The authorities in Hawaii are struggling to transport tanks of oxygen from the mainland as the state’s hospitals grow increasingly strained by new coronavirus infections.
Medical authorities are asking people to postpone elective surgeries and the state’s 223 I.C.U. beds have dwindled to 16 available, said Hilton R. Raethel, the president and chief executive of the Healthcare Association of Hawaii.
“The most critical point for Hawaii that we’ve experienced during this entire pandemic is right now,” he said.
Since July 1, Hawaii has been battling its highest surge in virus infections and hospitalizations, with the seven-day average of reported cases reaching 884 on Tuesday, according to a New York Times database. The seven-day hospitalization average peaked at 427 on Monday. Health experts say the surge is driven by the highly contagious Delta variant and low vaccination rates.
Though Hawaii has seen droves of tourists coming to the islands — so many that the state’s governor last week asked them to stay away — Mr. Raethel said that around 95 percent of hospitalized patients are unvaccinated residents, not tourists.
These hospitalized patients are also largely the reason for a huge surge in requests for medical oxygen. The demand is up 250 percent since August began, the association said in a statement. The state authorities turned to the mainland for help, but encountered challenges.
An international shortage has limited the number of liquid oxygen tanks that the state can order, Mr. Raethel said. It also takes up to a month to ship the tanks in boats across the Pacific. (Liquid oxygen is highly flammable and dangerous to transport by plane.)
“If New York runs out of oxygen, you ship it in from New Jersey or put it on a truck,” he said. “Even Alaska can drive it across the border from Canada or Washington.”
The state currently has 10 tanks, Mr. Raethel said, and each carries up to 3,500 gallons of liquid oxygen.
The state authorities have requested assistance from the Federal Emergency Management Agency, U.S. Department of Health and Human Services and other agencies as it tries to increase its oxygen supply, the association said.
Mr. Raethel said he believes the state will weather the crisis without running out of oxygen. In addition to canceling elective surgeries, FEMA has approved the purchase of three oxygen generators, the authorities have asked shipping companies to speed up deliveries and the state has identified a few tanks that can carry liquid oxygen instead of other gases.
“Living in Hawaii is wonderful when things are going well,” he said. “But it’s really challenging when you have logistical concerns.”
In hospitals, I.C.U.s are equipped with specialized equipment and trained staff who can treat critically ill patients. Experts say maintaining existing standards of care for the sickest patients may be difficult or impossible at hospitals with more than 95 percent I.C.U. occupancy, and throughout the pandemic, hospitals have been forced to improvise solutions when I.C.U. space and staffing have dwindled.
The White House, under pressure to do more to address the global coronavirus pandemic, announced Thursday that it will invest nearly $3 billion to ramp up domestic production of critical vaccine components as part of President Biden’s push to make the United States the “arsenal of vaccines for the world.”
The money, $2.7 billion, will go to firms doing business in the United States that make supplies necessary for vaccine production, including lipids, bioreactor bags, tubing, needles and syringes, officials said. It will come from funds appropriated by Congress through the American Rescue Plan, the $1.9 trillion economic stimulus package Mr. Biden signed into law in March.
“This new investment will further expand domestic vaccine manufacturing capacity, helping the U.S. deliver on its commitment to be the arsenal of vaccines for the world and preparing America for future vaccination efforts,” said Jeffrey D. Zients, Mr. Biden’s coronavirus response coordinator, who announced the effort during a briefing with reporters.
Details, however, were scant. The Department of Health and Human Services is in the “final stages” of awarding contracts for the work, and will make announcements in the coming weeks, according to a White House official who was not authorized to speak publicly about the investment. Neither the official or Mr. Zients could provide an estimate of how many doses the investment would yield.
But Mr. Zients said that investing in the supply chain would also “create thousands of good paying American jobs.”
Mr. Biden has already either donated or pledged about 600 million vaccine doses to other countries — a small fraction of the 11 billion that experts say are needed to slow the spread of the virus worldwide. His administration has also taken steps to expand coronavirus vaccine manufacturing in the United States and India, and is supporting production in South Africa and Senegal to expand access to locally produced vaccines in Africa.
But the president has come under increasing criticism in recent weeks from global health advocates and experts who say he is nowhere near fulfilling his “arsenal” promise. Their outrage grew after the administration announced last month that it was recommending booster doses for all Americans — even before the Food and Drug Administration has had a chance to weigh in on whether such doses are necessary.
Worldwide, 81 percent of shots that have been administered have been in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Only 0.4 percent of doses have been administered in low-income countries.
Activists have been calling for the Biden administration to ramp up vaccine manufacturing around the world as well as in the United States. They also want the administration to press major vaccine makers to share their recipes and technical know-how with other companies — a process known as “tech transfer,” which Thursday’s announcement did not address.
“Major investments in urgent vaccine manufacturing are desperately needed, and after today’s announcement, still far more is needed to make the billions of doses lacking to end the pandemic,” said Peter Maybarduk of the consumer advocacy group Public Citizen, which has proposed a $25 billion investment to retrofit manufacturing facilities around the world, with the goal of making 8 billion doses of mRNA vaccine in one year.
Congress put a total of $16.05 billion in the American Rescue Plan this year, in two separate tranches, that could be used to procure and manufacture treatments, vaccines and tools for ending the pandemic. But in an analysis released last week, the AIDS advocacy group PrEP4All found that all told, the administration had spent $145 million — just $12 million of it from the American Rescue Plan — to expand vaccine manufacturing.
James Krellenstein, a founder of Prep4All and the author of the analysis, said Thursday that the $2.7 billion “does seem like a very significant investment” in the vaccine supply chain. But he questioned whether there is adequate capacity to make “drug substance” — the core ingredients of the vaccines — and whether the fresh investment would actually spur major vaccine manufacturers like Pfizer and Moderna to make more doses.
“It’s kind of like there is a massive cake shortage right now, and instead of making more bakeries, we are making more flour and assuming more cakes will be baked,” he said. “The question I have is, ‘Does the Biden administration have any plans to make more bakeries?’”
At the height of the pandemic, doctors and nurses made furious efforts to protect themselves with gowns and masks and scrambled to save the lives of the severely ill Covid-19 patients with ventilators.
But these efforts, among other life saving measures, had a side effect: drug-resistant infections have increased in hospitals.
The development, reported on Thursday by the Centers for Disease Control and Prevention, came about in part because drug-resistant bacteria thrived on reused protective equipment, intravenous lines and medical equipment like ventilators.
Drug-resistant infections have in recent years become a gnawing, sometimes deadly, problem. The threat has grown as various germs — notably bacteria and fungi — have mutated and developed defenses that allow them to resist medications and thrive; the germs prey in particular on older patients and the immunocompromised, limiting drug options to counter infections or, in extreme cases, leaving no effective treatments.
Immense efforts have been made in recent years to slow the growth of these noxious microbes that, increasingly, resist treatment by various classes of medicines. In the second half of 2020, though, “sometimes these efforts went terribly wrong,” with so much focus on stopping transmission of Covid-19, according to a commentary that accompanies the new study by the C.D.C. The authors wrote that the practices best known to stop the spread of drug-resistant infections were ignored or subverted in the face of a larger threat.
Drug-resistant bloodstream infections at hospitals rose 47 percent in the last three months of 2020 compared to the same period a year earlier. That was a sharp change in momentum. In the first three months of 2020, such infections had fallen nearly 12 percent compared to the same period a year earlier, reflecting heightened efforts at the time to stop the spread.
Similar trends showed up with regard to infections traced to ventilators, which rose 45 percent in the fourth quarter of 2020 over the previous year. During the same period, infections from one bacterium — methicillin-resistant Staphylococcus aureus, or MRSA —rose 34 percent after having fallen in the first quarter of 2020 as compared to the same period a year earlier.
Citing a surge in coronavirus cases driven by the Delta variant, officials in King County in Washington — which includes Seattle and its suburbs — said Thursday that it would require masks be worn at outdoor events that attract more than 500 people.
The mandate begins Tuesday, and it applies to residents 5 years of age and older, regardless of their vaccination status. The county is also strongly recommending masks for everyone over 5 years old in other outdoor settings where people cannot remain at least six feet apart from people outside their household.
County health officials said that hospitals are the most crowded since the pandemic began, and that health care workers were overburdened.
As of Wednesday, the seven-day average of new cases across Washington State has reached a new state record, with 3,465 a day, an increase of 19 percent in the last two weeks, according to a New York Times database. The data also shows that current hospitalizations have grown 35 percent over the same time period, to a daily average of 1,753, and new deaths have jumped 72 percent, to a daily average of 24.
Seventy-two percent of Washington residents 18 and older are fully vaccinated, according to federal data. People younger than 12 are not eligible for the vaccines.
“King County is committed to putting people first, and today’s order fully recognizes the risk to communities and our health care system if we don’t take action now to further prevent the spread of Covid-19,” Dow Constantine, the King County executive, said in a statement.
The King County order on Thursday continues to require masks in indoor public settings, including schools, grocery stores, malls, gyms, and community centers. The order is in sync with the state’s indoor mask mandate for everyone over 5 years of age, which went into effect late in August.
Oregon last week became the first state to restore a statewide mask mandate requiring masks outdoors regardless of vaccination status; it already had an indoor mask requirement statewide. And Los Angeles County recently put into a place a mask mandate for events that attract more than 10,000 people.
The Seattle region had recorded most of the nation’s first Covid deaths, as the virus rampaged through a nursing home in the Seattle suburbs in early 2020. In early 2021, the region’s deaths per capita were lower than any other large metropolitan area.
Sarah Cahalan contributed reporting.
Ross Wilson, the chargé d’affaires of the U.S. Embassy in Kabul who helped manage the evacuation from the Kabul airport, has tested positive for the coronavirus, according to a person familiar with his condition who was not authorized to speak on the record.
Mr. Wilson was one of a number of officials who continued operating in the country as Taliban fighters swept into the capital, prompting the evacuation of around 123,000 people. The last American diplomat to depart Kabul, he continued working at the airport to process the paperwork of Afghans who wanted to leave for two weeks after the embassy shut down on Aug. 15.
Mr. Wilson’s condition on Thursday was not immediately clear.
In the rush to complete the evacuation, military and diplomatic officials have scrambled to put in place a system for screening those airlifted out of the country for the virus. Many have arrived in the United States.
Pentagon officials have said that they established temperature checks and other Covid protocols at the airfield in Kabul. Last week, the White House press secretary, Jen Psaki, said that all evacuees would also be tested and offered vaccines upon arrival.
“With regards to Covid, the Afghans coming from the Middle East into our locations that we have stood up are all being tested, actually, multiple times,” Gen. Glen D. VanHerck, the commander of the North American Aerospace Defense Command, said last week.
Of those who arrived last week, roughly one out of 1,200 had tested positive, he said.
Addressing the evacuation efforts on Monday, Secretary of State Antony J. Blinken thanked Mr. Wilson, whom he credited for “exceptional, courageous work during a highly challenging time.”
Mr. Blinken also acknowledged the heavy toll that the pandemic had taken on Afghanistan, where vaccines have been scarce and a summer surge just months ago badly strained the country’s hospitals.
Lara Jakes contributed reporting.
SEOUL — North Korea has declined an offer of 2.97 million doses of the Sinovac vaccine, saying they should be sent to countries with worse outbreaks instead, a spokesperson for UNICEF, the United Nations agency for children, said on Wednesday.
The shipment of vaccines was funded by the global vaccine-sharing initiative called Covax that distributes shots to lower-income countries. North Korea said that the vaccines may be “relocated to severely affected countries,” the spokesperson said.
Having a decrepit public health system, North Korea shut its borders in January 2020 and declined other international aid, for fear that outside help might bring in Covid-19, which could overwhelm its public health system and damage an economy that was already struggling under international sanctions. The country continues to maintain that it has no virus cases, but outside health experts are skeptical.
UNICEF, which helps deliver the shots on behalf of Covax, said that North Korea’s public health ministry turned away the shipment citing the limited global supply of Covid-19 vaccines and continuing virus surges elsewhere. The North has said it will “continue to communicate with Covax facility to receive Covid-19 vaccines in the coming months,” the U.N. agency added.
A spokesperson for Gavi, the nonprofit leading Covax, said that it was continuing to work with the North Korean authorities to help respond to the pandemic.
Before declining the Sinovac vaccines, North Korea was expected to receive nearly two million doses of the AstraZeneca shot by the middle of this year for a population of about 25 million, according to a report by Covax from February. North Korea never accepted this shipment.
It has also attempted to steal Covid-19 vaccine technology by hacking international pharmaceutical companies, including Pfizer Inc., a South Korean lawmaker said earlier this year after a briefing by government intelligence officials.
Such attempts were part of numerous cyber-hacking activities initiated daily by North Korea, Ha Tae-keung, a lawmaker affiliated with the opposition People Power Party, told South Korean reporters in February. Mr. Ha, who provided no further details, spoke after he and other lawmakers were briefed by senior officials from the National Intelligence Service during the closed-door briefing. The National Intelligence Service declined to confirm Mr. Ha’s comment, citing its policy of not confirming information from closed-door parliamentary briefings.
Choe Sang-Hun contributed reporting.
As the United States confronts its worst moment of the pandemic since the winter, there is a group of 48 million people who do not have the option of getting a vaccine: children under 12.
Because a vaccine is not yet authorized for young children, and may not be for some time, their families are left in a particularly difficult position heading into this school year.
“Waiting for a vaccine for the under-12 set has started to feel like waiting for Godot,” said Dana Gilbert, 49, of Minneapolis. Her 11-year-old son was born prematurely and has special needs, and a family doctor advised that he not return to school in person until a vaccine is available.
Her plan is to wait out the clock: Keep him at home until a vaccine is authorized for emergency use, or until he turns 12 next year, whichever comes first.
The timeline for a vaccine for children under 12 — initially expected by this fall — appears to have slowed, as officials consider safety, effectiveness and dosage. Dr. Anthony S. Fauci, the nation’s top infectious-disease expert, recently indicated that a vaccine could become available to young children “hopefully by the mid, late fall and early winter.” Shots for children ages 5 to 11 are expected first; children as young as six months may have to wait longer.
In interviews, many parents of children under 12 described feeling increasingly desperate, angry and backed into a corner as they reluctantly send their children into the classroom this fall — or resort to drastic actions to keep them safe.
Others are less worried, but equally frustrated as they head into another school year marked by pandemic rules. In some cases, mandates are being applied most stringently to young children not eligible for a vaccine.
“It doesn’t feel like there are any good options at this point,” said Adina Ellis, 45, who tossed and turned in bed for hours the night before school started this week in Washington, D.C., racked with indecision about whether to send her 6-year-old son, Cassius.
On the first day of school, Ms. Ellis rose before dawn, sat on her front porch with her husband and made a “game-time decision,” she said, to drop her son off at school. Watching him walk up the steps, carrying a Hot Wheels backpack, some part of her became resigned to the possibility that he may get infected.
“That thought will haunt me for as long as he’s going to school unvaccinated,” she said.
Mobile coronavirus testing sites in New York City were reopening on Thursday as the area worked to recover from the flooding caused by the remnants of Hurricane Ida. Some vaccination sites also remained closed or with delayed openings, the city’s alert system said.
The city urged people seeking vaccinations to call ahead or check on its vaccine finder website before heading out, particularly as public transportation remains limited.
Overall, public and private city hospitals reported minimal storm damage and relatively normal operations as they dealt with both storm-related problems and the pandemic.
“Our facilities sheltered some community members through the storm, and today our social workers are connecting any patients affected with relevant community resources,” said Chris Miller, a spokesman for the city’s public hospital system.
A Northwell Health spokeswoman said some elective surgeries in Manhattan were being postponed because of staffing issues caused by public transportation problems, but that all of its hospitals were open.
The city is still dealing with a virus surge caused by the Delta variant, with an average of about 1,800 cases per day. Hospitalizations, however, have remained well below previous peaks. About 885 people are currently hospitalized in New York City for Covid-19, according to state data, compared to more than 12,000 in the spring of 2020.
All city-run virus testing sites will also be closed for Labor Day, the city announced, unlike earlier in the pandemic, when testing sites remained open on major holidays.
Adam Shrier, a spokesman for the city’s Test and Trace Corps, said the rainfall had prevented one city-run testing site, at St. James Recreation Center on Jerome Avenue in the Bronx, from opening on Thursday. But other sites were open as usual, and by noon on Thursday the city’s fleet of more than 40 mobile testing units was operational, Mr. Shrier said.
“Our staff are going above and beyond to continue their critical work with minimal disruption, as they have through inclement weather several times before,” Mr. Shrier wrote in an email. “It is our priority to provide no-cost, convenient testing options to patients across the city, a mission that is more important than ever as New Yorkers recover from the impact of this storm.”
Amtrak will require all its employees to be vaccinated against coronavirus as the highly contagious Delta variant continues to concern public health officials.
Rail service employees must be fully vaccinated by Nov. 1 or submit a weekly negative coronavirus test. As of Oct. 4, new hires must show proof of vaccination before their first day of employment.
Amtrak requires all customers and employees to wear face masks, regardless of vaccination status or state and local laws.
The company joins a heap of others that have mandated inoculation in the workplace. Other transportation companies and agencies, including Frontier Airlines and New York’s Metropolitan Transportation Authority, also announced mandatory vaccination for their workers. Delta Air Lines said it would impose a $200 monthly surcharge on employees who had not been vaccinated as of Nov. 1.
Amtrak has catered mostly to leisure travel during the pandemic, said a spokesman for the rail service. Many business travelers, on which it relies, are still working from home while their companies settle on return-to-office plans.
Amtrak provided 16.8 million customer trips in 2020, a decrease of 15.2 million passengers from the year before.
“Ridership continues to improve,” said the Amtrak spokesman, with levels rising to 65 percent of what they were in 2019.
GUANTÁNAMO BAY, Cuba — A key defense lawyer in the long-delayed Sept. 11 attacks proceedings was in quarantine Thursday after he was exposed to the coronavirus, potentially setting back the efforts once again.
Guantánamo, a base of 6,000 residents that sits behind a Cuban minefield, has managed to prevent an outbreak of the virus through quarantine, testing and closures.
But Walter Ruiz, the defense attorney, was with his client, a Saudi prisoner, Mustafa al-Hawsawi, for 90 minutes on Wednesday when guards abruptly ended the meeting. Mr. Ruiz and Mr. Hawsawi were wearing masks, but a medical official ordered Mr. Ruiz confined to his quarters because someone who sat near him on a Navy plane to the base on Tuesday was infected. Mr. Ruiz, who tested negative before and after his arrival, was to be tested again on Friday.
At issue is whether he would be released from quarantine in time for a closed conference Saturday at Guantánamo’s courtroom between the judge, Air Force Col. Matthew McCall, and case lawyers. Prosecutors are seeking the death-penalty in the five-man case and, by law, Mr. Ruiz must be present to represent Mr. al-Hawsawi.
Colonel McCall, who is the fourth judge assigned to preside in the Sept. 11 trial since 2012, has scheduled nine days of mostly administrative hearings to start Tuesday.
More than 100 people, including family members of victims of the attacks, are scheduled to arrive on Saturday for the hearings, the first since the start of the pandemic. It will also be the first court hearing since February 2020 with Khalid Shaikh Mohammed, who is accused of being the plot mastermind, and four other men who are accused of being accomplices in the attacks that killed 2,976 people in New York, Pennsylvania and at the Pentagon 20 years ago.
Before the pandemic, defense lawyers were beginning to call witnesses to contest potential trial evidence as tainted by torture. Since then, court related travel was halted and the judge who was presiding at the time abruptly retired.
Then, in July, the base recorded seven cases of the virus in a few weeks and added day-of-travel tests. Three people tested positive in the month of August, she said, resulting in the quarantine of at least 10 people through contact tracing.
Base health officials also increased mask requirements, consistent with Department of Defense policy. Visitors who arrived last month were told to wear them at all times indoors and also outdoors within six feet of other people.
At the court however, earlier this week, a Navy judge in a different war crimes case waived the mask requirement and presided for two weeks with no mask, and many of the legal teams followed suit. Cmdr. Hayes C. Larsen, the judge, called it “a personal decision” because of “robust screening measures in getting everyone safely to the island.”
The inconsistent masking so troubled another capital defender in the Sept. 11 case, Cheryl Bormann, that she sought emergency permission Wednesday night to participate remotely from a new satellite court for the Guantánamo proceedings near the Pentagon. The judge denied the request, noting that Ms. Borman refused to certify that her client, Walid bin Attash, could be adequately represented with her essentially participating by video conference.
Unemployment benefits have helped stave off financial ruin for millions of laid-off workers over the last year and a half. After this week, that lifeline will snap: An estimated 7.5 million people will lose their benefits when federally funded emergency unemployment programs end. Millions more will see their checks cut by $300 a week.
The cutoff is the latest and arguably the largest of the benefit “cliffs” that jobless workers have faced during the pandemic. Last summer, the government ended a $600 weekly supplement that workers received early in the crisis, but other programs remained in place. In December, benefits briefly lapsed for millions of workers, but Congress quickly restored them.
This time, no similar rescue appears likely. President Biden has encouraged states with high unemployment rates to use existing federal funds to extend benefits, but few appear likely to do so. And administration officials have said repeatedly that they will not seek a congressional extension of the benefits.
The politics of this cliff are different in part because it affects primarily Democratic-leaning states. Roughly half of states, nearly all of them with Republican governors, have already ended some or all of the federal benefits on the grounds that they were discouraging people from returning to work. So far, there is little evidence they were right: States that cut off benefits have experienced job growth this summer that was little different from that in states that retained the programs.
In the states that kept the benefits, the cutoff will mean the loss of billions of dollars a week in aid when the pandemic is resurgent and the economic recovery is showing signs of fragility. And for workers and their families, it will mean losing their only source of income as other pandemic programs, such as the federal eviction moratorium, are ending. Even under the most optimistic forecasts, it will take months for everyone losing aid to find a job, with potentially long-term consequences for both workers and the economy.
“I have no idea what I’m going to do once these benefits stop,” said Amanda Rinehart, who is considering borrowing money from her grandmother or selling blood plasma to feed herself and her son.
Evan Ocheret is considering giving up his career in music.
Mr. Ocheret, 32, is a professional oboist in Philadelphia. Before the pandemic, he cobbled together a living as a freelancer.
Without unemployment benefits to fall back on, he isn’t sure how he will get by. He has signed up for computer coding courses to give him another option — one that he doesn’t want to take.
“I hate to stop doing the thing I love,” Mr. Ocheret said. “But if things don’t start to improve, I may have to do something different.”
For college football players this season, a chance at glory could hinge on a team’s coronavirus vaccination rate, arguably the most important statistic in college leagues these days.
The mercies of the 2020 season, including rescheduled games and no-contests connected to the pandemic, have all but vanished for 2021 so the games go on and the money keeps flowing. Now there are largely unforgiving policies intended to keep players and coaches safe and furious efforts inside locker rooms to persuade young men to be inoculated so they can more likely stay on the field.
The results have often been robust, with many teams vaccinated at higher rates than their surrounding communities. Arizona, Boston College and Mississippi have reported 100 percent vaccination rates among football players; at least half of the teams ranked in the top 10 of The Associated Press preseason poll have said that 90 percent or more of their players are inoculated.
And in a stark departure from last year, when many athletic programs tried to keep their virus case counts out of public view, schools are sometimes celebrating their vaccination rates to the envy of their rivals.
“Football is competitive, coaching is competitive, the SEC is as competitive as you get, including in pro sports,” said Lane Kiffin, the coach at Mississippi, where about 47 percent of adults statewide are fully vaccinated. “This is probably the first thing where it was like, ‘OK, hey, we did this,’ and people are calling us for advice — other coaches, other trainers — and we’re openly sharing that.”
Universitywide vaccination mandates have eased the strain for some football programs, even though they have stirred some players to threaten to leave their schools entirely. But on many campuses, coaches, players, trainers and team doctors have taken the lead in prodding athletes to receive shots.
It has been a monthslong high-wire act, complicated by rampant misinformation about vaccines and worries about potential overreach by schools that already have enormous influence over athletes’ lives. Some coaches feared that their efforts would be seen as too self-serving.
“We tried here to take the lead from a sports medicine standpoint and really make it about health and safety,” said Ron Courson, Georgia’s executive associate athletic director for sports medicine. “You do have some concerns that if it’s coming from other people it could be construed as hazing or bullying, and we really wanted to stay away from that.”
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