The daily average for hospitalized Covid-19 patients in the United States is now more than 100,000. That average, calculated over the last seven days, is higher than in any previous surge except last winter’s, before most Americans were eligible to get vaccinated.
The influx of patients is straining hospitals and pushing health care workers to the brink as deaths have risen to an average of more than 1,000 a day for the first time since March.
Hospitalizations nationwide have increased by nearly 500 percent in the past two months, particularly across Southern states, where I.C.U. beds are filling up, a crisis fueled by some of the country’s lowest vaccination rates and widespread political opposition to public health measures like mask requirements.
In Florida, 16,457 people are hospitalized, the most of any state, followed by Texas, according to data from the U.S. Department of Health and Human Services.
With the surge pummeling the nation and overwhelming hospitals, a shortage of bedside nurses has complicated efforts to treat hospitalized coronavirus patients, leading to longer emergency room waiting times and rushed or inadequate care.
Earlier this month, one in five American I.C.U.s had reached or exceeded 95 percent of beds full. Alabama was one of the first states to run out, and the crisis is concentrated in the South, with small pockets of high occupancy elsewhere in the country. As cases and hospitalizations surged, the University of Tennessee Medical Center in Knoxville on Thursday requested assistance from the National Guard.
“I’ve never seen anything quite like it,” said Dr. Shannon Byrd, a pulmonologist in Knoxville, who described local hospitals filled to capacity, noting that the vast majority of I.C.U. patients in the region are unvaccinated. “It’s bringing whole families down and tearing families apart. They’re dying in droves and leaving surviving loved ones with a lot of funerals to go to.”
As in previous surges, hospitals have been forced to expand capacity by creating makeshift I.C.U.s in areas typically reserved for other types of care, and even in hallways or spare rooms. Experts say maintaining existing standards of care for the sickest patients may be difficult or impossible at hospitals with more than 95 percent I.C.U. occupancy.
Hard-hit communities in Oregon and elsewhere are asking for mobile morgues to store the dead.
Dr. Ijlal Babar, the director of pulmonary critical care for the Singing River Health System in coastal Mississippi, said the influx of mostly unvaccinated, younger Covid-19 patients is hampering care across the system’s hospitals.
“Because a lot of these patients are lingering on, the ventilators are occupied, the beds are occupied,” he said. “And a lot of other patients who need health care, we can’t do those things, because we don’t have the I.C.U. beds, we don’t have the nurses, we don’t have the ventilators.”
Like many health care workers, Dr. Babar voiced frustration at the refusal of many residents to get inoculated, even after they have lost an unvaccinated family member to the virus.
“The families, you don’t see them going out and talking about the benefits of vaccine,” he said. “Nobody brings it up, nobody expresses any remorse. It’s just something that they absolutely do not believe in.”
The European Union is set to advise member states that they should reintroduce travel restrictions for visitors from the United States, three E.U. officials said on Sunday, as coronavirus infections and hospitalizations have surged in the U.S. in recent weeks.
Starting Monday, the officials said, the United States will be removed from a “safe list” of countries whose residents can travel to the 27-nation bloc without additional restrictions, such as quarantine and testing requirements. The suggested restrictions, made by the European Council, will not be mandatory for member countries, and it will remain up to those countries to decide whether or not to impose them.
Most European countries reopened their borders to Americans in June, more than a year after imposing a travel ban, hoping that Americans would visit this summer and help an ailing tourism industry bounce back.
In essence, the European Union gave the United States a summertime pass to encourage tourism, despite the relatively high infection rates in parts of the country.
The threshold for being on the E.U. “safe travel” list is having fewer than 75 new Covid-19 cases daily per 100,000 people over the previous 14 days. The United States has an infection rate well above that threshold, and Covid hospitalizations in the country climbed above 100,000 last week for the first time since January.
Yet while American tourists were able to travel to Europe this summer, the United States has remained closed to Europeans, drawing anger from Europeans and their leaders, who have expressed frustration at the lack of reciprocity.
Travelers from countries on the safe list can usually visit E.U. countries without quarantining by showing a proof of vaccination or a negative test, while those from countries not on that list are barred from visiting for nonessential reasons and can be subject to further testing and quarantine requirements.
Most European countries reopened their economies this summer after vaccination campaigns picked up speed in recent months. Countries like France and Italy, among others, have required proof of vaccination or a negative coronavirus test result for people to dine in restaurants, visit museums or attend concerts, making Covid passes a fixture of daily life.
The decision to urge the reimposition of travel restrictions on U.S. travelers was first reported by Reuters. European officials who outlined the plan did so under condition of anonymity because they were not authorized to discuss the matter publicly ahead of an announcement planned for Monday.
Israel on Sunday extended its booster shot campaign to all citizens aged 12 and above amid a surge of Delta variant infections that has made the number of new daily cases among the highest in the world.
After a remarkably swift vaccination campaign in the winter and spring, about 80 percent of Israel’s adult population has been inoculated with at least two doses of the Pfizer-BioNTech vaccine administered three weeks apart.
But a new study by Israeli experts points to a waning of the vaccine’s protections over time for all ages, a finding that contributed to a U.S. decision to begin offering booster shots to Americans starting next month.
And a nationwide study of people over 60 completed by Israeli experts in late August demonstrates that a third shot provides significant extra protection against both infection and severe illness.
Israel began offering third booster shots on Aug. 1 to people aged 60 and above who had received a second shot at least five months earlier. The country rapidly expanded the program to include Israelis aged 30 and above. About 2 million Israelis, or half of those in the eligible groups so far, have already received a third shot.
“This is a privilege that no other country has,” Prime Minister Naftali Bennett of Israel said on Sunday, announcing the further expansion of the program to those aged 12 and above.
A preliminary study released this month by Maccabi, an Israeli health care provider, found that a booster shot of the Pfizer vaccine was 86 percent effective against infection in people over 60, a week or more after receiving the third dose.
After meeting Mr. Bennett at the White House on Friday, President Biden suggested that the U.S. government might offer coronavirus vaccine booster shots sooner than eight months after a second shot, underscoring the administration’s concerns about the spread of the Delta variant.
But on morning news shows on Sunday, Mr. Biden’s chief medical adviser, Dr. Anthony Fauci, said that the administration would for now stick with the plan to offer booster shots eight months after the second dose.
“We’re still planning on eight months — that was the calculation we made,” Dr. Fauci said on NBC’s “Meet the Press,” adding that the program would begin on Sept. 20 if cleared by federal regulators. Still, he said, that plan is flexible and could change with new information. “That’s the plan that we have but we are open to data as they come in,” he said.
As children’s hospitals in many parts of the United States admit more Covid-19 patients, a result of the highly contagious Delta variant, federal and state health officials are grappling with a sharp new concern: children not yet eligible for vaccination in places with substantial viral spread, who are now at higher risk of being infected than at any other time in the pandemic.
Nowhere is that worry greater than in Louisiana, which has among the highest new daily case rates in the country and where only 40 percent of people are fully vaccinated, putting children at particular risk as they return to school.
At Children’s Hospital New Orleans, the intensive care unit has been jammed with Covid-19 patients, and nurses have raced around monitoring one gut-wrenching case after another. One child was getting a complicated breathing treatment known as ECMO, a last resort after ventilators fail, which nurses said was almost unheard-of for pediatric cases. About half a dozen others were in various stages of distress.
Medical staff throughout the hospital said the causes of illness in children were often simple: parents, family members and friends who were unvaccinated and not wearing masks.
“I’ve had to kind of make peace with that people are not doing what they’re supposed to,” said Mark Melancon, a longtime nurse at the hospital. “The kids are suffering.
“Not that I accept it,” he added, “but if I get hung up in the anger of it, I would walk around confronting people in Walmart, here, everywhere.”
“I can’t tell them, ‘Why didn’t you isolate this kid?’” Mr. Melancon continued. “So we just tell them, ‘Your kid has Covid. It’s really hard on the lungs. Your child’s very sick. We’ll do everything we can to get him better.’”
Of the roughly 70 children admitted to the hospital with Covid-19 this month, about half were 12 or older — and thus eligible for vaccination — but only one was fully vaccinated, said Dr. Mark W. Kline, the hospital’s physician in chief.
Most children with Covid-19 have only mild symptoms, however, and there is not enough evidence to conclude that Delta makes some of them sicker than other variants do, scientists say. Doctors and nurses at Children’s Hospital New Orleans agreed with that assessment.
Theresa Sokol, Louisiana’s top epidemiologist, said that people younger than 18 had among the highest test positivity rates in the state and were responsible for a significant share of transmission, with many cases probably undetected.
“I don’t want any kids to get this, because I can’t guarantee that it’s not going to be your kid that’s going to have a problem,” she said. “But overall, statistically, most of them are doing fairly well.”
Louisiana hospitals scrambled Sunday to deal with two severe challenges, the landfall of Hurricane Ida and a surge of Covid that has stretched hospital capacity and left daily deaths at their highest levels in the pandemic.
Louisiana’s medical director, Dr. Joseph Kanter, had asked residents on Friday to avoid unnecessary emergency room visits to preserve the state’s hospital capacity, which has been vastly diminished by its most severe Covid surge of the pandemic.
And while plans exist to transfer patients away from coastal areas to inland hospitals ahead of a hurricane, this time “evacuations are just not possible,” Gov. John Bel Edwards said at a news conference.
“The hospitals don’t have room,” he said. “We don’t have any place to bring those patients — not in state, not out of state.”
The governor said officials had asked hospitals to check generators and stockpile more water, oxygen and personal protective supplies than usual for a storm. The implications of a strike from a Category 4 hurricane while hospitals were full were “beyond what our normal plans are,” he added.
Mr. Edwards said he had told President Biden and Deanne Criswell, the administrator of the Federal Emergency Management Agency, to expect Covid-related emergency requests, including oxygen.
The state’s recent wave of Covid hospitalizations has exceeded its previous three peaks, and staffing shortages have necessitated support from federal and military medical teams. On Friday, 2,684 Covid patients were hospitalized in the state. This week Louisiana reported its highest ever single-day death toll from Covid — 139 people.
Oschner Health, one of the largest local medical systems, informed the state that it had limited capacity to accept storm-related transfers, especially from nursing homes, the group’s chief executive, Warner L. Thomas, said. Many of Oschner’s hospitals, which were caring for 836 Covid patients on Friday, had invested in backup power and water systems to reduce the need to evacuate, he said.
The pandemic also complicated efforts to discharge more patients than usual before the storm hits. For many Covid patients who require oxygen, “going home isn’t really an option,” said Stephanie Manson, chief operating officer of Our Lady of the Lake Regional Medical Center in Baton Rouge, which had 190 Covid inpatients on Friday, 79 of them in intensive care units.
The governor said he feared that the movement of tens or hundreds of thousands of evacuees in the state could cause it to lose gains made in recent days as the number of new coronavirus cases began to drop. Dr. Kanter urged residents who were on the move to wear masks and observe social distancing.
On the ground floor of a parking garage at the University of Mississippi Medical Center, there are coronavirus patients where the cars should be — about 20 of them on any given day, laid up in air-conditioned tents and cared for by a team of medical personnel from a Christian charity group. Another garage nearby has been transformed into a staging area for a monoclonal antibody clinic for Covid-19 patients.
These scenes, unfolding in the heart of Mississippi’s capital city, are a clear indication that the health care system in the nation’s poorest state is close to buckling under the latest avalanche of cases triggered by the highly contagious Delta variant of the virus.
“We have reached a failure point,” LouAnn Woodward, the medical center’s top executive, said late last week. “The demand has exceeded our resources.”
The current coronavirus spike has hit the South hard, but a combination of poverty and politics made Mississippi uniquely unprepared to handle what is now the worst coronavirus outbreak in the nation. The state has fewer active physicians per capita than any other. Five rural hospitals have closed in the past decade, and 35 more are at imminent risk of closing, according to an assessment from a nonprofit health care quality agency. There are 2,000 fewer nurses in Mississippi today than there were at the beginning of the year, according to the state hospital association.
“If you look around, the state’s hospitals were in bad shape before there was such a thing as Covid,” said Marty Wiseman, an emeritus political science professor at Mississippi State University. “It was not a good time to layer a pandemic on top of that.”
Mississippi has waged decades of political battles over health care policy that can run almost as hot as the fights over the symbols of the old Confederacy. Most crucially, the state rejected a proposal to expand Medicaid, the federally subsidized health insurance program for low-income residents, a decision that critics say has deprived Mississippi of a much-needed infusion of federal money that might have strengthened small hospitals on the brink of failure and allowed them to recruit and retain doctors and nurses. That debate is being revisited by advocates who hope the pandemic will force a new reckoning.
What Mississippi has been left with, after years of infighting, is a system believed to be the weakest in the nation. According to a 2020 report from the Commonwealth Fund, a New York nonprofit group, Mississippi ranks at or near the bottom among states on key health care measurements, including infant mortality, childhood and adult obesity, and adults who have gone without care because they could not afford it.
During the first 18 months of the pandemic, Oregon’s Tillamook County reported five deaths from Covid-19. But from Aug. 18 to Aug. 23, it had six. And now the county has asked the state for a refrigerated truck to help store an overflow of bodies from the morgue.
In a letter published in the local newspaper, the Tillamook County Board of Supervisers pleaded with residents to “please get vaccinated,” noting that 86 percent of new cases are among the unvaccinated. The local funeral home is at capacity — the surge “has put a strain on our ability to store the bodies of the deceased,” the commissioners wrote.
The strain in Tillamook is being felt elsewhere in the state, with other local jurisdictions seeking help storing the deceased, according to The Associated Press.
The challenges reflected a 990 percent increase in Covid hospitalizations since July 9 in Oregon, where leaders have deployed the National Guard to hospitals, dispatched crisis teams to the hardest-hit regions of the state and ordered educators and health care workers to get vaccinated or lose their jobs.
In her latest mandate that will take effect on Friday, Gov. Kate Brown has gone beyond what any other state has done in battling the summer surge, requiring that both vaccinated and unvaccinated people wear masks when gathering closely in public, even when outdoors. She said more restrictions might be needed as the coming days unfold and the state tries to keep in-person schooling on track.
“All options are on the table,” Ms. Brown said in an interview this week.
The virus is rampaging through rural communities where vaccination rates remain low. Hospitals across the state are near capacity, almost 50 percent beyond the state’s previous peak in December. Last week, a coronavirus patient in Roseburg died while waiting for an I.C.U. bed.
The Oregon Health Authority director, Patrick Allen, said the situation was so “dire” that he was urging unvaccinated people to avoid engaging in any nonessential activities.
The weekly rhythms of Catholic life have started to return at Our Lady of Lourdes in Harlem. The pews are packed on Sunday mornings, prayer groups meet after work and the collection plate is almost as full as it was before the coronavirus pandemic began.
But parishioners are starting to worry about the virus again.
“For a little while, everyone felt more free, not using masks and things like that,” said the Rev. Gilberto Ángel-Neri, the pastor. “But now that we hear all the news about the Delta variant, everyone is using masks again.”
The progress made at Father Ángel-Neri’s church, and at houses of worship across New York City, may be threatened by a rise in virus cases in the past month and by an uneven patchwork of rules governing vaccination.
New rules to curb the spread of the virus’s more contagious Delta variant require New Yorkers to show proof of vaccination to participate in many indoor activities, including sitting inside restaurants or bars, going to a gym or nightclub and visiting a museum or zoo. But they do not apply to religious services, and most churches in the city do not require worshipers to be vaccinated, though approaches vary from place to place.
“Faith is a light to help you navigate through uncertainty and darkness, but what a lot of people have been grappling with is what do you do when church itself becomes a place of anxiety,” said John Gehring, the Catholic program director at the advocacy group Faith in Public Life.
Caleb Wallace, a leader of the anti-mask movement in Texas who became infected with the coronavirus and spent three weeks in an intensive care unit, has died, his wife, Jessica, said on Saturday.
“Caleb has peacefully passed on. He will forever live in our hearts and minds,” Mrs. Wallace wrote in a post on GoFundMe, where she had been raising money to cover medical costs.
Mrs. Wallace had said recently that her husband’s condition was declining and that doctors had run out of treatment options. On Saturday, he was to be moved to a hospice at Shannon Medical Center in the city of San Angelo so that his family could say their goodbyes, she said.
Mrs. Wallace, who is pregnant with the couple’s fourth child, recently told the San Angelo Standard-Times that when her husband first felt ill, he took a mix of vitamin C, zinc, aspirin and ivermectin — a drug typically used to treat parasitic worms in both people and animals that has been touted as a coronavirus treatment but was recently proved to be ineffective against the virus.
Mr. Wallace, 30, who campaigned against mask mandates and other Covid policies that he saw as government intrusion, lived in San Angelo for most of his life and worked at a company that sells welding equipment. He checked into the Shannon Medical Center on July 30.
Earlier that month, Mr. Wallace had organized a “Freedom Rally” for people who were “sick of the government being in control of our lives.”
He founded the San Angelo Freedom Defenders, a group that hosted a rally to end what it called “Covid-19 tyranny” according to a YouTube interview.
Mrs. Wallace had said her husband respected her own decision to wear a mask. “We joked around about how he was on one side and I was on the other, and that’s what made us the perfect couple and we balanced each other out,” she told the San Angelo Standard-Times.
She added that her three children are up-to-date on their vaccines and that she herself planned to get a coronavirus vaccine after the birth of her baby in late September. “We are not anti-vaxxers,” she said.
Covid-19 cases and hospitalizations have been on the rise in Texas over the past few weeks. In Tom Green County, which includes the San Angelo area, cases have increased by 50 percent over the past two weeks, and hospitalizations have risen by 33 percent, according to a New York Times database.
At Shannon Medical Center, the intensive care unit is about 70 percent occupied, according to a New York Times tracker. The U.S. average of I.C.U. occupancy is about 68 percent, while the state average in Texas is 94 percent.
As travelers prepare for their next vacation, among the essentials to take along — like a toothbrush, wallet and phone charger — could be proof of vaccination for Covid-19, depending on where they are booked to sleep.
As coronavirus cases surge again across the country, driven by the highly contagious Delta variant, a small number of hotels in the United States have announced that they will require proof of vaccination from guests and staff.
Accommodations such as PUBLIC Hotel, Equinox Hotel and Wythe Hotel, all in New York City, Urban Cowboy Lodge in Big Indian, N.Y., a hamlet in the Catskill Mountains, and Pilgrim House in Provincetown, Mass., are among the first in the United States to announce that they will require evidence of vaccination, via a physical card or a digital verification, from their guests.
The precedent for hotels requiring vaccination is already being set beyond the contiguous United States. In August, Puerto Rico issued an island-wide vaccine mandate that requires guests and staff at all hotels, guesthouses and short-term rentals, including Airbnb, to provide proof of vaccination or a negative PCR or antigen test taken within 72 hours before their visit. If a person is staying longer than a week, they will need to present negative tests to hotel staff on a weekly basis.
Elite Island Resorts, a Florida-based company that runs a collection of all-inclusive Caribbean resorts stretching from Antigua to Panama, announced that all guests over the age of 12 would be required to show proof of Covid-19 vaccination upon arrival beginning on Sept. 1.
“It’s imperative for us to protect the hospitals of these smaller island nations, and while they have had a good track record so far with Covid-19, we must remain vigilant, and all do our part to become part of the solution,” wrote Robert A. Barrett, the founder and chief executive of Elite Island Resorts, in the company’s announcement.
Although European destinations are rolling out various vaccine mandates, hotels are mostly not requiring proof of immunization. In Portugal, however, hotel guests need to show proof of vaccination or a negative Covid-19 test.