The US is in an 'absolute race' with new coronavirus strains as experts differ on vaccine strategy

By Christina Maxouris and Holly Yan, CNN

    (CNN) -- With multiple new coronavirus strains spreading across the country, the US is in an "absolute race" to vaccinate Americans before those variants overwhelm the country, health experts say.

"What concerns me most is that we already know that they're more transmissible, which means it's much easier for them to infect people," said emergency physician Dr. Megan Ranney, director of the Brown-Lifespan Center for Digital Health in Rhode Island.

"Right now we are in an absolute race against time with these variants, with trying to get people vaccinated before they spread too much across our country. It means that just going to the grocery store, to school or to work could become more dangerous. We have an already overtaxed and exhausted health care system."

The US just suffered its deadliest month of the entire pandemic, with more than 95,300 Covid-19 deaths in January. That's an average of more than 3,070 deaths a day.

The better news: New Covid-19 case numbers are decreasing in most states. And for the first time in almost two months, Covid-19 hospitalizations finally dipped below 100,000 after a catastrophic post-holiday surge.

"Despite the falling numbers, now is not the time to let up on the basic precautions," Ranney warned. "Wear a mask, avoid indoor unmasked gatherings, and of course, wash your hands and try to maintain a distance from others when possible."

"We have a little breathing room right now," she said. "But if these new variants become dominant in our country, we are going to be right back where we were in November and December -- and perhaps even worse."


Mask mandate on public transportation set for Monday night


A new order by the Centers for Disease Control and Prevention requiring people to wear masks while riding any kind of public transportation will go into effect at 11:59 p.m. Monday.

Airlines and airports will be required to report passengers who disobey the new federal mask mandate to federal authorities, according to documents obtained by CNN.

The directive says failure to comply with the mask rules at an airport "may result in the removal and denial of re-entry" of violators.

The CDC said public transportation operators must use best efforts to enforce the mandate, such as allowing only those wearing masks to board and disembarking passengers who refuse to comply.

The order was signed by Dr. Martin Cetron, director of the CDC's Division of Global Migration and Quarantine.

People can take their masks off briefly to eat, drink or take medication; verify their identity to law enforcement or transportation officials; communicate with hearing impaired people; don an oxygen mask on an aircraft; or during a medical emergency, the CDC said.

Children younger than 2 or people with a disability who cannot wear a mask are exempt.


The debate over how to vaccinate


About 26 million people have received at least one dose of their two-dose vaccines, according to the CDC.

About 6 million people have been fully vaccinated with both doses. That's 1.7% of the US population.

But with new variants spreading, some health experts say the US should go ahead and give first doses to as many people as possible -- even if that might delay second doses for some.

"We still want to get two doses in everyone," Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, told NBC on Sunday.

"But I think right now, in advance of this surge, we need to get as many one doses in as many people over 65 as we possibly can to reduce serious illness and deaths that are going to occur over the next weeks ahead."

Osterholm said he's worried about a potential surge caused by the highly contagious B.1.1.7 strain, first identified in the UK. That strain has now spread to at least 32 states, according to the CDC.

"The surge that is likely to occur with this new variant from England is going to happen in the next six to 14 weeks," Osterholm said.

"And if we see that happen ... we are going to see something like we have not yet seen in this country."

But some health experts are concerned second doses could be delayed. Recipients of the Pfizer/BioNTech vaccine are supposed to get their second doses 21 days after the first dose, and Moderna vaccine doses are supposed to be spaced 28 days apart.

The World Health Organization, Pfizer and Moderna have all said people can wait as long as six weeks between doses. But Pfizer and Moderna said they don't have any data on how long people can wait between doses and still get good protection.

While Osterholm's idea is "admirable, trying to give at least some protection to as many people as possible," it also has drawbacks, said William Haseltine, president of ACCESS Health International.

"First, they may not get fully protected, and that might accelerate the rate of variants taking over and causing us much more trouble in the future," said Haseltine, a former professor at Harvard Medical School.

"Secondly, we really don't know if delaying the second dose for a long time is going to give you the same degree of protection."

Ideally, people should stick to the recommended interval of either three weeks or four weeks, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"But if someone who, for one reason or another, is a bit late by a couple of weeks ... there is some wiggle room," Fauci said.

"It's not the end of the world if you delay a little bit. If you want to delay it by six months, that's different."

States should not be holding back doses to give people their second shot, Fauci said.

"The first priority will always be to get the people who have gotten their first doses to get their second doses," Fauci said.

But "a dose that's available is going to go into someone's arm. If a person is ready for their second dose, that person will be prioritized."

Ranney said she hopes increased production can help ensure people can get their second doses in a timely manner.

"We should count on Pfizer and Moderna and hopefully soon Johnson & Johnson as well to help fill that gap," she said.

"Give everyone the doses that you can right now and count on that increased production so that you can get people adequately protected."


Johnson & Johnson may have millions of doses soon


Many Americans hope Johnson & Johnson's Covid-19 vaccine will get emergency use authorization from the Food and Drug Administration this month.

That vaccine has been shown to be 66% effective in preventing moderate and severe disease in a global Phase 3 trial and 85% effective against severe disease, the company announced Friday. The vaccine was 72% effective against moderate and severe disease in the US.

There are two key advantages to the Johnson & Johnson vaccine. It requires only one dose, and it can be kept at normal refrigeration temperatures.

If the vaccine gets a green light from the FDA in the coming weeks, Johnson & Johnson said it would have fewer than 10 million vaccine doses available, a federal health official told CNN.

The number of doses available would be in the single-digit millions and that number would ramp up to 20 or 30 million doses by April, the official said. CNN has reached out to Johnson & Johnson for comment.


More fully at-home Covid-19 tests will be available


The US government is working with the Australian company Ellume to provide more of its fully at-home Covid-19 tests to the United States, the Biden administration said Monday.

"Ellume has been ramping up manufacturing and will ship 100,000 test kits per month to the US from February through July," said Andy Slavitt, senior White House adviser for Covid-19 response.

With a new $230 million contract, Ellume will "be able to scale their production to manufacture more than 19 million test kits per month by the end of this year, 8.5 million of which are guaranteed to the US government," Slavitt said.

The Ellume test can detect Covid-19 with 95% accuracy in about 15 minutes, he said.

This antigen test, sold over the counter, can be done at home using a nasal swab, dropper and processing fluid. Other at-home tests have required a prescription or required people to send test samples to a lab to get results.

The test uses an analyzer that connects with a software app on a smartphone to help the user perform the test and then interprets the results all from home, similar to at-home pregnancy tests.


The CDC offers tips for Super Bowl Sunday


One of the biggest celebrations of the year is coming up this weekend -- just as health officials beg Americans to hunker down to help stop the spread of new strains.

So the CDC has posted safety tips and warnings for those who want to watch the Super Bowl with others.

"Attending large gatherings like the Super Bowl increases your risk of getting and spreading COVID-19," the CDC's website says.

"The safest way to watch the Super Bowl this year is at home with people you live with," the CDC said.

If people insist on having a small watch party, they should host it outdoors and make sure everyone has a mask.

"Use a projector screen to broadcast the game. Sit at least 6 feet away from people you don't live with," the CDC says.

Going to watch parties or other larger events should provoke extra precautions, the agency said. In addition to wearing a mask:

-- Call the venue in advance to make sure it's taking safety precautions

-- Avoid the restroom and concession areas during busy times, such as at halftime or right after the game

-- Avoid chanting or cheering, as both can hurl viral particles into the air. "Stomp, clap, or bring hand-held noisemakers instead," the CDC says.

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