Happy Nice Mall

More people in Florida are catching the coronavirus, being hospitalized and dying of Covid-19 now than at any previous point in the pandemic, underscoring the perils of limiting public health measures as the Delta variant rips through the state.

This week, 227 virus deaths were being reported each day in Florida, on average, as of Tuesday, a record for the state and by far the most in the United States right now. The average for new known cases reached 23,314 a day on the weekend, 30 percent higher than the state’s previous peak in January, according to a New York Times database. Across the country, new deaths have climbed to more than 1,000 a day, on average.

And hospitalizations in Florida have almost tripled in the past month, according to federal data, stretching many hospitals to the breaking point. The surge prompted the mayor of Orlando to ask residents to conserve water to limit the strain on the city’s supply of liquid oxygen, which is needed both to purify drinking water and to treat Covid-19 patients.

Even as cases continue to surge, with more than 17,200 people hospitalized with the virus across Florida, Gov. Ron DeSantis, a Republican, has held firm on banning vaccine and mask mandates. Several school districts have gone ahead with mask mandates anyway.

Overall, 52 percent of Floridians are fully vaccinated, but the figure is less than 30 percent in some of the state’s hardest-hit counties.

On Monday, dozens of doctors and hospital employees in Palm Beach County gathered for an early morning news conference to beseech the unvaccinated to get shots, emphasizing that the surge was overwhelming the health care system and destroying lives.

“We are exhausted,” said Dr. Rupesh Dharia, an internal medicine specialist. “Our patience and resources are running low.”

A growing proportion of the people inundating hospitals and dying in Florida now are coming from younger segments of the population, particularly those ages 40 to 59, which were less vulnerable in earlier waves of the pandemic. The Delta variant is spreading among younger people, many who thought they were healthy and did not get vaccinated.

Dr. Chirag Patel, the assistant chief medical officer of UF Health Jacksonville, a hospital system in Northeast Florida, said the patients hospitalized with the virus during this latest surge tended to be younger and had fewer other health issues, but were nearly all unvaccinated. Of those who have died, including patients ranging in age from their 20s to their 40s, more than 90 percent were not inoculated, Dr. Patel said.

“We’ve had more patients this time around that have passed away at a younger age with very few if any medical problems,” he said. “They simply come in with Covid, and they don’t make it out of the hospital.”

Two months ago, the number of Covid-19 patients admitted at the system’s two University of Florida hospitals in Jacksonville was down to 14. On Tuesday morning, 188 coronavirus patients were in the hospitals, including 56 in the intensive care units.

One of the hardest parts of his job, Dr. Patel said, is having to tell family members that their unvaccinated loved one had succumbed to the virus. “It’s just such a senseless and preventable way of ultimately dying,” he said.

Lisa Waananen, Alison Saldanha and Sarah Cahalan contributed reporting.

Pfizer and BioNTech said on Wednesday they were now applying to the Food and Drug Administration for supplemental approval of a coronavirus vaccine booster shot for those aged 16 and up, and will submit all their supporting data by the end of this week. The move came as the companies said that a third shot of the vaccine sharply increased the levels of antibodies against the virus.

The companies conducted a study of 306 volunteers who received a booster shot about five to eight months after their second shot. Researchers found that the level of antibodies that block the coronavirus jumped more than three times higher than the level after the second dose.

The side effects of a third injection were about the same as after the initial two doses, the companies said. The underlying data was not included in the news release, nor were the dates or location of the study specified. The companies said they were preparing a scientific publication describing the research.

The news of Pfizer and BioNTech’s booster application came two days after the F.D.A. fully approved their two-dose vaccine for those 16 and older, making it the first to move beyond emergency use status.

Over the past few weeks, federal regulators have been racing to collect and evaluate data on booster shots. If the F.D.A. decides additional shots are safe and effective, the Biden administration has said it wants adults to get a third injection eight months after their second shot of the Pfizer or Moderna vaccines, starting the week of Sept. 20.

Federal health officials said last week that they believe that the potency of the Pfizer-BioNTech and Moderna vaccines wanes over time, raising the risk of infection from the highly contagious Delta variant. While data indicate that the vaccines continue to offer robust protection against hospitalization and severe disease, the officials said they fear that the situation could change without booster shots.

Some public health experts have challenged the plan as premature, saying the available data shows that the vaccines are holding up well against severe disease and hospitalization, including against the Delta variant. Extra shots would be warranted only if the vaccines failed to meet that standard, some have said.

Pfizer executives presented an early look at their booster data on July 23, during their second-quarter earnings call. In a smaller study, they found that antibody levels dropped markedly in the months following a second dose. But those levels jumped back up after a third dose. When researchers expanded their focus to a larger group of subjects, they continued to find a strong effect from the boosters.

Antibodies that can neutralize the coronavirus are only one kind of defense our immune systems use to fight it. The new study did not include details about other defenses provoked by the vaccine, such as immune cells trained to kill infected cells.

The participants in the new booster study were between the ages of 18 and 55. It was not immediately clear why the study did not include older people. Volunteers were followed for a median period of 2.6 months.

Pfizer and BioNTech said that in addition to the F.D.A., they plan to submit their data to regulatory authorities in Europe and other countries.

The administration’s booster plan does not as yet include recipients of Johnson & Johnson’s one-shot vaccine. Johnson & Johnson announced earlier on Wednesday that unlike the studies of Moderna’s and Pfizer’s vaccines, a study of 17 volunteers showed little change in their antibody levels over the course of six months.

But the study also showed that when the volunteers were given a second shot six months after their first, their antibodies against the coronavirus jumped nine times higher than the level after the first dose. Company officials said they are looking forward to discussing a potential booster strategy for their vaccine with federal health officials.

While Pfizer-BioNTech vaccine was fully approved as a two-shot regimen for those 16 and older, adolescents aged 12 to 15 can continue to be vaccinated under the vaccine’s emergency use authorization. Regulators have only authorized a third shot for some people with weakened immune systems.

A booster shot of the Johnson & Johnson vaccine dramatically raises the levels of antibodies against the coronavirus, the company reported on Wednesday.

Johnson & Johnson will submit the data to the Food and Drug Administration, which is evaluating similar studies from Pfizer and Moderna. If authorized by the agency, the Biden administration wants to provide booster shots eight months after vaccination.

The Johnson & Johnson vaccine was absent from the government’s initial booster plan, announced last week. But with the new data, the company hopes to be part of the initial distribution of additional shots, which could happen as early as September.

“We look forward to discussing with public health officials a potential strategy for our Johnson & Johnson Covid-19 vaccine, boosting eight months or longer after the primary single-dose vaccination,” Dr. Mathai Mammen, the global head of Janssen Research & Development at Johnson & Johnson, said in a statement.

In February, the F.D.A. gave emergency authorization to Johnson & Johnson for its one-shot vaccine. A clinical trial carried out last fall and winter showed that a single shot had a 72 percent efficacy in preventing symptomatic Covid-19 among U.S. participants. In the trial, none of the vaccinated volunteers were hospitalized or died.

Johnson & Johnson carried out its clinical trial before the Delta variant became widespread, leaving open the question of how well the vaccine worked against the highly contagious form of the virus. But in a study released earlier this month, South African researchers found that a single shot of the Johnson & Johnson vaccine was up to 95 percent effective against death from the Delta variant, and reduced the risk of hospitalization by 71 percent.

In its new study, Johnson & Johnson tracked 17 volunteers from last year’s clinical trial. Six months after vaccination, their level of antibodies had changed little.

That’s different than the pattern seen with the Moderna and Pfizer-BioNTech vaccines. Those shots initially produce higher levels of antibodies, but their levels then drop over several months.

When volunteers in the Johnson & Johnson trial were given a booster shot at six months, their antibodies against the coronavirus jumped nine times as high as after the first dose.

Studies on the Moderna and Pfizer-BioNTech vaccines found a comparable jump in antibody levels. Because the three vaccines were not tested in a head-to-head comparison, it’s not possible to determine which one provides the biggest boost.

Johnson & Johnson said that it had submitted a manuscript describing the research to the website Medrxiv. It has not been posted there yet.

Noah Weiland contributed reporting.

To help address unequal access to Covid-19 vaccines around the world — an issue that “remains the Achilles’ heel” of the pandemic fight —  the World Health Organization is starting a program to manufacture vaccines in Latin America and the Caribbean, Dr. Carissa Etienne, the director of the Pan American Health Organization, said Wednesday.

“Much of today’s vaccine supply remains in the hands of wealthy nations around the world,” she said. “We must expand regional pharmaceutical production so we can be in the driver’s seat.”

She said her organization, which is part of the W.H.O., was analyzing about 30 proposals to manufacture messenger RNA vaccines — the same type as the Pfizer-BioNTech and Moderna shots — and expects to decide next month which ones to implement.

The “most feasible proposals,” including those that already have guaranteed investment backing, will get priority in an effort to expedite the project, according to Dr. Jarbas Barbosa, the pan-American agency’s assistant director.

The mRNA “vaccines are some of the most effective vaccines against Covid-19, and the technology is highly adaptable, so it has enormous potential to be used against other viruses,” Dr. Etienne said.

Vaccines produced by the program are to be distributed to countries in Latin America and the Caribbean, a region where an average of only 23 percent of the population has been fully vaccinated so far. “In many countries coverage is much lower,” Dr. Etienne said. “Just over 3 percent of people have been vaccinated in Guatemala, and a little over 4 percent in Jamaica.”

Many islands in the Caribbean, including Jamaica, are reporting steep surges in new cases and Haiti’s health system is struggling to care for survivors of the devastating Aug. 14 earthquake that killed more than 2,200 people.

“Logistics and security challenges continue to limit the delivery of supplies, the deployment of personnel to affected areas and the transfer of patients to other hospitals,” Dr. Etienne said.

The Episcopal Diocese of Maine will mandate coronavirus vaccines for all clergy and staff members, becoming one of the first religious authorities in the country to require inoculations.

“We needed to join the public health leaders in giving a religious voice to what is a very pressing moral issue right now,” said Bishop Thomas J. Brown on Wednesday. “To lead in the public square, and to join other organizations, corporations and institutions with similar mandates is to say that we are all about loving God and loving our neighbors.”

Bishop Brown issued the directive on Monday and said it will apply to about 240 clergy and 14 employees, who will have until Sept. 30th to get fully vaccinated, unless they have a medical exemption from a physician. So far, all 170 religious who have responded have told him they are already inoculated. If any of the remaining 70 decline to get shots, he said the consequences would depend on their role.

The bishop said he issued the directive in an effort to safeguard the public well beyond the reach of the diocese, which includes more than 10,000 parishioners. “What it ultimately means is, we can say to people in Maine who are not in our churches that we stand on the side of public health.”

Some faith leaders in the United States have sought to tread carefully on issues like vaccines and masks, creating a patchwork of policies as they seek to reopen houses of worship after more than a year of restrictions. A smaller group of religious denominations and leaders have opposed public health rules and questioned inoculations.

The Episcopal Church, though, has been supportive of vaccinations long before this pandemic, Bishop Brown said. In 2019, the Executive Council of the Episcopal Church issued a resolution stating: “The proper and responsible use of vaccines is a duty not only to our own selves and families but to our communities. Choosing to not vaccinate, when it is medically safe, threatens the lives of others.”

Maine has fared relatively well amid the nation’s recent surge in cases and deaths driven by the Delta variant, with a seven-day average of 161 new cases per day and two deaths reported on Tuesday, according to a New York Times database. More than 70 percent of Maine residents have received at least one dose of the vaccines and 65 percent are fully vaccinated.

At the emergency department of Hilo Medical Center on the island of Hawaii Wednesday, patients lay on beds in the hallway as staff members scrambled to find space in other parts of the hospital.

“Today is the fullest we’ve been in over 15 years — maybe even ever,” said Elena Cabatu, director of public affairs at the hospital. Nurses “are almost beside themselves at this point,” she said.

Across the islands of Hawaii, hospitals are facing an acute shortage of beds and medical staff as the Delta variant causes a surge far worse than any the state experienced during earlier waves of the pandemic.

By virtue of its geographical isolation and stringent government restrictions, Hawaii maintains its position as the state with the lowest rates of Covid cases and deaths. But in recent months, as restrictions have loosened and travel has resumed, case numbers have skyrocketed.

On July 1, the state’s seven-day average was 40 new cases daily. By Aug. 19, the new case reports had peaked at 729 a day, according to a New York Times database, more than double the state’s previous high in September.

And, with just 55 percent of the state’s population fully vaccinated, according to a New York Times database, health care providers worry that the worst is yet to come.

Models show that the state could reach a daily average of 1,500 Covid hospitalizations by the end of September, said Hilton Raethel, president of the Healthcare Association of Hawaii. The state normally maintains just 2,000 staffed hospital beds across the islands.

“The numbers don’t work, obviously,” said Mr. Raethel. Options for obtaining additional beds are limited. “It’s not like New York where you can truck people or beds in from New Jersey. We’re a five-hour flight away from the mainland.”

Over 200 health care workers have been dispatched from the mainland to assist the strapped hospitals. Three hundred more will be on the way next week.

At the same time, officials are rushing to reinstate restrictions to temper the surge. On Monday, Mayor Rick Blangiardi of Honolulu prohibited indoor gatherings of more than 10 people and outdoor gatherings of more than 25 people for at least 28 days.

And at a news conference Monday, Gov. David Ige discouraged tourists from coming.

“It’s not a good time to travel to the islands,” he said. “The visitors who choose to come to the island will not have the typical kind of holiday that they expect to get when they visit Hawaii.”

The Pfizer-BioNTech Covid-19 vaccine is associated with an increased risk of myocarditis, an inflammation of the heart muscle, a large new study from Israel confirms. But the side effect remains rare, and Covid-19 is more likely to cause myocarditis than the vaccine is, scientists reported on Wednesday.

The research, which is based on the electronic health records of about two million people who are 16 or older, provides a comprehensive look at the real-world incidence of various adverse events after both vaccination and infection with the coronavirus.

In addition to myocarditis, the Pfizer vaccine was also associated with an increased risk of swollen lymph nodes, appendicitis and shingles, although all three side effects remained uncommon in the study. Coronavirus infection was not associated with these side effects, but it did increase the odds of several potentially serious cardiovascular problems, including heart attacks and blood clots.

“Coronavirus is very dangerous, and it’s very dangerous to the human body in many ways,” said Ben Reis, a co-author of the new study and the director of the predictive medicine group at the Boston Children’s Hospital Computational Health Informatics Program.

He added, “If the reason that someone so far has been hesitating to get the vaccine is fear of this very rare and usually not very serious adverse event called myocarditis, well, this study shows that that very same adverse event is actually associated with a higher risk if you’re not vaccinated and you get infected.”

The data arrived in the middle of an intense discussion among federal regulators about the risks of myocarditis and pericarditis, which is inflammation of the lining around the heart, in younger recipients of both the Pfizer-BioNTech and Moderna vaccines.

Health officials in Nebraska are so desperate for staff that they are recruiting unvaccinated nurses, an unconventional attempt to plug the shortage of nurses as the state battles a surge in coronavirus cases.

The advertisements for unvaccinated nurses are popping up on postcards, on Facebook and on state job postings: “$5,000 sign-on bonus!” and “No mandated Covid-19 vaccinations,” the notices say. The ads are for positions in veterans’ homes, psychiatric treatment facilities and other locations.

State Senator Carol Blood first heard about the advertisements on Monday, she said, when she was inundated with messages from constituents criticizing the outreach.

“Our health care professionals were calling my office in tears,” she said. “It’s a slap in the face to them.”

New cases in Nebraska have jumped, with hospitalizations rising to the highest level since January, according to a New York Times database. Nebraska’s nurses, like health care workers across the country, are a year and a half into a relentless battle to care for Covid patients. The latest and most severe cases, across the country, are among those who have yet to be vaccinated.

As the highly contagious Delta variant pummels the United States, nurses are reporting that they feel depleted and traumatized, their ranks thinned by early retirements or career shifts that traded the emergency room for less stressful jobs.

Gov. Pete Ricketts of Nebraska, a Republican, directed the state authorities to recruit unvaccinated nurses, said Taylor Gage, a spokesman for the governor.

“The state responded with this campaign so nurses throughout Nebraska know that state government is an alternative career choice,” Mr. Gage said in a statement.

The decision came after eight state hospitals mandated vaccines for their employees, KETV reported.

Ms. Blood, a Democrat, wrote a letter to the governor on Monday criticizing the recruitment scheme, saying the state’s decision was “of grave concern to myself and countless people in my district.”

“I do understand that we have a serious shortage of staff,” she wrote. “With that said, putting those who live in these facilities at risk because we need to find bodies to hire is not acceptable.”

Ms. Blood said on Wednesday night that she had not received a reply from the governor’s office.

The surge is being driven by the highly contagious Delta variant and low vaccination rates, health experts said. The authorities in Nebraska are struggling to vaccinate its citizens, with only 57 percent of people at least partially vaccinated. The national rate is 61 percent, according to the Centers for Disease Control and Prevention.

Mayor Lori Lightfoot of Chicago said on Wednesday that all city employees will have to be fully vaccinated against the coronavirus by Oct. 15. The action by the city, the second-largest in the United States to impose such a requirement, came as coronavirus infections continue to spread rapidly across the country.

The policy will apply to more than 30,000 employees, including police officers, firefighters, park employees and sanitation workers. Employees may apply for a medical or religious exemption.

“As cases of Covid-19 continue to rise, we must take every step necessary and at our disposal to keep everyone in our city safe and healthy,” Ms. Lightfoot said in a statement. “Getting vaccinated has been proven to be the best way to achieve that and make it possible to recover from this devastating pandemic. And so, we have decided to join other municipalities and government agencies across the nation, including the U.S. military, who are making this decision to protect the people who are keeping our cities and country moving.”

The Los Angeles City Council passed a similar vaccine mandate last week for the city’s nearly 60,000 municipal workers (the public schools there are not part of the city government). Los Angeles County and the city of Seattle have also adopted mandates.

In New York City, Mayor Bill de Blasio has announced that teachers and other school employees will be required to be vaccinated, and other city employees must either be vaccinated or submit to weekly coronavirus tests.

The Food and Drug Administration granted full approval on Monday to Pfizer-BioNTech’s coronavirus vaccine for people 16 and older, making the vaccine the first to move beyond emergency-use status in the United States.

Ms. Lightfoot, whose administration has had a rocky relationship with major labor unions, is expected to face resistance from their members, particularly in the union representing police officers. She said on Wednesday that her administration was in conversations with labor unions to “create a vaccination policy that is workable, fair and effective.”

The Fraternal Order of Police in Chicago said earlier this week that it opposed a mandate and was awaiting more information from the mayor’s office.

Bob Reiter, the president of the Chicago Federation of Labor, which represents union members in Chicago and Cook County, said that while unions believe in the benefits of vaccination, “we do not believe punitive mandates are the right path to significantly increase vaccine uptake.”

“We believe this announcement may harden opposition to the vaccine, instead of protecting the workers who have sacrificed so much over the past 18 months,” Mr. Reiter said in an email.

Nearly 64 percent of Chicago residents age 12 and older have been fully vaccinated; nationwide, 60 percent of Americans 12 and older have been fully vaccinated.

Mandatory vaccination against the coronavirus for active-duty U.S. service members who have not already gotten shots will begin now, though no hard deadline has been set to complete it, the secretary of defense said in a memo.

Lloyd J. Austin III, the secretary, directed “the secretaries of the military departments to immediately begin full vaccination of all members of the armed forces under D.o.D. authority on active duty or in the Ready Reserve, including the National Guard, who are not fully vaccinated against Covid-19.”

The memo, dated Tuesday, said that only vaccines that have been federally approved will be used. It said the leaders of each branch of the military should “impose ambitious timelines for implementation” and report back regularly on progress, using established systems for mandatory vaccine reporting.

John F. Kirby, a spokesman for the Pentagon, said at a news conference on Wednesday that 68 percent of active-duty troops were already fully vaccinated, including the National Guard and Reserves. He said the Navy was the most-vaccinated branch, with 73 percent of sailors fully inoculated, while the Army was the least, with just 40 percent of soldiers fully vaccinated.

“The secretary has made clear his expectation to the military departments that he wants them to move with some alacrity here, and get the force fully vaccinated as fast as possible,” Mr. Kirby said.

Federal approval for Pfizer-BioNTech’s vaccine for people 16 and older on Monday allowed the military to begin requiring Covid vaccinations. The other two vaccines now in use in the United States — made by Moderna and Johnson & Johnson — only have emergency use authorizations from the Food and Drug Administration.

“Mandatory vaccinations are familiar to all Service members, and mission critical inoculation is almost as old as the U.S. military itself,” Mr. Austin said. “Our administration of safe, effective Covid-19 vaccines has produced admirable results to date, and I know the Department of Defense will come together to finish the job, with urgency, professionalism and compassion.”

Over the months when vaccination was voluntary for the 1.4 million active-duty members of the military, a current of resistance developed among younger members.

Now that it will be mandatory, Mr. Kirby said, service members who refuse vaccination and lack a valid medical or religious exemption will be offered a chance to discuss the vaccine with a physician and with their commander, which would ideally address the service member’s concerns, before facing discipline.

“It’s a lawful order, and it’s our expectation that troops will obey lawful orders,” Mr. Kirby said. “And we also expect that commanders will have plenty of other tools available to them to get their vaccination rates up, and to get these individuals to make the right decision, short of having to use disciplinary action.”

Video

transcript

Back

transcript

Global Surge Is Stabilizing, Albeit at a High Level, W.H.O. Says

Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said the number of coronavirus cases worldwide showed signs of flattening after increasing for nearly two months, despite continuing increases in some regions.

After increasing for nearly two months, the global number of Covid-19 cases and deaths was stable last week. But it’s stable at a very high level, more than 4.5 million cases and 68,000 deaths. However, the situation is very different from region to region, country to country, province to province and town to town. Some regions and countries continue to see steep increases in cases and deaths, while others are declining. As long as this virus is circulating anywhere, it’s a threat everywhere.

Reports of new coronavirus cases around the world are showing signs of flattening, even though they are still rising rapidly in the United States, the World Health Organization said in its latest weekly assessment.

In the week ended Aug. 22, the W.H.O. said, some 4.5 million new cases were reported worldwide, about the same as the week before, and the rate now “seems to be stable” after two months of sustained growth.

“It is stable at a very high level,” Dr. Tedros Adhanom Ghebreyesus, the director general of the organization, said at a news briefing. “As long as this virus is circulating anywhere, it’s a threat everywhere.”

Deaths reported from Covid-19 were also similar to the previous week, at 68,000 overall, though they continued to rise in Europe and the Americas, the W.H.O. said.

The United States reported the most new cases and deaths of any country, and a 15 percent increase in cases from the week before, the W.H.O. noted, as the Delta variant spread rapidly and politicians sparred over whether to reintroduce mitigation measures. The country recorded 6,712 deaths for the week, an increase of 58 percent from the previous week.

Cases are also rising fairly rapidly in Britain, which recorded 219,919 new cases for the week, an 11 percent increase, the W.H.O. said. Iran and India each reported more new cases than Britain did, but their figures and those of Brazil, another major locus of the pandemic, fell last week.

Japan, host to the Olympic Games and now the Paralympic Games, reported the fastest case growth — its 149,057 new cases for the week represented an increase of 34 percent from the week before. Some Southeast Asian countries, particularly Malaysia and the Philippines, also reported significant increases in cases, while Thailand and the Philippines reported sharp increases in deaths.

So far, the W.H.O. said, about 211 million people around the world have had confirmed coronavirus infections since the start of the pandemic, and just over 4.4 million people are recorded as dying from Covid-19.

Experts studying the origins of the coronavirus for the World Health Organization warned on Wednesday that the inquiry had “stalled” and that further delays could make it impossible to recover crucial evidence about the beginning of the pandemic.

“The window is rapidly closing on the biological feasibility of conducting the critical trace-back of people and animals inside and outside China,” the experts wrote in an editorial in the journal Nature. Several studies of blood samples and wildlife farms in China were urgently needed to understand how Covid-19 emerged, they said.

Amid a rancorous debate about whether a laboratory incident could have started the pandemic, the editorial amounted to a defense of the team’s work and an appeal for follow-up studies. A separate report by American intelligence agencies into the pandemic’s origins was delivered to President Biden on Tuesday, but did not offer any new answers about whether the virus emerged from a lab or in a natural spillover from animals to humans.

The international expert team, sent to Wuhan, China, in January as part of a joint inquiry by the World Health Organization and China, has faced criticism for publishing a report in March that said a leak of the coronavirus from a lab, while possible, was “extremely unlikely.”

Immediately after the report’s release, Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director-general, said that the study had not adequately assessed the possibility of a lab leak.

Virologists have leaned toward the theory that infected animals spread the virus to people. In the editorial published on Wednesday, the expert team reiterated calls to test the blood of workers on wildlife farms that supplied animals to Wuhan markets, to see if they carried antibodies indicating past coronavirus infections. The team also recommended screening more farmed wildlife or livestock that could have been infected. (The editorial also notes, somewhat pessimistically, that many Chinese wildlife farms have been closed and their animals killed since the pandemic emerged, making evidence of early spillover from animals to humans hard to come by.)

The team pointed to a recent report showing that markets in Wuhan had sold live animals susceptible to the virus, including palm civets and raccoon dogs, in the two years before the pandemic began, and argued that the weight of evidence behind a natural spillover was greater than that for a lab leak.

Marion Koopmans, a Dutch virologist and co-author of the editorial, described it in an interview as a “cry for urgency.”

“We were getting a little concerned that there really is virtually no debate about the bulk of the recommendations that are not related to the lab hypothesis, and of course there’s a lot of discussion of the lab story, particularly coming from the U.S.,” she said. “Our concern is that because of that emphasis, the rest doesn’t get any more attention.”

To identify the first cases of the virus, Dr. Koopmans said, scientists also needed to examine blood specimens from late 2019 before they are thrown away. The expert team received assurances on its visit to Wuhan that blood banks there would keep samples beyond the usual two-year period, she said, but has still not received access to them.

The Chinese government has stopped cooperating with investigations by the W.H.O., making it difficult to assess any theories about the virus’s origins.

Michael Ryan, a W.H.O. official, criticized China at a news conference on Wednesday for pushing unproven ideas suggesting that the coronavirus escaped from an American military lab.

“It is slightly contradictory if colleagues in China are saying that the lab leak hypothesis is unfounded in the context of China, but we now need to go and do laboratory investigations in other countries for leaks there,” Dr. Ryan said.

He said, however, that Chinese scientists had reported beginning some of the follow-up studies recommended by the international expert team.

The editorial on Wednesday also raised concerns about delays at the W.H.O. The organization said this month that it would form an advisory group to study the emergence of new pathogens, and that the group would support inquiries into the coronavirus. The editorial warned that this new layer of bureaucracy “runs the risk of adding several months of delay.”

Dr. Tedros, the organization’s director-general, said on Wednesday that establishing the advisory group “will not delay the progress of the studies into the origins of SARS-CoV-2.”

The W.H.O. said that it was already working to verify studies into the earliest known cases outside China.

Delta Air Lines is intensifying pressure on employees to get vaccinated with a series of increasingly burdensome requirements over the coming weeks and months, though it stopped short of the mandates that other airlines and businesses have put in place.

In a letter to employees on Wednesday, the carrier’s chief executive, Ed Bastian, said those who had not been vaccinated would immediately be required to wear masks indoors. Starting on Sept. 12, they will also have to take weekly coronavirus tests.

On Sept. 30, unvaccinated workers will lose pay protection for employees who test positive for the virus and miss work while having to quarantine. Finally, starting on Nov. 1, any employee who remains unvaccinated will have to pay an additional $200 per month to remain on the company’s health care plan.

“This surcharge will be necessary to address the financial risk the decision to not vaccinate is creating for our company,” Mr. Bastian said. “In recent weeks since the rise of the B.1.617.2 variant, all Delta employees who have been hospitalized with Covid were not fully vaccinated.”

The average coronavirus-related hospitalization has cost the company about $50,000 per person, he said. (The airline had said the cost was $40,000 but later corrected the figure.) Like many large employers, Delta insures its own work force, meaning it pays health costs directly and hires insurance companies to manage its plans.

The onerous requirements apply to a shrinking share of the airline’s work force, with 75 percent of employees now vaccinated, Mr. Bastian said.

“We’ve always known that vaccinations are the most effective tool to keep our people safe and healthy in the face of this global health crisis,” he said. “That’s why we’re taking additional, robust actions to increase our vaccination rate.”

Delta, which is based in Atlanta, its biggest hub, operates the largest vaccination site in Georgia out of its flight museum, Mr. Bastian said. More than 115,000 doses have been administered to state residents there, and more than 150,000 doses have been given to employees, their family and friends.

About 50.5 percent of Georgia’s adult population is fully vaccinated, according to data from the Centers for Disease Control and Prevention, which puts the state near the bottom of the country.

The airline’s approach differs from that of some competitors. United Airlines, for example, announced this month that it would require vaccines across the board. That mandate will take effect on Sept. 27. United employees who provide proof of vaccination by Sept. 20 will receive a full day’s pay. Frontier Airlines, a smaller carrier, said it will require vaccination by Oct. 1.

When a conspiracy theory started circulating in China suggesting that the coronavirus had escaped from an American military lab, it largely stayed on the fringe. Now, the ruling Communist Party has propelled the idea firmly into the mainstream.

This week, a Chinese foreign ministry spokesman repeatedly used an official podium to elevate unproven ideas that the coronavirus may have first leaked from a research facility in Fort Detrick, Md. A Communist Party publication, Global Times, started an online petition in July calling for that lab to be investigated and said it had gathered more than 25 million signatures.

Officials and state media have promoted a rap song by a patriotic Chinese hip-hop group that touted the same claim, with the lyrics: “How many plots came out of your labs? How many dead bodies hanging a tag?”

Beijing is peddling groundless theories that the United States may be the true source of the coronavirus as it pushes back against efforts to investigate the pandemic’s origins in China. The volume has risen in recent weeks, reflecting the authorities’ anxiety about being blamed for the pandemic that has killed millions globally.

“This not only contributes to the further deterioration of U.S.-China relations but also makes it even less likely for the two countries to work together to face a common challenge,” said Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University. “We haven’t seen any bilateral cooperation over the vaccines, tracing the trajectory of the virus or mutations, any of these kind of things.”

Global Roundup

The authorities in at least 12 cities in China have warned residents that those who refuse Covid-19 vaccinations could be punished if they are found to be responsible for spreading outbreaks.

The latest government notices, issued this and last week, reflect China’s anxiety about stamping out the more transmissible Delta variant, which has spread recently in several cities. China has fully vaccinated roughly 55 percent of its population, but officials have said that rate needs to hit 80 percent for the country to reach herd immunity.

While private companies and government organizations in many countries are mandating Covid-19 vaccinations, China appears to be going much further in tying a refusal to get a vaccine to direct punishment.

The authorities said they would “hold accountable” people who refused to be vaccinated if they were responsible for spreading an outbreak, unless they had a medical exemption. They did not specify what the punishment would be. On Aug. 17, several cities in central Hubei Province announced that people who refused to be vaccinated would have that entered into their “personal credit score.” They could be barred from going to work or entering hospitals and train stations.

On Weibo, a popular instant messaging platform, some Chinese expressed anger at the latest mandates. Many said the policy went against their free will.

Although China has managed to reduce its number of daily cases to single digits, the recent outbreak has posed a threat to the government’s resolve in maintaining a zero-Covid strategy.

In other news from around the world:

• New South Wales, the most populous state in Australia, reported another daily record on Wednesday, with 919 new coronavirus cases. Its capital, Sydney, has now been locked down for two months. There are concerns that Sydney’s health care system is struggling to cope with the Delta outbreak after reports that one hospital at the cluster’s epicenter has started limiting the number of new patients it can admit. On Wednesday, the state of Queensland closed its borders to New South Wales, Victoria and the Australian Capital Territory, all of which are struggling to contain outbreaks, with Queensland authorities saying its quarantine system was overwhelmed.

• Five people in New Zealand may have been given saline solution instead of a vaccine dose at a center in Auckland, the country’s largest city, last month. Ashley Bloomfield, New Zealand’s top health official, said at a news conference on Wednesday that it was only a “possibility” that some of the 732 people vaccinated that day had not received a dose. On Wednesday, New Zealand reported 62 new cases, its highest daily total in more than a year, bringing its total for the pandemic to 3,160, according to figures compiled by Johns Hopkins University. The country had gone months without a case before an outbreak last week precipitated an immediate national lockdown.

• The western Pacific’s share of global coronavirus cases and deaths is “rising sharply” partially because of the Delta variant, the World Health Organization said in a briefing on Wednesday. “Until a few weeks ago our region had fared comparatively well, with around 2 percent of global cases and global deaths,” said Dr. Takeshi Kasai, the W.H.O. western Pacific regional director. However, in the first three weeks of August, that number jumped to 10 percent of new global cases and 8 percent of new global deaths, he said.

• A day after the Tokyo Paralympics held a spectator-free opening ceremony, Japan expanded its state of emergency to eight more prefectures on Wednesday, with 21 of the country’s 47 prefectures now under an emergency order. The number of new daily cases has increased by 65 percent over the past two weeks, to an average of 23,003 a day, according to a New York Times database. The state of emergency is expected to last until Sept. 12. The Paralympics, which close on Sept. 5, are being held almost entirely without spectators, much like the Olympics earlier this month.

• Vice President Kamala Harris on Wednesday promised a million doses of the Pfizer vaccine to Vietnam, which has been dealing with its worst outbreak to date. The pledge would bring total U.S. vaccine donations to the country to six million doses. Vietnam has also begun offering patients who have recovered from Covid a monthly allowance if they agree to stay on at stretched hospitals to help health workers, Reuters reported. The news agency cited a letter to patients from a hospital chief that promised “personal protective equipment, food, accommodation and a monthly allowance of 8 million dong,” about $350.

Natasha Frost, Hikari Hida and Yan Zhuang contributed reporting.

The director of national intelligence delivered a report to President Biden on Tuesday on the origins of the coronavirus epidemic, according to U.S. officials, but the nation’s spy agencies have not yet concluded whether the disease was the result of an accidental leak from a lab or if it emerged naturally in a spillover from animals to humans.

Mr. Biden had ordered the nation’s intelligence agencies three months ago to draft a report on the origins of the virus, which has been the subject of an intensifying debate, in part to give the agencies a chance to examine a trove of data that had not been fully exploited.

But the inquiry, which examined data collected from a virology research institute in Wuhan, China, the city where the virus first spread, has yet to answer the biggest outstanding question about where it came from. Its absence of conclusions underscores the difficulty of pinpointing the source of the virus, particularly given China’s refusal to continue to cooperate with international investigations into the origin the coronavirus.

In the months after the pandemic began, intelligence agencies began looking into how it started. Former Secretary of State Mike Pompeo pushed the agencies to look into the theory that the virus was created inside a Chinese lab and accidentally leaked. Mr. Pompeo formed his own research group to study the question.

During the Trump administration, intelligence agencies ruled out theories that the virus was deliberately leaked. But they said they could not make a conclusion about what was more likely: an accidental leak from a lab researching coronaviruses or a natural development of the virus.

While many scientists were initially skeptical of the lab leak theory, at least some became more open to examining it this year. And some criticized a World Health Organization report in March that found the lab leak theory unlikely.

After that report, Biden administration officials became frustrated with a decision by the Chinese government to stop cooperating with further investigations by the World Health Organization into the origins of the pandemic. In the face of what they called Chinese intransigence and a divided American intelligence community, Biden administration officials then ordered a 90-day review of the intelligence, resulting in the report delivered to the president on Tuesday.

Current and former officials have repeatedly warned that finding the precise origins of the pandemic may be more of a job for scientists than spies. Under Avril D. Haines, the director of national intelligence, the agencies have stepped up cooperation with scientists, hoping to better understand the current pandemic and possible future ones.

Officials also warned that the 90-day review was probably too brief to draw any definitive conclusions.

The report remains classified for now, and officials would not discuss its findings. But officials said that Ms. Haines’s office would most likely declassify some information later this week.

“I can’t obviously speak to a classified briefing,” Jen Psaki, the White House press secretary, said when reporters asked her about the report on Wednesday. “I know you are eager to receive an unclassified summary, that is something the intelligence community has been working to produce and as soon as that is available it will be put out publicly.”

Asked whether the president would be satisfied if the inquiry ended inconclusively, Ms. Psaki said that he was doing everything possible to uncover the truth.

“I can assure you the president wants to get to the bottom of the root causes of Covid-19, that as you noted has killed hundreds of thousands of Americans, and wishes that there had been more done earlier on to get to the bottom of it, and to of course save more lives,” she said.

Daniel E. Slotnik contributed reporting.