Category: Covid-19

MADRID (AP) Spains prime minister on Thursday announced that existing measures to protect the most vulnerable from the pandemics economic fallout will be prolonged until the end of October.

Spain, one of the countrys that was hardest hit at the beginning of the health emergency, has extended subsidies for the unemployed and furloughs for companies that have gone out of business to try to cushion an economic drop of 11% of its gross domestic product in 2020.

As a national lockdown extended in March last year, the government also rolled out a series of social measures, including a ban on leaving impoverished families without utilities and a moratorium on forced evictions for those who saw their income vanish.

During a televised briefing on Thursday to summarize progress during the first 1 years of his left-wing coalition, Prime Minister Pedro Snchez said that the so-called social shield will be extended beyond the current Aug. 9 expiration date to Oct. 31.

The change will be approved by the Cabinet next week, Snchez said.

Our priority is to fight inequality and social exclusion, the prime minister said, adding that the emptying rural areas where population rates are diminishing are a top priority for his administration: Our goal is that nobody, neither territories nor people, is left behind.

Spain is facing the paradox of being one of the worlds leaders in the uptake of coronavirus jabs, with 55.7% of its 47 million residents already fully vaccinated, but it also has among the highest infection rates in Europe for the past two weeks.

New cases have spread mostly among people under 30, which are largely yet to receive their jabs, although the speed of contagion has plateaued in recent days. Vaccinated people can also become infected with the coronavirus in what are called breakthrough cases.

The country has reported 4.3 million confirmed COVID-19 cases and over 81,000 pandemic-related deaths.

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Spain to extend COVID-19 aid to most vulnerable until Oct 31 - Associated Press

Medical staff members check on a patient in the COVID-19 Intensive Care Unit at United Memorial Medical Center in Houston last November. Doctors are now investigating whether people with lingering cognitive symptoms may be at risk for dementia. Go Nakamura/Bloomberg via Getty Images hide caption

Medical staff members check on a patient in the COVID-19 Intensive Care Unit at United Memorial Medical Center in Houston last November. Doctors are now investigating whether people with lingering cognitive symptoms may be at risk for dementia.

Before she got COVID-19, Cassandra Hernandez, 38, was in great shape both physically and mentally.

"I'm a nurse," she says. "I work with surgeons and my memory was sharp."

Then, in June 2020, COVID-19 struck Hernandez and several others in her unit at a large hospital in San Antonio.

"I went home after working a 12-hour shift and sat down to eat a pint of ice cream with my husband and I couldn't taste it," she says.

The loss of taste and smell can be an early sign that COVID-19 is affecting a brain area that helps us sense odors.

Hernandez would go on to spend two weeks in the hospital and months at home disabled by symptoms including tremors, extreme fatigue and problems with memory and thinking.

"I would literally fall asleep if I was having a conversation or doing anything that involved my brain," she says.

Now, researchers at UT Health San Antonio are studying patients like Hernandez, trying to understand why their cognitive problems persist and whether their brains have been changed in ways that elevate the risk of developing Alzheimer's disease.

The San Antonio researchers are among the teams of scientists from around the world who will present their findings on how COVID-19 affects the brain at the Alzheimer's Association International Conference, which begins Monday in Denver.

What scientists have found so far is concerning.

For example, PET scans taken before and after a person develops COVID-19 suggest that the infection can cause changes that overlap those seen in Alzheimer's. And genetic studies are finding that some of the same genes that increase a person's risk for getting severe COVID-19 also increase the risk of developing Alzheimer's.

Alzheimer's diagnoses also appear to be more common in patients in their 60s and 70s who have had severe COVID-19, says Dr. Gabriel de Erausquin, a professor of neurology at UT Health San Antonio. "It's downright scary," he says.

And de Erausquin and his colleagues have noticed that mental problems seem to be more common in COVID-19 patients who lose their sense of smell, perhaps because the disease has affected a brain area called the olfactory bulb.

"Persistent lack of smell, it's associated with brain changes not just in the olfactory bulb but those places that are connected one way or another to the smell sense," he says.

Those places include areas involved in memory, thinking, planning and mood.

COVID-19's effects on the brain also seem to vary with age, de Erausquin says. People in their 30s seem more likely to develop anxiety and depression.

"In older people, people over 60, the foremost manifestation is forgetfulness," he says. "These folks tend to forget where they placed things, they tend to forget names, they tend to forget phone numbers. They also have trouble with language; they begin forgetting words."

The symptoms are similar to those of early Alzheimer's, and doctors sometimes describe these patients as having an Alzheimer's-like syndrome that can persist for many months.

"Those people look really bad right now," de Erausquin says. "And the expectation is that it may behave as Alzheimer's behaves, in a progressive fashion. But the true answer is we don't know."

Another scientist who will present research at the Alzheimer's conference is Dr. Sudha Seshadri, founding director of the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases at UT Health San Antonio.

The possibility that COVID-19 might increase the risk of Alzheimer's is alarming, Seshadri says. "Even if the effect is small, it's something we're going to have to factor in because the population is quite large," she says.

In the U.S. alone, millions of people have developed persistent cognitive or mood problems after getting COVID-19. It may take a decade to know whether these people are more likely than uninfected people to develop Alzheimer's in their 60s and 70s, Seshadri says.

Studies of people who have had COVID-19 may help scientists understand the role infections play in Alzheimer's and other brain diseases. Previous research has suggested that exposure to certain viruses, including herpes, can trigger an immune response in the brain that may set the stage for Alzheimer's.

"If one understands how the immune response to this virus is accelerating [Alzheimer's] disease, we may learn about the impact of other viruses," Seshadri says.

Meanwhile, people like Cassandra Hernandez, the nurse, are simply trying to get better. More than a year after getting sick, she says, her brain is still foggy.

"We were at dinner and I forgot how to use a fork," she says. "It was embarrassing."

Even so, Hernandez says she's improving slowly.

"Before this I was working on my master's," she says. "Now I can do basic math, addition and subtraction, I can read at a fifth-grade level. I'm still working hard every day."

Hernandez has been working with Dr. Monica Verduzco-Gutierrez, chair of the department of physical medicine and rehabilitation at UT Health and director of the COVID-19 recovery clinic.

Verduzco-Gutierrez says her practice used to revolve around people recovering from strokes and traumatic brain injuries. Now she spends some days seeing only patients recovering from COVID-19.

The most common complaint is fatigue, Verduzco-Gutierrez says. But these patients also frequently experience migraine headaches, forgetfulness, dizziness and balance issues, she says.

Some of these patients may never recover fully, Verduzco-Gutierrez says. But she's hopeful for Hernandez.

"She's made so much improvement and I would love for her to go back to nursing," Verduzco-Gutierrez says. "But again, we don't know what happens with this disease."

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Memory Effects Of Long COVID-19 Can Resemble Alzheimer's : Shots - Health News - NPR

The month of July has seen Covid-19 cases in the United States increase at the fastest pace since last winter, marking the start of the latest wave of infections to afflict the nation. A new STAT analysis of Covid-19 case data reveals this new wave is already outpacing the spring and summer waves of 2020.

There are many metrics that governments, scientists, and media outlets have used to try and reckon with the Covid-19 pandemic. One of the most popular ways of visualizing Covid data has been to track the weekly average of new cases. This is pictured below.

The number represented by the line could be thought of as the velocity of cases in the U.S. It tells us how fast case counts are increasing or decreasing and does a good job of showing us the magnitude of each wave of cases.

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The chart, however, fails to show the rate of acceleration of cases. This is the rate at which the number of new cases is speeding up or slowing down.

As an analogy, a cars velocity tells you how fast the car is going. Its acceleration tells you how quickly that car is speeding up.

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Using Covid-19 case data compiled by the Center for Systems Science and Engineering at Johns Hopkins University and Our World in Data, combined with data from the Centers for Disease Control and Prevention, STAT was able to calculate the rate of weekly case acceleration, pictured below.

In this chart, we see how quickly the weekly average of new cases is changing. When the values are positive, new case counts are increasing, and when the values are negative, new case counts are falling. Highlighted in red, we can see each previous waves intensity and duration.

Looking at the data this way is useful because the rate at which cases increase is a reasonable indicator of how intense that wave might be and how long it might last. For example, case acceleration in the U.S. reached a peak in November 2020, closer to the start of the nations deadly winter wave than to when cases reached their zenith in January of 2021.

This view of the data reveals that the United States is currently in the midst of a fifth wave of cases and that this new wave is growing faster than the first and second waves from spring and summer of 2020.

STAT also calculated case acceleration rates for each state and major territory in the U.S., revealing where cases are increasing the fastest.

In the last two weeks, new case counts in Louisiana accelerated the fastest in the nation at an average rate of 444 cases per week per day (2.38 cases per 100,000 people per week per day). Only 36% of the states residents are vaccinated, making it among the least vaccinated in the country.

By looking at the states case acceleration rate, we can see that cases in Louisiana are currently increasing faster than they did at the start of last winters wave.

Likewise, in the state of Florida, the case acceleration rate has outpaced that states 2020 summer wave.

In Florida, about 48% of residents are fully vaccinated against Covid-19.

Cases are increasing in nearly every region of the country, but they are not increasing at the same rate everywhere. Vaccination rates likely help explain these variations.

The five states where cases are accelerating the fastest all have vaccination rates below the national average. But consider the state of Massachusetts, where about 63% of the population is fully vaccinated.

The New York Times Covid Dashboard reports the state has an alarming 351% increase in cases over the last 14 days, the highest such percentage change in the nation. Looking at Massachusetts case acceleration paints a different picture.

While cases in Massachusetts are increasing, the rate at which case reports are accelerating is much lower than it has been for any of the states previous waves, and is below the national average for case acceleration.

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A new way to visualize the surge in Covid-19 cases in the US - STAT - STAT

WASHINGTON, July 28 (Reuters) - Tempers flared in the U.S. Congress on Wednesday after its chief physician urged lawmakers to resume wearing masks to slow the spread of the highly contagious Delta variant of COVID-19, with the top Democrat labeling Republican opposition as "moronic."

A high-ranking aide to House of Representatives Speaker Nancy Pelosi stopped short of confirming a report based on garbled audio that Pelosi called her Republican counterpart "such a moron" because of his opposition to the new directive.

"The Speaker believes that saying a mask requirement is 'not a decision based on science' is moronic," Drew Hammill, deputy chief of staff for House Speaker Nancy Pelosi, said in a tweet.

Hammill was referring to a tweet by McCarthy in which he said, "Make no mistake - The threat of bringing masks back is not a decision based on science, but a decision conjured up by liberal government officials who want to continue to live in a perpetual pandemic state."

The high-level spat came as COVID-19 cases in recent days have been rising, along with deaths, across the United States.

Since early in the pandemic, mask-wearing and vaccinations have been U.S. political flashpoints, with Republicans, encouraged by former President Donald Trump, resisting and Democrats urging compliance with medical advice.

Many Republicans have complained that such government edicts infringe on individual liberties.

Late on Tuesday, Dr. Brian Monahan, the attending physician for Congress, required the use of masks indoors where people are congregating. It followed a similar move by the White House after the Centers for Disease Control and Prevention issued new mask recommendations to stem the spread of the new variant.

"Mask and vaccine mandates: Bullying, Controlling, Unconstitutional, Threats to Liberty!" Republican Representative Jody Hice of Georgia tweeted on Wednesday morning.

People wear masks against the coronavirus disease (COVID-19), following the CDC recommendation that fully vaccinated Americans wear masks as the highly transmissible Delta variant has led to a surge in infections, as they enter the Disney Store in Times Square in New York City, New York, U.S., July 27, 2021. REUTERS/Brendan McDermid

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Some 57.6% of Americans have received at least one dose of COVID-19 vaccine, with the lowest rates across the heavily Republican U.S. Southeast. Four of the five U.S. states with the lowest vaccination rates have Republican governors: Mississippi, Idaho, Wyoming and Alaska, according to a Reuters COVID tracker. The governor of the fifth state, Louisiana, is a Democrat.

The top Senate Republican, Mitch McConnell, is rolling out a campaign ad in his home state of Kentucky to counter what he called "bad advice" prompting some Americans to opt not to get vaccinated.

"For the Congress, representing a collection of individuals traveling weekly from various risk areas (both high and low rates of disease transmission), all individuals should wear a well-fitted, medical-grade filtration mask ... when they are in an interior space," Dr. Monahan said in a memo late Tuesday.

The rule applies to all House of Representatives office buildings, in the hall of the House and in committee meetings, he said.

Even before the recommendation, many congressional Democrats had resumed wearing masks in the Capitol this week.

At her weekly news conference, Pelosi attempted to cool passions somewhat by refusing to comment directly on whether McCarthy's position was "moronic." Instead, in response to a reporter's question, Pelosi said, "To say that wearing a mask is not based on science, I think is not wise."

Throughout the pandemic, the 100-member Senate and the 435-member House have taken different precautions to contain COVID-19 infections in the sprawling Capitol.

Monahan's latest directive did not require renewed mask-wearing on the Senate side of the Capitol - a decision that did not escape McCarthy.

"If she (Pelosi) knows so much about science explain to me where the science changes in the Rotunda," McCarthy said of the massive room that separates the House and Senate.

Reporting by Susan Cornwell, David Morgan and Doina Chiacu; Writing by Richard Cowan; Editing by Scott Malone, Jonathan Oatis and Richard Chang

Our Standards: The Thomson Reuters Trust Principles.

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Tempers flare in U.S. Congress as COVID-19 mask mandates return - Reuters

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NASHVILLE, Tenn. -- The Tennessee Titans opened up training camp on Wednesday with a 90% COVID-19 vaccination rate, according to GM Jon Robinson. It's unclear whether those are all fully vaccinated players or players with at least one shot, but one player in the process of getting vaccinated is Ryan Tannehill.

The quarterback spoke to the media after practice and said he's getting vaccinated only because of the NFL's severe protocols for the unvaccinated.

"I am currently in the process right now," Tannehill said. "The NFL has made it clear what they want to happen. If you don't fall in line, they're going to try and make your life miserable because of the protocol.

"I wouldn't have gotten the vaccine without the protocols that they are enforcing on us. I think it's a personal decision for each of us. They are trying to force our hands and ultimately have forced a lot of hands by the protocols. It is what it is."

Tannehill said he loves the game and his team, so he wanted to get vaccinated to help build chemistry with his teammates in the locker room and cafeteria as well as on the field. According to Tannehill, the Titans brought doctors and other medical authorities to help educate the players about vaccines.

Despite that educational experience, Tannehill is still not fully comfortable with COVID-19 vaccines. He declined to explain why.

Tannehill wore a mask during the team stretch period to start practice but was not required to wear the mask during practice. Robinson said it is part of new protocols that were instituted Tuesday night. Robinson also explained the four categories of players who have been vaccinated.

"There's a group that is fully vaccinated that has had either the single shot or two shots and has waited for the 14-day acclimation period," he said before practice. "The next category of players is one that has been vaccinated, but they are waiting to clear the 14-day period before they are fully vaccinated. There's a third category where they are in between shots. Then there's a fourth category where they haven't been vaccinated."

The Titans are encouraging the players to do more research and become more familiar with the vaccination process.

Added coach Mike Vrabel, "We are focused on making sure that we continue to educate our players to let them make the best decision for them and hopefully this football team. It is a personal decision and, hopefully, one that they can come to that will help them and that will help this team."

Vrabel said he expects the number of vaccinated players to continue to increase but maintains that protocols won't change as the percentage increases. While some teams have utilized a band to identify unvaccinated players, Vrabel said the Titans aren't utilizing such identifiers.

The entire Titans coaching staff is fully vaccinated, according to Vrabel. However, the team did place defensive back Chris Jones on the reserve/COVID-19 list before Wednesday's practice.

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Titans' Ryan Tannehill: NFL 'trying to force our hands' on COVID-19 vaccines - Tennessee Titans Blog- ESPN - ESPN

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We will maintain existing travel restrictions at this point for a few reasons: The more transmissible Delta variant is spreading both here and around the world, driven by the Delta variant cases are rising here at home, particularly among those who are unvaccinated and appear likely to continue in the weeks ahead. The C.D.C. just advised Americans against travel to the United Kingdom this past Monday given the surge in cases. They will evaluate and make recommendations based on health data. But I dont have a timeline to predict for you because its all about what success we have at getting more people vaccinated, getting more vaccines out to the world and fighting the virus.

The Biden administration will continue to restrict the entry of Europeans and others into the United States, citing concerns that infected travelers may contribute to further spread of the contagious Delta variant across the country, Jen Psaki, the White House press secretary, said Monday afternoon.

Concern about the variant had convinced officials not to lift the current travel restrictions on foreigners, Ms. Psaki said, some of which had been in place since the beginning of the pandemic. Vaccines remain effective against the worst outcomes of Covid-19, including from the Delta variant.

The more transmissible Delta variant is spreading both here and around the world, she told reporters, adding that cases are rising in the United States, particularly among the unvaccinated.

The decision is a blow to the travel industry, which hoped that a lifting of the travel bans could increase tourism for the remaining summer months, helping hotels, airlines and other businesses that have been struggling.

But Ms. Psaki said that it was unclear when the United States would remove the bans completely.

I dont have a timeline to predict for you because its all about what success we have at getting more people vaccinated, getting more vaccines out to the world and fighting the virus, she said.

The United States began restricting travel from foreigners in January 2020, when former President Donald J. Trump restricted some travel from China in the hopes of preventing the spread of the virus. That effort largely failed.

But health officials pressed the Trump administration to expand travel bans to much of Europe during the first surge of the pandemic in the spring of 2020, and more countries have been added to the ban as the original virus and several variants have spread rapidly from country to country.

The Trump administration also used a public health authority known as Title 42 to effectively shut down the southern border to entry, citing worries that immigrants crossing on foot could bring the virus into the country. The Biden administration stopped enforcing the rule for unaccompanied children crossing the border alone and for some families.

But Ms. Psaki said that the Title 42 restrictions, like the other travel bans, would remain for the time being.

We have never conveyed or announced a timeline for Title 42, she said. So nothing has changed in that regard, it remains in place, and it will remain in place as long as that is the guidance from our health and medical experts.

WASHINGTON The Department of Veterans Affairs will require 115,000 of its frontline health care workers to be vaccinated against the coronavirus in the next two months, making it the first federal agency to mandate that employees be inoculated, government officials said on Monday.

The move comes as concern is growing that the substantial portion of the population that has not been vaccinated is contributing to the rapid spread of the highly contagious Delta variant. While it was a sharp departure from the Biden administrations reluctance to embrace mandates, it was part of a broader shift in which New York City, many hospital chains and some private employers are deciding that the time has come to make being vaccinated a requirement.

I am doing this because its the best way to keep our veterans safe, full stop, Denis McDonough, the secretary of veterans affairs, said in a telephone interview on Monday. The department is one of the largest federal employers and is the biggest integrated health care system in the country.

The mandate will apply to workers who are the most patient-facing, Mr. McDonough said, including doctors, dentists, registered nurses, physician assistant and some specialists. Beginning on Wednesday, those health care workers will have eight weeks to get fully vaccinated or face penalties including possible removal, he said.

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On Sept. 13, the entire city workforce will be mandated under the Covid safety mandate to either get vaccinated, which is far preferable, or get tested once a week. September is the pivot point of the recovery. September is when many employers are bringing back a lot of their employees. September is when school starts full strength. September is when people come back from the summer. September is when it will all happen. And so on Sept. 13, which is the first full day of school, every single city employee will be expected to be either vaccinated or be tested weekly. This means everybody. This means, obviously, everyone who works in our schools, our educators and staffs staff it means the N.Y.P.D., the F.D.N.Y., it means all city agencies. It means people who work in offices and people work on the front line, everyone. So were going to keep climbing this ladder and adding additional measures as needed mandates and strong measures whenever needed to fight the Delta variant. No. 1 way to fight it is get vaccinated. Were proving it. This is the reason life is as good as it is in New York City, right now, because were above the national average in vaccinations. But we need to do more. We have to take seriously, if someones unvaccinated, unfortunately, they pose a threat to themselves, but they also have a greater chance of spreading the disease.

The drive to get Americans vaccinated accelerated on Monday when the most populous state and largest city in the United States announced that they would require their employees to get vaccinated against the coronavirus, or face frequent tests.

All municipal employees in New York City, including police officers and teachers, and all state employees and on-site public and private health care workers in California will have to be vaccinated or face at least weekly testing.

The Department of Veterans Affairs on Monday also became the first federal agency to mandate that some of its employees get inoculated.

The mandates are the most dramatic response yet to the lagging pace of vaccinations around the country in the face of the highly contagious Delta variant, which is tearing through communities with low rates of vaccination and creating what federal health officials have called a pandemic of the unvaccinated.

Vaccines remain effective against the worst outcomes of Covid-19, including from the Delta variant, but only 49 percent of people in the United States are fully vaccinated, according to federal data.

Misinformation and skepticism have dogged the vaccine rollout, too, and in recent weeks new coronavirus infections and hospitalizations have risen, with a fourfold increase in new cases per day over the last month.

But both indicators, as well as new deaths, remain well below their winter peaks. Cities, private employers and other institutions have been grappling with whether to require vaccines to help get more people vaccinated.

Nearly 60 major medical associations, including the American Medical Association and the American Nurses Association, signed a joint statement on Monday calling for the mandatory vaccination of health care workers that described inoculation as the logical fulfillment of the ethical commitment of all health care workers.

Hospitals and health care systems like NewYork-Presbyterian and Trinity Health have already announced vaccine mandates, in some cases touching off union protests. The National Football League recently announced it could penalize teams with players who do not get vaccinated. Delta Air Lines will require new employees to be vaccinated, but not its current workers. And last week a federal judge ruled that Indiana University could require vaccinations for students and staff members.

New York City will require its roughly 340,000 municipal workers to be vaccinated against the coronavirus by the time schools reopen in mid-September or face weekly testing, Mayor Bill de Blasio said.

Enforcing the testing requirement there could be complicated, since the more than two dozen unions that represent municipal employees could take issue with the rule.

Mr. de Blasio said the new measures were first steps and that more would follow, and he reiterated a call to private employers to set vaccine mandates for their workers.

Right now we are leading by example, the mayor said. A lot of times, thats what private sector employers say thats what they need.

In California, where 75 percent of the eligible population has received at least one vaccine dose, the new requirement will apply to roughly 246,000 state employees and many more health care workers in the state, Gov. Gavin Newsom said.

Everyone that can get vaccinated should, Mr. Newsom said on Twitter.

Gov. Andrew M. Cuomo of New York avoided supporting a statewide measure like Mr. Newsoms and argued most public-facing employees are municipal, not state workers, suggesting mandates were more of a question for localities.

Mr. Newsom blamed misinformation for the pandemics persistence, slamming in particular Republican members of Congress and Fox News pundits who have questioned vaccines.

We are exhausted respectfully, exhausted by the ideological prism that too many Americans are living under, he said. We are exhausted by the right-wing echo chamber that has been perpetuating misinformation around the vaccine and its efficacy and safety.

On Monday, Jen Psaki, the White House press secretary, said vaccine mandates are meant to keep Americans safe, but she distanced the federal governments vaccination efforts from such requirements, reinforcing comments she made last week that mandates were decisions best left to private sector companies, institutions and local communities.

We are not going to judge our success here by whether we score political points, she said on Monday. We are going to judge it by whether we are able to save more lives, and if the health and medical experts suggest thats the right way to go then we will support that.

Eliza Shapiro contributed reporting.

As coronavirus infections rise in the United States, concern is mounting among officials and health experts that a surge of cases could devastate unvaccinated populations and push some communities back into the types of lockdowns imposed at the peaks of the pandemic.

Although case numbers are still a fraction of what they were in the worst months, Dr. Anthony Fauci, the nations top infectious disease expert, told CNN on Sunday that the country was going in the wrong direction. And it is not just Dr. Fauci. Gov. Kay Ivey of Alabama, a Republican, told reporters last week that unvaccinated Americans are letting us down.

On Monday, U.S. officials matched the growing concern with steps aimed at controlling travel to and from the United States to stem the spread of the highly contagious Delta variant.

The Biden administration said it would continue to restrict the entry of Europeans and others into the country, citing concerns that infected travelers could contribute to Deltas spread. And the Centers for Disease Control and Prevention urged Americans to avoid traveling to Spain and Portugal, saying that as cases rise in both countries, even fully vaccinated travelers may be at risk for getting and spreading Covid-19 variants.

Spain and Portugal reopened their borders to American tourists in June. But over the past two weeks, there has been a 74 percent increase in new cases in Spain and an 18 percent rise in Portugal, according to New York Times data.

Last week, the C.D.C. put out a similar Level 4 travel notice the highest warning it issues for Britain. Almost all Covid restrictions have been lifted in England, and case numbers have been high.

Restrictions on travel from Europe and other parts of the world to the United States will remain in place, Jen Psaki, the White House press secretary, said on Monday afternoon, adding that she had no information on when the travel bans would be lifted.

I dont have a timeline to predict for you, because its all about what success we have at getting more people vaccinated, getting more vaccines out to the world and fighting the virus, she said.

The U.S. government began restricting travel from foreigners in January 2020, when President Donald J. Trump blocked some travel from China in the hopes of preventing the spread of the virus. That effort largely failed. But health officials pressed the Trump administration to expand travel bans to much of Europe during the first surge of the pandemic in the spring of 2020, and more countries have been added to the ban as the virus and variants have spread.

Controlling travel in and out of the country is proving to be less daunting for U.S. officials than other problems in the pandemic. Misinformation continues to undermine efforts to persuade people that the vaccines are safe, with wildly inaccurate claims of the health risks thriving in some corners of the internet.

In Louisiana, where the vaccination rate is just over 45 percent, according to New York Times data among the lowest in the United States public health workers are going door-to-door to counter the claims. As mass vaccination sites have closed, health workers are trying to persuade people who are hesitant, and people who outright refuse, to get the shots.

Some jurisdictions are adopting more aggressive tactics, such as insisting that employees be vaccinated. U.S. officials said on Monday that the Department of Veterans Affairs would require 115,000 of its frontline health care workers to be vaccinated against the coronavirus in the next two months, making it the first federal agency to issue such a mandate.

In New York City, all municipal employees, including police officers and teachers, will have to be vaccinated or face at least weekly testing. Similar rules will apply to state employees and on-site public and private health care workers in California.

Such steps could become more prevalent if the virus continues to spread through unvaccinated populations. Dr. Joseph Kanter, the top health official in Louisiana, lamented that his state had become the leading edge of the Delta surge, adding: We lost all the progress we had made.

California will require all state employees and on-site public and private health care workers to be vaccinated or face at least weekly testing, Gov. Gavin Newsom announced on Monday.

This is a requirement, to prove youve been vaccinated and if you have not, you will be tested, Mr. Newsom said.

The California move came a few hours after Mayor Bill de Blasio of New York City announced a similar vaccine mandate for all municipal workers, to take effect by the time schools reopen in mid-September. Last week, Mr. de Blasio announced a vaccine requirement for public health care workers part of an effort to speed up vaccinations as the city faces a third wave of coronavirus cases driven by the spread of the Delta variant.

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246,000 Californians are state employees, 246,000 Californians should be vaccinated. And if theyre not vaccinated, and cannot verify that theyve been vaccinated, we are requiring that they get tested. California is committed to vaccination verification and/or testing on a weekly basis. Were not stopping just with state employees today. Were also announcing partnerships that include those like Kaiser private sector, now stepping up, organizations representing physicians and dentists, dialysis clinics, stepping up. Private-sector clinics are committing to the same. And we hope this example of public and private leadership as it relates to vaccine verifications, vaccine mandates and/or mandated testing one to two times a week with also commensurate P.P.P., or rather P.P.E., obligations as it relates to protective gear N95 respirator masks as an example will lead to others to replicate this example, in the private sector.

State and local officials, businesses and residents across the country are grappling with whether vaccines should be mandated. The city of San Francisco, several Bay Area counties, the University of California and various hospital systems around the country have recently announced similar mandates.

The new requirement will apply to roughly 246,000 state employees and many more health care workers in the state, Mr. Newsom said. State departments will be expected to begin verifying the vaccination status of all state employees by Aug. 2, while the verification program for health care workers will go into effect on Aug. 9 and by no later than Aug. 23.

More than 64 percent of California residents have received at least one dose of the vaccine, according to federal data, but the speed of inoculations has slowed. The number of virus cases in California has risen to more than 6,300 on average per day, more than double the daily average two weeks ago.

A group of nearly 60 major medical organizations, including the American Medical Association and the American Nurses Association, called on Monday for mandatory vaccination of health care workers. As the highly contagious Delta variant drives a new surge of coronavirus cases, vaccination is an ethical obligation for health care workers, the groups said in a joint statement.

The statement said that all health care and long-term care employers should require their workers to receive the Covid-19 vaccine. This is the logical fulfillment of the ethical commitment of all health care workers to put patients as well as residents of long-term care facilities first and take all steps necessary to ensure their health and well-being, the statement said.

The document was signed by a wide array of professional associations, including those representing doctors, nurses, pharmacists and infectious disease experts. It said that exceptions could be made for the small subset of employees who are unable to be vaccinated for medical reasons.

In recent weeks, more hospitals and health care systems have announced that they would begin employees to be vaccinated. The U.S. Equal Employment Opportunity Commission has said that the mandates are legal, and many hospitals already require employees to get flu shots.

Health care organizations rarely agree on anything, but this is one thing where they are speaking with one voice and unanimity, said Dr. Ezekiel Emanuel, an oncologist and bioethicist at the University of Pennsylvania, who organized the joint statement. I think that attests to the wide recognition that this is the right thing to do for this country.

Although many health care workers have been eligible for vaccination since December, when the first shots were authorized, a significant number remain unvaccinated.

In New York, for instance, roughly 1 in 4 hospital workers have not yet been vaccinated, according to state data. Nationwide, just 58.7 percent of nursing home employees have been fully vaccinated, according to the Centers for Disease Control and Prevention.

Some health care workers have pushed back against vaccine requirements. A small group of employees sued Houston Methodist Hospital over its mandate. The suit was dismissed last month, and more than 150 workers at the hospital were fired or resigned over their refusal to be vaccinated.

Some employers have been reluctant to require the vaccines, which currently have an emergency use authorization, until they receive full approval from the Food and Drug Administration. That approval is expected, but could be months away.

But the joint statement noted that the Covid-19 vaccines have a good track record so far. We know the vaccines are safe and highly effective at preventing severe illness and death from Covid-19, Dr. Susan R. Bailey, the immediate past president of the A.M.A., said in a statement.

At the urging of federal regulators, two coronavirus vaccine makers are expanding the size of their clinical trials for children ages 5 to 11 a precautionary measure designed to detect rare side effects including heart inflammation problems that turned up in vaccinated people younger than 30.

President Biden promised at a meeting in Ohio last week that emergency clearance for pediatric vaccines would come soon, but the White House has not been specific on the timeline. It was unclear whether expanding the studies will affect when vaccines could be authorized for children.

The Food and Drug Administration has indicated to Pfizer-BioNTech and Moderna that the size and scope of their pediatric studies, as initially envisioned, were inadequate to detect rare side effects. Those include myocarditis, an inflammation of the heart muscle, and pericarditis, inflammation of the lining around the heart, multiple people familiar with the trials said.

Questions about vaccinating children including those under 12 are of huge interest to parents and teachers. Regulators will be required to balance potential side effects of coronavirus vaccination against the risks of Covid-19.

Members of a C.D.C. advisory committee have said that the benefits of shots for people older than 12 greatly outweigh the risks, including of heart problems.

The F.D.A. has asked the companies to include 3,000 children in the 5-to-11-year-old group, the group for whom results were expected first, according to people familiar with the situation. One of the people, granted anonymity to speak freely, described that figure as double the original number of study participants.

A spokesman for Moderna, Ray Jordan, confirmed that the company intends to expand its trial to enroll a larger safety database which increases the likelihood of detecting rarer events and expects to seek emergency authorization late this year or early next year.

The Moderna trial began recruiting patients in March with the aim of enrolling 6,795 participants younger than 12. The participants were to be split equally into three age brackets, including a 6 to 11 year old group, of 2,265 participants each. Mr. Jordan said the company is actively discussing a proposal with the F.D.A. to expand the trial.

Pfizer is on a faster timetable than Moderna, and may be able to meet the F.D.A.s expectations on a bigger trial size and still file a request to expand emergency authorization of its vaccine by the end of September. Reviewing all the safety and efficacy data will likely take regulators at least a few weeks.

Pfizer has previously said it expects to have results for the 5-to-11-year-old group in September, with results for children aged 2 to 5 shortly after that. Results for the youngest children 6 months to 2 years old are expected in October or November. A spokeswoman said Monday that the company had no updates on its timetable.

In June, the Centers for Disease Control and Prevention published data showing that the two vaccines may have caused myocarditis and pericarditis in more than 1,200 Americans, including about 500 who were younger than 30. The symptoms typically appeared within two weeks and were more common in young men and boys.

The rate was low: Fewer than 13 cases per one million second doses administered. Most cases were mild and quickly cleared up, the researchers said.

Dr. Paul A. Offit, an infectious disease specialist who previously served on the C.D.C.s Advisory Committee on Immunization Practices, noted that infection with the coronavirus also carries a risk and delays in authorizing vaccines because of expanded trials might also put children at risk. Theres always a human price to pay for knowledge, he said.

The F.D.A. authorized the Pfizer vaccine on an emergency basis for children ages 12 to 15 in April; the Moderna vaccine has been cleared only for people 18 and older. The agency attached a warning about potential heart problems to the fact sheets of the vaccines in June.

Many public health experts argue that, with so much attention focused on hospitalizations and deaths among older Americans infected with the coronavirus, the risk for children has been overlooked.

More than four million American children and adolescents have tested positive for the virus since the onset of the pandemic, the American Academy of Pediatrics reported last week. Of those, at least 346 have died.

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Thirty-one years ago, after its passage, many Americans have never lived in a world without the A.D.A. Generations have grown up not knowing a time before it existed, but many of us can still recall in America, where a person with a disability was denied service in restaurants and grocery stores, and could be, where a person using a wheelchair couldnt ride in a train or take a bus to work or to school, or an employer could refuse to hire you because of a disability an America that wasnt built for all Americans. Then we passed the A.D.A., and made a commitment to build a nation for all of us, all of us. For more than 60 million Americans living with disabilities, the A.D.A. is so much more than a law. Its a source of opportunity, participation, independent living and respect and dignity, the bulwark against discrimination and a path to independence. Im proud to announce a new effort, the first of its kind, to help Americans grappling with long-term effects of Covid-19 that doctors call long Covid. Many Americans who seemingly recover from the virus still face lingering challenges like breathing problems, brain fog, chronic pain and fatigue. These conditions can sometimes can sometimes rise to the level of a disability. So were bringing agencies together to make sure Americans with long Covid who have a disability have access to the rights and resources that are due under the disability law.

Americans suffering from long Covid a term referring to new or ongoing health problems from a coronavirus infection that occurred weeks or months ago will have access to the benefits and protection provided under federal disability law, President Biden said on Monday.

Speaking in the Rose Garden to celebrate the 31st anniversary of the Americans with Disabilities Act, Mr. Biden listed some of the lingering effects that have been seen in coronavirus survivors, including breathing problems, brain fog, chronic pain or fatigue, and noted that the effects sometimes rise to the level of a disability.

We are bringing agencies together to make sure Americans with long Covid, who have a disability, have access to the rights and resources that are due under the disability law, Mr. Biden said, noting that they would include special accommodations and services in the workplace, in schools and in the health care system.

In some cases, the health effects of Covid-19 can persist for months after initially causing only mild symptoms. A study published in April found that a coronavirus infection also appears to increase the risk of death and chronic medical conditions afterward, even in people who were never sick enough with the virus to be hospitalized.

The research, based on records of patients in the Department of Veterans Affairs health system, also found that non-hospitalized Covid survivors had a 20 percent greater chance of needing outpatient medical care in the six months following infection than did people who had not contracted the coronavirus.

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Covid-19 Updates: White House Will Keep Travel Bans in Place - The New York Times

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Officials in some of Texas' largest counties are asking residents even those vaccinated against the coronavirus to again wear masks in public as the highly contagious delta variant continues to spread across the state. And some officials are urging unvaccinated people to limit their trips outside the home.

The updated suggestions came as Harris, Dallas and Travis counties raised their local coronavirus threat levels or precautionary guidelines in recent days.

Travis County officials made the announcement in a virtual news conference Friday morning. Under Stage 4, Austin and Travis officials want residents vaccinated and unvaccinated to wear masks at all times in public, and for unvaccinated people to only leave their homes for essential trips.

"I know this transition back to Stage 4 may be difficult, but we must follow our local health authority's recommendations to once again flatten the curve and to ensure we continue to protect ourselves and our most vulnerable," Travis County Judge Andy Brown said in a press release.

That came a day after Harris County Judge Lina Hidalgo also urged residents, even those who have been vaccinated, to wear masks in public as the county increased its COVID threat level. And on Friday night, Dallas County officials increased their threat level, which asks unvaccinated people to limit trips outside the home, among other precautions.

Local officials cant enforce any restrictions, however, because Gov. Greg Abbott banned all local pandemic-related mandates in May. The recommendations differ from those of the U.S. Centers for Disease Control and Prevention, which says it safe for people who are fully vaccinated to resume activities that you did before the pandemic without wearing a mask or physically distancing.

The announcements come as COVID-19 cases and hospitalizations have risen statewide: Texas seven-day average of new cases jumped from 2,410 to 4,087 daily cases compared with the previous seven-day period, while hospitalizations increased 47% over the same period.

"Each of us has a personal choice to make will we do our part to stop disease transmission by getting vaccinated and taking the necessary precautions to protect ourselves and others, or will we be part of its continued spread?" Dr. Desmar Walkes, Austin-Travis County health authority, said in the Austin press release.

Brandon Formby contributed to this report.

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Austin, Dallas and Houston officials increase COVID-19 threat levels - The Texas Tribune

"Cases are exploding in our hospital and in our communities," Chad Neilsen, the hospital's director of infection prevention, told CNN's Alisyn Camerota on Wednesday.

Local leaders are reinstating mask mandates

While most businesses and local leaders across the US did away with mask requirements as summer inched closer -- most still asking unvaccinated Americans to keep on their face coverings -- mandates are now slowly coming back.

New Orleans announced a new mask advisory Wednesday, asking everyone, regardless of vaccination status, to keep a mask indoors when they're with people who are not in their household. Health officials said average daily cases in the city increased by more than 10 times over two weeks, the majority of which are unvaccinated people.

"People who continue to refuse to take the lifesaving COVID vaccine are now also putting the entire community in jeopardy. We must take action now to slow the rapid spread of the Delta variant," said Dr. Jennifer Avegno, the director of the city's health department.

Nevada's Clark County, which includes Las Vegas, announced it was reimplementing a mask mandate for workers in public places. The new requirement went into effect Wednesday after a unanimous approval from the Clark County Commission and will stay in effect through at least August 17.

Dozens of people spoke before the vote, nearly all of whom opposed the measure. Pediatric physician's assistant Amanda Knowles said she supported it because "we have a duty to protect our children who do not have the option to be vaccinated at this point."

In Missouri, the city of St. Louis and St. Louis County said that starting Monday, masks will be required in indoor public places and on public transportation for everyone 5 and older, regardless of vaccination status. Masks are also "strongly encouraged" outdoors as well, especially in group settings, officials added.

Schools are issuing similar requirements

About 18% of its eligible student population is fully vaccinated, the district said, and about 58% of employees are vaccinated or plan to be. Two other Atlanta suburban school districts, Clayton and Dekalb counties, also announced that masks will be required when the school year begins in August.

Parents and community members lined up to speak out against the mask policy.

"You're all hypocrites," said Annie Palumbo, among the evening's first speakers. "I'm here fighting with hundreds of other parents because we don't want our kids masked for seven hours a day. And I look around and I see all of you sitting here without masks. Seriously, what's the deal?"

Members of the board said its decisions followed guidance from the CDC and Virginia's health commissioner. In a letter to families on Thursday, Virginia Beach City Public Schools said administration officials have reviewed the state's latest guidance -- published a day after the board's meeting -- and are consulting with local and state health officials on a plan.

The recently issued state guidance leaves mask decisions to local districts but "strongly recommends" elementary schools put an indoor mask requirement in place for students, teachers and staff regardless of vaccination status and that that "at a minimum" middle and high schools require masks indoors for those who have not been fully vaccinated.

Some companies are rethinking their return to office

The pandemic drastically changed the way Americans worked. While many expect to return to the office in the coming weeks, the latest surge is forcing some employers to rethink their plans.

Among them, Apple.

Apple said that date could change again depending on the country's Covid-19 numbers, but that it would let employees know at least a month in advance, The Times said.

CNN reached out to Apple, but the company did not confirm the delay in plans.

The key to getting our lives back

"If you're somebody who's fully vaccinated, take a little breath here, you're still really well protected by this vaccine and you can do a lot of stuff that you couldn't do six months ago," National Institutes of Health Director Dr. Francis Collins told CNN's Jim Acosta on Wednesday.

"But, for those who are not vaccinated, this is becoming a pandemic that has you in its sights," he said.

But a majority of unvaccinated Americans say they're not at all likely to get a shot regardless of outreach efforts, according to new poll results published Tuesday, by Axios-Ipsos. A quarter or less of those who are unvaccinated said they would be likely to get the vaccine under certain circumstances, according to the poll, which was conducted July 16 to 19.

Without widespread protection against the virus, the country will likely continue to see outbreaks, experts have warned, and new -- potentially more dangerous -- variants could arise that could pose problems to vaccines.

CNN's Naomi Thomas, Andy Rose and Miguel Marquez contributed to this report.

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Many Americans were looking forward to a carefree summer. But Covid measures are creeping back into our reality - CNN

Associated Press| Associated Press

CORUNNA, Mich. Elected officials in a conservative Michigan county who gave themselves bonuses of $65,000 with federal COVID-19 relief aid said they will return the money following days of criticism.

Shiawassee County commissioners acted after the prosecutor said the payments were illegal, The Argus-Press reported.

The Michigan Constitution bars additional compensation for elected officials after services had already been rendered, prosecutor Scott Koerner said Friday.

The commissioners, all Republicans, voted on July 15 to award themselves $65,000 as part of a plan to give $557,000 to 250 county employees as hazard pay for dealing with the coronavirus pandemic.

The smallest amounts for recipients were $1,000 to $2,000. But County Board Chairman Jeremy Root got $25,000. Two more commissioners received $10,000 each, while four others received $5,000 each.

The vote was 6-0 with one commissioner absent.

The commissioners awarded money to other elected officials, including the prosecutor, the sheriff and the county clerk, all Republicans. They, too, said they would give it back.

Since these payments were made, confusion about the nature of these funds has run rampant, a statement from commissioners said. (We) deeply regret that this gesture has been misinterpreted, and have unanimously decided to voluntarily return the funds to the county, pending additional guidance from the state of Michigan.

Commissioner Marlene Webster insisted she had no idea that she had voted to pay herself and returned the money last week, even posting a copy of the check on Facebook. She criticized the latest statement, saying there was no misinterpretation of the payments.

Thats an insult to the citizens of Shiawassee County, Webster said.

Two Michigan congressmen, a Democrat and a Republican, said federal virus aid wasnt intended to reward elected officials.

Separately, a judge set a hearing for Monday in a lawsuit aimed at rescinding bonuses for the officials. It was filed before the latest action.

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Shiawassee County officials will return COVID-19 relief aid bonuses they gave themselves - Detroit Free Press

Update #2: Case Data and Surveillance Efforts

July 24, 2021 | Provincetown, MA Provincetown continues to work closely with county and state health officials to track and respond to the evolving COVID-19 cluster. Expanded testing and vaccination will continue through July 30th and have thus far proved to be vital tools in the response effort as participation numbers increase daily.

Surveillance Data

As of Friday, July 23rd, 430 confirmed positive cases of COVID-19 had been officially reported to the Massachusetts Department of Public Health associated with the Provincetown cluster. Of these cases, 342 are Massachusetts residents, 153 of which reside in Provincetown. The remainder of individuals who tested positive reside in other states. Cases among Massachusetts residents are found to be predominantly symptomatic (71%), with 69% of affected individuals reported to be fully vaccinated. Apart from 3 hospitalizations (2 in state and one out of state) associated with this cluster, symptoms are known to be mild and without complication.

Case investigation to determine the extent of the Provincetown cluster is ongoing and multi-jurisdictional, with involvement from the Centers for Disease Control (CDC) and other municipal public health authorities throughout the state of Massachusetts. Genetic sequencing, a multi-step process that takes several weeks to complete, is being conducted at the Massachusetts State Public Health Laboratory and other labs to determine whether a variant of concern is associated with the cluster. Officials are awaiting these results and will share them as they become available.

Daily testing of wastewater in Provincetown will commence today. Wastewater testing has been a valuable surveillance tool and was conducted in Provincetown throughout the pandemic. Thelast wastewater sampling was conducted in Provincetown in spring 2021. Going forward, the wastewater testing data will indicate the presence of COVID-19 in the 50% of the buildings in Provincetown connected to the towns sewer. Given the current cluster, presence of COVID-19 in wastewater sampling tests is expected.

Observed Improvement of Test Positivity Rates Testing is the best way for health officials to gauge the impact of a cluster and the success of measures that are being taken to reduce viral spread. The number of cases is expected to rise as more individuals take advantage of testing opportunities available in Provincetown and surrounding areas. Further, test positivity rates (the number of tests that come back positive in relation to the total number of tests) have improved since surveillance of the Provincetown cluster began, from 15% to 9%. A test positivity rate of <5% is considered progress towards cluster containment, while a testing positivity rate of <1% is considered fully contained.

Testing, Vaccination and Observance of Precautionary Measures Remain Essential Public health authorities continue to strongly urge residents, local businesses, and visitors in and around Provincetown to follow the precautions outlined in the advisory released Monday, July 19 regardless of vaccination status.

Anyone experiencing even mild symptoms should get tested, as well as anyone who has had a close contact with an individual who has tested positive for COVID-19. Testing is encouraged regardless of vaccination status.

Vaccines remain the single most important tool to combat COVID-19. As the proportion of vaccinated individuals increase, there will be more cases in people who have been fully vaccinated. COVID-19 vaccines do not prevent all infections, but they are 90-95% effective in preventing severe disease.

Additional information about vaccination and testing in Provincetown and elsewhere in the region can be found on the Provincetown and Barnstable County websites.

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July 24, 2021 | Provincetown's Continued Response to COVID-19 Cases - Barnstable County Department of Health and Environment