ImageA patient waited to be called for a booster shot at a grocery store pharmacy in Denver this month.
Credit…David Zalubowski/Associated Press

Citing the pervasive spread of the coronavirus across Colorado, Gov. Jared Polis said on Thursday that all adults would be eligible for a booster shot because of their high risk of exposure, assuming enough time had passed since their initial doses.

Mr. Polis, a Democrat, signed an executive order declaring the entire state at high risk from exposure and urged boosters for any adult at least six months past their second dose of the Pfizer-BioNTech or Moderna vaccines, or two months past the single-dose Johnson & Johnson vaccine.

Federal regulators have said that adults who received the Pfizer-BioNTech or Moderna vaccines are eligible for a booster if they are 65 or older, or if they are at increased risk because of medical conditions or where they work or live. Individuals who got the Johnson & Johnson shot, which is only available to adults, are eligible. People can select any of the three vaccine brands for their booster.

On Tuesday, Pfizer and BioNTech asked the Food and Drug Administration to expand eligibility for their boosters to all adults.

If the regulators sign off on that request, it would make official what health authorities say they already see happening frequently. Many people appear to be getting boosters whether or not they are technically eligible, so holding onto complex criteria may be futile, some health officials have said.

A growing body of early global research has shown that the vaccines available in the United States have remained highly protective against the disease’s worst outcomes over time, even during the summer surge of the highly transmissible Delta variant, with some exceptions among older people and those with weakened immune systems.

A number of published studies show that their protection against infection, with or without symptoms, has fallen. Public health experts say it does not mean the vaccines are not working. But the significance of waning effectiveness — and whether it suggests all adults should be eligible for a booster — is still up for debate.

Mr. Polis’s order justified broadening access to boosters by saying that since the entire state of Colorado has seen significant spread of the virus, it qualified as the kind of high-risk environment for which federal regulators cleared boosters.

“We want to ensure that Coloradans have every tool they need to protect themselves from this deadly virus and to help reduce the stress on our hospitals and health care workers,” the governor said in a statement. “Every Coloradan is now eligible to get the booster so they can protect themselves and their families.”

Source: State and local health agencies. Daily cases are the number of new cases reported each day. The seven-day average is the average of a day and the previous six days of data.

The order comes as Colorado faces its highest surge of virus cases in a year. As of Wednesday, the daily average of new cases was up 42 percent and average new deaths were up 52 percent over the past two weeks, according to a New York Times database. The seven-day average of new cases was 3,737, and the average number of daily deaths was 35.

“We’re experiencing a peak right now that many other areas of the country experienced a month or two ago,” Mr. Polis said at a news conference on Monday.

His executive order, signed Wednesday, said that as of that day, only 623 hospital beds remained unoccupied across the state, with 95 percent of the state’s intensive care beds full.

The governor had signed an executive order this month that allows hospitals to transfer patients out if they are nearing capacity.

Asked at a news conference on Wednesday about Colorado’s approach, Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, emphasized that the priority was to get people vaccinated in the first place. “That, I think, is the most important,” she said, “in terms of preventing hospitalizations and death and infection in and of itself.”

The F.D.A. “is currently looking at the data for expanding boosters to all populations,” she added.

In mid-August, President Biden announced plans to make boosters available to all adults, but the beginning of the campaign was delayed after regulators insisted they needed more time to review data.

Amy Schoenfeld Walker and Josh Holder contributed reporting.

Credit…Badru Katumba/Agence France-Presse — Getty Images

As much of the world moves closer to fully opening schools, at least one nation has stuck to keeping them fully or partly closed: Uganda.

Eighteen months into the pandemic, officials in the country have kept more than 10 million primary and secondary school students at home, with no plans to reopen their classrooms soon. And while Uganda’s leaders say that the policy is the safest option, on the ground, the effects of the closures are stark.

The “government has not left schools closed to punish you, but rather, to protect you from harm,” the education minister, Janet Museveni, who is also the country’s first lady, said on Twitter in September. She said that the government did not want to risk having parents become infected by students, who “would become orphans — just like H.I.V./AIDS did to many of our families.”

President Yoweri Museveni said in a televised address last month that parents should expect schools to reopen in January, along with other small businesses like bars, hair salons and recreational centers.

In the meantime, however, young women, abandoning hopes of going to school, are getting married and starting families instead. School buildings are being converted into businesses or health clinics. Teachers are quitting, and disillusioned students are taking menial jobs like selling fruit or mining for gold.

“The government has failed to strike a balance between the lives they are saving and the lives they are losing,” said Filbert Baguma, general secretary of the Uganda National Teachers’ Union.

He noted that public spaces like markets and churches had been allowed to reopen, thus exposing the same students to the coronavirus. “Students are not any better off in terms of protection than when they were in their learning institutions,” he said.

Even Uganda’s government has concluded that the sweeping closures have had a devastating effect.

A report released in August by the National Planning Authority, a government agency, found that “30 percent of the learners are likely not to return to school forever” and that 3,507 primary and 832 secondary schools in the country were likely to close.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

In June, the Delta variant contributed to a surge in cases and overwhelmed hospitals, pushing the authorities to suspend gatherings and impose a 42-day lockdown. But the country now has a relatively low infection rate, recording just 67 deaths in October, and is now averaging 372 new cases per day, according to Johns Hopkins University data.

The Education Ministry has tried to compensate by distributing home learning materials and broadcasting radio programs to help children learn remotely.

But Mary Goretti Nakabugo, the executive director of Uwezo, an education organization, said that only 20 percent of families contacted in a recent poll had received the materials. Even those families who had received them rarely made use of them, she said.

Bwengye Elia, a mathematics and physics teacher in the Wakiso district of central Uganda, said that few students could afford to meet school costs on their own.

“Data is expensive, which further limits the percentage of students who can afford to continue learning online,” he said. “Barely any students are learning at all.”

Many students have dropped out to seek work instead.

Mukasa Nicholas, 18, said that he had waited six months for classes to start before moving to Kampala, the capital, to find a job. He now sells medical masks on the street, bringing in about $2 a day.

“If my parents ask me to return to school,” he said, “I will reject them.”

Credit…Jan Hetfleisch/Getty Images

New lockdown restrictions for unvaccinated people in Austria are likely because new coronavirus cases in the country are rising rapidly, Chancellor Alexander Schallenberg said on Thursday.

Though such restrictions would be a “very harsh measure,” they appear to be necessary and “probably inevitable,” the chancellor said at a news conference.

The Austrian national health agency has reported an average of 760 coronavirus cases a day for every 100,000 people over the past week, a rate that has more than doubled since late October.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

About 64 percent of the country’s population has been fully vaccinated against the coronavirus so far — a larger share than in the United States or in Austria’s neighbors to the east, but smaller than in most Western European nations, according to government figures collated by the Our World in Data project.

The Austrian government said last week that it would bar people who are not fully vaccinated from entering places like restaurants and hair salons; that measure took effect on Monday. A lockdown like the one Mr. Schallenberg warned about would be much more restrictive.

“The situation in Austria and other European countries is serious,” Mr. Schallenberg said in a statement, noting that hospital intensive care units were filling up faster than expected.

The chancellor has been talking about the worsening picture in Austria for some time. “We are about to stumble into a pandemic of the unvaccinated,’’ he told The Associated Press last month.

At a news conference following a meeting with state governors last Friday, Mr. Schallenberg urged Austrians to get their shots.

“With a vaccination, we protect not only ourselves, but also our friends, family and colleagues,” he said, adding, “It is simply our responsibility to protect the people of our country.”

Credit…Cristian Movila for The New York Times

Coronavirus deaths in Europe rose 10 percent in the first week of this month and made up over half of the 48,000 coronavirus deaths reported globally in that time, even as new cases and deaths dropped or remained stable in the rest of the world, according to World Health Organization figures released this week.

The highest number of deaths were recorded in Russia, which has reported record Covid tolls in recent weeks, followed by Ukraine and Romania. The numbers of new infections were highest in Russia, Britain and Turkey, according to the W.H.O. figures.

Europe accounted for about two-thirds of the world’s 3.1 million new reported cases that week, the agency’s report said, and officials in hard-hit countries are weighing new restrictions to try to quell the outbreaks as winter approaches.

In Germany, where about 67 percent of the population is fully vaccinated against the virus, tens of thousands of new cases are being reported every day, the country’s highest caseloads since the pandemic began. Several of its states are now working on new regulations to introduce mask mandates and require proof of vaccination or past infection for entry to some venues.

Health experts in the Netherlands, where about 68 percent of people are fully vaccinated, have also called for more coronavirus restrictions as cases there put hospitals under strain. This month, the authorities reimposed requirements for the wearing of face masks in indoor public spaces and required coronavirus passes detailing vaccine status or past infections for entry.

In Romania, where only about 40 percent of the population is fully vaccinated, coronavirus deaths have hit record levels and intensive care units have been left strained.

Several deadly fires at the country’s hospitals have also added to the tragedy. On Thursday, two patients died when a blaze broke out at a hospital that was treating Covid patients in the city of Ploiesti, officials said, adding that the cause of the fire was not yet known. At least 20 people have died in such blazes at Romania’s hospitals since the pandemic began.

And in England, where the government is accelerating a program of booster vaccination shots in the hopes of stemming rising case numbers, the government has mandated vaccines for frontline health workers starting next spring. Officials have pushed back against calls for another lockdown, but said that they would consider imposing more coronavirus restrictions if necessary.

The trend in Europe is at odds with the trajectory of other regions: The rate of new reported Covid deaths worldwide decreased 4 percent in the first week of November, according to the W.H.O., while the rate of new infections remained stable.

In total, over 249 million cases and more than five million Covid deaths have been reported since the pandemic began.

Credit…Matthew Busch for The New York Times

A federal judge ruled on Wednesday that Gov. Greg Abbott’s ban on mask mandates in Texas schools violates the rights of students with disabilities, clearing the path for districts in the state to issue their own rules for face coverings, a decision that could affect more than five million students.

The ruling comes after months of politicized disputes over measures at the state level opposing mask-wearing policies that had been intended to prevent the spread of Covid.

The lawsuit, which sought to overturn the mandate, was filed on behalf of several families of students with disabilities and the organization Disability Rights Texas. They stated that the defendants — the state’s attorney general, Ken Paxton; the commissioner of the Texas Education Agency, Mike Morath; and the Texas Education Agency — had put students with disabilities at risk through their complete erasure of mask mandates.

The governor and some other state officials have maintained that protecting against the virus is a matter of personal responsibility.

Judge Lee Yeakel, who made the ruling in the suit filed in the United States District Court for the Western District of Texas, determined that the order from the governor violated the 1990 Americans With Disabilities Act because it put children with disabilities at risk.

The ruling also prohibits Mr. Paxton from enforcing the order by Mr. Abbott, who has repeatedly opposed Covid-related mandates.

“The spread of Covid-19 poses an even greater risk for children with special health needs,” Judge Yeakel said. “Children with certain underlying conditions who contract Covid-19 are more likely to experience severe acute biological effects and to require admission to a hospital and the hospital’s intensive-care unit.”

The State Supreme Court has repeatedly allowed the governor’s ban to remain in effect, but the impact of Wednesday’s federal ruling could ripple across the country in similar cases in other states.

Responding to the ruling in a statement, Mr. Paxton said that he disagreed, adding that his office was “considering all legal avenues to challenge this decision.”

Mr. Abbott’s office did not immediately respond to requests for comment on Wednesday night. Mr. Morath office also did not immediately respond.

The lawsuit was first filed in August, at the onset of the fall semester. Disability Rights Texas argued that school district leaders should make their own decisions about mask mandates based on the Covid transmission in their area and on their students’ needs.

The order from the governor, Judge Yeakel said, excluded “disabled children from participating in and denies them the benefits of public schools’ programs, services, and activities to which they are entitled.”

Several school districts had altered or undone their mask mandates since Mr. Abbott’s order.

Mr. Paxton sent letters to superintendents of school districts threatening them with “legal action by his office to enforce the governor’s order and protect the rule of law,” if they did not rescind their mask mandates, according to court documents. On Sept. 10, Mr. Paxton filed lawsuits against six school districts, the documents show.

The Justice Department signaled support for the lawsuit against the state in September, saying in a formal statement that “even if their local school districts offered them the option of virtual learning,” the ban still violated the rights of students with disabilities.

Credit…Alisha Jucevic for The New York Times

As tens of millions of people in the United States consider signing up for a Covid-19 booster shot, a growing body of early global research shows that the vaccines authorized in the country remain highly protective against the disease’s worst outcomes over time.

But while the vaccines’ effectiveness against severe disease and hospitalization has mostly held steady, a number of published studies show that their protection against infection, with or without symptoms, has fallen.

Public health experts say this decline does not mean that the vaccines are not working. In fact, many studies show that the vaccines remain more than 50 percent effective at preventing infection, the level that all Covid vaccines had to meet or exceed to be authorized by the Food and Drug Administration in 2020.

But the significance of these declines in effectiveness — and whether they suggest that all adults should be eligible for a booster shot — remains up for debate.

Credit…Bess Adler for The New York Times

The National Institutes of Health is prepared to aggressively defend its assertion that its scientists helped invent a crucial component of the Moderna coronavirus vaccine — including taking legal action if government lawyers deem it necessary, the agency’s director said on Wednesday.

Moderna’s vaccine, which appears to provide the world’s best defense against Covid-19, grew out of four years of collaboration with research scientists at the N.I.H.’s Vaccine Research Center. The New York Times reported on Tuesday that the company has blocked three N.I.H. researchers from being named on a key patent application.

Much more than scientific recognition is at stake. If federal researchers were named as co-inventors in the patent, the government would have a nearly unfettered right to license the Moderna vaccine to other manufacturers, which could expand access to it in poorer nations and bring the government millions in revenue.

The agency’s director, Dr. Francis Collins, declined to be interviewed. But speaking to Reuters in advance of a virtual health conference hosted by the news service, he made clear that the N.I.H., the government’s biomedical research agency, was not backing down.

“I think Moderna has made a serious mistake here in not providing the kind of co-inventorship credit to people who played a major role in the development of the vaccine that they’re now making a fair amount of money off of,” he told Reuters. He added: “But we are not done. Clearly this is something that legal authorities are going to have to figure out.”

A spokeswoman for Dr. Collins, Renate Myles, stopped short of saying that the dispute was headed to court.

“Dr. Collins simply stated that N.I.H. is not giving up on our claim that N.I.H. is a co-inventor on the mRNA technology used in the Moderna COVID-19 vaccine, but defers to legal authorities on how this might be resolved,” she said. By legal authorities, she said, Dr. Collins meant government lawyers.

The three government researchers that N.I.H. has been trying to get named alongside Moderna employees as co-inventors worked with company scientists on the genetic sequence at the core of how the vaccine triggers an immune response.

As the virus began to spread in January 2020, scientists at N.I.H. and Moderna worked in parallel over a single weekend to zero in on the gene for the virus’s spike protein. Both teams independently identified the same gene.

Moderna has rebuffed the government’s efforts. In a July filing with the United States Patent and Trademark Office, Moderna said it had “reached the good-faith determination that these individuals did not co-invent” the component.

Moderna’s chief executive, Stéphane Bancel, said on Wednesday that the company was in confidential discussions with the N.I.H. and would communicate publicly if a resolution to the dispute is reached.

“What we just need to work out with the N.I.H. is who are the inventors. And there are very clear rules set out by the law about inventorship, and they are very important to protect the patent,” Mr. Bancel said at a virtual conference put on by Wired magazine.

Moderna has received $1.4 billion from the federal government to develop its vaccine and another $8.1 billion to provide the country with half a billion doses. It is also earning billions in profits from supply deals.

Biden administration officials have said they lack the legal authority to require the company to share its vaccine recipe and technical know-how with manufacturers who could produce it at a lower cost for poorer countries.

After Dr. Collins’s comments were reported, a Moderna spokeswoman, reiterated that the company had concluded that only Moderna scientists came up with the sequence that powers the vaccine.

Credit…Geoff Forester/The Concord Monitor, via Associated Press

Ten states filed a lawsuit on Wednesday seeking to block the Biden administration’s coronavirus vaccine mandate for health care workers, on the heels of a court decision that temporarily halted the broader U.S. requirement that workers of all large employers be vaccinated or undergo weekly testing.

The new suit, filed in U.S. District Court in eastern Missouri, claims that the rule issued last week by the Centers for Medicare & Medicaid Services “threatens with job loss millions of health care workers who risked their lives in the early days of the Covid-19 pandemic to care for strangers and friends in their communities.”

The 10 states also argue that the rule “threatens to exacerbate an alarming shortage of health care workers, particularly in rural communities, that has already reached a boiling point.” They say any further losses will endanger patients, causing “devastating adverse effects on health care services.”

But the broader point echoes a separate lawsuit brought by many of the same Republican-led states against the private-employer mandate for those with 100 workers or more, contending that the Occupational Safety and Health Administration does not have the authority to dictate such policy.

In announcing the rule, the administration set a deadline of January for all 17 million health care workers to be fully vaccinated at health care facilities that receive government funding under Medicare or Medicaid. Employees of hospitals and nursing homes, along with other medical sites, would not have the option of testing in lieu of immunization.

Federal officials said they could not comment on pending litigation. In a statement, the Centers for Medicare & Medicaid Services said that “there is no question that staff in any health care setting who remain unvaccinated pose both direct and indirect threats to patient safety and population health.”

Legal experts said the agency generally had the ability to establish rules governing the organizations that it pays to deliver care. “C.M.S. has very broad authority to regulate Medicare-certified providers,” said Katrina A. Pagonis, a lawyer specializing in regulatory issues for Hooper, Lundy & Bookman.

Erin J. McLaughlin, a labor and employment lawyer for Buchanan, Ingersoll & Rooney, said the rule was “essentially a condition of participation” in federally funded programs. The administration invoked the Supremacy Clause in the Constitution to pre-empt state and local laws when issuing the rule.

President Biden’s call for mandates followed months of pandemic outbreaks as the Delta variant threatened regions of the country, some with low vaccination rates but also others with vulnerable populations like those in nursing homes that had just begun to recover from the devastating death toll of 2020.

As cases mounted earlier this year, several medical societies came out in favor of strict mandates for health care workers, arguing these employees have a special obligation to keep their patients and colleagues safe. And many large, multistate hospital systems and large nursing home companies began requiring staff vaccination, although others lobbied against blanket requirements.

Many nursing homes had large numbers of workers who remained unvaccinated even after Mr. Biden announced the plan to mandate immunizations. The administration said that about 40 percent of all hospitals already required vaccinations. About 73 percent of nursing home workers are now vaccinated, according to federal data.

In the new lawsuit, the 10 states — Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming — claim that the federal government has overreached its authority to dictate what happens in their states. “This case illustrates why the police power over compulsory vaccination has always been the province of — and still properly belongs to — the states,” they argue in the lawsuit.

Despite the push by some nursing homes and hospitals to weaken the requirement, the administration chose to insist on vaccination. “It’s critical to us to make sure we’re ensuring the safety of residents living in nursing homes and other individuals in health care settings,” said Chiquita Brooks-LaSure, the administrator for C.M.S., in an interview. Vaccinated staff are less likely to get sick and spread Covid, she said.

Ms. Brooks-LaSure acknowledged the providers’ concerns over losing workers who refuse to be vaccinated but she said mandates often ease shortages because employees don’t become infected. “What we’re seeing on the ground is that they are not going to work because they are sick,” she said.

She also cited the experience in states that have issued requirements as evidence that vaccination rates will rise as a result of the government’s decision. Many large systems mandated the vaccine but found only a small minority of employees unwilling to be vaccinated.

While some nursing homes and hospitals have expressed disappointment over the new rules, there is little expectation that large numbers will lose their government funding. Medicare does have the authority to discontinue financing for providers that do not comply, but Ms. Brooks-LaSure emphasized that the agency’s approach will be to work with facilities. “Our focus is really on educating providers and getting people to be in compliance,” she said.

Credit…Edgar Su/Reuters

After nearly five months of silence, Singapore’s restaurants and bars can play recorded music again — but not too loudly — as some coronavirus restrictions lift.

The country’s authorities, believing that loud music would force diners to raise their voices and increase the risk of coronavirus transmission, banned background music in food and beverage outlets in June.

Starting next Wednesday, “soft recorded music” can be played in restaurants again, the authorities said, as part of a gradual lifting of restrictions as the country’s coronavirus outbreak stabilizes. Live music and entertainment are still banned.

There was no word on what kinds of music — or what volume level — might be considered “soft.”

It is not the first time that music has been regulated to control the virus. In July, South Korea said that the music played at the gyms must be no faster than 120 beats per minute.

Health officials in Singapore cautioned that while the music was returning, the city still needed to remain vigilant to control the virus.

“While the total number of Covid-19 cases in hospitals and the intensive care unit (ICU) remains high, numbers are also stable,” the Health Ministry said in a statement announcing the change.

“We are easing off slightly on the bicycle brakes, but we must not let our guard down and lose control as we go down the slope,” the city-state’s finance minister, Lawrence Wong, said at a news conference on Monday.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

Although 82 percent of its population is fully vaccinated, Singapore imposed strict restrictions on residents in the face of a surge of new coronavirus cases from September.

On Wednesday, the country reported 3,481 new cases and 17 deaths. Over 70 percent of the country’s intensive-care system is currently in use, according to government data.

Also from Wednesday, five vaccinated people from any household will be able to dine together in restaurants, up from two people. Sporting events will begin to resume for vaccinated residents, as will more school activities, the authorities said.

Credit…Siphiwe Sibeko/Reuters

Covid-19 patients in Africa are significantly more likely to die if they have diabetes, the World Health Organization said on Thursday, a worrisome trend on a continent where diabetes rates are rising and where the condition remains undiagnosed in many.

Over 10 percent of patients with diabetes died when they caught Covid-19, compared with 2.5 percent for Covid-19 patients overall, according to an evaluation of data from 13 African countries carried out by the W.H.O. The study focused on underlying conditions in Africans who tested positive for Covid-19, and also found a higher fatality rate in patients with H.I.V. and hypertension.

In recent years, the prevalence of diabetes has grown rapidly in Africa — and 70 percent of people with the condition there are not aware that they have it, according to the W.H.O.

“Fighting the diabetes epidemic in Africa is in many ways as critical as the battle against the current pandemic,” Dr. Matshidiso Moeti, the agency’s regional director for Africa, said in a statement on Thursday.

“The Covid-19 pandemic will eventually subside, but Africa is projected in the coming years to experience the highest increase in diabetes globally,” she said. “We must act now to prevent new cases, vaccinate people who have this condition and, equally importantly, identify and support the millions of Africans unaware they are suffering from this silent killer.”

Changes in lifestyle and eating habits, rapid urbanization and a growing and aging population are some of the factors that have increased the prevalence of diabetes on the continent. Most of the cases in Africa are Type 2 diabetes.

The findings cited on Thursday echo those of studies done elsewhere in the world, which have shown that people with Type 2 diabetes are at higher risk of being hospitalized, admitted to intensive care and dying if they catch the coronavirus.

Credit…Chandan Khanna/AFP— Getty Images

A shortage of teachers in the United States has become so acute that substitute teachers, who have historically earned low pay, suddenly find themselves on the beneficial side of the demand-supply equation. In some cases, that has led to a rise in wages — and steady work.

But as the crunch continues, some schools are lowering their standards for substitute teachers, which were already lower than those for full-time faculty. The situation has become dire enough that within the last month, at least two states, Missouri and Oregon, temporarily removed college degree requirements for would-be hires.

The moves have led to concerns by parents, educators and policymakers over the quality of instruction. It’s already evident that a combination of school shutdowns, and remote learning, led to significant learning losses for students.

Substitutes teachers are “a short-term Band-Aid that shortchanges students,” said Kim Anderson, executive director for the National Education Association, which represents millions of education workers across the country.

Deborah Mitchell, 58, substitutes for Wake County Schools, in Raleigh, N.C., and doesn’t consider her training to be particularly extensive.

“They rely on us because so many teachers are just dropping out,” she said. “But with the amount of work that you need to do — you’re not just a teacher, you’re the social worker, the shoulder to cry on. It’s a lot more than just ‘teach me arithmetic.’”

Credit…Christof Stache/Agence France-Presse — Getty Images

BERLIN — The University Hospital of Giessen, one of Germany’s foremost clinics for pulmonary disease, is at capacity. The number of Covid-19 patients has tripled in recent weeks. Nearly half of them are on ventilators.

And every single one is unvaccinated.

“I ask every patient: Why didn’t you get vaccinated?” said Dr. Susanne Herold, head of infectious diseases, after her daily round on the ward on Thursday. “It’s a mix of people who distrust the vaccine, distrust the state and are often difficult to reach by public information campaigns.”

Patients like hers are the main drivers of a fourth wave of Covid-19 cases in Germany that has produced tens of thousands of new daily infections — more than the country has had at any point in the pandemic.

Source: Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. The daily average is calculated with data that was reported in the last seven days.

For Germany it is a startling turnabout. At the onset of the pandemic, Germany had set an example for how to manage the virus and keep the death toll low. It was quick to put in place widespread testing and treatment, expand the number of intensive care beds and had a trusted leader in Chancellor Angela Merkel, a trained scientist, whose government’s social distancing guidelines were widely observed.

But today, a combination of factors has propelled a new surge, among them wintry temperatures, a slow rollout of booster vaccines, and an even more pronounced spike in infections in neighboring eastern European nations like the Czech Republic. The fact that Germany is in a kind of political limbo as it transitions between governments has not helped.

“What we are experiencing is above all a pandemic of the unvaccinated,” the minister of health, Jens Spahn, said earlier this month.

Credit…Hannah Yoon for The New York Times

When the coronavirus hit the United States, the nation’s public health officials were responsible for monitoring cases in their communities, figuring out quarantine protocols, and setting the parameters of mask mandates and other rules.

But there has been resistance from the start, and a lot of that resistance is starting to become policy.

A New York Times investigation found that 100 new laws have been passed that wrest power from the hands of public health officials. What is the effect of those laws, and how might they affect the response to a future pandemic?

The Daily Poster

Listen to ‘The Daily’: The Public Health Officials Under Siege

During the pandemic, they have been the target of protests and of laws intended to curb their powers. Has this left the U.S. less prepared than ever for the next crisis?

Credit…Clodagh Kilcoyne/Reuters

Europe is facing fresh threats to its pandemic recovery as energy prices surge at a “tumultuous pace” and bottlenecks in the supply chain dampen growth and slow production, the European Commission said on Thursday.

In its latest economic forecast, the commission said sporadic pandemic-related lockdowns in some parts of Europe, together with emerging labor shortages, were adding to the disruptions, while inflation has hit a 10-year high.

Europe’s economy rebounded this year from the pandemic faster than expected, and regained prepandemic levels of growth during the summer. Among the 28 countries in the European Union, economic output is now expected to grow 5 percent this year, slightly better than a forecast made a few months ago — an unusually robust rebound after pandemic lockdowns shuttered the economy last year.

Growth will slow to a 4.3 percent pace next year and then decelerate to 2.5 percent in 2023, the commission said.

Europe spent hundreds of billions of euros to keep workers furloughed during national shutdowns, and such programs have helped millions of people stay in their jobs and avoid a surge in unemployment, the report said. About 1.5 million jobs were created from April to June, and nearly as many workers exited job retention schemes.

As in the United States and Britain, however, labor shortages have been plaguing industries that were quick to reopen, especially restaurants and parts of the retail sector. At the same time, there are still large numbers of people who are jobless and people who are available to work but not actively looking, the report said.

While the economic rebound has been swift, the surge in inflation is likely to weigh on the finances of Europe’s households and businesses. A jump in natural gas prices has led to higher electricity bills. Altogether, the price of goods, services, energy and food jumped 3.4 percent in September from a year earlier, and even without volatile food and energy prices, the inflation rate is the highest in a decade. Inflation is estimated to have climbed to 4.1 percent in October.

But prices have jumped because of postpandemic reopenings, the commission noted, so such pressures are expected to be largely fade over the next year, the commission said.