New York welcomes back students on Monday, as national trends offer signs of hope.

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New York welcomes back students on Monday, as national trends offer signs of hope.

Daily Covid Briefing

Sept. 12, 2021Updated 

Sept. 14, 2021, 12:48 a.m. ET

Sept. 14, 2021, 12:48 a.m. ETCredit…Michael Loccisano/Getty Images

As New York City’s public schools prepare to welcome roughly one million students Monday, many returning for the first time in 18 months, the experiences of school districts that have already reopened amid the spread of the highly infectious Delta variant provide hints of what to expect.

Some have experienced outbreaks and had to go back to remote learning or quarantines. Others are experimenting with novel measures to try to control spread of the virus. Schools in areas with high vaccination rates have tended to fare relatively well — a hopeful sign for New York City, where 70 percent of the eligible population has been fully vaccinated, though rates vary widely by neighborhood.

In contrast, in Mississippi, which has one of the lowest vaccination rates in the country, there were 69 outbreaks at schools in the first few weeks of classes. In one school district in Arkansas, where vaccinations are also lagging, more than 800 students and staff were quarantined just days after reopening.

In Kentucky, where 58 percent of the eligible population has been fully vaccinated, at least 31 school districts have had temporary closures, some without measures in place for remote classes. Arizona’s Maricopa County, where 55 percent of the eligible population is fully vaccinated, had 40 school outbreaks in its first few weeks.

Nationwide, schools invested heavily in plexiglass barriers to prevent the spread of the virus, but these have not proven to be effective, and may actually increase the spread because they prevent the air from circulating.

Portland, Maine, was one of several school districts that last year began moving many of its classes to outdoor spaces — a step New York City took a century ago, in response to epidemics of the Spanish flu and tuberculosis.

The Centers for Disease Control and Prevention has urged schools to reopen, citing the benefits for children of learning in person. And this summer, as the Delta variant spread, Mayor Bill de Blasio of New York remained steadfast in calling for in-person learning, without the option of remote classes, even as some parents and teachers pushed back.

New York City schools have relatively strong protocols for preventing spread of the virus, including vaccine mandates for all adults who work in the buildings. Children under 12 are not generally eligible for the vaccine, though some parents have found ways to get their children vaccinated.

All students, teachers and staff will have to wear masks during the school day, regardless of vaccination status.

The city also has aggressive guidelines for quarantining in the event of possible exposures, and it plans to test 10 percent of unvaccinated students and staff every other week.

Robin Lake, the director of the Center on Reinventing Public Education, a research and advocacy group that monitors school reopenings, said she had been disappointed by the lack of innovation nationwide in school responses to the virus, especially in comparison with last year, when many schools basically reinvented the way they taught.

And she warned that New York families may not be ready to send their children to in-person classes. “We’ve seen parents in some places, like Chicago, just keep their kids home,” she said. “That’s something New York has to be prepared for.”

Read moreThe surgeon general, Dr. Vivek Murthy, during a television interview outside the White House on Wednesday.Credit…Stefani Reynolds for The New York Times

Dr. Vivek Murthy, the surgeon general, made the rounds on Sunday television shows to defend the Biden administration’s new Covid vaccine mandates, portraying them as narrow directives that apply only to specific professions where the federal government “has legal authority to act” — a direct counter to Republican accusations of unconstitutional federal overreach.

Dr. Murthy called the plan “ambitious and thoughtful” on the ABC program “This Week,” saying, “These kinds of requirements actually work to improve our vaccination rates.” He said they were part of “a serious of steps that have to be taken in order to protect our country from Covid-19, and help us get through this pandemic.”

He cited Tyson Foods, one of the nation’s top meat processors. In August, it said it would require Covid vaccinations for its employees. The surgeon general said the company’s vaccination rate had shot up “from 45 percent to more than 70 percent in a very short period of time. And they’re not even at their deadline yet.”

The mandates — for either vaccination or weekly testing — cover 17 million health care workers in institutions that get Medicare and Medicaid funds, as well as roughly 80 million employees in private companies with more than 100 workers.

Asked about the administration’s novel use of the Occupational Safety and Health Administration’s powers over private workplaces to put the mandates in place, Dr. Murthy said the administration believed it was “appropriate” and “legal.”

O.S.H.A.’s foundational legislation, he said, gives the agency a responsibility “to ensure that the workplace is safe for workers, and that’s what this measure does.”

Republican governors in several states have pledged to file suit to prevent the rules from taking effect, opposition that reflects anger and fear Covid vaccines have stirred among a significant portion of G.O.P. voters.

Asked if the new mandates would harden calls for civil disobedience and opposition to Covid vaccinations, Dr. Murthy said it was entirely understandable that people were fatigued by the waves of viral illness and that some had lost patience with safety precautions.

But he pointed to the commemoration of the 20th anniversary of the Sept. 11 attacks a day earlier as a model for of how the nation could unify around crisis.

“This has been a long, difficult pandemic — I know it has generated a lot of anger and a lot of fatigue, a lot of impatience,” he said.

“But what we cannot allow,” he added, “is for this pandemic to turn us on each other. Our enemy is the virus. It is not one another.”

On CNN’s “State of the Union,” Dr. Murthy acknowledged that people would seek to sidestep the mandates with religious exemptions or other means, but noted that the nation had learned over the decades how to, for instance, enforce childhood vaccinations as a requirement for school attendance.

“We have experience in dealing with exemptions,” he said, “but have to be vigilant there and make sure people are using them in the spirit that they’re intended and not, as you know, abusing them or asking for exemptions when they don’t apply.”

Read moreA pharmacist puts a syringe into a vial of the Janssen Johnson & Johnson vaccine at Altru Chemists pharmacy in Brooklyn.Credit…Bess Adler for The New York Times

Covid-19 vaccines for children ages 5 to 11 could be available as soon as the end of October, two experts said on Sunday. Some senior officials of the Biden administration have said clearance for that age group was unlikely before the end of 2021.

At the moment, only children ages 12 and older qualify for vaccination. An earlier clearance for younger children would be good news for parents, many of whom are anxious about classroom safety as schools reopen.

The Food and Drug Administration recently warned parents against trying to get younger children vaccinated before an official recommendation, saying there are unanswered questions about dosing and immunity in this age group.

Getting the green light for younger children will require careful and expeditious review of the clinical data, Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration who sits on the board of Pfizer, one of the vaccine makers, said on the CBS program “Face the Nation.”

Still, “in a best-case scenario,” the Pfizer vaccine could be ready by Halloween, or Oct. 31, for younger children. “I have confidence in Pfizer in terms of the data that they’ve collected,” Dr. Gottlieb said.

The hope of fall clearance comes after two of the nation’s top public health officials — Dr. Francis S. Collins, the director of the National Institutes of Health, and Dr. Anthony Fauci, the administration’s chief pandemic adviser — backed away from that goal last month, instead seeing the step as more likely in the winter.

On “Face the Nation,” Dr. James Versalovic, the interim pediatrician in chief at Texas Children’s Hospital, said he agreed with Dr. Gottlieb on the feasibility of an October sign-off. “We’re doing everything we can now to move these trials ahead,” he said.

Both Pfizer and Moderna are gathering data on the safety, correct dose and effectiveness of the Covid vaccines in children. Compared with adults, children diagnosed with Covid are more likely to have mild symptoms or none at all. Children are also far less likely to develop severe illness, be hospitalized or die from the disease.

But hospitalizations of children are rising as the more contagious Delta variant spreads. Dr. Versalovic said that he and his colleagues are “seeing record numbers” of infected children, as are physicians nationally.

“We continue to be on a high plateau” and may yet hit “another peak,” he said.

Read more“Somebody shouldn’t have to make the choice between keeping their job and getting a jab in the arm,” said Gov. Pete Ricketts, of Nebraska.Credit…Kenneth Ferriera/Lincoln Journal Star, via Associated Press

Republicans officials on Sunday made further threats of legal action against President Biden’s sweeping plan to get tens of millions of American workers vaccinated, with even those who openly urge that people get shots claiming that the mandate violated civil liberties.

Gov. Pete Ricketts of Nebraska said he would do everything in his power to push back against Mr. Biden’s plan, which requires either vaccinations or weekly testing for workers at private companies if they have more than 100 employees.

“We have been encouraging people to get vaccinated; we’ve been providing information and encouraging people to reach out to their neighbors,” Mr. Ricketts said on “Fox News Sunday.”

“But it should be a personal health care choice. This is not something that the government should mandate. And somebody shouldn’t have to make the choice between keeping their job and getting a jab in the arm.”

About 63 percent of Nebraska’s eligible population has been fully vaccinated, a level equal to the national average.

Mr. Ricketts blamed vaccine hesitancy partly on what he described as confused and changing guidance from the Centers for Disease Control and Prevention. “By having the government force it on, you’re not building the trust. This is a process that’s going to take time to bring people along, and that’s why it should be a personal choice.”

Gov. Asa Hutchinson of Arkansas, who has encouraged vaccinations and even sought to have the state legislature ease a bill banning mask mandates that he signed in April, said Mr. Biden’s plan “disrupts and divides the country.”

“We’ve historically had vaccination requirements in schools, but those have always come at the state level — never at the national level,” he said on the NBC program “Meet the Press.”

Mr. Hutchinson argued the widespread vaccination increases could be achieved by measures like increasing community engagement and sending trusted messengers to talk to people about the inoculations. Arkansas has one of the country’s lowest vaccination rates; about 39 percent of the eligible population have not received even a single shot.

Some public health experts argued that the Biden plan could potentially do more harm than good. “I think that the downside of this mandate — in terms of hardening positions, and taking something that was subtly political and making it overtly political — could outweigh any of the benefits we hope to achieve,” Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration, said on the CBS’s “Face the Nation.”

Dr. Gottlieb pointed to the nation’s current vaccination rate for adult Americans, arguing that, even with other childhood immunizations, which are mandated, “we are not going to get above 90 percent.” About 74 percent of eligible Americans have received one dose or more, according to federal data.

And he said the federal mandate could deter companies from requiring the vaccine while they await the verdict on the promised legal challenges.

“In the near term, a lot of businesses that might have mandated vaccines are now going to sit on their hands and say, ‘I’m going to wait for OSHA to tell me just how to do it and give me more political cover,’” Dr. Gottlieb said. “So in the near term, it could actually discourage some vaccination.”

Read moreSoccer fans showed their Covid vaccination cards to a security officer at a soccer match in London on Sunday. While Britain has scrapped any immediate plans for vaccine passports, venues may still require proof of vaccination. Credit…Andrew Boyers/Action Images Via Reuters

After months of cries of tyranny and discrimination raised by speculation that Britain would require vaccine passports for entry into crowded venues like stores and nightclubs, the authorities said on Sunday any such plans had been scrapped, at least for the moment.

Sajid Javid, Britain’s health secretary, said the passports — essentially, documentation proving vaccination against Covid-19 — were still “a potential option” for the future. “It should be looked at in combination with other measures,” he told the BBC on Sunday.

Prime Minister Boris Johnson is expected to discuss the decision to scrap the passport idea on Tuesday, and a government statement said he would also address the likelihood that Covid booster shots would be rolled out soon and warn of the “renewed challenges” to come this winter as the flu season threatens to increase the strain on the country’s health care system.

After new cases plateaued this spring, the British authorities lifted its most recent lockdown restrictions in July. But the country is now grappling with a late summer surge, fueled by the Delta variant, and the seven-day average of new cases hit more than 36,000 on Saturday, a level not seen since after Christmas, according to data from the British government. Two-thirds of the country is fully vaccinated.

British lawmakers began suggesting in the spring that the government might require the passports, drawing fire from critics who said that the move would risk widening already dangerous social gaps between those who can access the vaccine and those who cannot.

Around the world, the idea of establishing passports — also referred to as health passes or digital health certificates — has been under discussion as a tool to allow economies to restart and to allow hundreds of millions of vaccinated people to return to a degree of normalcy. Some versions might permit bearers to travel internationally, or allow entry to vaccinated-only spaces like gyms, concert venues and restaurants.

But the mainstreaming of such credentials could also usher in an era of increased digital surveillance, privacy experts say, noting that they could enable location tracking and that there are few rules on how people’s digital vaccine data should be stored or shared.

The Biden administration has made clear that it will neither issue nor require the passports. In France, thousands have taken to the streets to protest the government’s new health pass law, which bars those without proof of vaccination or a recent negative test from many indoor venues. The Scottish Parliament voted last week to introduce a vaccine passport system as of Oct. 1. Italians have largely embraced the so-called green pass, which was put in place in early August.

Read moreMotorcycle enthusiasts at Sturgis, S.D., Motorcycle Rally on August 8, 2021.Credit…Scott Olson/Getty Images

Daily reports of new coronavirus cases grew tenfold in South Dakota in August, with the worst outbreaks concentrated in the western part of the state. Hospitalizations have increased swiftly in the last few weeks. National Guard soldiers were dispatched to aid with testing.

The increase came during and after the state’s annual Sturgis Motorcycle Rally, which drew more than 550,000 people from all over the country to South Dakota — even more than last year’s, which forged ahead while most large events were canceled. This year’s happened during a broad spread of the Delta variant that drove a spike in all 50 states.

Uncertain, experts said, was the role the rally may have had in spreading the virus in South Dakota. And unanswered was a larger question: How safe are major gatherings held at least partly outdoors — events like Sturgis, Lollapalooza and college football games.

Cases in Meade County, which includes Sturgis, began to rise in mid-August, just as the motorcycle rally was winding down. By the end of August, more than 30 county residents were testing positive most days, up from about one a day before the rally. Case levels have since started to decline.

But the vast majority of people at the rally came from elsewhere and, if they became infected, would be counted in the data in their home states.

As the Delta variant spreads widely, and as Americans yearn to go back to normal, health experts have debated the public health risks of large outdoor events and music festivals.

Outdoor events are far safer than those held in indoor, poorly ventilated spaces. But even gatherings where the main event is outside can include indoor opportunities for Covid to spread.

Dr. Ashish Jha, the dean of Brown University’s School of Public Health, said it may be too early to link the Delta variant surge that’s overwhelming hospitals and increasing case level to large outdoor events, including the rally in Sturgis.

“I haven’t seen any data so far that says outdoor gatherings themselves are pretty risky,” said Dr. Jha. “And what I’ve said about Sturgis is, I don’t think it was the rally itself, I think it was all the bars and restaurants and all the stuff and night and evenings and all the indoor stuff.”

Dr. Shankar Kurra, the vice president for medical affairs at Monument Health, which is headquartered in Rapid City, S.D., said last month that the number of coronavirus cases in the area was much higher at this time than they were following last year’s rally.

“It’s hard not to say these cases didn’t come from the rally,” Dr. Kurra. “The cases had to come from somewhere and we know these cases did not come from here.”

Local officials in Sturgis have pushed back against the scrutiny of the event, saying the rally has received unequal criticism compared to other large gatherings across the country.

“As the data illustrates, South Dakota’s current infection rate is mirroring the entire upper Midwest region,” said Dan Ainslie, the Sturgis city manager. “There was some spread of Covid from the rally, though the national media fixation on it is without merit given the fact that our experience is so similar to our neighbors.”

Read moreIsraeli travelers last year at Ben Gurion Airport, near Tel Aviv, returning from an annual pilgrimage to the grave in Ukraine of a revered rabbi.Credit…Menahem Kahana/Agence France-Presse — Getty Images

JERUSALEM — More than 150 Israelis suspected of using fake negative coronavirus test results to board flights home after a pilgrimage to Uman, Ukraine, have been summoned for questioning by the Israeli police in accordance with a strict, new government directive.

Offenders could be charged with fraud, forgery and spreading disease in aggravated circumstances, the Ministry of Public Security warned in a statement this weekend — criminal offenses that can lead to prison sentences of up to five years.

About 25,000 to 30,000 Israelis, most of them male Hasidic Jews, traveled to Uman to celebrate the Jewish New Year last week with a visit to the burial site of a revered 18th-century rabbi, Nachman of Breslav. Israel’s Health Ministry reported late last week that dozens of them had arrived back in Israel infected with the virus despite carrying documents indicating that they had tested negative.

Prime Minister Naftali Bennett’s office said in a statement that it “views with utmost gravity” the entry of people with forged documents, “willfully spreading a disease,” adding that severe action would be taken against offenders.

Israel is one of the world’s most vaccinated countries, but its coronavirus caseload recently spiked to a pandemic high, according to the Our World in Data Project at Oxford University. Cases have dropped sharply over the past 10 days, which officials attribute to their rollout of booster shots to about a third of the population of nine million. Still, deaths have risen to about 42 percent of the country’s highest toll, which was reached in late January.

Dr. Sharon Alroy-Preis, a senior official in Israel’s Ministry of Health, told public radio that there were at least 1,500 verified cases among the more than 17,000 pilgrims who returned to from Ukraine on Thursday and Friday. The Ministry of Public Security said on Sunday that at least 154 of the recent arrivals had been summoned by the police for questioning after the end of their 10-day period of home quarantine.

Magen David Adom, Israel’s ambulance service, had set up two sites in Ukraine in cooperation with the Ukrainian Red Cross to offer rapid molecular tests for the returnees, one at the airport in the capital, Kyiv, and one near the rabbi’s tomb in Uman,. Negative results would allow them to board flights home.

The problem, Dr. Alroy-Preis said, was that some who tested positive at the sites “hid” their results, and acquired fraudulent negative PCR test results elsewhere. Some of those travelers, she said, canceled their direct flights back to Israel, aware that Magen David Adom would have passed their names on to the airlines. Instead, they arrived in Israel via connecting flights.

But the names of all those who had tested positive at the two sites in Ukraine were also known to Israel’s immigration authorities, enabling those travelers to be identified on arrival. Israel in any case does not rely on tests carried out abroad and anybody landing in Israel is tested before leaving the airport.

Read moreA community vaccination event in Martinsburg, W.Va., in February. The state had success in the early vaccine rollout, but as demand slowed it has recently seen its reported case numbers near record levels.Credit…Kevin Lamarque/Reuters

Coronavirus cases are nearing record levels in West Virginia, and the state’s schools are closing and its hospitals are choked with patients stricken by the perniciously infectious Delta variant.

Just seven months ago, as the Covid vaccine was still being rolled out, the state was a national leader. By late June the state’s governor, Jim Justice, a Republican, had removed a statewide mask requirement.

But West Virginia has since fallen far behind, and its pandemic status has deteriorated, a situation shared with other states with large unvaccinated populations. Just under 48 percent of West Virginia’s 18 and over population is fully vaccinated, the lowest of any state, according to federal data compiled by The New York Times.

President Biden tried to push the roughly 80 million eligible but unvaccinated people in the United States to be inoculated when he announced on Thursday a sweeping plan that included vaccine requirements he said would cover some 100 million American workers.

Federally cleared vaccines greatly decrease the risk of hospitalization and death, even from the Delta variant, according to three studies released by the Centers for Disease Control and Prevention on Friday.

Governor Justice has been more outspoken about vaccinations than many other Republican governors.

“We can stop this, West Virginia, we can stop it,” Mr. Justice said at a news conference on Friday. “The vaccines are safe. The vaccines are not an invasion on anyone.”

Even though Mr. Justice regularly beseeches his constituents to get a shot, vaccine mandates are “something that I absolutely do not believe in,” he said. Mr. Justice also suggested that Mr. Biden’s announcement of new vaccine mandates was a ploy to try to distract the public from the chaotic withdrawal from Afghanistan and the crush of migrants at the southern border.

The latest surge has enveloped West Virginia with a ferocity the virus had not shown before there, said the official running the state’s coronavirus response, Dr. Clay Marsh.

“The rapid rate of growth and the level of severity of illness has really been much greater than we’ve ever seen before,” Dr. Marsh said.

West Virginia’s seven-day average of new reported cases has neared record levels for all of September, hovering above 1,500 per day for most of the past week, according to data compiled by The New York Times. The state recently surpassed a total of 200,000 cases, more than four times the population of Charleston, the capital and largest city.

Hospitalizations are nearing the state’s pandemic high, pushing its understaffed health centers to near capacity, and record numbers of Covid patients are being treated in intensive care units. Dr. Marsh said the state was reducing the number of elective procedures and taking steps to ensure that hospitals were adequately staffed.

And while deaths are averaging just 12 a day, that is more than 41 percent of the state’s peak average for the pandemic, reached in January.

Last January, when the state faced the worst conditions it had seen up to that point, West Virginia’s vaccine rollout was the envy of other states. But demand for the vaccine fell off, as it did in much of the country. Since then Mr. Justice has turned to a number of incentive programs, including $100 savings bonds for young people and a vaccine sweepstakes in which West Virginians can win cash, a scholarship, a sports car or a pontoon boat.

Maj. Gen. Jim Hoyer, a retired National Guard officer who leads the interagency task force that coordinates West Virginia’s vaccination efforts, said multiple approaches were necessary.

“Somebody said, ‘What’s the one thing that worked?’” Major General Hoyer said. “And there wasn’t one thing that worked. There was a whole series of things.”

The recent surge spurred more vaccinations, Major General Hoyer said, but the pace has slowed somewhat in recent days. Surveys showed that less than 20 percent of the people in the state were adamantly opposed to vaccination, he said, and direct outreach from health care providers was one important way to reach people who were hesitant.

Mr. Justice said that even with more West Virginians vaccinated there was no guarantee that the current surge was near its peak.

“Maybe we won’t peak until Halloween or Thanksgiving, and in all of that how many more are going to die, and die a horrible death, a death where you can’t breathe?” he asked.

Sarah Cahalan and Mitch Smith contributed reporting.

Read moreWahid Majrooh, the Minister of Public Health, toured a covid ward in the Afghan Japan Hospital, the main Covid-19 hospital in Afghanistan, in Kabul, Afghanistan on Wednesday.Credit…Victor J. Blue for The New York Times

A fourth wave of the pandemic is looming in Afghanistan — just as the nation’s health care system teeters on the verge of collapse.

The country’s health care has been propped up by aid from international donors. But after the Taliban seized power, the World Bank and other organizations froze $600 million in health care aid.

The Biden administration, too, is struggling with how to dispense donor money to a country now being run by several senior Taliban leaders whom the United States has designated to be terrorists.

If World Bank funding is not restored quickly, an exodus of health care workers may result. Many have remained on the job despite significant personal risks; already some have not been paid for months. Along with the loss of supplies, the cutoff would effectively end health care services in 31 of the nation’s 34 provinces, humanitarian groups say.

Assuming that health care coverage is cut by half because of the funding loss, deaths among women and children will increase by at least 33 percent over the next year — nearly 2,000 women and more than 26,000 children per year — according to one analysis.

“We are losing personnel, we are losing lives, and the morale and momentum we had,” said Dr. Wahid Majrooh, who was health minister under the previous government and has stayed on. “The crisis is very, very extensive.”

Afghanistan emerged from a third wave of virus infections just a few weeks ago, but it is already seeing a small uptick in cases, this time of the highly contagious Delta variant. Only 5 percent of the population have received at least one dose of a Covid-19 vaccine.

“It’s terrible timing that this would happen, when right now we’re faced with a situation where humanitarian needs are escalating,” said Dr. Richard Brennan, the regional emergency director for the World Health Organization’s Eastern Mediterranean region.

Read moreCrisann Holmes of Indiana has applied for a religious exemption to her employer’s vaccine mandate.Credit…Kaiti Sullivan for The New York Times

Major religious traditions, denominations and institutions are essentially unanimous in their support of the vaccines against Covid-19. But as more employers across the United States begin requiring Covid vaccinations for workers, they are butting up against the nation’s sizable population of vaccine holdouts who see their resistance in religious terms.

The conflict was picking up steam even before President Biden announced sweeping new workplace vaccine mandates last week.

Interest in religious exemptions is clearly rising. Mat Staver, the founder and chair of Liberty Counsel, a conservative Christian legal organization, said his group had received more than 20,000 queries on religious exemptions in recent weeks.

Exemption requests are testing the boundaries of the federal Civil Rights Act of 1964, which requires employers to provide reasonable accommodations for employees who object to work requirements based on religious beliefs that are “sincerely held.”

The Equal Employment Opportunity Commission has specified that religious objections do not have to be recognized by an organized religion and can be beliefs that are new, uncommon or “seem illogical or unreasonable to others.” They cannot, however, be based only on social or political beliefs.

For many skeptics, resistance tends to be based not on formal teachings from an established faith leader, but an ad hoc blend of online conspiracies and misinformation, conservative media and conversations with like-minded friends and family members.

“People who have already made up their minds are now looking for ways to continue to exempt themselves from the Covid vaccine,” said Joshua Williams, a pediatrician and assistant professor of pediatrics at the University of Colorado.

Crisann Holmes of Indiana is seeking a religious exemption to her employer’s vaccine mandate.

A few weeks after she submitted her exemption request, her employer requested more information, sending her a form for a religious leader to fill out to back up her account of her beliefs. “Religion doesn’t require a leader,” she said. But a pastor at her church, EUM Church in Greenville, Ohio, agreed to fill out the form.

Read moreAlaska State Senator Lora Reinbold on the floor of the Alaska Senate in April.Credit…Pool photo by Becky Bohrer

An Alaska lawmaker has asked to be excused from legislative sessions until next year, saying she has no way to fly to the state capital after she was barred from Alaska Airlines for violating mask policies.

The lawmaker, Lora Reinbold, a Republican state senator, was captured on video in April arguing with employees at Juneau International Airport about mask rules.

After the confrontation, Alaska Airlines said it had notified Ms. Reinbold that she was “not permitted to fly with us for her continued refusal to comply with employee instruction regarding the current mask policy.”

Ms. Reinbold had previously complained about Alaska Airlines on Facebook, saying it was “part of mask tyranny.”

She had also been scolded by Alaska’s governor, Mike Dunleavy, a Republican, who accused her of spreading misinformation about the state’s response to the coronavirus pandemic and of having “abdicated the tenets of your oath as a public servant.”

Speaking on the floor of the Alaska State Senate on Thursday, Ms. Reinbold asked that she be excused from Senate business from Sept. 11 through Jan. 15 “because there’s no airline other than Alaska Airlines that flies into Juneau during that period that I’m aware of.”

“The political ban is still in place as long as Biden’s illegitimate mask mandate is in place on private and public transportation,” she told her colleagues.

The Republican-led Senate accepted her request without objection and indicated that she would be shown as “excused on those dates.”

Ms. Reinbold represents Eagle River, Alaska. If she cannot fly, a trip from her district to Juneau, the state capital, could require her to travel more than 19 hours by car and ferry, and to cross over the Canadian border.

Alaska Airlines said on Saturday that Ms. Reinbold had been told on April 24 that she was not permitted to fly on the airline.

“Since then, a review did happen and the suspension was upheld,” the airline said in a statement. It added that the suspension would remain in effect “while the federal mask policy is in place.”

Referring to a previous statement from April, Alaska Airlines said: “Federal law requires all guests to wear a mask over their nose and mouth at all times during travel, including throughout the flight, during boarding and deplaning, and while traveling through an airport.”

On Thursday, Ms. Reinbold defended her request to be excused from Senate business.

“To be excused does NOT mean you will not be here, it means the legislative process cannot be inhibited if you are not there,” she wrote on Facebook.

If the only major airline offering flights to Juneau “can unconstitutionally impede a legislators ability to get to the Capital in a safe and timely fashion,” she added, “it could undermine our representative republic.”

Last month, the Transportation Security Administration announced that it was extending the requirement that travelers in the United States wear masks at airports, on airplanes, and on commuter buses and trains through Jan. 18.

Mask mandates have become a major flash point on airplanes, contributing to a surge in unruly and sometimes violent behavior from passengers who refuse to comply.

The T.S.A. first announced in February that everyone — except children under 2 and people with some disabilities — would be required to wear masks on airplanes and in airports in the United States. The agency has received more than 4,000 reports of mask-related incidents since then.

On Thursday, President Biden announced that the agency would double fines for travelers who refused to wear masks in airports and on commercial airplanes. The minimum penalty for first-time offenders was raised to $500. Second-time mask refusers may be fined as much as $3,000.

“If you break the rules, be prepared to pay — and by the way, show some respect,” Mr. Biden said.

In the video that was posted on Twitter in April, Ms. Reinbold is seen at the airport in Juneau, wearing a mask but arguing with employees about it.

“We need you to pull the mask up, or I’m not going to let you on the flight,” an employee tells Ms. Reinbold.

“It is up,” Ms. Reinbold responds.

“It is not,” the employee says. “It’s down below your nose. We can’t have it down.”

It was not clear if Ms. Reinbold had been permitted on the flight. One of the videos shows her leaving the boarding area.

In March, Ms. Reinbold said on Facebook that she had been asked to leave a committee hearing because she was not wearing an approved face shield. After that, Ms. Reinbold was barred from the State Capitol until she complied with health and safety protocols. She later returned to the Capitol in a clear face mask.

“My actions are to protect my constitutional rights, including civil liberties and those who I represent, even under immense pressure and public scrutiny,” Ms. Reinbold wrote in March.

She did not immediately respond to requests for comment on Saturday.

Read moreJordan Strait, 17, receives a Covid-19 vaccine during a free vaccination clinic held by San Antonio’s Metropolitan Health District on Saturday.Credit…Matthew Busch for The New York Times

Earlier this year, as Covid-19 vaccines became more widely available, some women and girls went on social media to describe changes in their menstrual cycles after receiving the shots, including irregular cycles, painful periods and heavy bleeding.

Some postmenopausal women shared stories about getting their periods for the first time in years. Many wondered whether the vaccines might be the reason.

Now researchers at five institutions, backed by funding from the National Institutes of Health, will be conducting yearlong studies to examine any possible connections between vaccination and irregular menstruation, and to help allay concerns that might prevent women from getting their shots.

The evidence around abnormal periods is so far purely anecdotal. There is no known link between vaccination and changes in menstruation, and public health experts reiterate that vaccines are safe, effective and necessary to end the pandemic.

But the stories underpin a persistent data gap about reproductive health and women’s menstrual cycles that is not collected during clinical trials, including during trials of the Covid vaccines. There have also been no scientific studies published examining a potential relationship between the two.

“This is an important, overlooked issue,” said Dr. Hugh Taylor, chair of the department of obstetrics, gynecology and reproductive sciences at Yale School of Medicine, who added that he has heard from his own patients about differences in their periods after receiving the vaccine.

“A lot of people have irregular menstruation for all sorts of reasons, so is this really different in people with the vaccine, or is it just that when people have it, they are linking it to the vaccine?”

The research will be undertaken by teams at Boston University, Harvard Medical School, Johns Hopkins University, Michigan State University and Oregon Health and Science University. The studies will include participants of all ages and backgrounds who have not yet been vaccinated, including those who plan to get the shots and those who do not, in order to study their menstrual cycles before and afterward.

Menstrual health can be a reflection of women’s overall health, doctors say. But they point out that a number of different factors can temporarily affect a woman’s period, including stress, illness or lifestyle changes. Periods, including length and flow of a menstrual cycle, also vary widely from person to person.

Read moreThe maternity department at Lewis County Health System in upstate New York will pause deliveries on Sept. 25, the chief executive said.Credit…Eric Gay/Associated Press

A small hospital in upstate New York is planning to suspend delivering babies starting in a few weeks because some of its labor and delivery nurses resigned rather than comply with the state’s Covid vaccine mandate.

The development underscores the challenges that many health care systems face amid a national shortage of nursing staff and vaccine hesitancy among some health care workers.

“The math is just not working,” said Gerald Cayer, chief executive officer of Lewis County Health System, at a news conference on Friday. “The number of resignations received leaves us no choice but to pause delivering babies.”

Six out of the 18 staff members in the maternity department at Lewis County General Hospital have resigned, and seven have not indicated whether they will get their shots, Mr. Cayer said in an interview on Monday. The hospital, located in Lowville, the county seat, had expected to deliver about 200 babies this year, he added.

At least 30 employees in the health system have resigned since former Gov. Andrew Cuomo mandated vaccinations by Sept. 27 for New York State’s health care workers, Mr. Cayer said. Of those who have resigned, 21 worked in clinical areas.

The maternity department at Lewis County General will pause deliveries on Sept. 25, Mr. Cayer said, and other units could be affected if more workers resign. Prospective parents in the area will have other options: There are hospitals with maternity departments in Carthage, about 15 miles from Lowville, and in Watertown, about 27 miles away.

The vast majority of workers in his health system have complied with the mandate. Mr. Cayer said that 464 employees, or 73 percent, have been fully vaccinated, and that he he hoped that the staff members who quit would reconsider and take the shots before the deadline. “Anyone who has resigned who changes their mind will be welcomed back,” he said.

The resignations have taken place in a region with a dire staffing shortage. There has been a lack of experienced maternity nursing staff throughout upstate New York, said Dr. Sean Harney, the hospital’s medical director. Thousands of open nursing positions remain, Mr. Cayer said.

Lewis County, with about 27,000 residents, is among the least populous and most politically conservative counties in the state, and has one of the lowest Covid vaccination rates: 44 percent of residents were fully vaccinated as of Friday, compared with 61 percent statewide, according to data from the Centers for Disease Control and Prevention.

Reports of new cases more than doubled in Lewis County, and hospitalizations rose 35 percent in the past 14 days, according to a New York Times database.

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