Covid Updates: Medical Groups Declare Youth Mental Health Crisis – The New York Times

ImageSeveral medical groups say the pandemic has worsened a mental health crisis among teenagers and children.
Credit…Christophe Ena/Associated Press

Leading medical groups have declared a national emergency in child and adolescent mental health triggered by prolonged isolation, uncertainty and grief during the coronavirus pandemic.

In a joint statement on Tuesday, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association said the coronavirus pandemic had worsened an already existing mental health crisis among children and teens.

Inequities resulting from structural racism contributed to disproportionate impacts of the pandemic on children from communities of color, the groups said.

The loss of a loved one has affected children and adolescents more than it has other age groups, research from the American Academy of Pediatrics shows. More than 140,000 children in the United States have lost at least one caregiver since the start of the pandemic, with youth of color disproportionately affected.

“This worsening crisis in child and adolescent mental health is inextricably tied to the stress brought on by Covid-19 and the ongoing struggle for racial justice, and represents an acceleration of trends observed prior to 2020,” the statement said.

Before the pandemic, mental health concerns and suicide had been rising steadily among children and adolescents between 2010 and 2020. By 2018, suicide was the second leading cause of death for youth ages 10 to 24.

According to the Centers for Disease Control and Prevention, between March and October 2020, emergency department visits for children with mental health emergencies rose by 24 percent for those between ages 5 and 11, and 31 percent for children 12 to 17. Among girls ages 12 to 17, E.R. visits identified as potentially the result of a suicide attempt were up more than 50 percent in early 2021 compared with the same period in 2019, according to the C.D.C.

“We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, their communities, and all of our futures,” Gabrielle A. Carlson, president of the American Academy of Child and Adolescent Psychiatry, said in a statement. “We cannot sit idly by.”

The organizations are urging policymakers to take actions such as increasing federal funding to ensure families have access to mental health services, supporting effective models of school-based care and accelerating the integration of mental health care into pediatric care.

The American Rescue Plan assigned $80 million to the Pediatric Mental Health Care Access program to integrate behavioral health needs into pediatric primary care, and $20 million to supporting youth suicide prevention programs. The plan also contributed $50 million for community-based funding for local behavioral health needs worsened by the pandemic.

Finding a provider can be difficult. The American Academy of Child and Adolescent Psychiatry reported earlier this year that there was a severe shortage of child psychiatrists in nearly every state in the country.

Getting children urgent mental health care can be even more challenging, especially when emergency rooms are full. Earlier this year when hospitals were overwhelmed in Colorado and Connecticut, for example, children were sent out of state for care.

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The Washington State Patrol announced that the state’s vaccine mandate has forced out 127 police officers and other employees, as state and city vaccine requirements begin to push out law enforcement officers who refuse to comply.

By Tuesday, 53 civil servants and 74 commissioned officers had left the agency, Chief John R. Batiste said in a statement.

“We will miss every one of them,” he said. “I truly wish that you were staying with us.”

Monday was Washington State’s deadline for more than 800,000 workers, including those at state agencies, schools and health care facilities, to prove they had been fully vaccinated against the coronavirus. The mandate, issued by Gov. Jay Inslee in August, is among the strictest in the country.

“Covid is a killer and the state is taking action intended to improve public safety,” Chief Batiste said in a message to employees on Monday. “I thank you for staying on post and staying in service to this state and agency. Better days are ahead.”

Police unions across the United States have clashed with local governments over Covid vaccine requirements.

In Chicago, the head of the police union told officers to ignore a city order to report their vaccination status by the end of the day last Friday.

On Tuesday, Chicago Police Superintendent David Brown said that 21 officers had been placed on “no pay status” for not complying with the city’s order to disclose their vaccination status.

Public health officials like Dr. Anthony S. Fauci, the nation’s top infectious disease doctor, have implored police officers and others responsible for public safety to get vaccinated.

“Think about the implications of not getting vaccinated when you’re in a position where you have a responsible job, and you want to protect yourself because you’re needed at your job, whether you’re a police officer or a pilot or any other of those kinds of occupations,” Dr. Fauci said on Fox News Sunday.

“We now know the statistics — more police officers die of Covid than they do any other causes of death,” he said. “So it doesn’t make any sense to not try to protect yourself, as well as the colleagues that you work with.”

Other agencies and police unions also reported that officers were leaving over vaccine requirements. At least 150 members of the State Police Association of Massachusetts, the union that represents state police, have resigned or intend to do so, the union told NBC Boston.

Credit…Erin Schaff/The New York Times

WASHINGTON — Justice Stephen G. Breyer on Tuesday turned away a request from health care workers in Maine who had asked the Supreme Court to block a state vaccine mandate based on their religious objections while their legal challenge moved forward.

Justice Breyer did not ask for a response to the workers’ application or refer it to the full Supreme Court. He said the workers could return to the Supreme Court after the federal appeals court rules on their appeal or if that court does not issue a decision by Oct. 29. That is the date on which the state has said it will start enforcing the requirement.

Last week, Judge Jon D. Levy of the Federal District Court in Maine, ruled that the requirement did not run afoul of the First Amendment’s protection of the free exercise of religion.

“Both the serious risk of illness and death associated with the spread of the Covid-19 virus and the efforts by state and local governments to reduce that risk have burdened most aspects of modern life,” he wrote.

“In this case, the plaintiffs — health care workers and a health care provider — have shown that their refusal to be vaccinated based on their religious beliefs has resulted or will result in real hardships as it relates to their jobs,” Judge Levy wrote. “They have not, however, been prevented from staying true to their professed religious beliefs which, they claim, compel them to refuse to be vaccinated against Covid-19.”

A unanimous three-judge panel of the appeals court, the U.S. Court of Appeals for the First Circuit, in Boston, refused to block the mandate while the workers’ appeal of Judge Levy’s ruling moved forward.

The Supreme Court had earlier rejected challenges to vaccination requirements at Indiana University and for personnel in New York City’s school system. Those rulings were also issued by just one justice, which can be a sign that the legal questions involved were not considered substantial.

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Hawaii’s governor, David Ige, announced on Tuesday that the state will “safely open” to fully vaccinated residents and visitors who are traveling domestically and between islands for business or pleasure, starting on Nov. 1.

The governor made the announcement Tuesday afternoon during the opening of the permanent Federal Inspection Services facility at the Ellison Onizuka Kona International Airport, on the island of Hawaii.

Mr. Ige cited lower coronavirus rates and fewer hospitalizations as reasons to welcome tourists back into the state.

“I think we are all encouraged by what we’ve seen over the last several weeks with the continuing trend of lower case counts,” Mr. Ige said. “Our hospitals are doing better, and we have fewer Covid patients in them,” he added.

In August, the governor had urged tourists to stay away from the islands while the state faced a Covid-19 surge that was straining hospitals and causing oxygen shortages.

In the last seven days, Hawaii has seen a daily average of 121 people testing positive for the coronavirus, compared to a daily average of 910 during the state’s peak in September, according to a New York Times database. In the past two weeks, new cases decreased by 55 percent and hospitalizations decreased by 46 percent.

On Oct. 2, the governor extended his emergency order in the state until Nov. 30. Under the current order, social gatherings are restricted to 10 people indoors and 25 people outdoors. At restaurants, bars and other social establishments, customers must maintain 6-foot social distancing, wear masks except when eating or drinking. The order also puts a 50 percent capacity on bars, restaurants, gyms and social establishments.

Earlier this year Mr. Ige said that once 70 percent of Hawaii residents were fully vaccinated, he would drop all Covid-19 related restrictions. Fifty-nine percent of Hawaii’s population is fully vaccinated, according to a New York Times database.

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Alejandro N. Mayorkas, the secretary of the Department of Homeland Security, tested positive on Tuesday morning for the coronavirus, his spokeswoman said.

The secretary, who is vaccinated, learned of his infection during routine testing ahead of a foreign trip.

“Secretary Mayorkas is experiencing only mild congestion,” the department’s spokeswoman, Marsha Espinosa, said in a statement. “He is fully vaccinated and will isolate and work at home per C.D.C. protocols and medical advice.”

Ms. Espinosa said that officials have begun tracing those who had been in recent contact with Mr. Mayorkas.

Ms. Espinosa said that Mr. Mayorkas was near President Biden outdoors on Saturday at the National Peace Officers Memorial Service, an annual event honoring officers who die in the line of duty.

That was also the most recent contact between Secretary Mayorkas and any other senior White House officials, the White House said in a statement.

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Neil Cavuto, a Fox News anchor, has tested positive for the coronavirus.

Mr. Cavuto, who is vaccinated against Covid, said he learned about the tests results Monday after his show, “Your World with Neil Cavuto,” and was not on the air Tuesday.

“While I’m somewhat stunned by this news, doctors tell me I’m lucky as well. Had I not been vaccinated, and with all my medical issues, this would be a far more dire situation,” Mr. Cavuto said in a statement released by Fox News. “It’s not, because I did and I’m surviving this because I did.”

Mr. Cavuto has been very public with his health issues throughout the years. He was treated for cancer in the 1980s and had open-heart surgery in 2016. He was diagnosed with multiple sclerosis in 1997.

Mr. Cavuto’s announcement came on the same day that CNN anchor John King disclosed on air that he has multiple sclerosis. Mr. King brought up his diagnosis while discussing the death of former Secretary of State Colin Powell on Monday of complications from Covid-19.

Mr. Powell, who was immunocompromised after a multiple myeloma cancer diagnosis, died despite being vaccinated.

“I’m going to share a secret I have never shared before. I’m immunocompromised. I have multiple sclerosis. So I’m grateful you’re all vaccinated,” Mr. King said during a panel on his program, “Inside Politics.”

He added that although he does not “like my boss telling me what to do,” he thanks his employer for requiring vaccinations to keep those like him safe. “In this case, it’s important,” Mr. King said.

It’s unclear exactly how common breakthrough infections are, but recent outbreaks suggest that the numbers may have increased after the arrival of the Delta variant.

Still, most vaccinated people who get infected are likely to have mild symptoms. And they may even benefit in the long run by strengthening their immune system’s defenses against variants.

The Centers for Disease Control and Prevention has said that those who are immunocompromised may not always be fully protected after an initial vaccination and should continue to take all precautions. The C.D.C. also recommends that moderately to severely immunocompromised people receive a booster shot.

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Australia has overcome a sluggish start to its Covid vaccination campaign, inoculating more people with at least one dose as a percentage of the population than the United States, according to government figures collated by the Our World in Data project.

The country has given at least one dose to 72 percent of its population as of Tuesday, compared with 66 percent in the United States. The two have fully inoculated about 57 percent of their people, according to the data. In Israel, one of the first nations to start vaccinating people in 2020, 63 percent have received two shots.

The success of Australia’s campaign has allowed thousands of children in Sydney to return to school and state governments to announce the relaxing of borders. Australia abandoned earlier plans to eliminate the virus and shifted to vaccinating as many people as possible. In the state of Victoria, where one of the world’s longest lockdowns is set to end on Thursday, close to 90 percent of the eligible population have now had one dose.

The rollout was a “great achievement,” Australia’s prime minister, Scott Morrison, said on Friday. It was also, he added, “allowing Australians to start reclaiming so many of the things that have been taken from them throughout this pandemic.”

When 80 percent of the eligible population is vaccinated nationwide, Mr. Morrison has said the country will begin to reopen its international borders, closed since March 2020, to the world.

Credit…Photo by Yichuan Cao/Sipa USA

An In-N-Out in San Francisco has reopened for takeout after being temporarily shut down on Oct. 14 by the city’s department of health for violating Covid-19 health protocols by not checking patrons for proof of vaccination. It is the only restaurant in San Francisco to have been closed over the vaccinate mandate, the health department said in a statement.

San Francisco mandated in August that customers who dine indoors must show proof of full vaccination.

“Vaccination is particularly important in a public indoor setting where groups of people are gathering and removing their masks, factors that make it easier for the virus to spread. That is why San Francisco requires proof of vaccination for indoor dining,” the department said in a statement.

The In-N-Out, located in San Francisco’s popular Fisherman’s Wharf tourist area, has since reopened, but only for takeout.

In-N-Out acknowledged the enforcement violation, but called San Francisco’s indoor vaccination requirement “intrusive, improper, and offensive” governmental “overreach” in a statement from Arnie Wensinger, Chief Legal & Business Officer for the California burger chain.

The department of public health said it asked the restaurant to correct the violations on Sept. 24 after a complaint to the city. Inspectors from the department followed up with the location on Oct. 6 and found that the staff was still not asking patrons for proof of vaccination while dining indoors. Inspectors attempted multiple times to bring the store into compliance, but In-N-Out refused to comply, resulting in a notice of closure.

“The business was instructed to cease all operations on site immediately because of the threat it poses to public health,” the department said.

In-N-Out said the store “properly and clearly” posted signs of local vaccination requirements, but also said it refused to become “the vaccination police for any government,” read the statement from Mr. Wensinger.

Credit…Victor Moriyama for The New York Times

BRASÍLIA, Brazil — A Brazilian congressional panel is set to recommend that President Jair Bolsonaro be charged with “crimes against humanity,” asserting that he intentionally let the coronavirus rip through the country and kill hundreds of thousands in a failed bid to achieve herd immunity and revive Latin America’s largest economy.

A report from the panel’s investigation, excerpts from which were viewed by The New York Times ahead of its scheduled release this week, also recommends criminal charges against 69 other people, including three of Mr. Bolsonaro’s sons and numerous current and former government officials.

The panel had initially recommended in the report that Mr. Bolsonaro be charged with mass homicide and genocide against Indigenous groups in the Amazon, where the virus decimated populations for months after hospitals there ran out of oxygen. But less than a day after The Times and several Brazilian news outlets reported on those plans, several senators said that the accusations had gone too far.

Late Tuesday, on the eve of the scheduled release of the report, the committee removed the recommended charges of homicide and genocide, said Renan Calheiros, the centrist Brazilian senator who was the lead author of the report, just after midnight on Wednesday local time.

It is at best uncertain whether the report from the 11-member panel — seven of them opponents of Mr. Bolsonaro — will lead to any actual criminal charges, given the political realities of the country.

Credit…Christopher Capozziello for The New York Times

The Pfizer-BioNTech vaccine was 93 percent effective against hospitalization with Covid-19 among 12- to 18-year-olds, the Centers for Disease Control and Prevention reported on Tuesday, the strongest evidence to date of the vaccine’s ability to keep young people out of the hospital.

With federal regulators now considering authorizing the vaccine for children ages 5 to 11, the study offered additional signs that extending vaccines to more young people could not only reduce the spread of the virus in the United States, but also protect those children from the rare cases in which they become severely ill.

“This evaluation demonstrated that two doses of Pfizer-BioNTech vaccine are highly effective at preventing Covid-19 hospitalization among persons aged 12–18 years,” the agency’s scientists wrote, “and reinforces the importance of vaccination to protect U.S. youths against severe Covid-19.”

The agency studied young people who were hospitalized at 19 pediatric hospitals across 16 states from June through September, as the Delta variant spread across the country and exacted a devastating toll in less-vaccinated states in the South and West. It compared the odds of vaccination among children hospitalized with Covid and children hospitalized with other illnesses.

Among the 179 patients in the study who had Covid, three percent were vaccinated and 97 percent were unvaccinated. Twenty-nine of the young Covid patients needed life support, and two died; all of those patients were unvaccinated, the agency said. Vaccinated children with Covid also tended to have shorter hospital stays than unvaccinated children.

Nearly three-quarters of the Covid patients in the study had at least one underlying health condition, including obesity, diabetes, asthma or respiratory disorders, putting them at higher risk of severe illness.

As of Monday, the C.D.C. said, 46 percent of children ages 12 to 15 were fully vaccinated nationwide, as were 54 percent of 16- and 17-year-olds. The Pfizer-BioNTech vaccine is authorized for emergency use in children ages 12 to 15, and fully approved in people ages 16 and over. Booster shots have not been authorized for anyone in the United States under 18 years old.

Pediatric hospitalizations rose as the Delta variant spread across the United States, reaching their highest level during the pandemic in September, the C.D.C. said.

A clinical trial of the Pfizer-BioNTech vaccine had earlier shown that the shots were highly effective at preventing Covid cases in children, but had not examined effectiveness against hospitalization in that group.

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Some of the world’s most isolated and smallest nations, by both population and land mass, have achieved some of the highest rates of vaccination against the coronavirus.

The Pacific island nation of Palau, an archipelago of hundreds of islands with a population of around 17,600 people that sits due east of the Philippines, has now vaccinated 92 percent of its population, according to government data. That equates to 99 percent of those eligible, a spokeswoman from the Pacific office of the Red Cross said, placing Palau ahead of any other country in the world.

New Zealand has played a critical role in helping neighboring Pacific island nations with their vaccine programs, supplying doses of the Pfizer-BioNTech and AstraZeneca vaccines to the Cook Islands, Niue, Samoa, Tonga, Tokelau and Tuvalu.

The Cook Islands, a self-governing associated state of New Zealand, had as of last month vaccinated almost 100 percent of people aged 16 and over, according to its government, and is now inoculating ages 12 to 15. Its neighbor Niue, which has a population of about 2,000 and a similar relationship to New Zealand, had as of July vaccinated more than 97 percent of adults. Both countries are using only the Pfizer-BioNTech vaccine.

Nauru, an independent island state north of Australia, in four weeks vaccinated more eligible people than were recorded in its 2019 census — about 6,800 — with supply donated by Australia, according to the country’s Bureau of Statistics.

Most of these nations closed their borders early in the pandemic, favoring a total pause on tourism rather than risking the strain of an outbreak on often basic health systems. The Cook Islands has reported no cases in the community since the pandemic began, for example. A quarantine-free travel tunnel between the Cook Islands and New Zealand has been closed since August, because of an outbreak of the more contagious Delta variant of the virus in New Zealand.

Other Pacific countries have contended with challenging outbreaks of the coronavirus. Fiji, with a population of around 900,000, was pummeled by the Delta variant earlier this year, with ​​a total of 663 deaths from the virus. The country has now vaccinated 77 percent of the eligible population, and intends to reopen its borders to fully vaccinated tourists on Dec. 1.

Not every Pacific island nation has had such ample supply of a vaccine, however, while others have had to contend with extreme vaccine hesitancy. In Kiribati and the Solomon Islands, both of which are using the Sinopharm vaccine provided by China, less than 10 percent of the population is vaccinated, while in Papua New Guinea, around 1 percent of the population have received two doses of a vaccine.

Credit…Gabby Jones for The New York Times

The Occupational Safety and Health Administration said Tuesday that it was taking steps that could strip three states — Arizona, South Carolina and Utah — of their authority to regulate workplace safety, citing shortcomings in policies on coronavirus protection.

Under federal law, states can assume responsibility for occupational safety if the government approves their plan for doing so and if the plan remains at least as effective as federal enforcement.

Federal officials said Tuesday that the three states had failed to adopt a rule that OSHA issued in June — or to adopt one at least as effective — requiring certain Covid-related safety measures by employers, like providing protective equipment.

“OSHA has worked in good faith to help these three state plans come into compliance,” Jim Frederick, the agency’s acting director, said on a call with reporters. “But their continued refusal is a failure to maintain their state plan commitment to thousands of workers in their state.”

Emily H. Farr, the director of South Carolina’s Department of Labor, Licensing and Regulation, expressed disappointment in the action, saying that the state’s program had “proven effective as South Carolina has consistently had one of the lowest injury and illness rates in the nation.”

In a statement, Arizona’s governor, Doug Ducey, said its workplace safety regulator had told OSHA that it believed the state was already in compliance with the new rule and that it had promptly initiated a rule-making process to “review the mandate” once the federal agency informed the state that it was not in compliance.

Gov. Spencer J. Cox of Utah said in a statement that the state had previously expressed concern to the Labor Department that the rule would place an undue burden on the health care industry. The state rejected the conclusion that its plan was less effective than the federal plan.

Twenty-eight states or territories have OSHA-approved plans for enforcing workplace safety. Where no plan has been approved, OSHA retains primary authority.

The action comes as OSHA prepares to release a rule mandating that companies with 100 or more workers require employees to be vaccinated or to submit to weekly Covid-19 testing. Some states have indicated that they will challenge the rule, though the legal basis for doing so appears weak.

OSHA, which is part of the Labor Department, will publish a notice in the Federal Register announcing its proposal to reconsider and revoke approval of the three states’ self-regulation plans. There will be a 35-day comment period on the proposal before it can be finalized.

Seema Nanda, the Labor Department solicitor, said that as a result of the process, the states’ authority to regulate workplace safety could be revoked entirely or partially, such as for certain industries.

Correction: 

An earlier version of this article misspelled the surname of the Department of Labor solicitor. She is Seema Nanda, not Namda. 

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The Food and Drug Administration seems likely to allow Americans to switch vaccines when choosing a Covid-19 booster shot. That authorization, which could come this week, is the latest development in a long-running debate over whether a mix-and-match strategy helps protect people from the coronavirus.

Here are answers to some common questions about mixing and matching booster shots.

How is mix-and-match different?

Immunizations typically consist of two or more doses of the same vaccine. The Moderna vaccine, for example, is administered in two identical shots of mRNA, separated by four weeks.

A double dose can create much more protection against a disease than a single shot. The first dose causes the immune system’s B cells to make antibodies against a pathogen. Other immune cells, called T cells, develop the ability to recognize and kill infected cells.

The second shot amplifies that response. The B cells and T cells dedicated to fighting the virus multiply into much bigger numbers. They also develop more potent attackers against the enemy.

In recent years, some vaccine researchers have experimented with a switch from one vaccine to another for the second dose. This strategy is technically known as a heterologous prime-boost.

The pandemic spurred more research into this possibility.

How well do mix-and-match boosters work?

The studies of heterologous prime-boosts in Europe earlier this year suggested that mixed vaccines can still deliver good protection against Covid-19. In June, the National Institutes of Health started its own variation on these trials, looking at what happens when fully vaccinated people switch to a new vaccine for a booster.

Dr. Kirsten Lyke of the University of Maryland School of Medicine presented the first results of the trial at Friday’s F.D.A. meeting. The researchers recruited people who had gotten one of the three vaccines authorized in the United States, and then gave them one of the three vaccines as a booster. All told, they compared nine groups of 50 volunteers each.

Dr. Lyke and her colleagues found that switching boosters raised the level of coronavirus antibodies, no matter which combination people got. “Maybe these things are going to play well together,” she said in an interview. And switching to a new booster did not produce any notable side effects.

The results for people who initially received a Johnson & Johnson vaccine were particularly striking. Those receiving a Johnson & Johnson booster saw antibodies go up just fourfold. Switching to a Pfizer-BioNTech booster raised antibody levels by a factor of 35. A Moderna booster raised them 76-fold.

Dr. Lyke cautioned against drawing hasty conclusions from the results so far. The researchers hope that by next month they’ll know how well the different boosters increase T cells, not just antibodies. It’s possible that Johnson & Johnson’s vaccine will shine in those results.

“We’ll get a more rounded picture,” she said.

Credit…Ruth Fremson/The New York Times

The Justice Department must help protect public health officials across the country who have been threatened with violence and harassment during the pandemic, a group representing nearly 3,000 local health departments said.

The National Association of County and City Health Officials wrote to Attorney General Merrick Garland on Monday, requesting that a recent federal effort to protect school board members, teachers and other school employees be expanded to include local health officials as well.

The letter cited a report by The New York Times examining hundreds of health departments, including some in every state, and finding that the United States may be less well prepared for the next pandemic than it was for the current one.

Threats, intimidation and harassment have become commonplace experiences for local health officials, The Times found. Many of the officials said they had installed security cameras, had started carrying pepper spray, or were getting police patrols at their houses.

Public meetings have turned into battlefields. More than 100 hours of video from local meetings, viewed by The Times, showed that officials who were making decisions about pandemic restrictions were often the target of vitriol from members of the public.

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Public Health Officials Face Fury Over Covid Rules

At public meetings across the country, local officials making health decisions have endured threats and hostility over pandemic restrictions.

You, doctor, are going to be arrested for crimes against humanity. The governing body should fear the people. We are pissed off. Dr. Berry, we’re coming for you. [music plays] Quit abusing our kids! We will not bow down to communism! We will not allow this regime to continue! And I will not be muzzled like a mad dog! We will be outside your houses with megaphones. You will not get sleep. We are not giving up any rights. My 12-year-old son is home by himself right now, and there are protesters banging outside the door. Do you think that the four feet of marble that holds you above, high in this chamber, will help you from the fate of humanity, which you are unleashing? No, it won’t! I’ll get in if I want, I promise you. This is not your building. This is not your building. No, no, no, no, no, we will not be pushed — locked out. [Chanting] U.S.A, U.S.A, U.S.A., U.S.A.! You! The evil, the wicked, will be dethroned. Put our public servants on notice that we will not now, nor ever again, allow our inalienable rights and constitutionally protected liberties be taken from us! We will give no more ground! We will not comply! And for you to propose vaccines for children is genocide. This is wrong! You all know it! I told you! [Chanting] No more masks! No more masks! No more masks! And I’m not going to threaten anybody, but there’s a lot of good guys out there ready to do bad things soon. Watch what’s coming!

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At public meetings across the country, local officials making health decisions have endured threats and hostility over pandemic restrictions.

The Times has identified more than 500 top health officials who left their jobs in the past 19 months, in part because of abuse and threats.

The Centers for Disease Control and Prevention surveyed more than 26,000 state, tribal, local and territorial public health workers and reported in July that about 23 percent of the respondents said they felt bullied, threatened or harassed because of work, and that about 12 percent said they had received job-related threats.

Mr. Garland directed the Federal Bureau of Investigation and U.S. Attorneys’ Offices earlier this month to meet with federal, state, tribal, territorial and local law enforcement leaders and discuss strategies for addressing a disturbing trend of threats and abuse toward public school officials.

The Justice Department also said it would create specialized training and guidance for local school boards and school administrators to help understand how to report threats and to preserve evidence of threatening conduct.

The letter from the national group representing city and county health officials said that threats and acts of violence against public health officials were having profound effects on their families.

“Some have had to move to driving unmarked cars, or adding at-home security cameras,” the letter said. “Others have had to rely on police escorts and round-the-clock security, while others changed their children’s behavior, worried about if they will be targeted instead.”

The letter said that a health director in Michigan was almost run off the road by an angry individual.

“We don’t want to have to wait for a full-blown tragedy,” said Adriane Casalotti, the group’s chief of public and government affairs.

Credit…Allison Zaucha for The New York Times

California has mandated that all schoolchildren must eventually get Covid-19 vaccines, the first and so far the only state to do so. In protest, some parents pulled their children from school on Monday and took to the streets in Bakersfield, Los Angeles, Vacaville, Sacramento and more.

The signs at scattered rallies were familiar to anyone who has followed the state’s childhood vaccine wars over the years.

“Our kids are not lab rats.” “My body, my choice.” “Coercion is not consent.”

At the heart of this fight is a complicated truth: California’s new student vaccination requirements haven’t yet begun, but the state already has a remarkably low number of coronavirus outbreaks at schools.

Of the 2,321 school closures because of Covid-19 that have been announced across the country, about 1 percent have been in California — even though the state accounts for 12 percent of the nation’s K-12 students, according to data from Burbio, a technology company that monitors outbreaks.

While experts say California’s classroom safety measures are highly effective, the fall semester has also coincided with a precipitous drop in coronavirus spread statewide. In other words, more protection may be needed if cases begin to climb again.

Linda Darling-Hammond, the president of California’s Board of Education, said she saw vaccines as the next stage of the state’s pandemic response. Gov. Gavin Newsom has often been criticized for introducing restrictions — as he was in July when he mandated universal mask-wearing in schools — only for the move to be later endorsed by federal officials.

“The science works, if you are very, very persistent and purposeful about implementing it,” Ms. Darling-Hammond said in an interview. “I think there’s a human tendency to say — as soon as things look good — ‘OK, we can take our foot off the gas.’ We can’t.”

Statewide, 71 percent of Californians who are 12 or older are fully immunized, one of the highest rates in the nation, according to a tracker by The New York Times. The percentage is lower — around 57 percent — for the youngest age group that is eligible for vaccines, those between 12 and 17.

But there’s a lot of variation across the state, and school outbreaks have typically hit places where coverage was low, Ms. Darling-Hammond said.

Counties where more than one school has closed this fall include Kern (where 43 percent of people 12 and over are fully vaccinated), Tehama (41 percent) and Lassen (32 percent).

Credit…Gleb Garanich/Reuters

KYIV, Ukraine — The Ministry of Health in Ukraine, the country with the lowest rate of coronavirus vaccination in Europe, reported on Tuesday that 538 people had died of Covid-19 in the country over the previous 24 hours. It was the highest daily death toll since the beginning of the pandemic.

The country’s health officials are struggling with two interconnected and vexing problems: widespread vaccine skepticism, and illegal schemes selling fake Covid credentials that people use to get around restrictions intended to slow the virus’ spread, like a new rule taking effect Thursday that requires a vaccination certificate or negative test to board a train.

The problem of fraud is significant enough that President Volodymyr Zelensky discussed it at a meeting with government ministers and law enforcement officials this week.

The proliferation of fake vaccination certificates in a country that has struggled for years with corruption in many spheres of public life threatens to undermine Ukraine’s fight against the virus. A deputy minister of health, Maria Karchevych, said in a statement earlier this month that police officials suspect at least 15 Ukrainian hospitals of having issued fake certificates in exchange for payments.

Ukrainian news outlets have carried numerous reports about people not only obtaining false certificates, but also having them registered in an online government database, inflating the official vaccination figures.

It is unclear how many such fakes have been registered. But even if the figures are taken at face value, the country still has the lowest vaccination rate in Europe, with just 15 percent of its population fully inoculated.

The country’s health care system is under significant stress. Hospitals in Ukraine are currently 65 percent full; one region — Kherson in the south — ran out of free beds and had to transport patients to hospitals elsewhere. The mayor of Odessa, Ukraine’s third-largest city, said that hospitals there have struggled to find enough doctors.

Ukraine, with a population of some 44 million, has been reporting an average of 14,348 cases a day over the past week, but the country’s low testing rate means the actual number of new infections may be far higher.

Credit…Hilary Swift for The New York Times

New York City students without permanent housing have significantly lower attendance rates than students with permanent housing, a reality that the coronavirus pandemic has exacerbated, a daunting new study released this week revealed.

Advocates for Children of New York, a nonprofit group, analyzed attendance data from the New York City Department of Education and found that attendance rates for students living in shelters fell to just 73 percent in the first few weeks of the new school year. The attendance rate for all New York City students is around 90 percent this year so far.

The study, released on Monday, noted that students living in shelters had a hard time making it to class before the pandemic began, but the virus has only made things worse.

Each year, roughly 30,000 students in New York spend time living in shelters. The average attendance rate for homeless students during the 2019-2020 school year was around 83 percent, compared to 92 percent for permanently housed students, before school buildings were closed in March 2020.

But from January to June of this year, attendance rates for homeless students trailed behind those of students with permanent housing by 10.6 to 14.1 percentage points, depending on the month.

“These are days of instruction that they can’t get back,” Jennifer Pringle, director of Advocates for Children’s Learners in Temporary Housing project, said. “Homelessness and education are inextricably linked. So if we really want to break the cycle of homelessness we need to focus on education and make sure that families and students have the supports that they need to overcome these barriers to attendance.”

The group said it was calling on the city to use federal Covid-19 relief money to hire 150 community coordinators to help students get to class every day.

Ms. Pringle said the community coordinators would proactively reach out to families and provide resources to help get students to school regularly.

“That could be things like helping out with child care, helping out with busing, helping out with enrollment and getting special needs services,” she said. “It’s important that we have the shelter-based daily support who can help families navigate what services are available and get them in place.”

Credit…David L. Ryan/The Boston Globe, via Associated Press

The firing of Washington State University’s head football coach, Nick Rolovich, for refusing to get a Covid vaccine was the most high-profile consequence of several statewide vaccine mandates for government workers that took effect on Monday.

In Washington, Monday was the final day for more than 800,000 workers, including those at state agencies, schools and health care facilities, to prove they had been fully vaccinated against coronavirus. The mandate, issued by Gov. Jay Inslee in August, is among the strictest in the country.

Compliance generally appeared to be high, especially in Seattle, where local media reports said that 99 percent of city employees either were vaccinated or had applied for exemptions. The Washington State Patrol said on Tuesday that 127 employees — a bit less than 6 percent of its work force — had left or been let go because of the mandate. Somewhat more than half of them were sworn officers. “We will miss every one of them,” Chief John R. Batiste said in a statement.

In Massachusetts, nearly 1,600 state executive-branch employees missed the Sunday vaccination deadline, the administration of Gov. Charlie Baker announced on Monday. These unvaccinated workers, who do not have the option to submit the regular testing instead of getting vaccinated, now face suspension and the loss of their jobs. Governor Baker does not expect to experience staffing shortages in Massachusetts, the statement said, but some politicians say requiring vaccines will strain an already stressed work force.

The governor’s executive order was unsuccessfully challenged in court by the unions representing state police troopers and state prison guards.

New Jersey’s vaccine mandate for school and state workers also took effect this week and requires employees to provide proof of vaccination or complete a Covid-19 test at least once a week. The state’s next deadline is Nov. 1, when workers at child care facilities will be required to be fully vaccinated or have regular Covid-19 tests administered.

At a news conference on Monday, Gov. Phil Murphy said he didn’t immediately know what percentage of state employees had been vaccinated, but added, “It’s a very high percentage.”

Mayor Lori Lightfoot of Chicago said on Monday that some police officers in the city were no longer receiving pay because they had not complied with requirements to get vaccinated. “The disciplinary process will proceed from there,” she said. “My understanding is it’s a very small number.”

Preliminary data indicates that mandates are working to persuade many holdouts to get vaccinated. In New York, for instance, teachers and health care workers rushed to get the shots just before the state’s mandate took effect, and private companies that issued vaccination requirements have seen widespread compliance.

In several states, officials are taking a wait-and-see approach to penalizing the noncompliant, rather than acting right away.

Mike Faulk, a spokesman for Governor Inslee, said Washington state employees who did not verify their status or get an exemption accommodation by Monday are no longer working, but depending on the contracts and labor agreements covering them, they may be permitted to return to work over the next month either by verifying that they are vaccinated or by obtaining an approved exemption.

In New Jersey, 386 school districts have been granted extensions of the deadline by the state because of delays in getting testing programs set up, officials said.

Credit…Nate Palmer for The New York Times

Dr. Rachel Levine, who has helped lead the nation’s coronavirus response as President Biden’s assistant secretary for health and made history as the first openly transgender federal official confirmed by the Senate, has a new title: admiral.

The Department of Health and Human Services announced Tuesday morning that Dr. Levine has been sworn in as a four-star admiral in the U.S. Public Health Service Commissioned Corps, which she already leads in her role as assistant secretary.

Admiral Levine is the first female four-star admiral in the history of the corps, a uniformed service of more than 6,000 health, science and engineering professionals who work in federal agencies and on the front lines of health crises and natural disasters. She is also the first openly transgender person to become a four-star officer in any of the nation’s eight uniformed services.

As assistant health secretary, Admiral Levine has a broad portfolio that also includes addressing racial disparities in health and the effects of climate change on health.

In a brief interview, she said joining the corps and wearing the uniform of a public health service officer was “consistent with my thoughts about service” and her desire to be a role model and advocate for transgender people, especially transgender youth.

Credit…John Taggart for The New York Times

The long-awaited return of Broadway has brought back many familiar preshow rituals — and also spurred a few that are new. One takes place a few hours before curtain time in the middle of Times Square, under a canopy with a sandwich-board sign proclaiming it to be a “Broadway Show Testing Site.”

It is there that some of the most dedicated theatergoers in the city — children under 12 who are not yet eligible for coronavirus vaccines — are taken by their parents to submit to nasal swabs, so they can get the negative coronavirus test results that the unvaccinated need to see shows.

Remy Keller, a 5-year-old from Chicago who needed a test so she could see “The Lion King,” was among the crowd at the testing canopy on a recent Saturday, bracing herself for the swab. There were a few tears.

“There’s a lot of things we all have to do to minimize the effects of the virus on vulnerable people; I’m not saying I’m not willing to jump through the hoops, but why are we putting the kids through all this?” said her mother, Avery Keller, noting that Remy had already been tested dozens of times for school. “I think we’ve got to really weigh the mental health impacts of this on our children.”

The return of live performance in New York — on stages from Broadway to Carnegie Hall to Lincoln Center to the Brooklyn Academy of Music — after the long shutdown has been a cause for celebration for culture-starved theatergoers and music and dance lovers.

But as with so many things in the age of the coronavirus, coming back has entailed a few adjustments: the ability to deftly juggle proof of vaccination, photo IDs and tickets at the door; preshow announcements that now urge people to keep their cellphones off and their masks on; and the absence of intermissions at some concerts and dance performances.

Credit…Desiree Rios for The New York Times

Earlier this year, New York created a $2.1 billion fund to help undocumented immigrants and others who weathered the pandemic without access to government relief. The Excluded Workers Fund, by far the biggest of its kind in the country, was intended to provide eligible workers with one-time payments to help cover costs associated with joblessness, such as back rent and medical bills.

But just a few months after the state began accepting applications, the fund is about to run out of money, after a blitz in claims and a speedy distribution of aid.

The fund’s rapid depletion could mean that tens of thousands of applicants might miss out on payments, according to organizers and state lawmakers who championed the fund.

Soaring demand for the fund has placed pressure on Gov. Kathy Hochul to add more money to the pot in what could be an early test of her progressive bona fides as she campaigns next year. Ms. Hochul, a Democrat, had made it a priority to fast-track the disbursement of the original $2.1 billion when she ascended to the state’s top job after Gov. Andrew M. Cuomo resigned in August.

To date, the state has distributed just over two-thirds of the fund, to about 128,000 people, a fraction of the nearly 351,000 claims that were received.

Ms. Hochul said last week that “$2.1 billion was an extraordinary amount of money, and we don’t have that level of money available just to deploy for something like this.”