The director of the Centers for Disease Control and Prevention on Wednesday stood by advice that people fully vaccinated against the coronavirus do not need to wear masks in most situations, but added that there are instances where local authorities might impose more stringent measures to protect the unvaccinated.
The comments came after the World Health Organization recently reiterated longstanding guidance that everyone, vaccinated or not, wear masks and take other precautions, following a global surge in infections of the highly contagious Delta variant. On Monday, Los Angeles County recommended that even fully vaccinated people wear masks indoors.
In May, the C.D.C. advised that fully vaccinated Americans could forgo masks in most settings. The agency’s director, Dr. Rochelle P. Walensky, said during multiple television appearances on Wednesday that local changes to masking and distancing rules were consistent with those guidelines.
“We have always said that this virus is an opportunist, and in areas where we still have rates of low vaccination, that is where the virus is likely to take hold,” she said on “Good Morning America.” “We are still seeing uptick of cases in areas of low vaccination, and in that situation we are suggesting that policies be made at the local level.”
Dr. Walensky added that the W.H.O.’s blanket suggestion that both vaccinated and unvaccinated individuals wear masks was informed by its global purview. “The W.H.O. really does have to make recommendations for an entire world,” and many countries have far less access to vaccines than the United States, she said.
The Delta variant now accounts for about one in every four infections in the United States, according to new estimates this week from the C.D.C. But cases across the country have plummeted in recent months, along with hospitalizations and deaths.
Still, the average rate of U.S. vaccinations a day has decreased by about 75 percent from the peak reported in mid-April. As of Tuesday, about 46 percent of people of all ages and about 57 percent of adults are fully vaccinated, according to federal data.
Vaccines consistently protect people from the variants circulating in the United States, including the Delta variant, Dr. Walensky noted on NBC’s “Today” show on Wednesday. But “local policymakers need to make policies for their local environment,” she said, especially in parts of the country with low rates of vaccination.
“Those masking policies are not to protect the vaccinated — they are to protect the unvaccinated,” she added, noting that “everybody should consider their own situation if they would feel more comfortable wearing a mask.”
In Los Angeles County, where half of the population is fully vaccinated, health officials recommended that everyone wear masks indoors because of an uptick in cases and an increase in infections with the Delta variant. Officials in other large cities, like New York and Chicago, indicated earlier this week that they did not plan to change their guidance on masks.
On Tuesday, Dr. Anthony S. Fauci, the government’s top infectious disease expert, said on CNN that he was particularly concerned about the Delta variant causing outbreaks in states, cities and counties with low vaccination rates.
“It’s almost like it’s going to be two Americas,” he said, noting that areas where relatively fewer people are fully vaccinated — as is the case in many parts of the South — are far more at risk than regions with high inoculation rates.
“If you are vaccinated, you diminish dramatically your risk of getting infected and even more dramatically your risk of getting seriously ill,” Dr. Fauci said. “If you are not vaccinated, you are at considerable risk.”
Dr. Vivek Murthy, the United States surgeon general, said on CNN on Wednesday morning that he saw nothing wrong with local authorities imposing new restrictions if they seemed necessary.
“If I was in a community that had a low vaccination rate, as a number of our communities do around the country, if I was seeing a rise in the Delta variant, I think it’s perfectly reasonable to think about different approaches we could take to limit spread to try to get ahead of it,” Dr. Murthy said.
BUENOS AIRES — As some wealthy countries ease coronavirus restrictions, or make plans to in the near future, Latin America and the Caribbean continue to be hammered by increased infections and deaths, highlighting the stark inequalities in access to vaccines around the world, officials from the World Health Organization warned on Wednesday.
“When we are seeing some reprieve from the virus in countries in the northern hemisphere, for most countries in the region, the end remains a distant future,” said Carissa Etienne, the director of Pan American Health Organization, which is part of the W.H.O.
“Despite this worrisome picture, just one in 10 people in Latin America and the Caribbean have been fully vaccinated against Covid-19,” she added, calling it an “unacceptable situation.”
Economic inequality, the huge informal economy and the difficulty of implementing public health measures in Latin America and the Caribbean have all been major obstacles to containing the coronavirus there, said Ciro Ugarte, PAHO’s director of health emergencies.
New cases continue to rise in many countries in Central America, including Panama and Guatemala; the Caribbean, including Cuba and the Dominican Republic; and South America, including Colombia and Brazil.
Brazil recently surpassed 500,000 official Covid-19 deaths, the world’s second-highest total behind the United States. About 1 in every 400 Brazilians has died from the virus, but many experts believe the true death toll may be higher. Home to just over 2.7 percent of the world’s population, Brazil accounts for roughly 13 percent of recorded fatalities, and the situation there is not easing.
Now in addition to a worsening situation, countries in the region have to prepare for conditions that could lead to a further spike in cases, including hurricane season and the flu season farther south, both of which come at a time when social distancing measures have been relaxed.
Coronavirus variants have been detected across the region, with 14 countries in the Americas detecting cases of the Delta variant, creating more urgency to vaccinate as many people as quickly as possible, said Dr. Etienne. She added that inoculation can be ramped up in part through donations from developed countries.
Although there is not yet good data on how all of the vaccines hold up against Delta, several widely used shots, including those made by Pfizer-BioNTech and AstraZeneca, appear to retain most of their effectiveness against the Delta variant, research suggests.
Eighty-five percent of shots that have gone into arms worldwide have been administered in high- and upper-middle-income countries, according to the Our World in Data project at the University of Oxford. Only 0.3 percent of doses have been administered in low-income countries.
Less wealthy countries are relying on a vaccine-sharing arrangement called Covax, which aims to provide two billion doses by the end of the year.
On Wednesday, Jen Psaki, the White House press secretary, said the United States is sending 2.5 million doses of the Johnson & Johnson vaccine to Colombia, part of President Biden’s pledge to dispatch doses to countries desperate for vaccines.
“Access to Covid-19 vaccines shouldn’t be a privilege for a few but a right we all share,” Dr. Etienne said.
For now, the Delta variant remains largely tied to travelers in Latin America and the Caribbean and “community transmission has been limited,” said Jairo Méndez, a PAHO regional adviser for viral diseases.
The connection between travelers and the increase in infections from variants led PAHO to call on governments with a high rates of variants to limit travel from their countries to others, or even close their borders entirely.
“Now may not be the ideal time for travel, especially in places with active outbreaks or where hospital capacity may be limited,” Dr. Etienne said.
Dan Levin contributed reporting.
The German company CureVac announced on Wednesday the final results of its late-stage vaccine trial, confirming earlier data showing that its shot is far less protective than other vaccines.
Overall, the CureVac vaccine had an efficacy of just 48 percent against Covid-19. The Moderna and Pfizer-BioNTech vaccines, which use the same mRNA technology as CureVac’s, delivered efficacy rates around 95 percent in clinical trials.
CureVac’s vaccine proved somewhat better for younger volunteers: For those between the ages of 18 and 60, the efficacy rose to 53 percent. In that group, the researchers also found the vaccine provided 100 percent protection against hospitalization and death.
Forty thousand people participated in the company’s trial in Europe and Latin America. By the end of the study, 288 volunteers had gotten Covid-19.
CureVac had to contend with 15 different variants of the coronavirus. Genetic testing showed that only 3 percent of the cases were caused by the original version of the coronavirus. It’s possible that some of the variants were able to evade the immunity provoked by the CureVac vaccine. (No variants had become widespread in 2020 when Moderna and Pfizer-BioNTech ran their trials.)
But vaccine experts have also questioned whether part of CureVac’s problem was with the design of the vaccine itself. The precise recipe that CureVac used to build its vaccine may have blunted its effectiveness.
The European Medicines Agency opened a rolling review of CureVac’s vaccine in February, and the company said it would continue its submission with these data. The vaccine “will be an important contribution to help manage the Covid-19 pandemic and the dynamic variant spread,” Franz-Werner Haas, the chief executive of CureVac, said in the announcement.
A grand jury in Texas declined on Wednesday to indict a Houston doctor who was accused earlier this year of stealing 10 doses of Covid-19 vaccine — worth a total of $135 — and inoculating a few faint acquaintances and finally his wife in a late-night race in December to use the medicine before it expired.
The doctor, Hasan Gokal, received support for his actions from, among others, the Texas Medical Association and the Harris County Medical Society. But the Harris County district attorney, Kim Ogg, chose to present the case to a grand jury, even after a criminal court judge had dismissed the matter in January for lack of probable cause.
The allegation upended Dr. Gokal’s life. He was fired from his government job and his name ricocheted around the world. A news release from the district attorney’s office asserted that the doctor “stole the vial,” and, according to Ms. Ogg, had “abused his position to place his friends and family in line in front of people who had gone through the lawful process to be there.”
After a monthlong investigation by prosecutors and two days of testimony, a grand jury in Harris County disagreed.
Dr. Gokal expressed relief in a telephone call Wednesday afternoon. “For the first time in six months I’m going to be able to go to bed tonight and not wake up in the middle thinking about this,” he said.
His lawyer, Paul Doyle, said, “What a colossal waste of time.”
In late December, Dr. Gokal, 48, a veteran emergency room doctor then working for the Harris County Public Health Department, set up a vaccination event in the Houston suburb of Humble. Just as the event was about to close for the night, an eligible person showed up. A nurse punctured a new vial to administer the vaccine, which activated the six-hour time limit for its 10 remaining doses.
Dr. Gokal later said that he was determined to abide by his understanding that not a dose of the precious vaccine should be wasted. Colleagues at the event either declined or already had been vaccinated. So, as he drove home to a neighboring county, he called acquaintances to ask whether they knew of older people needing to be immunized.
Within a few frantic hours, he had vaccinated various people in need, most of them older or in fragile health, and unknown to him. As midnight approached, he had one last dose and no one to vaccinate, so he presented the situation to his wife, whose pulmonary sarcoidosis made her eligible — but she was hesitant.
“It makes perfect sense,” he later said he told her. “We don’t want any doses wasted, period.”
The next morning, Dr. Gokal submitted the documentation for the 10 people he had vaccinated with that last vial. Several days later, he was fired from his county job; he said he was told that he should have returned the doses to the office, which by then was closed, or thrown them away.
Soon after, the district attorney’s office issued its news release, with the headline “Fired Harris County Health Doctor Charged with Stealing Vial of Covid-19 Vaccine.”
On Wednesday afternoon, Dr. Gokal — who, since his firing, has been volunteering at a nonprofit health clinic for the uninsured — was busy answering congratulatory text messages and telephone calls. He said he was looking forward to a return to normality for his wife and three children.
Meanwhile, the district attorney’s office issued a statement that read in part: “We respect the decision of the grand jury in this and every case. Evidence, not public opinion, is the guiding principle of our work.”
The Delta variant of the coronavirus now accounts for about one in every four infections in the United States, according to new estimates this week from the Centers for Disease Control and Prevention.
First identified in India, Delta is one of several “variants of concern,” as designated by the C.D.C. and the World Health Organization. It has spread rapidly through India and Britain and poses a particular threat in places where vaccination rates remain low.
Here are answers to some common questions.
Does the Delta variant cause different symptoms?
It’s not clear yet. “We’re hurting for good data,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
But some evidence of a potential shift is emerging in Britain, where Delta has become the dominant variant.
“What we’ve noticed is the last month, we’re seeing different sets of symptoms than we were seeing in January,” said Tim Spector, a genetic epidemiologist at King’s College London, who leads the Covid Symptom Study, which asks people with the disease to report their symptoms in an app.
Headaches, a sore throat, and a runny nose are now among those mentioned most frequently, Dr. Spector said, with fever, cough and loss of smell less common.
These findings, however, have not yet been published in a scientific journal, and some scientists remain unconvinced that the symptom profile has truly changed. The severity of Covid, regardless of the variant, can vary wildly from one person to another.
If I’m vaccinated, do I need to worry?
Although there is not yet good data on how all of the vaccines hold up against Delta, several widely used shots, including those made by Pfizer, Moderna and AstraZeneca, appear to retain most of their effectiveness against the Delta variant, research suggests.
“If you’re fully vaccinated, I would largely not worry about it,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health.
Pockets of unvaccinated people, however, may be vulnerable to outbreaks in the coming months, scientists said.
“When you have such a low level of vaccination superimposed upon a variant that has a high degree of efficiency of spread, what you are going to see among under-vaccinated regions, be that states, cities or counties, you’re going to see these individual types of blips,” Dr. Anthony Fauci, the nation’s leading infectious disease expert, said on CNN on Tuesday. “It’s almost like it’s going to be two Americas.”
The World Health Organization wants everybody to wear masks, but according to the U.S. Centers for Disease Control and Prevention, vaccinated people often don’t need to wear them.
So which do we listen to?
Virus experts and epidemiologists also offer mixed advice, but largely agree on one point: Whether a fully vaccinated person needs to wear a mask really depends on the circumstances and what’s happening in your community.
The reaffirmed push to ask vaccinated people to mask up has sown confusion. Here are some answers.
Why is the W.H.O. telling vaccinated people to wear masks?
Mask mandates are largely intended to protect the unvaccinated — people who are vaccinated are already well protected by vaccines, and breakthrough infections are still very rare. But since you can’t tell who is vaccinated and who is not, advising everyone to wear a mask can help stop the spread of the virus.
Linsey Marr, a professor at Virginia Tech and one of the world’s leading experts on viral transmission, said her advice to a fully vaccinated friend about mask wearing would be to follow local rules and to take extra precautions in certain situations, like a very crowded indoor setting or an airplane.
What’s my risk of getting Covid-19 after I’m fully vaccinated?
Although the Covid vaccines are highly effective, no vaccine offers 100 percent protection. While breakthrough infections happen, they are extremely rare, and in most cases, they cause only mild illness.
But because the risk isn’t zero, some health experts still advise that vaccinated people take reasonable precautions, like wearing a mask in crowded spaces.
And people who live in areas with low vaccination rates may also want to consider wearing masks in public because of the potentially higher number of unvaccinated people they might encounter.
Those suggestions could change with time, Dr. Marr said.
“I know everyone wants this to be over or wants a one-size-fits-all rule, but we need to get used to things changing as the virus changes, vaccines roll out, public health responses in different countries shift, and scientists learn more,” she said. “The 1918 flu pandemic lasted two years.”
North Korea’s leader, Kim Jong-un, said that lapses in his country’s anti-pandemic campaign have caused a “great crisis” that threatened “grave consequences,” state media reported on Wednesday.
Mr. Kim did not clarify whether he was referring to an outbreak in North Korea, where the authorities had said there were no cases of the virus. But state media reported that the matter was serious enough for Mr. Kim to convene a meeting of the Political Bureau of his ruling Workers’ Party on Tuesday, during which Mr. Kim reshuffled the top party leadership.
Senior officials neglected implementing antivirus measures and had created “a great crisis in ensuring the security of the state and safety of the people,” Mr. Kim said.
Mr. Kim also berated party officials for their “ignorance, disability and irresponsibility,” said the official Korean Central News Agency.
A report said there would be some “legal” consequences for the officials.
The news agency said that some members of the Politburo and its Presidium, as well as some Workers’ Party secretaries, were replaced. In North Korea, all power is concentrated in the leadership of Mr. Kim, and he frequently reshuffles party officials and military leaders, holding them responsible for policy failures.
The North claims officially to be free of the virus, although outside experts remain skeptical, citing the country’s threadbare public health system and lack of extensive testing.
Still, North Korea has enforced harsh restrictions to contain transmission.
Last year, it created a buffer zone along the border with China, issuing a shoot-to-kill order to stop unauthorized crossings, according to South Korean and U.S. officials. South Korean lawmakers briefed by their government’s National Intelligence Service last year have said that North Korea executed an official for violating a trade ban imposed to fight the virus.
Last July, when a man from South Korea defected to the North, North Korea declared a national emergency for fear he might have brought the virus.
But Mr. Kim has also shown confidence that at least his inner circles were virus-free, sometimes presiding over meetings of party elites where no one wore masks.
During the meeting on Tuesday, Mr. Kim urged party officials to double down on his efforts to build a “self-reliant” economy. As North Korea’s economy has been hit hard by the pandemic, Mr. Kim has acknowledged that his five-year plan for growth had failed and instructed his officials to wage an “arduous march” through difficult economic times. This month, he warned of a looming food shortage.
The party meeting on Tuesday “suggests that the situation in the country has worsened beyond the capacity of self-reliance,” said Leif-Eric Easley, an associate professor of international studies at Ewha Womans University in Seoul.
“Pyongyang may be setting up a domestic political narrative to allow the acceptance of foreign vaccines and pandemic assistance,” he said. “Kim is likely to blame scapegoats for this incident, purging disloyal government officials and replacing them with others considered more capable.”
President Vladimir V. Putin urged Russians to get vaccinated against the coronavirus on Wednesday — his most extensive comments on the matter yet — as his country scrambles to contain a vicious new wave of the illness.
Speaking at his annual televised call-in show, Mr. Putin spent the opening half-hour trying to convince Russians to get one of the country’s four domestically produced shots. It was the latest instance of a marked change in tone about the pandemic from Russian officials, who for months did little to push a vaccine-wary public to get immunized but are now starting to make vaccination mandatory for some groups.
“It’s dangerous, dangerous to your life,” Mr. Putin said of Covid-19. “The vaccine is not dangerous.”
Only 23 million Russians, or about 15 percent of the population, have received at least one vaccine dose, Mr. Putin said. Polls this year by the independent Levada Center showed that some 60 percent of Russians did not want to be vaccinated, even though the domestically produced Sputnik V vaccine is widely seen as safe and effective.
Analysts attribute Russians’ hesitancy to a widespread distrust of the authorities combined with a drumbeat of state television reports that described the coronavirus as either mostly defeated or not very dangerous to begin with.
Mr. Putin revealed that he himself had received the Sputnik V vaccine this year — the Kremlin had previously refused to specify which shot he had been given — and that he had experienced a brief fever after the second dose.
He spoke just as his handling of the pandemic — long touted by the Kremlin as superior to the approach taken in the West — threatened to turn into a major debacle. Russia’s biggest cities, Moscow and St. Petersburg, have been reporting more than 100 deaths per day recently, setting records; nationwide, the number of reported new cases per day has doubled to more than 20,000 in recent weeks, with 669 deaths reported on Wednesday. The official toll is likely to be a significant undercount.
Regional officials in Moscow and elsewhere have resisted lockdowns. But, almost certainly with Mr. Putin’s blessing, they have made vaccination mandatory for large groups of people, such as service workers. That has prompted an outcry from many Kremlin critics and supporters alike.
“I don’t support mandatory vaccination, and continue to have this point of view,” Mr. Putin said, putting the responsibility for such orders on regional officials.
The renewed surge of the coronavirus could derail the Kremlin’s message of competence in comparison to Western dysfunction just as parliamentary elections approach in September. Mr. Putin’s most vocal opponents have already been jailed, exiled or barred from running, but obvious election fraud or a poor showing by his governing United Russia party could still weaken the president’s domestic authority.
Helped along by an enormous infusion of federal pandemic aid, New York City officials agreed on Wednesday to adopt the city’s largest budget ever, a $98.7 billion spending plan that restores many of the service cuts prompted by the sudden economic downturn caused by the coronavirus.
The budget, which includes $14 billion in federal aid, represents a sharp reversal from last year when the city locked down its economy to control the outbreak, creating a major financial strain and forcing the city to reduce its spending.
But with the pandemic receding amid rising vaccination rates and the lifting of public health restrictions, the outlook for New York has grown brighter. Restaurants and bars are filling with patrons, and popular gathering spots like Times Square are showing glimmers of their prepandemic bustle.
Mayor Bill de Blasio has called his last spending plan a “recovery budget” that builds on the $8 billion the city has already spent to fight the pandemic. The city will spend $30 million to promote the return of tourism and hire 10,000 residents to form a cleaning corps across the city.
To address racial and economic disparities exposed by the pandemic and national protests over the killing of George Floyd, the city will deposit $100 into the accounts of all kindergartners as part of a “Baby Bonds” effort that could expand to $15 million in the next fiscal year.
The city will also invest $4 million to fund full scholarships for Black and low-income residents to the City University of New York and $6.5 million to quickly train 1,000 New Yorkers for jobs in high-demand fields.
To address a rise in shootings and homicides that have plagued the city since the pandemic, the city will spend $24 million to hire 1,000 people who are most at risk of participating in or being a victim of violence in various neighborhoods, including Brownsville, Brooklyn, South Jamaica, Queens, and Mott Haven in the Bronx.
The city also set aside $1 billion in a rainy-day fund to respond to any unexpected challenges, including another pandemic.
But some critics said the budget does not focus enough on creating jobs and instead invests money on starting programs that will require tax increases to maintain once the federal aid dries up.
Because of an editing error, an earlier headline on this article incorrectly described the status of the budget agreement. New York officials agreed on a budget deal, but they have not yet voted to pass it.
Seoul’s mayor, Oh Se-hoon, announced Wednesday that the city will extend current social distancing regulations for the capital and its surrounding areas for a week, reversing an earlier decision to ease restrictions starting July 1. The decision was made less than 12 hours before the partial reopening, following an emergency meeting with 25 district mayors.
The government had previously said that beginning Thursday, gatherings of up to six people would be allowed, an increase from the current limit of four, regardless of whether they are held indoors or outdoors. After two weeks, that number would have risen to eight. The government had also announced that businesses could operate until midnight, two hours longer than the current 10 p.m. curfew.
Wednesday’s move put those plans on hold for now.
The delay to relax protocol comes after a spike in coronavirus cases earlier this week, as the country broke a two-month record of 794 new daily cases on Tuesday, according to the Korea Disease Control and Prevention Agency. Seoul also reported 375 new daily cases on Tuesday, the largest amount of new cases in a single day for the city this year. As new infections increase, authorities have expressed concerns about the recent discovery of the Delta variant among confirmed cases.
Mr. Oh said if Seoul did not see a decrease in new reported cases, then the government would decide whether to further extend the delay on lifting restrictions.
Thirty percent of South Korea’s population have received one vaccine dose and 9.5 percent are fully vaccinated, according to Our World in Data.
Countries across Asia and the Pacific region are scrambling to slow the spread of the more infectious Delta variant, reimposing restrictions and stay-at-home orders in a jarring reminder — for societies that had just begun to reopen — that the pandemic is far from over.
A rift has emerged between Australia’s federal government, state leaders and medical groups over vaccination advice, with several officials issuing public objections to Prime Minister Scott Morrison’s decision to make the AstraZeneca vaccine available to those under 40.
Australia’s vaccine advisory body has recommended that people under 60 should be vaccinated with the Pfizer shot because the AstraZeneca vaccine is associated with a very small risk of a serious blood-clotting disorder. But the country’s vaccination campaign was initially planned around AstraZeneca, and supplies of other shots are so far relatively constrained, with Pfizer appointments not yet open to most people under 40.
Less than 5 percent of Australians are fully vaccinated, and just under a quarter have had one dose of a vaccine. Parts of four states or territories, including four major cities, are in lockdown to halt outbreaks associated with the Delta variant, and there are restrictions in two more.
In response to outbreaks of the more infectious Delta variant of the virus, Mr. Morrison announced on Monday that the federal government would allow family doctors to administer the AstraZeneca vaccine to those under 40 who wanted it.
“If you wish to get the AstraZeneca vaccine, then we would encourage you to go and have that discussion” with your doctor, he said.
But soon after, state leaders spoke against the decision. “I do not want under-40s to get AstraZeneca,” Queensland’s chief health officer, Dr. Jeannette Young, said at a news conference on Wednesday. “I don’t want an 18-year-old in Queensland dying from a clotting illness who, if they got Covid, probably wouldn’t die.”
Parts of Queensland recently entered a three-day lockdown as authorities race to contain an outbreak.
The premier of Western Australia, Mark McGowan, echoed Dr. Young’s position and called for people over 60 to be given the Pfizer vaccine to combat vaccine hesitancy.
Dr. Omar Khorshid, president of the Australian Medical Association, which represents doctors and medical students, said the announcement “was a surprise.” While some medical clinics have started providing consultations to younger people wanting to get the AstraZeneca vaccine, some doctors have said they want more information before they would be comfortable doing so.
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