New federal guidance issued on Thursday clears the way for Americans who are fully vaccinated against the coronavirus to drop mask-wearing in most situations. But the guidance came with caveats and confusion, and it sent state and local officials, as well as private companies, scrambling to decide whether and when to update their own rules.
There was plenty of cause for celebration, too, for many Americans weary of restrictions and traumatized by more than a year of a pandemic that has killed more than 583,000 people in the United States and more than 3.3 million around the world.
“We have all longed for this moment,” Dr. Rochelle P. Walensky, the director of the Centers for Disease Control and Prevention, said as she announced the shift at a White House news conference on Thursday. “If you are fully vaccinated, you can start doing the things that you had stopped doing because of the pandemic.”
Fully vaccinated people are still told to cover their faces when flying or taking public transit, when visiting health care facilities, and in congregate settings like prisons and homeless shelters.
The recommendations came as a surprise to many people in public health. They offered a stark contrast with the views of a large majority of epidemiologists surveyed in the last two weeks by The New York Times, who said that until many more Americans were vaccinated, there would be too many chances for vaccines, which are not 100 percent effective, to fail.
“Unless the vaccination rates increase to 80 or 90 percent over the next few months, we should wear masks in large public indoor settings,” said Vivian Towe, a program officer at the Patient-Centered Outcomes Research Institute, an independent nonprofit organization in Washington, D.C.
The new recommendations also caught state officials and businesses by surprise and raised a host of difficult questions about how the guidelines would be carried out. Some states lifted mask mandates immediately, while others took a more cautious approach.
Most of the state officials who responded immediately to the shift were Democrats, and they used the moment to stress the need to get vaccinated to take advantage of greater freedom. Half of the country’s governors — most of them Republicans — had already lifted mask mandates in some form.
On Thursday, the governors of New Jersey, New York, North Carolina and Virginia, and the mayors of New York City and Washington, D.C., all Democrats, said that they were taking the new guidance under advisement before adopting it. Los Angeles County also said that it and the State of California were reviewing the new guidelines. In deference to local authorities, the C.D.C. said vaccinated people must continue to abide by existing state, local or tribal laws and regulations, and to follow local rules for businesses and workplaces.
After the new guidance was announced, at least seven states led by Democrats began to lift mask mandates: Connecticut, Illinois, Kentucky, Minnesota, Nevada, Oregon and Pennsylvania. Others had yet to weigh in publicly.
In Washington State, Gov. Jay Inslee, who usually wears a mask while speaking at his news conferences, began his gathering on Thursday by removing it. He said the state was immediately incorporating the new federal guidance.
“This is a heck of a benefit for people who have been annoyed by this mask,” Mr. Inslee said. “This is a really good reason to get vaccinated. That shot is a ticket to freedom from masks.”
Yet the C.D.C. guidance leaves a number of issues unaddressed. There was no specific language about masking in schools, for instance. And an even broader question remains unclear: Who knows who is justified in claiming the new freedoms?
“I think the challenge is that it’s impossible to determine who is vaccinated and who is not vaccinated,” said Gov. David Ige of Hawaii, where a mask mandate will stay in place.
About 64 percent of Americans are not fully vaccinated. And vaccination rates have been falling, although the campaign to inoculate 12- to 15-year-olds has just begun. Ohio has created a weekly state lottery that would give five people $1 million each in return for being vaccinated. People who receive a vaccine are issued a white paper card, but online scammers have sold forged versions of those.
The guidance seemed to catch many retailers by surprise. Macy’s, Target and the Gap said they were still reviewing it, while Home Depot said it had no plans to change its rules requiring customers and workers to wear masks in its stores.
The United Food and Commercial Workers union, representing thousands of grocery store workers, criticized the C.D.C. for failing to consider how the new policy would affect workers who have to deal with customers who are not vaccinated.
Gov. Kate Brown of Oregon emphasized that the state would not be operating on an honor system. She said that the health department would soon provide guidance for businesses, employers and others “to allow the option of lifting mask and physical distancing requirements after verifying vaccination status.”
The British authorities said on Friday that they are considering changing vaccination protocols and reintroducing local lockdowns to stem the spread of a coronavirus variant first detected in India, a warning sign for countries that are easing restrictions even though their own vaccination campaigns are incomplete.
The numbers of cases involving the variant, known as B.1.617, rose from 520 last week to 1,313 cases this week in Britain, according to official statistics.
The extent to which the variant has spread globally is unclear, because most countries lack the genomic surveillance capabilities employed in England.
That surveillance capability has allowed health officials in Britain to spot the rise of concerning variants more quickly than other nations, offering an early warning system of sorts as a variant seen in one nation almost invariably pops up in others.
Most cases detected in Britain are in northwestern England. The focus has been on Bolton, a town of nearly 200,000 that has one of the country’s highest rates of infection and where health officials have warned of widespread community transmission of the variant. Some cases have also been reported in London. The rapid spread of the variant has led officials to debate speeding up dosing schedules and opening up access to shots in hot spots to younger age groups.
National restrictions in England are scheduled to be eased on Monday, with indoor dining and entertainment returning, but officials have cautioned that those plans might be in danger.
Prime Minister Boris Johnson said on Thursday that the reopening next week would go ahead, but he said he was “anxious” about the new variant. “There may be things that we have to do locally,” he added.
Nadhim Zahawi, the government minister in charge of vaccinations, told the BBC on Friday morning that, “We will take nothing off the table.”
Much is unknown about the new variant, but scientists fear it may have driven the rise of cases in India and could fuel outbreaks in neighboring countries.
Dr. Maria Van Kerkhove, the technical lead of the World Health Organization’s coronavirus response, said a study of a limited number of patients, which had not yet been peer-reviewed, suggested that antibodies from vaccines or infections with other variants might not be quite as effective against B.1.617. The agency said, however, that vaccines were likely to remain potent enough to provide protection from serious illness and death.
British officials have said the variant appears to be more contagious than one detected last year in Kent, southeast of London, which swept across Britain in the winter, forcing the country into one of the world’s longest national lockdowns. The British variant has now been found in countries around the world.
The variant first detected in India has been found in virus sample from 44 countries, the W.H.O. said this week.
The U.N. agency has designated the B.1.617 variant as a variant of concern.
Christina Pagel, a member of a group of scientists advising the government, known as SAGE, said postponing next week’s reopening would avoid “risking more uncertainty, more damaging closures and longer recovery from a worse situation.”
“We need to learn from previous experience,” Dr. Pagel, the director of the Clinical Operational Research Unit at University College London, said on Twitter.
Britain briefly reopened its economy at the end of last year, only to abruptly impose new restrictions that remained in place for months as it fought a deadly wave of infections.
In an attempt to offer at least partial protection to as many people as quickly as possible, Britain spaced injections between doses for two-stage coronavirus vaccines up to 12 weeks after the first vaccines were approved in December. That was far longer than the three- or four-week interval employed by most other countries.
The speedy rollout saved at least 11,700 lives and prevented 33,000 people from becoming seriously ill in England, according to research released by Public Health England on Friday.
But the campaign has slowed down since last month because of supply shortages and the need to start distributing second doses. The number of daily first doses on average last month was 113,000, far below the average of 350,000 daily doses administered in March.
Only those over 38-years-old are currently eligible for vaccination.
Officials suggested Friday that the spread of the B1.617 variant may force a shift in strategy: In areas where the variant is spreading, they may move up the second doses in order to provide stronger protection and allow younger people in multigenerational households to be inoculated.
But it was unclear whether the country had the vaccine supplies on hand to move rapidly.
Mr. Zahawi, the vaccines minister, said Britain would “flex the vaccine program according to the clinical advice.” He also urged people to regularly use free P.C.R. tests that have been available since last month, and to “isolate, isolate, isolate” if they test positive for the coronavirus.
BUENOS AIRES — For most of the past year, Uruguay was held up as an example for keeping the coronavirus from spreading widely as neighboring countries grappled with soaring death tolls.
Uruguay’s good fortune has run out. In the last week, the small South American nation’s Covid-19 death rate per capita was the highest in the world, according to data compiled by The New York Times.
As of Wednesday, at least 3,252 people had died from Covid-19, according to the Uruguayan Health Ministry, and the daily death toll has been about 50 during the past week.
Six out of the 11 countries with the highest death rates per capita are in South America, a region where the pandemic is leaving a brutal toll of growing joblessness, poverty and hunger. For the most part, countries in the region have failed to acquire sufficient vaccines to inoculate their populations quickly.
Contagion rates in Uruguay began inching up in November and soared in recent months, apparently fueled by a highly contagious variant first identified in Brazil last year.
“In Uruguay, it’s as if we had two pandemics, one until November 2020, when things were largely under control, and the other starting in November, with the arrival of the first wave to the country,” said José Luis Satdjian, the deputy secretary of the Health Ministry.
The country with the second-highest death rate per capita is nearby Paraguay, which also had relative success in containing the virus for much of last year but now finds itself in a worsening crisis.
Experts link the sharp rise in cases in Uruguay to the P.1 virus variant from Brazil.
“We have a new player in the system and it’s the Brazilian variant, which has penetrated our country so aggressively,” Mr. Satdjian said.
Uruguay closed its borders tightly at the beginning of the pandemic, but towns along the border with Brazil are effectively binational and have remained porous.
The outbreak has strained hospitals in Uruguay, which has a population of 3.5 million.
On March 1, Uruguay had 76 Covid-19 patients in intensive care units. This week, medical professionals were caring for more than 530, according to Dr. Julio Pontet, president of the Uruguayan Society of Intensive Care Medicine who heads the intensive care department at the Pasteur Hospital in Montevideo, the capital.
That number is slightly lower than the peak in early May, but experts have yet to see a steady decline that could indicate a trend.
“It is still too early to reach the conclusion that we’ve already started to improve, we’re in a high plateau of cases,” Dr. Pontet said.
Despite the continuing high number of cases, there is optimism that the country will be able to get the situation under control soon because it is one of the few in the region that has been able to make quick progress on its vaccination campaign. About a quarter of the population has been fully immunized.
“We expect the number of serious cases to begin decreasing at the end of May,” Dr. Pontet said.
Once Americans return to crowded offices, schools, buses and trains, so too will their sneezes and sniffles.
Having been introduced to the idea of wearing masks to protect themselves and others, some Americans are now considering a behavior scarcely seen in the United States but long a fixture in other cultures: routinely wearing a mask when displaying symptoms of a common cold or the flu, even in a future in which Covid-19 isn’t a primary concern.
Such routine use of masks has been common for decades in other countries, primarily in East Asia, as protection against allergies or pollution, or as a common courtesy to protect nearby people.
Leading American health officials have been divided over the benefits, partly because there is no tidy scientific consensus on the effect of masks on influenza virus transmission, according to experts who have studied it.
Nancy Leung, an epidemiologist at the University of Hong Kong, said that the science exploring possible links between masking and the emission or transmission of influenza viruses was nuanced — and that the nuances were often lost on the general public.
SINGAPORE — Singapore said on Friday that it would ban dining in restaurants and gatherings of more than two people to try to stem a rise in coronavirus cases, becoming the latest Asian nation to reintroduce restrictions after keeping the illness mostly in check for months.
The new measures came after the city-state recorded 34 new cases on Thursday, a small number by global standards, but part of a rise in infections traced to vaccinated workers at Singapore Changi Airport.
The airport outbreak began with an 88-year-old member of the airport cleaning crew who was fully vaccinated but who tested positive for the virus on May 5. Co-workers who then became infected later visited an airport food court, where they transmitted the virus to other customers, officials said.
None of the cases linked to the airport outbreak are believed to have resulted in critical illness or death, according to officials.
In all, 46 cases have been traced to the airport, the largest of about 10 clusters of new infections in the country.
“Because we do not know how far the transmission has occurred into the community, we do have to take further, more stringent restrictions,” said Lawrence Wong, co-chair of Singapore’s coronavirus task force. The measures will be in effect for about one month beginning on Sunday.
According to preliminary testing, many of those infected were working in a zone of the airport that received flights from high-risk countries, including from South Asia. Several have tested positive for the B.1.617 variant first detected in India, which the World Health Organization has said might be more contagious than most versions of the coronavirus.
Singapore health officials said that of 28 airport workers who became infected, 19 were fully vaccinated with either the Pfizer or Moderna vaccines, the only two approved for use in Singapore.
“Unfortunately, this mutant virus, very virulent, broke through the layers of defense,” Transport Minister Ong Ye Kung told a virtual news conference on Friday.
Mr. Ong also said that the rise in cases “very likely” means that a long-delayed air travel bubble with Hong Kong would not begin as scheduled on May 26.
Singapore, a prosperous island hub of 5.7 million people, saw an explosion of infections among migrant workers living in dormitories, but a two-month lockdown and extensive testing and contact tracing contained the outbreak. Although Singapore has kept much of its economy open, its vaccination effort has not moved as quickly as many expected: less than one-quarter of the population has been fully inoculated.
Changi Airport, which served more than 68 million passengers in 2019, is operating at 3 percent of capacity as Singapore has paused nearly all incoming commercial traffic. Employees there work under strict controls, wearing protective gear and submitting to regular coronavirus tests.
Singapore joins Japan, Thailand and other Asian countries that have struggled to contain new outbreaks fueled in part by variants. But Paul Ananth Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, said that the rise in cases was not overly worrying.
“The reason for my optimism is that we now have effective vaccines, better diagnostics, proven treatments and even potential prophylactic agents,” he said. “If these are employed in a targeted approach, it is unlikely that we will end up with the same problems we had last year.”
After shortages in oxygen in New Delhi led to scores of people dying in hospitals, officials said there was now enough supply in the Indian capital to start sharing a surplus of the lifesaving gas to needier parts of the country.
For weeks, the New Delhi government appealed to Prime Minister Narendra Modi for a larger share of India’s oxygen reserves, with the battle for air ending up in the nation’s highest court.
On Thursday, just days after receiving the amount it had requested, New Delhi’s second-highest official, Manish Sisodia, said the city’s demand had fallen and its excess supply should be reallocated.
“The number of cases is coming down, hospital bed occupancy is coming down, and demand for oxygen, too, is down,” Mr. Sisodia told The New York Times.
It was an indication that the crisis in the capital might be reaching a peak.
The oxygen shortage in New Delhi began in April and has been linked to dozens of deaths, in and out of hospitals.
Health care facilities and crematories were overwhelmed, and medical professionals and residents were left scrambling for scarce resources.
Thousands of people in the city of 20 million stood in line at oxygen refilling stations, bringing cylinders into hospitals for friends and family or hoarding them at home in case the need arose.
The rise of new coronavirus infections in India has slowed. But, in pattern seen in nation after nation battered by the virus, death rates often plateau a few weeks later. And with the virus spreading in low-income rural areas, the overall crisis shows no sign of abating.
As of Wednesday, the official death toll surpassed 258,000, although experts suspect the true number to be much higher.
As the smoke from New Delhi crematories starts to clear, dozens of bodies have surfaced along the holy Ganges River in the states of Uttar Pradesh and Bihar.
Krishna Dutt Mishra, an ambulance driver in the Bihari village of Chausa, said that poor people were disposing of bodies in the river because the cost of cremations had become prohibitively expensive.
On Friday, the Indian news media showed bodies wrapped in cloth of the saffron color, considered auspicious in Hinduism, buried in shallow graves on the sandy banks of the Ganges River in the Unnao district of Uttar Pradesh.
Priyanka Gandhi, a leader of the opposition Indian National Congress party, called for a High Court investigation, saying that what was happening in Uttar Pradesh was “inhuman and criminal.”
Latino adults in the United States have the lowest rates of Covid-19 vaccination, but among the unvaccinated they are the demographic group most willing to receive the Covid shots as soon as possible, a new survey shows.
The findings suggest that their depressed vaccination rate reflects in large measure misinformation about cost and access, as well as concerns about employment and immigration issues, according to the latest edition of the Kaiser Family Foundation Covid-19 Vaccine Monitor.
Earlier polls had suggested that skepticism about the vaccine was widespread among Latinos, but the latest survey showed that hesitation is declining.
Nearly 40 percent of all the unvaccinated Latinos responding to the survey said they feared they would need to produce government-issued identification to qualify. And about a third said they were afraid that getting the shot would jeopardize either their immigration status or that of a family member.
Their responses also pointed to the importance of community-based access. Nearly half said they would be more likely to be vaccinated if the shots were available at sites where they normally go for health care.
Throughout the pandemic, few topics have touched so raw a nerve in the United States as mask wearing. Confrontations have erupted from state capitols to supermarket checkout aisles, and debates raged over whether mask mandates violate First Amendment rights.
The Centers for Disease Control and Prevention provoked a flood of reaction with its announcement on Thursday that Americans who are fully vaccinated may stop wearing masks or maintaining social distance in most indoor and outdoor settings. Here’s a sampling, edited for length and clarity, of how Times readers reacted to the news on Facebook and on our website:
“I think this is a good incentive for the hesitators. Hopefully they’ll want to participate in activities (the ones that require proof of vaccination) maskless, so perhaps this will be an incentive, as they see others in the community enjoying life more.” writes Jerry B., on Facebook.
“Very, very few people have been wearing masks for the past 6 months. Covid is a real risk — I certainly don’t want it — but our cases have dropped precipitously, even with minimal masking. This announcement is welcome — the world will not end if people stop masking,” writes Stephen from Oklahoma City.
“I see the need for this policy change, but I fear that the cheaters — those who are not vaccinated but pretend to be — will be the ruin of us all,” writes Cary in Oregon.
“I have my doubts about the incentivization bit,” writes Andrew from Colorado Springs, Colo. “I figure it will simply mean that suddenly everyone’s been fully vaccinated, true or not. That said, as a double-shotted person, I figure my chances of being taken out by an anti-vaxxer are now less than my chances of being taken out by a texting driver. I’m down with that.”
“What’s to stop anti-masker/anti-vaxxer contrarians from mingling unmasked with the vaccinated population? I have little trust in this,” writes Mary Beth in Santa Fe, N.M.
“I am fully vaccinated and caught Covid anyway. I do think it made my symptoms more mild, but you can bet your bippy I’m going to be wearing my mask when I am out of quarantine.” — writes Jaime P., on Facebook.
What do you think about the guidance? Join the conversation.
Kevin Hayes contributed research.
Gov. Ron DeSantis of Florida said on Wednesday that he would pardon “any Floridian” who violated mask or social distancing mandates.
Mr. DeSantis, a Republican, made the announcement during an appearance on the Fox News program “Ingraham Angle,” just a day before the Centers for Disease Control and Prevention shifted its guidelines to allow vaccinated people to skip wearing masks in most places.
The show’s host, Laura Ingraham, first interviewed Mike and Jillian Carnevale, the owners of a Broward County gym, who said they had been arrested for violating a county mask mandate. Mr. DeSantis then said their case was “a total overreach.”
Widely seen as positioning himself as a 2024 Republican presidential nominee, Mr. DeSantis throughout the pandemic has criticized coronavirus restrictions and mandates.
Mr. Carnevale said he and Ms. Carnevale were arrested three times after violating Broward County’s mask mandate. Mr. Carnevale was charged with two second-degree misdemeanors and if convicted would face a 120-day jail sentence, and Ms. Carnevale was charged with one second-degree misdemeanor, facing 60 days in jail, said Cory Strolla, a lawyer representing the couple.
Last month, Mr. DeSantis issued an executive order prohibiting businesses from requiring patrons or customers to show vaccination documentation, or risk losing grants or contracts funded by the state. Norwegian Cruise Line, which is requiring all guests and crew members to be vaccinated, said it was considering skipping Florida ports over the order.
The Biden administration on Thursday outlined how it will spend $7 billion to expand the nation’s public health workforce, adding tens of thousands of jobs to respond to the Covid-19 pandemic and future outbreaks, including disease investigators, contact tracers and epidemiologists.
Over $4 billion will go to state and local health departments to help with their Covid-19 response, the White House said in a news release, allowing them to “quickly add staff.” Hiring would include vaccine and test administrators, data scientists, epidemiologists and school nurses who can work to vaccinate teens and children in the coming months. Some of the hiring will boost the ranks at the Epidemic Intelligence Service, the vaunted arm of the Centers for Disease Control and Prevention that investigates disease outbreaks.
“Though many threats have increased in complexity and scale in recent years, our nation’s public health workforce has gotten smaller,” Dr. Rochelle Walensky, the C.D.C. director, said at a White House news conference Thursday. “This support will immediately add more staff in health departments across the country.”
C.D.C. leaders have long complained of neglect and underfunding, saying that lawmakers typically only send more resources to the agency when there is a dire public health emergency. Other federal health agencies, particularly the National Institutes of Health, are significantly better funded. Many local health departments have also been short on funding for years.
State and local governments would be able to decide how they use the money, which was allocated through the American Rescue Plan, said Carole Johnson, the Biden administration’s testing coordinator.
The funding underscored a sharp contrast with the Trump administration, which routinely sought to cut off congressional funding for the C.D.C. and stifle its independence within the Department of Health and Human Services.
And it offered relief for local health departments that have been sapped by low morale, firings and harassment. One challenge, though, might be finding enough qualified people to fill new job openings.
Ms. Johnson said money could also go to increasing the number of “disease intervention specialists,” or health workers who would conduct contact tracing, work on case management and help with outbreak investigations. And $400 million would go to a new partnership between the C.D.C. and AmeriCorps, a sprawling national service organization. Called Public Health AmeriCorps, the program would form a “pipeline” for public health workers.
The administration was providing another $3 billion to a new C.D.C. grant program to help smaller local health departments keep staff. The grants would allow those hired to help with the coronavirus pandemic to “continue their careers beyond the pandemic as public health professionals,” the White House said.
“We really are asking grantees to prioritize recruiting from communities they serve and backgrounds that are underrepresented,” Ms. Johnson said.
