Get shots or weekly testing, California, NYC workers told

Gov. Gavin Newsom holds a face mask while speaking at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom holds a face mask while speaking at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)

California and New York City announced Monday that they would require all government employees to get the coronavirus vaccine or face weekly covid-19 testing, and the Department of Veterans Affairs became the first major federal agency to require health care workers to receive the shot.

Meanwhile, in a possible sign that increasingly dire health warnings are getting through to more Americans, vaccination rates began to creep up again, offering hope that the nation could yet break free of the coronavirus if people who have been reluctant to receive the shot are finally inoculated.

The announcements are the "opening of the floodgates" as more government entities and companies impose vaccine mandates after nationwide vaccination efforts "hit a wall," said Dr. Ashish Jha, dean of Brown University's School of Public Health.

"Some people find mask mandates annoying, but the reality is they're temporary. We can't do them forever," he said. "Vaccine mandates have to be one of the major paths moving forward because they get us closer to the finish line. Mask mandates just buy you a little more time."

In New York City, Mayor Bill de Blasio announced that all municipal workers -- including teachers and police officers -- will be required to get vaccinated by mid-September or face weekly testing, making the city one of the largest employers in the U.S. to take such action.

California said it will similarly require proof of vaccination or weekly testing for all state workers and millions of public- and private-sector health care employees starting next month.

The VA's move came on a day when nearly 60 leading medical and health care organizations issued a call through the American Medical Association for health care facilities to require their workers to get vaccinated.

It was unclear what would happen to employees who refuse to comply.

The longstanding policy in the health care industry is for staff to stay up-to-date with vaccinations, such as annual flu shots, but a general rule also allows exceptions for medical reasons, such as allergies.

Elsewhere, St. Louis became the second major city to mandate that masks be worn indoors, regardless of vaccination status, joining Los Angeles in reimposing the orders.

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"For those who are vaccinated, this may feel like punishment, punishment for doing the right thing," St. Louis County Executive Sam Page, a Democrat, said Monday. "I've heard that, and I feel that frustration."

President Joe Biden should "lead by example" and impose further mandates on the federal workforce and in public venues where the government has jurisdiction, including in planes, trains and federal buildings, said Dr. Leana Wen, a former Baltimore health commissioner.

"We need vaccine mandates and vaccine verification," she said. "We're well past the time for the Biden administration to get on board with this. What we're doing is not working. Doing more of the same is not the answer here."

The administration has so far recommended that unvaccinated people keep wearing masks indoors, but top officials over the weekend said they are considering recommending that the vaccinated also wear them indoors.

"We're going in the wrong direction," Dr. Anthony Fauci, the nation's top infectious disease expert, said Sunday.

Wen, who is also an emergency physician and a professor at George Washington University, said public health experts have worried for months about this very scenario.

"We were worried the honor system would not work, the unvaccinated would be behaving as if they're vaccinated, and people would think the pandemic is over," she said. "That's precisely what has happened, and it's incredibly frustrating."

The U.S. should not have been caught off-guard after watching the delta variant ravage India in May and then land in the United Kingdom, Israel and other highly vaccinated nations with force last month, added Dr. Albert Ko, an infectious disease specialist at Yale's School of Public Health.

"We have learned multiple times to not take anything for granted with covid," he said.

Jha said Americans should brace for another rough few months of covid, which has already claimed nearly 611,000 lives in the U.S.

"I really thought this would be a fabulous summer, but I underestimated the misinformation campaign that was coming," he said Monday. "What were the chances that after more than half a million Americans dead, that one-third of the country would still not want to end the pandemic?"

Vaccinations ticked up over the weekend, with about 657,000 vaccines reported administered Saturday and nearly 780,000 on Sunday, according to CDC data. The seven-day rolling average on Sunday was about 583,000 vaccinations a day, up from about 525,000 the previous week.

Public health experts Monday said the uptick is encouraging but warned that it's far too early to say if millions of unvaccinated people are finally overcoming their reticence.

"I wish I could say yes, but I honestly don't know," said Ko. "There is a lot of ground to cover."

The U.S. is around 67% immune from covid-19 when prior infections are factored in, but it will need to get closer to 85% to crush the resurgent virus, Jha said.

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"So we need a lot more vaccinations. Or a lot more infections," he said.

The seven-day rolling average for daily new cases in the country shot up over the past two weeks, from more than 19,000 on July 11 to nearly 52,000 on July 25, according to data from Johns Hopkins University.

Health experts said they are hopeful that some of the prominent conservative and Republican voices that have spent months casting doubt on the vaccination effort are finally willing to help move the needle.

Facebook also needs to do a better job cleaning up misinformation, Jha said. And he said the Food and Drug Administration needs to fully approve the vaccines, which currently have only emergency approval.

"FDA approval matters a lot," Jha said. "It's absurd at this point. The safety and efficacy of these drugs has been well-documented."

MASK-RULE LAWSUIT

The attorney general in Missouri has sued in an effort to halt a mask mandate that took effect Monday in the St. Louis area amid a rise in covid-19 cases that are burdening a growing number of hospitals around the state.

The mandate, one of the first to be reinstated in the country, requires everyone 5 and older to wear masks in indoor public places and on public transportation in St. Louis city and St. Louis County even if they are vaccinated. Wearing masks outdoors is strongly encouraged, especially in group settings.

But the lawsuit said the mandate "undermines the important push for vaccinations" and that mandating children to wear masks in school is arbitrary and capricious because they are less likely to become seriously ill.

"This continued government overreach is unacceptable and unconstitutional, especially in the face of a widely available vaccine," Attorney General Eric Schmitt said.

St. Louis Mayor Tishaura Jones said Schmitt, who is seeking the GOP nomination for U.S. Senate, would not be successful in his legal challenge. She noted that last year he filed an unsuccessful lawsuit against the Chinese government, alleging that its officials are to blame for the pandemic.

"I wish that he would put more of his attention toward serving the people of the state of Missouri," she said, "and holding our health and safety paramount instead of filing frivolous lawsuits that waste taxpayer dollars."

MASKED IN GEORGIA

The largest city on Georgia's coast has reimposed a requirement that people wear masks in some public settings, citing a "steep and alarming rise" in cases of covid-19.

Savannah Mayor Van Johnson made the announcement Monday, saying people now must wear masks anytime they are indoors with people who are not members of their immediate families.

However, the order says it applies only to city buildings, child care centers, hospitals, public transit and tourism vehicles. The order says masks are "strongly advised" in businesses and "highly recommended" during religious services. That's less strict than Savannah's earlier order.

Also Monday, the Bibb County school district became the latest Georgia district to announce that all students and staff must wear masks when indoors, regardless of vaccination status. Other Georgia school districts taking that position include DeKalb County, Clayton County, Atlanta, Rockdale County and Decatur.

"As COVID-19 cases are rising in all 50 states, I want to encourage all Georgians to talk with their doctor and get vaccinated," Gov. Brian Kemp tweeted Monday.

Georgia remains among the eight lowest states by vaccination rate, according to federal data.

VA MANDATE

The Department of Veterans Affairs on Monday became the first federal agency to mandate that frontline workers including physicians, dentists, podiatrists and registered nurses must be vaccinated against the coronavirus.

Veterans Affairs Secretary Denis McDonough said the safety of veterans had driven the decision as new infections surge around the country.

"Since the pandemic began, we have tragically lost tens of thousands of veterans to this deadly disease," said VA spokesperson Randal Noller. "This action is aimed at ensuring that we are doing everything we can to protect our veterans and the system that serves them."

The directive, which gives employees eight weeks to comply, is in line with vaccination requirements that other health care systems and hospitals have implemented, Noller added, citing the statement released Monday from dozens of medical groups calling for all health workers to be vaccinated.

The statement -- issued by many groups urging a mandate for the first time -- represents an increasingly tough stance by the medical and public health establishment amid the sluggish pace of national vaccinations. It comes as new cases rip through the nation, driven by the hyper-transmissible delta variant. Hospital leaders in states such as Alabama, Florida and Missouri have implored holdouts to get vaccinated, citing data that the shots prevent hospitalizations and even death.

"We call for all health care and long-term care employers to require their employees to be vaccinated against covid-19," the American Medical Association, the American Nurses Association and 55 other groups wrote. "The health and safety of U.S. workers, families, communities, and the nation depends on it."

Health leaders said the slowed pace of vaccinations, coupled with the threat of the delta variant, compelled them to act.

"We feel that it's important to sign our name onto this," said Rachel Villanueva, an OB/GYN and president of the National Medical Association, which represents more than 50,000 Black physicians and is calling for a vaccination mandate for the first time.

"We want to continue to dispel myths, educate, increase confidence and increase vaccination rates in our communities," she said.

Ezekiel Emanuel, a bioethicist at the University of Pennsylvania who organized Monday's statement, said he thinks requiring vaccinations could boost uptake of the shots, beginning with health workers.

"Despite everything -- cajoling, making access readily available at any pharmacy, making it free, having the president plead -- all of this hasn't really moved the needle very much in the nation," said Emanuel, who spent two weeks organizing the joint statement and praised the buy-in from so many groups.

"One of the things that resonated with people is, 'Look, we're the medical community. This is a health problem. We need to lead -- and we need to have the courage of our convictions,'" Emanuel said.

Information for this article was contributed by Philip Marcelo, Lindsey Tanner, Alexandra Jaffe, Aamer Madhani, Heather Hollingsworth, Jim Salter, Sarah Blake Morgan, Jeff Amy and Jeff Martin of The Associated Press; and by Dan Diamond of The Washington Post.

Gov. Gavin Newsom, left, speaks with Dr. Mark Ghaly, Secretary of the California Health and Human Services, at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom, left, speaks with Dr. Mark Ghaly, Secretary of the California Health and Human Services, at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom, middle left, speaks at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom, middle left, speaks at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Oakland Mayor Libby Schaaf listens to speakers at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Oakland Mayor Libby Schaaf listens to speakers at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom, from left, Assemblywoman Buffy Wicks, D-Oakland, and Oakland Mayor Libby Schaaf listen to spekers at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom, from left, Assemblywoman Buffy Wicks, D-Oakland, and Oakland Mayor Libby Schaaf listen to spekers at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom speaks at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
Gov. Gavin Newsom speaks at a news conference in Oakland, Calif., Monday, July 26, 2021. California will require state employees and all health care workers to show proof of COVID-19 vaccination or get tested weekly. Officials are tightening restrictions in an effort to slow rising coronavirus infections in the nation's most populous state, mostly among the unvaccinated. (AP Photo/Jeff Chiu)
FILE - A sign advises shoppers to wear masks outside of a store Monday, July 19, 2021, in the Fairfax district of Los Angeles. Infections are climbing across the U.S. and mask mandates and other COVID-19 prevention measures are making a comeback in some places as health officials issue increasingly dire warnings about the highly contagious delta variant. But in a possible sign that the warnings are getting through to more Americans, vaccination rates are creeping up again, offering hope that the nation could yet break free of the coronavirus if people who have been reluctant to receive the shot are finally inoculated. (AP Photo/Marcio Jose Sanchez, File)
FILE - A sign advises shoppers to wear masks outside of a store Monday, July 19, 2021, in the Fairfax district of Los Angeles. Infections are climbing across the U.S. and mask mandates and other COVID-19 prevention measures are making a comeback in some places as health officials issue increasingly dire warnings about the highly contagious delta variant. But in a possible sign that the warnings are getting through to more Americans, vaccination rates are creeping up again, offering hope that the nation could yet break free of the coronavirus if people who have been reluctant to receive the shot are finally inoculated. (AP Photo/Marcio Jose Sanchez, File)
FILE- A health care worker fills a syringe with the Pfizer COVID-19 vaccine, Thursday, July 22, 2021, at the American Museum of Natural History in New York. The number of Americans getting a COVID-19 vaccine has been rising in recent days as virus cases once again surge and officials raise dire warnings about the consequences of remaining unvaccinated.  (AP Photo/Mary Altaffer, File)
FILE- A health care worker fills a syringe with the Pfizer COVID-19 vaccine, Thursday, July 22, 2021, at the American Museum of Natural History in New York. The number of Americans getting a COVID-19 vaccine has been rising in recent days as virus cases once again surge and officials raise dire warnings about the consequences of remaining unvaccinated. (AP Photo/Mary Altaffer, File)
FILE - A health care worker inoculates Evelyn Pereira, right, of Brooklyn, with the first dose of the Pfizer COVID-19 vaccine as her daughter Soile Reyes, 12, looks on, Thursday, July 22, 2021, at the American Museum of Natural History in New York. The number of Americans getting a COVID-19 vaccine has been rising in recent days as virus cases once again surge and officials raise dire warnings about the consequences of remaining.  (AP Photo/Mary Altaffer, File)
FILE - A health care worker inoculates Evelyn Pereira, right, of Brooklyn, with the first dose of the Pfizer COVID-19 vaccine as her daughter Soile Reyes, 12, looks on, Thursday, July 22, 2021, at the American Museum of Natural History in New York. The number of Americans getting a COVID-19 vaccine has been rising in recent days as virus cases once again surge and officials raise dire warnings about the consequences of remaining. (AP Photo/Mary Altaffer, File)
FILE - Carlos Arrendondo arrives for his appointment to get vaccinated, as banners advertise the availability of the Johnson & Johnson and Pfizer COVID-19 vaccines at a county-run vaccination site at the Eugene A. Obregon Park in Los Angeles Thursday, July 22, 2021. The number of Americans getting a COVID-19 vaccine has been rising in recent days as virus cases once again surge and officials raise dire warnings about the consequences of remaining unvaccinated. (AP Photo/Damian Dovarganes, File)
FILE - Carlos Arrendondo arrives for his appointment to get vaccinated, as banners advertise the availability of the Johnson & Johnson and Pfizer COVID-19 vaccines at a county-run vaccination site at the Eugene A. Obregon Park in Los Angeles Thursday, July 22, 2021. The number of Americans getting a COVID-19 vaccine has been rising in recent days as virus cases once again surge and officials raise dire warnings about the consequences of remaining unvaccinated. (AP Photo/Damian Dovarganes, File)

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