Credit…Sarahbeth Maney/The New York Times

President Biden told a town hall audience in Ohio on Wednesday evening that he expected the Food and Drug Administration would give final approval “quickly” for Covid-19 vaccines, as he pressed for skeptical Americans to get vaccinated and stop another surge of the pandemic.

Mr. Biden said he was not intervening in the decision of government scientists, but pointed toward a potential decision soon from the F.D.A. to give final approval for the vaccines, which are currently authorized for emergency use. Many medical professionals have pushed for the final approval, saying it could help increase uptake of the vaccines.

“My expectation talking to the group of scientists we put together, over 20 of them plus others in the field, is that sometime maybe in the beginning of the school year, at the end of August, beginning of September, October, they’ll get a final approval” for the vaccines at the F.D.A., Mr. Biden said.

The president also said he expected children under the age of 12, who are not currently eligible to receive the vaccine, would be approved to get it on an emergency basis “soon, I believe.”

The president’s comments at the town hall came as the spread of the Delta variant has led to a national rise in coronavirus cases. Over the past week, an average of roughly 41,300 cases has been reported each day across the country, an increase of 171 percent from two weeks ago. The number of new deaths reported is up by 42 percent, to an average of 249 deaths per day for the past week.

In some states, such as Missouri, Arkansas, Louisiana and Florida, new infections have increased sharply, also driving an increase in hospitalizations. Cases are increasing more rapidly in states where vaccination rates are low.

In Ohio, where Mr. Biden traveled on Wednesday to talk up what he pitched as the good-paying union jobs that his infrastructure plan would create, the president found him fielding questions from audience members concerned about low vaccination rates in their communities.

“This is simple, basic proposition,” he said. “If you’re vaccinated, you’re not going to be hospitalized. You’re not going to be in an I.C.U. unit. And you are not going to die.”

Later, Mr. Biden exaggerated the efficacy of the vaccine, even as some vaccinated staffers in the West Wing have recently tested positive for the coronavirus. “You’re not going to get Covid if you have these vaccinations,” he said.

In response to a move by Speaker Nancy Pelosi earlier Wednesday to bar two of former President Donald J. Trump’s most vociferous Republican defenders in Congress from joining a select committee to investigate the Jan. 6 riot at the Capitol, Mr. Biden was unequivocal about what happened that day.

“I don’t care if you think I’m Satan reincarnated, the fact is you can’t look at that television and say nothing happened on the 6th,” he said. “You can’t listen to people who say this was a peaceful march.”

But speaking in a red state that Mr. Trump won in the 2020 election, as he tries to build support for his infrastructure plans, Mr. Biden kept his criticism to some of the lawmakers elected to office, rather than Republican voters who got them there.

“I have faith in the American people, I do, to ultimately get to the right place,” he said. “Many times Republicans are in the right place.”

Jesus Jiménez contributed reporting.

Awaiting vaccination in Tegucigalpa, the capital of Honduras, on Tuesday. Honduras has vaccinated less than 1 percent of its people.
Credit…Gustavo Amador/EPA, via Shutterstock

Covid-19 cases are increasing in many Central American and Caribbean countries, officials from the World Health Organization warned on Wednesday as they called on richer nations to step up vaccine donations to a region where immunization rates remain perilously low.

The Americas have become “a region divided by vaccine access,” said Dr. Carissa Etienne, the director of the Pan American Health Organization, which is part of the W.H.O.

Countries with higher rates of vaccination, including Costa Rica, Uruguay and Chile, are seeing sharp drops in cases, while others are experiencing vastly different realities.

Only 15 percent of people across Central America and the Caribbean have been fully vaccinated against Covid-19, and in some countries, including Honduras and Haiti, the figure is less than 1 percent.

Several Caribbean nations are seeing a rise in cases, including Cuba, where infections and deaths have been soaring and which saw a recent outbreak of street protests against the government, the largest in decades.

“Cuba is currently seeing the highest number of confirmed cases of Covid-19” in the region, said Ciro Ugarte, the director of health emergencies at the Pan American Health Organization. In a population of less than 12 million, more than 43,000 new cases were reported for the current week, up 21 percent from the week before, and the authorities have confirmed that the highly contagious Delta variant is circulating in several provinces.

Other Caribbean nations are also reporting surges. Cases in Martinique, for example, have tripled over the past week, many involving “young people in their 20s,” Dr. Etienne said.

Most Central American countries are also seeing a sharp rise in coronavirus cases, with Guatemala reporting high rates of hospitalizations and neighboring Honduras seeing a spike in cases along its border. There are also hot spots in Amazonian states in Colombia and Peru.

“Covid-19 remains entrenched within our region, particularly in countries with low vaccination coverage, and the spread of variants only makes matters worse,” Dr. Etienne said.

There was a rare bit of good news out of Haiti, which has been engulfed in political unrest since the assassination of its president two weeks ago. Vaccinations against Covid-19 finally began there on Friday, two days after the country received 500,000 doses of the Moderna vaccine donated by the United States through the Covax vaccine-sharing mechanism.

“We clearly need more vaccines and we need them now,” Dr. Etienne said, adding that donations “are really the only way for many countries in our region to secure the doses that they need quickly.”

The U.S. government has vowed to donate around 12 million doses to Latin America and the Caribbean, and has already delivered some 4.5 million doses to Honduras, El Salvador, Bolivia and Haiti.

Officials also expect to receive doses from Spain and Canada, and are optimistic that others, including France, will join the donation effort.

“We want to commend all countries for sharing vaccines with our region, but the truth is, we need more,” Dr. Etienne said. “Please don’t wait until you have surplus doses. Vaccines are not a privilege for the few, they are the right of everybody.”

Boris Johnson's former adviser Dominic Cummings launched a new attack on the British prime minister in an interview with the BBC on Tuesday.
Credit…Pool photo by Jeff Overs

A former aide to Prime Minister Boris Johnson of Britain deepened his attacks on his former boss this week, saying that Mr. Johnson made dismissive comments about the pandemic’s toll on older people as cases rose in the country last year.

Dominic Cummings, once one of Mr. Johnson’s closest advisers, was fired as the two fell out last November and has since become something of a whistle blower. In parliamentary testimony this May, he accused Mr. Johnson of incompetence that had caused tens of thousands of extra Covid deaths.

On Tuesday, Mr. Cummings said in an interview with the BBC that Mr. Johnson expressed hesitancy about ordering a second shutdown last fall, saying that “the people who are dying are essentially all over 80.”

The BCC said Mr. Cummings provided a WhatsApp message from October 2020 in which Mr. Johnson said, “I no longer buy all this nhs overwhelmed stuff. Folks I think we may need to recalibrate.”

In the interview, Mr. Cummings said the prime minister’s attitude about the pandemic last fall “was a weird mix of, partly ‘It’s all nonsense and lockdowns don’t work anyway’ and partly ‘Well this is terrible but the people who are dying are essentially all over 80 and we can’t kill the economy just because of people dying over 80.’”

“He put his own political interests ahead of people’s lives, for sure,” Mr. Cummings said.

Mr. Johnson faced questions about Mr. Cummings’ comments on Wednesday from Keir Starmer, the leader of the Labour Party, who asked Mr. Johnson whether he would apologize.

The prime minister, addressing Parliament virtually while he is in quarantine after being exposed to someone who tested positive for coronavirus, sidestepped.

“These are incredibly tough, balancing decisions that you have to take,” Mr. Johnson said. “You have to balance the catastrophe of the disease against the suffering that is caused by lockdowns.” He then shifted to praising the U.K.’s rapid vaccine rollout and urging British residents to get vaccinated.

Mr. Starmer asked whether the virtual connection with prime minister was working properly, “Because the prime minister’s answers have no resemblance to the questions I’m actually asking him.” The question drew chuckles from members of Parliament.

Since the pandemic began, more than 5.5 million coronavirus cases have been recorded in the United Kingdom, including that of Mr. Johnson, who was hospitalized and required treatment in intensive care in April 2020. More than 128,000 British residents have died from the coronavirus.

Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, addresses a Senate committee hearing on Tuesday.
Credit…Stefani Reynolds for The New York Times

Trust in the U.S. federal health agencies responding to the coronavirus pandemic remains strong among a significant sector of the American public, according to a new survey from the Annenberg Public Policy Center at the University of Pennsylvania, but Americans place their deepest faith closer to home.

In a telephone poll of 1,719 adults, 76 percent reported being somewhat or very confident in the trustworthiness of information about Covid-19 from the Centers for Disease Control and Prevention, and 77 percent expressed the same confidence about the Food and Drug Administration. Both results, from a survey conducted from June 2 to 22, were largely unchanged from an April poll.

Respondents’ highest confidence, at 83 percent, was reserved for their primary health care provider. The poll had a margin of error of plus or minus 3.2 percentage points.

The agencies have been the targets of frequent criticism over their responses to the pandemic on an evolving variety of frequently politicized topics including testing guidelines, testing accessibility, vaccines, masks, school safety and more.

The survey also found that 68 percent of participants believed that Dr. Anthony S. Fauci, the nation’s foremost infectious disease specialist, provided trustworthy advice on the pandemic. Dr. Fauci has come under repeated attack from conservative media figures like Laura Ingraham and Tucker Carlson of Fox News.

In the survey, respondents who relied on conservative media were found to have a lower level of confidence in the health agencies and Dr. Fauci. Only 38 percent of consumers of what the survey called “very conservative media,” for instance, said they had confidence in Dr. Fauci, compared with 84 percent of consumers of “broadcast-newspaper mainstream” media.

The data comes as the U.S. vaccination rate stagnates and the country struggles with a rising number of cases, particularly in states with fewer vaccinated residents, while at the same time the highly infectious Delta variant is spreading.

The survey also found that confidence remained high in the safety and efficacy of vaccines, with 78 percent of respondents believing “definitely or probably” that they were effective in preventing Covid-19.

A child in Uttar Pradesh, India, whose parents died from Covid, now lives with her grandparents. She and her siblings are pandemic orphans. 
Credit…Rebecca Conway for The New York Times

An estimated 1.5 million children worldwide lost a mother, father or other caregiving relative in the first 14 months of the pandemic, according to a new study. More than a million lost primary caregivers.

“These unnamed children are the tragic overlooked consequence of the millions of pandemic dead,” the researchers wrote in the study, which was published in The Lancet medical journal on Tuesday.

Many more children will experience such losses as the virus rages in many countries, the researchers predict, and the bereaved are likely to be at risk for an array of further traumas that may include mental health problems, abuse, chronic diseases and poverty.

The estimates were developed using death statistics and other data for 21 countries that accounted for more than 76 percent of global Covid deaths up to April 30, 2021. The international research team was led by a member of the U.S. Centers for Disease Control and Prevention and included experts from international agencies, including the World Health Organization and Imperial College London.

The deaths of grandparents represent a powerful blow to many children. “In the U.S.A., 40 percent of grandparents living with grandchildren serve as their primary caregivers; in the U.K., 40 percent of grandparents provide regular care for grandchildren,” the researchers wrote.

In a separate online report linked to the study, the researchers warned that with the pandemic far from over and vaccinations yet to reach much of the global population, the deaths of caregivers were likely to keep mounting, with “severe consequences lasting at least through the age of 18 years for children affected.”

“The impact of these parental and caregiver deaths differs across families, communities and nations,” the researchers wrote. “Yet, there is one commonality: A child’s life often falls apart when he or she loses a parent or grandparent caregiver.”

The Department of Homeland Security announced that U.S. land borders with Canada will remain closed to nonessential travelers, as they have been since March 2020, when customs officers guarded the border between the United States and Ontario.
Credit…Lars Hagberg/Agence France-Presse — Getty Images

The United States will keep its land borders with Mexico and Canada closed for all nonessential travel for at least another month, the Department of Homeland Security said on Wednesday, extending the travel restrictions just days after Canadian officials announced they would soon reopen to U.S. travelers.

“To decrease the spread of Covid-19, including the Delta variant, the United States is extending restrictions on nonessential travel at our land and ferry crossings with Canada and Mexico through August 21,” a spokesman for the department said in an email. “D.H.S. is in constant contact with Canadian and Mexican counterparts to identify the conditions under which restrictions may be eased safely and sustainably.”

The United States closed land borders with its two neighbors in March 2020 to limit the spread of the coronavirus. D.H.S. has renewed the restrictions every month since, in coordination with Canadian and Mexican authorities.

On Monday, Canadian officials said that U.S. travelers could enter the country beginning on Aug. 9, if they have been fully inoculated with a vaccine approved by the Canadian government.

Jen Psaki, the White House press secretary, told reporters on Air Force One on Wednesday afternoon that “we rely on the guidance of our health and medical experts, not the actions of other countries” to determine border security policy.

Prime Minister Justin Trudeau of Canada affirmed at a news conference on Tuesday that individual countries decided their own border restrictions.

“Every country gets to set its own rules about how it will keep its citizens safe,” Mr. Trudeau said.

U.S. citizens can travel into Mexico for any reason — to buy cheaper goods of access cheaper health care, or because they live in Mexico and commute to the United States for work — but the border shutdown has meant many border businesses have lost customers and been forced to close.

On Wednesday, after the United States announced the extension of restrictions, Marcelo Ebrard, Mexico’s foreign minister, said that the rise in cases on both sides of the border and the surge of the Delta variant had “complicated” the border reopening.

Nonessential travel restrictions from Canada and Mexico do not apply to air, freight rail or sea, and traveling by land is still allowed for many reasons, including business, medical purposes and education. All international air travelers into the United States have to present a negative coronavirus test taken within three days of departure or proof of recovery from the virus within 90 days.

Canada made the decision to reopen its border based on its vaccination progress — more than three quarters of the country has received at least one dose of vaccine, according to governmental data, a far higher percentage than the United States, where a little more than 56 percent of the population has received at least one dose, according to the Centers for Disease Control and Prevention.

Residents within the United States and across its land borders have pressed for reopening, and more than 2,800 people have joined a private Facebook group organized by Let Us Reunite, an advocacy group.

One of the group’s members is Heather Kienle, a U.S. citizen who lives in Montreal. Crossing the border has not been a problem for Ms. Kienle, but her husband, a Canadian, cannot.

So Ms. Kienle, who is six months pregnant, often drives alone or with her 4-year-old daughter more than eight hours to West Babylon, N.Y., to care for her mother, who has endometrial cancer.

“It was just very stressful because I had to travel by myself, without my husband, and I had to take care of my daughter in the back seat,” Ms. Kienle said on Wednesday.

U.S. politicians from both parties have also objected to the restrictions.

Brian Higgins, a congressman who represents a district in Western New York that borders Canada, said in a statement on Wednesday that “today’s decision by the Biden administration harms economic recovery and hurts families all across America’s northern border; this is completely unnecessary.”

Also on Wednesday, President Biden nominated David L. Cohen, a lobbyist and senior adviser to the chief executive at Comcast Corporation, as ambassador to Canada. Mr. Biden has tried to demonstrate diversity in terms of the kinds of people he is appointing to high-profile postings abroad, but Mr. Cohen represents the old model of rewarding campaign donors with coveted posts abroad.

A Democratic fundraiser, Mr. Cohen hosted Mr. Biden’s first formal presidential event at his home in 2019 and helped him raise hundreds of thousands of dollars. Mr. Cohen was also the longtime chair of the board of trustees at the University of Pennsylvania, an institution that hired Mr. Biden for a lucrative university position after the Obama administration.

Annie Karni and Natalie Kitroeff contributed reporting.

Friends and family paid their respects to a man who died from Covid-19 at a funeral home in Elsa, Texas, last year.
Credit…Tamir Kalifa for The New York Times

CHICAGO — Life expectancy in the United States fell by a year and a half in 2020, largely because of the deadly coronavirus pandemic, a federal report said on Wednesday, a staggering drop that affected Hispanic and Black Americans more severely than white people.

It was the steepest decline in life expectancy in the United States since World War II.

From 2019 to 2020, Hispanic people experienced the greatest drop in life expectancy — three years — and Black Americans saw a decrease of 2.9 years. White Americans experienced the smallest decline, of 1.2 years.

The numbers can vary from year to year, providing only a snapshot in time of the general health of a population: If an American child was born today and lived an entire life under the conditions of 2020, that child would be expected to live 77.3 years, down from 78.8 in 2019.

Racial and ethnic disparities have persisted throughout the coronavirus pandemic, a reflection of many factors, including the differences in overall health and available health care between white, Hispanic and Black people in the United States. Black and Hispanic Americans were more likely to be employed in risky, public-facing jobs during the pandemic — bus drivers, restaurant cooks, sanitation workers — rather than working from home in relative safety on their laptops in white-collar jobs.

They also more commonly depend on public transportation, risking coronavirus exposure, or live in multigenerational homes and in tighter conditions that were more conducive to spreading the virus.

Dr. Mary T. Bassett, a former New York City health commissioner and professor of health and human rights at Harvard University, said that the numbers were devastating, but not surprising.

The coronavirus “uncovered the deep racial and ethnic inequities in access to health, and I don’t think that we’ve ever overcome them,” Dr. Bassett said. “To think that we’ll just bounce back from them seems a bit wishful thinking.”

The precipitous drop in 2020, caused largely by Covid-19, is not likely to be permanent. In 1918, the flu pandemic wiped 11.8 years from Americans’ life expectancy, and the number fully rebounded the following year.

But even if deaths from Covid-19 markedly decline in 2021, the economic and social effects will linger, especially among racial groups that were disproportionately affected, researchers have noted.

The deal marks the first time Pfizer’s Covid vaccine will be partly produced in Africa.
Credit…Brett Carlsen for The New York Times

Pfizer and BioNTech said on Wednesday that they have reached an agreement with a South African vaccine manufacturer, starting next year, to handle the final stages of manufacturing for doses of their Covid shot that will be supplied exclusively to African nations.

The deal represents the first time Pfizer’s Covid vaccine will be partly produced in Africa and it could eventually help increase supply to a continent where months of severe vaccine shortages have resulted in only about 1.5 percent of people being fully immunized.

But the agreement comes with caveats that will significantly limit its impact at a time when the fast-spreading Delta variant has driven a surge in infections and hospitalizations and sent the continent into the most devastating phase of its pandemic.

Crucially, the South African producer, Biovac, will only be handling distribution and “fill-finish” — the final phase of the manufacturing process, during which the vaccine is placed in vials and packaged for shipping. It will rely on Pfizer facilities in Europe to make the vaccine substance and ship it to its Cape Town facility.

Public health activists have called on Pfizer and other major vaccine manufacturers to transfer their technology to local producers in poorer parts of the world so as to ramp up production and alleviate shortages. Sharing recipes in this way can either be voluntary or forced.

Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University, called Wednesday’s agreement “deeply disappointing.”

“What we have seen from all of these licensing agreements that only are fill-finish and keep the full production capacity to high-income-country producers is that they continue to just perpetuate the inequalities in distribution,” Mr. Kavanagh said.

A company spokeswoman, Pamela Eisele, said that in trying to rapidly scale up Covid vaccine manufacturing, Pfizer is “primarily focusing on multiple existing sites, looking to external contract manufacturers to support the important fill-and-finish and distribution steps.”

Michelle Viljoen, a spokeswoman for Biovac, said that starting with fill-finish is “the quickest manufacturing step to making vaccines accessible.” Ms. Viljoen added: “We will continue to pursue our vision of drug substance manufacture. We view this initiative as a stepping stone towards the realization of that vision.”

Pfizer has pledged that it will supply two billion doses of its vaccine to low- and middle-income countries through various channels by the end of 2022, but so far, only a small fraction of those doses have been delivered.

Pfizer said that efforts would begin immediately to transfer technology and install the necessary equipment at Biovac’s facility. Pfizer said the plant would be able to fill-finish more than 100 million doses annually at full capacity, though it did not say when that would be reached. Those doses will be supplied only to the 55 member states that make up the African Union, the company said.

To people “who have expressed concern that Africa is being left behind in part due to lack of vaccine manufacturing, I want to say that we hear you,” Pfizer’s chief executive, Dr. Albert Bourla, said in prepared remarks to a meeting put on by the World Trade Organization on Wednesday.

But Mr. Kavanagh said he was worried that Pfizer would not send enough drug substance to Cape Town, especially if wealthy countries sought third booster shots for their populations. In that scenario, he said, “what likelihood is it that most of the drug substance is going to shift to Africa to do first vaccinations instead of doing boosters in high-income countries that pay more and have political power to demand it?”

Melbourne in Victoria, Australia, which extended its lockdown after the state case total passed 100.
Credit…Daniel Pockett/Getty Images

Thirteen million people in Australia — about half the country’s population — are under some form of lockdown as the country struggles to contain outbreaks of the Delta variant across three states.

The state of South Australia was placed under a seven-day lockdown on Tuesday after recording five coronavirus cases. The state of Victoria, which includes Melbourne, extended its lockdown for another week as its case total surpassed 100.

“With the vaccination rates the way they are, we won’t be able to live freely and safely unless we’re able to quash this current outbreak,” Gladys Berejiklian, the premier of New South Wales, said on Wednesday.

About 29 percent of Australia’s population has received at least one vaccine dose and 11 percent are fully vaccinated, according to a New York Times database.

New infections show no sign of slowing in Sydney, which is in New South Wales. The city, the country’s largest, is now in its fourth week of lockdown and has recorded over 1,000 cases. Sydney reported 110 new local cases on Wednesday, the third-highest daily total since its outbreak began.

With overall case numbers relatively small, Australia has used a strategy of swift local lockdowns to keep the virus under control since last year. But because of the high transmissibility of the Delta variant, and the country’s slow vaccination campaign, infectious disease experts are concerned that it might be impossible to completely stamp out outbreaks.

Prime Minister Scott Morrison said on Wednesday that the country had administered a million doses in the past seven days, the first time it had reached that weekly mark. If that rate continues, he added, all Australians who wanted a vaccine would be able to get one by the end of the year.

Relatives and friends gathering to bury some of those killed by Covid-19 in New Delhi in April.
Credit…Archana Thiyagarajan/Agence France-Presse — Getty Images

Facing a chorus of criticism over accusations of underreporting the Covid-19 death toll, India’s government sought to shift blame to the states, suggesting that local officials were not accurately registering deaths.

The government’s response came in a reply to questions raised by opposition leaders in the Parliament on Tuesday, as a new study found that the number of people who have died in the coronavirus pandemic in India so far is likely to exceed three million. That is nearly 10 times the official Covid-19 death toll, and would make it one of the worst human tragedies in the nation’s history.

“Many people here said that the government of India is hiding deaths. The government of India compiles the numbers sent by state governments and publishes it,” Prime Minister Narendra Modi’s new health minister, Mansukh Mandaviya, said in Parliament. “Our job is only to publish the data.”

The estimate of more than three million deaths was the result of a comprehensive examination by the Center for Global Development, a Washington research institute, which attempted to count excess deaths from all causes during the pandemic by looking at state data, international estimates, serological studies and household surveys.

During India’s devastating second wave of infections earlier this year, journalists from The New York Times and other news outlets interviewed staff members and families at cremation grounds across India and found an extensive pattern of deaths far exceeding the official figures.

Mr. Mandaviya said that allegations that the government was trying to minimize the toll of Covid were untrue.

“The government of India has not told anyone to report less numbers,” he said. “We have not asked of anyone to report less Covid patients. There is no reason for it.”

U Nyan Win in Yangon in 2015. He acted as a spokesman for Daw Aung San Suu Kyi’s National League for Democracy.
Credit…Nicolas Asfouri/Agence France-Presse — Getty Images

U Nyan Win, a spokesman for the governing party of Myanmar that was ousted by the military earlier this year, died on Tuesday of Covid-19 contracted in prison, his lawyer said.

The death of one of the most high-profile of thousands of political prisoners locked up since the February coup underscored the tragedy unfolding in Myanmar, where a failing health system has been utterly shattered by a junta determined to keep oxygen and other lifesaving care from those who oppose its rule.

In addition to acting as a spokesman for the former governing party, the National League for Democracy, Mr. Nyan Win, 79, served as a lawyer for Daw Aung San Suu Kyi, the onetime civilian leader of Myanmar. Both were imprisoned after the coup, along with the party’s entire senior leadership.

Mr. Nyan Win was charged with sedition and sent to Insein, Myanmar’s most notorious prison. On July 11, he was transferred to a hospital in Yangon, the largest city in Myanmar, the National League for Democracy said.

After earlier waves of the coronavirus crested in Myanmar last year, the Delta variant has washed over the country in recent weeks, devastating a country that was already reeling from the bloody aftermath of the coup. More than 900 people have been killed by the military since the putsch, according to a monitoring group. Among the dead are dozens of children.

The military has halted a nationwide vaccination campaign, reserving most doses for those who publicly support the coup. It has also hoarded oxygen for soldiers and their families, doctors say, making a private trade in oxygen akin to a criminal act. The enforced oxygen shortages have prematurely ended hundreds of lives, medical experts said.

Mr. Nyan Win is not the only senior politician to have contracted the coronavirus while in detention. U Phyo Min Thein, the former chief minister of the area surrounding Yangon, the largest city, is in critical condition because of the virus, according to the National League for Democracy, as is the former head of the party’s national vaccination effort.

Medical experts fear that the coronavirus is spreading fast in the country’s crowded prisons, just as it has among the general population. Myanmar borders India, where the highly transmissible Delta variant was first identified. Bodies are piling up at crematories in major cities, according to witnesses.

A health care worker administered a dose of the Pfizer vaccine to a medical office assistant at University Hospital in Newark, N.J., last year. Vaccination rates among hospital staff have stalled, prompting many to require immunization.
Credit…Kirsten Luce for The New York Times

More and more hospitals and major health systems are requiring employees to get the Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities and even within their work force. They range from academic medical centers like NewYork-Presbyterian and Yale New Haven to large chains like Trinity Health.

Watching cases rise prompted Trinity Health, a Catholic system with hospitals in 22 states, to become one of the first major groups to decide earlier this month that it would mandate inoculations. “We were convinced that the vaccine can save lives,” said Dr. Daniel Roth, Trinity’s chief clinical officer. “These are preventable deaths.”

A large Arizona-based chain, Banner Health, announced Tuesday that it would also impose a mandate, and New York City said it would require all health care workers at city-run hospitals or clinics to be vaccinated or undergo weekly testing.

Many hospitals say their efforts to immunize their employees have stalled. One recent estimate indicated that one in four hospital workers were not vaccinated by the end of May, with some facilities reporting that fewer than half of their employees had gotten the shots.

At UF Health Jacksonville, in Florida, the number of Covid patients being treated has surged to levels not seen since January, and only half of its health care workers are vaccinated, said Chad Neilsen, the director of infection prevention. Seventy-five employees were out sick with the virus, the vast majority of whom were unvaccinated, while more await test results. “We are absolutely struggling for staffing right now,” he said.

Some employees want more data, while others say the process has been too rushed. Many of the same conspiracy theories and misinformation — that the vaccines will make women infertile or contain microchips — hold sway among staff members. “Our health care workers are a reflection of the general population,” he said.

With formal approval of the vaccines by the Food and Drug Administration potentially months away, hospitals find themselves at the center of the national debate over whether to impose mandates. While the vaccines are being offered under emergency use authorization, supporters argue there is ample evidence that the ones available in the United States are both safe and effective.

In states like Missouri, which has reported a sharp increase in cases, there is newfound urgency. “We felt we could not wait,” said Dr. Shephali Wulff, the director of infectious diseases for SSM Health, a Catholic hospital system whose headquarters are in St. Louis. SSM, where about two-thirds of employees are now vaccinated, is requiring everyone to get their first dose by Sept. 1.

Nippon Budokan in Chiyoda ward in Tokyo on Sunday.
Credit…Hiroko Masuike/The New York Times

The discovery of isolated cases, even in vaccinated athletes at the Olympics in Tokyo, is entirely expected, scientists say, and not necessarily a cause for alarm.

“This isn’t really that much of a surprise,” said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan.

Still, these cases do raise thorny questions about how to design testing programs — and respond to test results — at this phase of the pandemic, in which the patchy rollout of vaccines means that some people and communities are well protected from the virus while others remain at risk.

As Dr. Rasmussen put it: “When does a positive test really indicate that there’s a problem?”

Covid-19 tests, which were once profoundly limited, are now widely available in most of the developed world, making it possible for organizations — including private employers, schools, professional sports leagues and the Olympics organizers — to routinely screen people for the virus.

Vaccination is not required for Olympic participants, and officials are relying heavily on testing to keep the virus at bay in Tokyo. Those headed to the Games must submit two negative tests taken on separate days within 96 hours of leaving for Japan regardless of vaccination status, according to the Olympic playbooks, or manuals.

At least one of the two tests must be taken within 72 hours of departure. Participants are again tested upon arrival at the airport.

Athletes, coaches and officials are also required to take daily antigen tests, which are less sensitive than P.C.R. tests but are generally quicker and cheaper. (Olympic staff and volunteers may be tested less frequently, depending on their level of interaction with athletes and officials.) If a test comes back unclear or positive, a P.C.R. test is administered.

“Each layer of filtering is a reduction in the risk for everybody else,” Brian McCloskey, the chair of the Independent Expert Panel of the International Olympic Committee, told reporters this week, adding that the number of confirmed infections so far are “lower than we expected.”

Questions about transmission remain unsettled. Vaccinated people with asymptomatic or breakthrough infections may still be able to pass the virus on to others, but it is not yet clear how often that happens. Until that science is more definitive, or until vaccination rates rise, it is best to err on the side of safety and regular testing, many experts said.

But when you look that hard for infections — especially in a group of people who have recently flown in from all over the globe and have had varying levels of access to vaccines — you’re all but destined to find some.

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