Struggles over vaccine mandates, the death of Colin Powell: the week in Covid news.

As tens of millions of Americans remain unvaccinated, state and local governments have introduced mandates requiring public employees be fully inoculated against the coronavirus. And while orders in some localities have translated into a last minute surge in vaccination rates, they are also met with steadfast refusal, leading to legal challenges or concerns over staffing issues.

Washington State’s mandate, one of the strictest in the country, went into effect on Monday. The order requires more than 800,000 public workers to be fully inoculated against the coronavirus, save for a religious or medical exemption, or risk losing their jobs. Yet as the mandate kicked in, some resistance remained firm.

The Washington State Patrol announced that 127 employees left the agency, or just under 6 percent of its work force. In one high profile case, Washington State University fired its football coach, Nick Rolovich, and four of his assistants, for their failure to comply.

Similar issues are playing out elsewhere across the country. In New York City, Mayor Bill de Blasio took one of his administration’s most aggressive steps yet by requiring that all municipal workers get at least one shot by the end of the month or risk losing their paychecks. The order was met with mixed reactions from unions representing those workers, though many agree that the move could burden city agencies by leading to widespread resignations or early retirements.

Nursing homes, hit hard by the pandemic, are also struggling with low vaccination rates among staff. Some operators across the country are waiting for the federal government to issue new rules around a mandatory vaccination program for their staffs, like the one President Biden announced two months ago for workers at facilities receiving federal funding, while other facilities and labor groups are still pushing for a testing alternative for their employees.

Here’s what else happened this week:

• Widespread public mistrust of the Russian government has translated into skepticism about coronavirus vaccines, experts say, leaving the country vulnerable to a surge in new cases that are now setting records for severity. For the first time in the pandemic, Russia recorded more than 1,000 deaths in a 24-hour period, though skepticism about the validity of the official numbers remains high. President Vladimir Putin announced a national “nonworking week” to begin next Saturday, and even stricter measures were planned in Moscow, including a citywide lockdown starting next Thursday.

• The World Health Organization warned that health care workers around the world are nearing a breaking point. Health care employees are plagued by anxiety, burnout, illness and death on the front lines, the agency said, and countries need to do more to protect them. In the United States, a group representing more than 3,000 local health departments urged the Justice Department to protect public health care workers who have faced threats of violence and harassment since the onset of the pandemic.

• A New York Times review of hundreds of health departments in all 50 states indicates that local public health departments across the country are less equipped to confront a pandemic now than at the beginning of 2020. The Covid death toll in the United States has now surpassed 735,000.

• Post-vaccination infections made headlines. Former Secretary of State Colin Powell, who was vaccinated but dealing with cancer, died on Monday from Covid-19 complications. Two other vaccinated figures tested positive: the Fox News anchor Neil Cavuto, and the director of homeland security, Alejandro Mayorkas.

• In a joint statement on Tuesday, leading U.S. medical groups declared a national emergency in child and adolescent mental health triggered by prolonged isolation, uncertainty and grief during the coronavirus pandemic, worsening an existing mental health crisis among children and teens.