Wearing a mask — any mask — reduces the risk of infection with the coronavirus, but wearing a more tightly fitted surgical mask, or layering a cloth mask atop a surgical mask, can vastly increase protections to the wearer and others, the Centers for Disease Control and Prevention reported on Wednesday.
New research by the agency shows that transmission of the virus can be reduced by up to 96.5 percent if both an infected individual and an uninfected individual wear tightly fitted surgical masks or a cloth-and-surgical-mask combination.
Dr. Rochelle P. Walensky, director of the C.D.C., announced the findings during Wednesday’s White House coronavirus briefing, and coupled them with a plea for Americans to wear “a well-fitting mask” that has two or more layers. President Biden has challenged Americans to wear masks for the first 100 days of his presidency, and Dr. Walensky said that masks were especially crucial given the concern about new variants circulating.
“With cases hospitalizations and deaths still very high, now is not the time to roll back mask requirements,” she said, adding, “The bottom line is this: Masks work, and they work when they have a good fit and are worn correctly.”
Virus-related deaths, which resurged sharply in the United States in November and still remain high, appear to be in a steady decline; new virus cases and hospitalizations began to drop last month. But researchers warn that a more contagious virus variant first found in Britain is doubling roughly every 10 days in the United States. The C.D.C. cautioned last month that it could become the dominant variant in the nation by March.
As of Feb. 1, 14 states and the District of Columbia had implemented universal masking mandates; masking is now mandatory on federal property and on domestic and international transportation. But while masks are known to both reduce respiratory droplets and aerosols exhaled by infected wearers and to protect the uninfected wearer, their effectiveness varies widely because of air leaking around the edges of the mask.
“Any mask is better than none,” said Dr. John Brooks, lead author of the new C.D.C. study. “There are substantial and compelling data that wearing a mask reduces spread, and in communities that adopt mask wearing, new infections go down.”
But, he added, the new research shows how to enhance the protection. The agency’s new laboratory experiments are based on the ideas put forth by Linsey Marr, an expert in aerosol transmission at Virginia Tech, and Dr. Monica Gandhi, who studies infectious diseases at the University of California, San Francisco.
One option for reducing transmission is to wear a cloth mask over a surgical mask, the agency said. The alternative is to fit the surgical mask more tightly on the face by “knotting and tucking” — that is, knotting the two strands of the ear loops together where they attach to the edge of the mask, then folding and flattening the extra fabric at the mask’s edge and tucking it in for a tighter seal.
Dr. Brooks cautioned that the new study was based on laboratory experiments, and it’s unclear how these masking recommendations will perform in the real world (the experiments used three-ply surgical and cloth masks).“But it’s very clear evidence that the more of us who wear masks and the better the mask fits, the more each of us benefit individually.”
Other effective options that improve the fit include using a mask-fitter — a frame contoured to the face — over a mask, or wearing a sleeve of sheer nylon hosiery material around the neck and pulled up over a cloth or surgical mask, the C.D.C. said.
Even as vaccines are being slowly rolled out across the country, the emergence of the new variants, which may respond differently to treatments or dodge the immune system to some degree, has prompted public health officials to emphasize that Americans should continue to take protective measures like masking.
Gov. Andrew M. Cuomo of New York said that large arenas and stadiums across the state would be able to open for events with spectators, at very limited capacity, as soon as Feb. 23. Attendees will be required to provide a negative coronavirus test result.
Venues that hold 10,000 people or more would be allowed to host 10 percent of their normal capacity, if they are approved by the state’s Department of Health.
Attendees will have to provide a negative P.C.R. test, taken within 72 hours of the event, before they can enter. Socially distanced assigned seating will be mandatory, as will face coverings and temperature checks.
While controlling the spread of the coronavirus, the state has to simultaneously “get this economy open intelligently,” Mr. Cuomo said, adding that “this hits the balance of safe reopening, and again a P.C.R. test is as safe as you can get.”
The governor cited the success of a recent Buffalo Bills’ playoff game, attended by about 6,700 people who had to provide a negative coronavirus test before they could enter, as the inspiration for his decision. A negative test result is a snapshot in time of whether the virus can be detected if a person is infected, and may miss individuals who are infected but do not yet carry enough of the virus for the test to come back positive.
“The testing is the key,” Mr. Cuomo said at a news conference on Wednesday.
Mr. Cuomo said that the Barclays Center in Brooklyn would reopen on Feb. 23, for a Brooklyn Nets game against the Sacramento Kings.
But the Bills’ stadium is open air, unlike the Barclays Center. Public health experts say the quality of ventilation is crucial when considering indoor gatherings because the virus is known to spread more easily indoors.
At his news conference, Mr. Cuomo did not offer details on ventilation, but a release from his office later said that in order to reopen venues to professional sports, sites had to “meet enhanced air filtration, ventilation and purification standards.”
Attending an indoor event is risky even with ample ventilation and other precautions, said Saskia Popescu, an epidemiologist at George Mason University.
“Bringing thousands of people indoors for an event that elicits screaming and socializing is not ideal right now,” Dr. Popescu said in an email.
As for playing games at venues like Citi Field or Yankee Stadium, which are being used as vaccination sites, the governor joked that “between innings, people will do vaccines.”
Gareth Rhodes, a member of the governor’s Covid-19 task force, said the state planned to work with teams so the vaccinations could continue.
The Citi Field vaccination site, which serves eligible Queens residents and taxi drivers and food service workers from all five boroughs, opened Wednesday. It will have 200 appointments a day available during its first week of operation and will offer 24-hour service starting next Wednesday, officials said. The site will be able to administer 4,000 doses of the vaccine a week by next week, Mayor Bill de Blasio said at an appearance outside the stadium. It could provide 5,000 doses a day if the city had more supply, he added.
“This site is the beginning of something very big,” Mr. de Blasio said. “The Mets are doing something crucial today for the people of Queens.”
The site was supposed to open the week of Jan. 25, but it was postponed because of vaccine shortages.
The mayor also said that mass vaccination sites were still planned at Empire Outlets in Staten Island and at the Barclays Center, though he did not specify dates when they will open.
A World Health Organization panel of experts on Wednesday recommended that the vaccine developed by AstraZeneca and the University of Oxford be used in countries where concerning new variants of the coronavirus are circulating.
The guidance comes after South Africa’s decision on Sunday to at least temporarily halt plans to roll out AstraZeneca’s vaccine after a small clinical trial failed to show that the vaccine could protect against mild and moderate disease caused by avariant of the virus first seen in that country. Researchers were unable to draw a conclusion about the impact of the variant, known as B.1.351, on the vaccine’s ability to prevent severe disease.
Despite recommending the AstraZeneca vaccine for use everywhere, W.H.O. scientists conceded that each country should take into account the state of the virus and the type of variants spreading there.
The W.H.O. has not yet granted an emergency-use listing for the AstraZeneca vaccine, a step which would set into motion the rollout of the vaccine in many lower- and middle-income countries. The W.H.O. will separately consider the vaccine’s two manufacturers: AstraZeneca and the Serum Institute, the Indian producer that will supply many doses for the Covax initiative to bring vaccines to poorer parts of the world. The W.H.O. will weigh those decisions in the next week, with decisions expected around the middle of this month.
The W.H.O. at the end of last year approved Pfizer’s vaccine. Its decision on AstraZeneca’s vaccine is highly anticipated, because countries around the world are counting on the cheap and easy-to-store product.
Countries are expected to begin receiving their first tranches of the AstraZeneca vaccine from Covax later in February.
The W.H.O.’s decisions come as concern is rising about whether certain variants may reduce the effectiveness of Covid-19 vaccines and treatments. The B.1.351 variant has so far generated the most worry. The AstraZeneca vaccine and other leading vaccines still appear to provide strong protection against another, more contagious coronavirus variant first identified in Britain, known as B.1.1.7.
But scientists have cautioned against drawing firm conclusions from preliminary data.
“We are so in the early stages of understanding what any specific change in the virus means for the performance of one or another of the vaccines or the vaccines as a whole,” said Katherine O’Brien, the W.H.O.’s director of immunization, vaccines and biologicals, at Wednesday’s news conference.
For now, South Africa is planning to inoculate health workers starting next week with the Johnson & Johnson vaccine, which prevented hospitalizations and deaths in clinical trials in the country. The vaccine is not yet authorized there, but officials said they would use it as part of an ongoing clinical trial.
As for the AstraZeneca vaccine, South African health officials indicated on Wednesday that they were considering selling or swapping their million doses of the vaccine for different shots. W.H.O. scientists said that they were open to discussing such plans as part of the Covax initiative.
The W.H.O. panel that issued recommendations on Wednesday, known as the Strategic Advisory Group of Experts on Immunization, also advised that the AstraZeneca vaccine be given to adults regardless of their ages, breaking with a number of European countries that have opted to restrict the use of the vaccine to younger people.
The W.H.O. panel also recommended that the two doses of the AstraZeneca vaccine be given between four and 12 weeks apart. The guidance follows the release of a paper last week that found that the vaccine appears to work better when second doses are delayed. Britain and other countries have opted to delay second doses of the vaccine in an effort to get more first doses into their populations.
Coronavirus-related deaths, which rose sharply in the United States beginning in November and remain high, appear to be in a steady decline, following in the tracks of new virus cases and hospitalizations, which began to drop last month.
The country has reported about 2,800 deaths a day recently, an average that excludes one anomalous day last week when Indiana announced a large number of backlogged death reports. That national average remains far above the level of early November, before the country’s recent surge, when roughly 825 deaths were being reported daily. But it is down significantly from the peak just a few weeks ago, when the average was more than 3,300 a day.
New coronavirus cases are a leading indicator for deaths, and that statistic has been improving markedly for a month. On Tuesday, the country reported 96,400 new cases, the third day in a row of having fewer than 100,000 new recorded cases, a level not seen since early November.
The seven-day average of new cases, a more reliable indicator of the pandemic’s direction, has fallen more than 50 percent since it peaked on Jan. 8.
Whether that will continue remains in doubt. Researchers warn that a more contagious virus variant first found in Britain is doubling roughly every 10 days in the United States. The Centers for Disease Control and Prevention cautioned last month that it could become the dominant variant in the nation by March.
Deaths tend to lag behind new cases by several weeks, and the day-to-day statistics can be prone to reporting vagaries. For a while, it was hard to discern clear signs that deaths had begun to decline. But the national trend now is unmistakable: The daily average has dropped about 18 percent since Jan. 12.
Although deaths are still rising in some states, including Alabama and South Carolina, far more are reporting sustained declines. Over the past two weeks, reports of virus deaths have dropped more than 40 percent in New Mexico and more than 30 percent in Arkansas, Colorado and Connecticut.
The declines are heartening but are not a reason for people to let down their guard, said Bill Hanage, an epidemiologist and associate professor at Harvard.
Dr. Hanage said the surges in new cases and deaths in December and early January had probably stemmed from the increase in gatherings over the holidays and from the onset of winter. Influenza and most kinds of coronavirus infections peak during winter, and there is little reason to think that Covid-19 is any different. (Influenza is not a coronavirus infection, as an earlier post suggested.)
The more infectious nature of the Covid-19 virus, and the appearance of variants that may spread even more easily, remain a significant cause for caution, he said.
“If in response to these dropping numbers people relax, then it is entirely possible and expected that we will see that decline start to bottom out and even start to increase again,” he said.
A New York Times analysis found that about half of the country’s roughly 465,000 Covid-19 deaths have occurred since the brutal surge began in November.
After a two-week pause of in-person instruction, the Chicago Teachers Union said early Wednesday that its members had approved an agreement to reopen classrooms in the country’s third-largest public school system.
More than 20,000 ballots were cast, with 13,681 members voting in favor and 6,585 voting against, the union said.
Under the agreement, prekindergarten and some special education students will return to classrooms on Thursday. Staff in kindergarten through fifth-grade classrooms will return on Feb. 22, and students in those grades will return on March 1. Staff members in sixth- through eighth-grade classrooms will return March 1, and students on March 8.
As part of the agreement, the city committed to offering 2,000 coronavirus vaccine doses this week to staff members in classrooms that were set to reopen on Thursday and any other employees who live with people who were at high risk from the virus. It would then provide 1,500 doses a week to school staff in the weeks after that.
Teachers who have no students attending in-person classes could continue to teach remotely, and unvaccinated teachers could take unpaid leaves of absence for the next quarter instead of teaching in person. The agreement also set thresholds for what would lead the district, as well as individual schools or classrooms, to temporarily revert to distance learning.
“This plan is not what any of us deserve,” Jesse Sharkey, the president of the Chicago Teachers Union, said in a statement. “This agreement represents where we should have started months ago, not where this has landed.”
“We will protect ourselves by using the school safety committees created under this agreement to organize and see that C.P.S. meets safety standards and mitigation protocols,” Mr. Sharkey said. “Safety Committees will enforce this agreement, have access to information and the ability to change unsafe practices in their school.”
Ms. Sharkey criticized Mayor Lori Lightfoot over her handling of the situation and said that union delegates had passed a vote of no confidence in the mayor and school leadership on Monday night.
Ms. Lightfoot and the chief executive of the district, Janice K. Jackson, said in a statement, “This vote reaffirms the strength and fairness of our plan, which provides families and employees certainty about returning to schools and guarantees the best possible health and safety protocols.”
Ms. Lightfoot, a Democrat, and the union have been locked in one of the most intense disagreements over reopening anywhere in the country. The mayor has argued that the city’s most vulnerable students need the opportunity to return to school in person, while the union condemned the city’s reopening plan as unsafe.
A year into the pandemic, the disposable, virus-filtering N95 mask remains a coveted piece of protective gear. Continuing shortages have forced doctors and nurses to reuse their N95s, and ordinary Americans have scoured the internet — mostly in vain — to get them.
But Luis Arguello Jr. has plenty of N95s for sale — 30 million of them, in fact, which his family-run business, DemeTech, manufactured in its factories in Miami. He simply can’t seem to find buyers.
After the pandemic exposed a huge need for protective equipment, and China closed its inventory to the world, DemeTech, a medical suture maker, dived into the mask business. The company invested tens of millions of dollars in new machinery and then navigated a nine-month federal approval process that allows them to market the masks.
But demand is so slack that Mr. Arguello is preparing to lay off some of the 1,300 workers he had hired to ramp up production.
“It’s insane that we can’t get these masks to the people who desperately need them,” he said.
In one of the more confounding disconnects between the laws of supply and demand, many of the nearly two dozen small American companies that recently jumped into the business of making N95s are facing the abyss — unable to crack the market, despite vows from both former President Donald Trump and President Biden to “buy American” and buoy domestic production of essential medical gear.
These businesses must overcome the ingrained purchasing habits of hospital systems, medical supply distributors and state governments. Many buyers are loath to try the new crop of American-made masks, which are often more expensive than those produced in China. Another obstacle comes from companies like Amazon, Facebook and Google, which banned the sale and advertising of N95 masks in an effort to thwart profiteers from diverting vital medical gear needed by frontline medical workers.
What’s required, public health experts and industry executives say, is an ambitious strategy that includes federal loans, subsidies and government purchasing directives to ensure the long-term viability of a domestic industry vital to the national interest.
“The government needs to call the outsourcing of America’s mask supply what it is: a national security problem,” said Mike Bowen, the owner of Prestige Ameritech, a Texas mask producer who has testified before Congress about the need to support domestic manufacturers.
The White House, attempting to ramp up its mass coronavirus vaccination effort, is standing up five new inoculation centers, including three in Texas and two in New York that are specifically aimed at vaccinating people of color, officials said Wednesday.
President Biden has said repeatedly that racial equity will be at the core of his coronavirus response, but there are stark racial disparities in the vaccination campaign. In some cities, wealthy white people have been flocking to clinics that primarily serve Black people and Latinos, using up scarce supplies of vaccine.
And the administration’s effort to gather race and ethnicity data on vaccine recipients is faltering.
“This is a perfect example of our equity work coming to life, and this is a model for the potential we have to do this well around the country,” Dr. Marcella Nunez-Smith, the chair of Mr. Biden’s Covid-19 Equity Task Force, said Wednesday during a news conference with Governor Andrew M. Cuomo of New York, referring to the new centers.
“It’s a bold step that we should take as a sign of hope,” Mr. Cuomo said.
On his first day in office, the president directed the Federal Emergency Management Agency to begin establishing federally supported community vaccination centers, with the goal of having 100 centers in operation within a month. On Tuesday, the administration announced that it intends to start shipping one million doses of vaccine per week to federally supported community health centers in underserved neighborhoods.
On Sunday, Mr. Biden told Norah O’Donnell of CBS News that Roger Goodell, the commissioner of the National Football League, had extended an offer for the administration to use all 30 league stadiums to distribute Covid-19 vaccines.
People in underserved neighborhoods face a variety of obstacles in getting vaccinated, experts say, including registration phone lines and websites that can take hours to navigate, and a lack of transportation or time off from jobs to get to appointments. And people of color, particularly Black people, are more likely to be hesitant about getting vaccinated, in light of the history of unethical medical research in the United States.
But Mr. Cuomo said he rejected the term “vaccine hesitancy,” adding, “Let’s call it what it is. It’s a lack of trust — for understandable reasons.”
The New York centers will be located at York College in Queens and Medgar Evers College in Brooklyn, Mr. Cuomo said, and will be capable of vaccinating 3,000 people a day. The federal government will provide a special dosage allocation for the sites, and they will be staffed jointly by the federal government, military personnel and members of the National Guard.
Last week, the administration announced that it was building two mass vaccination clinics in California, one in Los Angeles and the other in Oakland. The Texas clinics will be located in Arlington, Dallas and Houston, White House officials said.
Primary care doctors have grown increasingly frustrated with their exclusion from the nation’s vaccine rollout, unable to find reliable supplies for even their eldest patients and lacking basic information about distribution planning for the shots.
“The centerpiece should be primary care,” said Dr. Wayne Altman, the chairman of family medicine at Tufts University School of Medicine, who also sees patients in Arlington, Mass. State officials there are using Fenway Park and Gillette Stadium as mass vaccination sites, rather than ensuring practices like his can inoculate patients who are at high risk from the coronavirus.
“If you distribute the vaccine to all these practices and let them go at their pace, it would accelerate this rollout dramatically,” Dr. Altman said.
There are roughly 500,000 primary care doctors in the United States, who have traditionally administered nearly half of all adult vaccinations, inoculating their patients against pneumonia, flu and other infectious diseases. While most physician offices can’t handle storage for the Pfizer-BioNTech vaccine because of its need for special freezers, doctors say they could easily administer the Moderna vaccine with adequate storage measures as well as some of the others likely to become available soon.
“We’re ready,” said Dr. Elizabeth Kozak, an internist in Grand Rapids, Mich. She was approved in early January to deliver the Moderna vaccine. “We haven’t seen a thing, but we’re ready.”
While some physicians say they have received small amounts of the vaccine, many say they are still waiting for any indication about when they might get doses and how they fit into the long-range timetable for broader distribution.
Doctors say they are critical to reaching people who would not otherwise get a vaccine because they are unable or unwilling to go to mass vaccination sites or even their local pharmacy.
“We can’t have one or two strategies for vaccine distribution,” said Dr. Evan Saulino, a family physician in Portland, Ore., who has talked to patients, including those who are Black or Spanish-speaking, who are not sure they want the vaccine. Some of his patients are distrustful of the government and may not want to get a shot from someone in uniform. One person he spoke with would not go to the drugstore but might consider being inoculated at his clinic.
Dr. Kozak, the internist from Michigan, agreed, saying doctors like her could focus their attention on people who can’t easily navigate the current set up. “We might not be able to do the numbers but we are able to do the more fragile and vulnerable populations,” she said.
Vacationing abroad may not be possible for residents of Britain until all adults in the country have been vaccinated, a government official said on Wednesday, raising questions about how the tourism industry might cope with such restrictions and dashing hopes of many who hoped that a relatively successful vaccine rollout in Britain could let them enjoy trips abroad this summer.
The transportation secretary, Grant Shapps, said on British television that international travel would depend on “everybody having their vaccinations” in Britain, and that restrictions could remain as long as other countries have not made significant progress in vaccinations.
“We’ll need to wait for other countries to catch up as well, in order to do that wider international unlock,” Mr. Shapps said.
As of Wednesday, Britain had administered more than 12.5 million vaccine doses, equivalent to about 18 percent of its population, one of the highest rates in the world. At the current pace, the country is on track to give the first shot of a two-dose coronavirus vaccine to its entire population by the end of June.
The authorities have reported a sharp drop in the number of infections in recent days, and Prime Minister Boris Johnson is expected to announce a potential loosening of restrictions this month.
But on Wednesday, Mr. Shapps urged caution about travel plans for this year and advised people not to book vacations either within Britain or abroad. “I’m afraid I can’t give you a definitive ‘will there or will there not be’ the opportunity to take holidays,” he told Sky News.
Mr. Shapps’s warning came a day after the authorities announced new travel restrictions, including prison sentences of up to 10 years for anyone traveling to Britain who lies about where they’ve been.
Mr. Shapps called the measures, including the jail sentence, “appropriate.” Under other restrictions that are set to come into force on Monday, British residents arriving in England from more than 30 countries where coronavirus variants are believed to be widespread, will have to pay up to 1,750 pounds ($2,410) for a 10-day quarantine in government-managed hotel rooms.
Britain has reported 114,000 deaths from the coronavirus, the world’s fifth-highest known death toll.
In other developments around the world:
Prime Minister Yoshihide Suga of Japan said on Wednesday that the country would begin its vaccination program next week, starting with medical workers.
The leaders of the World Health Organization and the United Nations agency for children, Unicef, warned in a joint statement that the vast chasm of inequality in the global vaccine rollout will “cost lives and livelihoods, give the virus further opportunity to mutate and evade vaccines and will undermine a global economic recovery.” Of the 128 million vaccine doses administered globally, more than three quarters were in just 10 countries, while nearly 130 other countries are yet to administer a single dose, the statement said.
Germany will remain in lockdown for at least another month because of the danger of more infectious variants of the virus, Chancellor Angela Merkel and governors decided on Wednesday.
“We know that this mutation is a reality now and we know it will increase,” said Ms. Merkel after meeting with governors from the 16 German states. “The question is how quickly will it increase.”
Although a sharp drop in new daily infections shows that a nearly two-month lockdown is having an effect, the authorities worry about the spread of more infectious variants. Nearly 6 percent of the positive coronavirus cases in Germany were found to be caused by more contagious variants, with the variant that has been found in Britain dominating.
The lockdown extension is designed to prevent the contagious variants from gaining steam.
Most shops, museums and services will remain closed until the number of new infections reaches an average of 35 cases per 100,000 people over a week, a rate that should be reached by March if the current trend holds. Over the past week, there has been an average of 68 cases per 100,000 people. The reopening of schools and day care centers, which the government has prioritized, will be overseen by the states and will most likely happen sooner. Hair salons are allowed to open on March 1 under strict safety rules. The opening of other businesses, such as gyms, bars and restaurants, will be discussed at a future meeting, Ms. Merkel said.
Over the past week, there has been an average of 8,887 new cases per day in Germany, far fewer than the nearly 25,000 a day around Christmas, according to a New York Times database.
The lockdown rules are in effect until March 7. Ms. Merkel and state governors will meet again on March 3, to decide on future measures.
A top European Union official said on Wednesday that the bloc was “not where we want to be” in handling the pandemic, after missteps in lining up vaccine supplies left it lagging behind other countries.
“We were late to authorize,” the official, Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, told lawmakers in Brussels.
“We were too optimistic when it came to massive production, and perhaps too confident that what we ordered would actually be delivered on time,” she said. “We need to ask ourselves why that is the case.”
She stood by the view that buying vaccine doses as a bloc had been the right decision, however.
“I cannot even imagine what would have happened if just a handful of big players — big member states — had rushed to it and everybody else would have been left empty-handed,” she said, adding that it would have been “the end of our community.”
Her comments came as criticism has mounted over Ms. Von der Leyen’s handling of negotiations with pharmaceutical companies to secure vaccines for the 450 million people living in the bloc’s 27 member states.
Whereas Britain and United States have surged ahead in rolling out vaccines, the European Union has been more cautious and price-conscious, leading to a crisis after vaccine producers said there were delays in filing orders.
Its tensions with Britain, which left the bloc’s authority at the end of last year, were magnified after the Commission reversed an attempt last month to restrict vaccine exports into the country via Northern Ireland.
“The bottom line is that mistakes were made in the process leading up to the decision,” Ms. von der Leyen said on Wednesday. “And I deeply regret that. But in the end, we got it right.”
Over 17 million people, or about 4 percent of people living in the bloc, have received at least one vaccine dose, she said.
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