Top health officials urge Americans to get vaccinated but barely address the J.&J. dose pause.

Three top federal health officials appeared on Capitol Hill on Thursday and implored Americans to get vaccinated against the coronavirus, but said little about the investigation into whether the Johnson & Johnson vaccine may be linked to a small number of cases of rare blood clots, or when that vaccine might be put back into use.

“Hopefully we’ll get a decision quite soon, as to whether or not we can get back on track with this very effective vaccine,” Dr. Anthony S. Fauci, President Biden’s top medical adviser for the coronavirus, told a House panel.

Dr. Fauci’s comments came as the future of the Johnson & Johnson one-shot vaccine hung in the balance. Earlier this week, the Food and Drug Administration and the Centers for Disease Control and Prevention called for a pause in the use of the vaccine in the wake of reports of a small number of rare blood clots in recipients. Though it is unclear whether the vaccine was responsible for the clots, injections came to a sudden halt across the country.

On Wednesday, a C.D.C. advisory panel suggested that it would be a week to 10 days before they had enough information to assess the vaccine’s risks and could make a decision about its future. In the meantime, the officials — Dr. Fauci; Dr. Rochelle Walensky, the C.D.C. director; and Dr. David Kessler, who runs the Biden administration’s vaccine effort — urged Americans to continue to get vaccinated.

an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.

  • All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
  • Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
  • The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
  • Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
  • The reports of blood clots were the second recent blow to the Johnson & Johnson vaccine. Earlier this month, an ingredient mix-up at a Baltimore manufacturing plant owned by Emergent BioSolutions ruined up to 15 million doses of the vaccine. The F.D.A. is now inspecting the plant to see whether any vaccine doses manufactured there can be released to the public.

    About 7.7 million Americans had received the Johnson & Johnson vaccine as of Wednesday, accounting for less than 4 percent of the more than 198 million doses administered across the country. The Pfizer and Moderna vaccines are in much greater supply.

    Officials note that the blood clots are extremely rare; the handful of cases represent less than one in one million recipients, although that incidence estimate could go up if more cases are reported.

    Biden administration officials say that the absence of the Johnson & Johnson vaccine might not have a major impact on the U.S. vaccination campaign. But if use of the vaccine is severely restricted worldwide, it could prove disastrous for the global vaccination effort.

    Health officials had hoped that the Johnson & Johnson vaccine, along with a similar vaccine developed by AstraZeneca, would help supply the world because they are less expensive and easier to store and handle than the Pfizer and Moderna vaccines.

    Denmark, where two recipients suffered severe blood clots, permanently suspended use of the AstraZeneca vaccine.

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    The C.D.C. director says Michigan needs to shut down, not get extra vaccine, to slow its virus outbreak.

    “I made the case for a surge strategy. At this point that’s not being deployed, but I am not giving up,” Ms. Whitmer said last week, describing a Thursday evening call with the president. “Today it’s Michigan and the Midwest. Tomorrow it could be another section of our country.”

    Ms. Whitmer has emphasized demand for Johnson & Johnson’s one-dose vaccine, which will be extremely limited until federal regulators approve production at a Baltimore manufacturing plant that recently contaminated up to 15 million doses in a factory mixup.

    Andy Slavitt, a White House pandemic adviser, said on Monday that instead of playing “whack-a-mole” with vaccines, the federal government was working to help Michigan more efficiently administer the doses it has now and “rebalance” its supply.

    “We know there are appointments available in various parts of the state, and so that means that we have excess vaccine in some parts of the state,” he said.

    Mr. Slavitt said that the federal administration had also offered to send Michigan extra supplies of monoclonal antibody treatments and testing, and that there was a team from the C.D.C. in the state, in addition to 140 new vaccinators from the Federal Emergency Management Agency.

    Elizabeth Hertel, the director of the Michigan Department of Health and Human Services, said last week that she was optimistic that the continued rollout of vaccines and the governor’s new recommendations would help bring case numbers down. But if that did not happen, she said, more restrictions were possible.

    In response to Dr. Walensky’s remarks, a spokesman for Ms. Whitmer said on Monday in a statement that while the governor appreciated the federal government’s assistance, “she will not stop fighting to get more vaccines for the people of Michigan.”

    “As our nation’s top health experts have said, this is not a failure of policy, but rather a compliance, variant, and mobility issue, which is why it’s important for us to ramp up vaccinations as quickly as possible,” the spokesman, Bobby Leddy, said.

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    Has the Era of Overzealous Cleaning Finally Come to an End?

    When the coronavirus began to spread in the United States last spring, many experts warned of the danger posed by surfaces. Researchers reported that the virus could survive for days on plastic or stainless steel, and the Centers for Disease Control and Prevention advised that if someone touched one of these contaminated surfaces — and then touched their eyes, nose or mouth — they could become infected.

    Americans responded in kind, wiping down groceries, quarantining mail and clearing drugstore shelves of Clorox wipes. Facebook closed two of its offices for a “deep cleaning.” New York’s Metropolitan Transportation Authority began disinfecting subway cars every night.

    But the era of “hygiene theater” may have come to an unofficial end this week, when the C.D.C. updated its surface cleaning guidelines and noted that the risk of contracting the virus from touching a contaminated surface was less than 1 in 10,000.

    “People can be affected with the virus that causes Covid-19 through contact with contaminated surfaces and objects,” Dr. Rochelle Walensky, the director of the C.D.C., said at a White House briefing on Monday. “However, evidence has demonstrated that the risk by this route of infection of transmission is actually low.”

    primarily through the air — in both large and small droplets, which can remain aloft longer — and that scouring door handles and subway seats does little to keep people safe.

    who wrote last summer that the risk of surface transmission had been overblown. “This is a virus you get by breathing. It’s not a virus you get by touching.”

    The C.D.C. has previously acknowledged that surfaces are not the primary way that the virus spreads. But the agency’s statements this week went further.

    “The most important part of this update is that they’re clearly communicating to the public the correct, low risk from surfaces, which is not a message that has been clearly communicated for the past year,” said Joseph Allen, a building safety expert at the Harvard T.H. Chan School of Public Health.

    Catching the virus from surfaces remains theoretically possible, he noted. But it requires many things to go wrong: a lot of fresh, infectious viral particles to be deposited on a surface, and then for a relatively large quantity of them to be quickly transferred to someone’s hand and then to their face. “Presence on a surface does not equal risk,” Dr. Allen said.

    In most cases, cleaning with simple soap and water — in addition to hand-washing and mask-wearing — is enough to keep the odds of surface transmission low, the C.D.C.’s updated cleaning guidelines say. In most everyday scenarios and environments, people do not need to use chemical disinfectants, the agency notes.

    “What this does very usefully, I think, is tell us what we don’t need to do,” said Donald Milton, an aerosol scientist at the University of Maryland. “Doing a lot of spraying and misting of chemicals isn’t helpful.”

    Still, the guidelines do suggest that if someone who has Covid-19 has been in a particular space within the last day, the area should be both cleaned and disinfected.

    “Disinfection is only recommended in indoor settings — schools and homes — where there has been a suspected or confirmed case of Covid-19 within the last 24 hours,” Dr. Walensky said during the White House briefing. “Also, in most cases, fogging, fumigation and wide-area or electrostatic spraying is not recommended as a primary method of disinfection and has several safety risks to consider.”

    And the new cleaning guidelines do not apply to health care facilities, which may require more intensive cleaning and disinfection.

    Saskia Popescu, an infectious disease epidemiologist at George Mason University, said that she was happy to see the new guidance, which “reflects our evolving data on transmission throughout the pandemic.”

    But she noted that it remained important to continue doing some regular cleaning — and maintaining good hand-washing practices — to reduce the risk of contracting not just the coronavirus but any other pathogens that might be lingering on a particular surface.

    Dr. Allen said that the school and business officials he has spoken with this week expressed relief over the updated guidelines, which will allow them to pull back on some of their intensive cleaning regimens. “This frees up a lot of organizations to spend that money better,” he said.

    Schools, businesses and other institutions that want to keep people safe should shift their attention from surfaces to air quality, he said, and invest in improved ventilation and filtration.

    “This should be the end of deep cleaning,” Dr. Allen said, noting that the misplaced focus on surfaces has had real costs. “It has led to closed playgrounds, it has led to taking nets off basketball courts, it has led to quarantining books in the library. It has led to entire missed school days for deep cleaning. It has led to not being able to share a pencil. So that’s all that hygiene theater, and it’s a direct result of not properly classifying surface transmission as low risk.”

    Roni Caryn Rabin contributed reporting

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    More Contagious Covid Variant Is Now Dominant in U.S., C.D.C. Says

    WASHINGTON — A highly infectious variant of the coronavirus that was first identified in Britain has become the most common source of new infections in the United States, the director of the Centers for Disease Control and Prevention said on Wednesday. The worrisome development comes as officials and scientists warn of a possible fourth surge of infections.

    Federal health officials said in January that the B.1.1.7 variant, which began surging in Britain in December and has since slammed Europe, could become the dominant source of coronavirus infections in the United States, leading to a huge increase in cases and deaths.

    At that point, new cases, hospitalizations and deaths were at an all-time high. From that peak, the numbers all declined until late February, according to a New York Times database. After several weeks at a plateau, new cases and hospitalizations are increasing again. The average number of new cases in the country has reached nearly 65,000 a day as of Tuesday, concentrated mostly in metro areas in Michigan as well as in the New York City region. That is an increase of 19 percent compared with the figure two weeks ago.

    Dr. Rochelle Walensky, the C.D.C. director, who warned last week that she felt a recurring sense of “impending doom,” said on Wednesday that 52 of the agency’s 64 jurisdictions — which include states, some major cities and territories — are now reporting cases of these so-called “variants of concern,” including B.1.1.7.

    60 percent more contagious and 67 percent more deadly than the original form of the coronavirus, according to the most recent estimates. The C.D.C. has also been tracking the spread of other variants, such as B.1.351, first found in South Africa, and P.1, which was first identified in Brazil.

    The percentage of cases caused by variants is clearly increasing. Helix, a lab testing company, has tracked the relentless increase of B.1.1.7 since the beginning of the year. As of April 3, it estimated that the variant made up 58.9 percent of all new tests.

    That variant has been found to be most prevalent in Michigan, Florida, Colorado, California, Minnesota and Massachusetts, according to the C.D.C. Until recently, the variant’s rise was somewhat camouflaged by falling infection rates over all, leading some political leaders to relax restrictions on indoor dining, social distancing and other measures.

    against the warnings of some scientists.

    Federal health officials are tracking reports of increasing cases associated with day care centers and youth sports, and hospitals are seeing more younger adults — people in their 30s and 40s who are admitted with “severe disease,” Dr. Walensky said.

    It is difficult for scientists to say exactly how much of the current patterns of infection are because of the growing frequency of B.1.1.7.

    “It’s muddled by the reopening that’s going on and changes in behavior,” said Dr. Adam Lauring, a virologist at the University of Michigan.

    But he noted that people were becoming less cautious at a time when they should be raising their guard against a more contagious variant. “It’s worrisome,” he said.

    At the same time, the United States is currently vaccinating an average of about three million people a day, and states have rushed to make all adults eligible. The C.D.C. reported on Tuesday that about 108.3 million people had received at least one dose of a Covid-19 vaccine, including about 64.4 million people who have been fully vaccinated. New Mexico, South Dakota, Rhode Island and Alaska are leading the states, with about 25 percent of their total populations fully vaccinated.

    Scientists hope that vaccination will blunt any potential fourth surge.

    On Tuesday, President Biden moved up his vaccination timetable by two weeks, calling states to make every American adult eligible by April 19. All states have already met or expect to beat this goal after he initially asked that they do so by May 1.

    hundreds of genomes predicted that this variant could become predominant in the country in a month. At that time, the C.D.C. was struggling to sequence the new variants, which made it difficult to track them.

    But those efforts have substantially improved in recent weeks and will continue to grow, in large part because of $1.75 billion in funds for genomic sequencing in the stimulus package that Mr. Biden signed into law last month. By contrast, Britain, which has a more centralized health care system, began a highly promoted sequencing program last year that allowed it to track the spread of the B.1.1.7 variant.

    “We knew this was going to happen: This variant is a lot more transmissible, much more infectious than the parent strain, and that obviously has implications,” said Dr. Carlos del Rio, a professor of medicine and an infectious disease expert at Emory University. In addition to spreading more efficiently, he said, the B.1.1.7 strain appears to cause more severe disease, “so that gives you a double whammy.”

    Perhaps even more troubling is the emergence of the virulent P.1 variant in North America. First identified in Brazil, it has become the dominant variant in that country, helping to drive its hospitals to the breaking point. In Canada, the P.1 variant emerged as a cluster in Ontario, then shut down the Whistler ski resort in British Columbia. On Wednesday, the National Hockey League’s Vancouver Canucks said at least 21 players and four staff members had been infected with the coronavirus.

    “This is a stark reminder of how quickly the virus can spread and its serious impact, even among healthy, young athletes,” the team’s doctor, Jim Bovard, said in a statement.

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    Most U.S. infections are now caused by a contagious new virus variant, the C.D.C. says.

    Scientists have been predicting another rise in infections, as states relax their public health restrictions and restive Americans go back to school and work. But they are hoping that vaccination will blunt any potential fourth surge.

    On Tuesday, President Biden moved up his vaccination timetable by two weeks, calling on states to make every American adult eligible for coronavirus vaccination by April 19, a goal nearly all states have already met or expect to beat after he initially asked they do so by May 1.

    “It is in our power to minimize death, disease, and misery,” Andy Slavitt, a White House pandemic adviser, said Wednesday. “If all of us do our part, we can help save lives in April, May, and June. Wear a mask. Socially distance. Get vaccinated when it’s your turn.”

    In February, a study that analyzed half a million coronavirus tests and hundreds of genomes predicted that in a month this variant could become predominant in the United States. At that time, the C.D.C. was struggling to sequence the new variants, which made it difficult to track them.

    But those efforts have substantially improved in recent weeks and will continue to grow, in large part because of $1.75 billion in funds for genomic sequencing in the stimulus package that President Biden signed into law last month. By contrast, Britain, with a more centralized health care system, began a highly touted sequencing program last year that allowed it to track the spread of the B.1.1.7 variant.

    “We knew this was going to happen, this variant is a lot more transmissible, much more infectious than the parent strain and that obviously has implications,” said Dr. Carlos del Rio, a professor of medicine and infectious disease expert at Emory University. In addition to spreading more efficiently, he said, the B.1.1.7 strain appears to cause more severe disease, “so that gives you a double whammy.”

    The White House also announced an expansion to its vaccination program at community health centers, bringing the total to nearly 1,400 community centers across the country where people can get vaccinated. Mr. Slavitt said most of these community centers are in underserved neighborhoods with many uninsured patients. Last week, Mr. Biden promised that 90 percent of adults in the country will have a vaccine site within five miles of their home.

    Eileen Sullivan contributed reporting.

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    Can Vaccinated People Spread the Virus? We Don’t Know, Scientists Say.

    The Centers for Disease Control and Prevention on Thursday walked back controversial comments made by its director, Dr. Rochelle P. Walensky, suggesting that people who are vaccinated against the coronavirus never become infected or transmit the virus to others.

    The assertion called into question the precautions that the agency had urged vaccinated people to take just last month, like wearing masks and gathering only under limited circumstances with unvaccinated people.

    “Dr. Walensky spoke broadly during this interview,” an agency spokesman told The Times. “It’s possible that some people who are fully vaccinated could get Covid-19. The evidence isn’t clear whether they can spread the virus to others. We are continuing to evaluate the evidence.”

    The agency was responding in part to criticism from scientists who noted that current research was far from sufficient to claim that vaccinated people cannot spread the virus.

    MSNBC’s Rachel Maddow, Dr. Walensky referred to data published by the C.D.C. showing that one dose of the Moderna or Pfizer-BioNTech vaccine was 80 percent effective at preventing infection, and two doses were 90 percent effective.

    That certainly suggested that transmission from vaccinated people might be unlikely, but Dr. Walensky’s comments hinted that protection was complete. “Our data from the C.D.C. today suggests that vaccinated people do not carry the virus, don’t get sick,” she said. “And that it’s not just in the clinical trials, it’s also in real-world data.”

    Dr. Walensky went on to emphasize the importance of continuing to wear masks and maintain precautions, even for vaccinated people. Still, the brief comment was widely interpreted as saying that the vaccines offered complete protection against infection or transmission.

    In a pandemic that regularly spawns scientific misunderstanding, experts said they were sympathetic to Dr. Walensky and her obvious desire for Americans to continue to take precautions. It was only Monday that she said rising caseloads had left her with a sense of “impending doom.”

    “If Dr. Walensky had said most vaccinated people do not carry virus, we would not be having this discussion,” said John Moore, a virologist at Weill Cornell Medicine in New York.

    “What we know is the vaccines are very substantially effective against infection — there’s more and more data on that — but nothing is 100 percent,” he added. “It is an important public health message that needs to be gotten right.”

    Misinterpretation could disrupt the agency’s urgent pleas for immunization, some experts said. As of Wednesday, 30 percent of Americans had received at least one dose of a vaccine and 17 percent were fully immunized.

    “There cannot be any daylight between what the research shows — really impressive but incomplete protection — and how it is described,” said Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York.

    “This opens the door to the skeptics who think the government is sugarcoating the science,” Dr. Bach said, “and completely undermines any remaining argument why people should keep wearing masks after being vaccinated.”

    All of the coronavirus vaccines are spectacularly successful at preventing serious disease and death from Covid-19, but how well they prevent infection has been less clear.

    Clinical trials of the vaccines were designed only to assess whether the vaccines prevent serious illness and death. The research from the C.D.C. on Monday brought the welcome conclusion that the vaccines are also extremely effective at preventing infection.

    The study enrolled 3,950 health care workers, emergency responders and others at high risk of infection. The participants swabbed their noses each week and sent the samples in for testing, which allowed federal researchers to track all infections, symptomatic or not. Two weeks after vaccination, the vast majority of vaccinated people remained virus-free, the study found.

    Follow-up data from clinical trials support that finding. In results released by Pfizer and BioNTech on Wednesday, for example, 77 people who received the vaccine had a coronavirus infection, compared with 850 people who got a placebo.

    “Clearly, some vaccinated people do get infected,” Dr. Duprex said. “We’re stopping symptoms, we’re keeping people out of hospitals. But we’re not making them completely resistant to an infection.”

    The number of vaccinated people who become infected is likely to be higher among those receiving vaccines made by Johnson & Johnson and AstraZeneca, which have a lower efficacy, experts said. (Still, those vaccines are worth taking, because they uniformly prevent serious illness and death.)

    Infection rates may also be higher among people exposed to a virus variant that can sidestep the immune system.

    Cases across the country are once again on the upswing, threatening a new surge. Dr. Walensky’s comment came just a day after she made an emotional appeal to the American public to continue taking precautions.

    “I am asking you to just hold on a little longer, to get vaccinated when you can, so that all of those people that we all love will still be here when this pandemic ends,” she said.

    Given the rising numbers, it’s especially important that immunized people continue to protect those who have not yet been immunized against the virus, experts said.

    “Vaccinated people should not be throwing away their masks at this point,” Dr. Moore said. “This pandemic is not over.”

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    Fully vaccinated people in the U.S. now have more guidance from the C.D.C. on activities. That doesn’t yet include travel.

    When the Centers for Disease Control and Prevention announced new freedoms for the fully-vaccinated members of the population, questions about traveling to visit grandchildren, for example, were immediate.

    The answer, the C.D.C. director, Dr. Rochelle Walensky, said was yes, as long as the vaccinated grandparents lived nearby. But the agency continues to warn Americans against traveling in general.

    “We know that after mass travel, after vacations, after holidays, we tend to see a surge in cases,” Dr. Walensky said Monday night on MSNBC. “And so, we really want to make sure — again with just 10 percent of people vaccinated — that we are limiting travel.”

    To the frustration of airlines and others in the travel industry, the latest guidance comes as students and families are considering spring break plans almost a year after wide swaths of the United States first shut down, and a growing share of Americans tentatively book travel for later in the year.

    scientists do not yet understand whether and how often immunized people may still transmit the virus. If they can, then masking and other precautions are still needed in certain settings to contain the virus, researchers have said.

    “We know that the travel corridor is a place where people are mixing a lot,” Dr. Walensky said during a White House briefing on Monday. “We’re hopeful that our next set of guidance will have more science around what vaccinated people can do, perhaps travel being among them.”

    Airlines for America, an industry organization, has argued that airplanes have a very low risk for virus transmission because of high-end cabin ventilation systems, strong disinfection practices and strict rules requiring that passengers wear masks. The industry has also argued that it plays a vital economic role and that further restrictions to travel could hinder the recovery.

    “We remain confident that this layered approach significantly reduces risk and are encouraged that science continues to confirm there is a very low risk of virus transmission onboard aircraft,” the group said.

    included $50 billion in grants and loans to prop up the airline industry, which was hobbled by the pandemic. In December, Congress approved another $15 billion in grants to keep airline workers employed. The relief bill passed by the Senate on Saturday, includes $14 billion more for airlines, a measure applauded by the industry.

    In a Monday letter to President Biden’s coronavirus response coordinator, Jeffrey D. Zients, a coalition of travel and tourism trade groups asked to work with the White House on federal guidance for temporary virus “health credentials,” which could be used to securely and uniformly verify test results or vaccination status. Such guidance could also yield benefits beyond aviation, they argued.

    “It could encourage more widespread adoption of processes to verify testing and vaccination records, from sports arenas to restaurants, business meetings, theme parks, and more,” the group wrote.

    Currently, the Biden administration requires people traveling to the United States from another country to present a negative virus test. At one point this year, administration officials were considering a similar requirement for domestic travel, a move the airline industry pushed back against, saying it was needlessly restrictive and would hurt an already struggling sector. The C.D.C. in February said it was not recommending testing for domestic travel “at this time.”

    “We remain in the midst of a serious pandemic,” Dr. Walensky said Monday at the news conference. “Therefore, everyone, whether vaccinated or not, should continue to avoid medium- and large-sized gatherings, as well as nonessential travel.”

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