The Centers for Disease Control and Prevention has issued an order requiring travelers in the United States to wear masks as part of a new initiative aimed at stemming outbreaks of the coronavirus.
According to the 11-page order issued on Friday, travelers entering and transiting throughout the country will be required to wear face coverings in all transportation hubs, which the C.D.C. defines as including any “airport, bus terminal, marina, seaport or other port, subway station, terminal, train station, U.S. port of entry or any other location that provides transportation.”
The language of the order largely puts the onus on transit operators to enforce the rule.
“Conveyance operators must use best efforts to ensure that any person on the conveyance wears a mask when boarding, disembarking and for the duration of travel,” the document said.
The new mandate, which comes as the country surpassed 26 million cases, is part of a string of executive orders and directives that President Biden signed on Thursday that aimed to ramp up the new administration’s ambitious goals of containing the latest surge and accelerating vaccine distribution.
A similar order was proposed during the Trump administration, but the White House Coronavirus Task Force, led by Vice President Mike Pence, blocked the effort.
“Requiring masks on our transportation systems will protect Americans and provide confidence that we can once again travel safely even during this pandemic,” read the order, signed by Dr. Martin Cetron, director of the C.D.C.’s Division of Global Migration and Quarantine. “Therefore, requiring masks will help us control this pandemic and aid in re-opening America’s economy.”
A footnote in the order states that the C.D.C. reserves the right to enforce the order “through criminal penalties.” But a spokesman for the agency said that the order relied heavily on voluntary action to enforce the mandate.
“C.D.C. strongly encourages and anticipates widespread voluntary compliance as well as support from other federal agencies in enforcing this order, to the extent permitted by law,” he said. “C.D.C. will be assisted with implementation by other federal partners, including D.H.S. and D.O.T.,” referring to the Department of Homeland Security and the Department of Transportation.
The establishment of a national mask mandate for travelers was hailed by public health officials as a necessary step to fix the patchwork of local regulations that at times have let travelers move freely without facial coverings, in spite of ample data showing that mask wearing is key to preventing the spread of the virus.
“You needed this kind of coordinated response for quite some time,” said Dr. Melissa J. Perry, a professor of environmental and occupational health at George Washington University. “So, uniform, across the board, everyone, everywhere, being required to wear masks will get us more soon to the end of the pandemic.”
Countries are tightening their borders as a ban takes effect Saturday on noncitizens traveling to the United States from South Africa, amid warnings over the threat posed by a virus variant spreading rapidly there and signs that it can weaken the effectiveness of vaccines.
In recent days, Johnson & Johnson and Novavax have each announced that their vaccines provided strong protection against Covid-19, but the results came with a significant cautionary note: Their efficacy rate dropped in South Africa, where the highly contagious variant is driving most cases. Studies suggest that the variant also blunts the effectiveness of Covid vaccines made by Pfizer-BioNTech, Moderna and Novavax.
The variant, B.1.351, has spread to at least 31 countries, including two cases documented in the United States this week.
Dr. Anthony S. Fauci, the top infectious disease expert in the U.S., said on Friday that virus variants should serve as a “wake-up call” to the public, warning vaccine companies they must be “nimble to be able to adjust readily to make versions of the vaccine that are actually, specifically directed to whatever mutation is actually prevalent at any given time.”
Other countries hoping to slow the spread of more contagious variants will soon be under new restrictions. Prime Minister Justin Trudeau of Canada has announced some flights from Mexico and Caribbean nations will be suspended. International travelers must take coronavirus tests when they return to Canada and will have to wait up to three days for results in an approved hotel at their own expense.
Restrictions in France and Germany begin this weekend. Starting Sunday, France will ban most travel from all countries outside of the European Union. Except for cross-border workers, travelers from E.U. countries will be required to present a negative test before entering the country, said Jean Castex, the French prime minister.
In Germany, nonresidents from several countries — Portugal, Brazil, South Africa, Lesotho and Eswatini (formerly known as Swaziland), Britain and Ireland — will be restricted from entering the country, even if they test negative for the virus.
The United States is also extending its ban on travel from Brazil, Britain and 27 European countries.
The first U.S. case of a Brazil-based variant, known as P.1, was confirmed in Minnesota on Monday. Scientists expect it to behave similarly to the South African-based variant because it shares genetic similarities.
Vaccines have proven effective in studies against the highly contagious Britain-based variant, called B.1.1.7, but the Centers for Disease Control and Prevention has warned it could become the main source of U.S. infection by March and drive more cases and deaths.
Dr. Rochelle Walensky, the new C.D.C. director, said Friday that the variant first identified in Britain has now been confirmed in 379 cases in 29 states. She said officials remained concerned about the variants and were “rapidly ramping up surveillance and sequencing activities” to closely monitor them. Unlike Britain, the United States has been conducting little of the genomic sequencing necessary to track the spread of the variants.
The spreading variants have added renewed urgency to speeding up vaccine distribution. The E.U. is grappling with disrupted vaccine deliveries, while the Biden administration is pushing to accelerate the slow, chaotic inoculation drive in the United States.
Gov. Larry Hogan of Maryland on Saturday said there had been at least one confirmed case in the state of a more contagious variant of the coronavirus found in South Africa that has proved to be more resistant to vaccines.
The individual who had tested positive for the variant had not traveled internationally, according to the statement from the governor’s office, compounding fears that the variant was already present and spreading locally.
“The case announced today involves an adult living in the Baltimore metro region,” the statement said, adding that “comprehensive contact tracing efforts are underway to ensure that potential contacts are quickly identified, quarantined and tested.”
The variant was first detected in the United States this week in South Carolina, which is already experiencing one of the worst coronavirus outbreaks in the nation. Not long after, a second case was discovered with no known connection to the first, state officials announced on Thursday.
Neither patient had a history of travel, officials said, suggesting what many public health experts feared had come to pass: The new variant of the virus had taken root in the United States.
The Biden administration on Saturday put in place a ban on incoming travel from South Africa of noncitizens.
Known as B.1.351, the variant is one of several that have emerged during the pandemic. Others include a variant from Brazil, which has been detected in Minnesota, and one from Britain, which is spreading more widely in the United States.
The emergence of the South African variant in the United States adds to concerns that new forms of the virus will become widespread, setting back efforts to contain the virus before the more contagious variants become the dominant versions.
Epidemiologists tracking the United States epidemic were already concerned that the variant first identified in Britain could become the dominant strain circulating in the United States by March. The United States is conducting little of the genomic sequencing necessary to track the spread of new variants that have caused concern.
Both Moderna and Pfizer-BioNTech — the companies manufacturing the two vaccines on the U.S. market — have said their shots are slightly less effective against the variant from South Africa, and the companies are considering creating either a booster shot or new version to head off the variant. The vaccine developed by Novavax, which has yet to be administered in the United States, appeared to be especially ineffective in trials at protecting against the South Africa variant.
Public health officials including Dr. Anthony S. Fauci, the nation’s top infectious disease expert, have warned that circulation of new variants with increased transmissibility would invariably lead to more infections, and by extension, increased hospitalizations and deaths. Dr. Fauci said Friday that new clinical trial results from Johnson & Johnson, showing that its vaccine is less effective against the variant from South Africa, were a “wake-up call.”
The European Union early Saturday abruptly reversed an attempt to restrict vaccine exports from the bloc into Britain, the latest misstep in the continent’s faltering vaccine rollout.
The bloc had come under harsh criticism on Friday from Britain, Ireland and the World Health Organization when it announced plans to use emergency measures under the Brexit deal to block Covid-19 vaccines from being shipped across the Irish border into Britain.
The reversal came as the European Commission and its president, Ursula von der Leyen, were already under fire for the comparatively slow rollout of vaccinations in the 27 member states, especially compared with Britain and the United States.
The commission announced the restrictions without consulting member states or Britain, a former member — unusually aggressive behavior that is not typical of the bloc, said Mujtaba Rahman, the head of Europe for the Eurasia Group, a political risk consultancy.
“There’s clearly panic at the highest levels of the commission, and the issue of the Northern Ireland agreement has been swept up in this bigger issue of the E.U.’s poor vaccine performance,” he said.
The drama unfolded just as the bloc’s plan to vaccinate 70 percent of its adult population by the summer was unraveling. Already slow in ordering and delivering the vaccines, the European Union was hit with a devastating blow when AstraZeneca announced that it would slash vaccine deliveries because of production problems.
The initial E.U. plan for export controls brought cries of outrage from both the Republic of Ireland, a member of the European Union, and Northern Ireland, a part of the United Kingdom. Both sides are committed to not recreating any land border between the two parts of the island of Ireland.
Triggering the emergency measures in the Brexit agreement so soon after Britain left the bloc’s authority at the end of 2020 seemed to call into question the European Union’s sincerity in following through with the deal regarding Ireland — which was one of the biggest sticking points to reaching the deal. Ireland’s prime minister, Micheal Martin, immediately raised the issue with Ms. von der Leyen.
Prime Minister Boris Johnson of Britain spoke to both leaders. And Arlene Foster, Northern Ireland’s first minister, called the bloc’s move “an incredible act of hostility.”
Britons who favored Brexit point to their country’s more rapid vaccination rollout as a benefit of leaving the bloc and its slower, collective processes.
With nearly eight million people, or 11.7 percent of the population, having already received their first shot, Britain’s pace of vaccination is the fastest of any large nation in the world. Only Israel and the United Arab Emirates are moving faster.
The rapid rollout is a rare success for a country whose response to the coronavirus has otherwise been bungled — plagued by delays, reversals and mixed messages. All of which have contributed to a death toll that recently surged past 100,000 and cemented Britain’s status as the worst-hit country in Europe.
In other virus news from around the world:
The government of the Philippines has extended a contentious policy that bars children under 15 from leaving their homes. President Rodrigo Duterte’s administration this week overruled advice from a government task force on infectious diseases that had questioned the policy. “They can glue their attention to TV the whole day,” Mr. Duterte told reporters, referring to children under lockdown.
When the Australian Open begins in February in Melbourne, the capital of Victoria, up to 30,000 spectators a day will be allowed to attend, the sports minister of the state of Victoria said on Saturday. Such numbers would make the tennis tournament a sports rarity during the pandemic, though attendance would still be down by about half from a normal year.
Reporting was contributed by Steven Erlanger, Matina Stevis-Gridneff, Jason Gutierrez and Matt Futterman.
The coronavirus test center on A Street in Davis, Calif., was bustling on a recent morning. Michael Duey was in line, as usual, with his teenage son. Margery Hayes waited for her wife in the parking lot. Dr. Elizabeth Pham hustled her children in for a quick pit stop.
Inside, each received a five-minute screening for the virus, administered and paid for by the University of California, Davis. Yet none of them is associated with the school.
All last fall, universities across the country were accused of enabling the pandemic’s spread by bringing back students who then endangered local residents, mingling with them in bars, stores and apartments. So U.C. Davis is trying something different.
Rather than turning the campus into a protective bubble for students and staff, as some schools have attempted, it has quietly spent the past six months making its campus bubble bigger — big enough, in fact, to encompass the entire city.
Public health experts say the initiative is the most ambitious program of its type in the country and could be a model for other universities. U.C. Davis has made free coronavirus tests — twice weekly, with overnight results — available to all 69,500 people in the city of Davis and hundreds of nonresidents who just work there.
It has also trained dozens of graduate students to help with contact tracing; recruited hotel and apartment owners to provide free isolation and quarantine housing to anyone in town exposed to the virus; and hired some 275 undergraduate ambassadors to combat health disinformation and hand out free masks.
Nearly a year into the pandemic, as thousands of patients are dying every day in the United States and widespread vaccination is still months away, doctors have precious few drugs to fight the virus.
A handful of therapies — remdesivir, monoclonal antibodies and the steroid dexamethasone — have improved the care of Covid patients, putting doctors in a better position than they were when the virus surged last spring. But these drugs are not cure-alls and they’re not for everyone, and efforts to repurpose other drugs, or discover new ones, have not had much success.
The government poured $18.5 billion into vaccines, a strategy that resulted in at least five effective products at record-shattering speed. But its investment in drugs was far smaller, about $8.2 billion, most of which went to just a few candidates, such as monoclonal antibodies. Studies of other drugs were poorly organized.
The result was that many promising drugs that could stop the disease early, called antivirals, were neglected. Their trials have stalled, either because researchers could not find enough funding or enough patients to participate.
At the same time, a few drugs have received sustained investment despite disappointing results. There is now a wealth of evidence that the malaria drugs hydroxychloroquine and chloroquine did not work against Covid. And yet there are still 179 clinical trials with 169,370 patients in which at least some are receiving the drugs, according to the Covid Registry of Off-label & New Agents at the University of Pennsylvania. And the federal government funneled tens of millions of dollars into an expanded access program for convalescent plasma, infusing almost 100,000 patients before there was any robust evidence that it worked. In January, those trials revealed that, at least for hospitalized patients, it doesn’t.
The lack of centralized coordination meant that many trials for Covid antivirals were doomed from the start — too small and poorly designed to provide useful data, according to Dr. Janet Woodcock, the acting commissioner of the Food and Drug Administration. If the government had instead set up an organized network of hospitals to carry out large trials and quickly share data, researchers would have many more answers now.
Wearing bathrobes, pajamas or whatever else they could quickly throw on, hundreds of people flocked to get Covid vaccines in Seattle on Thursday night after a refrigerator that was chilling 1,600 doses broke down, leading to a frenzied overnight inoculation drive.
The impromptu vaccinations began after a refrigerator malfunctioned at a Kaiser Permanente hospital in Seattle, meaning the Moderna vaccines inside had to be quickly injected or they would become less effective and need to be thrown away. Health officials reached out to two other hospital systems in the city, and an urgent call was issued around 11 p.m., alerting residents that they had a rare chance to get vaccines if they could come right away.
“We’ve got to get these 1,600 doses into people’s arms in the next 12 hours,” Susan Mullaney, Kaiser’s regional president for Washington, said at a virtual news conference on Friday, describing the hospital’s call to action.
Within minutes, there were long lines outside of at least two medical centers, and by about 3:30 a.m., the vaccines had all been administered, hospital officials said.
In interviews with local television stations, the arriving patients said they had been relaxing at home, washing dishes or watching the news when they saw that they suddenly had a chance to get a shot. One couple said their daughter had called after they were in bed to say that she had signed them up for an appointment at 1 a.m.
“We didn’t have time to dress up, so I just came as I am,” the mother said, motioning toward her husband, who was wearing a bathrobe.
The situation in Seattle was only the latest instance in which a breakdown in the inoculation process forced health officials to give the vaccines to anyone they could find. It also highlights the challenge posed by the two vaccines that have so far been approved in the United States — both need to be kept cold. Earlier this week, health workers stuck in a snowstorm in Oregon walked from car to car, asking stranded drivers if they wanted a shot, after realizing that the doses they were transporting might expire as they waited on the highway.
Seattle hospital officials told local news outlets that they had tried to prioritize older patients and others who were already eligible for vaccines in the state, but they said their first priority had been to give out all of the vaccines before they expired.
“We are tired, but we are inspired,” Kevin Brooks, the chief operating officer of Swedish Health Services, one of two hospitals that administered the vaccines, said in a statement. “It was touching to see grandmas in wheelchairs at 2 a.m. being vaccinated.”
Ms. Mullaney, the Kaiser regional president, said that every refrigerator and freezer at the Seattle location had since been tested and were all working properly.
In Los Angeles County, the impacts of the pandemic have been relatively dispersed, with millions of residents suffering and grieving in isolation across a famously vast sprawl. Lockdowns — some of the nation’s most stringent, credited with saving thousands of lives — have kept Angelenos apart for months on end.
But recently, as Los Angeles County has become the epicenter of the pandemic in the United States, the astonishing surge has reinforced the virus’s unequal toll, pummeling poorer communities of color. Experts say that deeply rooted inequality is both a symptom and a critical cause of Covid-19’s overwhelming spread through the nation’s most populous county.
“The challenge is that even before the surge, we had unevenness in Los Angeles County and in the state of California — we had smoldering embers in parts of our community all the time,” said Dr. Kirsten Bibbins-Domingo, the vice dean for population health and health equity at the School of Medicine at the University of California, San Francisco. “Our interconnectedness is part of the story.”
County officials recently estimated that one in three of Los Angeles County’s roughly 10 million people have been infected with Covid-19 since the beginning of the pandemic. But even amid an uncontrolled outbreak, some Angelenos have faced higher risk than others. County data shows that Pacoima, a predominantly Latino neighborhood that has one of the highest case rates in the nation, has roughly five times the rate of Covid-19 cases as much richer and whiter Santa Monica.
Experts point to a combination of factors that have made the uneven impacts of the virus tragically predictable across the country, an imbalance that is often magnified in California.
The religious sisters who lived in retired seclusion at the Dominican Life Center in Michigan followed strict rules to avoid an outbreak of coronavirus infection: They were kept in isolation, visitors were prohibited and masks were required by everyone on campus.
But after months after being kept at bay, it found its way in.
On Friday, the Adrian Dominican Sisters said nine sisters died in January from Covid-19 complications at the campus in Adrian, about 75 miles southwest of Detroit.
“It’s numbing,” said Sister Patricia Siemen, leader of the religious order. “We had six women die in 48 hours.”
The deaths of the sisters in Michigan have added to what is becoming a familiar trend in the spread of the virus, as it devastates religious congregate communities by infecting retired, aging populations of sisters and nuns who had quietly devoted their lives to others.
Now some of these sisters have been thrust into the public eye, as details about their names, ages and lifetimes of work are being highlighted as part of the national discourse about Americans lost to the coronavirus.
“It is a moment of reckoning with the place that they have in our culture now,” said Kathleen Holscher, a professor who holds the endowed chair of Roman Catholic studies at the University of New Mexico. “Fifty or 60 years ago, they were the face of American Catholicism, in schools and in hospitals.”
Several of the women who died at the Adrian Dominican Sisters campus had been nurses or teachers. Others had dedicated decades of their lives to religious service.
“Americans are being reminded they are older, and still there,” Dr. Holscher said. “But now they are living in these community situations and caring for one another.”
The accounting of the deaths in the nation’s religious congregate communities started in the first half of 2020 as the country broadly began to take note of the deadly transmission of the virus and the lives it took.
At first glance, the results reported on Friday from the long-awaited trial of Johnson & Johnson’s Covid-19 vaccine might have seemed disappointing. Its overall efficacy — the ability to prevent moderate and severe disease — was reported at 72 percent in the United States, 66 percent in Latin American countries and 57 percent in South Africa.
Those figures appear far below the high bar set by Pfizer-BioNTech and Moderna, the first two vaccines authorized for emergency use in the United States, which reported overall efficacy from 94 to 95 percent.
But Dr. Anthony S. Fauci, the nation’s leading infectious disease expert, said that the more crucial measure was the ability to prevent severe disease, which translates to keeping people out of the hospital and preventing deaths. And that result, for Johnson & Johnson, was 85 percent in all of the countries where it was tested, including South Africa, where a rapidly spreading variant of the virus had shown some ability to elude vaccines.
More important than preventing “some aches and a sore throat,” Dr. Fauci said, is to fend off severe disease, especially in people with underlying conditions and in older adults, who are more likely to become seriously ill and to die from Covid-19.
Researchers warn that trying to compare effectiveness between new studies and earlier ones may be misleading, because the virus is evolving quickly and to some extent the trials have studied different pathogens.
“You have to recognize that Pfizer and Moderna had an advantage,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said in an interview. “They did their clinical trials before the variant strains became very apparent. Johnson & Johnson was testing its vaccine not only against the standard strain but they had the variants.”
Teachers in Chicago moved closer on Friday to striking over the city’s plan for reopening the nation’s third largest school district.
Mayor Lori Lightfoot said that the city had not yet reached a reopening deal with the Chicago Teachers Union and that it planned to welcome tens of thousands of students back to in-person classes on Monday.
The union has directed its members to work remotely until a deal is reached. It has vowed to strike if the district locks teachers out of its electronic systems or otherwise retaliates against them for staying home.
The battle over reopening Chicago’s schools has complex racial undercurrents. The mayor, who is Black, has argued that schools should open to prevent racial achievement gaps from widening. But the union says reopening now would be unsafe, and it claims that the majority of the district’s mostly Black and Hispanic families agree.
Only a third of Chicago families have decided to send their children back to school in person.
Prekindergarten and some special education students returned to in-person instruction on Jan. 11 and continued until last week, when the union directed their teachers to stay home. Students in kindergarten through eighth grade are expected to return on Monday.
Ms. Lightfoot said on Friday that the district expected teachers to be there for both groups of students. But given the current state of negotiations, she said, “we owe it to our students and families” to prepare for the possibility that the teachers could stay home.
Each side blames the other for the impasse.
Ms. Lightfoot said on Friday that the union’s leadership had refused to put areas of agreement in writing and purposefully disrupted some in-person instruction.
“We had three weeks of success, which is precisely why the C.T.U. leadership blew it up and created chaos,” she said.
But the union said it had been close to reaching a deal on reopening when Ms. Lightfoot stepped in “at the 11th hour and blew it to pieces.”