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San Francisco will require proof of vaccination for many indoor activities, like visiting restaurants, bars and gyms, The A.P. reports.

The F.D.A. is expected to authorize a third dose of a vaccine for some people with weak immune systems.

The Department of Health and Human Services will mandate vaccines for its more than 25,000 health workers.

Get the latest updates here, as well as maps and a vaccine tracker.

Texas hospitals are on the brink, again

A surge of Covid-19 cases driven by the Delta variant is hobbling the health care system in Texas, where health officials are warning of overloaded hospitals, a dangerous crisis which the state also experienced in early February.

In Houston, at least two hospitals have erected overflow tents outside. In Austin, hospitals are nearly out of beds in their intensive care units. And in San Antonio, children as young as 2 months old are tethered to supplemental oxygen.

My colleague Edgar Sandoval, who covers South Texas for The Times, recently reported from inside a San Antonio hospital. He told us that the strength of the surge left many in the state flat-footed.

“They were kind of caught off guard this time around,” Edgar said. “People in South Texas, like the rest of the country, thought that the virus was behind them. And even the experts believed that, even if they were going to have surges from the Delta variant, they were going to be able to manage it. But in the last couple of weeks we’ve seen an explosion of cases. Medical officials in Texas are — as we speak — still trying to figure out how to handle this coming surge.”

More than 10,000 Texans have been hospitalized this week and at least 53 hospitals were at maximum capacity in their intensive care units. Hospitals are being taxed across the South in places like Huntsville, Ala., Jackson, Miss., New Orleans and Miami. As with previous waves this summer in Florida, Louisiana and Arkansas, the vast majority of patients who are hospitalized in Texas are not vaccinated.

The surge also comes as the state’s governor, Greg Abbott, refuses to enact any statewide mandates requiring masks while prohibiting local officials from doing so. To help manage the surge, Abbott has instead asked health care workers outside the state to travel to Texas and help the overloaded hospitals.

Some health officials have blamed the state for not putting enough government effort toward increasing vaccination rates, which Abbott has framed as an issue of individual rights.

Still, local officials in some of Texas’ largest cities, including San Antonio, Houston, Dallas and Austin, have defied Abbott’s orders and issued new mask requirements in city buildings and schools, citing community spread and low vaccination rates.

The worst is also far from over for Texas. According to the University of Texas at Austin Covid-19 Modeling Consortium, the number of coronavirus-related hospitalizations across the state is projected to climb to well over 15,000 by the end of this month.

“Hospitals are trying to figure out day by day how to manage the flow of people,” Edgar said, such as treating patients in waiting rooms because of a shortage of beds. “I’m surprised there was no plan implemented after the last surge,” Edgar said. “But here we are.”

Latest Updates

Who should be wearing masks?

Last month, as the contagious Delta variant spread, the C.D.C. workshopped its advice. One internal presentation obtained by The Times had a clear recommendation: “Given higher transmissibility and current vaccine coverage, universal masking is essential.”

But the agency’s ultimate guidance was more nuanced. The C.D.C. advised masking in indoor public settings in communities with “substantial” or “high” transmission, regardless of a person’s vaccination status.

Looking back, some experts think the agency should have just gone with a nationwide call to wear masks indoors.

“The messaging from the C.D.C. was less than optimal,” said Dr. Ezekiel Emanuel, vice president for global initiatives at the University of Pennsylvania. “We need to be clear and relatively simple about it.”

Understand the State of Vaccine and Mask Mandates in the U.S.

• • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
  • Vaccine rules . . . and businesses. Private companies are increasingly mandating coronavirus vaccines for employees, with varying approaches. Such mandates are legally allowed and have been upheld in court challenges.
  • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
  • Schools. On Aug. 11, California announced that it would require teachers and staff of both public and private schools to be vaccinated or face regular testing, the first state in the nation to do so. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.  
  • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
  • New York. On Aug. 3, Mayor Bill de Blasio of New York announced that proof of vaccination would be required of workers and customers for indoor dining, gyms, performances and other indoor situations, becoming the first U.S. city to require vaccines for a broad range of activities. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
  • At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

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