Advisers to Biden Transition Team Call for Entirely New Covid Strategy

On the day President Biden was inaugurated, the advisory board of health experts who counseled him during the presidential transition officially ceased to exist. But its members have quietly continued to meet regularly over Zoom, their conversations often turning to frustration with Mr. Biden’s coronavirus response.

Now, six of these former advisers have gone public with an extraordinary, albeit polite, critique — and a plea to be heard. In three opinion articles published on Thursday in the Journal of the American Medical Association, they are calling for Mr. Biden to adopt an entirely new domestic pandemic strategy — one that is geared to the “new normal” of living with the virus indefinitely, not to wiping it out.

The authors are all big names in American medicine; several, including Dr. Luciana Borio, a former acting chief scientist at the Food and Drug Administration and Dr. David Michaels, a former head of the Occupational Safety and Health Administration, have held high-ranking government positions. The driving force behind the articles is Dr. Ezekiel Emanuel, an oncologist, medical ethicist and University of Pennsylvania professor who advised former President Barack Obama.

They say the first thing the administration needs to do is take a broader vision, by recognizing that Covid-19 is here to stay. In one article, Dr. Emanuel and two co-authors — Michael T. Osterholm, an epidemiologist at the University of Minnesota, and Dr. Celine Gounder, an infectious disease expert at New York University — pointedly note that in July, Mr. Biden proclaimed that “we’ve gained the upper hand against this virus,” which in retrospect was clearly not the case.

Now, with the Omicron variant fueling a dramatic new surge, they write, the United States must avoid becoming stuck in “a perpetual state of emergency.” The first step, Drs. Emanuel, Osterholm and Gounder wrote, requires recognizing that the coronavirus is one of several respiratory viruses circulating, and developing policies to address all of them together.

To be better prepared for inevitable outbreaks, they suggest that the administration lay out goals and specific benchmarks, including what number of hospitalizations and deaths from respiratory viruses, including the coronavirus, that should trigger emergency measures.

“From a macro perspective, it feels like we are always fighting yesterday’s crisis and not necessarily thinking what needs to be done today to prepare us for what comes next,” Dr. Borio said in an interview.

Mr. Biden published a pandemic strategy when he came into office, and recently released a new winter strategy to battle the coronavirus, just as the Omicron variant began spreading in the United States. Many of the steps the authors suggest — including faster development of vaccines and therapeutics; “comprehensive, digital, real-time” data collection by the Centers for Disease Control and Prevention; and a corps of “community public health workers” — are already part of his plans.

But the authors say the administration needs to acknowledge that Omicron may not mark the end of the pandemic — and to plan for a future that they concede is unknowable. They also make clear that the current rate of Covid hospitalizations and deaths is unacceptably high.

The White House had no immediate response. Dr. Anthony S. Fauci, Mr. Biden’s top medical adviser for the pandemic, declined to comment in an interview Tuesday night.

In the three articles — one proposing a new national plan, the others suggesting improvements to testing, surveillance, vaccines and therapeutics — the authors also make more specific suggestions.

They call for every person in the United States to have access to low-cost testing, saying the Biden administration’s purchase of 500 million rapid tests is not enough; for next-generation Covid vaccines that would target new variants or perhaps take new forms, like nasal sprays or skin patches; for a “universal coronavirus vaccine” that would combat all known coronaviruses, and for major upgrades to public health infrastructure.

The authors also said that vaccine mandates should be imposed more broadly, including for schoolchildren, and that N95 masks should be made free and readily available to all Americans, as should oral treatments for Covid. (Mr. Biden has ordered several vaccine mandates on workers, but they are tied up in court.) The authors called, as well, for a broad “electronic vaccine certification platform,” which Mr. Biden has resisted.

In interviews, the authors said they had made their views known to Biden officials, but had sometimes felt unheard. The articles reflect both their frustrations and their desire to help, they said. They also recognize that they have the luxury of taking a 30,000-foot view while administration experts are slogging it out in the trenches.

“We understand that they have their hands full and are working to try to do everything right to get through this surge,” said Dr. Rick Bright, the chief executive of the Rockefeller Foundation’s Pandemic Prevention Institute, who led a federal biomedical agency during the Trump administration and co-wrote two of the pieces. “But at the same time, we think a lot of work still needs to be done.” Dr. Gounder said she has been disappointed by the administration’s “single-minded focus on vaccines” and with the decreasing emphasis on mask-wearing. Dr. Borio said she has been “very frustrated” that there is no federal system linking testing to treatments, so that people who test positive and are at high risk for Covid complications, can get prescriptions on the spot for new antiviral medicines.

Dr. Emanuel echoed that sentiment, saying in an interview that if distribution of new therapies is left to “the usual health care system,” only “rich, well-connected people,” would have access to therapies.

The most surprising thing about the articles is that they were written at all, and that the authors are airing their criticisms so publicly. Several said in interviews they were dismayed that the administration seemed caught off guard by the Delta and Omicron variants. Dr. Bright recalled the warning he issued when the advisory board had its last meeting on Jan. 20, 2021.

“The last thing I said,” he said, “is that our vaccines are going to get weaker and eventually fail, we must now prepare for variants, we have to put a plan in place to continually update our vaccines, our diagnostics and our genomics so we can catch this early, because these variants will come.”

The Biden administration has largely responded to the near vertical rise in coronavirus cases by pushing for more people to get not only their initial doses of vaccine, but booster shots as well.

This week, federal health officials endorsed boosters for youths 12 to 17 who had initially gotten the Pfizer-BioNTech vaccine. The government also changed the definition of “up to date” Covid vaccination to include boosters.

But even as the United States has moved rapidly to expand who is eligible for boosters, progress in persuading Covid-fatigued Americans to get them has stalled.

About 62 percent of Americans — about 206 million people — are fully vaccinated, according to federal data. But according to a C.D.C. database, only about 35 percent of Americans have received a booster since mid-August, when additional shots were first authorized, even as eligibility has greatly expanded.

On Nov. 19, the F.D.A. authorized boosters for everyone 18 and older who had received two doses of the Moderna and Pfizer vaccines, and on Dec. 9, it authorized boosters of the Pfizer vaccine for 16- and 17-year-olds.

Those changes led to more Americans getting boosters, according to the federal database, but that has since leveled off.

After the discovery of the Omicron variant in late November, the pace of all vaccinations sped up, but it peaked in early December, and then it plateaued. (Reporting lags around the Thanksgiving, Christmas and New Year’s holidays have affected the daily numbers throughout this period.)

Omicron, which is highly transmissible, has shown that it is better at evading vaccines than other variants. But scientists say booster shots can offer substantial protection, especially against severe disease.

The United States is averaging a staggering 585,000 cases a day, a record and a 247 percent increase from two weeks ago. Hospitalizations are rising more slowly, up 53 percent in the past two weeks, and a smaller percentage of patients are landing in intensive care units or requiring mechanical ventilation, compared with those in previous waves. Deaths are down by 3 percent.

The Centers for Disease Control and Prevention went even further in encouraging booster shots on Wednesday, when health officials recommended that to remain up to date, people should get three doses of Pfizer’s or Moderna’s vaccines. The agency also recommended that recipients of Johnson & Johnson’s one-dose vaccine receive a second dose, preferably of Moderna’s or Pfizer’s.

“There really isn’t debate here in what people should do,” the C.D.C.’s director, Dr. Rochelle P. Walensky, said in an interview on Tuesday. “If they’re eligible for a boost, they should get boosted.”

Still, the expansion of booster shot eligibility has not been met with an equal amount of demand. Dr. Rebekah E. Gee, the former health secretary of Louisiana, chalked up the resistance to boosters to pandemic fatigue.

Referring to the pandemic’s many problems, Dr. Gee said some people simply “don’t want this to be there” and are trying to “will it out of existence.”

Novak Djokovic, the top player in men’s tennis and its leading vaccine skeptic, was stopped at the border in Melbourne late Wednesday after flying from Dubai to defend his Australian Open title.

State government and Australian tennis officials had granted Mr. Djokovic an exemption from Covid vaccination rules that would allow him to compete in the event. But upon his arrival, federal border officials said that Mr. Djokovic did not meet the country’s requirements for entry because he was unvaccinated, and they canceled his visa. He filed a legal appeal on Thursday.

The exemption had stirred anger in Australia, which has enforced tough rules to prevent the spread of the coronavirus and has maintained one of the world’s lowest Covid death rates. Citizens who endured long lockdowns, and for months faced strict limits on leaving or returning to the country, demanded to know if Mr. Djokovic had been given special treatment.

Mr. Djokovic’s limbo appears to be rooted in confusion over the exemption granted by Australian tennis officials and local authorities in Victoria, the state where the tournament is held. The exemption was believed to have been approved because of Mr. Djokovic’s previous coronavirus infections — grounds that federal officials had warned were invalid.

As a dizzying surge in coronavirus cases spurred by the fast-spreading Omicron variant has disrupted life in New York City and undermined its economic recovery, its subway system — the nation’s largest — has confronted a staggering worker shortage that has hampered its ability to keep trains running.

On any given day this week, 21 percent of subway operators and conductors — about 1,300 people out of a work force of 6,300 — have been absent from work, according to the Metropolitan Transportation Authority, which oversees the city’s subways, buses and two commuter-rail lines.

The soaring jump in absenteeism, which the transportation authority attributes to the virus, has meant a lack of workers to keep up with the regular train schedules, leading officials to suspend service this week on three of the system’s 22 subway lines and reduce schedules on many others, leading to longer wait times.

The unraveling of train schedules is the latest hit to a transit network that has been battered by the pandemic, which has killed more than 150 workers and chased away millions of daily riders and the fares they pay, inflicting a brutal financial blow that threatens the system’s future.

The worker shortage has not shut down service at any of the system’s 472 subway stations — all those on the suspended lines are served by other trains. But the disruptions have led to longer commutes and travel delays for riders, a major challenge for transit officials who were hoping to lure back more passengers at the start of the year.

“I feel like it’s been bad since Christmas,” Jennifer Hall, 41, said Wednesday morning as she waited with her son for a D train in the Bronx.

Portugal’s government said on Thursday it would loosen pandemic rules for people who have received a booster dose of the coronavirus vaccine, in order to encourage residents to maintain the country’s status as one of Europe’s most vaccinated.

People who have received a booster will no longer be required to present a negative Covid test to attend events or enter sites where that is otherwise mandatory.

People with booster shots will also no longer have to isolate themselves after coming in contact with a person diagnosed with the coronavirus, unless the infected person lives with them. People without booster shots will still be required to isolate after any contact.

The new rules, announced by Prime Minister António Costa, will come into force on Monday.

Portugal is relaxing its rules in part to forestall staff shortages and disruptions in workplaces and schools as it grapples with the rapid spread of the Omicron variant, which is better at bypassing vaccine protection than earlier virus variants were.

Portugal mounted one of Europe’s most successful vaccination rollouts last year, and 89 percent of its population of about 10 million people has now been fully vaccinated, Mr. Costa said. About three million residents have also received a booster so far.

Last month, as Omicron started to spread, Portugal reintroduced a battery of restrictions, including the closure of nightclubs and bars and a requirement for negative tests to enter hotels and restaurants. The government said on Thursday that bars and clubs could reopen on Jan. 14.

Portugal reported 39,000 new coronavirus cases on Wednesday, its highest daily since the appearance of Omicron. Mr. Costa noted that Omicron accounted for about 90 percent of the new cases, and that so far at least, they were not overwhelming hospitals.

“Despite having many more cases, we thankfully have a much lower level of hospitalization” than a year ago, Mr. Costa said. As a result, he said, Portugal was in a “quiet situation” that allowed for the lifting of some restrictions “with caution.”

Xi’an, a city of 13 million people, has been under a citywide lockdown since Dec. 22. It is the longest lockdown in China since the first one in Wuhan, where the coronavirus outbreak began almost two years ago.

In scenes recalling the early days of the pandemic, hungry residents have traded coffee for eggs and cigarettes for instant noodles. A pregnant woman and an 8-year-old boy with leukemia are among those who have been denied medical care. People in need of lifesaving medications have struggled to obtain them.

China’s ability to control the virus has come a long way since the pandemic started: The country has inoculated nearly 1.2 billion people and set up a nationwide electronic health database for contact tracing.

Yet it has continued to rely on the same authoritarian virus-fighting methods from early 2020, including strict quarantines, border closings and lockdowns. These have led to food and medical shortages and growing questions about how much longer its zero-Covid strategy, the last in the world, can continue.

Parents across Chicago raced to find child care on Wednesday morning after jarring news: Classes in the nation’s third-largest public school district were canceled. The teachers’ union and Mayor Lori Lightfoot’s administration had failed to agree on how to keep schools open during an Omicron-fueled virus surge.

Across the country, the wildly contagious Omicron variant has infected millions and complicated the return to classrooms and workplaces. But nowhere has returning to school been more acrimonious and unpredictable than in Chicago, where, after two days back in classrooms following winter break, 73 percent of teachers voted to stop reporting to work. The city responded by calling off school altogether, refusing the teachers’ call for remote instruction. With no deal reached by Wednesday evening, district officials said classes would be canceled again on Thursday.

The abrupt pause in the academic calendar, rooted in years of enmity between the Chicago Teachers Union and City Hall, jumbled plans for hundreds of thousands of students and posed another major test for Ms. Lightfoot, a Democrat whose tenure has been marked by labor strife, the pandemic and a surge in homicides.

“If they are in class and Covid is rampaging, that’s a problem. If they are not there and out on the streets, that’s a problem,” said Tamar Manasseh, who leads an anti-violence group in the city, and who said she was looking into ways to help children with nowhere to go during the day. “This has put us in an untenable situation.”

Ms. Lightfoot, whose disagreements with the Chicago Teachers Union date back to a strike in the early months of her term, said in an interview that the two sides remained far apart as negotiations continued. Ms. Lightfoot said she intended to take legal action against the union, and on Monday evening said the city had filed an unfair labor practices complaint. The school district opened buildings for meal distribution on Wednesday and published a list of places where parents could get emergency child care.

“The consequences of the union acting like this time and time again are profound,” Ms. Lightfoot said. She added, “You think about the consequences for the families to be faced with the hostage choice of either going to work or taking care of their kids and home-schooling — no parent should be put in that position.”

Zolan Kanno-Youngs contributed reporting.

TOKYO — Japan asked the United States on Thursday to impose lockdowns on its military bases in the country as it tries to stanch a rapid climb in Covid infections linked in part to outbreaks among American service members.

While Japan has not yet seen the kind of explosion in cases experienced by other countries grappling with the Omicron variant of the coronavirus, daily case numbers passed 2,600 on Wednesday after remaining in the low hundreds through late December.

“The government of Japan is deeply concerned about the spread of infections on Japanese and American military facilities and in the surrounding areas,” the chief cabinet secretary, Hirokazu Matsuno, told reporters.

Japan’s foreign minister, Yoshimasa Hayashi, made the lockdown request to his American counterpart, Secretary of State Antony J. Blinken, during a phone call to discuss diplomatic issues, Mr. Matsuno said. It was unclear what steps the United States would take.

The spread of the virus on American military bases in Japan has outpaced that in the country at large, and local authorities have linked outbreaks in their communities to contact among residents and U.S. personnel.

Japan has largely closed its borders to foreigners since the beginning of the pandemic, and it further tightened restrictions soon after the first cases of Omicron were identified in southern Africa in November. Travelers to Japan must present a negative Covid test before departure.

But American service members have been allowed to enter the country without testing, Mr. Matsuno told reporters in late December. The requirement was waived under the status of forces agreement that governs the large U.S. military presence in the country.

On Thursday, the governor of Okinawa said he would ask the government to help prepare the prefecture to go onto an emergency footing as daily case counts approach 1,000. Cases there have increased significantly after an outbreak at one of the island’s American military bases.

Another outbreak has been linked to the Marine Corps base in Iwakuni, southwest of Hiroshima. In response, local officials asked the facility to restrict the movement of its personnel in an effort to stem the transmission.

A senior Hong Kong official was sent to quarantine after attending a birthday party with a person who later tested positive for the coronavirus, the government said on Thursday, fueling public scorn in a city facing the threat of a new wave of the pandemic.

Hong Kong has largely managed to keep the coronavirus at bay, but health officials have warned that the Omicron variant could change that. Carrie Lam, the chief executive, announced a series of new restrictions on Wednesday, including a two-week ban on flights from eight countries, among them the United States.

Mrs. Lam said Thursday that she was “disappointed” in the officials who attended the party on Monday, days after Hong Kong began reporting the local spread of Omicron cases. The first local cluster of the variant is believed to have started on Dec. 27, when a flight attendant for Cathay Pacific violated quarantine to dine out with family members.

While Monday’s party did not break any current rules, it was a bad look at a time when the government has been urging extra caution.

But Mrs. Lam dismissed comparisons between her and the management of Cathay Pacific, whom she had criticized for its staff’s rule violations.

“If all you want is for me to say the chief executive should take responsibility for every matter and every action of the principal officials, this is not the duty of chief executive,” she said at a news conference. “All I can say is we are making an all-out effort in fighting the epidemic.”

Ten senior government officials were among 100 people who attended Monday’s party, at a Spanish restaurant in the Wan Chai District of Hong Kong Island. They included the police chief, the immigration director and the head of the city’s anticorruption body. Eight of them are believed to have left before the person later confirmed to be infected arrived, Mrs. Lam said.

Caspar Tsui, the secretary for home affairs, stayed longer and is considered a close contact of the positive case. He has been sent to a government-run quarantine center at Penny’s Bay, Mrs. Lam said.

Mr. Tsui posted an apology on Facebook, saying that as an official, he “should be more vigilant and cautious to take action with epidemic prevention as the first consideration!”

Comments on the post were filled with schadenfreude that a top official would have to face the same onerous quarantine that Hong Kong residents who travel abroad must undergo. One posted a 2020 headline quoting Mr. Tsui saying that punishments should be increased against rule-breakers who risked making the pandemic worse.

WASHINGTON — President Biden came into office vowing to restore public trust in the Centers for Disease Control and Prevention after the Trump White House had tied the agency’s hands and manipulated its scientific judgments on the pandemic for political ends.

Yet in his first year, Mr. Biden has presided over a series of messaging failures that have followed a familiar pattern, with the agency’s director, Dr. Rochelle P. Walensky, and her team making what experts say are largely sound decisions, but fumbling in communicating them to America.

Dr. Walensky, a highly regarded infectious disease expert from Boston with no prior government experience, insisted in February that schools must keep students six feet apart; in March, she said three feet was enough. She said in February that teachers did not need to be vaccinated to reopen schools; the White House said the next day that she was speaking “in her personal capacity.”

In May, she said that vaccinated people generally did not need to wear masks in public, a sudden change that flummoxed state health officials. Two months later, she reversed that guidance after it was shown that vaccinated people could still transmit the coronavirus.

More recently, with the Omicron variant driving a near vertical rise in cases, Dr. Walensky alerted the White House that she planned to recommend that people infected with the virus isolate for five days instead of 10. To avoid another messaging fiasco, she briefed other top Biden health officials on her proposal so they would all be on the same page, according to two people familiar with her actions.

But both Dr. Anthony S. Fauci, the nation’s top infectious disease expert, and Dr. Vivek H. Murthy, the surgeon general, took issue on national television with the agency’s policy of not requiring a negative Covid test before ending the shorter isolation.

Dr. Tom Frieden, the agency’s director under President Barack Obama, said he did not believe the latest recommendations on isolation were significantly wrong, but “the way they were released was very problematic.”

The crux of the problem, several administration officials said, is a failure by the C.D.C. and the Biden administration’s messaging experts to work in concert. Dr. Walensky’s critics say she is not collaborative enough, too often springing decisions on other federal officials who then struggle to defend them in public. Her defenders say that she strives to coordinate, but that it is not her job to ensure consensus across the entire administration.

Some suggest the White House has gone too far in its hands-off, let-the-scientists-rule approach, leaving a vacuum of leadership and forcing ad hoc coordination between the various public health agencies.

Kitty Bennett contributed research.