The U.S. Virgin Islands face their worst surge since the start of the pandemic.

As coronavirus cases and hospitalizations rise across the country, some areas with low vaccination rates have been hit hard, like Louisiana, Florida and Mississippi.

The same is true for the U.S. Virgin Islands, where only about a third of residents are vaccinated. In recent days, the islands have seen their highest numbers of confirmed cases and hospitalizations since the start of the pandemic.

The islands, a popular tourist destination with a year-round population of about 106,000, are now in the top 20 U.S. states and territories for cases per capita, according to a New York Times database.

Active cases have been ticking up for weeks, rising from around 60 at the beginning of July to a high of 401 on Friday, according to data from the islands’ Department of Health. Before this summer’s surge, the highest number of active cases was 295, reported nearly a year ago. Only 37 percent of the population was fully vaccinated as of Saturday, trailing every state but Mississippi and Alabama, according to federal data.

Richard Motta Jr., communications director for the territory’s governor, Albert Bryan Jr., said in a telephone interview early last week that there were 26 Covid hospitalizations, more than at any time since the pandemic response on the islands began in March 2020.

Mr. Motta attributed the lagging vaccination rate to misinformation, a segment of the islands’ population that is deeply suspicious of vaccines and the fact that the shots are not yet fully approved but are being administered under emergency use authorizations.

The islands have set up a lottery to incentivize vaccinations, Mr. Motta said, and shots or regular testing are required for the roughly 6,000 government employees, the staff members at the territory’s hospitals, as well as students and workers at the University of the Virgin Islands.

The islands made vaccines available to all adults when much of the country still limited them to high-risk groups, leading some Americans to visit in order to be inoculated.

All deaths and hospitalizations recorded in the islands involve unvaccinated people, Mr. Motta said, and the few documented breakthrough infections were not serious — more evidence that vaccines offer high protection from the worst outcomes.

The islands have stricter precautions than much of the mainland, including an indoor mask mandate, social distancing rules and a curfew on beaches and businesses.

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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