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President Biden on Thursday will use the full force of his presidency in a push to require tens of millions more American workers to get vaccinated against the coronavirus, including the vast majority of federal employees, who could face disciplinary measures if they refuse.
Through a pair of executive orders and other federal rules, Mr. Biden will either require or prod two-thirds of the American work force to get vaccinated, officials said. His administration also intends to compel vaccination for federal contractors as well as 17 million health care workers in hospitals and other institutions that receive Medicare and Medicaid funding.
Beyond that, Mr. Biden is seeking to extend vaccine mandates to the private sector. He will also instruct the Department of Labor to draft a rule mandating that all businesses with 100 or more workers require their employees to either get vaccinated or face mandatory weekly testing, the officials said.
The mandate for federal workers is an especially assertive move by the president. Jen Psaki, the White House press secretary, told reporters on Thursday that, aside from some religious and disability exemptions, the vast majority of federal workers would be subject to a 75-day grace period for receiving a vaccine.
If workers decline to receive shots in that time frame, Ms. Psaki said, they will “go through the standard H.R. process,” which she said would include progressive disciplinary action. At least one major labor union challenged the mandate even before Mr. Biden delivered his speech.
Cathie McQuiston, a deputy general counsel for the American Federation of Government Employees, a union representing some 700,000 federal workers, said in an interview that her organization would be working with agencies to “not skip over procedures and make sure employees have due process” if they were disciplined.
The new moves, which the president is to announce in a White House speech scheduled for 5 p.m. Eastern time, are the most expansive actions he has taken to control the pandemic since he assumed the presidency in January. Initially reluctant to enact mandates, Mr. Biden is now waging an aggressive effort that will also put pressure on private businesses, states and schools to enact stricter vaccination and testing policies as the Delta variant continues its spread across the United States.
It is unclear how long it will take for the new requirements to go into effect, and some will almost certainly give rise to lawsuits.
The federal employee mandate will apply to employees of the executive branch, including the White House and all federal agencies and members of the armed services — a work force that numbers more than four million — but not to those who work for Congress or the federal court system, according to White House officials.
The mandate for health care workers will apply to those employed by institutions that accept Medicare and Medicaid reimbursement, including hospitals and nursing homes, according to the officials, who insisted on anonymity to preview the president’s plan.
“We would like to be a model for what we think other business and organizations should do around the country,” Ms. Psaki added.
The spread of the highly infectious Delta variant had pushed the country’s daily average caseload over 150,000 for the first time since late January, overwhelming hospitals in hard-hit areas and killing roughly 1,500 people a day. The surge has alarmed Mr. Biden and his top health advisers, who see mass vaccination as the only way to bring the pandemic under control.
Mr. Biden, who was briefed by his team of coronavirus advisers on Wednesday afternoon, will outline six broad strategies for better combating Covid-19.
Mr. Biden had already pushed federal workers to get vaccinated by announcing that those who refused would have to undergo regular coronavirus testing. But the surge, coupled with last month’s decision by the Food and Drug Administration to grant full approval to the Pfizer-BioNTech vaccine to those 16 and older, has made him decide to take more aggressive steps, eliminating the option of testing, the officials said.
Companies had put off the question of whether to mandate for months, worried about potential litigation and employee pushback. But stalling vaccination rates and the rise of the contagious Delta variant put new pressure on executives. They were provided cover to go forward with requirements after earlier mandate moves by the Biden administration.
Soon after, Walmart, Walt Disney Company, Google and others said they would implement mandates. When the Pfizer vaccine received full federal approval late last month, Goldman Sachs, Chevron and others followed suit as Mr. Biden encouraged corporate mandates.
The mandates are a marked shift for a president who, mindful of the contentious political climate around vaccination, initially steered away from any talk of making vaccines mandatory. But the F.D.A. approval — which also prompted the Pentagon to require its employees to get vaccinated — has clearly strengthened Mr. Biden’s hand.
“Never before have we mandated a vaccine throughout the federal work force, the National Guard, among government contractors and also using the bully pulpit to try to influence businesses and universities and cities and states to do the same,” said Lawrence O. Gostin, a professor of global health law at Georgetown University.
Still, Mr. Gostin said, there is much more the president could do. He has already exercised his executive authority to require masks on airplanes and interstate trains and buses, and could similarly mandate vaccination for international or interstate travel — a step that Mr. Gostin described as “low-hanging fruit.”
One thing Mr. Biden cannot do is require all Americans to get vaccinated; in the United States, vaccinations are the province of the states. But Mr. Gostin said the president could also dangle the prospect of federal funding to prod states to require their own workers to get vaccinated, and his administration could offer technical guidance to states that want to develop “vaccine passports” for people to provide digital proof of vaccination.
Lauren Hirsch contributed reporting.
President Biden is expected to instruct the Occupational Safety and Health Administration to draft a rule mandating that all businesses with 100 or more workers require their employees to either get vaccinated against the coronavirus or face mandatory weekly testing.
The efforts will mark the government’s biggest push yet to draw employers into efforts to vaccinate the country and would affect some 80 million workers.
OSHA will issue an emergency temporary standard to implement the requirement, which will impact more than 80 million workers, according to officials familiar with a larger plan that the president is expected to outline on Thursday.
The Biden administration also intends to require vaccination for federal contractors as well as 17 million health care workers in hospitals and other institutions that receive Medicare and Medicaid funding, the officials said.
OSHA, which is part of the Department of Labor, oversees workplace safety, which it will likely contend extends to vaccine mandates. The agency has issued other guidelines for pandemic precautions, such as a rule in June requiring health care employers to provide protective equipment, provide adequate ventilation and ensure social distancing, among other measures.
“I think that the Department of Labor probably is in good stead to be able to justify its mandate for health and safety reasons for the workers,” said Steve Bell, a partner at law firm Dorsey & Whitney specializing in labor and employment.
“They’ve got a broad pretty solid basis for saying: ‘We’re here to protect the workers, and this is part of our purview, and we think that this is something that will protect employees,’” he said.
Still, OSHA’s authority does not mean it won’t face pushback or lawsuits challenging the order. And enforcement may be a challenge, particularly since there is no national system for employers to track or report vaccination status.
A number of large employers, ranging from CVS Health to Goldman Sachs to Chevron, have already put in place some form of vaccine mandate. Companies have been eager to get their workers back into the office and return to a degree of normalcy.
Still, many of these mandates are not comprehensive. Companies like Walmart and Citigroup have mandates for their corporate employees, but not for frontline workers in stores or at branches. Many companies are dealing with labor shortages and varying levels of vaccine hesitancy among workers, and a number of states have proposed legislation that could limit companies’ abilities to to mandate vaccines for employees or customers.
Mr. Biden has raised the pressure on private employers to help with vaccination efforts. In August, the White House met with executives of companies that had mandated vaccination, including Scott Kirby of United Airlines, to discuss how they could encourage fellow business leaders to do the same.
After the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine on Aug. 23, Mr. Biden encouraged corporate vaccine mandates.
“If you’re a business leader, a nonprofit leader, a state or local leader, who has been waiting for full F.D.A. approval to require vaccinations, I call on you now to do that,” he said at the time. “Require it.”
Coronavirus infections are more than ten times higher than they need to be in order to end the pandemic, Dr. Anthony S. Fauci, the nation’s top infectious disease doctor, told the political news site Axios.
There are currently roughly 150,000 new infections a day in the United States. “That’s not even modestly good control,” Dr. Fauci told Axios.
He added, “In a country of our size, you can’t be hanging around and having 100,000 infections a day. You’ve got to get well below 10,000 before you start feeling comfortable.”
Case rates did fall to almost that level in June, when there were roughly 12,000 new infections per day, on average.
But that was before the highly infectious Delta variant spread widely throughout the country, causing a major surge in cases and hospitalizations, especially in areas of the country with low vaccination rates.
That surge has also impacted children, who are currently being hospitalized at the highest levels reported to date, with nearly 30,000 entering hospitals in August. No vaccine has been cleared for children younger than 12, who make up a sizable unvaccinated population in the United States.
In an interview with Apoorva Mandavilli, a New York Times reporter who covers science and global health, Dr. Fauci said that “we are still in the middle of a serious pandemic, and it is definitely involving children.”
“We’re seeing more children in the hospital now, because the Delta variant is more readily transmissible among everybody, adults and children,” Dr. Fauci said in the interview, which appeared on The Times’s website on Thursday.
Children still remain markedly less likely to be hospitalized or die from Covid-19 than adults, especially older adults. But experts say that the growing number of hospitalized children, however small compared with adults, should not be an afterthought, and should instead encourage communities to work harder to protect their youngest residents.
Although concerns have been growing about breakthrough infections, which officials acknowledge are not as rare as they once indicated, the vaccines continue to provide robust protection against the worst outcomes, including hospitalization and death.
Vaccination remains the best path out of the pandemic, experts and health officials have repeatedly said. “The endgame is to suppress the virus,” Dr. Fauci told Axios. “Right now, we’re still in pandemic mode.”
The number of children admitted to the hospital in the United States with Covid-19 has risen to the highest levels reported to date. Nearly 30,000 of them entered hospitals in August.
Pediatric hospitalizations, driven by a record rise in coronavirus infections among children, have swelled, overwhelming children’s hospitals and intensive care units in states like Louisiana and Texas. During the summer surge, the hospitalization rate was about 10 times as high in unvaccinated adolescents as in those who were vaccinated, according to a recent federal study. Data on hospitalizations among children of different ages is limited.
Children remain markedly less likely than adults to be hospitalized or die from Covid-19. But the United States recorded more than 250,000 child virus cases in the past week, the highest number to date, according to the most recent American Academy of Pediatrics survey of state data.
“It should concern us all that hospitalizations — indicators of severe illness — are rising in the pediatric population, when there are a lot of steps we could take to prevent many of these hospitalizations,” said Jason L. Salemi, an epidemiologist at the University of South Florida, who tracks Covid-19 hospitalization data.
According to Dr. Christopher Carroll, a pediatric intensivist at Connecticut Children’s Medical Center, the average U.S. pediatric I.C.U. in the U.S. has 12 beds. “In a system that small, even a few patients can quickly overrun the capacity, ” he said. “And there are fewer specialty trained pediatric clinicians to pick up the slack.”
Experts have said that vaccinations can make all the difference. States with the highest vaccination rates in the country have seen relatively flat pediatric hospital admissions for Covid-19 so far, while states with the lowest vaccine coverage have child hospital admissions that are around four times as high.
The decision by some rich nations to offer booster shots will hinder coronavirus vaccine access for low-income countries, the director of the Africa Centers for Disease Control and Prevention said on Thursday, arguing there is no conclusive evidence healthy people who are not immunocompromised need an extra shot.
In wealthy countries — including Germany, France, Israel and the United States — there has been growing momentum to offer additional doses to certain vulnerable populations, including older citizens, and to the general public.
“The problem we have with the third doses is that we have not seen enough science behind them,” the director, Dr. John Nkengasong, said in an online news conference with journalists on Thursday. “It is really still confusing to me as to why we are moving toward a vast recommendation for a booster dose.”
By offering booster shots, he added, “we will surely be gambling.”
The World Health Organization has warned that booster shots could divert vaccine supplies from countries with largely unvaccinated populations. On Wednesday, the agency asked wealthy countries to hold off on administering booster shots for healthy patients until at least the end of the year as a way of enabling every country to vaccinate at least 40 percent of their populations.
W.H.O. officials have tried to distinguish between booster shots that increase immunity in already vaccinated populations, and additional doses that may be needed by the immunocompromised to develop immunity in the first place. Officials are not opposed to additional doses for the immunocompromised.
Despite the flurry of booster programs in wealthier nations, the science of whether they are needed is not yet clear.
Some studies suggest that the protection that the vaccines provide against infection and mild disease may be waning. But they remain highly effective at preventing the worst outcomes, including severe disease and death, and scientists have said that a blanket recommendation for boosters is premature.
Experts generally agree, however, that a third shot is warranted for people with compromised immune systems, who may not have mounted a strong immune response to the initial doses. Several countries, including the United States, are now offering additional shots to this vulnerable group.
Dr. Nkengasong’s comments came as the W.H.O.’s Africa director, Dr. Matshidiso Moeti, said on Thursday that the continent will receive fewer Covid-19 vaccine doses than expected for the rest of the year from Covax, the global immunization program.
On Wednesday, Covax slashed its forecast for doses available in 2021 by roughly a quarter, another setback for an effort that has been hampered by production problems, export bans and vaccine hoarding by wealthy nations. Dr. Moeti said the fewer doses were “in part because of the prioritization of bilateral deals over international solidarity.”
Around 3 percent of Africa’s population, or 39 million of 1.3 billion residents, has been fully vaccinated, and 72 percent of all doses received have been administered, according to the W.H.O.
The African continent is coming off a severe third wave of the pandemic, driven largely by the Delta variant.
The continent has so far reported 7.9 million cases and over 200,000 deaths from the virus as of Thursday, according to the Africa C.D.C.
Dr. Nkengasong said wealthy nations should first come through on their commitments to donate hundreds of millions of doses, so as to help end the acute phase of the pandemic.
Dr. Moeti said those donated doses were not only the clearest pathway out of the pandemic but would help alleviate already strained health care systems. The Democratic Republic of Congo, for example, is dealing with a meningitis outbreak and the risk of the resurgence of deadly diseases like measles.
“If producing countries and companies prioritize vaccine equity, this pandemic can be over quickly,” Dr. Moeti said.
Emily Anthes contributed reporting.
Qantas, Australia’s largest airline, will require that all passengers on international flights are vaccinated against the coronavirus when it restarts worldwide operations in December, its chief executive said Wednesday, making it one of the first airlines in the world to require proof of vaccination for everyone on board.
Alan Joyce, the chief executive of the airline’s parent company, Qantas Group, made the announcement in an interview with the Trans-Tasman Business Circle, a network for business leaders in Australia and New Zealand.
“Qantas will have a policy that internationally we’ll only be carrying vaccinated passengers because we think that’s going to be one of the requirements to show that you’re flying safe,” he said, adding that many countries are requiring arriving travelers to be vaccinated anyway. He said he hoped the policy would be in place “by Christmas.”
Qantas, which is headquartered in Sydney, suspended international operations during the pandemic — but did resume flights to New Zealand in April this year before suspending them again on July 31. The airline plans to restart flights abroad in December. Mr. Joyce said in November of last year that he was considering banning unvaccinated travelers on international flights, but did not offer a timeline.
Other airlines have announced that they will require flight attendants and pilots to be vaccinated, but few other airlines have committed to banning unvaccinated passengers. Air Canada seems to be the only other airline that is poised to soon begin turning away unvaccinated passengers. By the end of October, the Canadian government will require all commercial airline employees and passengers to be vaccinated. Air Canada endorsed the government’s position in August.
Leonard J. Marcus, the co-director of the National Preparedness Leadership Initiative at Harvard University and the director of an initiative focused on public health on flights, said he hoped that other airlines would follow Qantas’s lead.
“I think this would be a bold and courageous step in the right direction,” he said. Requiring passenger vaccinations is currently easier in Australia than in other parts of the world, he said, because the country has a uniform system of validating vaccination status, in contrast to places like the United States.
Qantas did not respond to an inquiry on whether it would make exceptions for children too young to be eligible for vaccination and for people who cannot take the shots for medical reasons, two of the populations that would be most affected by the vaccination status of passengers sitting near them.
Qantas has made vaccination central to its marketing strategy throughout the pandemic. A recent television ad, which has been widely shared, shows Australians longing to travel and then getting vaccinations before heading off on international flights.
Airlines ended the traditional summer travel season on a high note, but hopes for the fall have dimmed as employers delay office reopenings and the Delta variant of the coronavirus has eroded sales and driven up cancellations in recent weeks.
United Airlines said in a securities filing on Thursday that it no longer expected to turn a profit, before taxes, for the three months ending in September and that revenue would probably be down about a third from the same period in 2019. Nevertheless, the airline said it expected to reap previously predicted cost savings.
Delta Air Lines appeared to be in a stronger position. The airline said in a filing that it still expected a pretax profit for the quarter, but that revenue would probably be at the lower end of a forecast it made earlier this summer. Costs were at the higher end of expectations as Delta staffed up to keep operations running smoothly through the rebound.
“The story for the quarter really has been about the amazing surge in demand that we’ve witnessed,” Ed Bastian, Delta’s chief executive, said at a Thursday conference hosted by Cowen, an investment bank.
Both United and Delta said they expected to see the recovery resume once virus cases peaked, with Mr. Bastian adding that the airline was already seeing a rebound in the South, where infections began rising sharply in the summer. United and Southwest Airlines said in filings that the latest wave of infections had less of an effect on the business than previous jumps in coronavirus cases.
American Airlines and Delta said that they had performed better than expected in July, but that the pace of the recovery paused in August. Delta said the rebound in business travel had frozen, too, as companies delayed or scaled back plans to reopen offices. Still, the airline said, ticket sales had generally stabilized in the last 10 days.
American said in a securities filing on Thursday that although its third-quarter financial results would probably be weaker than an earlier forecast, the company still expected the quarter to be its best by certain measures since the pandemic began.
For Southwest, a slower-than-expected September will be a drag on revenue, but the company said it still expected to end the quarter within the range it had predicted. Corporate travel was down nearly two-thirds in July and August from the same months in 2019 and is expected to remain down a similar amount in September. Mr. Bastian said Delta was seeing similar trends in corporate travel.
For much of the summer, which is the industry’s busiest season, airlines were flying about 80 percent as many customers as in 2019. That figure started to sag in the second half of August, but rebounded over the Labor Day holiday, according to Transportation Security Administration passenger screening data.
Though it’s early still, American and Southwest said they had solid ticket sales for holiday travel at the end of the year.
Israel plans to allow visits from organized groups of vaccinated tourists after Yom Kippur, the holiest day of the Jewish year, taking a step toward reopening to the world even as health officials record thousands of new coronavirus infections daily.
Tourism Ministry officials said the government decision was approved as a pilot program and emphasized that it constituted only an initial step.
“This program is a foot in the door,” said Pini Shani, a senior Tourism Ministry official. “It’s the start of a process that we hope will lead to the renewal of the tourism industry.”
The ministry then hoped, he said, that the government would allow entry starting in October to individual travelers.
Before the pandemic, tourism was booming in Israel, with 4.55 million visitors in 2019 bringing $7.18 billion in revenue into the country, according to Tourism Ministry statistics.
The pilot program will come into effect on Sept. 19, allowing the entry of groups of five to 30 people on condition that they adhere to a host of virus-related measures, including providing a negative P.C.R. test taken 72 hours before landing and undergoing a second test as well as a serological examination upon arrival, the ministry said.
All travelers will be required to show proof of being fully vaccinated within the previous six months or proof of having received a booster shot, the ministry said, with a vaccine approved by the Food and Drug Administration or the European Medicines Union. The program will not be open to those coming from a list of “red” countries, which currently includes Bulgaria, Brazil, Mexico and Turkey.
This program, announced on Sunday, will be Israel’s second attempt to begin reopening to tourists. An earlier effort began in May, but was halted in August when infections surged with the spread of the highly contagious Delta variant.
Mr. Shani emphasized that only three to four of some 2,800 people who visited under the previous pilot program had contracted the virus.
George Horesh, the chief financial officer and co-founder of the tour company Alma-Israel, expressed concerns about the “bureaucratic complications” of requiring travelers to do several tests upon arrival — especially serological tests, which require drawing blood — but added that he thought the authorities would find a way to smooth the process.
“Our business was basically eliminated during the pandemic, but we think things are finally improving and are on the right track,” he said.
A state judge granted an injunction on Wednesday prohibiting disruptive protests near school campuses after anti-mask demonstrations in a high school in the Washington city of Vancouver resulted in a lockdown.
According to a statement from the Vancouver School District, the injunction requires that “protests, rallies, gatherings on or near school premises that disrupt educational services, immediately cease and desist and not be allowed to convene on or within a one-mile radius of any Vancouver School District building or grounds.” The injunction, granted by a judge in the Clark County Superior Court, is effective as long as state-issued mask mandates are in place.
The injunction follows protests outside one of the district’s schools, Skyview High School. Groups including some members of the far-right Proud Boys gathered there twice this month to protest the state’s mask mandate for schools.
After the second protest, during which demonstrators left the sidewalk and came onto the campus, the school went into lockdown on Sept. 3, the district’s statement said. The neighboring Alki Middle School and Chinook Elementary School also locked down as a precaution. More protests had been scheduled for this week.
“Our district understands and supports free speech and the right for people to be involved in peaceful protests,” the superintendent of the Vancouver district, Jeff Snell, said in a statement. “However, our first priority is to ensure student and staff safety and an educational environment free of disruption. This responsibility prompted us to present our concerns to the court.”
As of Wednesday, the seven-day average of new cases across Washington State was 3,431 a day, a slight increase over the last two weeks, according to a New York Times database. Hospitalizations have risen 3 percent over the same time period, to a daily average of 1,598. Approximately 61 percent of the state’s population is fully vaccinated.
After staying quiet on vaccine mandates for months, companies began this summer to announce new requirements as vaccination rates stalled and the highly contagious Delta variant of the coronavirus began to spread.
The issue has been a delicate balance for employers, weaving in politics, health and privacy. But the government has put increasing pressure on employers to play a role in helping to vaccinate the country — and executives are desperate to get back to a degree of normalcy.
On Thursday, President Biden is expected to ask the Occupational Safety and Health Administration to draft a rule mandating that all businesses with 100 or more workers require their employees to either get vaccinated against the coronavirus or face mandatory weekly testing. That move would affect some 80 million workers.
Even before that announcement, mandates and inducements by city, state and federal governments, as well as full Food and Drug Administration approval of the Pfizer-BioNTech coronavirus vaccine for people 16 and older, made it easier for executives to go ahead.
How extensive are company mandates?
Corporate vaccine mandates began to roll out substantially in late July, shortly after the Biden administration announced that it was requiring all civilian federal employees to be vaccinated against the coronavirus or submit to regular testing and other strict requirements. Walmart and Disney led the way, followed by others including Uber and Google. When the F.D.A. granted its approval on Aug. 23, more mandates came flooding in from Goldman Sachs, Chevron and others.
Still, many are not comprehensive. Companies like Walmart and Citigroup have mandates for their corporate employees, but not frontline workers. Many companies are dealing with labor shortages and varying levels of vaccine hesitancy across state lines.
In a recent Willis Towers Watson survey of nearly 1,000 companies, which together employ almost 10 million people, 52 percent of respondents said they planned to have vaccine mandates by the end of the year, compared with 21 percent that said they already had vaccine requirements.
How are companies carrying out mandates?
The approach to mandates runs the gamut. Some, like Tyson Foods, which is requiring vaccines for its entire U.S. work force, have said that vaccines are a condition for employment. United Airlines has said it will fire employees who do not abide by the airline’s vaccine mandate or get an exemption; those who are exempt will be placed on temporary leave, in many cases unpaid.
Others, though, have worked a degree of flexibility into their requirements. Many, like AstraZeneca, are offering employees with religious or medical exemptions to undergo weekly testing as an alternative to vaccination. Some, including UBS, have said employees who do not want the vaccine may work from home.
A recent poll by Aon of 583 global companies found drastically different policies. Of employers that have vaccine mandates, 48 percent said they were allowing for religious exemptions; just 7 percent said they would fire a worker for refusing to get vaccinated.
What are companies doing about unvaccinated employees?
Companies are offering incentives to persuade workers to get the vaccine. Some, such as Kroger, have offered bonuses, while others have provided vaccinations in the workplace and additional paid time off to increase inoculation rates.
But others are using deterrents, including loss of employment. Delta Air Lines, for example, is requiring unvaccinated employees to pay an extra $200 a month to stay on the airline’s health plan. Other companies are restricting office entry for those who are not vaccinated.
Workers who are unvaccinated because of a disability or conflicting religious beliefs have been told that they must follow strict safety guidelines like regular coronavirus testing, masking and social distancing. Some are allowed to work remotely.
How does the law cover vaccine mandates?
Companies are legally permitted to make employees get vaccinated, according to guidance from the U.S. Equal Employment Opportunity Commission, though a number of states have proposed legislation limiting the ability to mandate for employees or guests.
Employers are allowed to ask about a worker’s vaccination status, which is not protected by the Health Insurance Portability and Accountability Act, known as HIPAA. The law, which protects a patient’s confidential health information, applies only to companies and professionals in the health care field.
A fire at a temporary hospital where coronavirus patients were being treated in North Macedonia has left at least 14 people dead, the country’s health minister said.
All 14 were patients, and 12 others being treated at the center suffered injuries in the fire that broke out Wednesday evening, the country’s health minister, Venko Filipce, said. No health workers were reported injured what Mr. Filipce described as a “terrible accident.”
The fire, which began at around 9 p.m. at a mobile hospital in Tetovo, in the country’s northwest, was extinguished within 45 minutes, but it had spread quickly through the building, one fire official told a local news outlet.
Footage from the scene showed a plume of black smoke rising as flames engulfed the hospital. Videos aired later on local news showed fire trucks at the scene and wheelchairs scattered around the charred shell of the structure, a one-story modular building.
The blaze was driven in part by explosions, according to the country’s prime minister, Zoran Zaev, who immediately launched an investigation. The prime minister’s office said the cause of the fire had yet to be determined, and that three days of national mourning had been announced.
Oxygen tanks being used to treat patients with severe Covid-19 have been blamed for deadly fires at other coronavirus clinics around the world. In July, at least 39 people were killed at a hospital in southern Iraq after an oxygen tank explosion in a ward where Covid-19 patients were being treated. In April, a fire caused by an oxygen tank explosion at a coronavirus hospital in Baghdad killed at least 82 people.
Sasho Trajcevski, the deputy commander of the Tetovo fire department, told the local television station 360 that the plastic elements in the modular building had driven the flames.
Alisa Dogramadzieva contributed reporting.
President Jair Bolsonaro of Brazil is temporarily banning social media companies from removing certain content, including his claims that the only way he’ll lose next year’s elections is if the vote is rigged — one of the most significant steps by a democratically elected leader to control what can be said on the internet.
The new social media rules, issued this week and effective immediately, appear to be the first time a national government has stopped internet companies from taking down content that violates their rules, according to internet law experts and officials at tech companies. And they come at a precarious moment for Brazil.
Under the new policy, which will expire after 120 days unless Mr. Bolsonaro can secure support for it in Brazil’s Senate, tech companies can remove posts only if they involve certain topics outlined in the measure, such as nudity, drugs and violence, or if they encourage crime or violate copyrights. To take down others, they must get a court order.
That suggests that, in Brazil, tech companies could easily remove a nude photo, but not lies about the coronavirus. The pandemic has been a major topic of disinformation under Mr. Bolsonaro, with Facebook, Twitter and YouTube all having removed videos from him that pushed unproven drugs as coronavirus cures.
“You can only imagine how hard it would be for a big platform to get a judicial order for every single piece of disinformation they find,” said Carlos Affonso Souza, a law professor at Rio de Janeiro State University.
Mr. Bolsonaro has used social media as a megaphone to build his political movement and make it to the president’s office. Now, with polls showing he would lose the presidential elections if they were held today, he is using sites like Facebook, Twitter and YouTube to try to undermine the legitimacy of the vote, following the playbook of his close ally, former President Donald J. Trump.
Brazil’s new internet rules are the latest effort in a larger fight that conservatives are waging against Silicon Valley. Politicians and pundits on the right have argued that tech companies are censoring conservative voices, and increasingly they have pushed laws making it harder for social networks to remove posts or accounts from their sites.
Late last year, the federal government’s chief statistician on death received word about a tantalizing discovery: Someone had died from Covid-19 in January 2020, a death certificate said, a revelation that would have sped up the timeline of the virus’s spread in the United States by several weeks.
That death was ultimately not what it seemed. The person who certified it had meant June 2020, not January. But that blip on the radar screen of Robert Anderson, the chief of mortality statistics at a branch of the Centers for Disease Control and Prevention, helped to kick off a quiet, yearlong campaign at the agency to check and recheck the country’s first suspected Covid-related deaths in the uncertain days of early 2020.
Now, at least four possible Covid-19 deaths from January 2020 have survived Dr. Anderson’s vetting. Spread out across four states, they have become part of a scattershot collection of clues about the virus’s early spread beyond China — some of them trustworthy, others less so — that have begun drawing more attention as scientists and intelligence officials try to unravel how the pandemic began.
The odds that all four of the C.D.C.’s new death cases — from Kansas, California, Alabama and Wisconsin — really did result from Covid-19 are slim, some scientists said. This year, a doctor or another official certifier reclassified them as being Covid-related. But whether they did so solely on the basis of the person’s symptoms, or with the help of more useful blood or tissue samples, is not clear.
Los Angeles is poised to become the first major school district in the United States to mandate coronavirus vaccines for students 12 and older who are attending class in person.
The district’s elected Board of Education will meet Thursday afternoon to vote on the measure, which is expected to pass with broad support. The Los Angeles Unified School District is the second largest in the nation, serving over 600,000 students, and the mandate could set an important national precedent.
Students would need their first vaccine dose by Nov. 21 and their second by Dec. 19 to begin the next semester fully inoculated. Those who turn 12 after those dates will have 30 days after their birthday to receive their first shot.
Students participating in in-person extracurricular activities will need both shots by the end of October. The resolution mentions “qualified and approved exemptions,” but does not offer details.
The district offers online independent study for those who opt out of in-person learning this year, but so far, only a tiny percentage of students have chosen it.
The months before the mandate takes effect will allow the district to conduct outreach and educational programs for families. According to the Los Angeles County Department of Health, 58 percent of the district’s 12-to-18-year-olds have already received at least one vaccine dose.
Los Angeles Unified has been operating vaccine clinics in schools, and has the nation’s broadest school testing program, screening all students and staff members weekly. Masks are required for every individual on campus, indoors and outdoors, and staff members must be vaccinated, with limited exceptions for serious medical conditions and sincerely held religious beliefs.
“Our goal is to keep kids and teachers as safe as possible and in the classroom,” said Nick Melvoin, a Los Angeles school board member, in a written statement expressing support for the resolution. “A medical and scientific consensus has emerged that the best way to protect everyone in our schools and communities is for all those who are eligible to get vaccinated.”
A key constituency supporting the student vaccine mandate is the city’s teachers’ union, United Teachers Los Angeles. Since the start of the pandemic, the group has pushed for stringent safety measures, and during the last academic year, a longer period of remote learning.
Initial data on infections at Los Angeles schools this year has been reassuring. According to a Los Angeles Times tracker based on district data, 1,620 active Covid-19 cases had been identified at schools as of Sept. 6; only five were linked to on-campus transmissions, at two schools.
While it is typically states, not individual districts, that are responsible for school vaccine mandates, the Culver City school system, a small district also in Los Angeles County, announced a student mandate last month, and other California districts are considering similar requirements. Legal challenges are likely.
The Food and Drug Administration has authorized the Pfizer-BioNTech vaccine on an emergency basis for children ages 12 to 15, but could potentially grant full approval for that group later this year, which could pave the way for more school mandates.
On Thursday, New York City expanded its coronavirus vaccine requirement for educators, and now will require all employees of city-contracted early childhood education programs and after school programs to be vaccinated. There will be no test-out option. Last month, Mayor Bill de Blasio announced that all Department of Education staff, including educators, would have to get at least the first dose of their coronavirus vaccine by Sept. 27.
While the new mandate will compel 24,000 people to be vaccinated in the coming weeks, it does not cover private pre-kindergarten or after school programs or those that do not contract with the city. Public school classes begin in the city on Monday.
Eliza Shapiro contributed reporting.
As parts of Scotland are seeing some of the highest coronavirus rates in Europe, members of the Scottish Parliament voted on Thursday to introduce a vaccine passport system as of Oct. 1, requiring proof of vaccination to visit crowded venues and some large events.
The plan was formally approved in the Parliament, or Holyrood, after the country’s National Party and the Green Party voted in favor of the plan.
The new rules mean that people over age 18 will have to show that they are fully vaccinated before being allowed entry to crowded sites at adult entertainment venues including nightclubs, music festivals, some soccer grounds, some live events and any event that is expected to draw more than 10,000 people. All those 16 and older are eligible for vaccination in Scotland.
After the vote, Humza Yousaf, Scotland’s health secretary, said in a statement that vaccination certification “will only be used in certain higher risk settings and we hope this will allow businesses to remain open and prevent any further restrictions as we head into autumn and winter.”
Scotland’s leader, Nicola Sturgeon, told the Scottish Parliament on Wednesday that requiring people to present vaccine certificates in these circumstances was a “reasonable response to a very difficult situation.”
“Fundamentally, we believe that certification can help us reduce the overall harms caused by the pandemic,” Ms. Sturgeon added. “It will help to reduce transmission in some higher risk settings, and it will maximize protection against serious illness.”
Across Britain, anyone over 18 who has been administered two vaccines can download or get a paper copy of a coronavirus pass proving their vaccination status.
The momentum for vaccine passports has been building in numerous countries. Italy, for example, requires proof of vaccination for dining indoors, long-distance travel and some cultural activities. The British government’s vaccines minister, Nadhim Zahawi, has previously described vaccine passports as “discriminatory” but now says they should be introduced in nightclubs and large-capacity venues.
“We are living through difficult and unprecedented times,” Mr. Zahawi said in the British Parliament on Wednesday.
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