In addition to Covid, more children are getting a respiratory virus more commonly seen in winter.

Daily Covid Briefing

Aug. 17, 2021, 6:57 a.m. ET

Aug. 17, 2021, 6:57 a.m. ET

A student in New York last month. Rising cases of Covid-19 and respiratory syncytial virus are straining pediatric resources in parts of the United States.
Credit…Jose A. Alvarado Jr. for The New York Times

U.S. health officials have expressed concern over a simultaneous rise in Delta infections and cases of respiratory syncytial virus, a highly contagious seasonal flulike illness that is more likely to affect children and older adults.

Cases of R.S.V. have risen gradually since early June, with an even greater spike in the past month, according to data from the Centers for Disease Control and Prevention. The illness, which can cause symptoms that include a runny nose, coughing, sneezing and fever, normally begins to spread in the fall, making this summer spike unusual.

In a series of posts on Twitter, Dr. Heather Haq, a pediatrician at Texas Children’s Hospital in Houston, described an increase in both coronavirus and R.S.V. hospitalizations.

“After many months of zero or few pediatric Covid cases, we are seeing infants, children and teens with Covid pouring back into the hospital, more and more each day,” she wrote, adding that patients have ranged in age from 2 weeks to 17 years old, including some with Covid pneumonias.

“We are on the front end of a huge Covid surge,” wrote Dr. Haq, who could not be reached for comment on Sunday. “We are now having winter-level patient volumes of acutely ill infants/toddlers with R.S.V., and I worry that we will run out of beds and staff to handle the surge upon surge.”

R.S.V. cases in Texas began to increase in early June and appeared to peak in mid-July, according to data from the state’s health department.

There has been a similar spike in Florida, where infections “were above those seen at this time in past years,” according to a surveillance report.

In Louisiana, where cases have jumped 244 percent in the past two weeks, Our Lady of the Lake Children’s Hospital in Baton Rouge was nearing its capacity on Friday, CNN reported.

“You start with the pandemic for the last 18 months, and then R.S.V. for the last couple of months,” Dr. Trey Dunbar, the hospital’s president, told the network. “It just seems to be one thing after another that’s keeping our teams very busy.”

In Oklahoma, which has also had a spike in R.S.V. cases, beds are becoming scarce at hospitals.

Dr. Cameron Mantor, the chief medical officer for Oklahoma Children’s Hospital at OU Health, told The Oklahoman that in the past two months R.S.V. cases in the state had been “exponentially off the charts.”

“R.S.V. is a real issue right now,” he told the newspaper. “What is going to happen if we do have a surge in pediatric Covid cases?”

The rise comes as new coronavirus infections have risen 148 percent in the United States in the past two weeks and hospitalizations have increased 73 percent, according to New York Times data. The surge of coronavirus infections has been largely attributed to the highly contagious Delta variant and to low vaccination rates in some states.

“I worry as kids go back to school with the Delta circulating, we will see huge school outbreaks that we didn’t see in prior waves, disproportionately affecting kids,” Dr. Haq wrote. “I’ve cared for hospitalized pediatric patients with Covid throughout the pandemic, but this time with unvaccinated, susceptible children plus Delta variant, we will see more pediatric Covid admissions.”

Gov. Greg Abbott of Texas has prohibited local governments and state agencies from mandating Covid vaccines and barred local officials from requiring face masks.

Florida could face similar challenges with viruses when the school year begins. Gov. Ron DeSantis has spoken out against new masking recommendations from the C.D.C., with his office saying in a statement last week that “parents know what’s best for their children.”

Surges in R.S.V. infections have also been reported in places like New Zealand, where it is currently winter. Experts there say that children may be more vulnerable than usual to seasonal viruses and infections because they were underexposed to germs during lockdowns early in the pandemic.

A vial of the Pfizer-BioNTech coronavirus vaccine at a vaccination site in Denver. The slowing pace of inoculation has contributed to wasted vaccine doses.
Credit…Kevin Mohatt for The New York Times

A survey of data from 10 states shows that about one million doses have gone to waste since the nation began administering Covid-19 vaccines in December.

Much of the loss has come as demand for inoculations plummeted, with the daily rate of vaccinations now at less than one-fifth of its peak average of 3.4 million shots, reached in mid-April.

More than 110,000 doses have been destroyed in Georgia, officials there said. Of the more than 53,000 doses wasted in New Jersey, nearly 20,000 were discarded in June, up from around 4,000 in April. Around 50,000 doses in Maryland were not used, officials said.

In Ohio, state officials reported on July 20 that more than 370,000 doses have been reported as unusable by state providers. [Update Aug. 2, 2021: On Monday, the day after this article was originally published, a spokeswoman for the state health department revised the number downward to more than 230,000.]

Reasons for vaccine wastage include breakage, storage and transportation problems, expiration, and shots that were prepared but not used after people did not show up for appointments, officials said. In many states, data shows that wasted or unusable doses are no more than about 2 percent of those received from the federal government and successfully administered.

In Georgia, more than 8.5 million doses have been administered; the state’s unused doses total just 1.4 percent of that number, officials said. Idaho has wasted about 2 percent of delivered doses, and New Jersey less than half of 1 percent.

Other states are likely to face some of the same issues as the 10 states whose data was reviewed by The New York Times, suggesting that the number of wasted doses in the country could be far higher. Other states, including North Carolina and South Carolina, did not respond to requests for information. State data does not include all doses that the federal government ships directly to chain pharmacies, so there could be unaccounted-for waste.

The Centers for Disease Control and Prevention tracks wasted doses, but did not respond to a request for that data, which would provide a broader national picture.

The rise in wasted vaccine doses reflects the challenge American health officials face in inoculating residents, even as the more contagious Delta variant of the coronavirus fuels outbreaks among the unvaccinated across the United States. Delta is also one driver of a rise in cases globally, and many countries are begging for vaccine doses.

Full vaccination offers strong protection against severe disease and death, including from the Delta variant, and the C.D.C. says breakthrough infections in vaccinated people are rare. However, recent data suggest that vaccinated people infected with the Delta variant may transmit the virus to others, a finding that contributed to the C.D.C.’s recent decision to advise vaccinated people in Covid hot spots to wear masks again in indoor public areas.

Vaccinations are now ticking upward in some states; more than 850,000 shots were recorded on Friday, raising the daily national average to more than 650,000 from about 500,000 three weeks ago. Still, more than half of the U.S. population is not fully vaccinated, according to a Times database. That includes children under 12, who are not yet eligible.

“Early on, it was kind of a crisis because people wanted it and couldn’t get it, and now it’s a crisis because we’ve got it and people don’t want it,” said Dr. Marcus Plescia, who represents state health agencies as the chief medical officer for the Association of State and Territorial Health Officials.

Many states have asked about redistributing unused vaccines abroad, but once the doses are shipped out to states, federal regulations prohibit recalling them. And some countries, like Canada, have declined states’ offers of surplus vaccines.

“Here we are with loads of vaccine, and there are other countries in the world where people are desperate for vaccination,” Dr. Plescia said.

With vaccinations lagging, some state health officials have directed providers in recent months to open a new vial even if some of it goes unused.

“It’s better to give two doses and waste 12 than to leave 14 doses sitting in the freezer,” said Kristen Dillon, a director of the Oregon Health Authority’s Covid-19 Vaccine Planning Unit. Oregon has reported more than 78,000 doses as nonviable, the “vast majority” of which were unused doses from opened vials, officials said.

In Arkansas, where just 36 percent of residents are fully vaccinated, nearly 55,000 doses had gone to waste by mid-July, up from around 580 in mid-March, as officials prioritized vaccinations over saving doses. “If we have the opportunity to give the vaccine, let’s go ahead and do it,” said Robert Ator, a retired National Guard colonel who runs the state’s vaccination effort.

Like officials in many other states, Mr. Ator said he stopped ordering additional doses in April as demand dropped, and he has since shifted to repackaging doses in smaller quantities for distribution to drugstores and doctors’ offices. The state’s stockpile has decreased from 550,000 doses in April to about 350,000 in late July, he said.

Despite his efforts, Mr. Ator projected that about 100,000 doses of the state’s stockpile could expire over the next three months.

Tourists in Miami last week. 
Credit…Scott McIntyre for The New York Times

The nation’s top infectious disease expert predicted on Sunday that the number of cases and hospitalizations in the United States “will get worse” but that measures seen in the early days of the pandemic, such as closing businesses, were unlikely to return.

In an interview on the ABC program “This Week,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said the number of Americans who were already vaccinated was most likely sufficient to prevent caseloads and hospitalizations on the scale seen by much of the country last winter.

“I don’t think we’re going to see lockdowns,” he said. “I think we have enough of the percentage of people in the country — not enough to crush the outbreak — but I believe enough to not allow us to get into the situation we were in last winter. But things are going to get worse.”

Over the past two weeks, new coronavirus infections have risen 148 percent in the United States, and hospitalizations have increased 73 percent, according to New York Times data. The surge of infections has been largely attributed to the highly contagious Delta variant and to low vaccination rates in some states.

“We are seeing an outbreak of the unvaccinated,” Dr. Fauci said, noting that there are 100 million people in the United States who are eligible to get vaccinated but have not done so.

As of Sunday, 57 percent of eligible Americans had received at least one dose of a coronavirus vaccine and 49 percent were fully vaccinated, according to New York Times data.

“We’re looking not, I believe, to lockdown, but we’re looking to some pain and suffering in the future because we’re seeing the cases go up,” Dr. Fauci said. “The solution to this is: Get vaccinated, and this would not be happening.”

Dr. Francis Collins, director of the National Institutes of Health, in May. 
Credit…Pool photo by Stefani Reynolds

As cases and hospitalizations rise across the country, Dr. Francis Collins, director of the National Institutes of Health, said on Sunday that businesses asking employees for proof of vaccination or regular testing were taking steps “in the right direction.”

“I think anything we can do to encourage reluctant folks to get vaccinated — because they’ll want to be part of these public events — that’s a good thing,” Dr. Collins said on CNN’s “State of the Union.”

Dr. Collins said he was pleased to see companies such as Disney and Walmart asking their employees to get vaccinated. And he expressed support for President Biden’s decision last week requiring federal workers to get the vaccine or, “if they’re not, to get regular testing, which is inconvenient.”

“All of those steps I think are in the right direction,” Dr. Collins said.

When asked whether airlines should require proof of vaccination for passengers, Dr. Collins said that the decision was up to the airlines, but that it could motivate people to get vaccinated if they want to be able to travel.

Businesses and government agencies are recommending or requiring employees to get vaccinated amid a surge in coronavirus infections across the country. In the past two weeks, new infections have risen 148 percent in the United States, and hospitalizations have increased 73 percent, according to New York Times data.

The surge has been largely attributed to the highly contagious Delta variant, and to low vaccination rates in some states.

In an interview on the CBS program “Face the Nation” on Sunday, Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, emphasized the importance of getting more Americans vaccinated as the country faces the more contagious Delta variant of the virus, which is now the dominant source of U.S. infections.

“We’ve really got to get those people to change their minds, make it easy for them, convince them, do something to get them to be vaccinated, because they are the ones that are propagating this outbreak,” he said.

Dr. Fauci also addressed the recommendation last week from the Centers for Disease Control and Prevention that Americans wear masks, regardless of vaccination status, in areas where transmission rates are high. The recommendation was issued days before the agency released a report on Friday suggesting that fully vaccinated people with so-called breakthrough infections of the Delta variant are capable of spreading the virus to others just as readily as unvaccinated people.

“We’re now dealing with a virus that has an extraordinary capability of spreading from person to person,” Dr. Fauci said. “So when you superimpose one on the other, you have a very difficult situation, a pool of unvaccinated people and a virus that spreads very efficiently.”

Cars waiting to cross the border from the United States to Niagara Falls, Ontario, in July. Since July 5, Canada has required fully vaccinated travelers to submit proof of vaccination before arriving at a port of entry.
Credit…Peter Power/The Canadian Press, via Associated Press

Two Canadian citizens who recently traveled from the United States to Toronto were fined nearly $20,000 each by the Public Health Agency of Canada for providing false proof of vaccination documents.

The Canadian government announced on Friday that the two travelers were each fined a total of $19,720 for providing false proof of vaccination and pre-departure coronavirus tests, as well as for not complying with the country’s requirements to stay at a government-authorized accommodation and be tested upon arrival. The travelers arrived in Toronto the week of July 18, Canadian officials said.

The Public Health Agency of Canada had previously fined people for providing false testing documents, but these two travelers were the first to be fined for providing fraudulent vaccination information, a spokesman for the agency said.

It was unclear how the travelers arrived in Canada, why they provided false documents or whether they were infected with the coronavirus. The Canadian government said it works with international partners to detect false documents.

Since July 5, Canada has required fully vaccinated travelers to submit proof of vaccination before arriving at a port of entry.

“For all travelers coming to Canada, it is important to be informed and to plan in advance,” the Canadian government said in a statement. “It is the traveler’s responsibility to ensure they are eligible to enter Canada and that they meet all of the mandatory requirements.”

Under Canadian law, submitting false information about vaccination status can result in a fine of up to $750,000 or six months in jail.

“The government of Canada will continue to investigate incidents reported and will not hesitate to take enforcement action where it is warranted to protect the health of Canadians from the further spread of Covid-19 and its variants of concern,” the government said.

Canada recently announced that starting on Aug. 9, citizens and permanent residents of the United States will be allowed to enter the country as long as they have been fully vaccinated for at least 14 days before travel.

Canada plans to allow fully vaccinated visitors from other countries beginning on Sept. 7.

Maps produced by Milwaukee County show vaccination rates in mid-March, left, and late July. Orange areas show higher levels of social vulnerability and lower vaccination rates.
Credit…Milwaukee County

Amid the highly uneven rollout of Covid-19 vaccines, many health officials and community organizations are drawing upon geospatial data to plan their vaccination campaigns and track their progress in fine-grained detail, brandishing brightly colored maps to pinpoint the exact neighborhoods where cases are rising or where testing rates are lagging.

In mid-March, for instance, officials in Milwaukee County released a color-coded map that categorized census tracts according to their vaccination rates and their scores on a national “social vulnerability index,” incorporating more than a dozen social, economic and demographic factors to calculate how susceptible a given community would be in the event of some kind of disaster, like a hurricane or a pandemic.

The map revealed a county divided: Much of the city of Milwaukee was colored dark orange, signaling that the area had high levels of social vulnerability but low vaccination rates, whereas the suburbs, where the population is wealthier and whiter, were shaded a pale yellow, indicating that they had low scores on the vulnerability index but climbing vaccination rates.

County and city officials began pouring resources into deep orange neighborhoods, prioritizing those residents for vaccine appointments, adding more vaccination sites in those areas and creating pop-up sites and events at churches, food pantries, libraries, schools and cultural centers. They also started a community ambassador program — the Crush Covid Crew — to train volunteers from those deep orange census tracts to talk to their neighbors about the vaccines and dispel misinformation about them.

Although vaccination rates in the most vulnerable areas still lag behind, they have more than tripled since mid-March. “The darkest orange communities are now gone,” said Dr. Ben Weston, who oversees the medical aspects of the county’s Covid-19 response. “So we’re making progress.”

People on the boardwalk in Myrtle Beach, S.C., in May.
Credit…Sean Rayford for The New York Times

The Republican governors of South Carolina and Ohio both said on Sunday that they would not renew public health mandates like mask-wearing and social distancing, even as their states continue to battle a raging pandemic.

Both states had taken such measures earlier in the pandemic, including declaring a state of emergency.

“I really think we have got to stay calm,” Gov. Henry McMaster of South Carolina said on “Fox News Sunday.” “We have put the fire out — it’s smoldering in places and could come back up — but the house is not on fire again.”

In recent weeks, coronavirus cases have risen rapidly across the country, enabled by lagging vaccination rates and the spread of the highly contagious Delta variant of the virus. Despite a vaccination push from the Biden administration, public health protocols remain a state-by-state decision.

In South Carolina, coronavirus cases increased 258 percent in the past 14 days, and hospitalization and death rates also rose, according to a New York Times database. Mr. McMaster played down those numbers.

“I think there’s some exaggeration going on, some hyperbole, of those figures that you just mentioned,” he told Fox’s Dana Perino, adding that the state’s increasing cases “were not nearly as high as they were last July.”

Only 41 percent of South Carolina residents are fully vaccinated, according to the database; that figure is below the national average of 49 percent. Both Mr. McMaster and his wife contracted the virus in late December, shortly after attending a Christmas party at the White House; both were vaccinated in the spring. On Sunday, the governor maintained that getting vaccinated was an individual’s personal decision, and he said that the state would not reintroduce a mask mandate.

“We are not going to have a statewide mask mandate, like they have in some other places,” Mr. McMaster said. “We are not going to require people to get vaccinated.”

Gov. Mike DeWine of Ohio made similar remarks on CNN’s “State of the Union.” Just 46 percent of the state’s residents are fully vaccinated, according to a Times tracker, and the number of cases has risen 177 percent in the last two weeks, with a 30 percent increase in hospitalizations.

While conceding that his state had “room to grow” in increasing its vaccination rate, Mr. DeWine said that he had no plans to reintroduce mandates. Asked about capacity restrictions or social distancing requirements, Mr. DeWine deflected: “The whole game today is vaccinations.”

Neither Ohio nor South Carolina will require students to wear masks in schools. “We came out last week with recommendations — they are recommendations — we leave it up to the local schools,” Mr. DeWine said, adding later that “some will do that, some will not.”

In South Carolina, the state passed legislation last month that prohibits mask mandates in public schools.

“This ought to be up to the parents, whether the children will wear masks when they go to school,” Mr. McMaster said. “That’s a parent decision.”

Indianapolis Colts wide receiver T.Y. Hilton declined to confirm his vaccination status during an N.F.L. news conference on Tuesday. The Colts have a vaccination rate below 70 percent.
Credit…Phelan M. Ebenhack/Associated Press

N.F.L. players remain divided over vaccines, even as the professional football league offers more education and levies harsher penalties on the unvaccinated.

As of Friday morning, 88.5 percent of all players had received at least one vaccine dose, according to an N.F.L. spokesman, a more than 8 percent jump from the previous week. Twenty of the 32 teams have more than 90 percent of their rosters vaccinated, while two teams, the Indianapolis Colts and the Washington Football Team, have vaccination rates below 70 percent.

Despite high-profile examples of players with reservations about the vaccine, the leaguewide vaccination rate exceeds that of the United States, with the Centers for Disease Control and Prevention reporting that nearly 70 percent of adults have received at least one dose.

In July, the N.F.L. issued a memo to all 32 teams outlining steep penalties for those who refuse inoculation. If an unvaccinated player or staff member is found to have caused an outbreak that forces a schedule change, the team experiencing the outbreak will be held financially responsible for the other club’s expenses, the memo said. If the game cannot be rescheduled, the team experiencing the outbreak will forfeit.

Unvaccinated players still face several restrictions, including daily testing, capacity limits in weight rooms and a requirement to travel on a separate plane from teammates. The league can also fine them as much as $50,000 for breaking Covid-related protocols. Regardless of the decrees from the N.F.L., individual teams are still encountering some resistance.

In June, Washington Coach Ron Rivera addressed his team’s low vaccination rate by inviting Kizzmekia Corbett, an immunologist who helped develop the Moderna vaccine, to speak with players and address their questions.

Some remained skeptical, including defensive end Montez Sweat, who said he was “not a fan” of the vaccine. Rivera, who is immune-compromised after battling cancer, said he continues to wear a mask around groups of players to protect himself.

“I’m truly frustrated,” Rivera said. “I’m beyond frustrated.”

The stringent new rules, though, seem to have had an effect. Colts running back Nyheim Hines said that he initially did not want to be vaccinated, but that the protocols had changed his mind. He called the shift a “business decision.”

Tennessee Titans quarterback Ryan Tannehill agreed, saying he would not have received the vaccine otherwise.

“They’re trying to force your hand, and they ultimately have forced a lot of hands,” Tannehill said.

Ayana Campbell, 14, received a Covid shot at Jackson State University in Mississippi on Tuesday.
Credit…Rogelio V. Solis/Associated Press

Vaccinations are rising in U.S. states where lagging demand left entire regions vulnerable to a Delta-driven surge of coronavirus cases. The shift offers a sign of hope, even as the country’s known cases since the start of the pandemic surpassed 35 million on Saturday.

For the third consecutive week, states with the highest number of coronavirus cases also had the highest vaccination rates, Karine Jean-Pierre, the deputy White House press secretary, said on Friday.

In Mississippi, where 44 percent of adults have been fully vaccinated, the seven-day average of people receiving a first dose was 5,203 on July 27, more than triple the average from July 1, according to data from the Centers for Disease Control and Prevention.

The same pattern is in play for other less-vaccinated states where infections are surging. From July 1 to July 28, Louisiana almost quadrupled its seven-day average of administered first doses. And in Missouri, where the Delta variant spurred an outbreak in early July, the number of first doses administered daily almost doubled over a month.

Still, compared with the rest of the country, these states’ vaccination rates remain low. And their rates of hospitalizations and deaths are higher compared with states with more vaccinations.

More than 850,000 shots were recorded on Friday, raising the daily national average to more than 650,000 from about 500,000 three weeks ago. But the overall rate is less than a fifth of the U.S. peak average of 3.4 million shots, reached in mid-April.

The C.D.C. said on Friday that about 190.5 million people had received at least one dose of a Covid vaccine, and about 164.2 million people were fully vaccinated, some by Johnson & Johnson’s single-dose vaccine but many more by the two-dose series made by Pfizer-BioNTech and by Moderna.

That still leaves more than half the country not fully vaccinated, including about 48 million children under 12, who are not eligible. Only full vaccination affords high protection from severe disease if someone is infected with the Delta variant.

The national outlook is quickly worsening. Louisiana, which was averaging fewer than 400 cases a day at the start of July, is now averaging more than 4,100 cases a day, the most ever. The county that includes Jacksonville, Fla., is averaging almost 1,200 cases a day.

As a whole, daily case reports in the United States have risen 150 percent over the past two weeks, pushing the known pandemic total past 35 million.

Dr. Bertha Hidalgo, an associate professor of epidemiology at the University of Alabama at Birmingham, said the higher vaccination numbers in recent days are a clear improvement, even later than hoped.

“It’s not as optimal as we would like, but anything that trends in the positive direction with respect to vaccination is fantastic,” Dr. Hidalgo said. “It’s absolutely not too late because Delta is, unfortunately, likely not the only variant that we may see unless we continue to increase vaccination rates.”

Ordering takeaway food at a restaurant in Bangkok last month.
Credit…Candida Ng/Agence France-Presse — Getty Images

Thailand will enforce stricter coronavirus measures in more areas of the country starting Tuesday, as the Delta variant is sharply driving up the numbers of cases and deaths.

Rules were already in place in areas deemed virus hot spots — including Bangkok, the capital — and were set to expire on Monday. But officials said on Sunday after an emergency meeting that they would instead add 16 provinces to their designated “dark-red zones,” including provinces near Bangkok and in the country’s central and southern regions, to try to stem transmission of the virus.

Residents in those zones, where rules are the tightest, must abide by a 9 p.m. to 4 a.m. curfew and a five-person limit on gatherings. They also cannot use public transportation.

Restaurants can be open for takeaway and delivery services, but salons and sports venues must be closed.

The new measures are meant to “help to control and contain Covid,” Natapanu Nopakun, a spokesman for the Foreign Ministry, said, adding that officials hoped the effort would “bear fruit” by the government’s next review in two weeks. But he said that the measures would most likely be in place until the end of August.

In the past week Thailand has reported a daily average of 16,474 cases and 132 deaths, according a New York Times database, after months of reporting no local transmission. But that changed this spring after an outbreak linked to nightclubs in Bangkok led to a surge in cases in the capital.

A national vaccination campaign is underway, but only about 5 percent of Thailand’s population is fully vaccinated. Almost 200,000 vaccine doses were administered on Saturday, the government said, bringing the total number given in the country to about 17 million.

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Protesters converged in Paris to oppose France’s new health pass policy, which bars people without proof of vaccination or a recent negative Covid-19 test from indoor venues. Demonstrations also took place in other cities in France.CreditCredit…Alain Jocard/Agence France-Presse — Getty Images

PARIS — Pascale Collino, 64, is far more afraid of the Covid-19 vaccines than of the disease itself. So when the French government decided to implement a new health pass policy barring those without proof of vaccination or a recent negative test from many indoor venues, she took to the streets in protest.

“We have to be on the front lines of this fight,” Ms. Collino said on Saturday near the French health ministry in Paris, where a large crowd had converged, banging pots and cowbells.

For the third week in a row, thousands took to the streets around France to protest the government’s health pass law, which was passed by Parliament recently but still needs a final greenlight from a top constitutional council, expected next week, before it can be fully enforced.

The protests come as the authorities try to stem a new wave of infections that is starting to put pressure on France’s hospitals, where 85 percent of Covid-19 patients are unvaccinated, according to a government report published this week.

More than 200,000 people marched in Paris, where 3,000 police officers were deployed, and in other cities, including Marseille, Rennes and Strasbourg, according to the French interior ministry. The growing size of the protests from week to week and their motley mix of demonstrators have become an increasing source of concern for the government.

The demonstrators are united in their distrust of the news media and of President Emmanuel Macron’s government, but that is where the similarities end. They include far-right and far-left activists, Yellow Vest members and vaccine conspiracy theorists, as well as vaccinated people who argue that the health pass is oppressive and unfair. They also encompass families angry over new rules dictating that unvaccinated middle and high school students, but not vaccinated ones, will be sent home if a coronavirus infection is detected in their class.

One march that started in northern Paris ended with violence on the Place de la Bastille, where some protesters set trash cans on fire and threw projectiles at riot police officers, who responded with tear gas and water cannons.

Around France, three police officers were injured and 19 people were arrested, the interior minister said.

In southern Paris, Ms. Collino, maskless and carrying a French flag, said she was angry that health workers were forced to get vaccinated by this fall, and that access to bars, restaurants, movie theaters, museums, gyms and other indoor venues would be restricted.

Around her, families waved French flags and protesters shouted “freedom” and “resistance” while carrying makeshift cardboard signs with slogans like “Don’t give in to blackmail” and “No to segregation.”

When the protesters passed a statue of Louis Pasteur, the renowned 19th-century French scientist credited with discovering the principles of vaccination, few seemed to take notice. One elderly man, who was walking past the demonstrators, did. “Pasteur must be turning over in his grave,” he grumbled.

The march there was organized by Florian Philippot, a former member of the far-right National Rally party who has become a figurehead of the anti-health pass movement. Two video journalists for Agence France-Presse left the march after protesters insulted them, spat on them and prevented them from filming, the agency reported.

“We no longer have the freedom to seek the treatment that we want,” said Ms. Collino, a retired I.T. specialist who lives in the nearby town of Sèvres. She did not trust officials to tell the truth about vaccines and said that she had taken it upon herself to seek out information about the pandemic online.

Her attitude, however, has isolated her from some friends and family who favor the health pass policy, as do a majority of French people, according to recent polls. Millions have rushed to get their Covid shots since the pass was announced. But Ms. Collino said she would rather die than get vaccinated.

“I don’t understand why they are in favor while I’m against,” she said.

Alex Garcia, 25, does not plan to get the vaccine anytime soon, believing his immune system is healthy enough to fight off the virus.
Credit…Dylan Cole for The New York Times

As coronavirus cases rise across the United States, the fight against the pandemic is focused on an estimated 93 million people who are eligible for shots but have chosen not to get them. These are the Americans who are most vulnerable to serious illness from the highly contagious Delta variant and most likely to carry the virus, spreading it further.

It turns out, though, that this is not a single set of Americans, but in many ways two.

In one group are those who say they are adamant in their refusal of the coronavirus vaccines; they include a mix of people but tend to be disproportionately white, rural, evangelical Christian and politically conservative, surveys show.

In the other are those who say they are open to getting a shot but have been putting it off or want to wait and see before making a decision; they are a broad range of people, but tend to be a more diverse and urban group, including many younger people, Black and Latino Americans, and Democrats.

The problem is the same surveys show that the group firmly opposed to the vaccines outnumbers those willing to be swayed. And unless the nation finds a way to persuade the unwavering, escaping the virus’s grip will be a long way off, because they make up as much as 20 percent of the adult population.

Part of the challenge is that the unvaccinated live in communities dotted throughout the United States, in both lightly and densely populated counties. Though some states like Missouri and Arkansas have significantly lagged behind the nation in vaccination rates, unvaccinated Americans are, to varying degrees, everywhere: In Cook County, Ill., which includes Chicago, 51 percent of residents are fully vaccinated. Los Angeles County is barely higher, at 53 percent. In Wake County, N.C., part of the liberal, high-tech Research Triangle area, the vaccination rate is 55 percent.

The rate of vaccinations across the country has slowed significantly since April, but there are signs in recent days of a new rise in shots being distributed, with upticks in vaccinations particularly in states like Arkansas, Louisiana and Missouri, where cases have grown. As of Friday, about 652,000 doses, on average, were being given each day, according to data from the Centers for Disease Control and Prevention; that was up from recent weeks, when the country hovered just above 500,000 shots a day. Nationwide, about 97 percent of people hospitalized with Covid-19 are unvaccinated, federal data shows.

Dr. Laolu Fayanju, a family medicine doctor in Ohio, has encountered patients on both ends of the spectrum: those who are insistent in their refusal to be vaccinated, and others who agree to a shot after he painstakingly lays out the facts.

Never did he expect that so many Americans would still be resisting a shot this many months into the vaccination effort.

“I vacillate between anguish and anger,” Dr. Fayanju said. “We live in an era of unprecedented scientific breakthroughs and expertise. But we’re also stymied by the forces of misinformation that undermine the true knowledge that is out there.”

Coronavirus testing at a mobile station in Palmetto, Fla., in July.
Credit…Octavio Jones for The New York Times

As a wave of major U.S. employers said last week that unvaccinated workers would need to submit to regular coronavirus testing, it raised a thorny question: Who pays for those tests?

Doctors typically charge about $50 to $100 for the tests, so the costs of weekly testing could add up quickly. Federal law requires insurers to fully cover the tests when ordered by a health care provider, but routine workplace tests are exempt from that provision.

“It’s really up to the employer,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “They can require employees to pick up the tab.”

Employers have taken a range of approaches, from fully covering the costs to having unvaccinated workers pay full freight.

The U.S. government will pay for its unvaccinated workers’ coronavirus testing, Karine Jean-Pierre, the deputy White House press secretary, said at a news briefing on Friday. Each federal agency will come up with a plan for testing its unvaccinated work force, she said, adding that the costs and procedures of each agency’s testing protocols will depend on the number of unvaccinated people they need to monitor.

A cluster of coronavirus cases in Provincetown, Mass., which has one of the highest vaccination rates in the country, was cited by the Centers for Disease Control and Prevention in its decision to issue new indoor mask guidance.
Credit…Matt Cosby for The New York Times

By the Fourth of July, the tourist season in Provincetown, Mass., had built to a prepandemic thrum. Restaurants were booked solid, and snaking lines formed outside dance clubs. There were conga lines, drag brunches and a pervasive, joyous sense of relief.

“We really thought we had beat Covid,” said Alex Morse, who arrived this spring as town manager.

Mr. Morse didn’t think much of it, five days after the holiday, when the town’s Board of Health logged two new cases of coronavirus. A week later, though, the cluster of cases associated with gatherings in Provincetown was growing by 50 to 100 cases per day. Alongside the numbers was an unsettling fact: Most of the people testing positive were vaccinated.

Provincetown, a quirky beach community at the tip of Cape Cod, has provided a sobering case study for the country, abruptly tugging Americans back to the caution of winter and spring.

The Centers for Disease Control and Prevention cited the cluster on Friday as key to its decision to issue new indoor mask guidance, saying viral loads among the vaccinated people there were found to be as high as among the unvaccinated.

The good news is that people infected in Provincetown were for the most part not seriously ill. The bad news is that the variant is extraordinarily contagious — as contagious as chickenpox, the C.D.C. said — and people with breakthrough infections may spread the virus to others.

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