Covid Updates: W.H.O. Urges Masking for the Vaccinated, in Split With C.D.C.

Here’s what you need to know:

Credit…Sarahbeth Maney/The New York Times

World Health Organization officials, concerned about the easing of precautions meant to stop the spread of the coronavirus even as the most contagious variant to date has emerged, have urged even fully vaccinated people to continue wearing masks and to keep taking other measures to prevent infection.

The Centers for Disease Control and Prevention, on the other hand, told fully vaccinated Americans in May that they no longer needed to wear masks indoors or to maintain a distance of six feet from other people. The agency also eased advice about testing and quarantine after suspected exposure to the virus.

Asked on Monday about the new cautions expressed by the W.H.O. — the world’s largest public health organization — a C.D.C. spokesman pointed to the existing guidance and gave no indication it would change.

A highly infectious form of the virus, called the Delta variant, was first detected in India and has been identified in at least 85 countries. In the United States, where its prevalence has doubled in the last two weeks, the variant is responsible for one in every five Covid-19 cases. Dr. Anthony Fauci, the nation’s top infectious disease doctor, has called it “the greatest threat” to eliminating the virus in the United States.

The rise of new variants “makes it even more urgent that we use all the tools at our disposal to prevent transmission,” including consistent use of both vaccination and public health and social measures, Dr. Tedros Adhanom Ghebreyesus, the director-general of the W.H.O., said at a news briefing on Friday.

Dr. Mariângela Simão, the W.H.O.’s assistant director-general for access to medicines, vaccines and pharmaceuticals, emphasized at the briefing that even vaccinated people should continue to consistently wear masks, avoid crowds and maintain social distance from others, make sure they are in well-ventilated spaces, wash hands frequently, and avoid sneezing or coughing around other people.

“What we’re saying is, ‘Once you’ve been fully vaccinated, continue to play it safe, because you could end up as part of a transmission chain.’ You may not actually be fully protected,” said Dr. Bruce Aylward, a senior adviser to the W.H.O.

He added, “I think the first message we want to be careful about is saying, ‘Once you’re vaccinated, you can just go ahead and do whatever.’”

The comments were made in the context of broader statements criticizing the inequitable distribution of vaccines around the globe and the lack of access to vaccination in many parts of the world where the virus is spreading.

Covax, the W.H.O. program that poor countries rely on for vaccines, has “zero doses” of AstraZeneca or Johnson & Johnson vaccines, or those made by the Serum Institute of India, available for distribution, Dr. Aylward said. While less than 2 percent of the population of Africa is vaccinated, some countries are purchasing vaccines for young people who are at relatively low risk from the virus, he noted.

Even in countries where there are ample supplies of vaccine, full vaccination rates are lower than they could be, Dr. Alyward said.

Though fully vaccinated people are largely protected from symptomatic and asymptomatic coronavirus infections, studies suggest the Pfizer-BioNTech vaccine’s efficacy against the Delta variant is slightly lower than against other variants; the efficacy is significantly lower for individuals who have received only one dose of the vaccine.

And countries with relatively high vaccination rates have seen an uptick in infections driven by the Delta variant: Britain, where some two-thirds of the population has received at least one dose of the Pfizer-BioNTech or AstraZeneca vaccine and just under half have received two doses, is nonetheless grappling with a sharp rise in infections from the variant.

In Israel, which has one of the highest vaccination rates in the world, a rise in cases attributed to the Delta variant has led the government to reimpose mask mandates indoors and at large outdoor gatherings.

Given how pernicious and fast moving the variant is, “the vaccine approach is not enough,” said Eric Feigl-Ding, senior fellow at the Federation of American Scientists in Washington. “We’re not at the level of vaccinations where we can release the brakes on everything else and herd immunity will grind transmissions to a halt.”

Other scientists disagreed, saying guidance has to be more nuanced and tailored to local communities, varying according to vaccination rates and infection rates.

“The W.H.O. is looking at a world that is largely unvaccinated, so this makes sense,” said Dr. Ashish Jha, the dean of the Brown University School of Public Health.

In parts of the United States with low vaccination rates, too, masks may be appropriate, and recommendations should be tailored appropriately, he added: “If I were living in Missouri or Wyoming or Mississippi, places with low vaccination rates, I would not be excited about going indoors without wearing a mask — even though I’m vaccinated.”

Vaccine Protection

General practitioner displaying empty vials of the Pfizer and AstraZeneca vaccines in Berlin in April.Credit…Fabrizio Bensch/Reuters

Early results from a British vaccine study suggest that mixing different brands of vaccines can provoke a protective immune response against Covid-19. In the trial, volunteers produced high levels of antibodies and immune cells after getting one dose of the Pfizer-BioNTech vaccine and one dose of the AstraZeneca-Oxford shot.

Administering the vaccines in either order is likely to provide potent protection, Dr. Matthew Snape, a vaccine expert at the University of Oxford, said at a news conference on Monday. “Any of these schedules, I think could be argued, would be expected to be effective,” he said.

Dr. Snape and his colleagues began the trial, called Com-COV, in February. In the first wave of the study, they gave 830 volunteers one of four combinations of vaccines. Some got two doses of either Pfizer or AstraZeneca, both of which have been shown to be effective against Covid-19. Others got a dose of AstraZeneca, followed by one of Pfizer, or vice versa.

For the first wave of volunteers, the researchers waited four weeks between doses. Studies have found that the AstraZeneca vaccine provides stronger protection if the second dose is delayed for up to 12 weeks, so the researchers are also running a separate 12-week trial which should deliver results next month.

The researchers found that volunteers reported more chills, headaches and muscle pain than people who get two doses of the same vaccine. But the side effects were short-lived.

Dr. Snape and his colleagues then drew blood to measure the immune response in the volunteers. They found that those who got two doses of Pfizer-BioNTech produced levels of antibodies about 10 times as high as those who got two doses of AstraZeneca. Volunteers who got Pfizer followed by AstraZeneca showed antibody levels about five times as high as those with two doses of AstraZeneca. And volunteers who got AstraZeneca followed by Pfizer reached antibody levels about as high as those who got two doses of Pfizer.

Dr. Snape said that the differences would most likely narrow in the volunteers who get a second dose after 12 weeks, when the AstraZeneca vaccine has had more time to strengthen its effects.

The study also found that using different vaccines produced a higher level of immune cells primed to attack the coronavirus than did giving two doses of the same vaccine. Dr. Snape said it wasn’t clear yet why mixing had that advantage. “It’s very intriguing, let’s say that much,” he said.

Dr. Snape and his colleagues have begun a similar trial, adding vaccines from Moderna and Novavax to the list of possibilities.

For now, he said, the best course of action remains getting two doses of the same vaccine. Large clinical trials have clearly demonstrated that this strategy reduces the chances of getting Covid-19. “Your default should be what is proven to work,” Dr. Snape said.

But there are many cases in which that may not be possible. Vaccine shipments are sometimes delayed because of manufacturing problems, for example. Younger people in some countries have been advised not to get a second dose of AstraZeneca because of concerns about the small risk of developing blood clots. In such situations, it’s important to know whether people can switch to another vaccine.

“This provides reassuring evidence that should work,” Dr. Snape said.

Vaccine Protection

Prepped Pfizer and Moderna vaccines at a pharmacy in Little Rock, Ark., in March.Credit…Rory Doyle for The New York Times

The vaccines made by Pfizer-BioNTech and Moderna set off a persistent immune reaction in the body that may protect against the coronavirus for years, scientists reported on Monday.

The findings add to growing evidence that most people immunized with the mRNA vaccines may not need boosters, so long as the virus and its variants do not evolve much beyond their current forms — which is not guaranteed. People who recovered from Covid-19 before being vaccinated may not need boosters even if the virus does make a significant transformation.

“It’s a good sign for how durable our immunity is from this vaccine,” said Ali Ellebedy, an immunologist at Washington University in St. Louis who led the study, which was published in the journal Nature.

The study did not consider the vaccine made by Johnson & Johnson, but Dr. Ellebedy said he expected the immune response to be less durable than that produced by mRNA vaccines.

Dr. Ellebedy and his colleagues reported last month that in people who had survived Covid-19, immune cells that recognize the virus remained in the bone marrow for at least eight months after infection. A study by another team indicated that so-called memory B cells continue to mature and strengthen for at least a year after infection.

Based on those findings, researchers suggested that immunity might last years, possibly a lifetime, in people who were infected and later vaccinated. But it was unclear whether vaccination alone might have a similarly long-lasting effect.

After an infection or a vaccination, a specialized structure called the germinal center forms in lymph nodes. This structure is an elite school of sorts for B cells.

The broader the range and the longer these cells have to practice, the more likely they are to be able to thwart variants of the virus that may emerge.

After infection with the coronavirus, the germinal center forms in the lungs. But after vaccination, the cells’ education takes place in lymph nodes in the armpits, within reach of researchers.

Dr. Ellebedy’s team found that 15 weeks after the first dose of vaccine, the germinal center was still highly active in all 14 of the participants, and that the number of memory cells that recognized the coronavirus had not declined.

“The fact that the reactions continued for almost four months after vaccination — that’s a very, very good sign,” Dr. Ellebedy said. Germinal centers typically peak one to two weeks after immunization, and then wane.

“Usually by four to six weeks, there’s not much left,” said Deepta Bhattacharya, an immunologist at the University of Arizona. But germinal centers stimulated by the mRNA vaccines are “still going, months into it, and not a lot of decline in most people.”

Dr. Bhattacharya noted that most of what scientists know about the persistence of germinal centers is based on animal research. The new study is the first to show what happens in people after vaccination.

The results suggest that a vast majority of vaccinated people will be protected over the long term — at least, against the existing variants. But older adults, people with weak immune systems and those who take drugs that suppress immunity may need boosters; people who survived Covid-19 and were later immunized may never need them at all.

Exactly how long the protection from mRNA vaccines will last is hard to predict. In the absence of variants that sidestep immunity, in theory immunity could last a lifetime, experts said. But the virus is clearly evolving.

Vaccine Protection

Nurses preparing AstraZeneca vaccine doses in Bratislava, Slovakia, in April.Credit…Akos Stiller for The New York Times

A third dose of the Covid-19 vaccine developed by AstraZeneca and the University of Oxford generated a strong immune response in clinical trial volunteers, Oxford researchers reported on Monday.

The finding indicates that the AstraZeneca vaccine could be an option should third shots end up being needed, for example, to extend immunity. To date, the vaccine has been given as two doses, typically between four and 12 weeks apart.

The new data, detailed in a preprint manuscript that has not yet been peer reviewed, came from 90 study volunteers in Britain who were among the earliest to receive the shots in a clinical trial last year. This past March, they were given a third dose, roughly 30 weeks after their second.

Laboratory analyses showed that the third dose increased levels of antibodies to the virus in the volunteers to a point higher than seen a month after their second dose — an encouraging sign that the third shot would be likely to bring greater protection if the effectiveness of two doses waned over time.

“We do have to be in a position where we could boost if it turned out that was necessary,” Prof. Andrew Pollard, an Oxford researcher who has led studies of the vaccine, said in a news conference on Monday. “I think we have encouraging data in this preprint to show that boosters could be used and would be effective at boosting the immune response.”

Scientists and policymakers do not yet know whether booster shots may be needed.

Scientists reported Monday that the vaccines made by Pfizer-BioNTech and Moderna set off a persistent immune reaction in the body that may protect against the coronavirus for years, but it isn’t clear if the same is happening with other vaccines, including AstraZeneca.

Emerging coronavirus variants could also accelerate the need for booster shots. If third shots are deemed necessary in the coming months, their availability could be severely limited, especially in poorer countries that are lacking enough supply to give first doses to their most vulnerable citizens.

Earlier this month, the National Institutes of Health announced that it has begun a new clinical trial of people fully vaccinated with any of the three authorized vaccines in the United States. The goal is to test whether a booster shot of the vaccine made by Moderna will increase their antibodies against the virus. Initial results are expected later this summer.

The AstraZeneca vaccine has won authorization in 80 countries since last December but is not approved for use in the United States, which already has more than enough doses of its three authorized vaccines to meet demand. The shot has been the backbone of the struggling Covax program to provide vaccines to poor countries, accounting for more than 88 percent of the doses shipped out to middle- and low-income nations through last week.

AstraZeneca announced on Sunday that the first volunteers had been vaccinated in a separate study assessing a new version of the vaccine designed to protect against the Beta variant of the virus first seen in South Africa. Some study results suggested that the original version of the AstraZeneca vaccine may not be effective against that variant. Professor Pollard said the study would compare the effects of a third dose of the original vaccine against those of boosting volunteers with the new Beta-targeted vaccine.

Passengers at the British Airways counter of the Hong Kong International airport last week.Credit…Anthony Kwan for The New York Times

Hong Kong will suspend all passenger flights from Britain beginning July 1, the government said on Monday, citing the spread of the more virulent Delta coronavirus variant in the United Kingdom, which will be reclassified as “extremely high-risk.”

People who have stayed in Britain for longer than two hours will also be barred from boarding passenger flights bound for Hong Kong, the authorities said.

“A number of cases imported from the U.K. involving variant virus strains have persistently been found in the past few days,” officials said, according to Hong Kong’s government news agency.

The restrictions are the second time Hong Kong has suspended flights from Britain. After an outbreak of a dangerous variant in December, authorities barred passengers from entering, leaving many Hong Kong residents angered and confused as they desperately tried to return home.

Those restrictions were lifted in May.

Now, Britain is struggling with rising infections, recording a 109 percent spike in cases over the past 14 days, though cases remain a fraction of their winter peak, according to a New York Times database. Experts say the rise is likely linked to the highly contagious Delta variant, which is spreading rapidly in other countries as well.

The World Health Organization has said the variant is likely to become the most globally dominant strain of the disease.

On Monday, the prime minister of Spain, Pedro Sánchez, also announced new restrictions on visitors from Britain. They will be required to present a negative coronavirus test or proof of full vaccination to enter the country.

In Hong Kong, restrictions on passengers arriving from Brazil, India, Indonesia, Nepal, Pakistan, the Philippines and South Africa will also remain in place.

Oregon officials say no one will be turned away from cooling centers because of Covid restrictions, which are expected to end in the state by June 30. Kermic Luster rested in a cooling center at the Oregon Convention Center in Portland on Sunday.Credit…Nathan Howard/Getty Images

To help people in the Pacific Northwest escape record-breaking temperatures, local officials have opened cooling centers — and relaxed some Covid-19 restrictions.

In Oregon, where temperatures are forecast to reach 113 degrees on Monday, roads have buckled from the extreme heat, and relatively few homes have air-conditioners, state health officials suspended capacity limits at swimming pools, movie theaters and shopping malls on Friday, and said that no one would be turned away from cooling centers because of crowding.

The decision follows a sustained decline in new reported coronavirus cases and deaths in the state, and Gov. Kate Brown’s announcement that Oregon would fully open no later than June 30. Nearly 70 percent of adult residents in the state have received at least one vaccine dose, Governor Brown’s benchmark for lifting the state’s remaining restrictions.

Gov. Jay Inslee of Washington has suspended capacity restrictions at publicly owned or operated cooling centers and those run by nonprofit organizations in his state, though not for “private, for-profit businesses that offer air-conditioned spaces to the general public,” according to a memo released on Friday.

More than 70 percent of adults in Washington have received at least one vaccine dose, according to a vaccine tracker maintained by The New York Times. Governor Inslee has said that all restrictions in his state will be lifted no later than June 30 as well.

Local officials in the Northwest have tried to balance pandemic safety with the need to provide places for the public to cool off indoors. In Multnomah County, Ore., which includes Portland, people have been asked to wear face masks and maintain social distance at official cooling centers, including several public libraries with extended hours, movie theaters and the Oregon Convention Center, according to Dr. Jennifer Vines, the county health officer.

People who come in are not being asked about vaccination status, she said, but officials are offering vaccine shots at the convention center for anyone who needs them.

Dr. Vines said that though the coronavirus precautions were important, they were secondary to ensuring that residents can get relief from the record-breaking temperatures.

“Cooling people down is the more immediate life safety issue,” she said.

This is not the first time officials in Oregon have had to weigh competing health crises during the pandemic. Last September, Portland had the worst air quality of any major city in the world because of wildfire smoke, prompting a rapid shift in public health protocols to address that more immediate threat.

“We had been in full-on Covid response, and we suddenly had to do a complete 180 and say, ‘If you have to evacuate, find friends and family — just get inside and close your windows,’” Dr. Vines said on Monday.

“It’s a form of triage,” she added. “Working in our favor right now is that we do have a number of people vaccinated. So that makes me feel a little bit better about putting Covid in the back seat, at least for these few days.”

On the move in Dhaka, Bangladesh, on Monday as the government began to implement new lockdown measures.Credit…Munir Uz Zaman/Agence France-Presse — Getty Images

Bangladesh will return to national lockdown by the end of the week, responding to a wave of infections that on Monday brought its highest single-day death toll of the pandemic so far.

The looming restrictions, imposed in a series of steps, have sent tens of thousands of migrant laborers in Dhaka, the capital and largest city, scrambling to get to their villages in scenes reminiscent of neighboring India’s migrant exodus last year.

The garment industry, which employs 4.5 million people and makes up 80 percent of the country’s exports, will remain open. But other businesses were instructed to limit their operations to minimum levels of required staffing, and almost all public transportation systems are either closing or already closed.

Residents of Dhaka expect to be largely confined to their homes after Thursday, the first day of what the government has called a “hard lockdown,” though how strictly the measures will be implemented remains to be seen. The government has said the army, police, and border guard will be deployed for strict enforcement.

Bangladesh had slowed the spread of the virus with sporadic restrictions and reduced movement while trying to keep much of the economy open. But a fast-spreading wave now, with barely 3 percent of the population vaccinated, has forced officials to take more drastic measures.

The country reported 119 deaths on Monday, the highest daily toll since the pandemic began, while the test positivity rate was over 20 percent. Bangladesh has officially reported a total of nearly 900,000 infections and 14,172 deaths from the virus, though experts believe the true numbers are much higher.

The current lockdown has been gradual. The government stopped trains and long distance buses last week. It also imposed lockdowns in seven districts surrounding Dhaka, aiming to avert a surge there. Shopping malls are closed, and restaurants are limited to takeout orders only.

The full lockdown, initially expected to last one week, begins on Thursday. All transportation systems except for auto-rickshaws will be shut.

The government has instructed garment factory owners to arrange transportation for their workers during previous rounds of restrictions. When the public transportation was shut in April to slow the spread of the virus, factory owners who did not arrange transportation were accused of violating the order, and workers had to walk for miles twice a day to get to work.

As the latest lockdown approached, ferry stations in Dhaka have been swamped by people trying to cross the river to the southern districts.

New cases overnight prompted the state of Queensland, Australia, to issue a lockdown order for its capital, Brisbane.Credit…Darren England/EPA, via Shutterstock

After months with hardly any community transmission of the coronavirus, Australia is facing a grim and unfamiliar challenge: simultaneous outbreaks in several parts of the country, fueled by the spread of the highly infectious Delta variant.

On Tuesday, the state of Queensland announced a three-day lockdown in the capital, Brisbane, and surrounding areas. The announcement came after two positive coronavirus cases were detected in the community overnight, including a woman working as a receptionist at a hospital’s coronavirus ward who had not been vaccinated.

The most notable outbreak centered in Sydney, Australia’s most populous city, which is now in at least a two-week lockdown and reported 18 new cases on Monday, bringing its total to 130. Other states across Australia also reported new cases and toughened restrictions, and an expansion of Australia’s lagging vaccination program was announced after an emergency cabinet meeting.

Tens of thousands of people in the state of New South Wales, which includes Sydney, rushed to get tested for the coronavirus, with more than 300 locations around Sydney having been identified as visited by people who were infectious.

That raised concerns that the outbreak is far from over. Still, no deaths from the new outbreak have been recorded, and no one in Australia has died from the virus this year. Two people are in intensive care, and officials encouraged everyone who is eligible for a vaccine to line up for one — and otherwise, stay home.

Not everyone heeded that warning, and one case in particular made much of Australia smile.

Two nude sunbathers were caught violating lockdown rules when a deer chased them from their beach. The two men were found by emergency responders, separately, at about 6 p.m. on Sunday, after one of them called for help, according to a police statement. Each were fined 1,000 Australian dollars ($758).

As news of the case traveled across the country, Mark McGowan, the premier of Western Australia, joked: “I hope the deer is OK.”

(An earlier version of this item misidentified Mr. McGowan as Australia’s prime minister.)

Workers refilling oxygen cylinders at a factory in Delhi in early May.Credit…Atul Loke for The New York Times

At 9:45 p.m., alarms blared across the intensive care unit of Jaipur Golden Hospital. Over two dozen patients on ventilators couldn’t breathe. Some flailed their arms and legs. Others cried for help, choking sounds coming from their throats as if they were being strangled.

Mechanics sprinted to the maintenance room to see what was wrong. Nurses grabbed small plastic pumps to fill the lungs of critically ill patients by hand.

It wasn’t enough. Jaipur Golden, a respected hospital in Delhi, had run out of medical oxygen. Over the next seven hours, 21 coronavirus patients died.

“Nobody can forget that night,” said Shaista Nigar, the hospital’s nursing superintendent. “It was a total breakdown.”

Across India, amid a devastating second wave of Covid-19, hospitals ran out of beds and critical supplies, contributing to deaths and worsening an already tragic outbreak. By one count, oxygen shortages alone have killed at least 600 people over the past two months.

India’s leaders knew the country was vulnerable. Yet Prime Minister Narendra Modi’s government and local officials alike failed to prepare for the second wave, according to interviews and a review of government documents by The New York Times.

India is a major producer of compressed oxygen. But the Indian government moved too late to distribute supplies.

State governments feuded over oxygen and seized tankers, creating bottlenecks and delays.

Delhi city officials didn’t build systems to produce or store oxygen and struggled to allocate dwindling supplies. When tight supplies and government missteps led oxygen to run out at Jaipur Golden, some families said the hospital offered no warning.

Without a comprehensive coronavirus plan, Mr. Modi’s government has left much of the burden to states, cities, hospitals and even individuals. The oxygen crisis tragically revealed the limits of a do-it-yourself approach.

That approach will be tested again. Though infections have dropped, a vaccine shortage puts India at risk of a third wave. Without adequate preparations, the second wave’s tragedies could return.

“With an effective surge plan,” said Robert Matiru, a director at Unitaid, a health initiative affiliated with the World Health Organization, “this could have been averted.”

Bruce Springsteen in “Springsteen on Broadway” at the St. James Theater on Saturday night. There will be additional performances of the show through Sept. 4.Credit…Sara Krulwich/The New York Times

In a city whose cultural soul had been closed for more than a year with boarded-up windows and empty streets, it was Bruce Springsteen who called it back to life on Saturday night, his gruff and guttural rasp the first to echo across a Broadway stage to a paying audience in 471 days.

Of course, “Springsteen on Broadway” is no traditional Broadway production. The show consists of a man alone onstage; his ensemble a microphone, a harmonica, a piano and six steel strings stretched across a select slab of spruce wood.

“I am here tonight to provide proof of life,” Springsteen called out early on. It was a line from the monologue of his original show — which ran for 236 performances, in 2017 and 2018 — and now it carried extra weight. That proof, he continued, was “to that ever elusive, never completely believable, particularly these days, us.”

For the “us” that packed inside the St. James Theater — 1,721 filled seats, very few masked people, all vaccinated — that first chord from “Growin’ Up” was indeed proof that the rhythms that moved New York City were emerging from behind a heavy, dark and weighty curtain.

The 15 months that Broadway had been closed were its longest silence in history. In years past, strikes, hurricanes, blizzards and blackouts had managed to tamp down the lights on Broadway only for a few days, weeks or a month.

But the pandemic forced the Theater District into an extensive darkness on March 12 of last year, as New York was quickly becoming the epicenter of the epidemic in the United States.

Though “Springsteen on Broadway” largely hewed to the original incarnation, Mr. Springsteen also tried to make sense of the moment.

“It’s been a long time coming,” he said after finishing the first song, stepping away from the microphone and speaking directly to the crowd. “In 71 years on the planet, I haven’t seen anything like this past year.”

“This is not a get-out-of-jail-free card,” said Wendy Hechtman, who is serving a 15-year prison sentence but was released to home confinement during the pandemic. “But what it is is an opportunity card.”Credit…Hilary Swift for The New York Times

Some 4,000 federal offenders who were part of a mass release last year of nonviolent prisoners to help slow the spread of the coronavirus could soon return to prison — not because they violated the terms of their home confinement, but because the United States appears to be moving past the worst of the pandemic.

In the final days of the Trump administration, the Justice Department issued a memo saying inmates whose sentences lasted beyond the “pandemic emergency period” would have to go back to prison.

But some lawmakers and activists are urging President Biden to revoke the rule and use his executive power to keep the prisoners on home confinement or commute their sentences entirely, arguing that the pandemic offers a glimpse into a different type of punitive system in America, one that would rely far less on incarceration.

Mr. Biden has vowed to make overhauling the criminal justice system a crucial part of his presidency, saying his administration could cut the prison population by more than half and expand programs that offered alternatives to detention.

While the White House has yet to announce a decision about those on home confinement, the administration appears to be following the direction of the Trump-era memo.

Andrew Bates, a spokesman for Mr. Biden, said in a statement that the president was “committed to reducing incarceration and helping people re-enter society,” but he referred questions about the future of those in home confinement to the Justice Department.

The White House revisits the emergency declaration every three months, leaving the former prisoners in a constant state of limbo. The next deadline is in July.

Dan Bourque, an Uber driver in San Francisco, saw Womply’s ads and applied for a loan in mid-April. Seventeen days later, he had a $10,477 deposit in his bank account.Credit…Jim Wilson/The New York Times

Though Congress approved billions in aid for small companies to help them keep paying their employees during the pandemic, it wasn’t reaching the tiniest and neediest businesses.

Then two small companies came out of nowhere and found a way to help those businesses.

They also helped themselves. For their work, the companies stand to collect more than $3 billion in fees, according to a New York Times analysis — far more than any of the 5,200 participating lenders.

One of the companies, Blueacorn, didn’t exist before the pandemic. The other, Womply, founded a decade ago, sold marketing software. But this year, they became the breakout stars of the Paycheck Protection Program.

Blueacorn and Womply aren’t banks, so they couldn’t actually lend any money. Rather, they acted as middlemen, charging into a gap between what big banks wouldn’t do and what small banks couldn’t do.

From late February to May 31, when the program ended, the companies processed 2.3 million loans. Most were for less than $17,000, and the vast majority went to solo ventures, which are more likely to be run by women and people of color.

All that hustle had downsides, however, including widespread customer service failures. And some lenders now have regrets about signing rushed deals that delivered most of the profit to their partners.

Gloria Molina, 28, checked in for her second dose of the vaccine at Samuel Rodgers Health Center in Kansas City, Mo.Credit…Chase Castor for The New York Times

As the country’s vaccination campaign slows and doses go unused, it has suddenly become clear that one of the biggest challenges in reaching mass immunity will be persuading skeptical young adults of all backgrounds to get vaccinated.

Federal officials expressed alarm in recent days about low vaccination rates among Americans in their late teens and 20s, and have blamed them for the country’s all-but-certain failure to reach President Biden’s goal of giving 70 percent of adults at least an initial dose by July 4.

The straightforward sales pitch for older people — a vaccine could very possibly save your life — does not always work on healthy 20-somethings who know they are less likely to face the severest outcomes of Covid.

As public officials race to find ways to entice young adults to get vaccinated, interviews across the country suggest that no single fix is likely to sway these holdouts. Some are staunchly opposed. Others are merely uninterested. And still others are skeptical.

But pretty much everyone who was eager for a vaccine already has one, and public health officials now face an overlapping mix of inertia, fear, busy schedules and misinformation as they try to cajole Gen Z into getting a shot.

Public health experts say vaccinating young adults is essential to keeping infection numbers low and preventing new case outbreaks, especially as the more infectious Delta variant spreads.

Since vaccines became available six months ago, health departments have focused with varying degrees of success on urging groups identified as reluctant — including people living in rural communities, African American residents, conservatives — to get vaccinated.

But in recent days, public health officials have identified young adults as a significant challenge for a country where fewer than a million people a day are receiving a vaccine, down from an April peak of more than 3.3 million.

In a federal report released last week, just over one-third of adults ages 18 to 39 reported being vaccinated, with especially low rates among Black people; among people 24 or younger; and among those who had lower incomes, less education and no health insurance.

Global Roundup

Tourists enjoying the beach at the Spanish Balearic Island of Mallorca, Spain, this month.Credit…Francisco Ubilla/Associated Press

Prime Minister Pedro Sánchez of Spain announced on Monday that British visitors would have to present a negative Covid-19 test or proof of full vaccination, bowing to concerns about a massive influx of summer tourists from Britain, which has been grappling with the Delta variant of the disease.

Last week, the British government added Spain’s Balearic Islands to its “green list” of countries and territories from which British visitors can return without quarantining, providing a major lift to the islands’ tourism-dependent economies.

But the authorities on the islands then asked Spain’s central government for tougher screening measures for arrivals from Britain. Sensitivities were also raised after an outbreak among hundreds of Spanish students who were visiting Mallorca, the largest of the islands, to celebrate the end of their academic year.

Spain lifted restrictions on British visitors on May 24, just as Germany, France and some other European countries reintroduced quarantine rules for the British in order to avoid the spread of the Delta variant. Since then, Germany and France have pushed for a British quarantine obligation to be applied across the European Union, but so far to no avail, as countries like Spain rely heavily on British visitors in the summer tourism season.

In other news from around the world:

  • Italy said on Monday that people were no longer required to wear masks outside, joining Spain and France in relaxing the rules as cases dropped. Masks must still be worn indoors and in crowded areas. In Rome, many still wore masks on Monday, citing concerns about the Delta variant, but some took advantage of the new rules. “It feels like freedom,” said Francesca Tronconi, a tour guide, as she crossed Piazza Navona with her mask around her arm.

  • Young people in Greece will be offered an incentive to get vaccinated, Prime Minister Kyriakos Mitsotakis said on Monday, in the form of a “freedom pass” of 150 euros, about $180, in prepaid credit to be spent on tourism, culture and travel. The pass will be available from July 15 for people ages 18 to 25 who have had at least one shot. “It is a thank you to youngsters for their patience and persistence and an incentive to get inoculated,” Mr. Mitsotakis said.

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