From Health and Fitness

High Turnover at Nursing Homes Threatens Residents' Care

High Staff Turnover at U.S. Nursing Homes Poses Risks for Residents’ Care

A new study highlights the persistent problems caused by an unstable work force, an underlying threat that may have led to staggering death tolls in the pandemic.

Emergency medical technicians transported a patient from a nursing home to an emergency room bed at St. Joseph’s Hospital in Yonkers, N.Y., last year.
Emergency medical technicians transported a patient from a nursing home to an emergency room bed at St. Joseph’s Hospital in Yonkers, N.Y., last year.Credit…John Minchillo/Associated Press
Reed Abelson

  • March 1, 2021, 4:05 p.m. ET

Extraordinarily high turnover among staffs at nursing homes likely contributed to the shocking number of deaths at the facilities during the pandemic, the authors of a new study suggested.

The study, which was published Monday in Health Affairs, a health policy journal, represents a comprehensive look at the turnover rates in 15,645 nursing homes across the country, accounting for nearly all of the facilities certified by the federal government. The researchers found the average annual rate was 128 percent, with some facilities experiencing turnover that exceeded 300 percent.

“It was really staggering,” said David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors. Researchers pointed to the findings to urge Medicare to publish the turnover rates at individual nursing home sites, as a way of putting a spotlight on substandard conditions and pressuring owners to make improvements.

Inadequate staffing — and low pay — have long plagued nursing homes and quality-of-care for the more than one million residents who live in these facilities. But the pandemic has exposed these issues even more sharply, with investigations underway into some states’ oversight of the facilities as Covid cases spiraled unchecked and deaths skyrocketed.

The high turnover rate likely made it harder for nursing homes to put in place strong infection controls during the pandemic, and led to rampant spread of the coronavirus, said Ashvin Ghandi, the lead author and a health economist and assistant professor at the University of California Los Angeles Anderson School of Management.

Nursing-home owners blame inadequate reimbursement from Medicaid, the federal-state program for elderly skilled nursing care.

“Workforce recruitment and retention is among the most pressing challenges confronting longterm care providers, and we have been calling for help for years,” Dr. David Gifford, the chief medical officer for the American Health Care Association and National Center for Assisted Living, a trade group, said in an emailed statement.

“It’s high past time that providers receive the proper resources to invest in our frontline caregivers in order to improve quality care,” he said.

At least 172,000 deaths from the virus had been reported among either residents or employees of nursing homes and other long-term care facilities by late February, according to a database compiled by The New York Times. The nursing home death toll alone has accounted for more than one-third of all Covid deaths in the United States, although death and case rates have begun to decline steeply as more than 70 percent of residents have received vaccinations.

Eleanor Garrison, a resident of Arbor Springs Health and Rehabilitation Center in Opelika, Ala., last month.
Eleanor Garrison, a resident of Arbor Springs Health and Rehabilitation Center in Opelika, Ala., last month.Credit…Julie Bennett/Associated Press

Industry criticism has also focused on decades of ownership of nursing homes by private equity and other private investment firms, which prioritized profits for investors above the well-being of residents. These owners have long been accused of insufficiently staffing their facilities and underpaying workers.

Labor is one of the main expenses in the operation of a nursing home, Dr. Gandhi said. “It’s not a very high margin industry, in general,” he said. “Any facility trying to maximize profits is going to be thinking carefully about its staffing costs.”

Nursing home staffs have also shown resistance to getting vaccinated against the coronavirus, complicating efforts by public health officials and nursing homes to provide blanket immunization protection for an individual facility. If a nurse who was immunized leaves and is replaced, the facility will need to ensure the new employee is also vaccinated, especially given the reluctance of some workers to getting a coronavirus shot.

“Trying to do a one-shot vaccination push isn’t enough,” Dr. Gandhi said. “You need continued vaccination outreach.”

Registered nurses, who are the most skilled workers, had the highest rates of turnover, and turnover varied widely across facilities. Among the states with the highest rates were Oklahoma, Montana and Kansas. Facilities that had low-star ratings on Medicare’s website comparing nursing homes had the highest median turnover, and nursing homes with high ratings had the lowest turnover. Turnover was also higher at for-profit institutions, owned by chains and those serving Medicaid beneficiaries, according to the study.

Melissa Unger, the executive director at S.E.I.U. 503, an Oregon division of the Service Employees International Union, said nurses struggle to work at facilities with too few staff members to adequately care for the residents.

“You don’t feel great about the job you’re doing,” Ms. Unger said, noting that many staff members are women and people of color. “You’re doing all of that for crappy benefits and low pay.”

Summer Trosko, a union member working at an Oregon nursing home, said she was used to colleagues leaving from burnout because of inadequate staffing and a lack of money. “They get tired and just can’t take it anymore and quit,” she said. Many are replaced by people who have just graduated from high school with little training, she said.

In addition to making the turnover rates available to the public, the authors point to a number of steps lawmakers could take to improve retention. Medicare could incorporate turnover into its star-rating system, and Medicare and Medicaid could reward nursing homes with higher rates if they had lower turnover. “If we’re going to change nursing homes, we have to start with the staff,” Dr. Grabowski said.

The researchers used newly available payroll-based data collected by the Centers for Medicare and Medicaid Services for registered nurses, licensed practical nurses and certified nursing assistants to calculate turnover rates in 2017 and 2018. They looked at the percentage of hours worked by a nursing employee in a given year and calculated higher rates if the person leaving had provided more care.

A Covid Vaccine Side Effect, Enlarged Lymph Nodes, Can Be Mistaken for Cancer

A Covid Vaccine Side Effect, Enlarged Lymph Nodes, Can Be Mistaken for Cancer

The condition is becoming more common as immunization rates increase. Experts are suggesting ways to ease patients’ fears and avoid needless testing.

Covid-19 vaccinations at the Community Center in Rohnert Park, Calif. Swelling of lymph nodes in the armpit became a  recognized side effect in the trials of the Moderna and Pfizer-BioNTech vaccines.
Covid-19 vaccinations at the Community Center in Rohnert Park, Calif. Swelling of lymph nodes in the armpit became a  recognized side effect in the trials of the Moderna and Pfizer-BioNTech vaccines.Credit…Jim Wilson/The New York Times

  • March 1, 2021, 3:14 p.m. ET

Coronavirus vaccinations can cause enlarged lymph nodes in the armpit or near the collarbone, which may be mistaken for a sign of cancer.

As vaccines are rolled out across the country, doctors are seeing more and more of these swollen nodes in recently immunized people, and medical journals have begun publishing reports aimed at allaying fears and helping patients avoid needless testing for a harmless condition that will go away in a few weeks.

The swelling is a normal reaction by the immune system to the vaccine, and occurs on the same side as the arm where the shot was given. It can also occur after other vaccinations, including those for flu and the human papillomavirus (HPV). Patients may or may not notice it. But the enlarged lymph nodes show up as white blobs on mammograms and chest scans, resembling images that can indicate the spread of cancer from a tumor in the breast or elsewhere in the body.

“I am particularly eager to get the word out to all the patients undergoing surveillance after successful prior treatment of cancer,” said Dr. Constance D. Lehman, an author of two journal articles on the problem and the chief of breast imaging at the Massachusetts General Hospital. “I can’t imagine the anxiety of getting the scan and hearing, ‘We found a node that is large. We don’t think it’s cancer but can’t tell,’ or worse, ‘We think it might be cancer.’”

The swelling in the armpit was a recognized side effect in the large trials of the Moderna and Pfizer-BioNTech vaccines. In Moderna’s study, 11.6 percent of patients reported swollen lymph nodes after the first dose, and 16 percent after the second dose. Pfizer-BioNTech appeared to have a lower incidence, with 0.3 percent of patients reporting it. But those figures reflect only what patients and their doctors noticed, and radiologists say that the real rate is probably higher, and that many more cases are likely to show up on imaging like mammograms, or M.R.I.s or CT scans.

The condition was not listed among the reported side effects in a briefing document from the Food and Drug Administration about the Johnson & Johnson Covid vaccine. On Saturday, the agency authorized the company’s vaccine for emergency use.

The image on the left shows a 41-year old man’s right shoulder, with arrows pointing to normal-sized lymph nodes in the armpit. The image on the right shows swelling in his left arm (dashed yellow arrow) and enlarged lymph nodes (yellow arrows) in his armpit. He had received a Covid vaccination four days earlier. Although he previously had cancer, the swollen nodes were thought to be caused by the vaccine.
The image on the left shows a 41-year old man’s right shoulder, with arrows pointing to normal-sized lymph nodes in the armpit. The image on the right shows swelling in his left arm (dashed yellow arrow) and enlarged lymph nodes (yellow arrows) in his armpit. He had received a Covid vaccination four days earlier. Although he previously had cancer, the swollen nodes were thought to be caused by the vaccine.Credit…Özütemiz et al., Radiology 2021

Dr. Lehman said it was important for imaging centers to ask patients if they have had Covid inoculations and to record the date of the shot and the arm in which it was given.

Her clinic includes this advisory in a letter to patients whose screenings detect swelling but no other abnormalities: “The lymph nodes in your armpit area that we see on your mammogram are larger on the side where you had your recent Covid-19 vaccine. Enlarged lymph nodes are common after the Covid-19 vaccine and are your body’s normal reaction to the vaccine. However, if you feel a lump in your armpit that lasts for more than six weeks after your vaccination, you should let your health care provider know.”

One way people could avoid the problem would be to postpone routine mammograms and other imaging for at least six weeks after the last dose of vaccine, according to an article by an expert panel in the journal Radiology, published on Wednesday.

A professional group, the Society of Breast Imaging, offers similar advice: “If possible, and when it does not unduly delay care, consider scheduling screening exams prior to the first dose of a Covid-19 vaccination or 4-6 weeks following the second dose of a Covid-19 vaccination.”

But the expert panel also cautioned that nonroutine imaging, needed to help deal with an illness or other symptoms that might indicate cancer, should not be delayed. Nor should immunization.

People who have cancer are generally advised to be vaccinated against the coronavirus, particularly because they are at higher risk of dying from Covid than the general population. But some cancer treatments may interfere with the body’s ability to respond fully to the vaccine, and the American Cancer Society advises patients to consult with their oncologists about vaccination.

In recently vaccinated people who have cancer and develop enlarged lymph nodes, it may be necessary to perform more tests, including a biopsy of the nodes, Dr. Lehman said.

She described one patient with a newly diagnosed breast tumor who had swollen lymph nodes on the same side, and had recently received a Covid shot in the arm on that side.

A biopsy was performed, an important step to determine whether there were malignant cells in the nodes that would then help decide a course of treatment. It was negative for cancer. The vaccine had most likely caused the swelling.

In another case, a woman who previously had cancer in her right breast had a routine mammogram that showed an enlarged lymph node in her left armpit, and no other abnormality. She’d recently received a Covid vaccination in the left arm. Doctors determined that no more tests would be needed unless the swollen nodes lasted more than six weeks.

In a man with a history of bone cancer, a chest CT scan performed as part of a follow-up found swollen lymph nodes in one armpit — on the side where he’d recently had a Covid inoculation. Nothing else was wrong and no further tests were needed. The same decision was made for similar findings in a recently vaccinated man who had a chest CT to screen for lung cancer, and in a woman with a history of melanoma.

For patients undergoing treatment for cancer in one breast, Dr. Lehman said, the Covid shot should be given in the arm on the other side. The vaccine can also be injected into the thigh to prevent any issues with lymph node swelling.

“This could really impact a lot of people if we don’t start recording vaccination status immediately at imaging centers,” Dr. Lehman said. “I also want cancer patients to know they can get the vaccine on the opposite side or even the leg to avoid confusion.”

Why I Overcame My Vaccine Hesitancy

Personal Health

Why I Overcame My Vaccine Hesitancy

The more people who become immune to the virus, the less this scourge will be able to mutate and evade the vaccines already available

Credit…Gracia Lam
Jane E. Brody

  • March 1, 2021, 5:00 a.m. ET

Had I been polled last fall, I would have registered as a Covid vaccine skeptic. I told anyone who asked that I was going to wait at least six months after a vaccine was approved, by which time I hoped we’d know more about the degree and possibly the duration of its effectiveness and its potential side effects, especially in the elderly.

I was hardly alone in my concern that political influence might result in premature approval of a vaccine before its safety was well established.

Well, that hesitancy quickly dissipated after listening to reports from the directors of the Food and Drug Administration and the Centers for Disease Control and Prevention and several vaccine experts I know and trust, all of whom gave an enthusiastic thumbs-up to both the Pfizer and Moderna vaccines.

So in mid-January, when Gov. Andrew M. Cuomo of New York announced that residents 75 and older would qualify for the vaccine, I found a computerized link to schedule an appointment five days later.

At the mass vaccination site I went to in Brooklyn, everyone I encountered was cheerful, patient and reassuring, even the young woman checking me in who couldn’t find me on her list of 3 p.m. appointments. “Don’t worry,” she said reassuringly, “you’ll get the vaccine.”

At the next window, a young man from Nigeria checked my ID and Medicare card and figured out what had happened. Turned out I had inadvertently booked a 3 a.m. appointment, not realizing the site was open 24-7. Another “don’t worry,” and I moved on to a young technician from Florida who painlessly injected the Moderna vaccine into my left arm.

I then sat in a holding tent for 15 minutes to be sure I would have no serious reactions. The next day I got a text: “Hi Jane, It’s time for your daily v-safe check-in” and a link to a C.D.C. site that asked: How are you feeling today? (Good, Fair, Poor); Have you had a fever or felt feverish today? (yes, no); followed by a symptom check, first at the injection site for pain, redness, swelling or itching and then generally for chills, headache, joint pains, muscle or body aches, fatigue or tiredness, nausea, vomiting, diarrhea, abdominal pain and rash or any other symptoms I wanted to report.

Finally, I was asked several overall health impact questions about my ability to work and do my normal daily activities and whether I needed to consult a health care professional. I received the same text at the same time each day for more than a week, and was also given a link if I wanted to send a report to the Vaccine Adverse Event Reporting System.

The second dose, administered 34 days later, went even more smoothly. By then I’d spoken to dozens of others of various ages who had gotten both shots. Only two reported bad reactions — fever, nausea, extreme fatigue — that lasted a day or two. I was prepared for the worst, but it never happened. My arm, shoulder and neck hurt the first night, but most of the pain was gone the next morning. Although my son was on call in case I couldn’t walk my dog, his help wasn’t needed. I was even able to swim that afternoon.

But I assure you, even if I’d had a bad post-vaccine reaction, I would have sucked it up as a small price to pay for protection against a most devastating and too-often deadly disease like Covid-19. And I will continue to urge everyone and anyone I meet to do their damnedest to get immunized against Covid-19, especially now that potentially more potent variants are beginning to appear and spread.

The more people who become immune to the virus, the less this scourge will be able to mutate and evade the vaccines already available and the updated versions of vaccines scientists are now scrambling to produce.

Some people, hearing that vaccinated people may still be able to spread the infection and should continue to wear masks and practice social distancing which I will definitely do even after being fully immunized, question whether it pays to get the vaccine. Absolutely, it pays.

While there’s a chance that an immunized person might be able to infect others, existing evidence suggests the risk is very small. Far more important is unimpeachable data that the vaccines are lifesaving. They nearly eliminate the risk of severe illness, hospitalization and death from the virus. Of the 32,000 people who got the vaccine in the Pfizer and Moderna vaccine trials, only one person developed a severe case of Covid. Even if future mutations of the virus make an annual booster necessary, what’s the big deal? We already do that with the flu shot.

Keep in mind, too, that up to a third of people who develop Covid-19 can end up with debilitating symptoms that persist for many months, perhaps indefinitely for some. This is not always just a bug like the flu or common cold that is over and done with a week later. Eight months after recovering from a rather mild case of Covid, an otherwise healthy middle-aged friend said his lungs still hurt when he exerted himself.

Anecdotal reports that vaccine reactions are sometimes worse after the second of the two shots given for the Pfizer and Moderna vaccines have prompted some people to question whether they need both shots. Again, the only reliable evidence shows that two doses are necessary to achieve maximum protection. Do you buckle your seatbelt only every other time you’re in a car?

Now think of what will be possible once you, your family members and friends have had both shots and then waited the two weeks after the final dose to achieve the maximum level of immunity. While I’ll continue to wear a mask and socially distance in public, I’ll gladly dine indoors at home or in a well-spaced restaurant with fully immunized friends and relatives who are not considered at high risk.

I can’t wait to again attend live performances of classical music and opera and watch movies and plays not on my computer or TV but on the big screen and in the theater with others who can laugh, cry or sneer with me. But until most of us are reliably immune to the coronavirus that has terrified and secluded so many of us for so long, none of this can happen.

Meanwhile, I will continue to present the known facts and try to dispel misleading information about the vaccines. And I’ll hope that celebrities who enjoy the respect of vaccine-hesitant communities will be able to convince their members that controlling Covid infections and spread is critical, not just for their own sake, but for the future of their families, their towns, their country and a life that might again assume some semblance of normal.

Diagnosing Autism in the Pandemic

The Checkup

Diagnosing Autism in the Pandemic

Autism spectrum disorder is often suspected when young children stand out as being different from their peers. That can be much harder in this isolated time.

Credit…Yifan Wu

  • March 1, 2021, 5:00 a.m. ET

We talk often in pediatrics about the importance of early identification and early treatment of autism spectrum disorder, with its hallmark issues of social communication problems and restricted repetitive behavior patterns. “Early” means paying particularly close attention to the behavior and development of children between ages 1 and 3, and checking in with their parents about any concerns.

But what does that mean for young children who have now spent half their lives — or more — in the special circumstances of the pandemic?

Dr. Heidi Feldman, a professor of developmental and behavioral pediatrics at Stanford University School of Medicine, said, “We don’t know what the impact of one year of very restricted social interaction is going to be on children.” Some of the behavior patterns that children are showing now may be the result of these strange living conditions, or they may reflect stress, trauma and the social isolation that many families have experienced, she said.

Dr. Feldman said that first-time parents who have been operating in the increased isolation of the pandemic may have very limited context for appreciating where their child’s behavior falls. They’re missing the input they might usually get from teachers and child care providers.

Dr. Eileen Costello, a clinical professor of pediatrics at Boston University School of Medicine and chief of ambulatory pediatrics at Boston Medical Center, said, “Especially for the really little ones, the only eyes that are on them are their parents’. They’re not seeing uncles and aunts and cousins, not in preschool.”

Dr. Costello and I are co-authors of the book “Quirky Kids: Understanding and Supporting Your Child With Developmental Differences.” We use the word “quirky” to encompass children whose development does not follow standard patterns, whether or not they fit the criteria for a specific diagnosis. Some of these children will accumulate several different diagnoses as they grow and change — and as different demands are made on them in terms of academic performance and social life — and others will never fit the criteria for any specific formal diagnosis.

Dr. Adiaha Spinks-Franklin, a developmental behavioral pediatrician at Texas Children’s Hospital and an associate professor at Baylor College of Medicine, said that because parents right now are at home more, sometimes they are more likely to notice unusual or concerning patterns — repetitive behaviors, or communications problems like echolalia, in which a child repeats words. This can be completely normal, and is in fact part of how children learn to talk, but it can be concerning if it’s the major part of a child’s language as the child grows. By the age of 2, children should be saying lots of their own words.

When parents — or teachers or doctors — do have concerns, getting a developmental assessment done has its own complexity in the pandemic.

Catherine Lord, a professor of psychiatry and education at the University of California, Los Angeles, said, “I’m doing diagnoses right now in my back yard, which is insane.” But with the protective gear that would have to be worn at the hospital, she said, “we look like we’re from outer space,” and could be too intimidating to small children.

Dr. Lord said. “We do remote interviews with parents, we try to see videos of the kid, then have them come — we have a big back yard.” And they continue to use the Zoom technology, even across the yard.

The standardized assessment for autism spectrum disorder can’t be done masked, because it depends on interpreting the child’s expressions and observing reactions to the examiner’s facial expressions. Dr. Lord said there is a shorter version that children can do with their parents — everyone unmasked — while the clinicians watch without being in the room. This may not be as accurate — researchers are still analyzing the data — but they are hopeful that it will be helpful in many cases.

“When we see kids in clinic, we have to be masked, and if they’re over 2, they have to be masked,” Dr. Feldman said. Earlier in the pandemic, a family that was convinced that their child had autism came to the clinic. “This kid had not seen anybody other than his parents and had not been anyplace other than his home — he was so terrified — the in-person visit was very, very hard.” They used a room with a one-way mirror, so the parents could be alone with the child, and could take their masks off, but “even with that, he had such a hard time settling down.”

Dr. Lord was the lead author on a review paper on autism spectrum disorder published in Nature Reviews in 2020. She emphasized the importance of early diagnosis so that children can get early help with communication: “Kids who are going to become fluent speakers, their language starts to change between 2 and 3, and 3 and 4, and 4 and 5,” Dr. Lord said. “We want to be sure we optimize what happens in those years and that’s very hard to do if people are stuck at home.”

She recommended that parents request the free assessments that can be done through early intervention, in many cases now being done remotely.

Developmental assessments can include remote visits. “We have gotten quite good at doing telehealth evaluations,” Dr. Feldman said. “We get the kids in their own environments and their own toys, we get to see what they do at home.”

“Sometimes making the diagnosis of autism over telehealth in a very young child is incredibly challenging,” Dr. Spinks-Franklin said. “Families that don’t have access to consistent reliable high-speed internet are also impacted — a video visit may not be possible or may be interrupted.”

Even before the pandemic, many families faced long waits to get those developmental assessments. “Those who are vulnerable already are always going to be more severely affected — families who already had more limited access to primary care providers or are underinsured or uninsured already had a harder time,” Dr. Spinks-Franklin said.

Now, she said, the pandemic is placing those families even more at risk, because of the likelihood of economic hardship from jobs loss, underemployment or lost health care benefits. The disparities are exacerbated, and the chance of getting to the right clinic and the right health care professional go down.

Right now, because families are isolated or may not have good access to medical care, neurodevelopmental problems may be being missed in these critical early years, when getting diagnosed would help children get therapy. On the other hand, some children who don’t have these underlying problems and are just reacting to the strange and often anxiety-provoking circumstances of pandemic life may mistakenly be thought to be showing signs of autism.

Parents and even doctors may worry about autism spectrum disorder in children who have attention deficit hyperactivity disorder or anxiety, and who are being seen in unusual situations — in a parking lot, for example. “I’ve been undoing diagnoses,” Dr. Lord said. “It’s not surprising that a kid is looking a bit less relaxed.”

Dr. Spinks-Franklin said that the pressures of the pandemic may act on children as other stresses do, and show up as more extreme behavior, such as more frequent tantrums or increased irritability.

“All that bounces is not A.D.H.D.; all that flaps is not autism,” Dr. Spinks-Franklin said.

What Parents Can Do

To understand whether a child’s extreme behavior represents chronic stress and increased frustration related to the hardships that families are living through, or is a sign of a neurodevelopmental disorder, it’s important to figure out whether these behaviors were present before the pandemic, Dr. Spinks-Franklin said.

If parents have concerns about a child’s development or behavior, a good place to start is to talk the question through with the child’s primary care provider, who can also review the record with the parents and talk about the child’s early developmental course.

If parents still have concerns, it’s reasonable to request a referral for a full developmental assessment. Early intervention, a federally mandated program, offers help and therapy if a child seems to be significantly delayed in any developmental domain, but does not make diagnoses.

Some developmental markers reflect a child’s early progress with speech and language, and with social interactions. The following are adapted from “Quirky Kids.

  • A baby babbles by 6 months, and the babble increases in complexity

  • By 9 months, a baby responds to his or her name

  • By 15 to 18 months, a child can say some words and follow simple directions

  • By 18 months, a child can put two words together

  • By 2 ½ to 3, a child can speak in simple sentences with some fluency and inflection — a question sounds like a question

  • By 4 months, babies make eye contact and respond with social smiles

  • By 1 year, they can point to show interest, and wave goodbye

  • From about 2, they respond to other children and can interact in games with some back-and-forth

Black Churches Fill a Unique Role in Combating Vaccine Fears

In the hospital with covid-19 in December, Lavina Wafer tired of the tubes in her nose and wondered impatiently why she couldn’t be discharged. A phone call with her pastor helped her understand that the tube was piping in lifesaving oxygen, which had to be slowly tapered to protect her.

Now that Wafer, 70, is well and back home in Richmond, California, she’s looking to her pastor for advice about the covid vaccines. Though she doubts they’re as wonderful as the government claims, she plans to get vaccinated anyway — because of his example.

“He said he’s not going to push us to take it. It’s our choice,” Wafer said, referring to a recent online sermon that praised the vaccines as God-given science with the power to save. “But he wanted us to know he’s going to take it as soon as he can.”

Helping people accept the covid vaccines is a public health goal, but it’s also a spiritual one, said Henry Washington, the 53-year-old pastor of The Garden of Peace Ministries, which Wafer attends.

Lavina Wafer was hospitalized with covid in December. Now that she’s well, she’s looking to her pastor for guidance on the covid vaccine shot. (Lavina Wafer)

Clergy must ensure that people “understand they have an active part in their own salvation, and the salvation of others,” said Washington. “I have tried to suggest that taking the vaccine, social distancing and protecting themselves in their household is something that God requires us to do as good stewards.”

Many Black Americans look to their religious leaders for guidance on a wide range of issues — not just spiritual ones. Their credibility is especially crucial on matters of health, as the medical establishment works to overcome a legacy of experimentation and bias that makes some Black people distrustful of public health messages.

Now that the vaccines are being distributed, public health advocates say churches are key to reaching Black citizens, especially older generations more vulnerable to severe covid disease. They have been hospitalized for covid and died at a disproportionate rate throughout the pandemic, and initial data on who is getting covid shots shows that Black people lag far behind other racial groups.

Black churches have also suffered during the pandemic. African American pastors were most likely to say they had had to delete positions or cut staff pay or benefits to survive, and 60% said their congregations hadn’t gathered in person the previous month, as opposed to 9% of white pastors, according to a survey published in October by Lifeway Research, which specializes in data on Christian groups.

Washington’s 75-member church is in Richmond, which has the highest number of covid deaths in Contra Costa County, outside of deaths in long-term care facilities. The very diverse city, across the bay from San Francisco, also has one of the lowest rates of vaccination.

Offerings to Washington’s church plunged 50% in 2020 due to job loss among congregants, but he’s weathered the pandemic with a small-business loan and a second job as a general contractor remodeling bathrooms and kitchens.

To combat misinformation, he’s been meeting virtually with about 30 other Black pastors once a month in calls organized by the One Accord Project, a nonprofit that organizes Black churches in the San Francisco Bay Area around nonpartisan issues like voter registration and low-income housing. Throughout the pandemic, the calls have focused on connecting pastors with public health officials and epidemiologists to make sure they have the most up-to-date information to pass on to their members, said founder Sabrina Saunders.

Sabrina Saunders is the founder of One Accord Project, a nonprofit that brings together Black churches in the Bay Area on nonpartisan campaigns like voter registration and low-income housing. Throughout the pandemic, she’s hosted monthly conference calls with up to 30 pastors to connect them with public health officials and epidemiologists. (Sabrina Saunders)

The African American church is an anchor for the community, Saunders said. “People get a lot of emotional support, people get resources, and their pastor isn’t just looked upon as a spiritual leader, but something more.”

And guidance is needed.

The share of Black people who say they have been vaccinated or want to be vaccinated as soon as possible is 35%, while 43% say they want to “wait and see” the shots’ effects on others, according to a KFF survey. Eight percent say they’ll get the shot only if required, while 14% say they definitely won’t be vaccinated. Among whites, the first two figures are 53% and 26%, respectively; for Hispanics, 42% and 37%. (KHN is an editorially independent program of KFF.)

Among the “wait and see” group, 35% say they would seek information about the shots from a religious leader, compared with 28% of Hispanics and 14% of white people.

Grassroots outreach to Black churches happens in every public health emergency, but the pandemic has hastened the pace of collaboration with public health officials, said Dr. Leon McDougle, assistant dean for diversity and cultural affairs at the Ohio State University College of Medicine. The last time he saw such a broad coalition across Black churches, medical associations, schools and political groups was during the HIV/AIDS epidemic in the 1980s.

“This is at an entirely different level, though, because we’ve had almost half a million die in a year,” McDougle said of the covid pandemic.

Historically, no other institution in African American communities has rivaled the church in terms of its reach and the trust it enjoys, said Dr. Paris Butler, a plastic and reconstructive surgeon at the University of Pennsylvania Health System. Last month, he and a colleague spoke to leaders from 21 churches in Philadelphia to answer basic questions about how the vaccine was produced and tested.

“Being an African American myself, and growing up in a Baptist church, I understand the value of that trusted voice,” Butler said. “If we don’t reach out to them, we’re making a mistake.”

Dr. Paris Butler was featured in Penn Medicine’s vaccination campaign. This poster appeared throughout Pennsylvania Hospital, where he practices, sharing his reasons for being vaccinated. (Penn Medicine)
Dr. Judith Green McKenzie, chief of the division of occupational medicine at the University of Pennsylvania’s Perelman School of Medicine, helps an employee fill out a consent form. She hopes that older people who get a covid vaccine can go on to influence younger relatives when their turn comes. (Daniel Burke / Penn Medicine) (Daniel Burke / Penn Medicine)

Leaders with massive social media followings, like Bishop T.D. Jakes, are also weighing in, publishing video conversations with experts including Dr. Anthony Fauci to inform followers about the vaccines.

Church attendance is waning among young Black adults, as it is for other races. But elders can set examples for younger people undecided about the vaccine, said Dr. Judith Green McKenzie, chief of the division of occupational medicine at the University of Pennsylvania’s Perelman School of Medicine.

“When they see their grandma go, they may say, ‘I’m going,’” she said. “Grandma got this two months ago and she’s fine.”

Pastor Eddie Anderson leads the McCarty Memorial Christian Church in Los Angeles. He’s asking members who have already gotten the vaccine to write down their experiences and prepare to share them with the rest of the congregation.(Rudy Espinoza)

Encouraging vaccine trust is delicate work. The Black community has reason to be skeptical of the health system, said Eddie Anderson, the 31-year-old leader of McCarty Memorial Christian Church in Los Angeles. In one-on-one conversations, congregants tell him they fear being guinea pigs. The low vaccine supply also makes Anderson hesitate to recommend, from the pulpit, that members get the shot as soon as they’re able. He fears frustration with difficult online sign-ups would further sap motivation.

“I want to do that when it’s readily available,” he said. “I want to preach it, and then within a weekend a family can actually go get the vaccine.”

Despite the doubts and fears, Anderson said the majority of his 125-member congregation, about half of whom are senior citizens, want the vaccine, in order to be with loved ones again. One older member is desperately seeking a vaccine appointment so he can help his daughter, who is going through cancer treatments. But the online sign-up process is confusing and nearly impossible for his followers, Anderson said.

For now, he’s focused on asking several vaccinated members to write down everything about their experience and share it on social media. He also plans to record them talking about their shots — and to show that many people of different races were in the same vaccine line — and will broadcast the videos during church announcements.

While he can’t tell people what to do, Anderson hopes he can remove any potential spiritual barriers to the vaccine.

“My biggest fear is for someone to say, ‘I didn’t get vaccinated’ or ‘I didn’t get a test’ because it’s against [their] faith, or because ‘I don’t see that in the Bible,’” he said. “Any of those arguments, I want to get those off the table.”

‘Into the Covid ICU’: A New Doctor Bears Witness to the Isolation, Inequities of Pandemic

Can’t see the audio player? Click here to listen on SoundCloud.

This week marks a grim milestone: Half a million Americans have died of covid-19. KHN reporter Jenny Gold, in collaboration with Reveal from the Center for Investigative Reporting and PRX, spent eight months following one first-year medical resident working on the front lines of the pandemic.

Dr. Paloma Marin-Nevarez graduated from the Stanford University medical school in June, right before the virus began its second major surge. She’s one of more than 30,000 new doctors who started residencies in 2020. Just weeks after graduating, Marin-Nevarez began training as an ER doctor at Community Regional Medical Center in Fresno, one of the areas in California hardest hit by the pandemic.

Listeners follow Marin-Nevarez as she faces the loneliness and isolation of being a new doctor, working 80 hours a week in the era of masks and physical distancing. She also witnesses the inequality of the pandemic, with Latino, Black and Native American people dying of covid-19 at much higher rates than white people. Marin-Nevarez finds herself surrounded by death and having to counsel families about the loss of loved ones. We view the pandemic through the eyes of a rookie doctor, finding her footing on the front lines of the virus.

Connecticut Is Doling Out Vaccines Based Strictly on Age. It’s Simpler, but Is it Fair?

With covid vaccines expected to remain scarce into early spring, Connecticut has scrapped its complicated plans to prioritize immunizations for people under 65 with certain chronic conditions and front-line workers. Instead, the state will primarily base eligibility on age.

Gov. Ned Lamont pointed to statistics showing the risk of death and hospitalization from covid-19 rises significantly by age.

Yet, shifting to an age-based priority system — after health workers, nursing home patients and people 65 and up have been offered vaccines — has frustrated people with health conditions such as cancer or diabetes who thought they would be next in line. It also could exacerbate the difficulty in getting people in underserved communities and those in minority racial and ethnic groups vaccinated, health experts said.

While it’s reasonable for states to want to vaccinate people in their 50s and 60s ahead of those in their teens and 20s, the experts added, there are no easy answers in deciding who should get vaccines first. Is a 40-year-old with diabetes at higher risk than a 64-year-old without serious health issues? How about an older person who works at home or a younger person whose job puts them at higher risk of infection?

Gini Fischer, 57, a portrait artist in Wilton, Connecticut, has mixed feeling about people her age being in line ahead of those with chronic illnesses. She also teaches water aerobics to seniors at her local YMCA and sees getting vaccinated as a way to protect others. So, she plans to make an appointment for the vaccine.

“I do think people with chronic illnesses are more vulnerable than I am,” said Fischer, a breast cancer survivor. But given her teaching responsibilities, “I certainly don’t want to be a risk to anyone in the class,” she said. “I do believe the more people who get vaccinated the safer it will be for others who have not been vaccinated.”

People 50 to 64 are nine times more likely to die of the virus than adults 30 to 39, according to the data from the Centers for Disease Control and Prevention.

“There’s no magic bullet,” said Claire Hannan, executive director of the Association of Immunization Managers, referring to the different priority lists.

(U.S. Centers for Disease Control and Prevention)

Under Connecticut’s new plan, the state on Monday will be the first to start vaccinating everyone age 55 to 64 and up. Later this spring, the state plans to vaccine younger adults. The only exception will be educators and child care providers, who also can also get vaccinated starting Monday.

Last month, Nebraska Gov. Pete Ricketts also indicated the state would adopt a plan to move away from prioritizing vaccinating people with chronic illnesses. But Friday he said Nebraska would issue plans in March to give certain people, such as those on dialysis and those who have compromised immune systems, priority when the state finishes vaccinating those 65 and older.

Rhode Island is the only other state with an age-based plan, and the state estimates it will begin vaccinating people younger than 65 by age group starting in mid-March. But between vaccinating the group of residents who are 60 to 64 years old and those with ages ranging from 50 to 59, Rhode Island also will offer vaccines to people with certain chronic illnesses. The state expects to start vaccinating those in the 16-to-39 age group in June.

“I am really happy to be able to get it,” said Cathy Wilcox, 59, of Stamford, Connecticut, who made an appointment for Monday. Wilcox, who wears a KN95 mask when working the front desk at an indoor tennis facility, expected she wouldn’t be eligible until April or later but is excited because she has been worried about her risk of getting covid-19. “What worries me about covid is you can have no symptoms but be a carrier and be fine or you can die or everything in between,” she said.

More than 40 states adopted plans to prioritize adults with certain chronic conditions, a strategy that generally uses the “honor system” for people to self-attest they have conditions ranging from a smoking history to asthma, according to KFF. (KHN is an editorially independent program of KFF.)

“There is no obvious right or wrong way to do it,” said Dr. Amesh Adalja, an infectious diseases expert with the Johns Hopkins Center for Health Security in Baltimore. He said the goal of the vaccine program — at least initially — is to protect the most vulnerable so they don’t overwhelm hospital capacity. But it is difficult to determine who is most at risk.

A simpler age-based system could speed vaccination efforts that some say have been complicated in states with covid priority phases with numerous tiers based on job and health status, Adalja said. “There is a clear argument to make it as simple and seamless as possible,” he added.

The big advantage of giving vaccines out by age is it could reduce people from gaming the system (or lying that they have a health condition) since vaccinators can easily check a person’s age identification, said Dr. Richard Zimmerman, a University of Pittsburgh professor who works with its Center for Vaccine Research.

“It may stop some people from skipping the line,” he said.

States and the District of Columbia defend their systems that give early access to people with chronic illnesses, saying they are following CDC recommendations.

After it finishes vaccinating seniors, Maryland will include all adults 16 to 64 who are front-line workers and adults with certain health conditions. A spokesperson for the Maryland Health Department said vaccines should be in large-enough supply in a few months so there won’t be a need to prioritize by age.

Washington, D.C., has a similar strategy. “Age is not a good metric for disease severity nor disease progression,” the city’s health department said in a statement when asked why it plans to eventually give people ages 18 to 64 equal access to the vaccine.

Age also doesn’t not necessarily reflect overall risk, said Dr. Ana Núñez, an internist and vice -dean for diversity, equity and inclusion at the University of Minnesota School of Medicine. Housing, employment and other social determinants can raise a healthy person’s chance of getting the virus.

Indeed, experts said these factors help explain why people from Black, Hispanic and Native American backgrounds are dying at disproportionately high rates.

Distributing by age without targeting the most affected populations also gives preference to white residents, she said, because they outnumber racial and ethnic minority groups in many states.

“If you just do age,” Núñez said, “who are you preferentially immunizing?”

Michelle Cantu, who oversees infectious disease and immunization programs at the National Association of County and City Health Officials, said it’s important for jurisdictions to use data to determine who and how they immunize.

Multiple locations with large minority populations have contacted her in the past month about how an age-based system doesn’t work for them, she said. “I think there are a lot of critical considerations that states and local health departments have to consider,” she said.

Figuring out the best priority order for vaccines will be a short-term issue, as the number of vaccine doses is expected to rise exponentially by late April. But the question of vaccine hesitancy may then become a greater challenge, said. Dr. Sonja Rasmussen, a professor in the departments of pediatrics and epidemiology at the University of Florida.

“I have a concern we will soon get to a point where we have more vaccine than people who want to get it.”

Looking to Kentucky’s Past to Understand Montana Health Nominee’s Future

The confirmation hearing of Adam MeierThe confirmation hearing of Adam Meier, Republican Gov. Greg Gianforte’s pick for director of the state Department of Public Health and Human Services. (Montana Legislative Services)

The nominee to be Montana’s next health director faced an unwieldy disease outbreak and pushed Medicaid work requirements — two issues looming in Montana — when he held a similar job in Kentucky.

Montana senators will soon decide whether to confirm Adam Meier, Republican Gov. Greg Gianforte’s pick for director of the state Department of Public Health and Human Services. He would earn $165,000 leading Montana’s largest state agency, which oversees 13 divisions and is a leader in the state’s pandemic response.

Gianforte is confident Meier “will bring greater transparency, accountability, and efficiency to the department as it serves Montanans, especially the most vulnerable among us,” Brooke Stroyke, a governor’s office spokesperson, said in an emailed statement.

For many Montana officials and health care industry players, the focus is on Montana’s future, not Kentucky’s past. But it can be instructive to see how Meier handled similar issues in his prior role, which he held from May 2018 through December 2019.

Some have praised the job he did in Kentucky, including his spearheading of a program that would have created work requirements in the state’s Medicaid program. But others criticized those proposed changes as well as his handling of a large hepatitis A outbreak that spread through rural Appalachia starting in 2017, ultimately sickening more than 5,000 Kentuckians and killing 62. The details of the state’s response to the outbreak came to light after an investigation in The Courier Journal in 2019.

“The hep A response is probably one of the darkest or most concerning things he did when he was in Kentucky. He also didn’t perform well in my eyes on other issues,” said Simon Haeder, an assistant professor at Pennsylvania State University who studies politics, health care and public policy. “He didn’t do so well in Kentucky, so I don’t know how well he’s going to do in Montana.”

Some have praised the job Meier did in Kentucky, including his spearheading of a program that would have created work requirements in the state’s Medicaid program. But others criticized those proposed changes as well as his handling of a large hepatitis A outbreak that spread through rural Appalachia starting in 2017.(Montana’s Office of the Governor)

Dr. Kevin Kavanagh, a retired Kentucky physician who runs the national watchdog group Health Watch USA, is among those who said Meier and his team needed to do more early on to curb the hepatitis outbreak as it made its way into Appalachia. Kavanagh said Meier’s handling of the outbreak provides a window into how he might handle the covid crisis in Montana.

“But it could be a learning opportunity if failed strategies are corrected,” Kavanagh said. “The biggest question is: What did he learn in Kentucky?”

During Meier’s confirmation hearing before Montana’s Senate Public Health, Wellness and Safety Committee, the nominee said one lesson he learned was to invest in public health infrastructure. Because hepatitis A was spreading in rural Kentucky mountains, he said, standard outreach to vulnerable populations in settings like homeless shelters didn’t work. Instead, health officials started vaccinating people at convenience stores.

“One of the things I’ve learned there is, you have to be creative about how you reach folks,” Meier said.

Kentucky’s outbreak first centered in Louisville, where a more than 200-person health department was able to administer tens of thousands of vaccines against the highly contagious liver infection caused by a virus. The Centers for Disease Control and Prevention called the city’s response a “gold standard.”

But in spring 2018, the disease began to spread in Appalachia, which had thinly staffed county health departments.

Dr. Robert Brawley, then the state’s chief of infectious diseases, sounded the alarm to his bosses. Brawley asked state officials to spend $10 million for vaccines and temporary health workers. Instead, the acting public health commissioner, Dr. Jeffrey Howard, sent $2.2 million in state funds to local health departments. Brawley called the response “too low and too slow.”

In the months that followed, the outbreak metastasized into the nation’s largest.

Meier stood by Howard’s decisions at the time and the agency’s response. In Meier’s Feb. 10 Montana hearing, he said Kentucky lacked the infrastructure to buy $10 million worth of vaccines, and they would have gone bad anyway because the state didn’t have the necessary storage. Brawley’s proposal had called for sending $6 million to health departments to buy vaccines, however, and $4 million for temporary health workers.

“The ‘too low and too slow’ response to the hepatitis A outbreak in Kentucky, reported in The Courier Journal, may be an albatross around his neck for a long time,” Brawley, who resigned in June 2018, said of Meier in an email.

Montana’s Democratic Party cited the hepatitis A outbreak when Meier was nominated for the Treasure State job in January, slamming him as unsuitable.

The health department declined KHN’s request for an interview with Meier but provided letters from local Kentucky officials written in 2019. Allison Adams, public health director of Buffalo Trace District Health Department in Kentucky, defended the state’s actions in one February 2019 letter, arguing Kentucky’s leadership “made sound decisions regarding the support and known resources available.”

Meier has pitched himself as someone who works well with others, bolstered Kentucky’s family services and cut through the state’s bureaucracy.

Meier, an attorney, lived in Fort Thomas, Kentucky, near Cincinnati, with his wife and three children, where he served on the City Council just before being named deputy chief of staff for former Gov. Matt Bevin in 2015. After leaving Kentucky’s health Cabinet, he worked as a policy consultant with Connecting the Dots Policy Solutions LLC.

During Meier’s confirmation hearing before Montana lawmakers, Erica Johnston, operations services branch manager for the health department, said she was already impressed by his knowledge of the agency’s programs and ideas for changes. Past colleagues said he listened to those he oversaw. John Tilley, a former Democratic Kentucky representative who served as the state’s former head of Kentucky’s Justice and Public Safety Cabinet, called Meier a problem-solver.

“What I got in Adam was this refreshing take on government, this less than bureaucratic take,” Tilley testified.

While deputy chief of staff for Bevin, Meier oversaw the development of a Medicaid overhaul plan called Kentucky HEALTH, which would have required recipients who were ages 19-64 and without disabilities to work or do “engagement” activities such as job training or community service.

Bevin, a Republican who, like Gianforte, joined politics after making a fortune in business, described the effort as a way to ensure the long-term financial stability of Medicaid and prepare enrollees to transition to private insurance. In Meier’s Montana hearing, he said the goal was for Medicaid recipients to be linked to employment and training. Kentucky opponents said the program would have caused people to lose coverage and increase the state’s administrative burden.

That debate is familiar in Montana, where lawmakers approved work requirements for people who joined Medicaid under its expansion. The work rules are awaiting federal approval.

Kentucky’s requirements never took effect. They were authorized by a federal waiver but were tied up in legal challenges until the state’s current Democratic Gov. Andy Beshear rescinded the rules.

Still, Meier has said Medicaid’s enrollment dropped during his leadership and benefits remained steady for those who stayed on the rolls. That drop paralleled an overall national decline in Medicaid enrollment that lasted through 2019.

Penn State’s Haeder, who observed Meier’s tenure, criticized Meier’s support for Medicaid work requirements, saying “excessive amounts of data show how detrimental they are to public health” because vulnerable people lose coverage.

Mary Windecker, executive director for the Behavioral Health Alliance of Montana, said work restrictions aren’t a good model for Medicaid. But she said it isn’t surprising Meier has been in favor of those steps, given Montana’s recent efforts.

Even so, Windecker is optimistic when she talks about Meier’s confirmation. She said she’s thrilled he has experience with another state health agency.

“These are very complicated systems to run,” Windecker said. “If you understand health care, you stand a better shot at getting this.”

The Montana Senate has to take up Meier’s confirmation, which moved out of a committee Feb. 17.

While Meier awaits confirmation, he is already engaged in the state’s covid vaccine efforts and is working on the agency’s daily tasks, department spokesperson Jon Ebelt said in a statement. Meier is “focused on the job at hand,” Ebelt said.

Houghton, Montana correspondent, reported from Missoula. Ungar, Midwest editor and correspondent, reported from Louisville and formerly worked for The Courier Journal.

Becerra Has Long Backed Single-Payer. That Doesn’t Mean It Will Happen if He’s HHS Secretary.

“Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage.”

TV ad funded by Cotton for Senate, Feb. 22

A digital ad running in Georgia and New Hampshire says Xavier Becerra, President Joe Biden’s nominee for Health and Human Services secretary, supports “Medicare for All.”

“Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage,” the narrator says.

The ad, funded by the campaign PAC of Sen. Tom Cotton (R-Ark.), is part of a blitz from conservative groups against Becerra’s confirmation. It first aired last week and will continue until the Senate’s confirmation vote. The gritty, foreboding ad includes a range of other attacks, including criticisms of California’s covid-19 response and Becerra’s role in legal cases on reproductive rights.

Another ad, this one funded by Heritage Action for America and airing in the Washington, D.C., market, uses similar talking points, including Becerra’s support for “government-run health care.”

Becerra underwent two Senate hearings last week in which he faced questions about his support for Medicare for All.

“Your long-standing support for single-payer, government-run health care seems hostile to our current system from my perspective,” Sen. Mike Crapo (R-Idaho) said during Wednesday’s Senate Finance Committee hearing. “What assurances can you give to Americans who currently have private insurance, including through Medicare Advantage, and are satisfied with their insurance provider that they will not lose their coverage in the future to some sort of Medicare for All approach or federal takeover of health care?”

Becerra responded that he was asked to serve at the pleasure of Biden, who has made it clear he wants to build on the Affordable Care Act. “That will be my mission,” he said.

Since a vote on Becerra’s nomination could happen this week, we thought it was important to check the claim from this ad and give context to what power HHS secretaries actually have.

We reached out to Cotton’s press team to ask for evidence to support the ad but didn’t hear back. The ad does cite a December New York Times article with the headline “Becerra Supports ‘Medicare for All’ and Could Help States Get There” to back up the claim.

Noah Weinrich, press secretary for Heritage Action for America, did provide evidence of Becerra’s support for Medicare for All. Weinrich sent clips of press interviews, as well as links to House of Representatives Medicare for All bills that Becerra co-sponsored over his years in Congress.

Where Becerra and Biden Stand on Health Care

Xavier Becerra was elected as a Democrat to represent a Los Angeles district in the U.S. House in 1993. He stayed in Congress 24 years. He resigned in 2017 to accept the position of attorney general of California, which was offered to him by then-Gov. Jerry Brown.

As attorney general, Becerra brought more than 100 legal challenges against the Trump administration for various health, environmental and immigration issues. One of his best-known lawsuits was in support of the Affordable Care Act. California took the lead with 18 other states in arguing against overturning the law before the U.S. Supreme Court. That decision is expected by the end of June.

Since Becerra was first elected to Congress, he has been an advocate for single-payer, or universal, health coverage. This type of coverage can take many forms, but by most definitions, it means the federal government would have some role in funding and administering health insurance for the public.

“I do, as I said before, join my colleagues who support the single-payer plan,” Becerra said during a congressional hearing in 1994. “For me, meaningful health care reform means that we must have universal coverage. We must have portability. We must have choice of provider.”

More recently, this approach took on the moniker of Medicare for All, in reference to Sen. Bernie Sanders’ (I-Vt.) health care bill with the same name. Sanders’ bill, first introduced in 2017, was designed to eliminate private health insurance after phasing in government-run health care, funded by raising taxes.

In 2017, Becerra said he would “absolutely” support Sanders’ bill. “I’ve been a supporter of Medicare for All for the 24 years that I was in Congress,” Becerra said during a Fox News interview. “This year, as attorney general, I would fight for that if we had an opportunity to put that forward in the state of California, because I think what we do is we give people that certainty that they’re going to be able to access a doctor or a hospital.”

And in 2019, Becerra told KHN’s Samantha Young he’s “been a single-payer advocate all my life.”

Reviewing Becerra’s statements, it’s clear he does support Medicare for All or similar plans.

But, if confirmed as head of the Department of Health and Human Services, Becerra will be a member of Biden’s Cabinet, and the president dictates policy priorities. During the Democratic presidential primaries, Biden was unwavering in his opposition to Medicare for All, instead throwing his support behind implementing a public option health plan and expanding the ACA. A public option is a government-run health insurance plan that would exist beside private health insurance coverage as a choice in the ACA marketplace.

It’s also important to note that while the ad says Becerra supports Medicare for All, thus “eliminating your employer-provided coverage,” that doesn’t mean your health insurance would be eliminated. Rather, it would be replaced by government-run health insurance.

“The notion that by having Medicare for All you’re going to lose insurance coverage is bizarre,” said Mark A. Peterson, a professor of public policy, political science and law at UCLA. “The whole point of Medicare for All is that everyone has health insurance.”

What an HHS Secretary Can Actually Do

Since Biden doesn’t support Medicare for All, would Becerra’s stance really matter?

No, said Joseph Antos, a health care scholar at the right-leaning American Enterprise Institute.

“He will not be able to, in this role, push the executive branch or the Congress in this direction in any perceptible way,” said Antos. “About all he could really do is use the waiver process and loosen up the various restrictions that the Trump administration tried to impose on states in the Medicaid programs. But that’s not the same thing as single-payer.”

Antos was referring to waivers that states can ask for in order to change how they administer the ACA exchanges or Medicaid.

Larry Levitt, executive vice president for health policy at KFF, said it certainly is possible Becerra could be called upon to consider state waiver proposals to implement single-payer systems. (KHN is an editorially independent program of KFF.)

“He would likely look more favorably on waivers like that than the Trump administration, which was quite clear they wouldn’t consider them. He might also view such waivers more positively than an HHS secretary that has not supported Medicare for All,” Levitt wrote in an email. “However, Becerra would not be making decisions on state waivers of such consequence unilaterally. He would certainly consult with the White House.”

Levitt added that it seems unlikely at this point any state could implement a single-payer system. Vermont dropped its efforts to do so after it became clear how much taxes would increase. California does have significant support for single-payer, but it seems unlikely to be realized in that state.

Plus, establishing a national single-payer system would require the support of both the president and Congress — and neither is ideologically there.

The White House maintains Becerra would be focused solely on Biden’s priorities and not Medicare for All.

Andrew Bates, a transition spokesperson for Biden, said in a statement that “Xavier Becerra will support and work to enact President Biden’s health care agenda — building on the ACA with a public option — as was made clear immediately after he was selected.”

But Heritage Action’s Weinrich took a different view: “The HHS secretary holds considerable policy-making and rule-making power, and Becerra’s long record indicates he would use that power to expand government’s role in health care in any way he can, with the ultimate goal of a single-payer option.”

Rhetoric Around Medicare for All, ‘Radical’ Californians

In the 2018 and 2020 elections, it was common for Republicans to paint Democrats as “socialists.” Sometimes this was illustrated through their support for Medicare for All or simply being from California.

The same rhetoric is being employed here, said Peterson.

“That Biden, by bringing in these officials from California, and the fact that Nancy Pelosi is speaker of the House, they’re arguing it’s just showing the infiltration of the radical socialist California state into the federal government,” he said. “But this is ridiculous, because there are not socialist politics, per se, happening in California, and often the California Democrats in Washington are moderate.”

Ultimately, though, the goal of an ad like this is to lay the groundwork for future campaigns.

“In a Senate that is split 50-50 and that 50th Democrat is a conservative Democrat, there is opportunity and leverage for Republicans to try and stand in the way,” said Peterson. “The less effective the Biden administration can be, the more effective campaigning will be for Republicans.”

Our Ruling

The ad states, “Becerra supports Bernie’s government takeover of your health care, eliminating your employer-provided coverage.”

Becerra’s past remarks illustrate he does support Medicare for All or other programs in which the government would run and fund health insurance.

We rate this claim True.


California Healthline, “With Becerra as HHS Pick, California Plots More Progressive Health Care Agenda,” Dec. 10, 2020

CNBC, “Biden Suggests He Would Veto ‘Medicare for All’ Over Its Price Tag,” March 10, 2020

CNS News, “California AG Would ‘Absolutely’ Support Medicare for All Plan,” Oct. 23, 2017, S.1804 — Medicare for All Act of 2017, accessed Feb. 24, 2021

C-SPAN, HHS Secretary Nominee Xavier Becerra Testifies Before Senate Finance Committee, Feb. 24, 2021

Email interview with Larry Levitt, executive vice president for health policy at KFF, Feb. 23, 2021

Email statement from Andrew Bates, transition spokesperson for Joe Biden, Feb. 23, 2021, Health Care, accessed Feb. 24, 2021

KHN, “Xavier Becerra in His Own Words: ‘Health Care Is a Right,’” Dec. 7, 2020

KHN, “For California Attorney General Xavier Becerra, Resistance Is Personal,” Feb. 4, 2019

KHN, “What to Know as ACA Heads to Supreme Court — Again,” Nov. 9, 2020

KHN, “Politicians Hop Aboard ‘Medicare-for-All’ Train, Destination Unknown,” Oct. 22, 2018

The New York Times, “Biden Picks Xavier Becerra to Lead Health and Human Services,” Dec. 6, 2020

The New York Times, “Becerra Supports ‘Medicare for All,’ and Could Help States Get There,” Dec. 10, 2020

Office of Attorney General of California, Attorney General Xavier Becerra, accessed Feb. 24, 2021

Phone interview with Anthony Wright, executive director of Health Access, Feb. 23 and 24, 2021

Phone interview with Mark A. Peterson, professor of public policy, political science and law at UCLA, Feb. 24, 2021

Phone interview with Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, Feb. 24, 2021

Politico, “A Trio of Conservative Groups Tries to Torpedo Two Top Biden Nominees,” Feb. 18, 2021

Twitter, @ddiamond tweet, Dec. 6, 2020, “Senator Cotton Launches Ads in Georgia and New Hampshire Targeting Xavier Becerra,” Feb. 22, 2021

U.S. House of Representatives History, Art & Archives, Becerra, Xavier, accessed Feb. 24, 2021

YouTube, “Becerra Can’t Be Trusted — New Hampshire,” accessed Feb. 24, 2021

YouTube, “Becerra — Not the Right Choice,” accessed Feb. 24, 2021

In Quest for Herd Immunity, Giant Vaccination Sites Proliferate

Thomas Hatcher Sr., 84, of Glastonbury, Conn., received a shot of the Pfizer-BioNTech Covid vaccine at a mass inoculation site set up at Rentschler Field in East Hartford this month.
Thomas Hatcher Sr., 84, of Glastonbury, Conn., received a shot of the Pfizer-BioNTech Covid vaccine at a mass inoculation site set up at Rentschler Field in East Hartford this month.

In Quest for Herd Immunity, Giant Vaccination Sites Proliferate

A day at one mass site in Connecticut shows both the promise and the shortcomings of the approach, which is at the center of President Biden’s plan to bring the pandemic to an end.

Thomas Hatcher Sr., 84, of Glastonbury, Conn., received a shot of the Pfizer-BioNTech Covid vaccine at a mass inoculation site set up at Rentschler Field in East Hartford this month.Credit…

  • Feb. 28, 2021, 3:00 a.m. ET

EAST HARTFORD, Conn. — With the nation’s coronavirus vaccine supply expected to swell over the next few months, states and cities are rushing to open mass vaccination sites capable of injecting thousands of shots a day into the arms of Americans, an approach the Biden administration has seized on as crucial for reaching herd immunity in a nation of 330 million.

The Federal Emergency Management Agency has joined in too: It recently helped open seven mega-sites in California, New York and Texas, relying on active-duty troops to staff them and planning many more. Some mass sites, including at Dodger Stadium in Los Angeles and State Farm Stadium in suburban Phoenix, aim to inject at least 12,000 people a day once supply ramps up; the one in Phoenix already operates around the clock.

The sites are one sign of growing momentum toward vaccinating every willing American adult. Johnson & Johnson’s single-dose vaccine won emergency authorization from the Food and Drug Administration on Saturday, and both Moderna and Pfizer have promised much larger weekly shipments of vaccines by early spring. In addition to using mass sites, President Biden wants pharmacies, community clinics that serve the poor and mobile vaccination units to play major roles in increasing the vaccination rate.

With only about 9 percent of adults fully vaccinated to date, the kind of scale mass sites provide may be essential as more and more people become eligible for the vaccines and as more infectious variants of the virus proliferate in the United States.

But while the sites are accelerating vaccination to help meet the current overwhelming demand, there are clear signs they won’t be able to address a different challenge lying ahead: the many Americans who are more difficult to reach and who may be reluctant to get the shots.

The drive-through mass vaccination site on a defunct airstrip here in East Hartford, outside Connecticut’s capital, shows the promise and the drawbacks of the approach.

Run by a nonprofit health clinic, the site has become one of the state’s largest distributors of shots since it opened six weeks ago, and its efficiency has helped Connecticut become a success story. Only Alaska, New Mexico, West Virginia and the Dakotas have administered more doses per 100,000 residents.

The site, on a defunct runway owned by Pratt & Whitney, has become one of the Connecticut’s largest distributors of shots since it opened six weeks ago.
The site, on a defunct runway owned by Pratt & Whitney, has become one of the Connecticut’s largest distributors of shots since it opened six weeks ago.
Susan Bissonnette, a nurse manager for Community Health Center, delivered vaccine doses to be administered to frontline health workers.
Staff members and National Guard troops arrived for a day of giving vaccinations and performing other jobs at the site.

Most of the people running mass sites are learning on the fly. Finding enough vaccinators, already challenging for some sites, could become a broader problem as they multiply. Local health care providers or faith-based groups rooted in communities will likely be far more effective at reaching people who are wary of the shots. And many of the huge sites don’t work for people who lack cars or easy access to public transportation.

“Highly motivated people that have a vehicle — it works great for them,” said Dr. Rodney Hornbake, who serves as both a vaccinator and the East Hartford site’s medic, on call for adverse reactions. “You can’t get here on a city bus.”

Before dawn on a recent raw morning, Susan Bissonnette, the nurse in charge, prepared enough vials of the Pfizer vaccine and diluent for the first few hundred shots of the day. At 7:45 a.m., her team surrounded her in a semicircle, stamping the snow off their boots and warming their fingers for the hours of injections that lay ahead.

“We’re going to start with 40 vials, eight per trailer,” Ms. Bissonnette shouted to the group of 19 nurses, a doctor and an underemployed dentist who had volunteered to help. “OK, so remember it’s Pfizer, right? Point three milliliters, right?”

The site vaccinates about 1,700 people on a good day, partly because Connecticut is small and gets fewer doses than many other states. It is a well-oiled machine, with a few dozen National Guard troops directing cars into 10 lanes, checking in people, who have to make appointments in advance, and making sure they have filled out a medical questionnaire before moving down the runway to their shots.

Troops also supervise the area at the end of the runway where people wait after their shots for 15 minutes — or 30, if they have a history of allergies — in case of serious reactions.

In between are the vaccinators, two per car lane, trading on and off between jabbing arms. When they need to warm up, they retreat inside heated trailers to draw up doses and fill out vaccination cards.

“If you simply open up with 10 lanes, it will be chaos unless you have teams all along the way at checkpoints, executing on the plan you’ve laid out,” said Mark Masselli, the president and chief executive of Community Health Center, which opened the East Hartford site on Jan. 18 and has since opened two smaller versions, in Stamford and Middletown. “You’ve got to marry some groups together — folks with health care delivery sense and folks with logistics sense.”

Monica Torrenegra, 53, left, a health care worker, and her mother, Mariela Medina, 75, both of Waterbury, in a waiting area after receiving their vaccines.
A dose ready for delivery. Most sites say their main challenge is not having enough supply to meet demand, a problem experts say will fade as more vaccines become available.
Bernie Delgado, 42, a nurse supervisor for Community Health Center, drew diluent into a syringe in preparing a dose of the vaccine.

The site came together in six days, as Mr. Masselli’s staff worked frenetically with the state to install trailers, generators, lights, a wireless network, portable bathrooms, traffic signs and thousands of orange cones to mark the lanes. Every worker has two all-important pieces of equipment: a walkie-talkie to communicate with all the stations and supervisors, and an iPad to verify appointments or enter information about each patient into a database.

The vaccine they use is Pfizer’s, which adds complexity because it has to be stored at minus 70 degrees Fahrenheit. The supply is kept in an ultracold freezer that Community Health Center installed at the adjacent University of Connecticut football stadium. Ms. Bissonnette and other supervisors speed there in bumpy golf carts several times a day to grab more vials, which last for only two hours at room temperature.

The first cars roll in at 8:30, often driven by the adult children or grandchildren of those getting shots.

Drive-through clinics can be better for infection control, some experts say — people roll down their car windows only for the injection — and more comfortable than standing in line. But a month into the Connecticut site’s existence, its weaknesses are also clear.

Traffic can get snarled on the busy road leading to the site, and bad weather can shut it down, requiring hundreds of appointments to be rescheduled on short notice. Spotty vaccine supply, which forced sites in California to close for a few days recently, can also wreak havoc.

More significantly, you need a car, gas money and, for some elderly people, a driver to get to and from the site. At this point, white people comprise 82 percent of those seeking shots at the East Hartford site, down from 90 percent in early February; their overrepresentation is partly because the older population now eligible is less diverse than the state overall.

Dr. Rodney Hornbake took the blood pressure of Katherine Delventhal, 85, of West Hartford after she received the vaccine. 
Marilyn Coppola, 82, of Madison got the shot. Officials have been taking pains to keep the crowds moving and happy. “If it’s really a pain in the neck, why would you go wait in line again a few weeks later?” said one expert.
Ms. Delgado with a fresh batch of vaccines ferried via golf cart from the nearby University of Connecticut football stadium, where the vaccines are stored at minus 70 degrees Fahrenheit.

To address problems of access and equity, FEMA is opening many of its new mass sites in low-income, heavily Black and Latino neighborhoods where fear of the vaccine is higher, vaccination rates have been lower and many people lack cars. In addition to its mass sites, Community Health Center, which serves large numbers of poor and uninsured people in clinics around the state, is also planning to send small mobile teams into neighborhoods to extend its vaccination reach.

The East Hartford site has hired several dozen temporary nurses and trained its dentists and dental hygienists to help with the shots. Still, staffing the site with 22 vaccinators daily remains a challenge, one that will grow nationally as more people become eligible for the shots.

Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, said the need for mass vaccination sites might wane as more and more of the low-hanging fruit — Americans who are highly motivated to get vaccinated as soon as possible — is picked.

“I think they have worked well in the current setting of demand substantially exceeding supply, drawing on many people who are eager to be vaccinated,” Dr. Plescia said. “As supply increases, and we have vaccinated the eager, we may find that lower-volume settings are preferable.”

Mobile vaccination clinics will reach some of the vaccine hesitant. But Dr. Plescia said people who are uncertain and fearful would be best served by doctors’ offices or community health centers where they can talk it through with health care providers they know.

“They’re not there to counsel you,” he said of mass sites. “You go to get the shot, end of story.”

Lena Bryant, 76, of Middletown, waited her turn for a shot.
National Guard troops are helping to oversee the operation.
Alcohol swabs and bandages prepped for action.

Dr. Nicole Lurie, who was the assistant health secretary for preparedness and response under President Barack Obama, said that instead of just asking FEMA for help, state and local governments should seek input from private companies used to keeping large crowds moving — while keeping them safe and happy.

In one such example, the company running Boston’s mass vaccination sites contracted with the event management firm that runs the Boston Marathon to handle day-to-day logistics. Several companies that ran large coronavirus testing operations are also involved in mass vaccination.

“These sites need to be motivated to make this a good experience for the customer, especially since they’re working with a two-dose vaccine,” Dr. Lurie said. “If it’s really a pain in the neck, why would you go wait in line again a few weeks later?”

Most sites say their main challenge is not having enough supply to meet demand. But with 315 million more Pfizer and Moderna doses promised by the end of May, and Johnson & Johnson pledging to provide the United States with 100 million doses of its newly authorized vaccine by the end of June, that complaint may fade before long.

The biggest headache for the East Hartford site has been the system for booking appointments, a clunky online registry known as VAMS that is being used in about 10 states. Many people 65 and older have had such a hard time navigating it that most end up calling 211, the phone number for health and social services assistance, to make appointments instead.

As the hours pass, the eternally smiling vaccinators in East Hartford get tired — and sometimes bone cold. But sometimes there are unexpected boosts, such as when John Rudy, 65, pulled up with his mother, Antoinette, in the back seat.

“We’ve got a 100-year-old!” Jean Palin, a nurse practitioner, announced as she prepared Ms. Rudy’s shot.

Antoinette Rudy, 100, arrived for her shot.
The biggest headache for the East Hartford site has been the clunky online appointment registration system, which many people 65 and older have had trouble navigating.
On days when there are more no-shows than usual, workers must find ways to administer the remaining doses before the vaccines are ruined from too much time out of the freezer.

The site usually closes at 4 p.m., but there was a problem: There were more no-shows than usual that day, in the middle of a snowy week, and there were 30 unused doses. Word went out from nurses at the site, including to people working at a nearby big-box store, who were not all eligible but could qualify for a vaccine if the alternative was throwing it away.

“It’s just a precision game toward the end of the day,” Ms. Bissonnette said.

At 5:15, Greg Gaudet, 63, drove up, teary with excitement. He had learned from one of the nurses, a former high school classmate, that a shot was available.

“I have a luckily dormant cancer, but my immunity is low,” said Mr. Gaudet, an architect whose form of leukemia was diagnosed six years ago. “I’m so grateful.”

How much the site will cost over time remains “a question that we are eager to work through,” Mr. Masselli said. Community Health Center spent about $500,000 to set it up and is spending roughly $50,000 a week on labor and other costs. It receives a fee for each shot it can bill insurance for — the Medicare rate is $16.94 for the first dose and $28.39 for the second — but is also counting on reimbursement from the state and FEMA for start-up and other costs.

Still, the expense has not stopped Mr. Masselli from imagining an expansion.

“There’s another runway over there,” he said, gesturing behind him. “Between the two, with two shifts, we could do 10,000 a day. March 14 is Daylight Saving Time; we’re going to pick up warmer weather, more light. The timing is right.”

How To Ritualize Tea Time

Settle In for a Cuppa

Tea might be the perfect drink for the pandemic winter malaise. Here’s how to start your own ritual.

“There’s been a culture of going out for coffee,” said Adrienne Blaine, a video producer in San Francisco, “but there’s something to be said for staying in for tea.”
“There’s been a culture of going out for coffee,” said Adrienne Blaine, a video producer in San Francisco, “but there’s something to be said for staying in for tea.”Credit…Hadley Green for The New York Times

  • Feb. 27, 2021

The consumption of tea around the world is second only to water, and it seems to have grown during these crisis-ridden times. TeaTime magazine in Birmingham, Ala., had a 30 percent increase in Facebook followers and a 45 percent increase in Instagram followers over the past year, according to Lorna Reeves, the magazine’s editor.

As pandemic fatigue and anger wear on, more people seem to be turning to tea for its health benefits and also as a remedy against burnout.

“It was exhausting not to have those pre-pandemic coffee breaks, not to feel like I had the ability to walk away from my desk,” said Leilani Zee, a book publicist in Las Vegas, “so I started to ritualize teatime.”

Adrienne Blaine, a video producer in San Francisco, and her boyfriend have recently gotten into drinking tea, finding it the perfect beverage for the homebound. “There’s been a culture of going out for coffee,” she said, “but there’s something to be said for staying in for tea.”

Here’s how to develop a tea ritual all your own.

Forget the fuss.

This is not “Downton Abbey” cosplay. While ceremony, protocol and ritual infuse tea practices worldwide, the manner of teatime is personal. Mister Rogers drank hot cranberry juice out of his mugs, so you can do anything (just avoid the hallucinogenic ayahuasca). The famed British version of afternoon tea can be as imposing as its fine bone china and three-tiered towers of snacks. By contrast, goûter, France’s teatime equivalent, often includes a casual bar of chocolate in a baguette. Chado, Japan’s tea ritual, favors tranquillity over decadence.

Tea is often paired with snacks that can be sweet (pastries) or savory (finger sandwiches). Indian tea culture has a particularly vast array of snacks, including miniature dried-fruit samosas and chakli, a fried spiral of spiced lentils. For scones, Ms. Reeves recommends freezing them raw and baking them individually in a toaster oven.

Mana Reshamwala, a Japanese native who lives in Durham, N.C., carves out an hour every other Thursday for a teatime with a neighborhood friend that complements a meditative activity like gardening or knitting. Her green tea sipped out of earthenware Hagi-Yaki cups is traditional. The rest is personal. “It’s very Mana time,” she said. “Just my time.” Asked what other personal time she has, Ms. Reshamwala, a mother of two young boys, laughed.

Any time can be teatime.

Ataya, Senegal’s tea ceremony, can last three hours. But most practical teatimes are about 30 minutes. The most common time is 3:30 or 4 p.m., but do whatever works for you. Perhaps, like Oprah Winfrey, your teatime is a morning chai. For late lunchers or those with particularly high-stakes mornings, maybe the elevenses, which occurs at 11 a.m., is a better fit. But teatime can just as easily be a calming sip of chamomile before bed.

Keep it simple.

There’s a lot of gear. And apparently 24 million ways to make tea. But here are some guideposts. Boiling water will ruin green or oolong teas, Ms. Reeves said. Teas have various steeping times, with an average of three minutes, she added, but check packaging instructions (oolong teas are great for multiple steeps). If you steep too long, you can add more water. Tea enthusiasts value loose leaves over tea bags. A BBC investigation into optimal tea recommended five-minute steeps and reported that the same tea will taste sweeter out of a red mug than a white one.

Set boundaries.

Teatime is the opposite of coffee or lunch consumed over your work-from-home laptop. On top of picking what time works best for you, pick a suitable location. Remember office coffee breaks? Apply similar strategies: Avoid work or distracting devices. No email. No phone. And maybe nobody but yourself.

Kids like teatime, too.

Afternoon tea is a convenient segue from pandemic at-home schooling to pandemic at-home home life. Three times a week, Calder Norris, an 8-year-old in Manhattan, has teatime with his nanny (mostly he drinks nut milk from a teacup). “People think teatime is for drinking tea — it’s not just that,” he said. “Our relationship grows stronger.”

Dances to Learn At Home

Think You Can’t Dance?

Online tutorials for TikTok and music-video routines can help prove you wrong. The “WAP” dance is within your reach.

Credit…A&M Records
Siobhan Burke

  • Feb. 27, 2021, 11:41 p.m. ET

In the early days of the pandemic, a strutting, hip-shaking dance trend took over social media: the J. Lo TikTok Challenge, a roughly 30-second piece of choreography from Jennifer Lopez’s Super Bowl halftime performance last year. It was hard to watch the routine and not want to learn it; in video after video, the energy was contagious.

But where was a novice to begin? A quick internet search for “Learn J. Lo TikTok challenge” would send you into another vortex: the vast, uneven world of online dance tutorials.

While some people excel at picking up choreography directly from videos, others do better with slower, step-by-step guidance. The internet is full of tutorials breaking down popular dance routines, but some are more helpful than others. Whether you’re trying to master dances from TikTok, music videos, movies or elsewhere, a decent tutorial can be the difference between a frustrating process and a fulfilling one. And as those who teach them can tell you, how you use these virtual lessons — namely, your approach to learning — also matters.

Across TikTok, many creators post short tutorials for their own dances (within the platform’s 60-second time limit), often recorded in slow motion to make them easier to follow. The app’s “duet” feature, which allows users to dance side-by-side with a slowed-down original, is also handy for studying choreography and syncing up your moves.

But sometimes, especially for fast and intricate movements, more detailed instruction is useful. On his YouTube channel, Online Dance Classes, the choreographer Vincent Vianen posts longer tutorials for trending TikTok dances (all his videos are free), with clear, specific directions and chances to practice at various speeds. His teaching style brings even the trickiest dance challenges, like the original “Renegade” (created by the innovative young dancer Jalaiah Harmon), within reach.

“When I make my tutorials, I really try to get inside the head of somebody that isn’t very experienced in dancing,” Vianen said in a video interview from Amsterdam, where he lives. One of his tips for beginners: Be patient, and allow yourself to mess up. “When you start, don’t expect to be perfect on the same day,” he advised. “Improving with dancing just takes time.”

The dancer Marissa Montanez has been making online dance tutorials since 2009, when she started a YouTube channel to teach Lady Gaga’s choreography. As a senior instructor with the New York dance-fitness studio Banana Skirt Productions, which has moved online during the pandemic, she often teaches routines from popular music videos for the class series known as Starpop Dance. (She also offers free mini tutorials on her personal TikTok page; a Banana Skirt subscription is $19.99 a month.)

For longer routines, Montanez recommends “setting realistic goals,” which might mean tackling just a couple of eight-counts at a time. “Being at home allows you the flexibility to break it up if you need to,” she said in a phone interview. She also suggested getting familiar with the original source, observing the dance in full a few times before trying it yourself.

With the suspension of live performances and in-person classes, larger organizations have also turned to tutorials to keep people engaged in their work. Last year, for instance, the Alvin Ailey American Dance Theater and Verdon Fosse Legacy (devoted to the work of the choreographer Bob Fosse and the dancer Gwen Verdon) released instructional videos that make classic modern-dance and movie-musical steps accessible to dancers of all levels.

If you’re looking for a place to begin to learn dance routines at home, here are five options of varying styles (in roughly ascending order of difficulty), with corresponding tutorials. Each is a good workout in its own way, so be sure to warm up, drink plenty of water and, as Montanez tells her students, “be kind to yourself.”

Credit…Warner Bros.

1. Musical-Comedy Moment

In the song-and-dance number “Who’s Got the Pain” from the 1958 movie “Damn Yankees,” Gwen Verdon and Bob Fosse ease into their comic stage routine with a punchy, hip-swaying backward walk. As part of the Verdon Fosse Legacy’s #FosseMinute series on YouTube, the dancer Dana Moore teaches that short sequence, known as the mambo step. It also involves some basic hat choreography and periodically exclaiming “Erp!”

Credit…Andrea Mohin/The New York Times

2. Classic Modern Dance

The centerpiece of the Alvin Ailey repertory, “Revelations,” choreographed in 1960, might look dauntingly complex when you see it in a theater. But in a 13-minute online workshop, the longtime Ailey dancer Hope Boykin brings passages of the choreography down to an attainable scale. In addition to movement cues, she offers insight into the history, imagery and inspiration behind the work — knowledge that makes the movement richer.

3. Timeless TikTok

TikTok dance trends are mostly fleeting, but some rise to the level of what could be called classics. Only time will tell, but the “WAP” dance might be one such routine, the kind that will forever spring to mind — and to the dance floor — when its song comes on. Created by the digitally savvy dancer Brian Esperon as a companion to Cardi B and Megan Thee Stallion’s summer hit “WAP,” the dance honors the raunchy brashness of the lyrics, complete with a giant hitch kick, a split and lots of twerking. (Unlike many TikTok dances, which tend to stay standing in one place, this one really goes to the floor and requires some space to spread out.) As Esperon warns in his tutorial, even he injured himself while doing it, so be careful.

Credit…Maddie Meyer/Getty Images

4. Super Bowl Sensations

It wasn’t just J. Lo who dazzled at the Super Bowl halftime show last year, with the irresistible routine (choreographed by Parris Goebel) that wound up all over the internet. She shared the stage with Shakira, whose performance also gave rise to a viral dance, the Champeta challenge, choreographed by Liz Dany Campo Diaz and named for its high-velocity style of Afro-Colombian dance. On his YouTube channel, Vianen offers tutorials for both the J. Lo and Shakira challenges, which could make for a fun (and sweaty) pairing.

Credit…A&M Records

5. ’80s Throwback

Where would choreographed dance in popular culture even be without Janet Jackson? Her catalog of dance-driven music videos is vast, but “Rhythm Nation,” with its militaristic moves by the choreographer Anthony Thomas, is among the most indelible. Banana Skirt hosts a couple of “Rhythm Nation” classes, including one taught by Montanez. And it takes some digging, but on the YouTube channel of the dance group Bay Area Flash Mob, you can find videos of Thomas teaching the choreography. Sometimes the best tutorial is one you piece together yourself.

Three More Tips for Learning Dance Routines at Home:

Record yourself: Vianen, who began his own dance training by watching videos, suggests filming yourself and watching the recording to see how you can improve. “Sometimes you’re going to be like, ‘Oof, what is this?’” he said. “You’re not going to like what you see, but that’s part of the progress.” In this way, he added, “you become your own teacher.”

Take breaks: Vianen likens learning a dance to solving a puzzle; sometimes it helps to leave and come back. “If you let it go, your subconscious can work on solving it without you actually thinking about it,” he said. When you return, you might find yourself closer to a solution.

Keep it low-pressure: Montanez reminds anyone dancing at home to not lose sight of having fun; it doesn’t have to be about reaching fitness goals or attaining perfection. “We can forget that dance can just be relaxing and joyful and a release from our everyday life,” she said. “It can be whatever you want it to be.”

Things To Do At Home

Cook With Cabbage and Sing a Sea Shanty

This week, get a tarot reading, unwind with a yoga class or learn about pendulums.

Credit…Rose Wong
  • Feb. 27, 2021, 11:22 p.m. ET

Here is a sampling of the week’s events and how to tune in (all times are Eastern). Note that events are subject to change after publication.


Tune in to an episode of “Your Magic,” a new podcast from Parcast. Each Monday, Michelle Tea, a writer and the show’s host, will explore mysticism and spirituality with guests including Phoebe Bridgers, Roxane Gay and Brittany Howard. Every episode will feature a tarot-card reading and interview, as well as a spell from a spiritual practitioner and the opportunity for listeners to have a tarot reading done by Ms. Tea. This podcast is free, and available on Spotify.

When Anytime


Grab a bag of popcorn and watch one (or many!) of the 78 films featured in the 2021 Athena Film Festival. The annual festival, a collaboration between Women and Hollywood, an organization devoted to gender diversity and inclusion in the film industry, and Barnard College’s Athena Center for Leadership, explores and celebrates female authority in film. This year’s lineup includes “Test Pattern,” which the film critic Devika Girish said forces viewers “to question our presumptions about what rape and victimhood look like — onscreen and in life,” in her review in The New York Times. Films will premiere throughout the month. Tickets are $12 per film, and viewers have 48 hours after starting a movie to finish it.

When Anytime until March 31



Learn the science behind pendulums and create one of your own (if you choose to) during this kid-friendly demonstration. Hosted by an expert from the Children’s Museum Houston, and sponsored by the chemical and fuel producer Flint Hills Resources, this event will show viewers how to craft a pendulum from household items. Museum educator Andrea Hernandez will also answer emailed audience questions. This event is free; registration is not required. (A recording of the event will be available on the museum’s YouTube channel.)

When 2:45 p.m.


Join the Nobel laureate Kazuo Ishiguro in conversation with the writer and critic Alex Clark. In this global, live-streamed event, Mr. Ishiguro will discuss his new novel, “Klara and the Sun,” his first since winning a Nobel Prize, and will answer audience questions. Tickets to this event, presented by The Guardian Live, start at $10.

When 2 p.m.



Unwind with an evening yoga class with Eric Mosley, the founder of Black Mat Yoga. Mr. Mosley, who aims to broaden the worlds of yoga and wellness, will teach a 45-minute flow class that is suitable for both beginners and experienced yogis. After class, students are encouraged to raise a beverage of their choice for a virtual toast and talk about their yoga practice or whatever else is on their minds. The class is $10, and registration closes at 5 p.m. Attendance is capped at 50, but Mr. Mosley teaches the same class every Wednesday.

When 6 p.m.



Spend the evening watching “What Becomes of Love?,” a new piece by the choreographer Sonya Tayeh. The performance, which features dancers from the American Ballet Theater and original music from Rhye, a project of the singer Mike Milosh, was created while Ms. Tayeh and the dancers were in a “ballet bubble” in upstate New York. A collaboration between American Ballet Theater and the music venue National Sawdust, the show will be followed by a conversation with the artists. This event is free.

When 6 p.m.


Learn a recipe for cabbage and prepare your garden for spring in a cooking and gardening class from the United States Botanic Garden. Each week the sisters Danielle Cook, a nutritionist and cooking instructor, and Adrienne Cook, a gardening and cooking writer, will share a recipe followed by gardening tips. This week, Danielle will demonstrate a meal using cabbage, and Adrienne will share ideas for getting a home garden ready for spring. This event is free.

When 12 p.m.



Stream “F*ck7thGrade,” a theatrical performance about rock ‘n’ roll from the singer-songwriter Jill Sobule. Directed by Lisa Peterson and with a book by Liza Birkenmeier, this autobiographical show about and starring Ms. Sobule explores her teenage years. Tickets to this prerecorded event, intended for audiences 15 and up and presented by City Theater in Pittsburgh, are $15.

When Anytime



Put your editing skills to the test with the National Museum of Women in the Arts’s Wikipedia Art and Feminism virtual edit-a-thon. This event, also presented by Wikimedia DC, will center on enriching and improving Wikipedia entries of notable female artists and art-related figures, with a special focus on female artists of color and women of African descent whose works are in the museum’s collection. People of all gender identities are invited to participate in this free event. Registration is required. Attendance is capped at 80.

When 10 a.m.


Credit…Rose Wong


Sing along to your favorite sea shanty in this presentation from the South Street Seaport Museum. Shanties have made a resurgence in the past year and have even gone viral on the social media app TikTok. This singalong will be hosted by Deirdre Murtha of the a cappella maritime music group The Johnson Girls, and by the fellow maritime musical group The New York Packet. A set list will be prepared in advance, and participants are encouraged to note if they’d like to lead a song from the list. This event is free, but registration is required.

When 2 p.m.


Show Thanks With A Gratitude Letter

How to Write a Gratitude Letter

Concerned about a friend or a loved one who may be feeling the winter doldrums? Try writing them a gratitude letter.

Credit…Rose Wong

  • Feb. 27, 2021, 11:03 p.m. ET

If you are looking to make someone — even yourself — feel better during what has been a hard winter of the pandemic, consider writing a gratitude letter. You can think of it as a slightly longer and more meaningful thank you note, but instead of offering thanks for a physical gift, you are offering thanks for something that was done or said.

There are two excellent reasons for writing a gratitude letter: It will make you feel really good, and it will make the recipient feel great. Among the research showing the benefits of letter writing is a study led by Indiana University and published in 2016 in the journal Psychotherapy Research and led by Indiana University, which tested whether gratitude writing helps people seeking psychotherapy. Scientists randomly assigned the 293 participants to three groups: Those receiving psychotherapy, those receiving psychotherapy and participating in expressive writing, or those receiving psychotherapy and participating in gratitude-letter writing. Even in the small study, participants in the gratitude group reported significantly better mental health than the other two groups, even three months after the trial ended.

On the receiving end, opening a gratitude letter feels even better than you might imagine. Amit Kumar, a social scientist at the University of Texas at Austin, studies the reactions of gratitude-letter recipients.

“It’s not like it makes some people feel great and some people feel just OK and some people feel kind of weird,” he said of his research findings. “Almost everybody is saying that they feel really, really great.”

The main barrier to expressing gratitude in a sentimental letter, he said, is the perceived awkwardness. “Part of the reason we did this research — the hope, at least — is that we will encourage people to do this more often,” Mr. Kumar said. “If you know from empirical research that it’s not actually as awkward as you think, and that it will mean a great deal to the person, maybe that can help you get over that hurdle.”

So if you were waiting for the right moment to start fully expressing your love and gratitude, perhaps that time is now. Here’s how to start.

Determine the recipient.

The first step is to decide whom to write to — perhaps a career mentor, a supportive family member or a dear friend.

When Chris Schembra, author of the book “Gratitude and Pasta: The Secret Sauce for Human Connection,” runs virtual gratitude workshops for executives through his company, 7:47, he begins with this question: “If you could give credit or thanks to one person in your life that you don’t give enough credit or thanks to, who would that be?” The answers vary, he said; executives have mentioned a former boss, a fifth-grade teacher and a stranger who saved a life.

Nancy Davis Kho, who in 2019 published “The Thank-You Project,” a book about her year writing 50 gratitude letters, offers this exercise: “Quickly, think of the five people you want to hug first after quarantine.” Then write their names down, she said, because “even carrying around that list is a reminder that you are not by yourself.”

Gather your supplies.

Decide your letter-writing method and get your supplies, such as stationery or notecards.

Handwritten letters are the gold standard because your handwriting is an extension of you. It’s personal and tactile. And don’t let messy penmanship be a deterrent: No one is expecting calligraphy. But there’s nothing wrong with typed letters; Ms. Davis Kho prefers to type and then print hers. Either way, the point is to create a physical artifact that the person first enjoys as a surprise in the mailbox, and then can keep as a memento.

Think about your recipient.

Once you have decided whom to write to, think about that person and his or her role in your life. You don’t need to spend a lot of time, but clear away any distractions and focus on some of your most cherished memories of this person. Think about how you met, what the recipient has done for you at what cost, what the person said that you have never forgotten or ways you have applied his or her advice in your life. Jot down a few bullet points or even a short outline if you would like, but do not overthink or get caught up on planning. A gratitude letter need not encapsulate your entire relationship, or cover everything this person means to you. You can say thanks for just one thing.

Sit down and write.

If it makes you more comfortable, you can start the letter by detailing a reason for reaching out. Ms. Davis Kho started her letters by explaining that it was a milestone birthday year for her, and that she was writing to people who had made a difference in her life. You could say you were inspired by this article. Or, you can keep your letter-writing reasons to yourself and just start with “thank you.”

Think back to your brainstorm, and, using evocative details, tell the person why you are grateful. That could be the exact words you remember this person saying, and where you were when they were said. Add how it made you feel — then and now. The recipient might remember the event or favor you are referring to, but the person most likely does not know how it made you feel (Thankful, probably, but also, perhaps, joyful? Safe? Relieved? Inspired?) Don’t hold back. It takes a little bravery, but writing sincerely and from the heart turns a polite note into a meaningful memento.

Write in your style.

Don’t worry about crafting each sentence just so. You’re trying to get to the meaning behind the words. If you can, try to write the way you speak. Imagine the person is on the phone: What would you say?

You might get caught up in selecting exactly what to say. But Mr. Kumar suggested you remember that your recipient will not be scrutinizing your choice of words.

“They are just reading what you have to say, and thinking, ‘This is really nice,’” he said. “They aren’t thinking, ‘Well, how could it have been nicer?’”

Instead of writing a traditional letter, feel free to write a more casual bulleted list. To a career mentor you might say something like: “I’ve been looking back on the stages of my career and thinking of people who made an impact. You are high up on the list. Here are five times your advice made a difference.”

Finish strong.

End with gratitude, and a compliment. What does this favor or event say about the person? Is it indicative of her or his generosity or kindness? Say that explicitly. With the final “thank you,” you could perhaps add a wish for the future — to meet at that museum you both love, or to return to the town where you met.

Keep copies.

Just as your recipient might keep the letter, so can you. Snap a picture or scan the letter before sending. Ms. Davis Kho has printed out all of her typewritten letters and bound them into a book. “When I’m feeling low, the book reminds me that I’ve done a good job selecting people,” she said, “and that there are people hidden in plain sight who make our lives better.”

Make A Paper Pulp Sculpture At Home

Get Your Hands Dirty With a Paper-Pulp Sculpture

The artist Wangechi Mutu uses pulped newspaper as a material for her sculptures. You can too.

Credit…Tony Cenicola/The New York Times

Sharon Coplan Hurowitz and

  • Feb. 27, 2021, 10:44 p.m. ET

The artist Wangechi Mutu, whose seven-foot-tall bronze sculptures of caryatids were the first pieces of art ever displayed in the niches of the Metropolitan Museum of Art’s facade, works in many media, including drawing, painting and video. To fuel her creative output, she constantly experiments with natural materials, many of which she finds or makes from scratch. One of these is paper pulp, an oatmeal-like mush from which she made five orb-shaped “Earth Androids” for the book “Open Studio, Do-It-Yourself Art Projects by Contemporary Artists,” published last year.

Mutu first came up with the formula when adding the final layers to the Afrofuturist sculptures she created for the 2015 Venice Biennale, wanting to recreate the organic look of mud-brick houses traditionally built by women in Kenya. You can also use her basic recipe to make whatever you want: a vase, a bowl or another tabletop object that’s meaningful to you.

Wangechi Mutu’s “The Seated III” was one of four sculptures placed in niches along the facade of the Metropolitan Museum of Art.Credit…Todd Heisler/The New York Times
Wangechi Mutu photographed in her Brooklyn studio.Credit…Sunny Shokrae for The New York Times

Start by tearing the newspaper into confetti-like shreds, and then combine with glue and water. Let the concoction soak in an airtight container for about a week so the paper becomes fully pulped. Adjust the color and texture as you like, adding items that you find around the house — food coloring, ink, flour, glue, salt, coffee grounds or even dirt from the backyard — that can bring a sense of place and identity. Mutu often uses red soil from Kenya to remind her of home. The idea, she said, is to learn about new materials, “allowing them to express themselves as much as I do and being resourceful.”

Credit…Tony Cenicola/The New York Times



Two cups wood glue

Backyard or potting soil

Liquid pigments (ground coffee or tea leaves or any ink color of your choice)

One-gallon container with airtight lid

Rubbing alcohol




Rubber gloves

Credit…Tony Cenicola/The New York Times

Step 1:

Shred enough paper to fill a one-gallon container. Fill three-quarters full with boiling water. The paper will absorb the water. Mix contents with a wooden spoon

Credit…Tony Cenicola/The New York Times

Step 2:

Add two cups wood glue, and stir until all shreds are soaked in water and glue. The glue will lighten and fluff the mixture. Cover container with an airtight lid and put mixture aside for a week.

Credit…Tony Cenicola/The New York Times

Step 3:

After the mixture sits for a week, it will be time to strain the pulp. Place a sieve over a bowl and pour the paper mixture in.

Credit…Tony Cenicola/The New York Times

Step 4:

Press on the pulp in the sieve with a spoon to remove excess liquid; discard liquid. Add half a cup of rubbing alcohol to the remaining paper pulp to kill bacteria. The texture should be the consistency of tacky oatmeal.

Credit…Tony Cenicola/The New York Times

Step 5:

Wearing plastic gloves, take a handful of the mixture and form a ball. Knead and shape it in your hands.

Credit…Tony Cenicola/The New York Times

Step 6:

Place the ball on a flat surface and sprinkle with coffee grounds, tea leaves or paint pigment on the surface. Compress the ball and add more pigment to stain it further and form a colored coating. Add more liquid pigment to the mixture for additional color.

Credit…Tony Cenicola/The New York Times

Step 7:

Shape the clay mixture into a sphere, a sausage or whatever shape you desire.

Credit…Tony Cenicola/The New York Times

Step 8:

To turn your clay into a keepsake bowl, place a small bowl upside down on parchment paper and cover with cling wrap. Mold the clay over the bowl pressing tightly.

Credit…Tony Cenicola/The New York Times

Step 9:

Set the form to dry (ideally outside in the sun), where the colors will change and cracks may form. Once dry, remove the bowl and cherish your new sculpture.

Credit…Tony Cenicola/The New York Times

Covid Vaccines: Johnson & Johnson's shot authorized by F.D.A.

F.D.A. Clears Johnson & Johnson’s Shot, the Third Vaccine for U.S.

The authorization of a third Covid-19 vaccine will bring millions more doses within days. But health officials worry that some people will see the vaccine as the inferior choice.

The company plans to ship around 20 million doses by the end of March.
The company plans to ship around 20 million doses by the end of March.Credit…Mark Ralston/Agence France-Presse — Getty Images
  • Feb. 27, 2021, 6:12 p.m. ET

WASHINGTON — The Food and Drug Administration on Saturday authorized Johnson & Johnson’s single-shot Covid-19 vaccine for emergency use, beginning the rollout of millions of doses of a third effective vaccine that could reach Americans by early next week.

The announcement arrived at a critical moment, as the steep decline in coronavirus cases seems to have plateaued and millions of Americans are on waiting lists for shots.

Johnson & Johnson has pledged to provide the United States with 100 million doses by the end of June. When combined with the 600 million doses from the two-shot vaccines made by Pfizer-BioNTech and Moderna slated to arrive by the end of July, there will be more than enough shots to cover any American adult who wants one.

But federal and state health officials are concerned that even with strong data to support it, some people may perceive Johnson & Johnson’s shot as an inferior option.

The new vaccine’s 72 percent efficacy rate in the U.S. clinical trial site — a number scientists have celebrated — falls short of the roughly 95 percent rate found in studies testing the Moderna and Pfizer-BioNTech vaccines. Across all trial sites, the Johnson & Johnson vaccine also showed 85 percent efficacy against severe forms of Covid-19 and 100 percent efficacy against hospitalization and death.

“Don’t get caught up, necessarily, on the number game, because it’s a really good vaccine, and what we need is as many good vaccines as possible,” Dr. Anthony S. Fauci, the government’s top infectious disease expert, said in an interview on Saturday. “Rather than parsing the difference between 94 and 72, accept the fact that now you have three highly effective vaccines. Period.”

If Johnson & Johnson’s vaccine would have been the first to be authorized in the United States instead of the third, “everybody would be doing handstands and back flips and high-fives,” said Dr. James T. McDeavitt, dean of clinical affairs at the Baylor College of Medicine.

On Sunday a committee of vaccine experts who advise the Centers for Disease Control and Prevention will meet to discuss whether certain population groups should be prioritized for the vaccine, guidance that state health officials have been eagerly awaiting in anticipation of the F.D.A.’s authorization.

One administration official familiar with the distribution of the vaccine said that shipments would begin on Monday and deliveries could arrive as soon as Tuesday.

Johnson & Johnson has said it will ship nearly four million doses as soon as the F.D.A. authorizes distribution and another 16 million or so doses by the end of March. That is far fewer than the 37 million doses called for in its $1 billion federal contract, but the contract says that deliveries that are 30 days late will still be considered timely.

The federal government is paying the firm $10 a dose for a total of 100 million doses to be ready by the end of June, substantially less per dose than it agreed to pay Moderna and Pfizer, which developed its vaccine with a German partner, BioNTech.

Johnson & Johnson’s one-dose vaccine will allow states to rapidly increase the number of people who have been fully inoculated. Unlike the other two vaccines, it can be stored at standard refrigeration temperatures for at least three months.

Dr. Danny Avula, Virginia’s vaccine coordinator, is excited by the arrival of the newest vaccine.
Dr. Danny Avula, Virginia’s vaccine coordinator, is excited by the arrival of the newest vaccine.Credit…Carlos Bernate for The New York Times

Dr. Danny Avula, the vaccine coordinator for Virginia, said the Johnson & Johnson shipments would boost the state’s allotment of vaccine next week by nearly one-fifth.

“I’m super-pumped about this,” he said. “A hundred percent efficacy against deaths and hospitalizations? That’s all I need to hear.”

He said the state was planning mass vaccination events specifically for the Johnson & Johnson vaccine, partly to quell any suspicion that it is a lesser product targeted to specific groups.

“It will be super clear that this is Johnson & Johnson, here’s what you need to know about it. If you want to do this, you’re coming in with eyes wide open,” he said. “If not, you will keep your place on the list.”

Michele Roberts, the assistant secretary of Washington State’s health department, said that it would be difficult to explain the technical aspects of how Johnson & Johnson’s vaccine trials differed from those of other drug makers. Because the studies were conducted at different times and with different protocols, precise comparisons can be problematic. All three trials showed the vaccines provided strong protection against Covid-19, especially for severe disease.

Understanding the subtle contrasts requires a lot of “scientific literacy,” she said. “There are so many different factors at play. But those aren’t, you know, quick public messages.”

Even some clinicians misinterpret the differences among the Covid-19 vaccines, health officials said. “They assume it’s apples to apples but it’s apples to oranges, or worse, apples to tires,” said Dr. Nirav Shah, the director of the Maine Center for Disease Control and Prevention.

Last week, Dr. Shah said, the leader of one group of specialty health clinics in his state initially turned down his offer to ship doses of the Johnson & Johnson vaccine, saying his health practitioners were concerned it was less efficacious than the other two.

He said he told him: “Stop right there. We need to have a Zoom conversation right now with your entire medical staff.” Instead, he carefully explained Johnson & Johnson’s results to the provider, who then spoke with his staff. Twenty minutes later, the provider sent him a message saying: “We’re on board. Send us the J & J.”

Some state officials have been frustrated by what they view as a lack of a coordinated plan from the Biden administration on how to deploy the new vaccine. Governors have asked the White House for guidance, but administration officials have so far left it up to the states to decide.

Even though Johnson & Johnson received ample federal support and agreed to manufacture at risk, federal officials familiar with its operation said the company took an overly conservative approach to production, emphasizing scaling up on the back end of its contract.

As a result, Johnson & Johnson is expected deliver the bulk of its 100 million doses in the late spring or early summer. The country will still need them: By the end of May, Pfizer and Moderna have promised to ship enough doses to vaccinate 200 million Americans, leaving roughly 60 million eligible adults still uncovered. But with the spread of more contagious variants of the virus, health officials are anxious to vaccinate as many Americans as fast as possible.

Johnson & Johnson produced its first batch of roughly four million doses at its Dutch plant, federal officials said. The company’s new plant in Baltimore is expected to supply the bulk of its doses for the United States.

Americans are becoming more open to getting Covid-19 vaccines, according to the latest survey from the Kaiser Family Foundation, which has been monitoring attitudes since December. Fifty-five percent of adults now say they have either received one dose or will get it as soon as they can, up from 34 percent in December.

A drive-through Covid-19 vaccination site at Dodger Stadium.Credit…Philip Cheung for The New York Times

But Rupali Limaye, who studies vaccine hesitancy at Johns Hopkins University, said she worried about whether health officials and community leaders would sufficiently emphasize the strengths of the Johnson & Johnson vaccine, including how well it prevents the onset of severe Covid-19, hospitalization and death.

“People will want to know: Why is this one so much less and what does it mean for us?” she said. “I’m worried it’s going to cause more questions than confidence.”

Absent more direction from the federal government, state health officials are consulting with each other about where to direct the new source of supply.

Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, which represents state health agencies, predicted that “many states are going to be a little bit cautious” about where they initially ship the vaccine.

“You don’t want to say, ‘OK, we’re going to use this vaccine for our rural populations because it’s easier to ship.’” That may trigger a backlash from people who wrongly suspect that for some reason or another, they are being offered a second-rate vaccine, he said.

Dr. Shah of Maine said the new vaccine was particularly well-suited for drive-through vaccination sites, partly because it appeared less likely to trigger the kinds of side effects that require monitoring. Health officials in other states said it might also make sense to direct doses toward transient population groups who might be less likely to show up for second shots. Colleges might be particularly interested.

Dr. Jennifer Dillaha, the state epidemiologist in Arkansas’s health department, said the vaccine’s easier storage conditions could also increase the number of vaccinations in other nonmedical settings, like senior centers or sites in underserved communities that lack pharmacies or health care providers.

In order to limit possible confusion, some state health officials said that they initially plan to direct the new vaccine to new sites, not ones that are already administering the other vaccines.

Dr. Shah said that some pharmacists in Maine would rather handle one type of Covid-19 vaccine at a time. Although that may change, Dr. Shah said, “Every day matters. Anything that is introduced into the workflow that slows down the pace of vaccination hurts us.”

Carl Zimmer contributed reporting.

¿Hay alimentos adictivos?

La comida muy procesada no solo es dañina, también podría ser adictiva

Los investigadores intentan saber si son adictivos los alimentos ultraprocesados, como las papas fritas o el helado, y si hacen que nuestro cerebro envíe la señal de que comamos en exceso.

Credit…Richard A. Chance
Anahad O’Connor

  • 27 de febrero de 2021 a las 05:00 ET

Hace cinco años, un grupo de científicos especializados en nutrición estudiaron lo que comían los estadounidenses y llegaron a conclusiones sorprendentes: más de la mitad de todas las calorías que consume el estadounidense promedio procede de alimentos ultraprocesados, los cuales definen como “fórmulas industriales” que combinan grandes cantidades de azúcar, sal, aceites, grasas y otros aditivos.

Pese a que se les asocia con la obesidad, las cardiopatías, la diabetes tipo 2 y otros problemas de salud, los alimentos altamente procesados siguen siendo predominantes en la dieta de los estadounidenses. Son baratos, prácticos y están diseñados para que sepan bien. La industria de los alimentos los comercializa de manera entusiasta. Pero una cantidad cada vez mayor de científicos afirma que otra razón por la que estos alimentos se consumen tanto es porque para muchas personas no solo son apetecibles, sino adictivos, una idea que ha provocado controversia entre los investigadores.

Recientemente, la revista American Journal of Clinical Nutrition analizó la ciencia detrás de la adicción alimentaria y si los alimentos ultraprocesados podrían estar contribuyendo a comer en exceso y a la obesidad. Destacó un debate entre dos de los principales expertos en el tema, Ashley Geardhardt, profesora adjunta en el Departamento de Psicología de la Universidad de Míchigan, y Johannes Hebebrand, director del Departamento de Psiquiatría, Psicosomática y Psicoterapia para Niños y Adolescentes de la Universidad de Duisburgo-Essen, en Alemania.

Gearhardt, psicóloga clínica, ayudó a desarrollar la Escala de Adicción a los Alimentos de la Universidad de Yale, que es un estudio que se emplea para determinar si una persona muestra indicios de comportamiento adictivo hacia la comida. En un estudio en el que participaron más de 500 personas, ella y sus colegas descubrieron que ciertos alimentos tenían una especial propensión a provocar comportamientos relacionados con la alimentación “parecidos a los de las adicciones”, como compulsión intensa, pérdida del control e incapacidad de reducir su consumo a pesar de experimentar consecuencias perjudiciales y muchas ganas de dejar de comerlos.

Al principio de la lista estaba la pizza, el chocolate, las galletas, el helado, todo tipo de papas fritas y las hamburguesas con queso. Geardhardt ha descubierto en su investigación que estos alimentos tan procesados tienen mucho en común con las sustancias adictivas. Al igual que los cigarrillos y la cocaína, sus ingredientes se derivan de plantas presentes en la naturaleza y de alimentos a los que se les retiran los componentes que ralentizan su absorción, como la fibra, el agua y la proteína. Posteriormente, sus ingredientes más atractivos se refinan y procesan para crear productos que se absorben con rapidez dentro del torrente sanguíneo, lo cual aumenta su capacidad para activar las regiones del cerebro que regulan la sensación de gratificación, las emociones y la motivación.

Gearhardt señaló que la sal, los espesantes, los sabores artificiales y otros aditivos de los alimentos muy procesados refuerzan su seducción al mejorar algunas propiedades como la textura y la sensación que produce en la boca, lo cual se asemeja a la manera en que los cigarrillos contienen una serie de aditivos diseñados para aumentar su potencial adictivo. Por ejemplo, el mentol ayuda a enmascarar el sabor amargo de la nicotina, mientras que otro ingrediente usado en algunos cigarrillos, el cacao, dilata las vías aéreas y aumenta la absorción de la nicotina.

Según Geardhardt, un común denominador de los alimentos ultraprocesados más irresistibles es que contienen grandes cantidades de grasa y carbohidratos refinados, una combinación poderosa que pocas veces se encuentra en los alimentos de origen natural que el ser humano ha evolucionado para consumir, como frutas, vegetales, carne, nueces, miel, frijoles y semillas. Muchos alimentos que encontramos en la naturaleza son ricos en grasas o carbohidratos, pero por lo general no son altos en las dos cosas.

“Las personas no presentan una respuesta conductual adictiva a los alimentos naturales que son buenos para la salud, como las fresas”, afirmó Gearhardt, quien también es directora del Laboratorio de Ciencia de la Alimentación y la Adicción y su Tratamiento en Míchigan. “El subconjunto de alimentos muy procesados está diseñado de un modo muy parecido a cómo producimos otras sustancias adictivas. Estos son los alimentos que pueden ocasionar la pérdida de control y los comportamientos compulsivos y problemáticos que se asemejan a lo que observamos con el alcohol y los cigarrillos”.

En un estudio, Gearhardt descubrió que cuando las personas reducían el consumo de alimentos muy procesados, experimentaban síntomas parecidos a la abstinencia que se observa en los drogadictos, como irritabilidad, fatiga, tristeza y compulsión. En estudios de imágenes del cerebro, otros investigadores han descubierto que las personas que a menudo consumen comida chatarra, con el tiempo pueden desarrollar tolerancia a ella, lo que hace que cada vez requieran mayores cantidades para obtener la misma satisfacción.

En su práctica clínica, Gearhardt ha visto pacientes —algunos obesos y otros no— que luchan en vano para controlar su ingesta de alimentos muy procesados. Algunos intentan comerlos con moderación, pero solo terminan perdiendo el control y comen hasta el punto de vomitar y sentirse angustiados. Muchos de sus pacientes ven que no pueden dejar estos alimentos pese a que tienen dificultades para controlar su diabetes y presentan un aumento excesivo de peso y otros problemas de salud.

“Lo sorprendente es que mis clientes son casi siempre muy conscientes de las consecuencias negativas de su consumo de alimentos altamente procesados, y normalmente han probado docenas de estrategias como dietas de choque y limpiezas para intentar controlar su relación con estos alimentos”, dijo. “Aunque estos intentos pueden funcionar durante un corto periodo de tiempo, casi siempre acaban recayendo”.

Sin embargo, Hebebrand rebate la idea de que algún alimento provoque adicción. Aunque las papas fritas y la pizza pueden parecer irresistibles para algunas personas, él sostiene que no ocasionan un estado mental alterado, lo que es característico de las sustancias adictivas. Por ejemplo, señaló, fumar un cigarrillo, beber una copa de vino o recibir una dosis de heroína provocan una sensación inmediata en el cerebro que los alimentos no producen.

“Siempre sucede que con cualquier droga adictiva casi toda la gente experimenta un estado mental alterado después de consumirla”, señaló Hebebrand. “Eso indica que la sustancia está causando un efecto en nuestro sistema nervioso central. Pero todos ingerimos alimentos muy procesados y nadie siente este estado mental alterado porque la sustancia no llega directamente al cerebro”.

En los trastornos por consumo de sustancias, las personas se vuelven dependientes de una sustancia química específica que actúa en el cerebro, como la nicotina de los cigarrillos o el etanol del vino y el licor. Al principio buscan esta sustancia química para obtener un subidón, y luego se vuelven dependientes de ella para aliviar las emociones negativas y depresivas. Pero en los alimentos altamente procesados no hay ningún compuesto que pueda señalarse como adictivo, dijo Hebebrand. De hecho, la evidencia sugiere que las personas obesas que comen en exceso tienden a consumir una amplia gama de alimentos con diferentes texturas, sabores y composiciones. Hebebrand argumentó que comer en exceso se debe, en parte, a que la industria de alimentos comercializa más de 20.000 productos nuevos cada año, lo que da a la gente acceso a una variedad aparentemente interminable de comidas y bebidas.

“Es la diversidad de alimentos la que resulta tan atractiva y causa el problema, no una sola sustancia en estas comidas”, añadió.

Quienes argumentan en contra de la idea de la adicción a los alimentos también señalan que la mayoría de las personas consumen diariamente alimentos altamente procesados sin mostrar ningún signo de adicción. Pero Gearhardt señala que las sustancias adictivas no enganchan a todos los que las consumen. Según las investigaciones, alrededor de dos tercios de las personas que fuman cigarrillos acaban convirtiéndose en adictos, mientras que un tercio no lo hace. Solo un 21 por ciento de las personas que consumen cocaína a lo largo de su vida se convierten en adictos, mientras que solo un 23 por ciento de las personas que beben alcohol desarrollan una dependencia de este. Los estudios sugieren que hay una amplia gama de factores que determinan que las personas se vuelvan adictas, como su genética, sus antecedentes familiares, su exposición a traumas y sus antecedentes ambientales y socioeconómicos.

“La mayoría de la gente prueba sustancias adictivas y no se vuelve adicta”, dijo Gearhardt. “Así que si estos alimentos son adictivos, no esperaríamos que toda la sociedad se convirtiese en adicta a ellos”.

A las personas que tienen problemas para restringir su ingesta de alimentos muy procesados, Gearhardt les recomienda llevar un registro de todo lo que comen para poder identificar los alimentos que ejercen una mayor atracción, es decir, los que producen una fuerte compulsión y que no se pueden dejar de comer una vez que se inicia el consumo. No se debe tener esos alimentos en casa y, en cambio, es recomendable llenar el refrigerador y la despensa con otras alternativas que les gusten y sean más saludables, señaló.

Se recomienda llevar un registro de los factores desencadenantes que provocan antojos y atracones. Pueden ser emociones como el estrés, el aburrimiento o la soledad. O puede ser el Dunkin’ Donuts por el que pasas en carro tres veces a la semana. Elabora un plan para controlar esos factores desencadenantes como, por ejemplo, tomar una ruta diferente para volver a casa o realizar actividades no alimentarias para aliviar el estrés y el aburrimiento. Y evita saltarte las comidas, porque el hambre puede desencadenar antojos que conduzcan a decisiones lamentables, dijo.

“Con el fin de poder transitar mejor un entorno alimentario muy desafiante, es importante asegurarte de proporcionarle a tu cuerpo alimentos nutritivos y muy poco procesados que te gusten con regularidad”, comentó Gearhardt.

Anahad O’Connor cubre temas de salud, ciencia, nutrición y otros. También es el autor de libros de salud exitosos como Never Shower in a Thunderstorm y The 10 Things You Need to Eat.

F.D.A. Expert Panel Endorses Johnson & Johnson’s Vaccine

F.D.A. Expert Panel Endorses Johnson & Johnson’s Vaccine

With this last hurdle cleared, formal authorization of the one-dose vaccine is expected on Saturday and distribution within days.

Vaccinations at the Steve Biko Academic Hospital in Pretoria, South Africa, earlier this week. The shot showed 82 percent against severe Covid in South Africa and 86 percent efficacy in the U.S.
Vaccinations at the Steve Biko Academic Hospital in Pretoria, South Africa, earlier this week. The shot showed 82 percent against severe Covid in South Africa and 86 percent efficacy in the U.S.Credit…Phill Magakoe/Agence France-Presse — Getty Images
  • Feb. 26, 2021, 6:25 p.m. ET

Johnson & Johnson’s Covid-19 vaccine was endorsed on Friday by a panel of experts advising the Food and Drug Administration, clearing the last hurdle before a formal authorization expected on Saturday, according to two people familiar with the agency’s plans. The nation’s first shipments will go out in the days after that.

It will be the third shot made available to the United States in the year since the first surge of coronavirus cases began washing over the country, and it will be the first vaccine to require just one dose instead of two.

Johnson & Johnson’s formulation worked well in clinical trials, particularly against severe disease and hospitalizations, even though it did not match the sky-high efficacy rates of the first two vaccines made by Pfizer-BioNTech and Moderna.

The panel, made up of independent infectious disease experts, statisticians and epidemiologists, voted unanimously in favor of authorizing the vaccine.

“We’re dealing with a pandemic right now,” said Dr. Jay Portnoy, an allergist at Children’s Mercy Hospital in Kansas City, M.O. and a member of the board. “It’s great that we have this vaccine.”

During Johnson & Johnson’s presentation to the panel, Dr. Gregory Poland, a virologist at the Mayo Clinic and a paid external consultant for the company, noted the vaccine’s efficacy, ease of use and low rate of side effects. It “nearly checks all the boxes,” he said. “To me, it is clear that the known benefits vastly outweigh the known risks.”

The vaccine had an overall efficacy rate of 72 percent in the United States and 64 percent in South Africa, where a concerning variant emerged in the fall. The shot showed 86 percent efficacy against severe forms of Covid-19 in the United States, and 82 percent against severe disease in South Africa.

Those are strong numbers, but lower than the roughly 95 percent efficacy rates of Pfizer-BioNTech and Moderna’s vaccines against mild, moderate and severe cases of Covid.

Johnson & Johnson’s vaccine is a single dose and uses a different kind of technology than the authorized vaccines. And the scale and size of the Johnson & Johnson trial was vast, spanning eight countries, three continents and nearly 45,000 participants.

Johnson & Johnson’s vaccine will be the third shot made available to the U.S. since the pandemic began, and it will be the first vaccine to require just one dose instead of two.
Johnson & Johnson’s vaccine will be the third shot made available to the U.S. since the pandemic began, and it will be the first vaccine to require just one dose instead of two.Credit…Phill Magakoe/Agence France-Presse — Getty Images

Although the vaccine works with one shot, studies are underway to determine if a second dose would increase its protective effects.

Dr. Paul Offit, a pediatrician at the Children’s Hospital of Philadelphia and one of the panelists, pointed out on Friday that in early clinical trials that took place over the summer, Johnson & Johnson found that a second dose led to levels of coronavirus antibodies that were almost three times higher than those produced by one dose alone.

The results of Johnson & Johnson’s two-dose, late-stage clinical trial are not expected until July at the earliest. If those results turn out to be better than a single dose, Dr. Offit asked, “Does this then become a two-dose vaccine?”

Dr. Johan Van Hoof, the global head of vaccine research and development at Janssen Pharmaceuticals, the drug development arm of Johnson & Johnson, said that the company decided to pursue the one-shot strategy after its studies on monkeys last spring showed that a single dose was enough to provide strong protection against the disease.

“It’s clear that in a situation of an outbreak, in a raging epidemic, the big challenge is to get the epidemic under control,” he said. “The regimen is extremely well positioned to be used in outbreak situations.”

But Dr. Van Hoof also noted that it will be important to track volunteers who received a single dose to see if their immunity changes in the months to come. It might be necessary to deliver a booster shot for long-term protection. “The big question mark still is, how long does protection last?” he said.

After the vote, the F.D.A. told Johnson & Johnson that it “will rapidly work toward finalization and issuance of an emergency use authorization,” according to a statement. The F.D.A. also said that it had notified other government agencies “so they can execute their plans for timely vaccine distribution.”

Sharon LaFraniere contributed reporting.

What to Do This Weekend

At Home Newsletter

What to Do This Weekend

Virtual travel and a whole mess of podcasts.

Lincoln Park in Chicago.
Lincoln Park in Chicago.Credit…Lyndon French for The New York Times

  • Feb. 26, 2021, 4:00 p.m. ET

Welcome. I’ve started to fantasize about travel, about waking up in a bed not my own, windows with strange views, days unshackled from routine. But travel is still complicated: The virus and its variants still pose risks, and mandatory government quarantines can keep travelers confined to hotels for up to two weeks. Better, perhaps, to wait for summer, when, if we maintain precautions, scientists say life may begin to feel normal again.

For now, I’m contenting myself with City Guesser, a surprisingly amusing game in which you’re plopped down in a random city and have to try to suss out where you are from store signs, architecture, context clues. The game’s part of Virtual Vacation, a quarantine project of Paul McBurney Jr., which also features walking, driving and flight tours crafted from online video footage. Check it out.

Then watch Lance Oppenheim’s Op-Doc about the Florida retirement community The Villages and a young girl who lives next door to it. (Oppenheim made a whole feature documentary about The Villages called “Some Kind of Heaven,” which you’ll want to take in next.)

More streamable stuff’s in the offing if you’re game: Marvel’s “WandaVision” is “TV’s latest diversion from the pandemic and perhaps its best metaphor,” according to the Times TV critic James Poniewozik. “The Father,” in which Anthony Hopkins plays a man with dementia, gave Jeannette Catsoulis chills. And it’s been available for a while, but I just recently started watching “How To With John Wilson,” a charming show in which Wilson explores New York City (pre-pandemic and bustling), chatting up strangers, finding beauty and absurdity around every corner.

Here are 36 podcast recommendations from people who make podcasts — queue up a few and take a walk if you can, or put one on while you’re driving. (I recommend “Welcome to Your Fantasy,” about the Chippendales dance troupe in the 1980s.)

Read “The Secret Life of H.G. Carrillo,” by Paula Mejía in Rolling Stone, about a writer and George Washington University professor who adopted a fictional identity that was only discovered after he died last April. Read Parul Sehgal’s essay “Reviewing the Book Review.” Read about the “bad boy harpsichordist” Scott Ross, then listen to some of the 555 Scarlatti sonatas he recorded.

There’s a new Diary of a Song, featuring Olivia Rodrigo talking about her No. 1 hit “Drivers License,” which is just delightful. So are Jill Clayburgh and Lisa Lucas singing “Maybe I’m Amazed” in “An Unmarried Woman,” from 1978. Julien Baker has a new album that I plan to play the bejesus out of this weekend; here she is performing Bruce Springsteen’s “Badlands” in 2016.

A reader recommends.

Jonna Ramey in Salt Lake City has been posting poems on repurposed election signs in her front yard twice a week during the pandemic:

My wife saw a mom have her son read a poem aloud to her. We watched a woman read “The Everlasting Self” by Tracy K. Smith to her dog. Three boys on bikes came by and read a poem together. A handful of kids hooted over “Snowball” by Shel Silverstein. Someone thanked us with a note scrawled in chalk on the sidewalk. Before lockdown, a local church group held a Sunday school session about one of the poems. Masked folks have hollered their thanks from 20 feet away or shoved cards through our mail slot. We’re now known as the Poetry Ladies in our Wasatch Hollow neighborhood. The poem that I selected to celebrate Ferlinghetti this weekend is, I now realize, about me as well as the poets he extols. “The state of the world calls out for poetry to save it.” Yes, indeed. Rest in peace, you poet-provocateur. I’ll keep putting poems out on the lawn.

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How to Help a Teen Out of a Homework Hole


How to Help a Teen Out of a Homework Hole

The more students fall behind in the pandemic, the less likely they are to feel that they can catch up.

Credit…Marta Monteiro
Lisa Damour

  • Feb. 26, 2021, 2:33 p.m. ET

Pandemic school is taking its toll on students, especially teens. A recent study, conducted by NBC News and Challenge Success, a nonprofit affiliated with the Stanford Graduate School of Education, found that 50 percent more kids in high school report feeling disengaged from school this year than last. In December, Education Week reported that schools were seeing “dramatic increases in the number of failing or near-failing grades” on report cards.

A major symptom of school disengagement is not turning in homework, a problem that can easily snowball. The further students fall behind, the more overwhelmed they often become and the less likely they are to feel that they can catch up.

The good news is that finding out about missing homework is a first step to helping kids get back on track. You just need to keep a few considerations in mind.

Empathy will get you further than anger

At this point in the pandemic, finding out that your child has let schoolwork slide may trigger an angry response. Everyone is worn down by the demands of pandemic life and many parents are already operating on their last nerve. Getting mad, however, is likely to cause kids to adopt a defensive or minimizing stance. Instead, try to be compassionate. What students who have fallen behind need most are problem-solving partners who want to understand what they are going through.

If you’re having trouble summoning your empathy, bear in mind that there are many good reasons a student could fall off pace this year. For instance, Ned Johnson, a professional tutor and co-author of the book “The Self-Driven Child,” noted that most teens have very little experience managing email, which is now a main source of information for those in remote or hybrid arrangements. “We know how overwhelmed we as adults are by email. Imagine not being comfortable with it, and then suddenly getting everything — from Zoom links to assignments — that way.”

Some students learning remotely may also have unreliable broadband service; others may miss key information because their attention is split between the teacher on the screen and distractions at home.

“Many adults are having the exact same issues,” said Ellen Braaten, a psychologist and the executive director of the Learning and Emotional Assessment Program at Massachusetts General Hospital. “They are really productive when they can physically be at work, but may find themselves less attentive in the unstructured environment of working from home.”

Even teens who are attending school in person and using familiar systems for tracking assignments may be having a hard time managing their work now. The mental skills that help us stay organized — commonly called executive functioning — are being undermined by psychological stress, which is unusually high among today’s teens.

Work together to diagnose the problem

Finding out that your child is in academic trouble can tempt you to jump to solutions. It’s best, however, to properly diagnose the problem before trying to address it. Liz Katz, assistant head for school partnership at One Schoolhouse, an online supplemental school, suggested looking into the reasons students fall behind at school. Some don’t know what they’re supposed to be doing, others know and aren’t doing it, and still others “are doing their best and just can’t meet expectations.”

As you talk with a teenager about where things have gone off the rails, be kind, curious and collaborative. “This isn’t about you being in trouble or getting off the hook,” you might say. “It’s simply about figuring out what’s going wrong so we can solve the right problem.”

Students who are struggling to keep track of what’s expected of them may need to reach out to their teachers, either for clarification about specific assignments or for general guidance on where and when they should be looking for information about homework. As a parent or caregiver, you can coach them on how to approach their instructors. Start by pointing out that teachers are almost always eager to lend support to students who seek it. You can also offer to give feedback on a draft email to an instructor explaining where the student got lost and what they have already tried.

“For many students, the ability to ask for help is not fully formed,” said Ms. Katz, “or it can feel like an admission that they’ve done something wrong. Normalizing and praising self-advocacy is so important.”

For students who know what they’re supposed to do but aren’t doing it, other approaches make sense. They may be having a hard time sustaining motivation and need support on that front, or they may be swamped with commitments, such as caring for younger siblings, that make it impossible to complete their schoolwork. Here, parents and students will want to work together to make a realistic plan for addressing the biggest priorities in light of these circumstances. This might mean coming to an agreement about where the teen’s energies should be directed or exploring what additional support might be put in place.

In some cases, academic problems may be linked to issues with mental health. If there’s a question of whether a student is suffering from depression or anxiety; using drugs; or exhibiting any other significant emotional or behavioral concern, check in with the school counselor or family doctor for a proper assessment. Treatment should always take precedence over schoolwork. “If you’re depressed,” Dr. Braaten said, “no amount of executive function coaching is going to help, because that’s not the issue.”

Some students have subtle learning or attention disorders that became an issue only when school went online. Under regular conditions, said Mr. Johnson, instructors can notice when a student is tuning out and bring back his or her attention in a gentle way. Unfortunately, “Teachers really can’t do that effectively on Zoom.” If this is a concern, parents should consider checking in with teachers or their school’s learning support staff to get their read on the problem and advice for how to move forward.

Step back to see the big picture

“We all need to be easier on ourselves,” Dr. Braaten said, “and to sort through what students really need to do and what they don’t.” Well-meaning parents might hope to motivate students by emphasizing the importance of high grades, but that can make it harder for kids to recover from a substantial setback.

As students start to work their way back, give some thought to how comprehensive their turnaround needs to be. Do they really need to get equally high grades in every class? Could they instead direct their energy toward getting square with the courses they care about most? Could they work with their teachers to agree upon trimmed-down assignments for partial credit? According to Mr. Johnson, “Lowering expectations, for now, can actually help kids to get back on track.”

Dr. Braaten also noted that much of what students gain from school is not about content, but about learning how to solve problems. Engaging teens in constructive conversations to figure out how they fell behind can be an important lesson unto itself. “Having a 16-year-old who understands, ‘When I’m stressed, this is how I react,’” says Dr. Braaten, “may put us further ahead in the long run.”

In any school year, students learn a great deal beyond academic content. This year, more than most, might be one where students gain a deep understanding of how they respond when feeling overwhelmed and how to ask for help or rebound from setbacks — lessons that they will draw on long after the pandemic is gone.

KHN’s ‘What the Health?’: Staffing Up at HHS

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More than a month into President Joe Biden’s term, nominees to fill some of the top posts at the Department of Health and Human Services are finally getting confirmation hearings in the Senate, starting with the nominee for secretary, California Attorney General Xavier Becerra. Barring something unexpected, it appears that Becerra, along with the surgeon general nominee, Vivek Murthy, and the nominee for assistant secretary for health, Rachel Levine, will all be confirmed, despite criticisms raised by some Republicans.

Meanwhile, the Supreme Court agreed to hear a case challenging the Trump administration’s rules for the federal family planning program that effectively evicted Planned Parenthood from participation. And the Biden administration asked the court to cancel oral arguments scheduled for late March about work requirements approved by the Trump administration for adult Medicaid recipients in some states.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Margot Sanger-Katz of The New York Times and Tami Luhby of CNN.

Among the takeaways from this week’s podcast:

  • Republican complaints that Becerra may not be qualified for the job of HHS secretary because he’s not a medical doctor were surprising to many. Since HHS was separated from the Department of Education, there have been 12 secretaries and only three have been physicians.
  • Democrats seem confident that Becerra weathered Republican criticism about his qualifications and his support for reproductive rights and that he will be confirmed.
  • The Republican arguments about Becerra’s positions on abortion may signal a shift away from the GOP’s emphasis on repealing the Affordable Care Act and back to traditional issues that galvanize conservative voters.
  • The people Biden has chosen to work on health policy by and large have strong backgrounds in management and many were in the Obama administration working on the implementation of the ACA. They are likely coming in with a mission to make changes and do so quickly.
  • The Biden administration is expected to seek to reverse the Title X rule at issue in a case just accepted by the Supreme Court before the justices hear the matter. But even if the administration can do that, conservatives may still ask the court to proceed.
  • The covid relief bill moving through Congress includes several measures that would make health insurance plans sold on the ACA marketplace more affordable, but those changes would last only two years. ACA advocates reason it would be hard, however, for future lawmakers to take those benefits away.

Also this week, Rovner interviews HuffPost’s Jonathan Cohn, whose new book, “The Ten Year War: Obamacare and the Unfinished Crusade for Universal Coverage,” is out this week.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Washington Post’s “The Joy of Vax: The People Giving the Shots Are Seeing Hope, and It’s Contagious,” by Maura Judkis

Margot Sanger-Katz:’s “Path to Normality: 2021 Outlook of COVID-19 in the US,” by Youyang Gu

Tami Luhby: The Guardian and KHN’s “’It Doesn’t Feel Worth It’: Covid Is Pushing New York’s EMTs to the Brink,” by Martha Pskowski

Alice Miranda Ollstein: KHN’s “Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind,” by Lauren Weber and Hannah Recht

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

At-Home Covid Testing Is Here

At-Home Covid Testing Is Here

But does it work?

Credit…Rose Wong

  • Feb. 26, 2021, 12:44 p.m. ET

In case you missed it: You can now get tested for the coronavirus in the comfort of your own home.

This is great news, especially for people who don’t have access to a testing site. Currently, these portable tests come in two flavors. The first is test-by-mail kits, which allow patients to swab their noses at home and mail them to a laboratory for a result in a day or two. The other types are called at-home tests, which give an answer on the spot.

Currently, the United States Food and Drug Administration has authorized dozens of test-by-mail kits, and three at-home tests.

These tests are not nearly as accurate as those taken in a clinic, but experts say coronavirus tests that can be done at home play an important role as the country continues to reopen. “They get actionable information in people’s hands quickly,” said Jennifer Bacci, an assistant professor at the University of Washington School of Pharmacy.

Of course, no coronavirus diagnostic test is 100 percent accurate. Even the gold-standard nasopharyngeal swab, given at many clinics, can return a negative result even though you might be carrying the coronavirus. And these tests only inform you about a single point in time. But even if home tests may be less accurate, they can quickly alert people if they test positive.

Certainly the market for home test kits will likely grow, said Gigi Gronvall, a public health expert at Johns Hopkins University. But with more options, consumers will need to learn what test is best for them.

Here are some key questions to consider when deciding on an at-home testing kit.

What are the trade-offs between mail-in kits and fully at-home tests?

Test-by-mail kits require users to purchase a kit, take a sample at home and ship the swab back to a lab. These kits take more processing time and use a method called polymerase chain reaction, or P.C.R., to detect coronavirus.

P.C.R. works by identifying and magnifying specific gene sequences. “It can take a very small signal and amplify it,” to detect smaller amounts of the virus, said Dr. Gronvall. These tests are highly sensitive, picking up positive cases nearly all the time (accuracy varies by lab, and false negatives can be as high as 20 percent). “A negative P.C.R. isn’t perfect, but it gives a high degree of assurance,” said Dr. Ashish Jha, dean of the Brown University School of Public Health.

Fully at-home tests, such as those made by Ellume and Abbott, require users to swab their noses and drop the swabs in a liquid. The tests provide an answer in as little as 15 minutes for the Abbott test and 20 minutes for Ellume.

These tests look for antigens — parts of microbes that cause an immune response. Unlike P.C.R., antigen tests do not amplify signals, which makes them faster but less accurate. These rapid antigen tests, Dr. Gronvall said, are good for measuring how contagious you are. “If you test positive on that, you really need to isolate,” she said, and get a clinical swab done to confirm the results.

False negatives, however, are much more common with antigen tests, meaning infected people might think they are virus free, especially if they are not having symptoms.

“The sensitivity of these tests tend to be pretty bad,” said Dr. Yvonne Maldonado, an infectious disease specialist at Stanford University School of Medicine. If users have symptoms, the BinaxNOW antigen test has a 64 percent chance of correctly spotting the virus (and about half that in those without symptoms). Accuracy for some antigen tests in asymptomatic individuals can be less than 50 percent — worse than flipping a coin, she said.

Remember, any test’s ability to detect coronavirus depends on how much virus is in the location of your body where you are taking a sample. Tests taken early, say, hours after a potential virus exposure, have a higher chance of being a false negative.

What home test should you use?

If you’re asymptomatic, you may have a smaller amount of virus in your body. In this case, experts said that your best bet for an accurate test is to use a test-by-mail kit because P.C.R. will be able to amplify lower levels of virus.

If you have symptoms, either a P.C.R.-based test or an antigen test will likely be able to confirm you have it. When choosing an antigen test, Dr. Jha said to look for whichever option at your disposal has the highest sensitivity, which refers to a test’s ability to detect the virus. Look for a sensitivity rating from 95 to 99 percent, he said.

Turnaround time is also important. Antigen tests are less accurate but offer an answer much faster without having to mail a sample. Results of either test should always be confirmed by a clinical test, said Dr. Maldonado.

Costs, too, may play a factor. Test-by-mail kits can cost $100 or more and may not be reimbursed by insurance companies. “Many patients have encountered unanticipated bills or red tape when seeking reimbursement for mail-in coronavirus testing, even though insurance companies are obligated to do so,” said Dr. Marisa Cruz, head of clinical affairs at Everlywell, a company that makes at-home health tests, including one for coronavirus.

Antigen tests, on the other hand, are a fraction of the cost, currently ranging from $25 to $50.

What should you check for on the box?

Make sure the home test or collection kit you’re looking to buy has an emergency use authorization from the F.D.A. (it will be printed on the box) and that the company works with certified lab partners. Also look for tests that offer a telemedicine consult, advised Dr. Cruz, so you can discuss your diagnosis and next steps.

How should I interpret a result from an at-home coronavirus test?

Following the test kit instructions is key to getting a reliable result. “A specimen that is not collected correctly may lead to false negative test results,” said Dr. Cruz. Imperfect swabbing technique, or swabbing only one nostril, may increase the risk of less accurate results. And samples for test-by-mail kits should be shipped the same day they are collected; the less time in transit, the better. Samples sent on weekends or holidays may be delayed, though some use FedEx and overnight shipping.

If you test positive on either a mail-in P.C.R. or at-home antigen test, you are likely to be infected and presumed contagious, said Dr. Bacci, so isolate from others and continue to monitor your symptoms. Repeat testing can help track the disease course, if, say, someone goes from being asymptomatic to displaying symptoms.

Negative results are more likely to be wrong than positive ones. “A negative result does not necessarily mean you do not have Covid, which is the same interpretation for either an at-home test, a mail-in test or one offered in a doctor’s office,” said Dr. Cruz. Continue to wear masks, socially distance and practice good hygiene, especially if you have symptoms or known contacts with others with Covid.

When would a test be inappropriate to use?

Dr. Gronvall is concerned that some people are using at-home tests after they’ve been vaccinated to make sure that the vaccine has worked. But neither the P.C.R. or antigen-based tests will be able to discern whether the vaccines have built up immunity in your body.

That’s because the vaccines encode for snippets of the virus and not the entire sequence. The P.C.R. and antigen tests search for a different portion of the virus from what’s included in the vaccines.

“These tests are not going to tell people if the vaccine is effective,” she said.

What does the future of at-home testing look like?

Beyond saliva and nasal swabs, some scientists are looking to develop devices that look like breathalyzers to detect chemicals in an individual’s breath that correspond to coronavirus infection. “We’re looking for the body’s response to infection and disease,” said Pelagia-Iren Gouma, a materials engineer at The Ohio State University.

Dr. Gouma and her colleagues are testing a small breathalyzer they have developed that can be used for up to one year and would cost perhaps a few dollars per device. Users would get an answer in 15 seconds, and the test appears to be accurate 96 percent of the time and can be reused, Dr. Gouma said. The device was submitted to the F.D.A. and has been awaiting emergency use authorization since September.

Experts hope that as the market for at-home testing expands, the options will grow and become cheaper. The cheaper the tests are, the more likely the government will subsidize them and consumers will buy them for routine testing. And the more testing, the better. As the world slowly reopens, home-based tests will help people make better decisions.

Wudan Yan is a journalist based in Seattle, Wash., writing about science and society.

Journalists Weigh In on Biden’s HHS Pick

KHN senior correspondent Noam Levey discussed Xavier Becerra’s nomination to lead the U.S. Department of Health and Human Services with KQED’s “Forum” on Tuesday.

KHN senior correspondent JoNel Aleccia discussed the story of an organ transplant patient who died after receiving lungs infected with covid-19 on KFI’s “The Daily Dive” podcast on Wednesday.

California Healthline senior correspondent Anna Maria Barry-Jester discussed vaccine distribution in California with KALW’s “Your Call” on Thursday. She also was part of a panel discussion about inequities in the vaccine rollout with Venice Family Clinic’s “Health and Justice” series on Wednesday.

KHN “Navigating Aging” columnist Judith Graham discussed the need for vaccinating family caregivers against covid with Newsy on Thursday.

Related Topics

Aging Public Health

How Pandemic Isolation Affected an Alzheimer's Patient in a Nursing Home


The Loneliest Room, for My Sister in a Nursing Home

The pandemic has stolen away the chance to surround the sister we are losing to dementia with our love, so that she does not have to face death alone.

Credit…Lucy Jones

  • Feb. 26, 2021, 5:00 a.m. ET

When I saw my sister Peggy in her nursing home last June, she was sitting up in bed, leaning forward slightly and staring into the corner of her room. She was 67, and did not know who I was. It had been five months since my last trip to see her. That time, she was in a hospital psychiatric unit being re-evaluated for treatment for both bipolar disorder and Alzheimer’s disease. It had taken her a moment to recognize me then, but once she did she hugged me and kept up a stream of chatter as we walked laps around the floor.

But by our June visit, the only evidence that there was anything going on in her mind was the constant motion of her hands, drifting up from her lap to touch her face and then fluttering down again, like fledglings not quite able to fly.

I had been given special permission to see her because she had just suffered a pulmonary embolism and her hospice workers believed she was weeks, if not days, away from death. I flew from Milwaukee to Austin, and my other sister picked me up and drove me straight to the nursing home, where Peggy was recovering, having fought her way back to life, such as it was.

I rolled her wheelchair next to her bed and sat in it, quiet and still, hoping that she could feel my presence and that it was familiar and comforting to her. I held her hand. Taking deep breaths, I summoned all of my love for her. I tried to bring into the room every moment of the life we have shared as sisters. I felt my lungs expand and release what felt like a greedy abundance of good health, and I gave it to Peggy. Here is my health, here is my love, I prayed. Take it. I have too much.

While the nursing assistants came to change Peggy’s bedding, I talked to her treatment nurse in the hallway. When Peggy had arrived at this facility about two weeks earlier, she had bedsores on her heels and on her lower back. In Peggy’s room, her nurse changed her bandages, pointing out the wounds on her heels, which did not look too bad, but on her back, just above her tailbone, was a dinner-plate-size sore, yellowish and raw. “That has gotten so much better,” the nurse said, her finger air-tracing a circle that was about a third larger than the one I could see.

Both bedsores and pulmonary embolisms can be caused by lying in the same position for too long. No one accused her previous nursing home of neglect, but they made it clear that when she arrived, the sores were already there. They had developed over the first four months of the Covid shutdown when my sister, her primary advocate, was not allowed to visit.

Her bandages changed and her sheets fresh, Peggy was turned on her side. Her eyes were calm and as she drifted off to sleep, I could see that she knew who I was.

While she slept, I explored her room to see what remnants of her curious and acquisitive life had persisted into that institutional space. Her photo album was sticky, its pages crackling with age. I knew many of those photos. There she was as a bridesmaid, tall and deeply tanned, her blue eyes bright, holding the hand of our father, who did not live very long after that picture was taken. There were photos of us as the five sisters we once were, and one of Peggy, 10 years older than me, standing in as surrogate mother at my high school graduation. There was a photo of the boyfriend who followed her to the ends of the earth but to whom she was not able to commit. There are photos from our house in New Jersey, of nieces and nephews, leafy patios and swimming pools, and Peggy on her skis.

They were from a life that none of us live anymore and they ended around 2005, when my mother sold her house and moved into assisted living, leaving Peggy, for the first time in her life, without a place to land. Her bipolar disease, which she struggled to manage, began to eat away at the life she’d built for herself before Alzheimer’s came to finish the job.

In the last hour of my visit on that June day, Peggy woke from her nap and wanted to talk. I held her hand and she stared at it as if it was not attached to her body, as if I had brought some strange little animal to her bed and was showing it to her. She mumbled phrases, the beginnings of sentences, and I offered endings. She watched me fish for meaning and then sighed, resigned but not unhappy, and we tried again. In this way we chatted like sisters until it was time for me to go.

This touch, the connection to family members, is crucial to the health of Alzheimer’s patients. Before my visit, it had been four months since anyone was able to visit Peggy. After this visit, it would be another four months before the nursing home eased its Covid-related restrictions and my sister was allowed to visit again. During that time, we called her, but she was losing her ability to speak. I sent pop-up greeting cards in the hopes that they would interest her.

Without anyone there to bring her back to this moment in time, Peggy has begun to fade. We were once five sisters. We are already down to four, and when Peggy goes, if she is next, we will be just three. With the loss of each sister go her special memories of us and ours of her. Our life together as sisters, as children of our parents, is known by fewer people and when they are gone, we are no longer completely knowable. When I lose the person who can help me burnish the memories of our lives together, I begin to lose those memories myself. The mirror of my past grows dark.

When the Covid restrictions were lifted, Peggy got a roommate — a former Head Start teacher who has been teaching Peggy to say thank you to her caregivers instead of yelling at them and calling them names.

And then recently, just days after Peggy got the first of her Covid vaccines, she, like many people with dementia, tested positive for the virus. She did not have symptoms, but she was moved to isolation, again alone without the familiar voice of her roommate or the touch of my sister that were both vital to keeping her connected to this world.

We were lucky that Peggy got the vaccine before she got infected. Her life may have been saved. But what the pandemic has taken from me and my sisters is our precious time together, time in which we could still share our lives, time in which we could continue as sisters, time to surround the sister we are losing with our love so that she does not have to face death alone.

Without us to remind Peggy of who she is, she has slipped away from us. The millions of moments that connected us to each other recede into a fog of time, their edges blurring together and disappearing like shadows in a darkening room. Without us there to say her name, to touch her hand, she is in that room alone.

Susan Nusser is an author and freelance writer who lives in Milwaukee where she teaches writing at a technical college.

Weekly Health Quiz: Diet, Weight and Covid

1 of 7

A study of Shuar children in Amazonian Ecuador suggests that this factor is the most important contributor to weight gain:




Socioeconomic status

2 of 7

The Centers for Disease Control and Prevention linked an outbreak of coronavirus cases in Chicago and Honolulu to carelessness about masks and symptoms in these venues:


Concert halls



3 of 7

These masks, made in South Korea, are a good option for the general public for protection against coronavirus, with a high filtration rate and moldable nose bridge providing a good fit:

N95 masks

KN95 masks

KF94 masks

Surgical masks

4 of 7

A new variant of the coronavirus called B.1.526 is spreading rapidly in this city, worrying experts because it may have added resistance to vaccines:

Los Angeles

New York



5 of 7

Shoe soles embedded with this substance were effective in preventing slipping and sliding on snow and ice:


Grit and glass fibers


Salt crystals

6 of 7

The potentially dangerous Covid-related disorder known as multisystem inflammatory syndrome in children, or MIS-C, appears to be most common in children of this age:

Birth to 3 years

3 to 6 years

6 to 12 years

Over 12 years

7 of 7

A transplant patient died after receiving a donation of this organ infected with coronavirus: