Fiji, which got through the first year of the pandemic almost untouched, is now battling one of the fastest-growing Covid-19 outbreaks in the world.
The number of new coronavirus cases reported daily in the Pacific island nation of 900,000 people has soared into the hundreds over the past month, after never exceeding single digits before late May. Officials said the outbreak appeared to have begun after a case of the highly contagious Delta variant escaped the country’s isolation facilities.
As of Wednesday, the country was averaging 383 new cases a day, or 43 for every 100,000 people, according to a New York Times database. The 636 new cases reported on Wednesday set a record. Thirty-seven of the 39 Covid deaths reported in Fiji throughout the pandemic have occurred since the latest outbreak began.
The surge is swamping the country’s ability to cope. Fiji’s largest hospital is now exclusively treating Covid patients, and its mortuary is filled to capacity, the health ministry said on Monday. More than 1,000 Covid patients have been sent home from medical facilities to isolate themselves because the facilities had no space. The government is working to turn a sports arena outside Suva, the capital, into a makeshift clinic.
Repeated breaches of local health restrictions have given the virus entry points. More than 1,000 people have been arrested over breaches of a national curfew, and 48 people were arrested in a 24-hour period this week over breaches of mask requirements, according to the police. The government has declined to impose a lockdown to contain the outbreak.
About 31 percent of Fijians have had at least one dose of a coronavirus vaccine, but fewer than 5 percent are fully vaccinated, according to a New York Times database. Partial vaccination provides poor protection against the Delta variant.
Fiji, which is using the AstraZeneca vaccine, is depending on Australia and New Zealand to supply it with doses, but New Zealand’s medical regulatory body has not yet authorized the AstraZeneca vaccine, complicating the rollout. Instead, New Zealand has provided the country with 40 million New Zealand dollars, or $28 million, worth of aid and support.
“We have provided support in the form of P.P.E. and of course the commitment we’ve made around AstraZeneca vaccines, which is what Fiji are using for their rollout,” Prime Minister Jacinda Ardern said.
James Fong, Fiji’s health secretary, said that some in the country were putting off seeking treatment for Covid symptoms, sometimes with deadly results.
“We are also sadly seeing people with severe disease die at home, or on the way to hospital, before our medical teams have a chance to administer what could potentially be lifesaving treatment,” Mr. Fong said.
In other news from around the world:
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The United States, as part of its commitment to send vaccines to countries in need, will ship one million doses of the Johnson & Johnson vaccine to Bolivia, Jen Psaki, the White House press secretary, said on Wednesday. Another one million doses will be sent to Paraguay, she said. On Tuesday, Ms. Psaki announced that 1.5 million doses of the Moderna vaccine would be shipped to Guatemala and two million doses of Moderna to Vietnam. On Friday, she said that 1.5 million doses of Moderna would be sent to El Salvador.
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Spain on Wednesday reported some of its highest levels of new infections since February, and the government announced that it would distribute five million antigen test kits to regional administrations in a bid to identify cases among younger people, who are often asymptomatic. Carolina Darias, the health minister, said that nightlife was helping spread the virus, but warned against “demonizing” anybody. “We have to establish synergies with younger people,” she said.
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A two-week lockdown in Sydney, Australia’s largest city, and its surrounding areas has been extended for another week, The Associated Press reported, Of the 27 people newly found to be infected with the Delta variant in the latest 24-hour period, only 13 had been in isolation while infectious, officials said. Only 9 percent of Australian adults are fully vaccinated, heightening fears that the Delta variant could quickly spread.
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The number of coronavirus cases in Germany ticked up again on Wednesday after more than two months of steady decline, Reuters reported, citing official data. The Robert Koch Institute, a federal health agency, said that the Delta variant was involved in 59 percent of the country’s cases by the end of June. However, the country’s daily death toll has dropped by 42 percent over the past two weeks, according to a New York Times database. Sixty-one percent of Germany’s population is not fully vaccinated.
Raphael Minder contributed reporting.
New York City has been scaling back its efforts to monitor the spread of the coronavirus, reflecting not only a steadily low caseload, but also a growing sense that the city, along with the entire country, is starting to leave the pandemic behind.
But some public health experts and elected officials worry that the de Blasio administration may be pulling back on its surveillance measures too soon, potentially leaving the city ill prepared should more contagious forms of the virus cause new outbreaks.
For the last few days, the daily average test positivity rate in New York City has begun to tick up slightly, to nearly 1 percent. Vaccination rates in a number of neighborhoods remain low. And the more contagious Delta variant is now the predominant variant in the city.
Last week, the city said that 44 percent of the positive virus cases it had sequenced most recently for variants were of the Delta variety. The variant was first detected in India, where it led to a surge of cases, and has increasingly spread across the United States.
That statistic was clouded by the fact that the city’s Pandemic Response Lab had sequenced only 54 cases, a tiny number compared with the 1,500 cases it was sequencing every week in March and April, and the lowest number of cases sequenced since the lab started tracking variants in January.
More than 125 children and adults who attended a religious camp in Texas last month have tested positive for the coronavirus, camp officials said this week in a statement that warned that “hundreds more were exposed” at the camp “and hundreds of others were likely exposed when infected people returned home.”
“From the beginning of the pandemic, we have sought to love our neighbors by practicing strict safety protocols,” Bruce Wesley, senior pastor for Clear Creek Community Church, wrote on the church’s website. “We are surprised and saddened by this turn of events. Our hearts break for those infected with the virus.”
The church is in League City, about 30 miles southeast of Houston. As of early May, masks were “optional in all areas,” according to the church’s camp website. Telephone and email messages sent to the camp on Tuesday evening were not immediately returned.
More than 400 people participated in the student ministry camp, according to the statement. The camp also said it had consulted with the Galveston County Health District and canceled services for now, but would resume activities on Sunday.
In a statement on Tuesday, Galveston health officials said the Delta variant of the virus had been detected in three test samples linked to “a church camp.” Dr. Philip Keiser, interim head of the Galveston County Local Health Authority, said, “In this outbreak, at least as of now, it appears most of the people who have tested positive are old enough to be vaccinated.” The camp served children in grades six through 12, it said.
News of the outbreak in Texas comes during the return of the traditional summer camp season, when day and sleep-away camps are about to welcome children who just completed a school year dramatically altered by Covid-19 health restrictions, and many children are looking for relief from the soaring summer temperatures.
In Illinois, 85 teenagers and adults tested positive for the virus after attending a camp that did not check the vaccination records of participants or require masks indoors, the Illinois Department of Public Health said last month. At least 25 workers at a Christian summer camp in Oklahoma tested positive for the virus in June, Public Radio Tulsa reported.
Officials across the country have rolled back face-covering and social distancing rules that were put in place more than a year ago, even as new variants of the virus have quickly spread in areas with low vaccination rates. In Galveston, 44 percent of residents have been vaccinated, slightly above the statewide vaccination rate of 41 percent.
In guidance for people attending or operating youth camps, the Centers for Disease Control said in late May that “everyone” aged 12 or older should get vaccinated and that camps “should be supportive of campers or staff who choose to wear a mask.”
The world’s known coronavirus death toll passed four million on Thursday, a loss roughly equivalent to the population of Los Angeles, according to the Center for Systems Science and Engineering at Johns Hopkins University.
It took nine months for the virus to claim one million lives, and the pace has quickened since then. The second million were lost in three and a half months, the third in three months, and the fourth in about two and a half months. The number of daily reported deaths has declined recently.
Those are officially reported figures, which are widely believed to undercount pandemic-related deaths.
“The numbers may not tell the complete story, and yet they’re still really staggering numbers globally,” said Jennifer B. Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health.
Ms. Nuzzo said the number of excess deaths reported around the world suggested that “lower-income countries have been much harder hit than their official numbers would suggest.”
Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, called four million dead a tragic milestone on Wednesday, and said the toll was continuing to mount largely because of dangerous versions of the virus and inequities in the distribution of vaccines.
“Compounded by fast-moving variants and shocking inequity in vaccination, far too many countries in every region of the world are seeing sharp spikes in cases and hospitalizations,” Dr. Tedros said at a news conference.
The official death toll numbers tell only part of the horrifying pandemic story. In many places, people have died without family to comfort them because of rules to prevent the spread of the virus. And many countries were completely overrun.
The dead overwhelmed cremation grounds in India in May, where at least 400,000 confirmed deaths have been reported and the actual number is likely higher. That was also the case in funeral homes in the United States, which surpassed 600,000 known deaths last month.
Latin America ravaged
The virus has hammered Latin America since the start of the pandemic, and some of those nations have been grappling with their deadliest outbreaks to date.
As of Tuesday, seven of the 10 countries with the highest death rates relative to their populations over the past week were in South America, according to data from Johns Hopkins, and the virus has been a destabilizing force in many countries in the region.
Government health data in Colombia show that more than 500 people died from the virus each day in June. The country has also gone through weeks of explosive protests over poverty made worse by the pandemic that were sometimes met with a violent police response.
A wave of cases in Peru cost many people their livelihoods, and thousands of impoverished people occupied empty stretches of land south of Lima. In Paraguay, which as of Tuesday had the highest number of Covid-19 deaths per capita of any country during the previous week, social networks often resemble obituary pages.
Brazil, which recently passed 500,000 official deaths, had the highest number of new cases and deaths of any country in the past week. A recent study found that Covid-19 had led to a significant decrease in life expectancy in Brazil.
Vaccines make a difference
Several vaccines have proven effective against the coronavirus, including the highly contagious Delta variant, and death rates have dropped sharply in many parts of the world where large numbers of people have been vaccinated, like the United States and much of Europe.
But the virus is still running rampant in regions with lower rates of vaccination, like parts of Asia, Africa and South America. Some places with relatively high vaccination rates, like England, are also seeing spikes in cases, though fewer of those cases have been leading to hospitalizations and deaths.
Dr. Maria Van Kerkhove, who works on coronavirus response for the W.H.O., said that there were “more than two dozen countries that have epidemic curves that are almost vertical.”
“The virus is showing us right now that it’s thriving,” she said.
Wealthy countries and international organizations have pledged billions of dollars to Covax, a global vaccine-sharing initiative, and nations like the United States have promised to supply hundreds of millions of doses. But those numbers pale in comparison with the 11 billion vaccine doses that experts estimate will be needed to rein in the virus around the world.
To date, just under 3.3 billion vaccine doses have been administered worldwide, according to vaccination data from local governments compiled by the Our World in Data project at the University of Oxford. Nearly all have been of vaccines that require more than one dose to be fully effective.
Country-to-country differences in progress are stark, with some already inoculating most of their adult citizens while others have yet to report administering a single dose.
School may still seem blissfully far off for American students in the midst of summer. But for many who are eligible, time may be running out for a back-to-school necessity: getting fully vaccinated against the coronavirus before classes resume.
Many of the country’s more than 13,000 districts, especially in the South and Southwest, plan to start the 2021-22 school year well before Labor Day. Completing a course of Pfizer-BioNTech’s vaccine, the only vaccine now federally authorized for 12- to 17-year-olds, takes at least five weeks for the two shots to be administered and full protection to be reached. In many of those early-starting districts, students would need to get their first dose in the next few days to be fully immune in time.
In the Hamilton County School District in Tennessee, the first day of school is scheduled for Aug. 12. Counting back from then, students would have to get their first shot no later than Thursday to be fully protected by opening day.
Cody Patterson, a spokesman for the district, which encompasses Chattanooga and serves 45,000 students, said recently that while vaccinations are not mandatory for the new school year, the district was making clear to parents “that we believe vaccination is a key strategy to keeping school open.”
Mr. Patterson said that individual schools in the district would probably accommodate students case by case if they are worried about finishing their vaccinations.
Schools across the country closed and switched to online instruction when the pandemic took hold last year. But as the pandemic wore on, research showed that elementary and secondary schools were not major drivers of infection.
Colleges are another matter, with a number of outbreaks seen on campuses. Many colleges (along with some private secondary schools) are requiring vaccinations for students to attend in person this fall. It’s harder for public middle and high schools to do that, for legal and other reasons, and a spokesman for the American Federation of Teachers said recently the union was not aware of any U.S. school district that is mandating vaccinations.
It has only been since May that any vaccine was available for 12- to 15-year-olds in the United States. In many states, teenagers need parental consent to be vaccinated. No vaccine has yet been authorized for children under 12.
Michael Poore, the superintendent of the Little Rock School District in Arkansas, said recently that the district had contacted parents, worked with local health authorities and done extensive outreach on local and social media to persuade students and their parents to get a vaccine.
The district also ran vaccination events at its 11 middle and high schools, he said, but only 300 to 400 of the district’s roughly 11,000 eligible students got shots at the events.
School in Little Rock starts on Aug. 16, so to be fully protected by then, students would have to get their first dose by Monday.
“We’re really going to push the vaccines in August,” Mr. Poore said, “because if you haven’t had the shot and you’re in close proximity to someone who has the virus, you’re going to have to be quarantined.”
It is already too late for not-yet-vaccinated students to get fully protected before school starts in some places, like the Chandler Unified School District in Arizona, which reopens July 21.
Kimberly Guevara, a district spokeswoman, said recently the district had informed parents when the vaccine was authorized for teenagers and told them how to get a shot, but “we’re not going to force vaccinations on students.”
Ms. Guevara said she and the eligible members of her family got vaccinated as soon as they could.
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