Dr. Anthony S. Fauci said on Sunday that he was open to relaxing indoor masking rules as more Americans get vaccinated against the virus, just two days after the Centers for Disease Control and Prevention belatedly emphasized the danger of airborne transmission.
Dr. Fauci, President Biden’s chief medical adviser for the pandemic, said that as vaccinations climb, “we do need to start being more liberal” in terms of rules for wearing masks indoors, though he noted that the nation was still averaging about 43,000 cases of the virus daily. “We’ve got to get it much, much lower than that,” he said.
On Friday, the C.D.C. updated its guidance about how the coronavirus spreads, stating explicitly that people can inhale airborne virus even when they are more than six feet away from an infected individual. Previously, the agency had said that most infections were acquired through “close contact, not airborne transmission.”
The update brought the agency in line with evidence of the danger from airborne droplets that epidemiologists had noted as the pandemic unfolded last year, and, according to some experts, also underscored the urgency for the federal Occupational Safety and Health Administration to issue standards for employers to address potential airborne hazards in the workplace.
Dr. Fauci’s comments on Sunday came in response to a question about comments that Dr. Scott Gottlieb, the former head of the Food and Drug Administration, made last week on CNBC. He said that relaxing indoor mask mandates now — “especially in environments where you know you have a high level of vaccination”— would give public health officials “the credibility to implement them” again in the fall or winter if cases surge again.
Dr. Fauci, asked by George Stephanopoulos on ABC’s Sunday program “This Week” whether he agreed, said: “I think so, and I think you’re going to probably be seeing that as we go along, and as more people get vaccinated.”
“The C.D.C. will be, almost in real time, George, updating their recommendations and their guidelines,” Dr. Fauci continued. “But yes, we do need to start being more liberal as we get more people vaccinated.”
Over a third of the U.S. population — more than 112 million people — is fully vaccinated and another 40 million people have received the first dose of a two-dose protocol.
The C.D.C., which issues national guidance on masking, says that even vaccinated people should continue to wear masks in indoor public spaces, including restaurants when they are not actively eating and drinking. In many places across the country, it is clear that the guidance is not being followed.
In a separate interview on Sunday, on CNN’s “State of the Union,” Jeffrey Zients, Mr. Biden’s Covid response coordinator, was somewhat more circumspect than Dr. Fauci when asked about Dr. Gottlieb’s comments.
“I think everyone is tired, and wearing a mask is — it can be a pain.” Mr. Zients said. “But we’re getting there. And the light at the end of the tunnel is brighter and brighter. Let’s keep up our guard. Let’s follow the C.D.C. guidance. And the C.D.C. guidance across time will allow vaccinated people more and more privileges to take off that mask.”
Mr. Zients also suggested that instead of reaching herd immunity — the point when enough people are immune to the virus that it can no longer spread through the population — the goal should be to achieve some sense of normalcy by getting 70 percent of Americans immunized. President Biden has called for 70 percent to have at least one dose by July 4.
Reaching 70 percent will create “a pattern of decreasing cases, hospitalizations and deaths and take us down to a sustainable low level,” Mr. Zients said, pointing to Israel, a world leader in vaccinations, as a model.
In that country, vaccinations have reached almost 60 percent of the population since they began on Dec. 19 last year, and the seven-day average of new cases has dropped from a high of more than 8,600 on Jan. 17 to fewer than 60 as of Saturday.
Vaccinations are picking up pace in the European Union, a stunning turnaround after the bloc’s immunization drive stalled for months.
On average over the last week, nearly three million doses of the Covid-19 vaccine were being administered each day in the European Union, a group of 27 nations, according to Our World in Data, a University of Oxford database. Adjusted for population, the rate is roughly equivalent to the number of shots given each day in the United States, where demand has been falling.
Last month, Ursula von der Leyen, the European Commission president, said that Pfizer had agreed to an early shipment of doses that she said should likely allow the bloc to reach its goal of inoculating 70 percent of adults by the end of the summer. The European Union is also on the verge of announcing a deal with Pfizer and its German partner BioNTech for 2022 and 2023 that will lock in 1.8 billion doses for boosters, variants and children’s vaccines.
The United States moved aggressively under the Trump administration’s Operation Warp Speed to procure millions of doses by funding and prodding vaccine production. But the European Union, rather than partnering with drugmakers as the United States did, acted more like a customer than an investor.
“I think it is overdue that the E.U. has stepped up their vaccination campaign,” said Beate Kampmann, director of the Vaccine Center at the London School of Hygiene and Tropical Medicine.
“I think in the context of the rate of deaths we’ve seen and new cases we’ve seen in the E.U., it is absolutely vital that we get the vaccine to people there very, very quickly,” she added.
The E.U.’s increase underscores the global disparities in vaccination efforts.
About 83 percent of Covid shots have been given in high- and upper-middle-income countries, while only 0.3 percent of doses have been given in low-income countries. In North America, more than 30 percent of people have received at least one dose, according to Our World in Data. In Europe, the figure is nearly 24 percent. In Africa, it’s slightly more than 1 percent.
Experts warn that if the virus can run rampant in much of the world, untamed by vaccines, dangerous variants will continue to evolve and spread, threatening all countries.
Last week, the Biden administration said it supported waiving intellectual property protections for Covid vaccines, which would need approval from the World Trade Organization. And even then, experts warn that pharmaceutical companies around the world would need technological help to make the vaccines and time to ramp up production.
European leaders like Ms. von der Leyen and President Emmanuel Macron have made it clear they think President Biden should take a different approach, and instead lift export restrictions on vaccines, which the United States has employed to keep most doses for use domestically. “We call upon all vaccine-producing countries to allow export and to avoid measures that disrupt the supply chains,” Ms. von der Leyen said in a speech last week.
But the matter is not so absolute, said Dr. Thomas Tsai, a professor who researches health policy at Harvard University. “What’s really needed is an all-of-the-above approach,” he said. Waiving patents is a big long-term step, he said, but lifting export bans would provide help sooner.
“There is a need to move toward a more comprehensive strategy” in vaccinating the world, Dr. Tsai said. “We need that same sort of Warp Speed type of commitment. It’s an investment.”
Dr. Anthony S. Fauci, the Biden administration’s top adviser on Covid-19, said on Sunday that the United States and other countries, as well as vaccine manufacturers, particularly need to help address the crisis right now in India, where less than 10 percent of the vast population is at least partly vaccinated as the country battles a devastating virus wave.
“Other countries need to chip in to be able to get either supplies to the Indians to make their own vaccines or to get vaccines donated,” Dr. Fauci said on ABC’s “This Week.” “One of the ways to do that is to have the big companies that have the capability to make vaccines to really scale up in a great way, to get literally hundreds of millions of doses to be able to get to them.”
ISTANBUL — Turkey’s health ministry on Saturday reported fewer than 20,000 new coronavirus cases in the previous 24 hours, a first since mid-March and 10 days into a lockdown.
The health ministry data shows 18,052 new cases and 281 new Covid deaths. The country’s seven-day average of new cases has been falling since April 20, when it hit a peak of more than 60,260 from fewer than 10,000 on March 3, according to data from the Our World in Data project at the University of Oxford. The plunge in new cases has been equally sharp, dropping to fewer than 24,000 as of Saturday.
Deaths, which lag infections by weeks, have only just begun to fall. The seven-day average peaked on May 2 at more than 355 and has now dropped to just over 320.
In what President Recep Tayyip Erdogan billed as a full lockdown, the government ordered nonessential workers to stay home, except to go to the nearest grocery store, starting on April 29, to last for almost three weeks. Day-care centers and kindergartens are open only for the children of workers exempt from the curfew.
However, a confederation of labor unions, known as DISK, estimated that 61 percent of the country’s workers are employed in exempted sectors, including manufacturing, construction, agriculture and transportation. In major cities like Istanbul, public transportation has been crowded, and there are traffic jams.
Turkey so far has fully vaccinated 10.3 million people, or about 12 percent of its population of 83 million; roughly three million people more have received their first dose, according to Our World in Data. The country mainly uses CoronaVac, developed in China, and has also distributed a small number of doses of the Pfizer-BioNtech vaccine.
Facing difficulties in securing enough vaccine, Turkey has resorted to postponing second doses. On April 12, the health minister, Fahrettin Koca, said 30 million more doses of the Pfizer-BioNtech would arrive in June. On April 28, he announced a deal to import 50 million doses of the Sputnik V vaccine from Russia within six months.
NEW DELHI — Doctors in India are concerned about an increasing number of potentially fatal fungal infections affecting either people who have Covid-19 or those who have recently recovered from the disease.
The condition, known as mucormycosis, has a high mortality rate and was present in India before the pandemic. It is caused by a mold that thrives in wet environments and can attack through the respiratory tract, potentially eroding facial structures and harming the brain.
The condition is relatively rare, but doctors and medical experts say it seems to be infecting some Covid patients whose weakened immune systems and underlying conditions, particularly diabetes, leave them vulnerable.
Some experts attribute the fungal infections to an increased use of steroids to treat hospitalized patients. Another factor could be that, with hospitals overwhelmed in this second wave of the pandemic, many families are self-medicating and applying oxygen therapy at home without the proper hygiene, experts say.
In the western state of Maharashtra, which includes the commercial hub of Mumbai and has been badly devastated by the pandemic, local news media reported that around 200 patients who had recovered from Covid were being treated for mucormycosis and that eight had died.
In Gujarat, a western state north of Maharashtra, the state government ordered the allocation of separate wards in hospitals for the treatment of the infection, and said it had put purchase orders for 5,000 doses of amphotericin b, a medicine used to treat it. Infections have also been reported in hospitals in the country’s capital, New Delhi.
Health experts are keeping close tabs on the situation. “We have heard that in some areas, people who are Covid-infected or recovered suffer from mucormycosis, but there is not big outbreak of it,” Dr. V.K. Paul, who heads India’s Covid task force, said last week. “We are watching and monitoring.”
“It is a fungus that has a strong relation to diabetes,” he added. “If the person is not diabetic, it is very uncommon that the person would have mucormycosis.”
Many less populous countries have higher percentages of diabetes, but only one — China, with a population even larger than India’s 1.38 billion — has a higher raw number of diabetics. In India, more than 10 percent of the adult population has the condition, or 77 million people. China has more than 116 million adult diabetics, or 9 percent, according to the 2019 International Diabetes Foundation Atlas.
Dr. K. Srinath Reddy, who leads the Public Health Foundation of India, said a large number of the recent reported mucormycosis cases are of hospitalized coronavirus patients who have been discharged after their recovery.
“You are using steroids to reduce the hyperimmune response, which is there in Covid,” Dr. Reddy said. “But you are reducing the resistance to other infections.”
Several states are turning away Covid vaccine doses from their federal government allocations, as the daily average of coronavirus vaccine doses administered across the United States has fallen below two million for the first time since early March. Experts say the states’ smaller requests reflect a steep drop in vaccine demand in the United States.
Wisconsin officials have asked for just 8 percent of the 162,680 doses the federal government had set aside for the state next week, according to The Associated Press. In Iowa, officials asked for just 29 percent of the state’s allocated doses. And in Illinois, the state is planning to request just 9 percent of its allotted doses for everywhere, except for Chicago, for next week, The A.P. reported.
North Carolina, South Carolina, Washington State and Connecticut are also scaling back on their vaccine requests.
As demand falls and the spread of the virus slows in the United States, the Biden administration is under increasing pressure to share vaccine doses with countries like India, which has been ravaged by a catastrophic surge. About 83 percent of shots have been administered in high- and upper-middle-income countries, while only 0.3 percent of doses have been given in low-income countries.
Dr. Amesh A. Adalja, an infectious disease physician at the Johns Hopkins Center for Health Security, said that a shift in U.S. demand was expected. After people who were most eager to be vaccinated had shots, he said, the rollout of vaccines “was going to be a much more challenging prospect.”
There remain people who are hesitant to take the vaccine or may have other reasons for not doing so, and that has led to a drop in demand, Dr. Adalja said. Nationwide, since a mid-April peak of some 3.38 million doses administered each day, daily average doses have fallen by about 41 percent. In turn, that has left states ordering fewer doses than they had at first.
But some places, like New York City, Maryland and Colorado, are still asking for the full amount, The A.P. found.
To increase demand once more, officials need to make it as convenient as possible, Dr. Adalja said, including expanding the availability of walk-in clinics and even door-to-door vaccinations.
The Johnson & Johnson vaccine is notably convenient, since it’s only one dose, and can be stored at normal refrigeration temperatures for at least three months, making its distribution considerably easier. But allocations of that have remained low nationally after a pause over extremely rare cases of blood clots was lifted last month, and that has contributed to the drop in vaccinations being given more broadly.
“Once you paused the vaccine, it was going to be very hard to unpause it,” Dr. Adalja said.
President Biden, confronting lagging vaccinations, has shifted the administration’s strategy to battle the pandemic. Changes include creating a federal stockpile of vaccine doses to given to states as needed, instead of strictly by population, and investing millions in community outreach to target underserved communities, younger Americans and those hesitant to get shots.
Mass vaccination sites will wind down in favor of smaller settings. Pharmacies will allow people to walk in for shots, and pop-up and mobile clinics will distribute vaccines, especially in rural areas. Federal officials also plan to enlist the help of family doctors and other emissaries who are trusted voices in their communities.
Dr. Adalja suggested that federal health guidance should take care to avoid “underselling the vaccine” as the nation tries to get more people vaccinated. Guidance on issues such as traveling and mask-wearing can be loosened “aggressively” for vaccinated people, Dr. Adalja said. “They seem to be several steps behind what infectious disease doctors like myself are telling people that are fully vaccinated what they can do.”
Experts warn that states where vaccinations are falling behind — particularly in the South — could be especially prone to outbreaks in the weeks ahead as more contagious virus variants spread. Texas and North Carolina are trailing the national average in vaccinations, with about 40 percent of people receiving at least one shot. In Alabama, Mississippi and Louisiana, about a third of residents have gotten their first shot.
When the pandemic hit New York City last March, Griselda San Martin, a documentary photographer, had a 5-month-old baby. She talked with other new mothers about how afraid and frustrated they felt. To capture their experiences, she began photographing the mothers and their babies in parks across the city, in poses that echo the iconic “Madonna and Child,” and asked the women to write letters to their children.
Even though the coronavirus seems to be in retreat in the United States as vaccinations continue, many school superintendents say fear of the virus itself is no longer the primary reason their students are opting out. Nor are many families expressing a strong preference for remote learning.
Rather, for every child and parent who has leapt at the opportunity to return to the classroom, others changed their lives over the past year in ways that make going back to school difficult. The consequences are likely to reverberate through the education system for years, especially if states and districts continue to give students the choice to attend school remotely.
Experts have coined the term “school hesitancy” to describe the remarkably durable resistance to a return to traditional learning.