| : This is the surge Here's the picture on Monday night. It's focused in certain areas, but stretches across the country.  : New talk of vaccine requirements The Covid spike is racing through Florida and Arkansas, in particular, but also affecting cities like Los Angeles. It's caused by the Delta variant raging through unvaccinated communities and breaking through to some vaccinated people too.
It's tearing open a new debate about how far the government or employers should go to protect their citizens or employees, and to what extent people should be free to make a wrong choice that endangers others.
New York City and the state of California issued a form of vaccine mandate for city or state workers or else they must submit to masking and testing. And the US Department of Veterans Affairs will require medical workers to be vaccinated, signaling a new openness from the Biden administration to vaccine requirements. Read more.
In Florida, the rate of new Covid cases per 100,000 people is more than triple the national rate of 16 new cases per 100,000 people.
Arkansas and Louisiana both have higher rates but, with smaller populations, are contributing far fewer total cases than Florida, where more than 10,000 people have tested positive each day for more than a week, triple the figure of two weeks ago and a quarter of all new Covid cases in the entire US.
Hospitalizations there have more than tripled in July to more than 6,000, testing hospital systems in a way not seen since the spring. Alix Zacharski, a nurse manager in the Covid ICU at Jackson Memorial Hospital in Miami, said Monday on CNN that when sick people come into her ICU asking for the vaccine, it's too late.
"When they come to the ICU is when they can't really breathe, and they're gasping for air. That's when they come into the ICU, and at that point they're just really in really bad shape," she said.
How to get people to get the shot. The answer to the Covid problem, almost everyone -- from doctors and health experts to Republican governors -- seems to agree, is vaccination.
But there is a gulf in the country between those who want to prod or compel vs. those who want to entice and persuade.
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In New York, where case counts are on the rise like most of the country but far from the massive spike in Florida, Gov. Bill de Blasio announced a new requirement for city workers -- 340,000 employees -- to either get the shot or start weekly Covid testing by September 13. The city is unveiling an app for users to maintain vaccination and test-result proof.
In addition, unvaccinated city employees must mask up indoors in New York as of August 2.
St. Louis imposed a new indoor mask requirement for everyone 5 and up, vaccinated or not, following a similar new requirement in Los Angeles. The difference is St. Louis may wind up in a legal standoff with the state's Republican attorney general.
As an either/or, New York City's action allows for some choice between vaccines and testing, but the message is clear to those who make their living with city money: Get the shot.
The city is already a relative vaccine success story -- 59% of the population and 71% of adults have been vaccinated already, de Blasio said. He urged private companies to impose their own version of a vaccine mandate and require masks for the unvaccinated, but he won't try to require it.
"My message to the private sector is: Go as far as you can go right now. Do what you can do," de Blasio said.
At the moment, everything is voluntary. Who knows if that person in front of you in line without a mask has the vaccine.
"I really wish that more businesses would be doing this," said Dr. Leana Wen, a CNN medical analyst, "because otherwise, it's hard for those of us, for example, who are parents of unvaccinated children if we're told that we have to come back to work in person and be sitting shoulder to shoulder with other people who are unvaccinated and we don't know whether they're carrying Covid? That's really dangerous for us, so this is really about protecting people's health and safety."
Many governments, employers, school districts and others may be waiting for the FDA to issue full approval for the vaccines, which are currently being given under emergency use authorization. Though some policymakers and politicians are exasperated at the FDA's pace, the agency is actually moving at record speed on this.
Related: Biden says full FDA approval of Covid vaccine could come by the end of August.
Doing business vs. government mandates. There is certainly a stronger push in Arkansas and Alabama, states harder hit by the Delta variant and with lower vaccination rates, for people who can to do the right thing and protect themselves and others.
But the push stops at guilt.
Alabama's Gov. Kay Ivey made headlines for saying it's time to start blaming the unvaccinated for not doing their part.
Blame, yes. Require, no. Her press secretary tweeted over the weekend that the governor can't make anyone get vaccinated. It's a person's responsibility. "Tip for media who keep pushing the idea of more government mandates: wearing a mask will not defeat the virus," Gina Maiola said on Twitter. "We have a vaccine that works, so, start acting like it. Government cannot force you to take care of yourself."
In Arkansas, Gov. Asa Hutchinson openly blames low vaccination rates for the Covid spike in his state. He's been on a tour of the state, encouraging people to get the shot, and he told CNN's Jake Tapper that encountering hardened opposition to the vaccine through a mandate would be counterproductive.
RELATED: Delta variant has even conservatives talking up the vaccine but reluctance remains
"We're not going to do that, because that would even cause a greater reaction of negativity toward the government and that imposition on freedom," Hutchinson said. He said the vaccine rate in his state, a Covid epicenter, has ticked up recently.
One piece of good news about vaccinations. While the number of vaccinations overall has flattened in the US, CNN's Harry Enten crunched data and argued there is some cause for optimism and vaccinations are increasing in some key places.
"This, to me, is the most interesting part of this," he said Monday on CNN. "Where are vaccinations going up? It's in the states with the most new weekly cases. So take a look. Arkansas, Missouri, all with the exception of Florida on the bottom half of the most vaccinations. Look at the rankings within the last week. ... What we're seeing there is essentially the places where the case numbers are highest at this point, that's where the highest number of new vaccinations are coming from. So people are scared. And because they're scared, they're going out and getting vaccinated." He's got the charts and maps to back up the argument in this video.
Vaccine requirement for health care workers pushed. Perhaps a mandate would not work for the general public, but what about for people working on the Covid front lines? More than 50 health and medical groups -- including the American Medical Association, the American College of Physicians, the American Academy of Pediatrics and the American Public Health Association -- issued a joint statement calling for all health care and long-term care employers to mandate that employees be vaccinated against Covid-19. "This is the logical fulfillment of the ethical commitment of all health care workers to put patients as well as residents of long-term care facilities first and take all steps necessary to ensure their health and well-being," they wrote in the joint statement issued Monday, according to CNN's report.
Mandates backfire. Dr. Seema Yasmin, the author and former CDC disease detective, was asked about such a requirement for health care workers during an appearance on CNN and she argued against the idea, saying it is exactly the wrong time to turn people off from working in health care.
"Health care workers don't differ that much from the general populace," she said of their openness to vaccines. "There are many who work in health care who we need to continue working in health care. We don't want to disenfranchise them."
She also argued that the contradictory messages on masking are contributing to an overall erosion in trust.
"I come back to this point that you can do on a local level what you need to do that's right for your municipality, for your state, but be careful about the messaging. Because at a time when we are losing trust in the public and the public is losing trust in the scientific establishment, we're seeding more confusion," she said.
The French model. The French government has not imposed a strict vaccine mandate for every person, but rather has tied vaccine status or a negative PCR test to a "health pass" and the privilege of eating inside or going to a concert -- and vaccination rates have surged. Health workers must get vaccinated by September 15. Other countries are following suit. CNN's Stephen Collinson has a thoughtful explanation for why a "health pass," already rejected by the Biden administration, wouldn't work in the US. Read it here.
Why Macron's 'Covid pass' wouldn't fly in the US
Meanwhile, America is opening up more and more, with people traveling, congregating inside and outside, and even going to concerts.
Shown pictures of a sea of people in line for a hip-hop festival in Florida, Dr. Erin Bromage, a comparative immunologist at the University of Massachusetts-Dartmouth, said on CNN that in full disclosure he'd also been to a concert over the weekend, and he had helped Dave Matthews Band try to conduct a safe event.
"We're moving to this stage now where everybody in that audience are adults. They've had choices to make on how they protect themselves through the vaccine or maybe they don't have the same risk profile," he said.
The ultimate result could be more masking inside -- That's the question school districts are grappling with.
Dr. Harry Atallah, chief medical officer of Jackon Memorial, said a return to indoor masking could be required to stop the Delta variant.
"There are things that we know that work, right?" he said on CNN. "We did this before ... a lot of people were vaccinated. We had people wear masks. We washed our hands. We socially distanced. We know those things work. I think it's a good idea if we were to follow the science and say we should probably start to mask again. That will help shorten or decrease the number of infections in the community. And it will ultimately help get us out of this situation we're in at the moment."
Dr. Jerome Adams, the US surgeon general under President Donald Trump, predicted a return to some restrictions as he warned about the rise in Covid cases "spiraling out of control."
"More mitigation is coming. Whether it's masking, or whether it's closures or whether it's your kids having to return to virtual learning -- that is coming," he said on CBS.
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